Evaluation of Hand Morphometry in Healthy Young Individuals from Different Countries / Evaluación de la Morfometría de la Mano en Individuos Jóvenes Sanos de Diferentes Países

SUMMARY: This study aims to examine the hand morphometry of healthy young individuals from different countries and investigate the differences between countries in typing of hand based on the morphometric values obtained. In the study, 16 different parameters, including two surface areas and 14 lengths, were measured from the right hand of 579 volunteers (250 females, 329 males) from 7 different countries (Turkey, Chad, Morocco, Gabon, Kazakhstan, Senegal and Syria). Factor analysis was performed on the parameters, cluster analysis was performed according to the factor score obtained, and the hand types in the study were determined. As a result of the study, four different hand types were defined, and the distribution of these types according to countries was analyzed. All parameters showed significant differences between countries in both genders (p<0.05). According to the results of the study, there was a difference between male and female hand types between countries. In females, the type 1 hand type was found only in Gabon, the type 2 hand type was found only in Senegal, the type 3 hand type was found in Turkey, Morocco and Kazakhstan, while the type 4 hand type was significantly distributed in Senegal and Gabon (X2 =104.62; df=18, p<0.05). In males, type 1 hand type was found in Turkey, type 2 hand type in Senegal and Gabon, type 3 hand type in Turkey, while type 4 hand type was significantly distributed in Morocco and Kazakhstan (X2 =76.964; df=18, p<0.05).

Este estudio tuvo como objetivo examinar la morfometría de la mano de individuos jóvenes sanos de diferentes países e investigar las diferencias en la mecanografía de la mano entre países en función de los valores morfométricos obtenidos. En el estudio, se midieron 16 parámetros diferentes, incluidas dos superficies y 14 longitudes, de la mano derecha de 579 voluntarios (250 mujeres, 329 hombres) de 7 países diferentes (Turquía, Chad, Marruecos, Gabón, Kazajstán, Senegal y Siria). Se realizó un análisis factorial de los parámetros, un análisis de conglomerados según la puntuación factorial obtenida y se determinaron los tipos de manos en el estudio. Como resultado, se definieron cuatro tipos diferentes de manos y se analizó la distribución de estos tipos según países. Todos los parámetros mostraron diferencias significativas entre países en ambos sexos (p<0,05). Según los resultados del estudio, hubo una diferencia entre los tipos de manos de los hombres y de las mujeres entre países. En las mujeres, el tipo de mano tipo 1 se encontró solo en Gabón, el tipo de mano tipo 2 se encontró solo en Senegal, el tipo de mano tipo 3 se encontró en Turquía, Marruecos y Kazajstán, mientras que la mano tipo 4 se distribuyó significativamente en Senegal y Gabón (X2=104,62; gl=18, p<0,05). En los hombres, el tipo de mano tipo 1 se encontró en Turquía, el tipo de mano tipo 2 en Senegal y Gabón, el tipo de mano tipo 3 en Turquía, mientras que la mano tipo 4 se distribuyó significativamente en Marruecos y Kazajstán (X2=76,964; gl=18, p <0,05).

Morphology and Morphometry of the Dorsal Interosseous Muscles of the Hand: Laterality and Sexual Dimorphism / Morfología y Morfometría de los Músculos Interóseos Dorsales de la Mano: Lateralidad y Dimorfismo Sexual

SUMMARY: The dorsal interosseous muscles (DIM) are intrinsic muscles of the hand located dorsally between metacarpal bones, which play a role in finger abduction. Anatomical variations of these muscles in terms of form and length have been well documented, but variations regarding sex and laterality are underexplored. The aim of this study was to investigate the morphology and morphometry of the DIM of the hand regarding sexual dimorphism and laterality. Twenty human cadavers belonging to the white individuals (n = 40 hands) with known sex and laterality were used for this study. DIMs were dissected and observed for morphology. Also, a digital calliper was used to measure the midpoint length of the DIM. The origin and insertion of all the DIM were normal with the left hand having no additional, supernumerary, and absent muscles in each compartment. The variations were only found on the right side and predominant in females: 2 out of 11 (18.18%) hands containing a space with a supernumerary muscle; 1 out of 11 (9.09%) hands having a space with a double muscle; and 1 out of 11 (9.09%) hands having a compartment with a unipennate muscle. In males, 1 out of 9 (11.11%) hands had a compartment with a supernumerary muscle. The mean midpoint length of each muscle in females and males in both hands from the first to the fourth muscle, respectively, was documented. In females on the left: 46.79 ± 3.56; 42.62 ± 3.57; 49.02 ± 4.21; 41.66 ± 2.15 and right: 47.30 ± 2.49; 39.27 ± 4.14; 45.69 ± 4.64; 38.12 ± 4.08. In males, it was on the left: 50.01 ± 3.95; 41.98 ± 3.79; 47.90 ± 4.83; 41.79 ± 4.25, and on the right: 46.65 ± 2.09; 39.01 ± 4.25; 47.47 ± 3.41; 38.31 ± 4.40. The mean midpoint length of the DIM was relatively higher on the left hand compared to the right hand in both females and males. In this study, variations regarding the supernumerary muscle, double interosseous space, and unipennate muscles were only observed on the right-hand side and predominantly in females, an insight that may guide in the treatment of fractures, stiffness of the hand, and compartment syndromes.

