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PubMed2001

Effect of radial artery harvesting on tissue perfusion and function of the hand.

This study was designed to measure the degree to which hand and forearm blood flow is reduced following harvesting of the radial artery in myocardial revascularization surgery and determine whether there is an effect on hand function. Twenty patients who had the radial artery used for myocardial revascularization underwent bilateral blood flow assessment of hands and forearms using Technetium-99m human serum albumin and clinical evaluation of hand function. Mean tissue perfusion in ml/100 ml/min +/- SD was as follows: donor hand 21.9 +/- 5.6, non-donor hand 25.5 +/- 6.1 (P = 0.00043), donor arm (hand and forearm) 17.5 +/- 3.7 and non-donor arm (hand and forearm) 21 +/- 5.1 (P = 0.000681). No clinical evidence of hand claudication was detected. This study suggests that removal of the radial artery reduces the tissue perfusion of the hand and forearm but does not affect hand function in the short term. The use of radial artery grafts in patients at risk of developing peripheral vascular disease should be carefully considered

Adult↗
PubMed1998

Three-dimensional ultrasound examination of the fetal hands: normal and abnormal.

PURPOSE: To assess particular features of fetal hand evaluation using three-dimensional ultrasound, and to determine whether any advantage is offered by three-dimensional over two-dimensional ultrasound in fetal hand evaluation. METHODS: Three-dimensional fetal data were collected prospectively from 44 hands in 40 fetuses from a predominantly high-risk patient population. All had a concurrent two-dimensional ultrasound examination of the hands. Diagnoses from two- and three-dimensional ultrasound examinations were compared and additional information from the three-dimensional volume assessment was noted. Three-dimensional assessment of distal forearm bones, wrist position, finger configuration and number of metacarpals and digits was recorded. RESULTS: Hands were appropriately identified as normal (32/32) or abnormal (12/12) by both two- and three-dimensional ultrasound. Three-dimensional ultrasound provided additional information when compared to two-dimensional ultrasound in both normal and abnormal hands, including the provision of three orthogonal planes with one volume acquisition, allowing rotation of the volume so that hands could be evaluated in planes not possible during two-dimensional imaging, assessment of a hand with loosely curled fingers as normal, the ability to evaluate thumb and fingers simultaneously, and improved assessment of abnormal hands. CONCLUSIONS: Three-dimensional ultrasound offers the potential to provide greater information in fetal hand evaluation for both normal and abnormal hands.

Embryonic and Fetal Development↗
PubMed2005

Clinical characteristics of an anatomical hand index measured in patients with rheumatoid arthritis as a potential outcome measure.

OBJECTIVES: To determine the clinical characteristics of an anatomical hand index previously reported as a potential measure of joint deformity and outcome in patients with rheumatoid arthritis. METHODS: The hand index (open hand span - closed hand span/lateral height of the hand) was measured in a cross-sectional study of 145 out-patients with rheumatoid arthritis with disease durations 0-55 yr. Subsets of patients were restudied at mean follow-ups of approximately 9 months and 4 yr. RESULTS: The hand index fell gradually with disease duration. Correlations were demonstrated with the Sharp index (r = - 0.39, P = 0.000) and to a lesser extent with disease activity score (r = - 0.28, P = 0.001). At 260 +/- 115 days the hand index worsened by 0.09 units (P = 0.09, NS). At 51.6 +/- 5.4 months the index showed a fall from 1.96 +/- 0.73 to 1.61 +/- 0.65 (P = 0.000). During the same interval the Sharp index increased from 60 +/- 68 to 80 +/- 71 (P = 0.000). CONCLUSIONS: Measurement of simple hand dimensions can demonstrate worsening of hand deformity with time in patients with rheumatoid arthritis. We suggest that more sophisticated analysis of digital hand images, as used in our original study, might yield additional information and increase the sensitivity of an anatomical hand index as an outcome measure in rheumatoid arthritis.

Anthropometry↗
PubMed1993

An evaluation, using computerized image analysis, of antimicrobial efficacy of an automatic hand washing machine with ultrasonic wave spraying.

