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PubMedDate not supplied

Left-handed surgeons: are they left out?

BACKGROUND: Left-handedness has been considered a simple inconvenience by some or something as convoluted as "the sinister," the Latin word for the left, by others. One in ten medical personnel is left-handed. The perceptions of left-handed surgeons regarding their laterality related inconveniences are unknown. OBJECTIVES: To determine the perceptions of left-handed surgeons and the way it has affected their surgical training and career. DESIGN AND SETTING: Web-based survey of left-handed surgeons. PARTICIPANTS: Left-handed surgeons in 2 boroughs of New York City, Manhattan and Brooklyn. METHODS: Distribution and completion of the survey. MAIN OUTCOME MEASURE: Career-oriented concerns of left-handed surgeons. RESULTS: Three percent of left-handed surgeons received laterality related mentoring during medical school. Ten percent of the programs mentored left-handed surgical residents, and 13% of the programs provided left-handed instruments during surgical residency. Laparoscopy and laparoscopic instruments did not eliminate the problems associated with instrument handling to left-handed surgeons. Ten percent of the left-handed surgeons expressed concerns when asked whether they would be comfortable being treated by another left-handed surgeon when they are the patients themselves. CONCLUSIONS: This study reveals the perceptions of left-handed surgeons in adapting to a right-handed world. Early laterality related mentoring in medical school and during surgical residency with provision of left-handed instruments might reduce the inconveniences of left-handed surgeons learning.

Attitude of Health Personnel↗
PubMed2000

Cricoid pressure: which hand?

We studied 20 anaesthetic assistants applying simulated cricoid pressure with the left or right hand in random order. Simulated cricoid pressure was continued for up to 5 min with one hand and then, after resting, with the other hand. Applied pressure was measured at intervals and the subjects were blind to the results. Nineteen assistants were right-handed and all routinely applied cricoid pressure with their right hand. Mean (SD) force applied during simulated 'awake' cricoid pressure was 13.8 (5.7) N with either left or right hand, and during 'anaesthetised' cricoid pressure it was initially 25.1 (8.2) N and 24.7 (8.8) N with left or right hand, respectively. Mean force was maintained above 20 N and below 30 N throughout the study period with either hand. Force applied with the left hand was significantly lower than with the right hand but the difference was clinically insignificant (0.4 N). Inadequate or excessive force was more frequently associated with use of the left hand (p < 0.0001). Cricoid pressure was released before 5 min in three cases, two left-handed and one right-handed. Our results demonstrate that anaesthetic assistants apply a lower force than is classically taught and are able to maintain the force with either hand for a sustained period. Application with the left hand is justified where clinically indicated but may have a lower margin for error than when applied with the right hand.

Anesthesia, General↗
PubMed2001

The outcome of the nonoperated contralateral hand in carpal tunnel syndrome.

It is not well known how the nonoperated contralateral hand behaves in bilateral carpal tunnel syndrome (CTS). The postoperative clinical course of the nonoperated contralateral hand in unilateral CTS is not well documented either. Of 324 CTS patients, the authors studied 37 who had carpal tunnel release on one hand only to evaluate the postoperative outcome of the nonoperated contralateral hand. The other 287 patients had operations on both hands. Seven patients were excluded because of missing data or because they could not be contacted. All 324 patients were subject to clinical and electrodiagnostic studies on both hands. The patients were divided into three groups. Group I was composed of patients who had bilateral CTS, diagnosed clinically and electrophysiologically, but who had surgery done only on the hand with the most pronounced symptoms. The patients in group II showed symptoms of CTS in one hand only. However, the opposite hand was diagnosed with subclinical CTS: Electrodiagnostic studies showed involvement of the median nerve, but without symptoms. Group III was composed of true unilateral CTS patients, diagnosed by symptoms and electrodiagnostic study. The results of the electrodiagnosis were categorized according to the severity of median nerve damage (mild, moderate, severe). The outcome and postoperative clinical course of the nonoperated contralateral hand were evaluated by electromyography and telephone survey. This method of survey was used because of the vast spread of patients throughout the country. Within 1 year, all 30 operated hands showed significant improvement, 20 of which belonged to group I. Regarding progress of the nonoperated contralateral hand, 10 patients showed improvement of one grade whereas 5 patients showed three grades of improvement. In another 5 patients there was no change whatsoever. In addition, from groups II and III there were 5 patients who showed no change in the nonoperated hand. The postoperative electromyographic findings of the nonoperated contralateral hand was not commensurate with the symptoms. However, regardless of electromyographic results, the nonoperated contralateral hand showed significant improvement (p < 0.0001). Patients with unilateral CTS did not experience any symptom development in the nonoperated contralateral hand.

