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PubMed2002

Hand and fingertip injuries in children.

BACKGROUND: Hands are frequently injured in children. To date, the literature has focused on the type and treatment of hand injuries. This study examines the epidemiology of hand and fingertip injuries in children who present to an emergency department (ED). DESIGN: Retrospective chart review. SETTING: Pediatric emergency center of an urban ED. PARTICIPANTS: All patients over a period of 8 months who presented with a chief complaint of hand injury. METHODS: A total of 17,859 charts were reviewed during the study period; 382 patients were enrolled in the study (male preponderance of 1.4:1; median age, 10 y). RESULTS: The most frequent injury setting was outdoors (47%). The most frequent injuries were lacerations (30%), followed by fractures (16%). Only five patients required hospitalization (1.3%). The digits are the most commonly injured part of the hand, particularly the thumb (19%). Fingertips are involved in 21% of cases. Radiographs and consultations were obtained in 64% and 16% of cases, respectively. Infection occurred in 14 (3.7%) patients. CONCLUSION: Hand injuries occur in a bimodal distribution in children. Children younger than 2 years suffered fingertip injuries in the home, and children aged 12 to 16 years suffered hand injuries. Sports injuries tend to present late and are the most common cause of hand fractures.

Adolescent↗
PubMed1999

Laparoscopic living donor nephrectomy: advantages of the hand-assisted method.

INTRODUCTION: The laparoscopic technique for living donor nephrectomy is a technically difficult procedure that has not yet gained widespread acceptance in the transplant community. The procedure may be more acceptable if alterations to the technique made it easier to perform and decreased operative times. METHODS: In August 1998, we altered the laparoscopic procedure to include the use of a device allowing hand assistance. Subsequently, all living donor nephrectomies have been done using the hand-assisted method. In this article, the results of 10 cases performed using the original laparoscopic technique are compared with the results of 12 cases using the hand-assisted technique, and a brief description of modifications to the original technique is given. RESULTS: No patients where turned down as living donors, and no contraindications to the pure or hand-assisted laparoscopic techniques where found. The hand-assisted technique significantly reduced the operative time (2.02+/-0.44 vs. 3.12+/-0.36 hr, P<0.05) and the warm ischemic time (1.23+/-0.54 vs. 3.91+/-0.53 min, P<0.05). The length of stay and recovery time to normal activities were not different between the pure laparoscopic and hand-assisted groups. CONCLUSION: The advantages of the hand-assisted technique include the ability to use tactile sense to facilitate dissection, retraction, and exposure. In addition, the final stages of vascular stapling and kidney removal are more sure and rapid. The modifications of the laparoscopic technique presented here provide measurable and subjective improvements to laparoscopic living donor nephrectomy. The hand-assisted method of laparoscopic nephrectomy may make the operation available to more transplant centers.

Adolescent↗
PubMed2006

Subspecialty certification in hand surgery.

Subspecialty certification in hand surgery was instituted in 1989 by the collaborative efforts of the American Boards of General Surgery, Plastic Surgery, and Orthopaedic Surgery. Candidates must be certified by their parent board and have demonstrated qualifications in hand surgery beyond those expected of other Board-certified surgeons. Qualifications include 1 year of additional training in an Accreditation Council for Graduate Medical Education accredited hand surgery fellowship, successful passage of a secure examination in hand surgery, and a practice characterized by a majority of cases in hand surgery. The certificates are time limited, and every 10 years one must successfully pass a recertification examination to maintain subspecialty certification. Since its inception, 1431 orthopaedic surgeons have passed the examination and the failure rate has been 3.1%. Six hundred and twenty-three have recertified with a failure rate of 2%. Possession of a certificate of subspecialty qualifications in hand surgery was never intended to bestow special privileges to those who practice hand surgery; rather, it was intended to demonstrate to the public and our profession that certificate holders have met Board Standards and are qualified to treat problems related to the hand and wrist.

Certification↗
PubMedDate not supplied

The effects of different hands' responses on main ERP components.

