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Cureus Aug 2020A 36-year-old man presented with incidental findings of an asymmetric chest with hypoplastic and flattened left anterior chest wall due to absent left pectoralis major....
A 36-year-old man presented with incidental findings of an asymmetric chest with hypoplastic and flattened left anterior chest wall due to absent left pectoralis major. He also had short and webbed fingers in the left hand. These deformities were present since birth. Chest X-ray showed hyperlucency on the left side. Computerized tomography (CT) scan showed an absence of the left pectoralis major. X-ray of the left hand showed hypoplasia of the proximal phalanx and aplasia of the middle and distal phalanges of the second digit, and aplasia of the middle phalanges of the third and fourth digits. A diagnosis of left-sided Poland syndrome with associated ipsilateral brachysyndactyly, which is a very rare entity, was made. The patient opted against any reconstructive procedure as he had a minimal functional limitation.
PubMed: 32944470
DOI: 10.7759/cureus.9755 -
European Journal of Orthopaedic Surgery... Sep 2023The ability to perform surgical replantation of individual digits and limbs can provide substantial functional improvement for patients who sustain devastating upper...
The ability to perform surgical replantation of individual digits and limbs can provide substantial functional improvement for patients who sustain devastating upper extremity injuries. Defining success in replantation surgery extends beyond the acute period and the binary metrics of survival or loss of the replanted part to include the long-term overall functional outcomes. Functional outcomes include both objective clinical evaluation and patient-reported outcomes. There has been significant variation in the way outcomes following replantation are measured, which inherently leads to heterogeneity in the reported outcome data. Given the variability among outcome measures, we aim to explore the outcomes of replantation surgery, particularly clinical evaluation and patient-reported functional outcomes following replantation.
PubMed: 37755559
DOI: 10.1007/s00590-023-03729-1 -
Vascular Medicine (London, England) Aug 2019Achenbach syndrome (paroxysmal finger hematoma) refers to a condition in which a patient exhibits episodic pain and swelling in one or more digits along with the... (Review)
Review
Achenbach syndrome (paroxysmal finger hematoma) refers to a condition in which a patient exhibits episodic pain and swelling in one or more digits along with the subsequent appearance of a hematoma on the palmar side of the proximal phalanges. Achenbach syndrome is a benign condition of unknown etiology in which prodromal symptoms, such as pain, tingling, and itching, may occur from minutes to hours before the color change appears. The subdermal bleeding usually stops spontaneously or after local pressure is applied. The color changes usually disappear within a few days, without permanent sequelae. The diagnosis of Achenbach syndrome is based strictly on its clinical features because the results of all routine investigations are usually normal. Physicians should become aware of this condition in order to advise their patients about its benign prognosis and to avoid unnecessary testing.
Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Fingers; Hematoma; Hemorrhage; Humans; Male; Middle Aged; Predictive Value of Tests; Remission, Spontaneous; Risk Factors; Syndrome
PubMed: 31159682
DOI: 10.1177/1358863X19849627 -
Annals of Plastic Surgery Jun 2024A common consideration for replantation success is the ischemia time following injury and the preservation temperature. A classic principle within the hand surgery... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
A common consideration for replantation success is the ischemia time following injury and the preservation temperature. A classic principle within the hand surgery community describes 12 hours of warm ischemia and 24 hours of cold ischemia as the upper limits for digit replantation; however, these limits are largely anecdotal and based on older studies. We aimed to compare survival data from the large body of literature to aid surgeons and all those involved in the replantation process in hopes of optimizing success rates.
METHODS
The PubMed database was queried on April 4th, 2023, for articles that included data on digit replantation survival in terms of temperature of preservation and ischemia time. All primary outcomes were analyzed with the Mantel-Haenszel method within a random effects model. Secondary outcomes were pooled and analyzed using the chi-square statistic. Statistical analysis and forest plot generation were completed with RevMan 5.4 software with odds ratios calculated within a 95% confidence interval.
RESULTS
Our meta-analysis identified that digits preserved in cold ischemia for over 12 hours had significantly higher odds of replantation success than the amputated digits replanted with 0-12 hours of warm ischemia time ( P ≤ 0.05). The odds of survival in the early (0-6 hours) replantation group were around 40% greater than the later (6-12 hours) replantation group ( P ≤ 0.05). Secondary outcomes that were associated with higher survival rates included a clean-cut amputation, increased venous and arterial anastomosis, a repair that did not require a vein graft, and replants performed in nonsmokers ( P ≤ 0.05).