Adult↗
PubMed1993

Occlusive arterial disease of the hand due to repetitive blunt trauma: a review with illustrative cases.

OBJECTIVE: to increase clinical awareness of the role of repetitive blunt trauma, often occupational, in the development of occlusive arterial disease of the hand. STUDY DESIGN: illustrative cases are presented to emphasize the varied etiology and clinical features of occlusive arterial disease of the hand resulting from repetitive blunt trauma and an historical review of the literature is presented. RESULTS: Occlusive arterial disease of the hand due to repetitive blunt trauma is a common but often preventable disorder. The superficial location of many of the arteries of the hands and digits plus their close proximity to the bones of the hand makes them uniquely susceptible to injury from repetitive blunt trauma. An ever increasing number of occupations and leisure activities have been causally related to occlusive arterial disease of the hand. The diagnosis of occupational occlusive arterial disease due to blunt trauma is suggested by eliciting a history of repetitive blunt trauma to the hand in a patient with symptoms and/or signs of digital ischemia. The dominant hand is most commonly involved, but the non-dominant hand or both hands are affected in certain occupations. Possible predisposing or aggravating factors include tobacco use and working in a cold environment. The diagnosis of occlusive arterial disease confined to the hand or digits is confirmed by non-invasive studies in the vascular laboratory and demonstrated by arteriography. Conservative measures and protection of the hand from further trauma is sufficient for most patients, with surgical therapy being reserved for patients refractory to medical therapy or those with more severe ischemia. CONCLUSION: occlusive arterial disease of the hand may be more common than formerly thought and is often preventable by the proper use of hand tools or instruments and hand protection. This is another type of occlusive arterial disease in which tobacco may be a predisposing or aggravating factor.

Adult↗
PubMedDate not supplied

Relationship between grip strength and hand bone mineral density in healthy adults.

The aim of this study was to assess site-specific relationship of hand bone mineral density (BMD) with hand size, pinch and grip strength in healthy people aged 19-50 years. A total of 143 healthy volunteers participated in the study (mean age: 34 years). One hundred-six were premenopausal women (mean age: 34 years) and 37 were men (mean age: 34 years). Grip and pinch strength was measured by a Jamar dynamometer (Jamar, Irvington, NY). Second, third and fourth middle phalanx BMD were measured on a MetriScan densitometer (Hayward, CA) and mean value of these three phalanxes were used in the analysis. There was not a significant correlation between hand BMD and grip, pinch strength or hand size in premenopausal women. A significant correlation between hand BMD and grip strength was found in men (right hand; r=0.44, p=0.007, left hand; r=0.33, p=0.05). Hand size was not correlated with hand BMD both in men and in women. The short-term precision for RA was estimated as 0.44%. This is the first report of a site-specific relationship of BMD measured by radiographic absorptiometry with hand size, pinch and grip strength in healthy men and premenopausal women. Our results revealed that there is a moderate correlation between hand-grip strength and hand BMD in men. Hand size does not predict hand BMD both in men and women. Radiographic absorptiometry is a practical and reproducible method to detect bone mineral density of hands and may be a valuable screening tool for osteoporosis.

Adult↗
PubMed2005

Activity limitations and participation restrictions in women with hand osteoarthritis: patients' descriptions and associations between dimensions of functioning.

