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At least 991 records · Page 55Linked to original sources
PubMed1997

The nature and importance of changes in toe-brachial pressure indices following percutaneous transluminal angioplasty for leg ischaemia.

OBJECTIVES: To document changes in toe-brachial pressure indices (TBPI) during the 6 months following percutaneous transluminal angioplasty (PTA) and relate these changes to restenosis. Furthermore, to ascertain the effect of administering a vasodilator, glyceryl trinitrate (GTN), immediately following PTA. DESIGN: Eighty-three technically successful PTA procedures were studied. Fifty-six were for intermittent claudication, 14 for ischaemic rest pain, and 13 for non-healing ulcers. Immediately following balloon dilatation an intra-arterial bolus of either 150 micrograms GTN, with or without a 10 mg GTN patch for 24 h, or a saline placebo was administered. TBPI were measured before and for 6 h after PTA and then at 24 h, 1 week, 1 month and 6 months. At this time, patency at the PTA site was determined by arteriography. RESULTS: There was continuing TBPI improvement over 1 month in patients given saline following PTA. In patients given GTN, peak TBPI was achieved by 1 week, and corresponded with the TBPI observed immediately following GTN administration. Restenosis occurred in 27 (33%) patients, and was significantly more frequent following the procedures for rest pain or ulceration, or where a TBPI increase of more than 0.15 by 1 week was observed. CONCLUSIONS: Haemodynamic changes following PTA continue for at least 1 month, can be modified by GTN administration, and are predictive of subsequent restenosis. Measuring the TBPI increase during the first week following PTA underestimates total improvement, and may give false reassurance with respect to recurrent disease.

Aged↗
PubMed2004

A new form of autosomal dominant limb-girdle muscular dystrophy (LGMD1G) with progressive fingers and toes flexion limitation maps to chromosome 4p21.

Limb-girdle muscular dystrophy (LGMD) is a genetic disorder characterized by progressive weakness of pelvic and scapular girdles and great clinical variability. It is a highly heterogeneous disease with 16 identified loci: six of them autosomal dominant (AD) (LGMD1) and 10 autosomal recessive (AR) (LGMD2). The responsible genes are known for three of the AD-LGMD and for all 10 AR-LGMD. Linkage analysis excluded these 16 loci in a Brazilian-Caucasian family with 12 patients affected by AD late-onset LGMD associated with progressive fingers and toes flexion limitation. Biceps muscle biopsy from one of the patients showed a predominantly myopathic histopathological pattern, associated with rimmed vacuoles. A genomewide scan was performed which mapped a new locus for this disorder at 4p21 with a maximum two-point lod score of 6.62 for marker D4S2964. Flanking markers place this locus between D4S2947 and D4S2409, within an interval of 9 cM. We propose to classify this AD form of LGMD as LGMD1G.

Chromosome Mapping↗
PubMed2002

A new automated toe blood pressure monitor for assessment of limb ischemia.

OBJECTIVE: toe blood pressure (TBP) is an important method to assess peripheral arterial disease especially in patients with diabetes, but remains difficult to measure. We have developed a simple portable device for TBP measurements. METHODS AND RESULTS: first, TBP was determined in 40 ischemic legs with both laser Doppler and photoplethysmography for perfusion monitoring, to assess if laser Doppler can be used for measurements. The median values recorded were identical, but slightly higher values were obtained with laser Doppler (p=0.03). Secondly, a computer based algorithm for automatic TBP readings with laser Doppler was compared to manual assessment in 28 legs of 20 patients. The median values differed 3mmHg (p=0.10). Finally the applicability of the new device was tested in eight legs of six patients by two nurses. CONCLUSION: laser Doppler is appropriate for perfusion monitoring during TBP measurements and automatic pressure readings seem accurate. The automatic portable device is simple to use and can probably determine TBP.