DISCUSSION
Overall, these findings suggest that when predicting digit replantation success, time is of the essence when the digit has yet to be preserved in a cold environment. This benefit, however, is almost completely diminished when the amputated digit is appropriately maintained in a cold environment soon after injury. In conclusion, our results suggest that there is potential for broadening the ischemia time limits for digit replant survival outlined in the literature, particularly for digits that have been stored correctly in cold ischemia.
Topics: Humans; Replantation; Amputation, Traumatic; Finger Injuries; Time Factors; Fingers; Warm Ischemia; Cold Ischemia; Ischemia; Temperature
PubMed: 38725110
DOI: 10.1097/SAP.0000000000003944 -
JPRAS Open Mar 2022Macrodactyly is a rare congenital disorder of overgrowth affecting the digits of the upper or lower extremity. Mostly, patients are surgically treated during childhood...
BACKGROUND
Macrodactyly is a rare congenital disorder of overgrowth affecting the digits of the upper or lower extremity. Mostly, patients are surgically treated during childhood to reduce the digit or to stop growth. There are no standardized guidelines for the treatment and follow-up of macrodactyly. Consequently, follow-up may not be regularly scheduled into adulthood.
METHODS
A retrospective, descriptive analysis of patients with the long-term progression of macrodactyly who presented at our tertiary referral hospital between July 2018 and March 2020 was performed. All patients from our local macrodactyly database were screened for progression of macrodactyly since adulthood; this resulted in four patients. The aim of these case series is to highlight the clinical features and disease course at long-term follow-up.
RESULTS
All patients were surgically treated during childhood and showed progression of tissue overgrowth during adult life. All patients developed severe secondary degenerative bone changes in macrodactyly affected digits, such as ankyloses of joints, new bone formation, and bony spurs. Subsequently, tissue overgrowth and degenerative bone changes led to functional problems.
CONCLUSION
Patients with macrodactyly may experience growth during adult life, which may progress to deforming changes. Consequently, patients should be informed about the possible growth, and the progressive growth should be monitored.
PubMed: 34869816
DOI: 10.1016/j.jpra.2021.10.004 -
Hand (New York, N.Y.) Jan 2021Digit replantation affords the opportunity to restore hand function following amputation. To date, however, few studies have evaluated functional outcomes following... (Meta-Analysis)
Meta-Analysis Review
Digit replantation affords the opportunity to restore hand function following amputation. To date, however, few studies have evaluated functional outcomes following replantation. Therefore, it was the objective of this study to perform a meta-analysis to better characterize the predictors of hand function. A literature search was performed using the PubMed database to identify studies that focused on digit amputation/replantation and functional outcomes. Studies were evaluated for patient- and injury-related factors and their respective effects on clinical outcomes of sensation, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Statistical analysis was conducted across the pooled data set to identify significant trends. Twenty-eight studies representing 618 replanted digits were included in this study. We found the average grip strength was 78.7% (relative to contralateral), the average 2-point discrimination (2PD) was 7.8 mm, and the average DASH score was 12.81. After conducting statistical analysis, we found patients with more proximal injuries had lower grip strength scores ( < .05). We found 2PD scores were influenced by age, mechanism of injury, and amputation level ( < .05). Finally, we found DASH scores after replantation were predicted by mechanism of injury and level of amputation ( < .05). The following variables did not influence outcomes: gender, tobacco use, ischemia time, and digit number. Digit replant does not restore premorbid hand function but does result in adequate hand function. Expected functional outcomes following replant should be considered in the decision-making process. These data can help risk-stratify patients, guide postreplant expectations, and influence the decision for replantation.
Topics: Amputation, Surgical; Amputation, Traumatic; Finger Injuries; Humans; Replantation; Retrospective Studies
PubMed: 30938181
DOI: 10.1177/1558944719834658 -
Entropy (Basel, Switzerland) Oct 2022Related to the letters of an alphabet, entropy means the average number of binary digits required for the transmission of one character. Checking tables of statistical...