OBJECTIVE: To describe the functional consequences of hand osteoarthritis, and analyse associations between personal factors, hand impairment, activity limitations, and participation restrictions within the framework of the International Classification of Functioning (ICF). METHODS: 87 women with hand osteoarthritis completed a clinical examination including recording of sociodemographic data, measures of hand impairment, and completion of self reported health status measures. The function subscale of the AUSCAN Osteoarthritis Hand Index was used as a measure of hand related activity limitations, while the Canadian Occupational Performance Measure (COPM) was used to describe and measure activity limitations and participation restrictions as perceived by the individual. The study variables were categorised using the dimensions in the ICF framework and analysed using bivariate and multivariate statistical approaches. RESULTS: The patients described problems in many domains of activity and participation. The most frequently described hand related problems were activities requiring considerable grip strength combined with twisting of the hands. On the impairment level, the patients had reduced grip force and joint mobility in the hands, and resisted motion was painful. Regression analyses showed that hand related activity limitations were associated with measures of hand impairment, while activity and participation (as measured by the COPM) were more strongly associated with personal factors than with hand impairment. CONCLUSIONS: Hand osteoarthritis has important functional consequences in terms of pain, reduced hand mobility and grip force, activity limitations, and participation restrictions. Rehabilitation programmes should therefore be multidisciplinary and multidimensional, focusing on hand function, occupational performance, and coping strategies.

Activities of Daily Living↗
PubMed1996

[Procedures for hand hygiene in German-speaking countries].

According to the field of application, strategies for the prevention of the transfer of microbial skin flora from the hands must consider the various categories of flora: transient, resident or stemming from infected lesions on the hands (infection flora). Depending on the species and virulence of the microorganism and of the susceptibility of the infection target, transient flora may or may not be of pathogenic importance. In contrast, resident skin flora is usually regarded as pathogenic only under certain circumstances such as in surgery, especially with transplantation of foreign bodies and in highly susceptible hosts. Microorganisms stemming from infected lesions are of proven pathogenicity. In the non-surgical field, only the transient and infection flora from the hands play a role. Such lesions are an absolute contraindication for patient-care, preparation of pharmaceuticals or foodstuff. In some procedures, the transmission of transient flora can be prevented by use of the non-touch technique ("instruments instead of fingers") or by the intelligent use of protective gloves. Hands already contaminated may be rendered safe by procedures for the elimination of transients such as handwashing, hygienic handwash and hygienic hand rub (in the order of increasing efficacy). Among all useable chemicals, ethanol, isopropanol and n-propanol (in the order of increasing efficacy) are the strongest and fastest agents. Furthermore, the duration of treatment (between 30 and 60 s) significantly influences the achievable reduction of microbial release. According to the new European standards (CEN) for testing chemical disinfectants and antiseptics, products for hygienic handwash must be significantly more efficacious than unmedicated soap, on artificially contaminated hands. In contrast, products for the hygienic hand rub must not be significantly less efficacious than a reference disinfection including isopropanol 60% vol rubbed onto the hands of the same volunteers during 1 min. By this, the average reduction of microbial release amounts to 4.2 to 4.4 lg, in our hands. The effectiveness of procedures for the hygienic handwash is usually significantly lower than that of alcoholic rubs. Therefore, in hospitals, they can be used only in certain indications such as patient care in reverse isolation, preparation of pharmaceuticals or foodstuff. In the surgical field, where not only transient but also resident flora is a cause of post-operative infection, the microbial release from the hands of the surgical team into the surgical wound must be prevented by using surgical gloves. Because of frequent glove lesions, a surgical hand disinfection is usually performed before donning gloves to keep a possible inoculumn as small as possible. Also in this field of application, alcoholic rubs proved to be significantly more effective than washing hands with antiseptic detergents. There exists a strong positive correlation of the reduction of microbial release and the duration of hand treatment, between 1 and 5 min. The European test standards (CEN) require products for surgical hand disinfection to be at least as efficacious as a reference disinfection of clean hands, which are constantly rubbed and kept wet with n-propanol 60% vol during 3 min. By this, the achievable average reduction of the microbial release ranges between 2.0 and 2.4 lg. In contrast, antiseptic washing procedures with preparations containing povidone-iodine, chlorhexidine gluconate or triclosan reduce the bacterial release within 2-5 min only by 0.5 to 1.2 lg. Some of them exert a bacteriostatic sustaining effect which is not found with alcoholic preparations. This, however, is not necessary with the latter as the initial bacterial reduction is that strong that restitution of the skin flora takes > 3 hours. Alcoholic preparations are at least as tolerable for the skin as antiseptic detergents, if not better, if they contain suitable emollients. Because dilution renders alcohols i

Colony Count, Microbial↗
PubMed2001

Bilateral deficit and symmetry in finger force production during two-hand multifinger tasks.

