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At least 199 records · Page 11Linked to original sources
PubMed2006

Transoesophageal echocardiography (TOE) in the operating room.

Perioperative transoesophageal echocardiography (TOE) was introduced from cardiology into cardiac anaesthesia in the 1980s. Initially TOE was used mainly as a monitor of left ventricular ischaemia, but now provides real-time dynamic information about the anatomy and physiology of the whole heart. TOE is of value in the management of patients undergoing procedures including cardiac valvular repair, surgery for endocarditis, surgery of the thoracic aorta, and may contribute useful information in a wide range of cardiac pathology. It is also useful in guiding therapy in haemodynamically unstable patients in the operating room and the intensive care unit. TOE is relatively cheap and non-invasive, but it should not be used as a stand alone device but as a tool which provides data in addition to the data acquired from other forms of monitoring. The use of TOE carries not only the benefits of a rapid and effective investigation, but also risks associated with the procedure itself and the burden of providing training and experience for practitioners. The establishment of TOE in perioperative cardiac anaesthetic care has resulted in a significant change in the role of the anaesthetist who, using TOE, can provide new information which may change the course and the outcome of surgical procedures.

Anesthesiology↗
PubMed2005

Culturing dermatophytes rapidly from each toe web by fingertip.

The diagnosis of tinea pedis is usually confirmed by microscopy and culture of skin scrapings. Isolating dermatophytes by fungal culture gives more reliable proof of infection and has the advantage of identifying the causative organisms. Nevertheless, culture examination is complementary to microscopy and is not routinely performed because it is time- and cost-consuming. Herein, we propose a new culturing method, the 'finger-sampling method', for collecting dermatophytes from patients' toe webs using the examiner's fingertip as a sample collection tool. Using this method, four toe webs of a foot can be examined at one time on one culture dish. Every toe web of 50 patients with untreated tinea pedis were examined, and dermatophytes were grown from 83 out of 107 (78%) KOH positive toe webs. The isolation ratio by the finger-sampling method was comparable to that by traditional slant culture of skin scrapings performed by skilled practitioners. Culture results were also positive in 19 out of 53 (36%) diseased but KOH negative toe webs and in 38 (16%) normal toe webs, suggesting the existence of unidentified infection. Additionally, we confirmed the efficacy of this method for detecting dermatophyte attachment on the healthy toe web skin of volunteers who had just been exposed to contaminated areas, i.e. Japanese public baths or a bath mat stepped on by a patient disseminating dermatophyte propagules.

Adolescent↗
PubMed1993

Flexor tendon transfer for metatarsophalangeal instability of the second toe.

Flexor to extensor transfer was used to treat painful second metatarsophalangeal joint instability in thirteen feet in eleven patients. All patients had their pain reproduced with vertical stress motion of 50% to 100% at the metatarsophalangeal joint. Seven feet had concomitant hallux valgus correction, two feet had no hallux valgus, and four feet underwent no correction for asymptomatic hallux valgus. Results at an average of 33.4 months followup showed that all patients had substantial pain relief, with eight patients becoming pain-free, and five patients experiencing mild pain. All but one were satisfied with their result. Stiffness appeared to be the source of the mild residual pain. All toes, including six toes with preoperative medial crossover toe deformity, were corrected into valgus alignment with adjacent toes. All toes operated on for the first time were able to touch the ground with grasp postoperatively. Flexor to extensor transfer is successful in reducing the second toe and relieving pain caused by instability of the second metatarsophalangeal joint, but may require rapid postoperative mobilization to ensure passive dorsiflexion equal to that of the adjacent toes to reduce postoperative uncomfortable stiffness.

Adult↗
PubMed1996

Plantarflexion injury to the metatarsophalangeal joint ("sand toe").