We studied the antimicrobial efficacy of hand washing with a quick-dry hand washing machine [TE-KIREIKI] employing ultrasonic wave spraying and its incidental alcohol-based product [AROKULIN-E]. The subjects of this study were 10 males who had been instructed not to use any antimicrobial agent for the previous 2 weeks or any hand soap for the previous 5 hours. They pressed their palms on agar before and after washing their hands. After 48-hour incubation at 37 degrees C, the bacterial colonies grown on the agar were counted using the [ASPECT] image processing system. The colony count was expressed as the post-stamp versus pre-stamp percent (%) reduction. Two patterns of hand washing were examined in this study: [A] a 3-second hand wash using an alcohol-based product [AROKULIN-E] and [B] a 30-second hand wash using a nonmedicated detergent soap with running water in addition to hand washing by [A]. The percent (%) reduction after hand washing patterns [A] and [B] were 49.1% and 51.3%. These reduction rates indicated that these patterns did not eradicate bacteria from the hand surface. Therefore, we concluded that this quick-dry hand washing machine employing an ultrasonic wave spraying method combined with an alcohol-based product needs improvement.

Bacteria↗
PubMed2002

[Antimicrobial effects and efficacy on habitually hand-washing of strong acidic electrolyzed water--a comparative study of alcoholic antiseptics and soap and tap water].

The rate of bacterial elimination for the stamp method was compared with regular hand-washing (using soap and tap water), hygienic hand-washing (using alcoholic antiseptics), and hand-washing using strong acidic electrolyzed water (the SAEW method) in routine work. After routine work, the average number of bacteria remaining on the nurse's hands with using the SAEW-method, rubbing method and tap water method, were: 54 +/- 63, 89 +/- 190, 128 +/- 194 CFU/agar plate, respectively (n = 81). In this study. It was clarified that a much larger number of Bacillus sp. were detected for the rubbing method than for the other methods. After further nurse work, the most number of absorbed bacteria on a nurse's hands were counted after cleaning a patient's body. The rate of bacteria elimination for hand-washing with soap and tap water after taking care of a patient was insufficient, especially when before care was provided the number of bacteria on the nurse's hands were less than 100 CFU/agar plate. From these results, the following manual for sanitary hand washing is recommended: 1. At first, dirty hands should be cleaned and the number of bacteria should be reduced using soap and tap water or by scrubbing with disinfectants. 2. After the number of bacteria has been reduced, use the SAEW method routinely. 3. For care requiring a high level of cleanliness or if no tap water facilities are available, use the rubbing method. Finally, routine use of the SAEW method in ICU could be recommended with conventional disinfectants and soap and tap water on a case by case basis for less than adverse reactions, such as in the case of rough-hands or keeping a low level of bacteria on hands.

Anti-Infective Agents, Local↗
PubMed1992

Faecal micro-organisms on the hands of carriers: Escherichia coli as model for Salmonella.

To evaluate the public health hazard caused by Salmonella carriers as food handlers, a study was carried out to gather more quantitative data about faecal contamination of hands after stools. Faecal E. coli was used as a model bacterium for Salmonella. In total 92 subjects cooperated in this study. The hand was sampled before toilet use, and also after stools, with or without washing of the hands. Besides E. coli the number of Enterobacteriaceae was also determined. It appeared that hands may be contaminated with Enterobacteriaceae, regardless of toilet use, for a well before as after stools about 60% of the sampled hands carried a detectable number of Enterobacteriaceae. That is why the presence of Enterobacteriaceae on hands is not a good indicator for toilet hygiene. In 4% of the samples before stools and in 25% of the samples taken after stools E. coli could be detected (> 20 CFU/sample). The average 10log CFU of E. coli in the positive samples taken before and after stools were about the same: 2.30 per sample. Hand washing after stools reduced the numbers of Enterobacteriaceae and E. coli on the hands. It was concluded that symptomless Salmonella excretors in the period starting two weeks after infection form only a low risk in carrying over Salmonella by their hands to food. Especially if normal hygiene is practiced like washing hands after stools, the number of contaminated hands will be very low and furthermore the number of faecal micro-organisms will be very small.(ABSTRACT TRUNCATED AT 250 WORDS)

Carrier State↗
PubMed1980

Somatic sensory cortex (SmI) of the prosimian primate Galago crassicaudatus: organization of mechanoreceptive input from the hand in relation to cytoarchitecture.