Los músculos interóseos dorsales (DIM) son músculos intrínsecos de la mano ubicados dorsalmente entre los huesos metacarpianos, que desempeñan un papel en la abducción de los dedos. Las variaciones anatómicas de estos músculos en términos de forma y longitud están bien documentadas, pero las variaciones con respecto al sexo y la lateralidad están poco exploradas. El objetivo de este estudio fue investigar la morfología y morfometría de los DIM de la mano con respecto al dimorfismo sexual y la lateralidad. Para este estudio se utilizaron veinte cadáveres humanos pertenecientes a individuos blancos (n = 40 manos) con sexo y lateralidad conocidos. Los DIM se diseccionaron y observaron para determinar su morfología. Además, se utilizó un calibrador digital para medir la longitud del punto medio del DIM. El origen y la inserción de todos los DIM fueron normales y la mano izquierda no tenía músculos adicionales, supernumerarios y ausentes en cada compartimento. Las variaciones se encontraron sólo en el lado derecho y predominaron en el sexo femenino: 2 de 11 (18,18%) manos contenían un espacio con un músculo supernumerario; 1 de cada 11 (9,09%) manos presentando un espacio con doble músculo; y 1 de cada 11 (9,09%) manos presentaba un compartimento con músculo unipenate. En los hombres, 1 de cada 9 (11.11%) manos tenía un compartimento con un músculo supernumerario. Se documentó la longitud media del punto medio de cada músculo en mujeres y hombres en ambas manos desde el primer al cuarto músculo, respectivamente. En mujeres de izquierda: 46,79 ± 3,56; 42,62 ± 3,57; 49,02 ± 4,21; 41,66 ± 2,15 y derecha: 47,30 ± 2,49; 39,27 ± 4,14; 45,69 ± 4,64; 38,12 ± 4,08. En los varones fue hacia la izquierda: 50,01 ± 3,95; 41,98 ± 3,79; 47,90 ± 4,83; 41,79 ± 4,25, y a la derecha: 46,65 ± 2,09; 39,01 ± 4,25; 47,47 ± 3,41; 38,31 ± 4,40. La longitud media del punto medio del DIM fue relativamente mayor en la mano izquierda en comparación con la derecha tanto en mujeres como en hombres. En este estudio, las variaciones con respecto al músculo supernumerario, el doble espacio interóseo y los músculos unipennados sólo se observaron en el lado derecho y predominantemente en el sexo femenino, un conocimiento que puede guiar en el tratamiento de fracturas, rigidez de la mano y síndromes compartimentales.

Hand Anthropometry of Italian Elite Male Swimmers / Antropometría de la Mano en Nadadores Italianos Masculinos de Élite

SUMMARY: Hand size is part of the anthropometric parameters that are assessed in swimmers to select elite athletes, as certain anthropometric relationships involving hand measurements are significantly correlated with sports performance in various swimming disciplines. The authors present the results of the anthropometric study carried out on the hands of 15 elite male Italian swimmers from to the Italian national open water swimming team. All swimmers participated at least once in World Cup and Absolute Italian Championships, winning at least one medal in their sporting career. In particular, the sample includes a medallist at the World Championships, a winner of the World Cup ultra swim marathon circuit and medallists at the European Championships. The sample consisted of 15 elite male swimmers with a mean age of 28.93 years. The following anthropometric measurements were taken on each athlete: Stature; weight; seven dimensions on each hand: hand length; hand breadth metacarpal; palm length; middle finger length; index finger length; thumb distance; and the distance from the thumb root to first flexure line of the index finger - trigger length. The size of the hands is an important factor in the swimmer's propulsion and push as a larger hand allows for greater support in the water and consequently generates more resistance. The anthropometric characteristics of the hands of Italian swimmers are missing from the anthropometric data already reported in the literature and can be used to make comparisons with elite athletes from other nations. Furthermore, anthropometric measurements could be used as predictors to estimate the swimmers' chance of success.

El tamaño de la mano es uno de los parámetros antropométricos que se evalúan en los nadadores para seleccionar a los deportistas de élite. Los autores presentan los resultados de un estudio antropométrico realizado en las manos de 15 nadadores italianos masculinos de élite pertenecientes al equipo nacional de natación en aguas abiertas. Todos los nadadores participaron al menos una vez en Copas del Mundo y Campeonatos de Italia, ganando al menos una medalla en su carrera deportiva. En concreto, la muestra incluye un medallista en los Campeonatos del Mundo, un ganador de la Copa del Mundo del circuito de ultra maratón de natación y medallistas en los Campeonatos de Europa. La muestra consta de 15 nadadores masculinos de élite con una edad media de 28,93 años. Se tomaron las siguientes medidas antropométricas a cada atleta: estatura; peso; siete dimensiones en cada mano: longitud de la mano, anchura de la mano en el metacarpiano, longitud de la palma, longitud del primer, segundo y tercer dedo, distancia entre la raíz del primer dedo y la primera línea de flexión del segundo dedo. El tamaño de las manos es un factor importante para la propulsión y el empuje del nadador, ya que una mano más grande permite un mayor apoyo en el agua y, en consecuencia, genera más resistencia. Las características antropométricas de las manos de los nadadores italianos faltan en los datos antropométricos recolectados en la literatura y pueden utilizarse para hacer comparaciones con los atletas de élite de otras naciones. Además, las medidas antropométricas podrían utilizarse como predictores para estimar las posibilidades de éxito de los nadadores.