This is a retrospective study of 12 cases of hyperplantarflexion injuries to the great toe and the lesser toes sustained in professional beach volleyball players. The hyperplantarflexion injury to the metatarsophalangeal joint, referred to as "sand toe," can result in significant functional disability. Push-off, forward drive, running, and jumping are compromised. The average player in this series took 6 months to fully recover from the injury, and the most common problem after injury was the loss of dorsiflexion, seen in six players. Five players had residual discomfort in the injured toe, and two demonstrated an unstable toe. Individuals who experience sand toe injuries should be treated conservatively, with taping, anti-inflammatory medications, shoe wear modification, ice, and rest. A toe strengthening program is also presented.

Adult↗
PubMed2003

A case-control study of the risk factors for toe amputation in a diabetic population.

Toe amputations are becoming more prevalent in the diabetic population. To prevent toe amputations, those individuals with the highest risk must be identified prior to developing a precipitating event. There are obvious risk factors for toe amputations, such as digital deformity, diabetic neuropathy, and ischemia. Other, less obvious, systemic comorbidities may be linked to toe amputations. This study also shows that gender plays a significant role as a risk factor for toe amputation. A foot infection, foot abscess, osteomyelitis, diabetic retinopathy, and diabetic nephropathy were also significant risk factors for toe amputations. This suggests a significant relationship between these complications and comorbidities that put these individuals at a higher risk for toe amputations.

Journal Article↗
PubMed1980

Discrepancies between bone ash and toe ash during aflatoxicosis.

Graded levels of aflatoxin (0, .625, 1.25, 2.5, 5.0, and 10.0 micrograms/g diet) were incorporated into a broiler-starter ration and fed to chicks from 1 day to 3 weeks of age. The tibias and middle toes were removed, and both bone ash and toe ash were determined. Toe ash significantly (P less than .05) increased at the aflatoxin levels of 2.5 ppm and above, while bone ash significantly (P less than .05) deceased at the same aflatoxin levels (2.5 ppm and above). The increase in toe ash could be partially attributed to a significant (P less than .05) decrease in toe lipid levels at the aflatoxin levels of 2.5 ppm and above. The data indicate that aflatoxin inhibits bone mineralization. The data also show that toe ash does not in all experimental designs reflect bone ash and that data interpreted solely on toe ash determination may not accurately reflect bone mineralization.

Aflatoxins↗
PubMedDate not supplied

Autogenous bone graft interpositional arthrodesis for the correction of flail toe. A retrospective analysis of 22 procedures.

Digital surgery is one of the most common types of surgery performed by foot and ankle surgeons. Flail toe is a complication that may occur after overaggressive resection arthroplasty of the proximal interphalangeal joint of the lesser toes. Correction of flail toe deformity has received little attention and has predominantly involved soft-tissue procedures. The authors' preferred technique for the surgical correction of flail toe is to place a unicortical autogenous bone graft (harvested from the ipsilateral calcaneus) within the revised proximal interphalangeal joint of the lesser toes to create a distraction arthrodesis. This technique allows restoration of digital length, stability, and purchase. A retrospective review of 22 such procedures in 13 patients is presented, along with a literature review of other procedures and a description of the authors' current surgical technique and postoperative management protocol. Overall success using the authors' procedure was 82%. Complications occurred in three patients, with one of the grafts showing complete resorption and two requiring additional surgical intervention owing to nonunion and malunion of toes.

Adult↗
PubMed2003

Painless legs and moving toes in a mother and her daughter.

Painful legs and moving toes (PLMT) is a rare syndrome which is characterised by involuntary movements of the toes and pain in the legs. We report on a mother and her daughter who both presented with involuntary movements of the toes similar to those seen in PLMT but without any associated pain. Neurological examination revealed intermittent 0.3 to 0.5-Hz flexion and extension of the toes and ankles of the right foot in the mother, and of both feet in the daughter. In both patients, the movements appeared during periods of rest that were uncorrelated with the time of day. Diagnostic work-up gave no evidence of radiculopathy or of focal neuropathy. Overnight polysomnography documented that movements of the toes and feet occurred only before sleep onset and during periods of nocturnal awakening or arousals. Because the movements observed in our patients were similar to those seen in patients with PLMT, we diagnosed an abortive form of this syndrome, which already has got the naming "painless legs and moving toes." The occurrence in a mother and her daughter may point to a hereditary component of this disorder.

