bluuebunny/crossref_metadata_2025 huggingface dataset:
Haemobartonella Felis: Recent Developments in Diagnosis and Treatment
Authors: Tasker S , Lappin MR
Published: September 2002

Haemobartonella felis is a pleomorphic uncultivated wall-less haemotrophic bacterial parasite. Phylogenetic analysis of 16S rRNA gene sequences from a number of isolates of H felis has demonstrated that these bacteria are most closely related to species in the genus Mycoplasma, and Haemobartonella and related organisms are currently being reclassified as Mollicutes. Diagnosis by cytological examination of blood smears has been problematic, but recent molecular studies have led to the development of sensitive polymerase chain reaction (PCR) assays for diagnosis. Such studies have also resulted in the recognition of two distinct strains of H felis, which are divided into different groups based on phylogenetic analysis. This evolutionary divergence between strains is accompanied by differences in pathogenecity. This review discusses new developments in the diagnosis and treatment of H felis, focusing on the use of, and interpretation of, PCR assays.
Plasma Leptin Concentrations are Independently Associated with Insulin Sensitivity in Lean and Overweight Cats
Authors: Appleton DJ , Rand JS , Sunvold GD
Published: September 2002

This study investigated relationships between plasma leptin, insulin concentrations, insulin sensitivity and glucose tolerance in lean and overweight cats. Leptin concentrations were measured in 16 cats during glucose tolerance tests before and after gaining weight, and after feeding a test meal in overweight cats.

An important finding of this study is that in both lean (r=-0.79) and overweight (r=-0.89) cats, the higher the leptin concentrations, the more insulin resistant the cat, independent of the degree of adiposity. Leptin concentrations at baseline and after consuming a meal tended to be higher in overweight cats with glucose intolerance, compared to overweight cats with normal glucose tolerance, although the difference was not significant. After feeding the test meal to overweight cats in the early morning, plasma leptin concentrations initially decreased before subsequently rising to peak 15 h later, which coincided with late evening. The leptin peak occurred 9 h after the insulin peak following ingestion of the test meal.

Importantly, this study suggests that increased leptin concentrations may contribute to the diminished insulin sensitivity seen in overweight cats. Alternatively, the compensatory hyperinsulinaemia found with insulin resistance in overweight cats could stimulate leptin production.
Hepatic Cysts Incarcerated in a Peritoneopericardial Diaphragmatic Hernia
Authors: Liptak JM , Bissett SA , Allan GS , Zaki S , Malik R
Published: September 2002

Peritoneopericardial diaphragmatic hernia is a common incidental finding in cats and is rarely symptomatic. The case report described herein presented with dyspnoea secondary to incarceration of hepatic cysts within the pericardial space of a cat with a peritoneopericardial diaphragmatic hernia.
OscillococcinumR in patients with influenza-like syndromes: A placebo-controlled double-blind evaluation
Authors: Papp Rosemarie , Schuback Gert , Beck Elmar , Burkard Georg , Bengel Jürgen , Lehrl Siegfried , Belon Philippe
Published: September 2002

A controlled clinical trial was conducted to assess the effectiveness of OscillococcinumR in the treatment of patients with influenza-like syndromes. 188 patients received the test drug and 184 patients were assigned to the placebo. Data were recorded by the participating physicians at the beginning of the treatment, after 48 hours and after 7–10 days. During the first few days, the patients recorded their rectal temperature twice a day (mornings and evenings), 9 symptoms on a rating scale (cough, catarrh, sore throat, muscle pain, etc.), and use of medication. Recovery was defined as follows: ‘rectal temperature < 37.5°C and no headache or muscle pain’. Effectiveness was defined as a statistically significant greater decrease in symptoms after 48 hours in the verum group or a shorter duration of symptoms in comparison to the placebo group. After 48 hours the symptoms of the patients in the verum group were significantly milder (P=0.023) than in the placebo group. The number of patients with no symptoms was significantly higher in the verum group from the second day onwards (verum: 17.4%, placebo: 6.6%) until the end of the patients’ recording (day 5 in the evening: verum: 73.7%, placebo: 67.7%). The biggest group difference was recorded for the time between the evening of the second day (10.6% more patients with no symptoms) and the morning of the fourth day (10.2% more patients with no symptoms). The clinical trial showed that treatment of influenza-like syndromes with OscillococcinumR has a positive effect on the decline of symptoms and on the duration of the disease.
The toxicology of the Latrodectus hasselti spider — the Australian red back spider
Authors: Bonnet MS
Published: September 2002

The zoology and behaviour of Latrodectus hasselti, the Australian red back spider is described. The symptoms of envenomation are discussed; the most prominent symptom is pain of various types in the head, abdomen and limbs.
How I treat irritable bowel disease: A survey of 25 consecutive patients
Authors: Gray Janet
Published: September 2002

The syndrome of irritable bowel disease and its conventional treatment is reviewed. The contribution of homoeopathy in the treatment of this condition is discussed and a retrospective survey of 25 patients with irritable bowel disease treated with homoeopathy is presented. Some illustrative case histories are given.
A study of remedies prescribed at Glasgow Homoeopathic Hospital
Authors: Kayne Steven , Beattie Neil
Published: September 2002