A comprehensive study of patterns of finger forces during one-hand and two-hand multifinger maximal force production trials was performed with particular emphasis on differences between tasks involving symmetrical and asymmetrical finger groups (symmetrical and asymmetrical tasks). Twelve healthy right-handed subjects performed maximal voluntary force production tasks with different finger combinations. Force deficit (FD) for a finger group within a hand was defined as a drop in peak force in a multifinger task as compared to the sum of individual finger peak forces in single-finger tasks. FD showed a dependence on both the number of fingers within the hand and the number of fingers in the other hand. An additional drop in peak finger forces was seen in two-hand tests (bilateral deficit, BD). BD summed over two hands was independent of the number of fingers involved in the two-hand tasks, but dependent on the distribution of fingers between the two hands. BD for a hand was larger for tasks involving fewer fingers within the hand and more fingers in the other hand. It was higher for asymmetrical tasks than for symmetrical tasks. The difference between asymmetrical and symmetrical tasks was due to the different behavior of asymmetrically involved fingers. FD was larger for asymmetrical master (explicitly involved) fingers, while forces produced involuntarily by asymmetrical slave (explicitly non-involved) fingers were larger. These differences brought down the total moment produced by both hands in the frontal plane. FD and BD are phenomena of different origin whose effects sum up. The observations have led to further development of a previously proposed double-representation, mirror-image (DoReMi) hypothesis and refinement of the neural network underlying the two-hand finger interaction.

Adult↗
PubMed2004

Analysis of anatomic variations in cleft hands.

PURPOSE: This study presents an overview of the clinical and x-ray findings observed in 54 cleft hands of 31 patients. The emphasis was on a detailed analysis of typical malformation-associated x-ray patterns such as aplasia and synostosis, with findings arranged as a function of cleft location and of the Manske and Halikis classification. METHODS: The charts and radiographs of 31 patients with 54 cleft hands were reviewed retrospectively and compared with data reported in the literature. Important clinical and x-ray findings as well as the typical morphology of cleft hands were analyzed. Cleft hands were differentiated according to their location and according to the Manske and Halikis classification. In the different locations the deformities were arranged in teratologic sequences. RESULTS: In cleft hands syndactylies were seen in 30 of the 54 hands, most commonly between the ring and the small finger. In 3 hands polydactylies were noted. Analysis of the x-ray morphology showed 2 typical patterns: aplasia and synostoses. Location-specific teratologic sequences showed that radial cleft hands were bilateral more frequently and were associated significantly more frequently with cleft feet. Aplasias predominated in radial cleft hands, whereas synostoses were more common in central cleft hands. In terms of the Manske and Halikis classification the unilateral cleft hands often corresponded to type I whereas bilateral cleft hands with cleft feet mainly were type IV and type V deformities. Cleft hands with synostoses often were seen in types I to III whereas cleft hands with aplasias were classified most frequently as type V. CONCLUSIONS: Analysis of the patients' clinical data and x-rays showed differences between radial and central cleft hands, as well as between the different Manske and Halikis types.

Abnormalities, Multiple↗
PubMed2005

Coupling of hand and foot voluntary oscillations in patients suffering cerebellar ataxia: different effect of lateral or medial lesions on coordination.

