Evidence for efficacy of new developments in reconstructive upper limb surgery for tetraplegia.

Nerve transfers are increasingly utilized for upper limb reconstruction in tetraplegia. We reviewed the literature for results achieved by nerve transfers for elbow extension, wrist control and finger and thumb flexion and extension. Muscle strength grading was the only outcome measure consistently reported.

Upper limb surgery for severe spasticity after acquired brain injury improves ease of care.

For individuals with acquired brain injury and severe upper limb spasticity, personal care is often difficult, time-consuming and painful. Previous studies on outcomes after surgery for upper limb spasticity have focused on functional gain, pain, hygiene and appearance. We operated on 38 non-communicative patients (45 limbs, 535 procedures) with severe spasticity and a non-functional upper limb(s).

Outcome of axillary nerve injuries treated with nerve grafts.

This study evaluates the outcome of axillary nerve injuries treated with nerve grafting. Thirty-six patients were retrospectively reviewed after a mean of 53 months (minimum 12 months). The mean interval from injury to surgery was 6.

Acute bilateral forearm compartment syndrome of unknown aetiology.

This is the first reported case of non-traumatic, acute bilateral forearm compartment syndrome. Despite a delay of over 24 hours until surgical decompression and 50% muscle fibre necrosis in the histopathological examination, the clinical outcome was excellent after fasciotomy, delayed primary wound closure and early institution of a range of motion exercise programme. The literature on non-traumatic causes of compartment syndrome is reviewed.

Surgical management of forearm pronation.

Active volitional supination enhances upper limb function. In the spastic forearm with pronation deformity, careful preoperative assessment of muscle function is necessary to design a treatment plan to improve supination. Concomitant procedures performed for flexion contractures have to be taken into consideration.

Control of a hand grasp neuroprosthesis using an electroencephalogram-triggered switch: demonstration of improvements in performance using wavepacket analysis.

Volitionally modulated electroencephalographic (EEG) waves were monitored for the purpose of controlling a hand neuroprosthesis in people with tetraplegia. The region of the EEG signal spectrum monitored was the occipital alpha wave (8-13 Hz), and volitional modulation was achieved with the opening and closing of the eyes. In a set of 13 trials evaluated, a subject with tetraplegia successfully completed ten trials undertaking stimulated grasp and release using the EEG-triggered switch.

The intravenous foreign body: a report of 2 cases.

Two cases of metallic foreign body injury to the upper limb are described. In both cases the foreign body was clearly visible on x-rays, considered to be lodged in the soft tissues, but migrated to one of the large subcutaneous veins. One subsequently migrated to the heart; the other was removed from the peripheral vein.

Synergistic control of stimulated pronosupination with the stimulated grasp of persons with tetraplegia.

The control of stimulated forearm pronosupination in concert with stimulated hand grasp of persons with tetraplegia has been investigated. It has been shown that hand grasp stability increased as supination was achieved. In accordance with this, a strategy of object acquisition has been proposed incorporating pronosupination and hand grasp.

The use of bilateral stimulated hand grasp in the bimanual activities of persons with tetraplegia.

Grasp and release has been provided to both upper extremities of subjects with tetraplegia using percutaneous and fully implanted stimulation. This is to determine quantitatively the performance of these subjects in three bimanual tests using two handed stimulation. Their performance here is compared with two separate cases: the same tests using single handed stimulation assisted by a nonstimulated hand and using two unstimulated hands.

Detection of fatigue in the isometric electrical activation of paralyzed hand muscles of persons with tetraplegia.

Paralyzed muscle fatigue is the eventual depression of force due to either prolonged or repetitive electrical stimulation of motor units. The robustness and safety of future functional electrical stimulation (FES) systems will rely on their ability to detect the onset of muscle fatigue. The relative degree of muscle activation can be estimated by monitoring the M-wave.

Quantitative evaluation of two methods of control of bilateral stimulated hand grasps in persons with tetraplegia.

Electrical stimulation has been applied to the paralyzed muscles of both hands of two persons with tetraplegia using percutaneous and implantable electrodes. Two separate methods of user control were being investigated. The first monitored the myoelectric signals from the user's own sternocleidomastoid muscles and the second monitored wrist joint angle.