Poly sensibilisation dans le cadre d'un eczéma de contact des mains chez une aide-ménagère dans le nord du Bénin / Poly sensitization in the context of hand contact eczema in a household helper in northern Benin

L'eczéma des mains est fréquent. Son étiologie est souvent multifactorielle comprenant les facteurs environnementaux et des facteurs individuels prédisposants. Il pose des problèmes de diagnostic étiologique en particulier dans un contexte de poly sensibilisation. Observation Il s'est agi d'une employée de maison âgée de 17 ans sans antécédents allergiques connus. Elle a développé un eczéma bilatéral des mains six mois après embauche. Le patch test avec la batterie standard européenne a montré une poly sensibilisation à plusieurs allergènes contenus dans les détergents et désinfectants. Le patch test aux gants est revenu négatif mais n'exclut pas son implication dans la survenue des lésions devant le caractère bilatéral et symétrique des lésions. Une réorientation professionnelle a été proposée devant le jeune âge de la travailleuse Conclusion La connaissance des allergènes en cause au cours d'un eczéma est un atout pour une meilleure prise en charge du patient mais leur identification n'est pas toujours aisée. La réorientation professionnelle lorsqu'elle est possible assure la guérison.

Introduction: Hand eczema is common. Its etiology is often multifactorial, including environmental factors and individual predisposing factors. It poses problems of etiological diagnosis, particularly in the context of poly sensitization. Observation: This case involved a 17-year-old domestic worker with no known allergic history. She developed bilateral hand eczema six months after hiring. The patch test with the standard European battery showed poly-sensitization to several allergens contained in detergents and disinfectants. The glove patch test came back negative, but did not rule out its involvement in the lesions, given the bilateral and symmetrical nature of the lesions. In view of the young age of the worker, a vocational reorientation was carried out. Conclusion: Knowledge of the allergens involved in eczema is an asset for better patient management, but identifying them is not always easy. When possible, professional reorientation ensures recovery

Extensor digitorum brevis manus, un diagnóstico diferencial / Extensor Digitorum Brevis Manus, a differential diagnosis

El músculo extensor digitorum brevis manus es una variante de los extensores de la mano. Se trata de un músculo supernumerario en el dorso de la muñeca ubicado en el cuarto compartimento extensor. Suele ser asintomático, pero ocasionalmente se presenta como una masa dolorosa; en estos casos, está indicado el tratamiento quirúrgico que consiste en la resección del músculo o la liberación del retináculo extensor del cuarto compartimento. Presentamos a una paciente de 30 años, con una masa dolorosa en el dorso de la mano izquierda. Según las evaluaciones clínica y ecográfica, se sospechó un ganglión y se programó la resección quirúrgica. En la cirugía, se encontró tejido muscular compatible clínicamente con el extensor digitorum brevis manus, y se liberó el retináculo extensor. Los estudios publicados sobre su incidencia y prevalencia son escasos y, en su mayoría, se trata de informes post mortem, por lo que este caso presentado reviste particular interés. Nivel de Evidencia: IV

The extensor digitorum brevis manus muscle is a variant of the hand extensors. It is a supernumerary muscle on the dorsum of the wrist, located in the fourth extensor compartment. It is usually asymptomatic, but when it causes discomfort, it manifests as a painful mass. When it is symptomatic, surgical treatment is recommended, which may include muscle excision or extensor retinaculum release. We present a 30-year-old patient with a painful mass on the dorsum of the left hand; clinically, a ganglion was suspected and scheduled for surgical resection. She underwent surgery and was diagnosed with symptomatic EDBM, which was treated with extensor retinaculum release. EDBM was found incidentally in a cadaveric dissection; therefore, its true incidence is unknown. EDBM originates in the wrist joint capsule, below the dorsal radiocarpal ligament; its distal insertion is the ulnar side of the extensor mechanism in the metacarpophalangeal joint where it is present. Innervated by the posterior interosseous, research has shown that its purpose is to extend and deviate the finger towards the side where it is inserted. This case is particularly interesting given the scarcity of information on its incidence and prevalence, with the majority of that information coming from postmortem reports. Level of Evidence: IV

Experiencia del paciente y análisis de ahorro de costos de la cirugía de síndrome del túnel carpiano con técnica WALANT / Patient experience evaluation and cost savings analysis of carpal tunnel syndrome decompression surgery using the WALANT technique