Motor coordination has been investigated in seven ataxic patients who underwent surgery of the cerebellar hemisphere (4) or of the vermis-paravermis region (3). Subjects, tested ipsilaterally to the lesion, were asked to couple in-phase rhythmic oscillations of the prone hand and the ipsilateral foot for at least 10 s. The oscillation frequency, paced by a metronome, ranged 0.8-3 Hz. Hand and foot angular displacements were measured by a potentiometric technique; EMG from Extensor Carpi Radialis and Tibialis Anterior was recorded by surface electrodes. The phase-relations between the hand and foot movements, as well as between the onsets of motor commands, were calculated. For each of the limbs the frequency-response curve was estimated by plotting the mean phase values between the onset of the motor command and the onset of the related movement. The experiment was repeated with the same schedule after a strong artificial increase of the hand inertial momentum (15 g m(2)). In the unloaded condition, all patients failed to achieve a hand-foot synchrony (0 degrees ), the hand movement showing a net phase-lag. In four hemispheric and one vermian patients (group 1) this lag progressively grew with frequency up to 110 degrees , in the other two vermian patients (group 2) the hand lag kept almost constant ( approximately 45 degrees ). Group 1 subjects were unable to adequate the delay between the motor commands to the increase in frequency, as instead did group 2 subjects, although this was insufficient to produce movement synchrony. Subjects reacted to hand loading with different strategies. In group 1, due to the net increase of hand inertia, movement synchrony required a strong advance of the hand motor command. Patients succeeded in this, but because of their inability to compensate for changes in frequency, they still produced a progressive lag between movements. In group 2, loading strongly increased the hand dynamic stiffness while it slightly lowered that of the foot, resulting in a rather small difference between mechanical properties of the limbs. Thus, compensation required only a slight anticipatory activation of the hand motor command. Patients failed to do so, however they were able to adjust the command delay to the required frequency and produced a constant hand lag. Their main motor handicap was found to to be the incapability of judging the hand lag as a lack of synchrony. These results seems to indicate that the cerebellum must be involved both in measuring the time difference between hand and foot movements and in weighting this delay in function of the oscillation frequency. These two processes may be confined to the vermis-paravermis region and to the hemisphere, respectively.

Cerebellar Ataxia↗
PubMed1994

Hand washing frequency in an emergency department.

STUDY OBJECTIVE: Previous studies, conducted mainly in ICUs, have shown low compliance with hand-washing recommendations, with failure rates approaching 60%. Hand washing in the emergency department has not been studied. We examined the frequency and duration of hand washing in one ED and the effects of three variables: level of training, type of patient contact (clean, dirty, or gloved), and years of staff clinical experience. DESIGN: Observational. SETTING: ED of an 1,100-bed tertiary referral, central city, private teaching hospital. PARTICIPANTS: Emergency nurses, faculty, and resident physicians. Participants were informed that their activities were being monitored but were unaware of the exact nature of the study. INTERVENTIONS: An observer recorded the number of patient contacts and activities for each participant during three-hour observation periods. Activities were categorized as either clean or dirty according to a scale devised by Fulkerson. The use of gloves was noted and hand-washing technique and duration were recorded. A hand-washing break in technique was defined as failure to wash hands after a patient contact and before proceeding to another patient or activity. RESULTS: Eleven faculty, 11 resident physicians, and 13 emergency nurses were observed. Of 409 total contacts, 272 were clean, 46 were dirty, and 91 were gloved. Hand washing occurred after 32.3% of total contacts (SD, 2.31%). Nurses washed after 58.2% of 146 contacts (SD, 4.1%), residents after 18.6% of 129 contacts (SD, 3.4%), and faculty after 17.2% of 134 contacts (SD, 3.3%). Nurses had a significantly higher hand washing frequency than either faculty (P < .0001) or resident physicians (P < .0001). Hand washes occurred after 28.4% of 272 clean contacts (SD, 2.34%), which was significantly less (P < .0001) than 50.0% of 46 dirty contacts (SD, 7.4%) and 64.8% of 91 gloved contacts (SD, 5.0%). The number of years of clinical experience was not significantly related to hand-washing frequency (P = .82). Soap and water were used in 126 of the hand washes, and an alcohol preparation was used in the remaining six. The average duration of soap-and-water hand washes was 9.5 seconds. CONCLUSION: Compliance with hand washing recommendations was low in this ED. Nurses washed their hands significantly more often than either staff physicians or resident physicians, but the average hand-washing duration was less than recommended for all groups. Poor compliance in the ED may be due to the large number of patient contacts, simultaneous management of multiple patients, high illness acuity, and severe time constraints. Strategies for improving compliance with this fundamental method of infection control need to be explored because simple educational interventions have been unsuccessful in other health care settings.

Analysis of Variance↗
PubMed2000

Recognising a hand by grasp.

