Valores normativos de pruebas conductuales de procesamiento auditivo para niños chilenos entre 7 y 12 años: una propuesta inicial / Normative values of auditory processing behavioral tests for chilean children between 7 and 12 years old: an initial proposal

Resumen Introducción: El trastorno del procesamiento auditivo en niños está relacionado con trastornos de lenguaje, bajo rendimiento académico, trastornos de aprendizaje y dificultades psicosociales. Existe consenso internacional sobre la utilidad de las pruebas conductuales para su evaluación y diagnóstico. Objetivo: Establecer valores normativos para pruebas conductuales de procesamiento auditivo en población pediátrica chilena con neurodesarrollo y audición normal. Material y Método: Se realizó un estudio observacional de corte transversal. Participaron 153 sujetos entre 7 y 12 años de la Región Metropolitana. Se estudiaron las pruebas de patrones de frecuencia, habla filtrada y dígitos dicóticos. Se construyeron modelos de regresión fraccional para estimar los valores normativos y además se calcularon los puntajes de corte en los percentiles 2.5, 5 y 10. Resultados: No se evidenciaron diferencias significativas entre oídos para las pruebas estudiadas a excepción de la prueba de dígitos dicóticos. Se construyeron modelos únicos para las pruebas patrones de frecuencia y habla filtrada, y modelos independientes para cada oído para la prueba dígitos dicóticos. Todas las estimaciones resultaron significativas y tuvieron niveles aceptables de precisión. Conclusión: Se obtuvieron los valores normativos y puntajes de corte para las tres pruebas estudiadas. Los valores obtenidos fueron similares a los reportados en otras poblaciones considerando los efectos de oído, de edad, sexo y escolaridad.

Abstract Introduction: Auditory processing disorder in children is related to language disorders, poor academic performance, learning disorders, and psychosocial difficulties. There is international consensus on the usefulness of behavioral tests for their evaluation and diagnosis. Aim: To establish normative values for auditory processing behavioral tests in Chilean pediatric population with normal neurodevelopment and hearing thresholds. Material and Method: An observational cross-sectional study was carried out. One hundred fifty-three subjects between 7 and 12 years old from the Metropolitan Region participated. Frequency pattern tests, filtered speech, and dichotic digits were studied. Fractional regression models were built to estimate the normative values, and cut-off scores were also calculated at the 2.5, 5, and 10 percentiles. Results: There were no significant differences between ears for the tests studied except for the dichotic digits test. Single models were built for the frequency and filtered speech patterns tests and independent models for each ear for the dichotic digit test. All estimates were significant and had acceptable levels of precision. Conclusion: The normative values and cut-off scores were obtained for the three tests studied. The values obtained were similar to those reported in other populations considering the effects of ear, age, sex, and education.

Determining caries risk susceptibility in children of Udaipur city with genetic taste sensitivity and hormonal fingerprint

Background: Propylthiouracil (PROP) (a medicated tool) and hormonal fingerprint (second to fourth digits [2D:4D]) ratio can be used for detection of caries which is most prevalent oral health disease. Aim: This study aims to determine the role of genetic taste sensitivity and hormonal fingerprint (2D:4D ratio) on caries risk susceptibility. Materials and Methods: The present study was an observational and cross-sectional study. It was conducted on 570 children aged 6–12 years. PROP sensitivity test was done by PROP impregnated filter paper strips and subjects were divided accordingly into supertasters, medium-tasters, and nontasters. 2D:4D ratio was obtained by measuring length ratio of index to ring finger using Vernier caliper. Dietary preferences of the subjects were recorded. The evaluation of decayed, missing, and filled teeth/deft indices was done. Statistical Analysis: Intergroup comparisons were performed using One-way ANOVA test, independent t-test and Chi-square test at 5% significance level. Results: Positive correlation between nontasters, low digit ratio, sweet likers, and high caries index was found with a high significant difference. Conclusion: Genetic taste sensitivity and hormonal fingerprint (biological marker) can be used for detection of caries as the present research confirmed impact of hormones on taste perception.

