The effect of a standard activity on the size of the median nerve as determined by ultrasound visualization.

The purpose of this study was to determine whether a standardized hand activity would produce changes in the cross-sectional diameter of the median nerve. Ultrasound measures of proven reliability of the cross-sectional diameter of the median nerve in the wrist were taken. These measures were taken before activity and immediately after the activity, after 5 minutes, and after 10 minutes.

Osteoprotegerin and receptor activator of nuclear factor kappaB ligand (RANKL) regulate osteoclast formation by cells in the human rheumatoid arthritic joint.

Objective: This study investigated the involvement of the recently identified regulators of osteoclast formation RANKL [receptor activator of nuclear factor kappaB (RANK) ligand, osteoclast differentiation factor, TRANCE, osteoprotegerin ligand] and its natural inhibitor, osteoprotegerin (OPG), in the bone erosion of rheumatoid arthritis (RA).

Methods: mRNA was extracted from cells isolated from the pannus and synovial membrane regions of joints of 11 RA patients. Semiquantitative reverse transcription-polymerase chain reaction was carried out, and the isolated cells were also cultured to determine their ability to form osteoclasts.

Sigmoid notch osteoplasty for chronic volar instability of the distal radioulnar joint: a case report.

Chronic recurrent volar dislocation of the distal radioulnar joint is a rare condition for which many operative procedures have been described. We describe a case of painful dislocation on supination. Investigation of the distal radioulnar joint revealed the absence of degenerative arthritis and a flat sigmoid notch that permitted dislocation.

Synthetic bone graft substitutes.

Replacement of extensive local bone loss is a significant clinical challenge. There are a variety of techniques available to the surgeon to manage this problem, each with their own advantages and disadvantages. It is well known that there is morbidity associated with harvesting of autogenous bone graft and limitations in the quantity of bone available.

Regulation of the helix-loop-helix proteins, E2A and Id3, by the Ras-ERK MAPK cascade.

Activation of mitogen-activated protein kinase (MAPK) pathways leads to cellular differentiation and/or proliferation in a wide variety of cell types, including developing thymocytes. The basic helix-loop-helix (bHLH) proteins E12 and E47 and an inhibitor HLH protein, Id3, play key roles in thymocyte differentiation. We show here that E2A DNA binding is lowered in primary immature thymocytes consequent to T cell receptor (TCR)-mediated ligation.

Digitally assisted acromioplasty: the effect of interscalene block on this new surgical technique.

Purpose: Interscalene brachial plexus (ISBP) block has been shown to be safe and effective for shoulder surgery with significant benefits. The purpose of this study was to introduce the technique of digitally assisted acromioplasty and assess the effect of ISBP on rehabilitation.

Type Of Study: Randomized controlled prospective trial.

Percutaneous A1 Pulley Release a Clinical Study.

Percutaneous A1 pulley release is being increasingly used as an alternative to open surgical release and injection of local steroids for the treatment of the trigger digit. In 31 cases (26 patients), a percutaneous release was performed with a 14-gauge intravenous catheter needle under local anaesthesia in the outpatient setting. We report a 97% successful release and only one case of incomplete release.

Clinical Utilisation of Computed Tomography of the Scaphoid.

Computed tomography is the best imaging modality to assess bony architecture. Scanning in the longitudinal plane of the scaphoid provides a greater appreciation of the humpback deformity. CT scan provides superior assessment of union and has a higher correlation with operative findings.

A systematic review of the content and quality of wrist outcome instruments.

Objective: To assess the content and quality of published wrist outcome instruments using standardized criteria.

Design: An analytical study that examined 32 wrist outcome instruments sourced from textbooks, Medline (1951 to present) and Current Contents.

Main Measures: The content of each instrument was classified into four categories: traditional measures (such as range of movement and strength), measures of the ability to perform daily activities, compensatory mechanisms used, and 'other'.

Repair of distal biceps tendon rupture: a new technique using the Endobutton.

The authors describe a technique with a single anterior incision and fixation with an internal button, the Endobutton. The procedure is performed through a 5-cm transverse skin incision, and the tendon is sutured to the Endobutton with 2 number 5 Ethibond sutures. Surgical repair in the depths of the muscular forearm is not required, because the tendon is simply sutured external to the wound.

The use of ultrasound-guided cutting-needle biopsy in paediatric neck masses.

Objective: Neck masses are common in children. Although there is a low incidence of therapeutically significant pathology, biopsy is occasionally required for evaluation. Open biopsy or fine needle aspiration may be used to obtain tissue.

Retro-recombination screening of a mouse embryonic stem cell genomic library.

Targeted gene disruption is an important tool in molecular medicine, allowing for the generation of animal models of human disease. Conventional methods of targeting vector (TV) construction are difficult and represent a rate limiting step in any targeting experiment. We previously demonstrated that bacteriophage are capable of acting as TVs directly, obviating the requirement for 'rolling out' plasmids from primary phage clones and thus eliminating an additional, time consuming step.