The present study aimed to demonstrate that motor representations are used to recognise biological stimuli. In three experiments subjects were required to judge laterality of hands and forearms presented by pictures. The postures of the hands were those assumed when holding a small, medium and large sphere. In experiment 1, the sphere held in hand was presented, whereas in experiment 2 it was absent. In experiment 3, the same images, showing holding-a-sphere hands, as in experiment 1 were presented, but without forearm. In all experiments one finger of each hand could be absent. In experiment 1 recognition time was longer for those hand postures for which the corresponding grasping motor acts required more accuracy. This was confirmed by a control experiment (experiment 4), in which subjects actually grasped the spheres. Absence of fingers did not influence right-left hand recognition. However, the absence of target object in experiment 2, and of forearm in experiment 3 reduced the effects of the type of holding on hand laterality recognition. The results of the present study indicate that grasp representations are used to recognise hand laterality. In particular, the visual description of how hand and object interact in space (the opposition space [M.A. Arbib, Programs, schemas and neural networks for control of hand movement: beyond the RS frameworks, in: M. Jeannerod (Ed.), Attention and Performance XIII: Motor Representation and Control, Lawrence Erlbaum, Hillsdale, NJ, 1990, 111-138; M.A. Arbib, T. Iberall, D. Lyons, Coordinated control programs for movements of the hand, in: A.W. Goodman, I. Darian-Smith (Eds.), Hand function and the neocortex, Springer, Berlin, 1985, pp. 135-170]) and the anchoring of the hand to the agent are the features of the grasp representations used in hand-recognition processes. The data are discussed according to the more general notion that motor representations are automatically extracted in the process of intuiting situations, or people's intentions. These motor representations, which are compared with those of other people, contain concrete information on the actions (the motor program) by which a situation is created and on the aim of the agents executing those actions.

Adult↗
PubMed2002

Asymmetry in hand grip strength and fatigue in low- and high-hostile men.

The present study examined the relationship between hostility level and cerebral hemispheric motor functioning of 70 left-cerebral dominant men. Using the Cook-Medley Hostility Scale, the subject group was divided into thirds: One-third (N = 23) were classified as low-hostile, one-third (N = 23) were classified as high-hostile, and the remainder (N = 24) were excluded from analysis. A hand dynamometer was used to assess hand grip strength, perseveration, and fatigue, as measures of hemispheric motor functioning. Results yielded a hand-by-hostility group interaction, which indicated that high-hostile men evidenced significantly less hand grip strength at the right hand and significantly greater hand grip strength at the left hand relative to low-hostile men. These results suggest that high-hostile men may experience relatively greater right-cerebral arousal relative to their low-hostile counterparts. In other results, both groups showed greater perseveration at the left hand than at the right hand. Both groups also showed significant fatigue across trials at both hands. Analysis also revealed a hand-by-trial interaction, indicating that the right hand fatigued more quickly than the left hand across trials. Resistance to fatigue at the left hand and overestimation or relative imprecision in motor movement at the left hand are discussed in terms of arousal theory. These results and others are cited as contributing inroads into distinguishing between the emotional problems of depression, anxiety, and hostility.

Adult↗
PubMed2003

Factors associated with hand hygiene practices in two neonatal intensive care units.

OBJECTIVE: To determine whether hand hygiene practices differ between levels of contact with neonates; to characterize the hand hygiene practices of different types of personnel; and to compare hand hygiene practices in neonatal intensive care units (NICUs) using different products. METHODS: Research assistants observed staff hand hygiene practices during 38 sessions in two NICUs. Patient touches were categorized as touching within the neonates' environment but only outside the Isolette (Level 1), touching within the Isolette but not the neonate directly (Level 2) or directly touching the neonate (Level 3). Hand hygiene practices for each touch were categorized into five groups: cleaned hands and new gloves; uncleaned hands and new gloves; used gloves; clean hands and no gloves; uncleaned hands and no gloves. RESULTS: Research assistants observed 1472 touches. On average each neonate or his or her immediate environment was touched 78 times per shift. Nurses (P = 0.001), attending physicians (P = 0.02) and physicians-in-training (P = 0.03) were more likely to use appropriate practices during Level 3 touches, but only 22.8% of all touches were with cleaned and/or newly gloved hands. The mean number of direct touches by staff members with cleaned hands was greater in the NICU using an alcohol-based hand rub than in the NICU using antimicrobial soap (P < 0.01). CONCLUSIONS: Hand hygiene was suboptimal in this high risk setting; administrative action and improved products may be needed to assure acceptable practice. In this study use of an alcohol-based product was associated with significantly improved hand hygiene and should be encouraged, as recommended in the new CDC hand hygiene guideline.