Specially formed radial collateral artery perforator flap in repair of complex defects of digits / 中华显微外科杂志

Objective:To explore the effects of specially formed radial collateral artery perforator flaps in reconstruction of the complex digit defects.Methods:From April, 2014 to March, 2020, 20 patients with multiple digit injuries combined with bone defects were treated by digit reconstruction with radial collateral artery chimeric and polyfoliate perforator flaps. Of the 20 patients, 7 patients were treated by chimeric perforator flaps, 12 by polyfoliate perforator flaps and 1 by chimeric polyfoliate perforator flap. Altogether 28 perforator flaps and 13 bone flaps were taken. The size of perforator flaps were 9.5 cm×4.0 cm to 4.0 cm×2.0 cm, and bone flap were 1.5 cm×0.6 cm×0.6 cm to 2.5 cm×1.0 cm×0.6 cm. All the donor sites were closed directly. Regular follow-up was performed. Function and clinical effect evaluation of repaired digits were made according to the Standard for Upper Limb Function Assessment of Hand Surgery Society of Chinese Medical Association and Sensory Function Assessment Criteria of British Medical Research Council (BMRC).Results:Twenty-seven flaps survived without any event. Venous congestion occurred in 1 flap with partial skin necrosis. Postoperative follow-up lasted from 3 months to 3.5 years (average 17.5 months). The appearance and texture of all flaps were good. All bone flaps properly healed. Sensory recovery achieved S 4 in 8 flaps, S 3 in 16 flaps and S 2 in 4 flaps. Hand function evaluation showed excellent in 12 patients and good in 8 patients. Conclusion:The specially formed radial collateral artery perforator flaps have the features of various designs with reliable blood supply, and are effective in repair of multiple digit injuries combined with soft tissue and bone defects.

Hematoma paroxístico de los dedos (Síndrome de Achenbach) / Paroxysmal finger haematoma (Achenbach syndrome)

RESUMEN El hematoma paroxístico de los dedos hace referencia a pacientes que padecen episodios súbitos de dolor y edema en uno o más dígitos con la subsecuente aparición de un hematoma, predominantemente en la región palmar de las falanges proximales. El hematoma paroxístico de los dígitos es una condición rara y benigna de etiología desconocida. Los síntomas prodrómicos como dolor, hormigueo y picazón pueden ocurrir desde minutos hasta horas antes de que aparezca el cambio de coloración. El sangrado subdérmico por lo general se detiene espontáneamente o minutos después de aplicar presión local y los cambios de coloración usualmente desaparecen. El diagnóstico se basa estrictamente en las características clínicas ya que todas las investigaciones de rutina suelen ser normales. El curso de esta condición es benigno y los síntomas se resuelven sin dejar secuelas permanentes. Los médicos deberían encontrarse alertas sobre esta condición para reconocerla y asesorar correctamente al paciente acerca de su pronóstico y evitar el pedido de estudios complementarios innecesarios.

SUMMARY Paroxysmal finger hematoma refers to patients suffering from episodic pain and swelling in one or more digits with subsequent appearance of a hematoma in the palmar aspect of the proximal phalanges. Paroxysmal finger hematoma is a rare and benign condition of unknown etiology. Prodromal symptoms such as pain, tingling and itching may occur from minutes to hours before the color change appears. Subdermal bleeding usually stops spontaneously or after local pressure is applied, and changes in coloration usually disappear. The diagnosis is strictly based on the clinical features since all routine investigations are usually normal. The course of this condition is benign and the symptoms resolve without permanent sequelae. Doctors should become aware of this condition to advise their patients about the prognosis and to avoid the request of unnecessary additional studies.

Using Flow-through flap pedicled with superficial palmar branch of radial artery for bridging finger replan-tation complex defect of soft tissue and vessel / 中华显微外科杂志

To evaluate the surgical technique and clinical effect of applying Flow-through flap pedicled with superficial palmar branch of radial artery for bridging finger replantation complex defect of soft tissue and vessel. Methods From February, 2013 to March, 2018, 9 cases of severed fingers composited defect of soft tissue and vessel were treated with Flow-through flap pedicled with superficial palmar branch of radial artery.The flap was designed from the proximal end of rasceta and the donor sites were sutured directly. The size of flaps was 3.0 cm ×1.5 cm-4.0 cm×2.2 cm. The superficial branch of the radial artery in the flap was used to bridge the finger artery. And the vein of proximal and distal ends in the finger was bridged by the subcutaneous vein. The proper palmar digi-tal nerve defect was bridged by palm skin graft of median nerve. The appearance, feeling and joint function of fingers was followed-up regularly after operation. Results All transfering flaps survived and all cases were followed-up for 7 to 33 months. The donor sites got primary healing with straight scars. The appearance and texture of the flaps were satisfactory. Two-point discrimination ranged from 8 to 11 mm. The pain sensation, warmth sensation and touch sen-sation of the flaps got better. And the appearance and functions of severed fingers recovered well. Conclusion The Flow-through flap pedicled with superficial palmar branch of radial artery is easy to harvest and anastomose, which is masked and a small incision for the donor site. It is an ideal method for bridging severed fingers and repairing of fin-ger wound.