In order to determine prescribing trends, data on the numbers of homoeopathic prescriptions in a winter month in four years were collected at the Glasgow Homoeopathic Hospital. The level of experience of prescribing doctors were also calculated. The most commonly prescribed medicine was Natrum muriaticum, the most frequently used dilution was 200 c.
Similitude in modern pharmacology
Authors: Teixeira MZ
Published: September 2002

The principle of the similitude, the basis of homeopathy, has correspondences in the clinical studies of secondary effects of many modern pharmaceutical agents through the observation of the rebound effects of these drugs. Through clinical pharmacology, I proposed a model on which to base the scientificism of the homeopathic model. We have studied the effects of the drugs in the human body using pharmacological compendia and recent scientific works, confirming the mechanism of the homeopathic medicines’ action through the verification of the primary action of the drugs and the consequent secondary reaction of the organism in hundreds of pharmaceutical agents. Treatment exploiting the “rebound” effect (curative vital reaction) may also be observed. This work suggests a research methodology to scientifically base the therapeutic principle of similitude.
Dual effects of a homeopathic mineral complex on carrageenan-induced oedema in rats
Authors: Bertani S , Lussignoli S , Andrioli G , Bellavite P , Conforti A
Published: September 2002

Carrageenan oedema, a classical experimental model commonly used to test activity of anti-inflammatory drugs, was used to evaluate the therapeutic activity of a low-potency mineral complex (MC). The MC was administered in the right plantar surface of albino rats 60 min before, simultaneously and 30 min after injection of carrageenan, an irritant which causes a local, transitory increase of fluid volume. The administration of the MC 60 min before the injection of carrageenan primed the animal to enhanced inflammatory response to the irritant. The administration of MC contemporarily to carrageenan did not modify the kinetic and the extent of the oedema, while the administration of the MC 30 min after the induction of the oedema significantly reduced the early phase of the inflammatory reaction. This indicated that the therapeutic action of this MC is not due to conventional anti-inflammatory effect but to activation of endogenous regulatory mechanisms, a phenomenon which may be regarded as a simple application of the ‘similia rule’.
Homeopathic treatment of migraine: A double blind, placebo controlled trial of 68 patients
Authors: Straumsheim P , Borchgrevink C , Mowinckel P , Kierulf H , Hafslund O
Published: September 2002

To evaluate the efficacy of homeopathy in preventing migraine attacks and accompanying symptoms, a randomised, double-blind, placebo-controlled clinical trial was conducted. There was a one-month registration period without treatment, followed by four months individualised homeopathic treatment or identical placebo. Patients were stratified for common or classical migraine.

Seventy-three patients were randomised, 68 completed the trial. Baseline values were similar in the two groups. Both the homeopathy and placebo groups had reduction in attack frequency, pain intensity and drug consumption, with a statistically non-significant difference favouring homeopathy. Migraine diaries showed no difference between groups. The neurologists’ trial evaluation showed a statistically significant reduction in attack frequency in the homeopathy group (P=0.04) and non-statistically significant trends in favour of homeopathy for pain intensity and overall evaluation.

Further research, with improved trial design, on the possible role of homeopathy in migraine prophylaxis is justified.
A new homeopathic approach to neoplastic diseases: from cell destruction to carcinogen-induced apoptosis
Authors: Montfort H
Published: September 2002

Neoplastic diseases are now among the most commonly seen conditions. Orthodox, non-surgical approaches, including chemotherapy and radiotherapy, have variable results, but many adverse affects that limit their use. These are sometimes the direct cause of death. More patients are choosing alternative treatments, mainly the homeopathic and herbal-nutrition approach.

Homeopathy does not have highly effective remedies for cancer in its literature, and has been limited to palliating the adverse effects of chemo/radiotherapy. Research into substances that can produce neoplastic diseases (carcinogens), may lead to them being used to treat the cancer they cause, according to the principle of similarity. I have used ultra-low doses (1×10−10 to 10−12 molar) of chemical carcinogens for 3–24 months, which have been given to cancer patients, usually in conjunction with conventional treatment. Using this procedure, complete remission or life extension has been achieved for some cancer cases. Three clinical cases are presented: a man with undifferentiated lung cancer; a child with an astrocytoma and a woman with leiomyosarcoma.
What research is needed to show the effectiveness of homeopathy?
Authors: Kleijnen J
Published: September 2002

Using the similia principle, the classical homeopath tries to find a substance that fits the patients complaints as closely as possible. Unusual symptoms that do not fit the symptom complexes recognised by conventional medicine may be considered even more important than the regular symptoms. This is why homeopathy is a highly individualised treatment, resulting in different treatments for patients who would receive an identical treatment in conventional medicine.
International integrative primary care outcomes study (IIPCOS-2): an international research project of homeopathy in primary care
Authors: Heger M , Riley DS , Haidvogl M
Published: September 2002

Objective: The primary objective is to evaluate the effectiveness of homeopathic treatment compared to conventional treatment for respiratory and ear complaints commonly seen in the primary care setting: runny nose, sore throat, ear pain, sinus pain, and cough.