The authors recorded event-related potentials (ERPs) in 14 subjects to explore the effects of different hands'responses on ERP components. Subjects used two different fingers of one hand to indicate whether the two sequentially presented visual stimuli were of the same color (match) or not (conflict) in the first half of the test, while they used the other hand in the last half. ERP components of contingent negative variation (CNV), P100, N160, N200, and late positive component (LPC) were recorded in either the match or conflict condition. Component N270 was recorded only in the conflict condition mainly on the centrofrontal area (F3, F4). The mean amplitude of the CNV was significantly higher when subjects used the right hand to respond. The mean amplitudes of N160 in the two conditions and N200 in the conflict condition were significantly higher when the left hand was used to indicate a response. There was no significant difference in the amplitude of N270 between the left-hand and right-hand responses. The N270 is thought to reflect activity in a conflict processing system. The LPC component was not affected by different hands'response-effect.

Adult↗
PubMed2006

Personal recognition using hand shape and texture.

This paper proposes a new bimodal biometric system using feature-level fusion of hand shape and palm texture. The proposed combination is of significance since both the palmprint and hand-shape images are proposed to be extracted from the single hand image acquired from a digital camera. Several new hand-shape features that can be used to represent the hand shape and improve the performance are investigated. The new approach for palmprint recognition using discrete cosine transform coefficients, which can be directly obtained from the camera hardware, is demonstrated. None of the prior work on hand-shape or palmprint recognition has given any attention on the critical issue of feature selection. Our experimental results demonstrate that while majority of palmprint or hand-shape features are useful in predicting the subjects identity, only a small subset of these features are necessary in practice for building an accurate model for identification. The comparison and combination of proposed features is evaluated on the diverse classification schemes; naive Bayes (normal, estimated, multinomial), decision trees (C4.5, LMT), k-NN, SVM, and FFN. Although more work remains to be done, our results to date indicate that the combination of selected hand-shape and palmprint features constitutes a promising addition to the biometrics-based personal recognition systems.

Algorithms↗
PubMed2001

Crystal structure of calcium-free human sorcin: a member of the penta-EF-hand protein family.

Sorcin is a 22 kD calcium-binding protein that is found in a wide variety of cell types, such as heart, muscle, brain and adrenal medulla. It belongs to the penta-EF-hand (PEF) protein family, which contains five EF-hand motifs that associate with membranes in a calcium-dependent manner. Prototypic members of this family are the calcium-binding domains of calpain, such as calpain dVI. Full-length human sorcin has been crystallized in the absence of calcium and the structure determined at 2.2 A resolution. Apart from an extended N-terminal portion, the sorcin molecule has a globular shape. The C-terminal domain is predominantly alpha-helical, containing eight alpha-helices and connecting loops incorporating five EF hands. Sorcin forms dimers through the association of the unpaired EF5, confirming this as the mode of association in the dimerization of PEF proteins. Comparison with calpain dVI reveals that the general folds of the individual EF-hand motifs are conserved, especially that of EF1, the novel EF-hand motif characteristic of the family. Detailed structural comparisons of sorcin with other members of PEF indicate that the EF-hand pair EF1-EF2 is likely to correspond to the two physiologically relevant calcium-binding sites and that the calcium-induced conformational change may be modest and localized within this pair of EF-hands. Overall, the results derived from the structural observations support the view that, in sorcin, calcium signaling takes place through the first pair of EF-hands.

Amino Acid Motifs↗
PubMed2004

An analogue assessment of repetitive hand behaviours in girls and young women with Rett syndrome.