Microstructure of Holstein and Gir breed adult bovine hooves: histomorphometry, three-dimensional microtomography and microhardness test evaluation / Microestrutura de cascos de bovinos adultos das raças Holandesa e Gir: avaliação por histomorfometria, microtomografia tridimensional e teste de microdureza

This study aimed to characterize and compare the aspects involved in the microstructural formation of the Holstein and Gir breed hoof wall by histomorphometry, three-dimensional microtomography and microhardness test techniques. Seventy-two (18H/18G thoracic and 18H/18G pelvic) Holstein (H) and Gir (G) breed hooves were collected in slaughterhouses. The hooves were divided into six groups according to breed and age group: 24 to 36 months (C1H/C1G), 36 to 60 months (C2H/C2G) and over 60 months (C3H/C3G). The normality and homogeneity analysis of morphometric variables by the Kolmogrov-Sminov and Bartlett tests was conducted as a statistical model. Once the assumptions were met, the Sigmastat 3.5 software was used and the means were compared by T test. The 5% probability level is considered. When the assumptions were not met, the means were compared by the Mann-Whitney nonparametric test, considering the 5% probability level. When comparing the Holstein and Gir breeds, no differences were noticed between them as to the length of the dermal papillae; young animals showed thicker papillae than adult animals; the Holstein breed hooves showed higher amount of 7pores on the wall and on the sole compared to the Gir breed; Holstein cattle hooves showed greater microhardness than Gir cattle; there was no microhardness difference between pigmented and non-pigmented hooves of Holstein and Gir cattle.

O presente estudo objetivou caracterizar e comparar os aspectos envolvidos na formação microestrutural do estojo córneo de bovinos das raças Holandesa e Gir pelas técnicas de histomorfometria, microtomografia tridimensional e teste de microdureza. Foram coletados em frigoríficos, de forma igualitária entre as raças Holandesa (H) e Gir (G), 72 cascos (18H/18G torácicos e 18H/18G pélvicos). Os cascos foram divididos em seis grupos de acordo com a raça e a faixa etária: 24 a 36 meses, (C1H/C1G), 36 a 60 meses (C2H/C2G) e acima de 60 meses (C3H/C3G). Como modelo estatístico, realizou-se análise de normalidade e homogeneidade das variáveis morfométricas empregando testes Kolmogrov-Sminov e Bartlett. Atendidas as pressuposições, empregou-se o programa Sigmastat 3.5 e compararam-se as médias pelo teste T. Considerou-se o nível de 5% de probabilidade. Ao comparar as raças Holandesa e Gir, observou-se que não houve diferença entre elas quanto ao comprimento das papilas dérmicas. Os animais jovens apresentaram papilas mais espessas que os adultos. Os cascos da raça Holandesa apresentaram maior quantidade de poros na muralha e na sola em relação à raça Gir. Os cascos de bovinos Holandeses possuem microdureza maior que os de bovinos Gir. No estudo não se evidenciou diferença de microdureza entre cascos pigmentados e despigmentados de bovinos Holandeses e Gir.

Study of Various Types Congenital Anomalies of Hand.

The present study is aimed at studying the various types, patterns and their percentages of incidences of anomalies of hand and associated with any other anomalies in district of Bangalore. A four years study was done in Bangalore district Bangalore. from 2007—2011. This fours years study was done on 1257 males 743 females of human hands for the presence of any anomalies .Out of them, only forty subjects had anomalies of hand ranging from new born to adult age group. Each case, a detailed history of family, personal history past history of drug intake in first trimester associated with any other anomalies were taken..Later relevant investigations were done for those subjects who had anomalies of hand.Then were ,grouped and photographed The subjects were classified into 5 groups as follows:Group-1,-Those subjects who had extra digits not involving the thumb(37.5%)--Post axial type polydactyly. Group-2,Those subject who had involvement of thumb(30.00%)…Preaxial type polydactyly.Group-3,Those subjects who had fusion of digits(27.5%),….Syndactyly. Group-4,Those subjects massive enlargement of thumb only(2.5%)…Macrodactyly .Group-5,Those subjects who had absence of fingers associated without shortening of limb .Most of the anomalies can be corrected surgically except those in cases of macrodactyly and absence of fingers Hence this study gives us knowledge of various types of anomalies hand not only to the Anatomists but also to plastic surgeons and to orthopedicians Hence it has been studied and reported.