Method: This study is an international, multi-center, prospective, outcomes study on the effectiveness of homeopathic treatment compared to conventional treatment. The participating investigators will be divided into three groups:

A total of 2400 patients will be recruited. Consecutive patients, age one month or older, presenting with one of the five chief complaints, and onset of symptoms less than seven days will be included into the study. Prior to enrolment into the trial each patient must provide written informed consent. Patient outcome will be measured using the Integrative Medicine Outcomes Scale (IMOS) at 7-, 14- and 28-d telephone follow-up. In addition, covariate data related to the following will be collected: patient demographics and medical history, patient preference for treatment and willingness to be randomized, health-related quality of life, primary treatment and adjunctive therapies prescribed, adverse events, type and length of consultation, follow-up recommendation, patient compliance, patient satisfaction with treatment, and patient willingness to choose therapy and health care provider again. The main outcome criterion will be the response rate according to the IMOS after 14 days of treatment.

Results: Preliminary interim results will be presented.

Conclusions: Lessons learned from the study will be discussed.
The economic evaluation of complementary medicine: a staged approach at the Royal London Homoeopathic Hospital
Authors: van Haselen R
Published: September 2002

Objective: The practical implementation of a staged, multifaceted research agenda for the economic evaluation of complementary medicine (CM) at the Royal London Homoeopathic Hospital (RLHH).

Method: The relative importance of economic evaluation as an evidence base of CM was assessed via a survey conducted with purchasers (n=481). The marginal costs of providing complementary care for patients with rheumatoid arthritis were calculated. The use, and changes in the use, of conventional medicines for patients’ main complaints were established retrospectively (n=499) and prospectively (n=70). Health-related quality of life (patient utility) of newly referred patients was assessed with the EQ-5D (EuroQol) instrument (n=70) on a 100 mm (0=worst, 100=best) scale.

Results: Economic evaluation was rated ‘important’ as an evidence base, after safety and RCT data (‘very important’). Consultation time (doctors and dietician) contributed 29% of the total costs of treating rheumatoid arthritis. The retrospective survey showed that many patients on conventional medication were able to stop (29%) or reduce (32%) intake in the course of treatment. The median (quartiles) health state of newly referred patients was 70 mm (50,78) in men and 60 mm (36,73) in women. Some results of an interim analysis of 6 months follow-up data are reported.

Conclusions: Economic evaluation of CM is becoming increasingly important and should take place by using a multifaceted, staged approach. Before embarking on randomised trials, observational data on cost, effectiveness and utility should be collected. The cost-effectiveness of CM appears to be most sensitive to the duration of the consultation.
Improving the evaluation of homeopathy: economic considerations and impact on health
Authors: Chaufferin G
Published: September 2002

Objectives: The financial crisis of health insurance systems sometimes drives public policy-makers to take precipitate action dominated by economic imperatives. The question addressed here consists in defining homeopathy’s scope of intervention, its place in health care strategies, recourse to treatment, and especially economic data appraising homeopathy’s impact on expenditures and outlay covered by health insurance in France.

Method: We used the General Evaluation Model to define the study (to whom is the evaluation made, situations, criteria, measurement of these criteria, quality and precision).

Results: The main results are in terms of costs, as follows:

The differences observed cannot be explained by the patient profile or the diseases treated. Furthermore, a study carried out in France showed that 87% of patients whose physicians had prescribed homeopathic treatment did not see another physician for the same problem.

Conclusions: Once basic analysis has been done, so that the economic and epidemiological impact of a certain health strategy can be determined, it is necessary to proceed further, helping healthcare providers and public authorities to make decisions. Various possibilities exist and should be investigated.
Inter-rater reliability of symptom repertorisation: a pragmatic empirical study
Authors: Vickers AJ , van Haselen RA , Pang L , Berkovitz S
Published: September 2002

Objective: To determine the extent to which two homeopaths agree on whether symptoms reported by patients in a proving are possibly associated with Mercurius solubilis.

Design: Blinded, inter-rater reliability study.

Participants: 104 subjects in a randomised, double-blind mercury proving.

Outcome measures: 557 symptom episodes spontaneously reported by subjects were classified as ‘mercury’ or ‘not mercury’ by two homeopaths working blind to each other's conclusions and to patient allocation.

Results: Initial agreement between homeopaths was 70.2%, a kappa of 0.39, (95% CI 0.31, 0.47). Some disagreements appear to have resulted from differing interpretations of the study instructions. After suitable correction, agreement was 76.5% and kappa 0.56 (95% CI 0.49, 0.63).

Conclusions: The study homeopaths had only a moderate level degree of agreement greater than that expected by chance. The main factor seems to have been differences between data from different sources. There is an urgent need for more research on the methods of choosing homoeopathic medicines in order to improve the reliability and validity of homoeopathic diagnoses.
No beneficial effect of isopathic prophylactic treatment for birch pollen allergy during a low-pollen season: a double-blind, placebo-controlled clinical trial of homeopathic Betula 30c
Authors: Aabel S
Published: September 2002