BACKGROUND: Rett syndrome is a neurodevelopmental disorder that almost exclusively affects females. In addition to neurodevelopmental regression and loss of hand skills, apraxia, deceleration of head growth, and increasing spasticity and scoliosis, a number of behavioural features are also seen, including stereotypic hand movements, hyperventilation and breath holding. The aim of the study was to investigate the extent to which analogue environmental conditions affected the frequency of repetitive hand behaviour in eight girls and young women with Rett syndrome. METHOD: The frequency of repetitive hand movements was observed every 10 s for four 4-min sessions under the following conditions: Continuous Adult Attention, Adult Demands, Stimulation and No Stimulation. RESULTS: The frequency of repetitive hand movements was high -- they occurred in above 60% of all intervals in all conditions for all participants and at nearly 100% for some participants in some conditions. For one participant the frequency of repetitive hand movements was somewhat reduced in the Stimulation condition; for another it was relatively increased in the No Stimulation condition. CONCLUSIONS: Overall, environmental manipulations had relatively limited effects on repetitive hand behaviours. Repetitive hand behaviour in Rett syndrome may be maintained by automatic reinforcement or neurochemical processes and may not be primarily influenced by contingent reinforcement.

Adolescent↗
PubMed1993

Hand abnormalities are strongly associated with the duration of diabetes mellitus.

OBJECTIVES: To study the prevalence of hand abnormalities in diabetic patients and to evaluate associations between the hand abnormalities and diabetic variables, ergonomic factors and smoking habits. DESIGN: Cross-sectional study of 100 patients selected at random. Setting. Out-patient clinic, Department of Internal Medicine, Orebro Medical Centre Hospital in Sweden. MAIN OUTCOME MEASURES: Presence and extent of carpal tunnel syndrome (CTS), Dupuytren's contracture (DC), flexor tenosynovitis (FTS), and limited joint mobility (LJM). Duration of diabetes, metabolic control, chronic diabetic complications, blood pressure, ergonomic factors and smoking habits. RESULTS: Carpal tunnel syndrome, DC, FTS and LJM were each present in about 20% of the patients. Hand abnormalities were observed in 50 patients and more than one abnormality was found in 26 of the patients. The hand abnormalities were associated with the duration of diabetes but not with the metabolic control or with other diabetic complications. However, the diabetic complications were associated with bad metabolic control and with the duration of diabetes. Hand abnormalities correlated with heavy manual work but not with smoking habits. Twenty-five of the 50 patients with hand syndromes were disabled to such an extent that surgery was recommended. CONCLUSION: The prevalence of hand abnormalities in diabetic patients is high and increases with the duration of diabetes. In many cases patients with hand abnormalities can be helped by surgery.

Adult↗
PubMed1979

A comparison of hand growth in elementary schoolchildren in Czechoslovakia and the United States.

Studies have been made of the growth patterns of hands of elementary schoolchildren in Czechoslovakia (1707 children) and in the United States (1641 children). This paper compares the results of these studies and summarizes the patterns of growth for both hands of boys and girls aged from five to 12 years. The results indicate that the United States children generally have shorter and wider hands than their Czech counterparts. In both countries, boys have wider hands than girls, although there is evidence that at ages 11 and 12 years the girls' hands are longer. Growth spurts in both width and length measurements are apparent in children's hands in both countries, but the spurt often occurs at an earlier age in Czech children. Awareness of these general patterns of hand growth should be of assistance to the hand surgeon.

Child↗
PubMed2006

Using the six sigma process to implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 intensive care units.

BACKGROUND: The Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene in Health Care Settings was issued in 2002. In 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) established complying with the CDC Guideline as a National Patient Safety Goal for 2004. This goal has been maintained through 2006. The CDC's emphasis on the use of alcohol-based hand rubs (ABHRs) rather than soap and water was an opportunity to improve compliance, but the Guideline contained over 40 specific recommendations to implement. OBJECTIVE: To use the Six Sigma process to examine hand hygiene practices and increase compliance with the CDC hand hygiene recommendations required by JCAHO. DESIGN: Six Sigma Project with pre-post design. PARTICIPANTS: Physicians, nurses, and other staff working in 4 intensive care units at 3 hospitals. MEASUREMENTS: Observed compliance with 10 required hand hygiene practices, mass of ABHR used per month per 100 patient-days, and staff attitudes and perceptions regarding hand hygiene reported by questionnaire. RESULTS: Observed compliance increased from 47% to 80%, based on over 4,000 total observations. The mass of ABHR used per 100 patient-days in 3 intensive care units (ICUs) increased by 97%, 94%, and 70%; increases were sustained for 9 months. Self-reported compliance using the questionnaire did not change. Staff reported increased use of ABHR and increased satisfaction with hand hygiene practices and products. CONCLUSIONS: The Six Sigma process was effective for organizing the knowledge, opinions, and actions of a group of professionals to implement the CDC's evidence-based hand hygiene practices in 4 ICUs. Several tools were developed for widespread use.