Extadigits: an unusual presentation.

Extra digit is a common congenital anomaly in our environment which usually affect the hands and occasionally the feet but very rarely both. A five months old male infant presented with accessory digits of the both hands and feet, with two extra digits on the left hand and one on the right hand, right foot and left foot. The extra digits were well developed, with normal range of motion, good capillary refill and intact sensation. General examination revealed an otherwise healthy child with no associated congenital malformations. The treatment modality used was surgical removal of the extra digits and reconstruction of any associated anomalies in the remaining ray such as longitudinal epiphyseal bracket. After the surgery the patients is no longer experience difficulty with fitting gloves and shoes as well as discrimination among peer groups in his future life.

Suspended Replantation in Complete Amputations of the Hand and Finger

PURPOSE: We report the results of replantations which was intentionally delayed for a certain period of time in patients with an amputation of multiple digits, both hands or the single digit presented at night. MATERIALS AND METHODS: Two staged intentianlly delayed replantations were performed in twenty patients. Three patients had amputations of four or more fingers, two had bilateral hand amputations and fifteen had a single digit amputation. RESULTS: The mean warm ischemic time was 3 hours and 58 minutes. The mean cold ischemic time was 2 hours and 36 minutes for the first operation, and 15 hours and 13 minutes for the second operation. Twenty digits out of 28 digits (85%) survived completely. At the mean follow-up of months, functional results according to Chen's criteria were rated as excellent in six patients, good in eight, and fair in five. CONCLUSION: When the patients had multiple finger amputations, bilateral hand amputations or presented late at night, intentional delay of the replantation also provide satisfactory outcomes.

Surgical Correction of Hexadactyly: Innovation of New Technique and Its Application

PURPOSE: Hexadactyly without thumb is a rare congenital anomaly of the hand where six triphalangeal digits are symmetrically distributed without thumb. Contrary to mirror hands, triphalangeal six digits are symmetrically distributed on each side at the midline with well-differentiated carpal bones, extensor tendons, one ulna and one radius. The authors developed a new surgical technique based on a three-dimensional concept to correct the hexadactyly and applied to 2 cases of hexadactyly with good functional and aesthetic results. Here we document the surgical technique and its result. METHODS: A 16 month old male patient visited our clinic with chief complaints of bilateral hexadactyly deformity. On physical examination most radial first and second digits showed no opposition and adduction motion on both side hands. Radiography showed 6 triphalangeal digits with normal development of carpal, radial and ulnar bone. Right side abnormality was corrected by removal of most radial side extra-digit, rotation and migration of 2nd ray to thumb position and creation of 1st web by transposing a mid-palm based rectangular palmar flap as in Snow & Littler procedure which has been being applied for correction of 1st web syndactyly in cleft hand deformity. Seven months later, left side abnormality was also corrected with the same procedure. RESULTS: Postoperative appearances of the both hands were satisfactory. Flexion, extension, opposition and grasping were possible with the pollicized 2nd ray. Pinching power was 3.0kg 15 months after the surgery and 2.5kg 22 months after in right hand respectively. CONCLUSION: In correction of hexadactyly deformity, satisfactory aesthetic and relevant functional results can be expected with authors' newly developed technique: removal of most radial digit, rotation and migration of 2nd digit to thumb position as well as creation of the 1st web space by transposition of mid-palm based rectangular flap.

Repair and functional reconstruction for compound defects of proximal phalanx and dorsal skin at multiple digits / 中华创伤骨科杂志

Objective To summarize our surgical experience in repair and functional reconstruction for compound defects of proximal phalanx and dorsal skin at multiple digits,Methods Six patients with multiple digital defects were treated in our department between June 1996 and March 2005.At the first stage,free iliac bone grafts were used to repair defects of proximal phalanges and temporary syndactyly between adjacent affected fingers was created through digital palmar skin sutures.The defects were covered with free flap transfer finally.Dorsalis pedis flaps were used in four patients,a lateral arm flap in one and a lateral thoracic flap in one respectively.At the second stage,a partial debulking procedure and division of syndaetyty followed three to six months later.Additional procedures were performed in three eases to reconstruct the digital extensor function through tendon transfer.The follow-ups ranged from six months to nine years.Results The flaps survived uneventfully in the six patients postoperatively.The dorsal aspects of reconstructed fingers demonstrated an aesthetically pleasing effect after the flap debulking procedures and division of syndactyly.Follow-up X-Ray examinations showed good lilac bone union and nearly normal structure of digital bone.The distal interphalangeal extension restored to normal in the three cases after extensor reconstruction.Conclusions Iliac bone graft to repair phalangeal defects and free flap transplantation to cover skin defects can be a good treatment for compound defects of proximal phalanx and dorsal skin at multiple digits.Secondary plastic procedure may greatly improve the appearance of a reconstructed digit,and extensor re- construction the function of distal interphalangeal extension too.