The objective of this research was to determine if the homeopathic medicine Betula 30c is more effective than placebo at reducing symptoms of pollen allergy in patients sensitive to birch pollen. It was a double-blind, randomized, placebo-controlled trial. Tablets were given both as a prophylactic agent, once a week four weeks before the pollen season and as an acute remedy during the pollen season. The study was done in Oslo, Norway, in May 1996 and involved 73 children, adolescents and young adults from 7 to 25 y of age. Allergy-symptoms were assessed on a visual analogue scale (VAS) by patients or parents. Main outcome measure was the median (with its 95% confidence interval) of the symptom scores for all the treated patients, each day during a 10-day period. The pollen count was very low in 1996, only three days were high enough to provoke allergic symptoms. Surprisingly, the verum treated patients fared worse than the placebo group; they used more rescue medication and had higher symptom scores during these three days. Homeopaths might attribute the findings to a putative aggravation response, but the results certainly do not lend support to the usefulness of the tested prophylactic approach, under conditions of low allergen exposure.
Cushing's Disease: a new approach to therapy in equine and canine patients
Authors: Elliott M
Published: September 2002

Forty-one cases of Cushing's Disease affecting both equine and canine patients were treated with an identical mixture of two homeopathically prepared remedies (ACTH 30c and Quercus robur 30c), and the clinical improvements seen in the cases assessed. Homeopathy has been described as a medicine that can only be prescribed on the basis of individual symptoms shown, fitting the remedy to the patient, not the disease. The aim of this study was to define whether a standardised approach, using homeopathically prepared remedies, was a valid system of therapy for this disease, and if so, whether results were repeatable between species. The overall success rate for the therapy was 80% and results were broadly similar between the two species, indicating that homeopathy lends itself to the treatment of Cushing's Disease, and also to both cohort studies and group medicine.
On the scientific status of homeopathy
Authors: Chibeni SS
Published: September 2002

Critics of homeopathy often claim that it is non-scientific. By offering adequate tools for the analysis of the foundations, structure and implications of scientific theories, philosophy of science can help to clarify this medical controversy. However, homeopathy has not yet attracted the attention of philosophers of science to any noticeable extent. Among the many topics to which philosophy of science could contribute, this paper selects two, not only for their intrinsic importance, but also because they are essential for any fruitful discussion of the rest. It is shown, first, that in homeopathy, as developed by Hahnemann, two related, but distinct theoretical levels can be identified. Then it is indicated that at least one of them—the phenomenological level—can be seen as embodying a largely autonomous research programme, on which homeopathic medical practice can rest. Finally, it is argued that this programme displays the basic theoretical and methodological traits of a genuine science, according to an influential contemporary approach in philosophy of science. Some misunderstandings involved in the debate are pointed out.
Effects of homeopathic treatment in women with premenstrual syndrome: a pilot study
Authors: Yakir M , Kreitler S , Brzezinski A , Vithoulkas G , Oberbaum M , Bentwich Z
Published: September 2002

Alternative therapies in general, and homeopathy in particular, lack clear scientific evaluation of efficacy. Controlled clinical trials are urgently needed, especially for conditions that are not helped by conventional methods. The objective of this work was to assess the efficacy of homeopathic treatment in relieving symptoms associated with premenstrual syndrome (PMS). It was a randomised controlled double-blind clinical trial. Two months baseline assessment with post-intervention follow-up for 3 months was conducted at Hadassah Hospital outpatient gynaecology clinic in Jerusalem in Israel 1992–1994. The subjects were 20 women, aged 20–48, suffering from PMS. Homeopathic intervention was chosen individually for each patient, according to a model of symptom clusters. Recruited volunteers with PMS were treated randomly with one oral dose of a homeopathic medication or placebo. The main outcome measure was scores of a daily menstrual distress questionnaire (MDQ) before and after treatment. Psychological tests for suggestibility were used to examine the possible effects of suggestion. Mean MDQ scores fell from 0.44 to 0.13 (P<0.05) with active treatment, and from 0.38 to 0.34 with placebo (NS). (Between group P=0.057). Improvement >30% was observed in 90% of patients receiving active treatment and 37.5% receiving placebo (P=0.048). Homeopathic treatment was found to be effective in alleviating the symptoms of PMS in comparison to placebo. The use of symptom clusters in this trial may offer a novel approach that will facilitate clinical trials in homeopathy. Further research is in progress.
Homeopathy: progress and promise, a critical perspective
Authors: Borneman JP
Published: September 2002

This lecture attempts to analyse the progress made by homeopathy in recent years, by analysing consumer awareness, sales and distribution trends of homeopathic products, and research publications. Sales of homeopathic medicines are growing rapidly, but remain a very small fraction of the total pharmaceutical market. The proportion of combination to single medicines varies widely between countries. The market is concentrated in a relatively small number of the available medicines; many available homeopathic medicines are never used. Regulation of homeopathic practitioners and medicines is problematic, the legal position varies between countries. The volume of research is growing steadily. A series of recommendations is made, including modernisation of the terminology of homeopathy, training of more practitioners, a defined research agenda and integration into the medical system.
Extensor Tendon Dislocation in Cerebral Palsy
Authors: NOSSAMAN B. C. , RAYAN G. M.
Published: September 2002