Mechanoreceptive input from the hand to the somatic sensory cortex (SmI) of the prosimian primate Galago crassicaudatus was examined with microelectrode mapping methods. In anesthetized animals, low threshold cutaneous input from the hand projects to SmI cortex in a single, complete, somatotopically organized pattern. Within this single pattern, cells with receptive fields on the glabrous skin of the palm, digits and digit tips are located in the rostral half, and cells with RFs on the hairy skin of the dorsal hand and digits are located in the caudal half of the hand areas. The cutaneous hand area is coextensive with the densely granular architectonic region of SmI. Studies of single cells in this region of awake galagos reveal the same pattern of cutaneous input and, in addition, demonstrate the presence of cells responding to joint movement not detected in anesthetized animals. Cells responsive to joint movement are arranged in vertically oriented columns located adjacent to cutaneous columns with receptive fields on the same part of the hand. In anesthetized animals, cells rostral to the granular region, in an area typified by increasing numbers of pyramidal cells in layer V and decreasing numbers of granular cells in upper layers, respond to high threshold stimulation of large areas of the hand. The few cells isolated in this area in awake animals respond to either active or passive hand movements. In such animals, cells caudal to the granular region, in an area characterized as agranular and alaminar cortex, respond to either passive stimulation of single or multiple joints or to active hand movements. These results, together with similar findings in a related prosimian, Nycticebus coucang, emphasize the generality of a single cutaneous hand area in SmI of prosimian species. The demonstration of multiple hand areas corresponding to multiple cytoarchitectonic subdivisions in SmI of Old and New World simians illustrates the increased degree of SmI differentiation from the prosimian to the simian grade of organization. The present results further suggest that determination of the homologues of multiple areas or subdivisions within and surrounding SmI in primates will require comparisons of somatotopy, submodality, sulcal patterns, cytoarchitecture, and connectivity in representative members of prosimian and simian families.

Anesthesia, General↗
PubMed2000

A performance measure of the degree of hand preference.

The present paper describes a performance method for determining hand preference. The task requires participants to reach into different regions of hemispace to perform various actions (point, pick up, toss, sweep, and position) with a dowel located at each position. In accordance with the participants' hand preference as measured by the Waterloo Handedness Questionnaire, the preferred hand was used more frequently on the various performance tasks. The distribution of hand use in working space indicates that preferred hand use was almost exclusive for actions carried out in ipsilateral hemispace, while it is used only moderately for actions in contralateral hemispace, revealing that this hand is used throughout a wider range of extrapersonal space than the nonpreferred hand. These trends were observed across all of the performance tasks, suggesting that task complexity did not affect the frequency of preferred hand use either overall or, more specifically, in right hemispace, as was predicted. This finding is inconsistent with empirical work on questionnaires indicating that verbal reports of preferred hand use increase for more complex tasks (e.g., Steenhuis & Bryden, 1988). As well, performance on the preferential reaching task correlated significantly with hand preference as measured on the Waterloo Handedness Questionnaire (Bryden, 1977), unlike the other performance measure examined, indicating that the preferential reaching task is sensitive to differences in the degree of hand preference.

Adult↗
PubMed1997

Inter- and intra-sensory modality matching in children with hand-eye co-ordination problems.

Inter- and intra-sensory modality matching by 8-year-old children diagnosed as having hand-eye co-ordination problems (HECP) and by a control group of children without such problems were tested using a target-location and pointing task. The task required the children to locate target pins visually (seen target), with the hand (felt target) or in combination (felt and seen target), while pointing to the located target was always carried out without vision. The most striking finding, for both the control and the HECP children, was the superiority of performance when the target had to be located visually. When combined scores for both hands were analysed, the HECP children showed inferior performance to the control children in both inter- and intra-modal matching. Analyses of the scores achieved with the preferred and non-preferred hand separately, however, demonstrated that the differences between the HECP and the control children could, in the main, be attributed to lowered performances when the non-preferred hand was used for pointing to the target. When pointing with the preferred hand, the only significant difference between the groups was when the target was visually located, the control children showing superior performance. Pointing with the non-preferred hand gave rise to significant differences, in favour of the control children, when the target was located visually, with the hand or in combination. These findings suggest that earlier studies, using only the preferred hand or a combination of the scores of both hands, might need to be qualified. Putative neurological disorders in the HECP children are invoked to account for the poor performance with the non-preferred hand.