Introducción: La técnica de anestesia local con epinefrina sin el uso de manguito hemostático (Wide Awake Local Anesthesia - No Tourniquet, WALANT) se desarrolló para mejorar el acceso a la atención de la cirugía de mano y optimizar recursos médicos. El principal objetivo de este estudio fue evaluar la experiencia del paciente y analizar el ahorro de costos hospitalarios en el tratamiento quirúrgico de descompresión del síndrome del túnel carpiano utilizando esta técnica anestésica. Materiales y Métodos: Se realizó un estudio descriptivo prospectivo observacional en pacientes con diagnóstico clínico de síndrome del túnel carpiano operados entre 2016 y 2022. El grado de satisfacción del paciente fue evaluado mediante un cuestionario sobre el dolor en diferentes momentos, la ansiedad y la experiencia con el procedimiento. También se analizaron los costos de la técnica anestésica. Resultados: Se evaluó a 92 pacientes. La mayoría se mostró satisfecha y el 94,5% confirmó que volvería a elegir este procedimiento, los niveles de dolor y ansiedad fueron bajos. Se registró un ahorro de costos del 60,6% por procedimiento. Conclusiones: La descompresión del síndrome del túnel carpiano con técnica WALANT generó un ahorro de costos considerable para el sistema de salud nacional, los resultados fueron buenos sobre la base de la satisfacción, la ansiedad y el dolor; y es un procedimiento seguro, cómodo y eficiente. Los beneficios y su rentabilidad al emplear menos recursos hospitalarios podrían ser optimizados y reproducidos para generar un ahorro considerable en gastos de salud. Nivel de Evidencia: IV

Introduction: Wide-awake local anesthesia no tourniquet (WALANT) is an anesthetic technique that was developed to improve patient access to treatment and optimize the use of available medical resources in hand surgery. The main purpose of this study was to evaluate patient experience and hospital cost savings during surgical treatment of carpal tunnel syndrome (CTS) with this technique at a South American public hospital. Materials and Methods: Between 2016 and 2022, a descriptive prospective observational study was conducted on patients with a clinical diagnosis of CTS who had undergone surgical treatment. Patient satisfaction was assessed using a questionnaire that asked about pain during different periods of time, anxiety, and the procedure itself. The costs of the anesthetic technique were also analyzed. Results: 92 patients were evaluated and the majority of them were satisfied with their WALANT experience; 94.5% said they would choose this procedure again, citing low levels of pain and anxiety. A cost reduction of 60.6% per procedure was achieved. Conclusions: CTS decompression with the WALANT technique resulted in significant cost savings for the national health system, as well as favorable outcomes in terms of satisfaction, anxiety, and pain; the procedure was safe, comfortable, and efficient. The benefits and profitability of employing fewer hospital resources could be further optimized and replicated to result in significant health-care cost savings. Level of Evidence: IV

Sensory and Motor Median Nerve Neuropathy Due to a Deep Giant Hand Lipoma: A Case Report / Neuropatia sensorial e motora do nervo mediano por um lipoma gigante na mão: Relato de caso

Abstract Lipomas are the most common soft-tissue tumors in the human body, but their location in the hand is rare. Symptomatic hand lipomas, due to nerve compression, are even rarer. We present a case of median nerve neuropathy as a result of a giant palm lipoma, located on the thenar and hypothenar areas of the hand. The patient had typical symptoms of carpal tunnel syndrome, along with compromised thumb motion. Intraoperatively, the recurrent motor branch of the median nerve was sitting on the lipoma under a great tension. This particular location of the motor branch of the median nerve in relation to the lipoma makes this case unique. The tumor was excised protecting the neurovascular structures, and a few weeks later the patient regained full thumb motion, grip strength, and resolution of dysesthesia.

Resumo Os lipomas são os tumores de partes moles mais comuns no corpo humano, mas sua localização na mão é rara. Os lipomas de mão que causam sintomas por compressão do nervo são ainda mais raros. Apresentamos um caso de neuropatia do nervo mediano decorrente de um lipoma palmar gigante, localizado nas regiões tenar e hipotenar da mão. A paciente apresentava sintomas típicos de síndrome do túnel do carpo, além de comprometimento dos movimentos do polegar. Durante a cirurgia, o ramo motor recorrente do nervo mediano repousava sobre o lipoma sob grande tensão. Esta localização particular do ramo motor do nervo mediano em relação ao lipoma torna este caso único. O tumor foi extirpado, protegendo as estruturas neurovasculares e, poucas semanas depois, a paciente havia recuperado totalmente os movimentos do polegar e força de preensão, além de apresentar resolução da disestesia.

Unusual Anastomosis between Branches of the Ulnar Nerve (Kaplan Type Anastomotic Variant) - Case Report / Anastomose incomum entre ramos do nervo ulnar (variante anastomótica de Kaplan) - Relato de caso

Abstract The Kaplan anastomosis is a rare communication originally described between the superficial and dorsal branches of the ulnar nerve, distal to the ulnar tunnel, and in strict relation with the pisiform bone. It reveals, by its particular location, a formation of high clinical-surgical expressiveness. In this paper, we describe a Kaplan-type communication from a left upper limb with an unusual loop conformation between branches of the ulnar nerve in the pisiform bone.