Adult↗
PubMed1994

The syndrome of painful legs and moving toes.

The clinical presentation, symptoms, and signs in 20 new patients with the painful legs and moving toes syndrome are presented. Painful legs and moving toes may develop in the setting of spinal cord and cauda equina trauma, lumbar root lesions, injuries to bony or soft tissues of the feet, and peripheral neuropathy. In 4 of the 20 cases in the present study, no definite cause was found. Pain preceded the onset of toe movements in 18 cases, but in 2 the reverse sequence occurred. The pain had many of the characteristics of causalgia, but none of the patients exhibited the full picture of reflex sympathetic dystrophy, and peripheral trauma was the trigger in only 5 cases. Several patients reported that the occurrence of toe movements was closely related to the pain, although abolition of pain with lumbar sympathetic blocks was not necessarily associated with disappearance of the movements. Several features suggest a central origin for the movements. Symptoms may begin on one side and become bilateral; movements may be momentarily suppressed by voluntary action or exacerbated by changing posture; and electromyography reveals complex patterns of rhythmic activity with normal recruitment of motor units involving several myotomes. Three other patients with similar moving toes but no pain are also described. The occurrence of similar movements in the absence of pain raises the possibility that these cases represent examples at one end of a spectrum of disorders, with pain alone (causalgia) at the other end and the syndrome of painful legs and moving toes in between.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Finger movement versus toe movement-related potentials: further evidence for supplementary motor area (SMA) participation prior to voluntary action.

The cerebral potentials associated with voluntary, self-paced rapid flexions of (1) right fingers, (2) left fingers, (3) right toes, and (4) left toes were compared in the same experiment using 32 right- and left-handed subjects. The Bereitschaftspotential (BP) or readiness potential was, in the first half of the foreperiod, bilaterally symmetrical for both finger and toe movements of either side. In the later foreperiod there were differences: Finger movements showed two maxima, an early one at Cz and a late one, which was lateralized toward the contralateral precentral region. With toe movements, the maximum BP amplitude was always at Cz and not lateralized and was twice as large as with finger movements. The data are compatible with the view that two principal sources of different spatial and temporal characteristics are active in the foreperiod of a voluntary movement. The early generator is probably the supplementary motor area (SMA) on the mesial surface of the hemispheres; the later is the primary motor cortex (MI) which is lateralized for finger but not for toe movements. In lateral leads, rather remote from the mesial source, the BP for toe movements showed a small but significant ipsilateral preponderance, which is obviously due to the fact that dipole sources located on the mesial surface of the hemispheres point to the opposite direction as compared to those on the convexity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Toe temperature versus transcutaneous oxygen tension monitoring during acute circulatory failure.

Measurements of toe temperature and transcutaneous PO2 (PtcO2) have been both suggested for non-invasive assessment of peripheral blood flow in acute circulatory failure. The underlying principle of the two methods is that cutaneous vasoconstriction occurs early when tissue perfusion is altered. In 15 patients, we compared the two measurements during cardiogenic shock (27 measurements) or septic shock (29 measurements). Toe-ambiant temperature gradient and PtcO2 correlated well together (r = 0.66, p less than 0.001) especially in hyperkinetic septic shock (r = 0.79, p less than 0.001). In cardiogenic shock, toe-ambiant temperature correlated well with cardiac index (r = 0.63), stroke index (r = 0.64) and oxygen transport (r = 0.65), and these correlations were stronger than for PtcO2. In septic shock, both techniques were poor indicators of blood flow indexes but PtcO2 rather correlated with arterial pressure (r = 0.66) and left ventricular work (r = 0.66). Trend evaluation of data revealed in cardiogenic shock that the increase in toe temperature usually preceded the increase in PtcO2. Since measurement of PtcO2 is technically more complicated, correlates less well with standard hemodynamic parameters and later reflects cardiovascular improvement, it has no advantage over measurement of toe temperature in circulatory shock. In cardiogenic shock, measurements of toe temperature can reliably track cardiac output changes. In septic states, however, non-invasive assessment of skin perfusion is of limited interest.

