Bipedicle strap flaps in reconstruction of longitudinal dorsal skin defects of the digits.

Dorsal skin defects in which the loss of integument is longitudinal in shape are not uncommon after injury by rotating machinery and by glass shearing along the length of the digit. This shape of defect is difficult to reconstruct with commonly used flaps but lends itself to reconstruction by the use of longitudinal bipedicle strap flaps moved across the dorsum of the finger from lateral to medial. A variant of this traditional technique was used in the reconstruction of 28 dorsal digital defects.

The early history of Dupuytren's disease.

Dupuytren's disease may have originated among the Vikings of northern Europe. Possible association of the disease with the Scottish bagpipe-playing MacCrimmon clan and the Papal Sign of Benediction also are examined. The evolution of pathologic understanding and the advent of surgical treatment of the disease in the late eighteenth and early nineteenth centuries in Europe and North America are reviewed in detail.

"Venting" or partial lateral release of the A2 and A4 pulleys after repair of zone 2 flexor tendon injuries.

The need for lateral release or "venting" of the A2 and A4 pulleys either to facilitate repair of the flexor tendon(s) or to allow free gliding of the repair(s) was examined in 126 consecutive zone 2 flexor tendon injuries within the tendon sheath and distal to the distal edge of the A2 pulley (zones 2A and 2B of Tang's classification) in which at least one flexor tendon had been completely divided. This study showed that 81 (64%) of these repairs required venting of one or the other pulley. It was necessary to vent the A4 pulley between 10 and 100% of its length in 71 (56%) of the fingers and to vent the distal edge of the A2 pulley by 4 to 10 mm in 10 (8%) of the fingers.

A prospective study of flexor tendon repair in zone 5.

A prospective study of postoperative mobilization of flexor tendon repairs in zone 5 was conducted over a 2-year period between 1994 and 1996 using a controlled active motion (active extension-active flexion) regimen of mobilization. Fifty-two patients, who had a total of 151 flexor digitorum superficialis (FDS) and 103 flexor digitorum profundus (FDP) divisions, were available for review at a mean follow-up of 10 months. Of the 161 fingers with division of one or both flexor tendons, 66% exhibited independent FDS function and 90% achieved good or excellent results of digital range of motion.

Treatment of painful neuromas of the hand and wrist by relocation into the pronator quadratus muscle.

Thirteen painful end-neuromas of nerves of the palm and the dorsum of the hand were treated by resection of the neuroma and relocation of the nerve ends into the pronator quadratus muscle proximal to the wrist in ten patients. The effectiveness of this treatment was assessed by measurement of changes in level of spontaneous pain, pain on pressure, pain on movement and hyperaesthesia at the original site and at the site to which the nerve was relocated. Subjective comments on changes of hand function and ability to return to work were also recorded.

Composite graft replacement of digital tips. 2. A study in children.

This study investigated the outcome of composite graft replacement of 50 amputated digital tips in 50 children over a period of 3 years and 6 months. Eleven of 18 tips (61%) which were replaced within 5 hours survived completely while none of 32 digital tips replaced after 5 hours survived completely. This difference was highly significant.

Composite graft replacement of digital tips. 1. Before 1850 and after 1950.

The successes of composite grafting of fingertips in the early years of plastic surgery have been repeated in the few studies of this treatment which have been reported during the last 50 years. The early and recent history of this subject are reviewed in the light of the increasingly pessimistic view of composite graft replacement of fingertips taken by recent reviewers.

Lack of Fc-epsilon receptors on murine eosinophils: implications for the functional significance of elevated IgE and eosinophils in parasitic infections.

Chronic infection with Schistosoma mansoni induces in humans and mice a Th2-dominant immune response in which eosinophils and IgE are conspicuously elevated. Human eosinophils express IgE receptors that participate in an IgE-dependent eosinophil-mediated ADCC reaction against Schistosomula larvae in vitro. To investigate the expression of IgE receptors on murine eosinophils, they were purified (>95% pure by Giemsa-stained cytospin preparations) from liver granulomas of Schistosoma-infected mice.

A historical record of traumatic rupture of Dupuytren's contracture.

Traumatic rupture of Dupuytren's contracture is rare. It has been reported only twice in recent times and only on four previous occasions over the last millenium. These cases are reported and the forces involved in rupturing Dupuytren's contracture are discussed.