Case-Control Studies↗
PubMed1999

Eye-hand coordination in uni- and bimanual goal-oriented tasks.

Two different drawer tasks were investigated with the aim of assessing the role of eye movements in well-coordinated hand movements. In an unimanual step-tracking task, which had a predictive and an unpredictive movement, a two-way repeated-measures ANOVA showed a significant effect of prediction on the onset of grip-force (GF) rate (300+/-39 ms for the predictive condition versus 394+/-53 ms for the non-predictive condition, P<0.0001). Correlation coefficients, computed from the eye and the hand movements were low for the right and the left hand. The saccade was more coupled with the visual step change than with the action of the hand per se. In a second bimanual pull-and-pick task, the instruction was to pull a drawer with the left hand from a closed position to a LED-cued open position and then to grasp and reinsert a small peg in the drawer with the right hand. Correlation coefficients, computed from the latencies of saccades and of the leading left hand or of the right hand, were significant in four of five subjects. Intermanual correlations were significant in all five subjects. In conclusion, we found that the initial saccade in the unimanual task was best related with the visual step change, but was poorly correlated with the pulling/pushing hand. In the bimanual task, a moderate, but significant temporal coupling between the eyes and hand events was observed. This coupling was, however, less tight than that between both hands.

Acoustic Stimulation↗
PubMed2001

Two kinds of body representation are used to control hand movements following tactile stimulation.

The task of reaching with a hand toward a target given in space is generally described as an ill-posed problem. It is often assumed that some kind of internal body model is required to solve this problem. This article provides information concerning the nature of this representation. Experiments were carried out in which blindfolded subjects were stimulated mechanically at one of eight possible stimulation sites on the legs and then asked to move one hand as quickly as possible to the stimulated site. In nine different postures of legs and hands, the frequency was recorded of the use of either hand. In addition, reaction times (RT) were measured and in two choice reaction tasks RTs were measured for different conditions (morphologically compatible vs morphologically incompatible, hands parallel vs hands crossed): The results support the hypothesis that the representation of the body is based on at least two systems, one which provides spatial information concerning the body position and a second one which is based on a morphological representation. According to this hypothesis, our results could be described by the following schema. Following the application of the stimulus, two processes were started in parallel. One concerned the activation of the spatial representation of body position, including the position of stimulus site and the possible response sites. This was more difficult, i.e., took more time, when the hands were crossed. Within this spatial representation, the distances between stimulus site and response sites were determined, and it was found that the smaller the distance, the more strongly the hands were activated. Simultaneously, in a second process the response site which was morphologically ipsilateral to the stimulus was excited. This schema could explain our results: In the behavioral experiments that hand which was most strongly excited, and which therefore exceeded a threshold sooner, won the decision and showed smaller RT values. In the choice reaction experiments, the winning hand was compared with the externally given task. The more strongly, according to the given task, the wrong hand was excited, the longer was the RT of the response.

Adult↗
PubMed2005

Evaluation of the kinesthetic sense and function of the hand in early period in operated cervical disc hernia.

A prospective study made into cervical disc hernias. To determine the kinesthetic sense and hand functions, which are important for the patients with cervical disc hernia to return to work life and daily activities that need skill. Neurosurgical department. Data Symptoms in cervical disc hernias and hand functions are affected depending on long-term pain. The evaluation of the hand is essential in assessing the patients' overall recovery and ability to return to daily activities and work life. Thirty-four patients with cervical disc hernia, who were operated on, were included in the study. Eight different test positions in the assessment of the hand's kinesthetic sense and hand function sort (HFS) in the evaluation of the hand function were applied. The disability levels of the patients were determined with The Neck Pain and Disability Scale, on the preoperative and postoperative discharge day and in the postoperative second month. Patients were divided into groups according to the side involved. In the evaluation of the kinesthetic test of the hand, only in the postoperative second month was a significant difference observed between the 1, 2, 3, and 4 test positions of the right side of the groups. On the other hand, no significant difference was found between the groups in the assessment of the hand function. In the measurement of hand functions and disability levels, strong and important correlations were determined. An early assessment of the hand's kinesthetic sense and function is instrumental in the patients' evaluation of recovery and resumption of work.