Blood Circulation↗
PubMed2002

Gangrene of the toes in a patient with chronic myelogenous leukemia after long-term hydroxyurea therapy.

Gangrene of the toes and digits appears to be a rare but very severe complication of long-term hydroxyurea therapy. Nothing is known regarding the pathophysiology and the type of vascular damage leading to this syndrome. Here we report a case of a 49-year-old male presenting with gangrene of the toes of both feet 4.5 years after initiation of hydroxyurea therapy for chronic myelogenous leukemia. Blisters on the toes occurred for the first time 9 months prior to hospitalization. Successively, all ten toes showed signs of beginning gangrene with one toe removed surgically 8 months before admission. Presence of diabetes mellitus or peripheral angiopathy was ruled out and platelet counts were within the physiologic range during the last years, excluding thrombocythemia as another rare cause for gangrene in patients with myeloproliferative diseases. Whereas perimalleolar ulcerations of the legs are a more common complication of hydroxyurea, gangrene of the toes as a consequence of hydroxyurea treatment has been described previously only once in the literature. At this point in time cessation of hydroxyurea treatment appears to be the only therapeutic option, thereby avoiding further progress of gangrene in patients with chronic myelogenous leukemia treated with hydroxyurea.

Antineoplastic Agents↗
PubMed1989

The independent long extensor tendon of the fifth toe as a source of tendon grafts for the hand.

The anatomical relationships of the extensor of the fifth toe to the long extensor of the other toes have been studied in 78 cadaver specimens. 50% of the specimens had an independent extensor to the fifth toe without interconnections to the other long toe extensors or the peroneus tertius. The independent fifth toe extensor was consistently of good quality and adequate length for use as a tendon graft, for which purpose it has been successfully used in five patients, with transfer of the adjacent long extensor from the fourth toe to maintain extension of the fifth metatarso-phalangeal joint.

Hand↗
PubMed2006

Cosmetic reconstruction of distal finger absence with partial second toe transfer.

The authors successfully performed a series of 32 distal finger reconstructions using partial second toe-to-finger transfers solely for aesthetic indications. The resulting hand function shows an average static 2-point discrimination of 8 mm. Total active range of motion was 205 degrees. Key-pinch strength and grip strength averaged 65 and 90% of the normal contralateral side, respectively. Patient satisfaction, as reflected by the average subjective satisfaction scores for aesthetic appearance and function (SSSAF) of the reconstructed distal finger, was high at 82 and 78, respectively. The SSSAF for the donor site averaged 88 for function and 75-80 for aesthetic appearance, which is statistically significant (p<0.05). The authors modified the technique of distal finger reconstruction using second toe transfers in three ways. One is to skeletonize the neurovascular bundle of the harvested toe and pass it through a subcutaneous tunnel between the distal finger incision and the web space incision to avoid lengthy and unsightly scars on the reconstructed finger. Another is to defat the skin flaps developed at the amputated stump and to use a zigzag incision on the toe flap to create a smoother skin junction between the stump and the transferred toe. The third refinement is to perform the arterial microanastomosis at the level of the web space to take advantage of the larger diameter of the vessels in this area. Cosmetic reconstruction of the distal finger with a partial second toe-to-hand transfer provides a high degree of patient satisfaction, both aesthetically and functionally.

Adolescent↗
PubMed2006

Temporary arteriovenous loop between the saphenous vein and the first plantar metatarsal artery in toe-to-hand transfers.