Adult↗
PubMed2001

Superficial acral fibromyxoma: a clinicopathologic and immunohistochemical analysis of 37 cases of a distinctive soft tissue tumor with a predilection for the fingers and toes.

This report describes the clinicopathologic features and immunohistochemical findings identified in 37 cases of a distinctive soft tissue tumor that has a predilection for the hands and feet. The study group included 25 male and 12 female subjects ranging in age from 14 to 72 (mean, 43; median, 46) years. The patients presented with solitary masses 0.6 to 5.0 cm (mean, 1.75 cm) that were present from 3 months to 30 years (median duration, approximately 3 years) before surgical intervention and involved the toes (n = 20), fingers (n = 13), and palm (n = 4). Twenty of the cases were documented to involve the nail region. Histologically, the tumors were typically located in the dermis or subcutis and composed of spindled and stellate-shaped cells with random, loose storiform, and fascicular growth patterns. The lesional cells were embedded in myxoid or collagenous matrix, often with mildly to moderately accentuated vasculature and increased numbers of mast cells. There was generally slight to mild nuclear atypia; only 3 cases had more substantial atypia. Mitotic figures were infrequent. Occasional multinucleated stromal cells were noted in 19 cases. The process showed immunoreactivity for CD34 (21 of 23 cases), epithelial membrane antigen (18 of 25 cases), and CD99 (11 of 13 cases). No immunoreactivity was detected for actins, desmin, keratins, or HMB-45, and only 1 of 23 tumors had weak reactivity for S100 protein. The surgical specimens consisted of biopsy or partial resection specimens (n = 4), local excisions (n = 29), and amputated or partially amputated digits (n = 4). Detailed follow-up, available for 18 patients (mean follow-up interval, 10.1 years), revealed 1 recurrence after local excision and 2 instances of persistent or progressive disease after partial excision. A differential diagnosis of fibrous histiocytoma, dermatofibrosarcoma protuberans, acquired (digital) fibrokeratoma, sclerosing perineurioma, cutaneous myxoma (superficial angiomyxoma), and acral myxoinflammatory fibroblastic sarcoma is discussed.

Adolescent↗
PubMedDate not supplied

Chondrosarcoma of the distal phalanx of the second toe: a case report.

Although chondrosarcoma is a relatively common malignant bone lesion, these lesions rarely affect the foot. This article presents the case of a 32-year-old woman with a chondrosarcoma in the distal phalanx of the right second toe. Radiography and computed tomography showed cortical disruption and soft-tissue expansion. Histologically, the tumor was classified as grade 2 chondrosarcoma according to the American Joint Committee of Cancer pathologic staging system. Amputation at the distal half of the second proximal phalanx was performed to obtain clear surgical margins. A literature review and discussion of salient diagnostic and treatment issues is included.

Adult↗
PubMed1999

Articular fractures of the proximal interphalangeal joint with missing elements: repair with partial toe joint osteochondral autografts.

Five cases of traumatic destruction of a condyle of the proximal interphalangeal joint repaired with a free autogenous graft of a corresponding toe condyle are presented. Precise fitting is essential: 1 patient required a second graft when the initial undersized graft was absorbed. Four of the 5 cases regained laterally stable bicondylar joints and functional fingers. Range of motion varied inversely to the magnitude of the injury and the surgery. Active range of motion at the proximal interphalangeal joint was 80 degrees in 2 digits, 45 degrees in 1, and 10 degrees in 1 complex case; 1 case was considered a failure.

Adolescent↗
PubMed1999

Psychological aspects of toe to hand transfer in children. Comparison of views of children and their parents.

Thirty-seven children with congenital (n = 32) or post-traumatic (n = 5) hand anomalies underwent unilateral or bilateral toe transfers. All had undergone preoperative counselling. After rehabilitation and more than 1 year after surgery, the children and their parents were reviewed by a clinical psychologist to assess the psychosocial outcome of the surgery. A high level of satisfaction was reported with regard to the surgery, in terms of function, cosmesis, donor site, psychosocial wellbeing and the reactions of others. This was true regardless of the gender of the child. However, there was a tendency for the children to be more positive in their responses than their parents.