Selective motor neuropathy of the median nerve caused by a ganglion in the carpal tunnel.

Carpal tunnel syndrome is the commonest peripheral compressive neuropathy. Typically, sensory symptoms predominate at presentation with motor dysfunction seen in more chronic cases. Isolated motor compression is rare.

The surgical treatment of brachial plexus injuries.

Background: Brachial plexus injuries cause a devastating loss of function in the arm. The aim of this study was to review the results of surgical treatment of patients with brachial plexus injuries.

Methods: Forty-seven patients were reviewed.

Does peri-operative guanethidine prevent reflex sympathetic dystrophy?

The use of intravenous guanethidine blocks is an accepted treatment for established reflex sympathetic dystrophy (RSD). Some units administer intravenous guanethidine peri-operatively with the intention of protecting their patients from post-operative dystrophy. There have been no studies confirming this protective effect of peri-operative guanethidine.

Wrist arthrodesis using a sliding radial graft and plate fixation.

In a retrospective study, the results of 18 wrist fusions with a radial sliding graft and a dynamic compression plate are reviewed. All 18 fusions united, with an average position of 16 degrees of extension and 7 degrees of ulnar deviation. Wrist strength and stability and diminished pain allowed improved function.

[Classification and surgical treatment of pronation deformity in cerebral palsy].

A clinically simple and logical classification of pronation deformity in cerebral palsy into four groups is presented. The appropriate procedure for each group is defined. The validity of this classification is documented with our results in 32 patients.

Antiproliferative and antitumor activity of the 2-cyanoaziridine compound imexon on tumor cell lines and fresh tumor cells in vitro.

Background: Imexon, a 2-cyanoaziridine, is therapeutic and reverses lymphadenopathy and splenomegaly in the LP-BM5 murine retrovirus-induced immunodeficiency disease (murine AIDS). It can restore chemotherapy-induced immunosuppression. Imexon reduced the incidence of lymphoma in severe combined immune deficient mice inoculated with human lymphocytes.

Surgery for cerebral palsy: Part 2. Flexion deformity of the wrist and fingers.

34 children with cerebral palsy had operations to correct flexion deformities of the wrist and fingers. 30 out of 34 patients were improved functionally and cosmetically. Zancolli's classification provides sound guidelines on which to base surgical decisions.

Surgery for cerebral palsy: Part 1. Classification and operative procedures for pronation deformity.

32 patients with cerebral palsy underwent operations for pronation deformity. The deformity is classified into four groups. Patients in group 1 are capable of supination beyond neutral.

Carpal tunnel syndrome in children with mucopolysaccharidosis and related disorders.

Four cases of mucopolysaccharidosis or mucolipidosis and carpal tunnel syndrome in children are presented. Carpal tunnel release achieved clinical and electrical improvement in all cases.

Cytostatic and cytotoxic activity of lymphokine-activated killer cell supernatants.

Incubation of peripheral blood mononuclear cells with interleukin-2 (IL-2) results in the release of a factor which is cytostatic and cytotoxic both to tumor cell lines (A375M, A375P, C480, MCF-7, Hey) and fresh tumor cells (in the human tumor cloning assay), including breast cancer, colon cancer, melanoma, myeloma and ovarian cancer. The factor cannot be detected in a 4-h chromium-release assay, but is best demonstrated after tumor cells have been to it for exposed 3 days. The factor is not cytotoxic to normal peripheral blood leukocytes or normal fibroblasts, and is not toxic to certain targets sensitive to lymphokine-activated killer (LAK) cells, such as K562 and Daudi cells.

Human monoclonal antibody against glycoproteins of human immunodeficiency virus.

We have established a program to make human monoclonal antibodies to the human immunodeficiency virus (HIV). Lymphocytes of lymph nodes from patients with the acquired immunodeficiency syndrome (AIDS) related complex (ARC) spontaneously produced antibodies to HIV in vitro and their antibody production was suppressed by culturing them in the presence of HIV antigens. Therefore, in vitro stimulation with HIV antigens was not done but rather, donor lymph node or spleen lymphocytes were directly fused with mouse myeloma cells.