We describe a technique for creating a temporary arteriovenous loop by anastomosing the saphenous vein to the first plantar metatarsal artery to facilitate harvesting and subsequent anastomosis of a great or second toe transfer. This technique has been used in 9 patients: 6 pediatric toe-to-hand transfers for congenital hand differences and 3 adult toe transfers for a thumb amputation. All 9 toe transfers survived. The advantages of this technique are that it allows precise determination of the exact length of the loop to reach the recipient artery, it facilitates palmar positioning of the arterial pedicle, and, if necessary, the saphenous vein can be anastomosed directly to the lateral digital artery of a great toe transfer or the medial digital artery of a second toe transfer rather than the first plantar metatarsal artery itself, thereby minimizing more proximal dissection of the first plantar metatarsal artery, which is more difficult and time consuming.

Adult↗
PubMed2003

Finger and toe ratios in humans and mice: implications for the aetiology of diseases influenced by HOX genes.

The differentiation of gonads, fingers, and toes is influenced by HOXA and HOXD genes. Therefore variation in the development of the gonads, and their fetal products such as testosterone, may be reflected in the morphology of the fingers and toes. One trait, the relative length of the second and fourth digits (2D:4D), shows sex differences (lower values in males) which are determined early, and 2D:4D has been found to correlate with fetal growth, sperm counts, family size, autism, myocardial infarction, and breast cancer. HOX genes are highly conserved in mammals and they influence the differentiation of all the fingers and toes. We suggest that (a) 2D:4D and other ratios of finger and toe length show sex differences throughout the mammals including humans and mice, (b) finger and toe ratios correlate with sex determination, the fetal production of sex steroids, and fetal programming of disease, and (c) HOX gene influences on sex determination, the morphogenesis of the urinogenital system, fertility, haematopoiesis, and breast cancer suggests that finger and toe ratios in humans and mice may correlate with many sex dependent diseases.

Animals↗
PubMed1985

Hand reconstruction for multiple amputations by double microsurgical toe transplantation.

Double microvascular toe transplant procedures were used to restore function in 16 mutilated hands. In eight hands, both opposing surfaces were reconstructed with the great toe or second toe used for the thumb and the contralateral second toe for the ulnar side of the hand. In eight hands in which the thumb was still present, two fingers were reconstructed with a second toe from each foot. All 33 transplanted toes survived. In all patients, hand function was substantially improved, with an average of 9.15 pounds of pinch strength between the transplanted opposing digits or the transplanted digit and a normal thumb. Adequate sensibility was restored. The two transplant procedures were done sequentially in six patients, while the two transplantations were performed simultaneously in 10 patients. Simultaneous reconstruction proved time- and cost-effective.

Adult↗
PubMed1985

Thumb reconstruction pollicisation or toe-to-hand transfers. A comparative study of functional results.

A statistical study of thumb reconstruction after traumatic amputation, based on the records of 33 pollicisations and 21 microsurgical toe-to-hand transfers was made. A precise method of evaluation of results is presented. The types of lesions are divided into 4 groups; 1: amputation of the thumb without injuries of the other fingers; 2: amputation of the thumb associated with amputations or mutilation of other fingers; 3: metacarpal hand; 4: amputation of the thumb distal to the metacarpophalangeal joint. The aim of this study was to determine the respective indications of the two methods. It may be concluded that: in group 1, the results of pollicisation and of toe-to-hand transfers are similar. The former is superior as far as the discriminative sensory and fine motor results are concerned, while toe transfer reestablishes better strength. In group 2, the more the other fingers are mutilated, the more toe transfers should be preferred to pollicisation which weakens the performance of the long fingers, especially when they are injured. In group 3 (metacarpal hand), the transfer of one or more toes is a revolution. It is the only technique capable of returning function and, if technique is correct, a cosmetically satisfactory aspect as well. In distal amputations of the thumb (group 4), the only indications for pollicisation are cases of a proximally injured finger with a healthy distal segment, transferable on healthy pedicles, which is relatively rare. Partial toe-to-hand transfers, is a new solution to this challenge.

Amputation, Traumatic↗