Adolescent↗
PubMed2001

[Operative treatment of vulnerable scars and deep soft-tissue defects of the thumb with a free toe pulp neurovascular flap].

Because of the capability of opposition, the thumb is the most important digit of the hand. In case of deep soft-tissue defects of the pulp, it is necessary to reconstruct the palmar surface of the distal phalanx of the thumb using tissue with good sensibility. Between 1982 and 1998 at the Department of Hand Surgery, Plastic and Microsurgery of the Berufsgenossenschaftliche Unfallkrankenhaus Hamburg, we used a free toe pulp neurovascular flap for reconstruction of the pulp of the thumb in nine patients. All flaps healed without complications. Indications, operative techniques, and results of this procedure are described.

Adolescent↗
PubMed1994

Reconstruction of a floating thumb with an excess big toe.

In a three-year-11-month-old girl, an excess big toe was transferred microsurgically to replace a congenital floating thumb. The reconstructed thumb was evaluated nine years after the transfer. It showed almost normal growth, compared with the contralateral side, and the aesthetic result was excellent. However, the patient does not use the reconstructed thumb with much skill. The reasons for this are discussed, and the importance of performing surgery early in life is stressed.

Age Factors↗
PubMed1994

Spiral oblique retinacular ligament (SORL) mallet correction in a finger with a proximal interphalangeal joint transferred from a toe.

The use of a spiral oblique retinacular ligament (SORL) reconstruction is reported in a middle finger that had previously undergone reconstruction of the proximal interphalangeal (PIP) joint, using a free, vascularized, second-toe PIP joint transfer. The SORL procedure was applied for the reconstruction of the terminal tendon. A satisfactory postoperative range of joint mobility and stability was achieved.

Adult↗
PubMed1996

Two-stage toe-to-thumb reconstruction in pollicized second metacarpal and useless fingers.

A case of a 25-year-old, male farm worker with a history of traumatic amputation of the right first ray, complete absence of the first metacarpal, and every phalanx of the second finger is presented. A two-stage surgical reconstruction was planned, initially, with transfer of the second metacarpal to the trapezium, creating the first web space which was covered with skin from a reverse radial forearm flap. The second stage included transfer of the right big toe to the hand with anastomoses of the first dorsal metatarsal artery to the radial artery (end-to-end) and the veins to the radial vena comitans and cephalic vein in the flap (reverse flow). Functional and cosmetic results were excellent. The physiologic considerations of reverse flow are discussed.

Adult↗
PubMed1992

Vessel pathology and its clinical significance in toe transfer.

One hundred cases of toe transfer were subjected to histopathologic vessel examination. Results indicated that vascular injuries are crucially responsible for perioperative and postoperative crisis. A thorough resection of the abnormal vessel segment can prevent circulatory crisis and elevate the survival rate.

Blood Vessels↗
PubMed1990

Free vascularized toe-joint transfer in hand reconstruction: a series of 25 patients.

Twenty-eight vascularized toe-joint transfers performed on 25 patients were reviewed. A number of different techniques were used: proximal interphalangeal joint or metacarpophalangeal joint reconstruction, one-stage double joint transfer, and interphalangeal thumb or trapezometacarpal joint replacement. Using these types of vascularized joint transfer allows one-stage composite transfer (including skin, bone, and extensor tendon) and provides rapid bone healing, potential growth in the young, good long-term cartilage preservation, normal lateral stability in pinch, and limited but useful range of motion (mainly at the proximal interphalangeal level).

Adolescent↗
PubMed1990

Toe replantation in the rat.

A big toe of a rat was successfully replanted by anastomosing the deep branch of the medial plantar artery and its concomitant vein. The procedure is demonstrated and discussed.

Amputation, Surgical↗