An 18-year-old man with cerebral palsy presented with a flexion deformity of the middle finger particularly at the metacarpophalangeal joint and ulnar dislocation of the extensor tendon. Releasing the tight ulnar sagittal band and imbricating the attenuated radial sagittal band allowed centralization of the extensor tendon. For complete correction of other deformities intrinsic release and extrinsic flexor muscle lengthening were done. Extensor tendon instability in this case was due to the combined forces of the extrinsic and intrinsic muscles on the retinacular system of the extensor mechanism.
Irreducible Galeazzi Fracture-Dislocation Due to an Avulsion Fracture of the Fovea of the Ulna
Authors: KIKUCHI Y. , NAKAMURA T.
Published: September 2002

We report a rare case of Galeazzi fracture-dislocation with an irreducible distal radioulnar joint. The cause of the irreducibility was entrapment of a fragment avulsed from the fovea of the ulna. The patient was successfully treated with open reduction and internal fixation of the radius, ulnar styloid process and avulsed fracture at the fovea of the ulna.
Closed Continuous Irrigation in the Treatment of Hand Infections
Authors: HARRIS P. A. , NANCHAHAL J.
Published: September 2002

We report our experience with a closed continuous irrigation system in 12 patients with hand infections: six cases of flexor tenosynovitis, three cases of septic arthritis and three palmar abscesses. Four of these patients had undergone previous surgical débridement and peroperative washout without elimination of the infection. The continuous irrigation system consists of two fenestrated tubes placed within the infected space, with the tip of the smaller calibre inlet tube positioned just inside the larger outlet tube. Resolution of infection was achieved in all 12 cases and all regained complete functional recovery. The closed continuous irrigation system is easy to manage, with no leakage of fluid; hand therapy may be started early and the patient is mobile throughout.
An Unusual Case of Multiple Recurrence of a Glomangioma
Authors: LOOI K. P. , TEH M. , PHO R. W. H.
Published: September 2002

Glomus tumour is a benign lesion arising from the glomus apparatus of the skin and subcutaneous tissue. Glomangioma is the angiomatous variant, which is uncommon. We report a very rare presentation of a glomangioma with multiple recurrences. We advocate preoperative angiography to delineate the extent of the lesion to facilitate complete excision.
The Mantero Flexor Tendon Repair in Zone 1
Authors: GUINARD D. , MONTANIER F. , THOMAS D. , CORCELLA D. , MOUTET F.
Published: September 2002

Mantero and colleagues have reported a modification of the Bunnell pull-out method for the repair of zone 1 flexor digitorum profundus (FDP) lacerations that allows active postoperative mobilization. We report a series of 24 FDP lesions in 20 adult patients treated with this technique. The mean duration of the rehabilitation regimen, which was followed by all patients, was 4.2 months. Functional assessment using Strickland’s criteria demonstrated 23 excellent to good results and one poor due to a septic rupture. Nineteen of the 20 patients were satisfied with treatment and all but one of the patients returned to work within an average of 2.6 months after operation. In comparison to other zone 1 repair methods with active mobilization regimens, the Mantero technique gives better functional outcomes and appears to be more reliable.
Experimental Study of Two New Flexor Tendon Suture Techniques for Postoperative Early Active Flexion Exercises
Authors: KUSANO N. , YOSHIZU T. , MAKI Y.
Published: September 2002

We used a rabbit model to test the postoperative mechanical strengths of two new tendon suture techniques. These were compared with the conventional modified Kessler and double looped suture techniques. For each technique, maximum load until 3 mm gap, load at 1 mm gap and ultimate load were measured at the time of operation and at weeks 1 and 3 after operation.

Maximum load until 3 mm gap and load at 1 mm gap were significantly higher in the new techniques than in the conventional techniques at the time of operation and at 1 week; there was no statistical difference between the four techniques at 3 weeks. No technique resulted in a decrease in maximum load until 3 mm gap, load at 1 mm gap and ultimate load at 1 week.

The new techniques reported here have the potential to withstand early active flexion exercises.
Microscopic Anatomy of the Posterior Interosseous and Median Nerves at Sites of Potential Entrapment in the Forearm
Authors: HILL S. , HALL S.
Published: September 2002

We describe the macroscopic and microscopic anatomy of the posterior interosseous (PIN) and median nerves, at the arcade of Frohse and pronator arch respectively, in nerves obtained from five cadavers. Nerves were either constricted at sites of potential entrapment; appeared swollen proximal to these sites; or exhibited neither swelling nor constriction. Renaut bodies were present in all nerves. In the PIN, most Renaut bodies were found beneath a tendinous arcade of Frohse, whereas in the median nerve most were found proximal to the pronator arch. We propose that since Renaut bodies appear to displace normal endoneurial components, and may be associated with low-grade axonal drop-out, their presence may adversely affect the functional outcome of surgical decompression of either the PIN or median nerve.
Endoscopic Release of the Carpal Tunnel: A Technical Note
Authors: SMITH A. M. , BELCHER H. J. C. R.
Published: September 2002

The Agee technique is a standard approach for the endoscopic release of the carpal tunnel. We describe a modification of the technique. This involves dilatation of the path for the blade assembly with urethral dilators. This permits a graded dilatation of the path. We believe it creates a track of more uniform width. It also provides more accurate information about the tightness of the carpal tunnel. Its adoption may reduce the chance of nerve injury.
Hand Injuries in Agricultural Accidents
Authors: HANSEN T. B. , CARSTENSEN O.
Published: September 2002