Activities of Daily Living↗
PubMed2003

Nondominant hand performance of the Japanese Trail Making Test and its mirror version.

OBJECTIVES: To investigate intermanual differences in the Japanese version of the Trail Making Test (JTMT) and to investigate whether a mirror version of the JTMT test sheet (JTMT-M) should be used when the task is performed with the nondominant hand. DESIGN: Intermanual differences were compared among the JTMT with the dominant hand, the JTMT with the nondominant hand, and the JTMT-M with the nondominant hand. SETTING: Rehabilitation center in a university hospital. PARTICIPANTS: A total of 150 persons (age range, 19-38y) who had no history of neurologic or musculoskeletal impairment. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The time to complete the task. RESULTS: Nondominant hand performance on the JTMT and JTMT-M did not differ significantly from that of the dominant hand on the JTMT. All left hand data except 1 in each task were within the previously reported reference values obtained from the JTMT with the right hand. CONCLUSIONS: The nondominant hand can be used as an alternative in the JTMT and can be expected to perform comparably to the dominant hand. There is no need to use the JTMT-M even when the task is conducted with the nondominant hand.

Adult↗
PubMed2001

Hand hygiene--comparison of international recommendations.

The value of hand hygiene for the prevention of cross-infection was first observed in the middle of the 19th century. Since then, which procedure is the most suitable for hand hygiene has been repeatedly discussed and several different guidelines and recommendations have been published. The aim of this review is to compare different recommendations for hand hygiene regarding technique and indication. Medline, the internet and a personal library were searched to obtain as many written recommendations as possible. In addition, a small questionnaire was sent by e-mail to 20 international colleagues. As a result, written recommendations from 10 countries could be compared. Recommended methods of hand hygiene include handwashing (washing hands with plain soap), hygienic handwash (washing hands with medicated soap) and hygienic hand-rub (use of antiseptic rubs). In most countries handwashing and hygienic handwash are the methods of choice and only in central European countries is hygienic hand-rub the preferred technique. Situations in which performance of hand hygiene is recommended are comparable. However, no single indication is recommended in all guidelines. Hand hygiene is most often recommended before performing invasive procedures and after microbial contamination. Guidelines should be clear and easy to follow for them to become standard of care. Thus, guidelines are needed that do not leave to the health care worker a decision as to whether hand hygiene is indicated.

Attitude of Health Personnel↗
PubMed1999

The prognostic factors regarding long-term functional outcome of full-thickness hand burns.

The treatment of the burned hand has always been a subject of special interest. In order to obtain a better understanding of the parameters involved in the long-term functional outcome of hand burns a retrospective study was performed on 88 consecutive patients with hand burns (143 hands), treated according to a standardised protocol. Patients were followed for at least 12 months postburn. Hand function was assessed by the seven objective test criteria (7-OTC) described by Jebsen. Logistic regression analysis produced five parameters that were found to have a significant predictive value for long-term hand function. In order of predictive value, these were finger amputations, age on admission, impaired autograft take, the full-thickness hand burn surface area and the full-thickness total body burn surface area. By fitting these five variables into an equation, a probability model was obtained, which could be applied to estimate a prognosis concerning the final hand function of an individual patient with a hand burn. No relationship was found between the postburn day of operation and the long-term hand function. This finding is inconsistent with the current consensus that functional outcome is improved by early excision and grafting. In practice, it suggests that hand function is well preserved when burns of uncertain depth are treated expectantly, followed by selective debridement and grafting. Advantages include reduced blood loss, no loss of vital tissue and a reduction of the need for donor sites.

Adult↗
PubMed2006

A quantitative lymphoscintigraphic evaluation of lymphatic function in the swollen hands of women with lymphoedema following breast cancer treatment.