Analysis of Variance↗
PubMed2003

Fetal hand movements and facial expression in normal pregnancy studied by four-dimensional sonography.

AIM: To evaluate the developmental pattern of fetal hand movements and facial activity and expression during the second and third trimester of pregnancy by four-dimensional ultrasound (4D-US). SUBJECTS AND METHODS: A total of 25 fetuses in uncomplicated pregnancies were analyzed; 15 fetuses at 13 to 16 weeks and 10 fetuses at 30 to 33 weeks of gestation were studied with abdominal 4D-US. After standard assessment in two dimensional (2D) real-time B mode, a 4D mode was switched on. Further examination lasted a maximum of 15 minutes. RESULTS: Isolated hand movement and subtypes of hand movements were easily recognized by 4D-US. The sub-types of hand to head movement are: hand to head, hand to mouth, hand near mouth, hand to face, hand near face, hand to eye and hand to ear. All subtypes of hand to head movement can be seen from 13 weeks of gestation, with fluctuating incidence. Facial activities and different forms of expression are easily recognized by 4D-US. Among these, two types can be easily differentiated: smiling and scowling. CONCLUSIONS: 4D-US is superior over real-time two-dimensional ultrasound (2D-US) for qualitative, but inferior for quantitative analysis of hand movements. Thus 4D-US makes it possible to determine exactly the direction of the fetal hand, but the exact number of each type of hand movements can still not be determined. 4D-US is superior over two- and three-dimensional sonography in the evaluation of complex facial activity and expression. Among facial activities observed by 4D-US, simultaneous eyelid and mouthing movements dominate between 30 and 33 weeks of gestation. Pure mouth movements such as mouth opening, tongue expulsion, yawning and pouting are present, but at a significantly lower incidence. Facial expressions such as smiling and scowling can be precisely observed using 4D-US.

Facial Expression↗
PubMedDate not supplied

[Changes of muscle excitability of the hand contralateral to a task performing one: a transcranial magnetic stimulation study].

It used to be considered that unilateral movements of distal limb parts are associated only with contralateral motor cortical activity. Recent neuroimaging studies, however, suggest that the motor cortex ipsilateral to a task-performing hand is also activated, and that motor patterns in one hand affect the degree of the activity of the ipsilateral motor cortex. If so, muscles of the hand contralateral to a task-performing one may change those excitability depending on types of tasks. We studied eight subjects who performed three different finger tasks by one hand: (a) pinch, (b) sequential finger opposition, and (c) tactile discrimination. Transcranial magnetic stimulation was delivered by a figure eight coil over the hemisphere ipsilateral to a task-performing hand. Motor evoked potentials and background electromyographic activities were recorded from the opponens pollicis muscle contralateral to the stimulated hemisphere. On average, the motor evoked potentials were larger during tactile discrimination task than those at rest in either hand (p < 0.01). Background electromyographic activities in the left hand increased significantly during right hand tactile discrimination task (p < 0.01), whilst those in the right hand did not change during the left hand performance (p > 0.05). These findings suggest the followings: (1) the hand muscle contralateral to a task performing one changes its excitability depending on types of tasks; and (2) increment of excitability of the left hand muscle associated with right hand tactile discrimination is greater than that of the right hand one in association with the same task by the left hand, thus supporting the idea that there is a functional asymmetry between the right and left motor cortex in respect of motor performance.

Adult↗
PubMed1990

Epidemiology of hand eczema in an industrial city.