Resumo A anastomose de Kaplan é uma rara comunicação originalmente descrita entre os ramos superficial e dorsal do nervo ulnar, distal ao túnel ulnar e em estreita relação com o osso pisiforme. O que revela, pela sua particular localização, uma formação de alta expressividade clínico-cirúrgica. Neste trabalho, uma comunicação do tipo Kaplan, porém, ainda não relatada, é descrita a partir de um membro superior esquerdo com uma inusual conformação em alça, ou um looping, entre ramos do nervo ulnar, no osso pisiforme.

First Experience of Plastination at 4150 Meters Above Sea Level, at the Altitude of La Paz, Bolivia / Primera Experiencia de Plastinación a 4150 Metros sobre el Nivel del Mar, en la Altura de La Paz, Bolivia

SUMMARY: Despite attempts to develop the plastination technique in Bolivia, standardized results have not yet been achieved that could be communicated via scientific publications. There is a great deal of misunderstanding around the technique, confusing it with classic techniques of inclusion in different types of resin, such as polyester and epoxy, but these protocols are not plastination. The aim of this work was to communicate the first standardized room-temperature plastination protocol with silicone in Bolivia, with the unique feature of doing so at the altitude of the city of La Paz, thus constituting the first communication of a plastination technique at 4,150 m.a.s.l. sub sede La Paz, La Paz, Bolivia.

En Bolivia, a pesar de los intentos en el desarrollo de la técnica de Plastinación, aún no se han alcanzado resultados estandarizados que pudieran ser comunicados por medio de publicaciones científicas. Existe una gran confusión al momento de desarrollar la técnica, confundiéndola con técnicas clásicas de inclusión en distintos tipos de reina, como poliéster y epoxy, pero no correspondiendo estos protocolos desarrollados a la técnica de plastinación. En este sentido, el objetivo de esta trabajo consistió en comunicar el primer protocolo estandarizado de plastinación a temperatura ambiente con silicona de Bolivia, con la particularidad de desarrollarlo en la altura de la ciudad de La Paz, constituyéndose, de esta manera, en la primera comunicación de una técnica de plastinación a 4.150 metros sobre el nivel del mar.

Futuros cirurgiões-dentistas canhotos graduandos da Universidade Federal de Uberlândia: perfil, dificuldades e dores osteomusculares / Future left-handed dentists graduating from the Federal University of Uberlândia: profile, difficulties and musculoskeletal pain

Os indivíduos canhotos necessitam de utensílios para concretização de suas atividades diárias, bem como, para o exercício da prática odontológica onde a escassez de equipamentos específicos pode refletir em desgaste corporal, com isso, o presente trabalho tem por objetivo identificar os estudantes canhotos do curso de Odontologia da Universidade Federal de Uberlândia além de identificar suas dificuldades, queixas e locais de dores osteomusculares nas atividades laboratoriais e clínicas. Métodos: Foram incluídos todos os alunos canhotos matriculados no ano de 2021. Foram aplicados questionários on line para coletar os dados dos alunos. Resultados: Foram tabulados e como resultados, encontrou-se que os canhotos representam 5,6% do total de alunos do curso de Odontologia, a maioria são mulheres (66,7%), com média de idade de 21 anos. O segundo período foi o que apresentou maior número de canhotos (25%). As atividades práticas do curso, estas foram cursadas por 91,7% dos entrevistados, que relataram com maior frequência usar a mão esquerda (62,5%), sentar na posição de 1 hora (20,8%) e ter maior dificuldade ao tratar o quadrante superior direito (45,8%). Os locais mais citados de dores osteomusculares após realizar essas atividades, foram: punhos e mãos (62,5%), parte inferior das costas (62,5%) e pescoço (58,3%). Conclusão: Os canhotos representam a minoria dos alunos e suas dificuldades são, a falta de estrutura física adequada e a incompreensão das pessoas ao redor. Em relação a queixa de dor ou desconforto, mãos, punhos, parte inferior das costas e pescoço foram os membros mais citados no estudo(AU)

Left-handed individuals need tools to carry out their daily activities, as well as for the exercise of dental practice where the scarcity of specific equipment can reflect on body wear, with this, the present work aims to identify left-handed students of the course of Dentistry at the Federal University of Uberlândia, in addition to identifying their difficulties, complaints and sites of musculoskeletal pain in laboratory and clinical activities. Methods: All left-handed students enrolled in the year 2021 were included, and three questionnaires were applied online to identify the profile of students and the difficulties encountered in laboratory and clinical practice. Results: They were tabulated and as a result, it was found that left-handers represent 5.6% of the total number of students in the Dentistry course, most of them are women (66.7%), with a mean age of 21 years. The second period was the one with the highest number of left-handers (25%). The practical activities of the course were carried out by 91.7% of the interviewees, who reported more frequently using their left hand (62.5%), sitting in the 1 o'clock position (20.8%) and having greater difficulty when treat the upper right quadrant (45.8%). The most cited sites of musculoskeletal pain after performing these activities were: wrists and hands (62.5%), lower back (62.5%) and neck (58.3%). Conclusion: Lefthanded people represent the minority of students, and their difficulties are the lack of adequate physical structure and the misunderstanding of the people around them. In relation to complaints of pain or discomfort, hands, wrists, lower back and neck were the most cited members in the study(AU)