In BCRL (breast cancer-related lymphoedema), arm swelling is unevenly distributed and some regions are partly or entirely spared. In particular, the hand may or not be swollen, but when involved functional impairment can be substantial. We have found previously that, when the ipsilateral hand is spared of swelling (in a limb with swelling proximal to the hand), the local lymph drainage rate constant (k) is at least as high as in the contralateral hand, contrary to the traditional 'stopcock' concept of reduced lymph drainage from the whole limb. In the light of this finding, we have investigated lymph drainage in the hands of eight women with BCRL and moderate-to-severe hand swelling, using gamma-camera quantitative lymphoscintigraphy. Images showed pronounced superficial activity in the ipsilateral swollen arms of most patients, indicating dermal backflow. k for 99mTc-labelled hIgG (human IgG) measured over 5 h in the subcutis of the ipsilateral swollen hand was 34+/-24% less than in the contralateral hand (P=0.013). Activity measured in the ipsilateral swollen forearm increased progressively, but there was very little increase in the contralateral forearm, indicating retention of 99mTc-labelled hIgG in the swollen forearm. It is concluded that lymphatic function in the swollen hand is impaired, and that there appears to be two populations of women with BCRL, i.e. spared-hand and swollen-hand, irrespective of the cancer treatment received.

Aged↗
PubMed2000

A qualitative study of stress factors in the early stage of acute traumatic hand injury.

The aim of the study reported in this paper was to identify stress factors in the early stage of acute traumatic hand injury. Stress factors were defined as circumstances which the hand-injured patients experienced as problems in the actual situation. A total of 20 patients, treated as inpatients at the Department of Hand Surgery in Orebro Medical Centre Hospital, Sweden, were interviewed 8-20 days after the day of the accident. The analyses of the interviews followed the first step in the analytical process described in a modified model of grounded theory. The trauma experience was one of the stress factors in the early stage. Single acute traumatic stress symptoms, mostly involuntary recollection and re-experience of the trauma, were found in a fourth of the hand-injured patients. All patients reported impaired functioning caused by their hand, irrespective of injury. Practical problems with daily activities and being dependent on help from others for solving practical problems were stress factors caused by functional impairment. Before the accident most of the hand-injured had been very active, also working a lot with their hands in their leisure-time. Involuntary inactivity was a big problem for some of them. Other stress factors in the early stage were uncertainty about function in the future and pain. The appearance of the hand was a minor problem before the first follow-up visit. Probably because the hand was hidden in a bandage. However, some hand-injured felt discomfort in seeing the hand when the dressing was changed at the first follow-up visit.

Activities of Daily Living↗
PubMed2000

Pattern of advancement in the zone of calcified cartilage detected in hand osteoarthritis.

OBJECTIVE: Using high definition macroradiography the pattern of advancement in the zone of calcified cartilage (termed a ZCC step) was detected in osteoarthritic hand joints of patients and compared to the joint space width (JSW) measurement. DESIGN: X5 macroradiographs were obtained of the osteoarthritic hands of 44 patients at baseline and at 18 months. The incidence of ZCC steps, identified as an advancement in the mineralized cartilage front into articular cartilage, was assessed at each articular surface. JSW was measured and was used to determine the difference in JSW between hands and groups of joints with and without ZCC steps at both X-ray visits. RESULTS: ZCC steps were found at the convex articular surfaces in only 42 (48%) hand joints in 28 (64%) patients. Here, ZCC steps were present in 36 joints in the non-dominant hand, compared with 30 joints in the dominant hand. In the former, they were present in 22 DIP, six PIP and eight MCP joints and in 12 DIP, eight PIP and 10 MCP joints in the dominant hand. By 18 months, new ZCC steps had formed in 15 hands with and 17 hands without previous ZCC steps. At both X-ray visits no statistically significant difference in JSW was found between the hands and joint groups with and without ZCC steps. CONCLUSION: In patients with ZCC steps, the pattern of distribution in the hand appeared to be related to that due to vascular changes, such as hyperlipidaemia, rather than to that associated with mechanical forces.

Calcinosis↗