Centers for Disease Control and Prevention, U.S.↗
PubMed1992

A prospective study of the development of hand eczema in an automobile manufacturing industry.

We have not been able to find any prospective study of the risk of developing occupational dermatitis in the car manufacturing industry. To try to define individual predictive risk factors for the development of hand eczema and to determine the prevalence of hand eczema within 1 year in an automobile manufacturing industry, we investigated prospectively 1564 new employees during one year of employment. Only persons with previous atopic dermatitis or hand eczema were restricted to dry and clean workplaces. The employees were personally interviewed and examined before their employment. Written questionnaires were used at 3 and 12 months to obtain information on type of work, exposure, protection and hand dermatitis. All patients developing hand eczema were examined, patch tested and followed to determine the course and consequence of their eczema. The risk turned out to be only 4% on average, but significantly higher in females (6%). Certain sections within the factory such as wet work (canteen/kitchen and cleaning) and work in the paint shop with high exposure to organic solvents carried significantly higher risks. Heavy exposure to mineral oil, a known risk factor, was effectively counteracted by the extensive use of protective gloves to yield a lower than average prevalence in the press and body shop. Individual risk factors for the development of hand eczema were previous hand eczema, atopic dermatitis, but also wool intolerance and hay fever as isolated phenomena. Most cases of hand eczema were mild, of irritant contact type and only 1 employee developed an allergic contact dermatitis due to the working environment.(ABSTRACT TRUNCATED AT 250 WORDS)

Automobiles↗
PubMed2006

Nickel allergy and hand eczema--a 20-year follow up.

The aim of this study was to investigate the occurrence of hand eczema after 20 years in women patch tested to nickel during childhood. In 1982-1983, 960 schoolgirls were patch tested for nickel allergy; its prevalence was found to be 9%. 20 years later, the same individuals received a questionnaire regarding hand eczema and factors of importance for the development of hand eczema. 735 of 908 women (80.9%) answered the questionnaire. In total, 17.6% of respondents reported hand eczema after the age of 15 years, and the 1-year prevalence was 12.8%. There was no statistically significant difference in the occurrence of hand eczema between the groups who had previously tested positive and negative for nickel allergy. 38.3% of the respondents considered themselves to be nickel sensitive at the time they answered the questionnaire; in this group, the reported prevalence of hand eczema after age 15 was 22.5%. 31.4% of those with a history of atopic dermatitis reported hand eczema after age 15, compared with 10.6% of those without (P < 0.001). In conclusion, contact allergy to nickel in childhood did not seem to increase the prevalence of hand eczema later in life.

Adult↗
PubMed2002

Cortically evoked neural volleys to the human hand are increased during ischaemic block of the forearm.