Clinical characteristics, ultrasonic diagnosis, treatment and outcomes of eosinophilic fasciitis: a retrospective single-center analysis of 45 cases / 南方医科大学学报

OBJECTIVE@#To evaluate the clinical features, laboratory and imaging results, treatment and outcomes of eosinophilic fasciitis (EF) and assess the value of ultrasound in the diagnosis of EF.@*METHODS@#We retrospectively analyzed the clinical data of 45 patients with EF treated in our center from January 1, 2006 to February 28, 2022. The consistency between the diagnoses of EF based on ultrasound and MRI findings was assessed.@*RESULTS@#In the 45 EF patients (male/female ratio 3.5:1), the age of onset ranged from 16 to 64 years with a mean disease course of 22.6 months. The average time from symptom onset to diagnosis was 16 months. The most common possible trigger of the disease was vigorous exercise (10/45), causing symmetrical lesions in the limbs, most commonly in the forearms (86.7%) and lower legs (80%). Clinical features of EF included subcutaneous swelling and induration (95.6%), arthralgia and arthritis (55.6%), groove sign (42.2%), hand joint contractures (42.2%), skin pigmentation (37.8%), and peau d'orange appearance (13.3%). Eosinophilia was found in 31 patients (68.9%). Hypergammaglobulinemia was seen in 23/44 (52.3%) and positive antinuclear antibodies in 9 (20%) of the patients. Twentyone of the patients were treated with high-dose methylprednisolone (≥200 mg daily for 3 to 5 consecutive days), and compared with the patients who did not receive this treatment, these patients more frequently experienced relapse before admission, had more extensive involvement, and had a higher rate of hypergammaglobulinemia without fever, but these differences were not statistically significant. Of the 31 patients (68.9%) with follow-up data (for a median of 3.2 years [range 0.2-15.9]), complete remission was achieved in 12 (38.7%) patients, and the accumulative complete remission rate was 44.1% at 5.5 years. No specific baseline characteristics or immunosuppressants were found to correlate with the treatment response. A total of 26 patients underwent both ultrasound and MRI examination, and the Kappa value of the diagnostic results between ultrasound and MRI was 0.91.@*CONCLUSION@#EF is characterized by symmetrical subcutaneous swelling and induration in the limbs, accompanied by eosinophilia and hypergammaglobulinemia. Glucocorticoid is effective for treating EF. Ultrasound examination can identify thickening of subcutaneous fascia for an early diagnosis of EF.

Professor LI De-hua's experience in treating facial nerve injury after total parotidectomy with blade needle based on jingjin theory / 中国针灸

The paper summarizes the academic thought and clinical experience of professor LI De-hua in treatment of facial nerve injury after total parotidectomy with blade needle based on jingjin (muscle region of meridian, sinew/fascia) theory. This disease is located at muscle regions of hand-/foot-three yang meridians; and the sinew/fascia adhesion is its basic pathogenesis, manifested by "transversely-distributed collaterals" and "knotted tendons". In treatment, the knotted tendons are taken as the points. Using the relaxation technique of blade needle, the lesions of sinews/fascia are dissected and removed to release the stimulation or compression to the nerves and vessels so that the normal function of sinews/fascia can be restored.

Theory and application of pulse diagnosis at Renying and Cunkou regions / 中国针灸

Renying and Cunkou pulse diagnostic method is one of the important parts of the pulse diagnosis in Huangdi Neijing (Inner Canon of Yellow Emperor) and has been controversial since its proposal. This article takes WANG Shu-he's diagnostic operation as the evidence, and is in reference of the statement, "Cun region (the region ahead of Guan region of Cunkou) determines the human life, that on the left hand refers to Renying, while on the right hand is Qikou". The pulse conditions on the left and right hands represent yin and yang. If Renying pulse on the left is greater, the diseases are in yang meridians, while if Cunkou pulse on the right is bustling, the diseases are in yin meridians. By comparing the pulse condition and strength, as well as the pulse beating (rapid and urgent) between Guan region and region ahead of Guan on the same side, the conditions of three yang and three yin meridians are detected. In treatment, based on the records of Renying and Cunkou pulse diagnosis in Huangdi Neijing, the principles are proposed for reinforcing and reducing methods on hand and foot meridians of yin and yang. Five-shu points and yuan-source points are taken as the main acupoints in acupuncture treatment. During treatment, the changes in pulse conditions should be emphasized specifically and those at Renying and Cunkou regions are the criteria for judging qi arrival and qi regulation.