Related to the letters of an alphabet, entropy means the average number of binary digits required for the transmission of one character. Checking tables of statistical data, one finds that, in the first position of the numbers, the digits 1 to 9 occur with different frequencies. Correspondingly, from these probabilities, a value for the Shannon entropy H can be determined as well. Although in many cases, the Newcomb-Benford Law applies, distributions have been found where the 1 in the first position occurs up to more than 40 times as frequently as the 9. In this case, the probability of the occurrence of a particular first digit can be derived from a power function with a negative exponent > 1. While the entropy of the first digits following an NB distribution amounts to H = 2.88, for other data distributions (diameters of craters on Venus or the weight of fragments of crushed minerals), entropy values of 2.76 and 2.04 bits per digit have been found.
PubMed: 37420433
DOI: 10.3390/e24101413 -
The Journal of Hand Surgery Jul 2020Venous congestion after digital replantation or revascularization threatens digit survival in the immediate postoperative period. External bloodletting, including leech... (Review)
Review
Venous congestion after digital replantation or revascularization threatens digit survival in the immediate postoperative period. External bloodletting, including leech therapy, provides a central role in salvage of the congested finger. Although there have been previous studies describing the initiation of leech therapy for digits experiencing venous insufficiency, few published articles and no consensus guidelines have discussed the weaning of leeches in the postoperative period. We review the current evidence behind leech therapy and offer a treatment algorithm based on available data and existing leech weaning protocols.
Topics: Amputation, Traumatic; Animals; Fingers; Humans; Leeches; Leeching; Replantation
PubMed: 32493632
DOI: 10.1016/j.jhsa.2020.03.026 -
Developmental Dynamics : An Official... Jan 2022Transforming growth factor beta (TGFβ) constitutes a large and evolutionarily conserved superfamily of secreted factors that play essential roles in embryonic... (Review)
Review
Transforming growth factor beta (TGFβ) constitutes a large and evolutionarily conserved superfamily of secreted factors that play essential roles in embryonic development, cancer, tissue regeneration, and human degenerative pathology. Studies of this signaling cascade in the regulation of cellular and tissue changes in the three-dimensional context of a developing embryo have notably advanced in the understanding of the action mechanism of these growth factors. In this review, we address the role of TGFβ signaling in the developing limb, focusing on its essential function in the morphogenesis of the autopod. As we discuss in this work, modern mouse genetic experiments together with more classical embryological approaches in chick embryos, provided very valuable information concerning the role of TGFβ and Activin family members in the morphogenesis of the digits of tetrapods, including the formation of phalanxes, digital tendons, and interphalangeal joints. We emphasize the importance of the Activin and TGFβ proteins as digit inducing factors and their critical interaction with the BMP signaling to sculpt the hand and foot morphology.
Topics: Animals; Bone Morphogenetic Proteins; Chick Embryo; Extremities; Mice; Morphogenesis; Signal Transduction; Transforming Growth Factor beta
PubMed: 33871876
DOI: 10.1002/dvdy.349 -
Cognition Jul 2022The present study investigated mechanisms of adaptive cognitive control in working memory (WM). WM is conceived as a system for short-term maintenance, updating and...
The present study investigated mechanisms of adaptive cognitive control in working memory (WM). WM is conceived as a system for short-term maintenance, updating and manipulation of representations required for goal-directed action. Adaptive control refers to the finding of flexible adjustments of control processes based on conflict. For instance, a higher frequency of incongruent stimuli, that is, stimuli evoking conflicting response tendencies, leads to a higher level of cognitive control as reflected by smaller congruency effects (i.e., the difference between congruent and incongruent items). Likewise, conflict on the previous trial leads to a higher level of cognitive control on the current trial. To investigate adaptive control in WM, we used a modified Sternberg paradigm. Participants memorized two differently colored lists of four digits (i.e., 2 5 7 1), in which corresponding positions in both lists contained the same digits (congruent items) or different digits (incongruent items). Participants were required to make a match/mismatch judgement (Experiment 1 and 2) or to recollect the correct digit at a probed position in one of the two lists (Experiment 3). In all experiments, we could replicate both hallmark effects of adaptive control, the proportion congruency effect, and the congruency sequence effect. Our results strongly support the assumption that WM representations can be dynamically adapted based on the amount of conflict, and that adaptive control of WM follows the same principles that have previously been shown for selective attention.
Topics: Adaptation, Physiological; Attention; Humans; Memory, Short-Term; Reaction Time
PubMed: 35217261
DOI: 10.1016/j.cognition.2022.105053