To elucidate the importance of hand eczema in the population of Gothenburg, a questionnaire was sent to 20,000 individuals aged 20-65 years, randomly selected from the population register of the city. After two reminders, a response rate of 83% was obtained. Those individuals considering themselves to have had hand eczema within the previous 12 months were invited to a dermatological examination including patch testing. 1385 persons (71%) participated. Analysis of drop-outs was performed by interview by telephone and post. The 1-year period prevalence of hand eczema was estimated to be about 11% and the point prevalence 5.4%. Hand eczema was twice as common among females as among males. The most common type of hand eczema was irritant contact dermatitis (35%), followed by atopic hand eczema (22%) and allergic contact dermatitis (19%). The most common contact allergies were to nickel, cobalt, fragrance-mix, balsam of Peru and colophony. Comparing these results with a 20-year earlier study on hand eczema, an increased prevalence, especially of atopic hand eczema, was found. The only occupational group that reported a significantly higher period prevalence of hand eczema was service workers. Of all occupations, cleaners had the highest period prevalence, 21.3%. Hand eczema was more common among people reporting some kind of occupational exposure. The most harmful exposure turned out to be to unspecified chemicals, water and detergents and dust and dry dirt. The only contact allergen that was statistically related to an occupational group was colophony among female office workers. Change of work, where the hand eczema was the main reason, was reported by 8% and was most common in service work. Hairdressers had the highest frequency of change. Hand eczema was shown to be a long-lasting disease with a relapsing course. 69% of the patients had consulted a doctor and 21% had been on sick-leave at least once because of their hand eczema. The mean total sick-leave time was 18.9 weeks, median 8 weeks. Treatment with topical steroids was reported by 51%, emollients by 85%. Frequent itching was reported by 54% of the patients. 81% experienced some kind of disturbance of their daily life considered to be caused by the hand eczema. A multiple logistic regression analysis revealed that the most important predictive factor for hand eczema was a history of childhood eczema. Number two was female sex, followed by occupational exposure, a history of asthma and/or hayfever and a service occupation.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2002

Hand-assisted laparoscopic gastric bypass does not improve outcome and increases costs when compared to open gastric bypass for the surgical treatment of obesity.

BACKGROUND: Hand-assisted laparoscopic Roux-en-Y gastric bypass (Hand-Lap GB) has been adopted by some surgeons to treat morbid obesity because it is easier to perform than the total laparoscopic procedure, but to date no study has compared the outcomes of patients undergoing the Hand-Lap GB to those obtained with the open procedure (Open GB). We hypothesized that patients undergoing Hand-Lap GB would lose a similar amount of weight when compared to Open GB patients, while experiencing no increase in complications, a shorter hospital stay, and lower overall costs of care, in part as a result of fewer incisional hernias requiring subsequent surgery. METHODS: Nonrandomized, prospective data were collected on all patients undergoing proximal GB via Hand-Lap or open approaches between May 1998 and July 1999. Our first 25 Hand-Lap GB procedures, performed in selected patients (with no extensive previous abdominal surgery) referred to two of us (E.J.D, M.A.S), were compared to all other (n = 62) concurrent open proximal GB performed by the group during this period of time in patients with body mass index (BMI) <50 kg/m2. RESULTS: Preoperatively, Hand-Lap GB patients did not differ from Open GB patients in age (40 +/- 11 vs 43 +/- 11 years), gender (92% female vs 81% female), incidence or type of preoperative comorbid conditions, preoperative weight (282 +/- 33 vs 280 +/- 37 lb), or BMI (45.5 +/- 5.4 vs 44.1 +/- 3.3 kg/m2). (Data given as mean +/- standard deviation). Although length of hospital stay did not differ between groups (3.6 +/- 1.3 vs 4.2 +/- 4.6 days), total hospital costs were significantly higher for Hand-Lap GB ($14,725 +/- 3089 vs. $10,281 +/- 3687, p <0.01 ANOVA). One patient in the Open GB group developed an anastomotic leak from the gastrojejunostomy. Follow-up revealed that Hand-Lap GB patients had a similar risk of postoperative complications as the Open GB group, including marginal ulcer (16% vs 14.5%), stomal stenosis (24% vs 23%), and, most notably, incisional hernia (20% vs 27%). There were no major wound infections or deaths in either group. One patient in each group developed a postoperative small bowel obstruction. Loss of excess weight in Hand-Lap GB patients at 12 months postoperatively was 66 +/- 14% vs 77 +/- 14% in the Open GB group. CONCLUSIONS: The Hand-Lap GB yielded good weight reduction in a population of morbidly obese patients, but at a higher cost for hospital care than Open GB. There was no decrease in the incidence of incisional hernias with the Hand-Lap GB procedure. Although Hand-Lap GB appears to be safe and effective, its failure to provide a decrease in hospital stay or risk of incisional hernia requiring subsequent surgical repair is significant. The primary role for the Hand-Lap GB procedure should therefore be to aid surgeons in developing skills to climb the steep learning curve for total laparoscopic gastric bypass, since Hand-Lap GB does not improve patient outcome and increases cost in comparison to the open GB procedure.

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