Anatomical reduction of intra-articular fractures of the distal radius. An arthroscopically-assisted approach.

We treated 31 intra-articular fractures of the distal radius by arthroscopically-assisted reduction and percutaneous fixation with Kirschner (K-) wires. Tears of the triangular fibrocartilage (58 %), scapholunate (85 %) and lunotriquetral (61%) instability and osteochondral lesions (19%) were also treated. A total of 26 patients was independently reviewed at an average of 19 months.

Internal suture for mallet finger fracture.

An internal suture technique has been used for mallet finger fractures involving at least 30% of the articular surface. It provides fixation without a button or transfixion of the fragment. An independent retrospective review was conducted of ten patients at a mean follow-up of 17 months.

Surgical approaches to the elbow.

The recent explosion of interest in the elbow and the need for better surgical approaches, has produced numerous new approaches and the modification of other approaches, the result of which is a much shorter but more useful list of surgical approaches. Surgeons who perform a large number of elbow procedures have found that these approaches permit them to perform the majority of elbow procedures with only one skin incision, usually a straight posterior midline incision. Knowledge of the deep intermuscular and internervous intervals allows the surgeon to expose the elbow circumferentially through one skin incision.

An overview of distal radial fractures.

Fractures of the distal radius include a wide spectrum of fracture patterns. As well as involving the distal radius, these injuries can involve the wrist, the distal radio-ulnar joint and the distal ulna. The management of these injuries is consequently diverse, ranging from a plaster cast to advanced surgery.

A systematic review of the clinical diagnostic tests for carpal tunnel syndrome.

The purpose of this report was to critically review studies of the clinical diagnostic tests for carpal tunnel syndrome. The reports were located through Medline, Current Contents, related readings, and the reference lists of the articles. They all explored the use of clinical diagnostic tests for carpal tunnel syndrome compared with the results of NCS.

Arthroscopic capsular release for contracture of the wrist: a new technique.

Stiffness of the wrist can occur following trauma or surgery. In some patients, loss of motion may be refractory to conservative treatment and operative treatment may thus be indicated. The authors report the results and technique of arthroscopic capsular release of the wrist.

Thymocyte maturation is regulated by the activity of the helix-loop-helix protein, E47.

The E2A proteins, E12 and E47, are required for progression through multiple developmental pathways, including early B and T lymphopoiesis. Here, we provide in vitro and in vivo evidence demonstrating that E47 activity regulates double-positive thymocyte maturation. In the absence of E47 activity, positive selection of both major histocompatibility complex (MHC) class I- and class II-restricted T cell receptors (TCRs) is perturbed.

A review of complex trauma to the elbow.

This paper presents a review of common complex elbow traumatic disorders. It presents an algorithm to aid in the management of these cases and discusses indications for radial head replacement and dynamic external fixateurs.

Arthroscopic relationship of the axillary nerve to the shoulder joint capsule: an anatomic study.

Twelve right shoulders in fresh cadavers were dissected to determine the relation of the axillary nerve to the shoulder capsule and glenoid. Needles transfixed the nerve to the capsule and into the shoulder joint. Arthroscopy was performed to determine the location of the needles on the glenoid clock.

Positive and negative regulation of V(D)J recombination by the E2A proteins.

A key feature of B and T lymphocyte development is the generation of antigen receptors through the rearrangement and assembly of the germline variable (V), diversity (D), and joining (J) gene segments. However, the mechanisms responsible for regulating developmentally ordered gene rearrangements are largely unknown. Here we show that the E2A gene products are essential for the proper coordinated temporal regulation of V(D)J rearrangements within the T cell receptor (TCR) gamma and delta loci.

Dynamic external fixation for injuries of the proximal interphalangeal joint.

Pain, stiffness, instability and degenerative arthritis are common sequelae of complex fracture-dislocations of the proximal interphalangeal (PIP) joint. Operations were carried out to obtain stability, followed by application of a dynamic external fixator in 20 patients with a mean age of 29 years. This provided stability and distraction, and allowed controlled passive movement.

Neural cells derived by in vitro differentiation of P19 and embryonic stem cells.

The past decade has seen great progress in understanding the key genes involved in GABAergic transmission. The genes for GAD, multiple subunits of the ionotropic GABA receptors, metabotropic GABA receptors, and GABA uptake proteins have been cloned. Analysis of the cloned genes has yielded a plethora of fundamental insights into the role of the corresponding proteins in mediating GABAergic signals (reviewed in Tobin et al.

Operative fluoroscopy in hand and upper limb surgery. One hundred cases.

We reviewed the use of a low radiation portable fluoroscopy unit in 100 patients. The most common indication was closed reduction of distal radial fractures. Fracture and joint stability were assessed on the real-time monitor and stored on videotape.