Microvascular second toe transfer for digital reconstruction.

Reconstruction of a severely damaged hand, with multiple amputations of digits, presents a difficult reconstructive problem. The development of a safe method of transfer of the great toe for thumb reconstruction, using the dorsalis pedis artery and the saphenous vein, suggested the possibility of one-stage microvascular transfer of the second toe for reconstruction of fingers. In two patients a one-stage transfer of the second toe was done to replace an index finger and in another for restoration of part of the left ring finger. The transplants survived without anticoagulants and vessel complications were not encountered. Sensory return was adequate and a significant improvement in function was achieved.     

A methodological critique of Bandura's self-efficacy theory of behavior change

This brief theoretical note identifies a major methodological problem in Bandura's argument in favor of self-efficacy theory and provides two methods of controlling for it. His data could likely be accounted for by social contingencies operating within his highly structured behavioral approach situation.     

Treatment of old unreduced dislocation of the elbow.

Twenty-six patients with old unreduced dislocation of the elbow treated by open reduction were reviewed. All patients improved after surgery. It is felt that any patient with an elbow dislocation which is less than 3 months old should be treated by open reduction. The operative technique using a medial and lateral approach and keeping the dissection extraperiosteal is described.     

Effects of task difficulty on EEG measures of cerebral engagement

EEGs were recorded while subjects constructed 14 block designs of graded complexity, and also while reading and writing. Two measures of design difficulty were used: time to complete each construction and Ss' subjective ranking. For each task, average alpha power for each lead and R/L ratios (C₄/C₃, P₄/P₃) were calculated.Within-subject and group analyses both showed higher alpha power and higher R/L ratios with increasing difficulty. There were important differences between subjects: some showed significant increases in alpha power only on the left, some only on the right, some bilateral. Regardless of difficulty however, the R/L alpha ratios were significantly lower for block design than for writing, as in our previous studies.     

Adherence to therapy in psychiatric patients: an empirical investigation

Patient adherence, i.e. the extent to which a patient's behavior, in terms of taking medications and keeping scheduled appointments, has been demonstrated to be essential for the successful treatment of various psychiatric disorders. The purpose of this study was to assess the impact of patient education on patient compliance to psychotropic medication after discharge from hospital. A sample of 36 psychiatric patients discharged from an inpatient care facility and receiving an oral form of psychotropic drug were the subjects of this study. Subjects were randomly assigned to two groups: a control group; and a directive patient education group. The subjects were followed up after discharge for a 6-month period. In analyzing the data, results indicated that the difference in percentage of compliance between the two groups was statistically significant. Findings imply that patient education did have an effect on patient compliance to medication. The findings of the study support a technique that can be incorporated in both in-patient and out-patient programs in psychiatric mental health facilities. It would increase patient compliance to medication and hence decrease chances of rehospitalization.     

Improved hemophilia A carrier detection by DDAVP stimulation of factor VIII

We studied the differential increase in FVIIIc and FVIII R:Ag after the intravenous infusion of 0.30 micrograms/kg DDAVP in 20 obligate hemophilia A carriers and in 20 female controls. FVIIIc increased in carriers (59.5 +/- 23.1 to 137.5 +/- 45.9) and in controls (98.0 +/- 20.7 to 259.9 +/- 57.4) (P less than 0.001), but the magnitude of the FVIIIc increase in carriers was less than that in controls by 51.9% (P less than 0.001). FVIII R:Ag increased comparably in carriers (105.2 +/- 30.4 to 171.9 +/- 25.4) and controls (92.1 +/- 33.0 to 165.2 +/- 20.6). Using the post-DDAVP instead of the standard FVIIIc/FVIII R:Ag ratio, hemophilia carrier detection was increased from 85% (with 10% false positive and 20% false negative assignments) to 95% (with 5% false positive and 5% false negative assignments). Toxicity associated with DDAVP infusion correlated linearly with doses greater than 10.5 +/- 1.3 micrograms/m2 (P less than 0.02) and with total doses greater than 17.0 +/- 4.5 micrograms (P less than 0.02). The use of DDAVP improves carrier detection in factor VIII-deficient hemophilia.     

Glucocorticoid receptors in human tumors

Glucocorticoid receptors were examined in a range of solid human tumors. In addition to breast carcinomas, subsets of other tumor types (notably renal cell carcinomas) contain concentrations of these receptors characteristic of glucocorticoid-responsive tissues. The physico-chemical properties of the single glucocorticoid receptor present in the human tumors resembled those of the glucocorticoid receptor in rat tumors and the pre-dominant form found in normal target tissues of the rat.