Reorganisation of the motor cortex may occur after limb amputation or spinal cord injury. In humans, transcranial magnetic stimulation (TMS) shows expansion of motor cortical representations of muscles proximal to the injury. Similarly, ischaemic block of the hand can increase acutely the representation of the biceps muscle, measured by increased biceps motor potentials evoked by TMS. It is thought that this increase occurs at the expense of the cortical representation of the paralysed and deafferented hand muscles but this has never been investigated. To study what changes occur in the cortical representation of the hand muscles during ischaemic block, a tungsten microelectrode was inserted into the ulnar or median nerve above the elbow and the size of the neural potential elicited by TMS in fascicles supplying the hand was measured in seven subjects. Prior to ischaemia, TMS evoked EMG responses in the intrinsic hand muscles. In the nerve, a brief motor potential preceded the response in the muscle and was followed by a contraction-induced sensory potential. During 40 min of ischaemia produced by a blood pressure cuff inflated around the forearm to 210 mmHg, the EMG response to TMS and the sensory potential from the hand were progressively blocked. However, the motor neural evoked potential showed a significant increase in amplitude during the ischaemic period (30.5 %, P = 0.005). The increase in the neural potential suggests that output to the hand evoked from the cortex by TMS was not decreased by ischaemic block. Thus, we conclude that the increased response of biceps to TMS during distal ischaemia is not accompanied by a corresponding decrease in the motor cortical representation of the hand.

Adult↗
PubMed1972

Improved experimental model for measuring skin degerming activity on the human hand.

A gloved-hand method is presented for evaluating the interaction of antimicrobial agents with the normal resident bacterial flora of human skin. One of the key features of the experimental model is a simplified technique for sampling the skin, which involves the addition of eluting fluid to the gloved hand. As with other skin sampling techniques, the number of bacteria recovered from the hands showed considerable variation from subject to subject. However, no significant differences were observed between the numbers of bacteria recovered from the right and left hands of individual subjects. The mean number of bacteria recovered from the hand before and after washing with nonmedicated soap was consistent and reproducible over a period of at least 5 consecutive days. The number of recoverable bacteria from the hand was greatly reduced by a single treatment with a surgical scrub preparation containing hexachlorophene. The extent of skin degerming achieved was little affected by the use of a surgical brush, and was maximal at approximately 30 min after contact with the hexachlorophene-containing formulation. It was determined that the level of transient bacteria on the hands could be controlled by a simple wash with nonmedicated soap, resulting in a stabilized base-line level from which treatment interactions with the resident microflora could be measured more precisely. The basic elements of the method presented fulfill the requirements of a satisfactory experimental model for the in vivo evaluation of skin-degerming agents on the hand. The selection of appropriate experimental designs allows treatment comparisons to be made with a high degree of statistical confidence.

Anti-Infective Agents, Local↗
PubMed2005

Hand bone loss in early undifferentiated arthritis: evaluating bone mineral density loss before the development of rheumatoid arthritis.

OBJECTIVES: (1) To examine the change in regional bone mineral density (BMD), including the hands, and assess its role as a predictor of outcome in patients presenting with an early undifferentiated inflammatory arthritis; (2) to examine for associations with the changes in hand BMD. METHODS: 74 patients with undifferentiated hand arthritis of less than 12 months' duration were examined at baseline and then at three, six, and 12 months follow up, including BMD measurement of the femoral neck, spine (L2-4), and the whole hands using dual energy absorptiometry (DXA). RESULTS: During the study, 13 patients were diagnosed as having rheumatoid arthritis, 19 as having inflammatory non-rheumatoid joint disorders, and 42 as having non-inflammatory joint disorders. At the femoral neck and lumbar spine no significant bone loss was seen in any of the three subgroups. At the 12 months follow up the mean (95% confidence interval) hand BMD loss in the patients with rheumatoid arthritis was -4.27% (-1.41 to -7.13); in the inflammatory non-rheumatoid group, -0.49% (-1.33 to +0.35); and in the non-inflammatory joint disorder group, -0.87% (-1.51 to -0.23). In a multivariate linear regression model (including age, rheumatoid factor, mean C reactive protein, mean HAQ score, and cumulative glucocorticoid dose), only mean C reactive protein (p<0.001) and rheumatoid factor (p = 0.04) were independently associated with change in hand BMD during follow up. CONCLUSIONS: Hand DXA provides a very sensitive tool for measuring bone loss in early rheumatoid arthritis and may be useful in identifying patients at high risk of developing progressive disease. Further studies are needed to evaluate the role of hand bone loss as a prognostic factor and outcome measure in rheumatoid arthritis.