The aim of this study was to investigate the incidence of hand injuries due to farming accidents in a defined population with a representative mixture of agricultural activities. During a 12-month period all agricultural accidents treated at the five hospitals in the County of Ringkøbing, Denmark were prospectively registered. Follow-up was done by telephone interview 4 months after the accident. Of the 260 persons injured in agricultural accidents, 117 (45%) had lesions of the upper extremity and 73 persons (28%) had hand injuries. The most common injuries were lacerations and amputations (45%) followed by fractures (36%). Mean sick leave was 25 days, and mean work impairment was 31 days in patients with hand injuries.
The Bilobed Flap in Treatment of Mucous Cysts of the Distal Interphalangeal Joint
Authors: YOUNG K. A. , CAMPBELL A. C.
Published: September 2002

The bilobed flap has many uses in the field of plastic and reconstructive surgery. We describe its use in achieving skin cover following excision of mucous cysts in six digits in six patients, with a minimum follow up of 1 year. There were no postoperative complications. No cyst has recurred and cosmesis has been excellent in all cases.
A Local Anaesthetic Technique for Endoscopic Carpal Tunnel Release
Authors: WOOD S. H. , LOGAN A. M.
Published: September 2002

A local anaesthetic technique for endoscopic carpal tunnel release is described. This accurately and rapidly blocks median and ulnar nerves in the distal forearm. It avoids the infiltration of local anaesthetic solution at the operation site, a technique which may render the endoscopic view unsatisfactory.
Dynamic Changes in the Shape of the Triangular Fibrocartilage Complex During Rotation Demonstrated with High Resolution Magnetic Resonance Imaging
Authors: NAKAMURA T. , YABE Y. , HORIUCHI Y.
Published: September 2002

We studied in vivo dynamic changes in the triangular fibrocartilage complex (TFCC) in ten healthy volunteers using high-resolution magnetic resonance imaging (MRI). A custom made surface coil, which was specially designed to allow movements of the wrist in all directions, was used in this study. MR images in the axial and coronal planes were acquired at maximum pronation, in the neutral position and at maximum supination.

During pronation and supination, little deformity of the disc proper was seen on axial sections. In contrast, the ulnar side of the TFCC around the ulnar styloid process showed obvious dynamic changes. The ulnar head translated palmarly to the radius in supination and dorsally in pronation, while there was little change in the position of the fovea of the ulna in relation to the radius. Considering the three-dimensional structure of the TFCC, these findings suggest that the disc proper is strong enough to support the ulnar carpus with little deformity during rotation and that the triangular ligament twists at its origin. During rotation there is friction between the proximal side of the disc proper and the ulnar head. On coronal sections, the disc proper became thinner in pronation due to increased ulnar variance.
Bone Mineral Density in the Distal Radius in a Healthy Japanese Population and in Relation to Fractures of the Distal Radius
Authors: ITOH S. , OHTA T. , SAMEJIMA H. , SHINOMIYA K.
Published: September 2002

Changes in bone mineral density with age were measured in the distal radius of healthy adults using dual energy X-ray absorptiometry. A total of 2789 healthy women (20–95 years old) and 1255 healthy men (20–87 years old), and 72 women (52–94 years old) and 23 men (51–79 years old) with fractures of the distal radius were assessed. Bone mineral density remains relatively stable in men despite aging, and was significantly higher than in women in every decade. In women aged 70 years and more, the bone mineral density was significantly lower in the fracture group than the nonfracture group. In men with fractures of the distal radius, there were no significant differences between bone mineral density and age. In the fracture groups loss of radial inclination after reduction correlated with decreased bone mineral density, but there was no significant regression between bone mineral density and the decrease in radial length or palmar tilt.
Clinicopathological Characteristics of Melanomas of the Hand
Authors: HOVE L. M. , AKSLEN L. A.
Published: September 2002

A 25-year clinicopathological review of 19 patients with malignant melanoma of the hand is reported. There were 11 women (median age 73 years) and eight men (median age 70 years). Eleven tumours were subungual, six on the dorsum of the hand, and two had a palmar location. Seven tumours were acral lentiginous melanomas, six were superfical spreading melanomas, and five were of the nodular subtype. Eleven patients presented with localized disease (clinical stage I), four with local spread (clinical stage II), and four with regional lymph node metastases (clinical stage III). Nine of the patients have died of the disease, with a median survival time of 30 months (range, 10–84 months). The subungual melanomas were thicker and the patients were older at presentation compared with the non-subungual sites. Review of our patients emphasized the need for early diagnosis.
A Patient-Reported Comparison of Trapeziectomy with Swanson Silastic Implant or Sling Ligament Reconstruction
Authors: LOVELL M. E. , NUTTALL D. , TRAIL I. A. , STILWELL J. , STANLEY J. K.
Published: September 2002