Application of automatic injection device based on automatic hemostasis in injection of radiopharmaceutical bolus injection / 生物医学工程学杂志

In clinical practice, radiopharmaceutical dynamic imaging technology requires the bolus injection method to complete injection. Due to the failure rate and radiation damage of manual injection, even experienced technicians still bear a lot of psychological burden. This study combined the advantages and disadvantages of various manual injection modes to develop the radiopharmaceutical bolus injector, and explored the application of automatic injection in the field of bolus injection from four aspects: radiation protection, occlusion response, sterility of injection process and effect of bolus injection. Compared with the current mainstream manual injection method, the bolus manufactured by the radiopharmaceutical bolus injector based on the automatic hemostasis method had a narrower full width at half maximum and better repeatability. At the same time, radiopharmaceutical bolus injector had reduced the radiation dose of the technician's palm by 98.8%, and ensured more efficient vein occlusion recognition performance and sterility of the entire injection process. The radiopharmaceutical bolus injector based on automatic hemostasis has application potential in improving the effect and repeatability of bolus injection.

Design and application of wrist restraint gloves suitable for patients with agitation / 中华危重病急救医学

Patients in the intensive care unit (ICU) often need to have various catheters placed on their bodies due to their severe condition. In order to prevent the occurrence of unplanned extubation, patients' hands should be restrained appropriately. The current restraint gloves used in clinical practice have problems such as improper restraint, easy falling off of oxygen saturation monitoring probes, and pressure injury of hands. Therefore, department of critical care medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine designed a wrist restraint glove suitable for restless patients, and obtained the national utility model patent (ZL 2020 2 1612453.7). The device is composed of restraint gloves and restraint rings, which can not only restrain patients, but also continuously monitor the changes of blood oxygen saturation in patients with restfulness. This device is convenient to use, low cost, comfortable to wear, and can prevent the occurrence of device-related pressure injuries, which is suitable for clinical application.

Mechanical effects of needle texture on acupoint tissue / 中西医结合学报

OBJECTIVE@#This study aims to clarify how the stimulation of acupuncture points is achieved by needles with different surface texture during acupuncture; it also seeks to lessen injury at the insertion site and increase the therapeutic efficacy of acupuncture, by simulating the mechanical effects of various needle surface patterns on Zusanli (ST36) without changing the radius of acupuncture needles.@*METHODS@#Five acupuncture needle models with different surface patterns, including the smooth needle, the lined needle, the ringed needle, the left-hand threaded needle and the right-hand threaded needle, and a layered model of the Zusanli acupoint were used to investigate how to reduce tissue damage and increase stimulation during acupuncture treatment. Puncturing of the skin as well as lifting-inserting and twisting needle manipulations were simulated using these models, and the degree of damage and force of stimulation caused by the acupuncture needles with different surface patterns during acupuncture were compared.@*RESULTS@#The smooth needle and the lined needle caused the least tissue damage during insertion, while the left-hand threaded and the right-hand threaded needles caused the most damage. The ringed needle, the left-hand threaded needle and the right-hand threaded needle stimulated the acupoint tissue more during lifting-inserting manipulations, while the lined needle and the smooth needle produced less stimulation. The stimulation of the lined needle on the acupoint tissue was the largest during twisting manipulation, whereas the left-hand threaded needle and the right-hand threaded needle had smaller effects. In lifting-inserting and twisting manipulations, both the left-hand threaded needle and right-hand threaded needle provided more stimulation, but the torsion direction in which they produced better stimulation was the opposite.@*CONCLUSION@#According to the simulation results, the ringed pattern enhances stimulation best in the lifting-inserting manipulation, whereas the lined pattern enhances stimulation best in the twisting manipulation. Both the right-hand and left-hand thread patterns have certain enhancing effects in these two operations. Taking the geometric properties of the pattern into account, the left-hand thread pattern and the right-hand thread pattern have the geometric characteristics of both the lined pattern and the ringed pattern. To conclude, a pattern perpendicular to the movement direction during the acupuncture manipulation creates more stimulation. These results have significance for future needle design. Please cite this article as: Sun MZ, Wang X, Li YC, Yao W, Gu W. Mechanical effects of needle texture on acupoint tissue. J Integr Med. 2023; 21(3): 254-267.

A prospective, comparative study of the analgesic effect between the WALANT technique and local anesthesia associated with sedation for hand surgery

Purpose: The primary objective of this study was to compare the WALANT (wide awake, local anesthesia, no tourniquet) technique with local anesthesia associated with sedation in relation to pain intensity for minor hand surgical procedures. The secondary objective was to evaluate the need for analgesic complementation. Methods: A prospective, randomized, comparative, and clinical study was carried out. The sample size in each group was determined after statistical evaluation of the results of a pilot project. The participants were allocated to one of two groups; those in group 1 were submitted to the WALANT technique, and those in group 2, to local anesthesia associated with sedation, for elective surgery. The surgical procedures were carpal tunnel syndrome, De Quervain's tenosynovitis, synovial cyst, finger cyst, and trigger finger. Pain intensity, need for complementation and evolution to complex regional pain syndrome were evaluated. Results: There was no difference between groups in pain intensity after WALANT and need for intraoperative complementation. There was no significant difference in the amount of opioid applied postoperatively between the groups. There was no difference between groups regarding comfort during surgery. There was no difference in adverse effects and complications between the groups. Hematoma was the most frequent adverse event. No severe adverse events were observed. Conclusions: The WALANT technique promoted an analgesic effect similar to that of local anesthesia associated with sedation, without increasing adverse effects.