How do faculty evaluate students' case presentations?

Background: Although the case presentation is a frequent activity, little is known about the attributes that faculty members use when assessing case presentation ability.

Purpose: Define the dimensions used by faculty when assessing students' case presentation abilities.

Methods: Eleven internal medicine faculty members independently assessed the same 17 videotaped student case presentations.

Effects of a multidimensional anabolic steroid prevention intervention. The Adolescents Training and Learning to Avoid Steroids (ATLAS) Program.

Objective: To test a team-based, educational intervention designed to reduce adolescent athletes' intent to use anabolic androgenic steroids (AAS).

Design: Randomized prospective trial.

Setting: Thirty-one high school football teams in the Portland, Ore, area.

Total middle ray amputation.

Eight patients underwent middle ray amputation with excision of the whole of the middle metacarpal and careful soft tissue repair. Excision of the base of the middle metacarpal allowed easier approximation of the index and ring rays without the tendency of these fingers to either scissor on finger flexion or to remain slightly apart. Complete removal of the middle metacarpal appears to allow the bases of the index and ring metacarpals to migrate together.

The Adolescents Training and Learning to Avoid Steroids (ATLAS) prevention program. Background and results of a model intervention.

Objective: To develop and test a school-based intervention to prevent anabolic androgenic steroid use among high-risk adolescent athletes.

Design: Nonrandom controlled trial.

Setting: Two urban high schools.

Palmar bands in rheumatoid arthritis and other chronic conditions of the upper limb.

Palmar prolapse of the flexor tendons as a result of attenuation of the A1 and A2 pulleys occurs in rheumatoid arthritis and other conditions in which the joints of the fingers are chronically flexed. The flexor tendons may be palpable and sometimes visible as longitudinal bands crossing the palm. This can lead to confusion with the palmar bands of Dupuytren's disease.

Dupuytren's disease in children.

Although Dupuytren's disease of the hand has been reported in teenagers, it is generally considered to be a disease of adults. A series of nine children who developed Dupuytren's disease of the hand before the age of 13 years is presented. Eight had surgical removal of the diseased tissue and histological confirmation of the diagnosis before the age of 13 years and one at 14 years of age.

Intervention and prevention of steroid use in adolescents.

Athletes with a higher intent to use anabolic steroids were similar to students who indicated no predisposition to use steroids on economic, academic, and physical measures. They had similar understandings of anabolic steroid effects, and their self-rated understandings of how to weight train and of sports nutrition were similar. In addition, the influence of the coaches and the media and the perceived prevalence of anabolic steroid use were not different between the higher- and lower-intent students.

The neurovascular Tranquilli-Leali flap.

A modification of the flap first described in 1935 by Tranquilli-Leali and described again by Atasoy et al (1970) is presented. The relative indications for use of the original and the modified flap are examined in the light of our experience of 116 flaps over a period of 4 years.

Cloning and characterisation of a bovine P2Y receptor.

Using a chick P2Y1 receptor cDNA probe we have isolated a mammalian P2Y receptor clone from a bovine aortic endothelial cell library. The sequence has a high degree of similarity to the chick P2Y1 clone. When transfected into the Jurkat cell line, the cDNA conferred sensitivity to purinoceptor agonists.

Principles of clinical medicine: an interdisciplinary integrated 2-year longitudinal course.

In keeping with the Report of the Panel on the General Professional Education of the Physician (Association of American Medical Colleges 1984), Oregon Health Sciences University (OHSU) School of Medicine is in the midst of revising its curriculum. After a 4-year process, the Curriculum Committee mandated development of the Principles of Clinical Medicine course, a 2-year longitudinal course integrating input from both basic and clinical science departments. We describe the steps leading to the course's implementation, its administrative and organizational structure, the evaluation of student performance, teacher training, course curriculum, and the use of interdisciplinary teaching.

Use of a group objective structured clinical examination with first-year medical students.

Purpose: To evaluate the implementation of a quarterly group objective structured clinical examination (GOSCE) to assess the patient-evaluation abilities of a medical school class.

Method: The study subjects were 94 first-year students participating in the Principles of Clinical Medicine course at the Oregon Health Sciences University School of Medicine in 1992-93. To create the GOSCE, the authors modified the format of the quarterly objective structured clinical examination by making each standardized-patient station the site of an interaction between a standardized patient and a group of four or five students.