A retrospective review of two types of operations for carpometacarpal osteoarthritis of the thumb was done for patients operated on between 1991 and 1996. Follow-up ranged from 18 to 90 months (mean 62 months). Fifty-eight Swanson Silastic arthroplasties and 56 sling excision arthoplasties were reviewed. Eight patients with Swanson arthroplasties underwent removal of the implant. Eight patients in the sling excision group required further surgery. These patients were excluded from further analysis. Questionnaires about pain, general satisfaction and function were sent to the other patients and 87 responses were received (sling 45, implant 42). In the implant group significantly better results were obtained for pain at 1 year, carrying a milk bottle and taking a handbrake off a car, and overall function. We conclude that trapeziectomy combined with Swanson implant gives better results in the short term if there are no complications of the operation.
Palmar Capsulodesis for Treatment of Symptomatic Hyperextensibility of the Metacarpophalangeal Joints
Authors: HOFER S. O. P. , ROBINSON P. H.
Published: September 2002

A modification of the technique of palmar capsulodesis described by Filler et al. (1976) for the treatment of hyperextensibility in the metacarpophalangeal joint of the thumb was used in the metacarpophalangeal joints of the fingers. Seven of eight patients regained normal range of motion without pain.
An Anterior Portal for Wrist Arthroscopy
Authors: THAM S. , COLEMAN S. , GILPIN D.
Published: September 2002

We have found that the standard portals described limit arthroscopic access to and visualization of some areas of the radiocarpal joint. We describe a radial anterior portal, which we believe is useful in the arthroscopic treatment of wrist conditions and describe its use in clinical practice.
Intramedullary Fixation by Resorbable Rods in a Comminuted Phalangeal Fracture Model
Authors: ROURE P. , IP W. Y. , LU W. , CHOW S. P. , GOGOLEWSKI S.
Published: September 2002

The mechanical rigidity of three different methods of resorbable intramedullary fixation (bone peg, and polyglycolide rods with and without interlocking) was assessed in a comminuted phalangeal fracture model and the results compared with two commonly used internal fixation devices (lateral plate, crossed K-wires) in a cadaver model. Each fixation technique was tested for its biomechanical strength in apex palmar bending, compression and torsion. Failure testing for the three resorbable methods was also done. The results showed that lateral plating provided the best rigidity in apex palmar bending and torsion, followed by intramedullary bone peg fixation. All resorbable intramedullary fixations had rigidity that was at least the same as crossed K-wires. For the torque test, polyglycolide rods with interlocking provided better rigidity than without interlocking. There was no significant difference between the different methods in the compression test, except that the intramedullary bone peg was significantly stiffer than K-wires.
Treatment of Mallet Fractures Using Compression Fixation Pins
Authors: YAMANAKA K. , SASAKI T.
Published: September 2002

Fifteen patients who underwent percutaneous fixation of mallet fractures of the distal phalanx using compression fixation pins were assessed. Anatomical reduction was achieved in all patients. There were no nonunions. The mean active range of motion of the distal interphalangeal joint was 1° of hyperextension to 69° of flexion. The fixation was stable enough to allow early active motion exercise of the distal interphalangeal joint. This technique results in a good range of motion in a shorter period of time than other treatments.
The Detection of Feigned Hand Weakness Using the Five Position Grip Strength Test
Authors: TREDGETT M. , PIMBLE L. J. , DAVIS T. R. C.
Published: September 2002

This study assessed the sensitivity and specificity of the five-position grip strength test (5PGST) for detecting feigned hand weakness in healthy volunteers. The 5PGST reliably detected feigned hand weakness in only 15% of cases. Thirty-three per cent of volunteers demonstrated an entirely normal pattern of grip strength when feigning weakness.
Pinch Reconstruction by Hand o Hand Finger Transfer Associated with Hallux Transfer after a Severe Frostbite Injury
Authors: FOUCHER G. , NAGEL D.
Published: September 2002

We report a case of severe frostbite in which a pincer hand was created by microsurgical transfer of a partially amputated small finger from the opposite hand combined with microsurgical transfer of a partially amputated great toe which was subsequently lengthened.
Carpal Tunnel Release by the Agee Endoscopic Technique
Authors: ERHARD L. , OZALP T. , CITRON N. , FOUCHER G.
Published: September 2002

Ninety-five hands (86 patients) were treated by endoscopic carpal tunnel release using the technique of Agee. They were the first ones operated on by the senior author (GF) using this technique. The patients were interviewed at a mean follow-up of 4.5 years: 72% of hands were free of symptoms and 94% were described by the patients as functionally normal. Seventeen hands (out of 27) with residual or recurrent symptoms were examined. Nine hands (nine patients) were only partially improved (mean 6.7 on a 10 point scale) and in eight hands (seven patients), some symptoms had recurred after a mean delay of 3.8 years. It was possible to find a second pathology in most of these cases. It is necessary to inform the patient before operation that incomplete relief or recurrence of symptoms can occur after endoscopic carpal tunnel release, as with conventional release.
Increased Mortality in Dupuytren’s Disease
Authors: MIKKELSEN O. A. , HØYERAAL H. M. , SANDVIK L.
Published: September 2002

A previous study showed a dip in the prevalence curve of Dupuytren’s disease in men over 79 years of age. This may indicate increased mortality. The aim of the present investigation was to study this hypothesis. Four hundred and twenty-six men with Dupuytren’s disease, born between 1900 and 1924 were followed for 26 years (1969–1996). Their mortality was compared with that of an age-matched control group of 426 men. In 1996, 361 with Dupuytren’s disease and 336 in the control group had died. Overall, patients with Dupuytren’s disease had a significantly increased mortality of 22%. The mortality was highest among those with onset of disease before the age of 60. In this age group men with Dupuytren’s disease had 70% higher mortality than that of the control group. Disease duration did not seem to influence the mortality.
The Symptomatic Carpal Boss
Authors: CLARKE A. M. , WHEEN D. J. , VISVANATHAN S. , HERBERT T. J. , CONOLLY W. B.
Published: September 2002