Median and Ulnar Sensory Nerve Conduction Study in Five Digits

OBJECTIVE: To establish the reference values of the sensory conduction for all the digits in the hand, conduction studies were performed using the standard technique. METHOD: One hundred hands of fifty neurologically healthy adults with mean age of 45 years (range, 23~69) were tested. Depending on ages, the 50 adults were devided into three groups: group 1, 20~45 years old; group 2, 46~60 years old; group 3, 61~ years old. Antidromic sensory nerve conduction techniques using a fixed distance were performed. The onset latency and baseline to peak amplitude of the sensory nerve action potentials (SNAPs) were measured. During the test, the skin temperature of the hand was maintained at 34 degrees C or above. These variables from SNAPs were compared according to age, gender, side, and recording digits. RESULTS: Comparison of the median and ulnar SNAPs between age groups revealed longer onset latency and smaller amplitude in the elderly group. The amplitude of SNAPs was larger in females than in males and the left side than the right side. Comparison of the latencies and amplitudes between the second and third digits showed no significant difference statistically. Also, the latencies and amplitudes of the median and ulnar nerves recorded from the fourth digits showed no significant difference statistically. CONCLUSION: Based on these results, the reference values for sensory conductions from all the digits were obtained. These values would be helpful in evaluation of CTS or unspecified finger pain or upper extremity neuropathy.

Fibro-osseous Pseudotumor of the Digits: A case report

Fibro-osseous pseudotumor of the digits is a heterotopic ossification closely related to myositis ossificans and occurs in the subcutaneous tissue of the digits. This lesion is considered a reactive fibroblastic proliferation with metaplastic bone formation. We report a case of fibro-osseous pseudotumor of left index finger in a 28-year-old woman. She had had an ovoid smooth subcutaneous mass with tenderness on the left index finger for one month. In gross, the specimen consisted of a relatively circumscribed, rubbery soft mass with grayish white cut surface measuring 2.0 1.7 1.5 cm. Upon microscopic examination the lesion showed irregular multinodular growth with considerably variable cellularity. Because of the focal hypercellularity, cellular atypia, and increased mitotic activity this lesion may be confused with extraskeletal osteosarcoma or parosteal osteosarcoma. This rare lesion is curable by complete local excision.

A Clinical Study of Replantation of Amputated Upper Limbs and Digits / 대한정형외과학회잡지

Since the first report of completely amputated thumb replantation by Tamai in 1965, replantation surgery has been popularized with increasing success rate and improving functional regain. Recently, difficult replantation such as traction avulsion amputation has been challenged and good success rate and function have been reported. We have analized 34 cases of upper extremity and finger replantation in 23 patients, which were performed at the Dept. of Orthopedic surgery. Hyun Dai Hae Seong Hospital, Ulsan, Korea, from June 1982 to January 1986. The results were as follows: 1. Male patients were 22, female was 1, left upper limbs and digits injuries were more prevalent(16: 7), and average age was 25 years old. 2. The most common injury was done by cutting machine. 3. The number of amputations of fingers were almost same in all fingers and most prevalent in zone III(26 cases, Danial classification). 4. Success rate of replantation was 82.4% In cases of less than 6 hrs ischemic time, the rate was 93.4%, and more than 6 hrs ischemic time, rate was 33.3% 5. Performing arterial anastomosis prior to venous anastomosis, can find out main draining vein, and with one vein and one artery anastomosis, can get good results distal to zone IV. 6. Functional results were satisfactory, evaluating by modified. Tamai score, average 87.5. 7. 6 cases of digital replantations distal to sublimis tendon insertion have good results functionally, cosmetically and technically easy (Tamai score 98). 8. 5 cases of traction avulsion amputations needed many additional surgery to restore function, but end results were relatively satisfactory.