Absorptiometry, Photon↗
PubMed1994

Defining osteoarthritis of the hand for epidemiological studies: the Chingford Study.

OBJECTIVES: To explore the relative merits of clinical and radiological examination in defining hand osteoarthritis (OA) for epidemiological purposes. METHODS: A total of 976 women aged 45-64 years were selected from the general population and underwent a structured interview, clinical examination of the hand joints and radiography of the hands and knees. The inter-relationship of the clinical and radiological findings was examined, and also the association of each with hand symptoms and the presence of knee OA. RESULTS: Clinical and radiographic signs of hand OA generally correlated with each other, and each was associated with hand symptoms to a similar degree. When analysed in combination, they were only marginally better at predicting symptoms than when tested individually. However, when they were examined in relation to radiographic features of knee OA, there was a significantly stronger association with radiographic features of hand OA than with clinical features. CONCLUSIONS: Hand radiology provides a better overall assessment of osteoarthritis than physical examination of the interphalangeal joints or carpo-metacarpal joint; in situations where radiology is not available clinical examination is a viable substitute.

England↗
PubMed1995

Skin of the dorsal aspect of human hands and fingers possesses an active vasodilator system.

To test for an active vasodilator system in human hand and finger skin, seven subjects had a small area of dorsal hand, palm, or dorsal finger pretreated with bretylium (BT) to block adrenergic vasoconstriction. Skin blood flow was monitored at a BT-treated site, a comparable untreated site, and the forearm by laser-Doppler flowmetry. Cutaneous vascular conductance (CVC) was evaluated from the ratio of blood flow to arterial pressure. Body cooling, to evaluate vasoconstrictor system blockade, caused CVC at untreated sites of forearm, palm, dorsal hand, and dorsal finger to fall by 45 +/- 4, 85 +/- 5, 51 +/- 9, and 63 +/- 7%, respectively (all P < 0.05). At BT-treated sites of palm, dorsal hand, and dorsal finger, reductions in CVC were only 13 +/- 3, 2 +/- 18, and 13 +/- 4%, respectively (dorsal hand not significant, others P < 0.05). With body heating, increases in CVC at untreated sites of forearm, palm, dorsal hand, and dorsal finger were 881 +/- 165, 779 +/- 368, 423 +/- 115, and 1,430 +/- 716%, respectively (all P < 0.05). At BT-treated sites of palm, dorsal hand, and dorsal finger, increases were 35 +/- 15, 342 +/- 107, and 343 +/- 34%, respectively (palm not significant, others P < 0.05). Increased CVC at the palm began after 1.2 +/- 0.2 min of heating, significantly earlier than forearm (11.8 +/- 2.5 min), dorsal hand (16.4 +/- 3.4 min), or dorsal finger (15.6 +/- 3.6 min), which did not differ significantly from one another.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

An ellipsoidal representation of human hand anthropometry.

The goal of this study was to collect anthropometric data that describe the geometry of the surface of the hand and to model this anthropometry as a function of gross external hand measurements. The depth and breadth of each segment of the hand were measured at points that were spaced at approximately equal distances between the joints of the hand. Linear models using hand breadth as the independent variable explained from 12% to 47% of the variation in segment breadths and from 6% to 74% in segment depths. Ellipsoids are used in biomechanical models as an efficient mathematical description of the shape of kinematic segments for use in the determination of contact with other objects. Therefore the primary objectives of this study were to approximate the semiaxis dimensions for these hand segment contact bodies using a linear model of the gross anthropometry and to evaluate the accuracy with which ellipsoids describe the geometry of the hand segments. Graphical comparisons showed that differences between the ellipsoidal approximations and the breadth and depth measurements were largest near the joints. Data collected in this study could be used to create a set of overlapping ellipsoids that would provide a more accurate representation of hand geometry, and this representation could be adapted to biomechanical models that use ellipsoids to define segment geometry.

Adult↗