We reviewed 48 patients with symptomatic carpal boss seen during the 10 year period 1985–1994. Thirty-one patients had undergone either local excision of the boss or arthrodesis of the affected carpometacarpal joint. The mean follow-up was 3 years and nine cases have been revised. Twenty-four patients remained symptomatic and considered that surgery had failed to relieve their symptoms. These findings are in sharp contrast to previous reports that suggest simple excision of the carpal boss gives uniformly good results.
Histoplasmosis of the Wrist
Authors: SCHASFOORT R. A. , MARCK K. W. , HOUTMAN P. M.
Published: September 2002

We present a case of synovitis of the wrist due to histoplasmosis, diagnosed only after extensive surgery and culturing. Treatment with amphotericin B in combination with radical surgery was effective in curing the disease. This manifestation was probably an exacerbation of a latent chronic infection with Histoplasma capsulatum, although it was unclear why the exacerbation occurred. Synovitis resistant to treatment should be assessed with great care, especially in view of the growing number of immunocompromised patients. Close collaboration between surgeon, rheumatologist, pathologist and microbiologist is paramount in such cases.
Flexor Tendon Repair Using a Stainless Steel External Splint
Authors: GORDON L. , DYSARZ F. A. , VENKATESWARA K. T. , MOK A. P. , RITCHIE R. O. , RABINOWITZ S.
Published: September 2002

A stainless steel external tendon splint was used in repair of cadaver tendons and compared with standard tendon repairs with suture. The splint was combined with a Kessler repair and tested against the Kessler, Becker, and Savage repairs in fresh human cadaver flexor digitorum profundus tendons. Biomechanical testing was done on a tensile testing machine, and load-displacement curves were generated. The repairs using the external tendon splint demonstrated a range of improvement of 32 to 146% in mean maximal tensile strength and a 20 to 185% improvement of mean ultimate tensile strength compared with all other repairs. The external tendon splint is relatively easy to apply to a tendon. The repair is strengthened and becomes capable of withstanding early active range of motion excercises. In vivo testing will be needed to assess the potential clinical usefulness of such a device.
Psychological Aspects of Toe to Hand Transfer in Children
Authors: BELLEW M. , KAY S. P.
Published: September 2002

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.
Transfer of a Single Fascicle from the Ulnar Nerve to the Biceps Muscle after Avulsions of Upper Roots of the Brachial Plexus
Authors: SUNGPET A. , SUPHACHATWONG C. , KAWINWONGGOWIT V. , PATRADUL A.
Published: September 2002

Thirty-six patients with avulsions of upper roots of the brachial plexus underwent transfer of a single fascicle from the ulnar nerve to the proximal motor branch of the biceps muscle to restore elbow flexion. The mean period of follow-up was 22 months. The average reinnervation time for the biceps muscle was 3.3 months. Thirty-four patients achieved biceps strength of Medical Research Council grade 3 or better. The operative results in the patients with C5, C6 avulsions were better than those with C5, C6, C7 avulsions. At the last follow-up examination, grip strength, pinch strength, moving two-point discrimination and the strength of flexion of the wrist on the affected side was not worse than before surgery in any patient.
The Effectiveness of ADCON-T/N, a New Anti-Adhesion Barrier Gel, in Fresh Divisions of the Flexor Tendons in Zone II
Authors: MENTZEL M. , HOSS H. , KEPPLER P. , EBINGER T. , KINZL L. , WACHTER N. J.
Published: September 2002

In a prospective randomized clinical trial, ADCON-T/N was investigated with regard to its effectiveness in fresh traumatic injuries of the flexor tendons in Zone II of the hand. Thirty patients participated in the trial. Following a standardized technique of tendon repair, the total active motion (TAM) and total extension lag (TEL) were determined after 12 weeks and evaluated according to the Buck-Gramcko score. Excellent results were achieved in 15 out of 16 patients in the ADCON-T/N group and 12 out of 14 in the control group. However, no statistically significant difference was found between the mean TAM and TEL in the two groups.
Outcome Measures Following Metacarpophalangeal Joint Replacement
Authors: SYNNOTT K. , MULLETT H. , FAULL H. , KELLY E. P.
Published: September 2002

We used the Jebsen–Taylor hand function assessment system to prospectively study the effect of metacarpophalangeal joint replacement on overall hand function in 29 hands. In addition pain relief, subjective improvement in hand function, appearance and overall patient satisfaction were assessed.

There was modest improvement in the number of Jebsen–Taylor tasks performed (1.8 to 3.1), and pain relief was good or excellent in 18 of 24 patients. Eleven patients felt their hand function had improved by more than 50%, and the majority of patients (22 of 24) were very satisfied with the procedure.

This study demonstrates that despite limited improvements in objective outcome measures, this procedure is reliable in producing a very high rate of patient satisfaction.