Colgajo microquirúrgico antebraquial en cirugía reconstructiva / Antebrachial microsurgical flap in reconstructive surgery

El colgajo antebraquial anterior es una excelente área dadora para transferir tejido. A lo largo de los años el colgajo antebraquial libre ha tomado fuerza dado que proporciona la cantidad de tejido a donar, su localización y, por sobre todo, la facilidad de disección, que se necesita para cubrir diferentes defectos en todo el cuerpo. Además, debe optimizar los resultados funcionales y estéticos. El sitio receptor debe cumplir en la medida de lo posible, utilizando colgajos con características similares, restablecer la integridad estructural o la función. Material y métodos. Se han realizado desde marzo 2021 a marzo del corriente año un total de 26 colgajos antebraquial libre. Los pacientes de esta serie fueron 80% hombres y 20% mujeres con un rango de edad de 25 a 73 años. Se utilizó tanto para patologías oncológicas, traumáticas e incluso colgajo de elección en pacientes trans para la creación del falo. Se tuvo en cuenta la utilización de la mano no hábil del paciente para así disminuir los riesgos de secuelas funcionales. Este colgajo aporta buen volumen de isla de piel, su pedículo es constante y confiable. La disección del colgajo, en manos entrenadas, acorta los tiempos quirúrgicos y demostró ser útil en muchísimas zonas receptoras del cuerpo. Resultados. Se logró el aporte de tejido necesario en todas las patologías a tratar, utilizando como zonas receptoras diferentes tipos de pedículos. También se logró un buen resultado tanto estético como funcional, volviendo a dar al paciente una calidad de vida aceptable. Conclusiones. El colgajo antebraquial libre ha demostrado ser útil en diversas patologías a tratar. Buen tegumento, su disección es fácil y accesible para cirujanos reconstructivos que recién comienzan su formación así como para cirujanos ya entrenados. Consta de un pedículo confiable con buen diámetro y longitud, lo cual lo hace aún más verídico para contar como primera opción cuando se lo necesita como colgajo libre.

The anterior antebrachial flap is an excellent donor area for tissue transfer. Over the years the free antebrachial flap has gained strength since it provides the amount of tissue to donate, its location and above all the ease of dissection, which is needed to cover different defects throughout the body. It must also optimize functional and aesthetic results. The receiving site should comply as far as possible, using flaps with similar characteristics, restore structural integrity or function

Técnica de WALANT en cirugías ambulatorias de mano en pacientes post COVID-19 / Walant technique in outpatient hand surgeries in post COVID-19 patients

El objetivo de esta investigación es evaluar la utilidad de la Técnica de WALANT en cirugías ambulatorias de mano en pacientes post Covid-19 en el Hospital General del Sur "Dr. Pedro Iturbe", Maracaibo, Estado Zulia, durante el periodo de julio del 2020 a octubre del 2021. Se realizó un estudio pre-experimental, longitudinal y prospectivo. El muestreo fue probabilístico al azar simple. Se aplicó un análisis estadístico de tipo descriptivo. Se incluyeron 50 pacientes con edad promedio de 37,02+/- 14,1(18-64) años, 52% de sexo femenino y 48% masculino. De ocupación 46% comerciante y obrero. Ama de casa y oficinista 44%, otros 10%. Con diagnóstico de dedo en gatillo 20%, síndrome del túnel carpiano 24%. Con la técnica se realizaron procedimientos quirúrgicos tipo neuroadhesiolisis del nervio mediano 24%, exéresis 22%. Tiempo quirúrgico de 5 a 10 minutos de duración en 56,9% de los casos. Se encontró punta de EVA: preoperatorio 56% de 7-10 ptos, Intraoperatorio 64% 0 ptos y postoperatorio 66% 0 ptos. Analgesia de rescate 92%. 88% sin complicaciones. La estancia Hospitalaria en 92% de los casos fue 1 hora. Reintegro a sus actividades 90%. Tiempo de reintegro en 46% de los casos de 1-5 días. 86% de los pacientes se sintieron satisfechos. En conclusión, la Técnica de WALANT en pacientes post Covid-19 es de gran utilidad para la realización de cirugías ambulatorias de bajo riesgo de mano, presentó pocas complicaciones, el tiempo quirurgo fue corto, el reintegro a sus actividades fue rápido y la satisfacción del paciente fue buena(AU)

The objective of this study is to evaluate the usefulness of the WALANT Technique in ambulatory hand surgeries in post- Covid-19 patients at the Hospital General del Sur "Dr. Pedro Iturbe", Maracaibo, Estado Zulia, during the period from July 2020 to October 2021. A pre-experimental, longitudinal and prospective study was made. Sampling was simple random probabilistic. A descriptive statistical analysis was applied. 50 patients were included with an average age of 37,02+/-14,1(18-64) years, 52,0% female and 48,0% male. Occupation 46,0% merchant and worker. Housewife and office 44,0%, others 10,0%. With a diagnosis of trigger finger 20,0%, carpal tunnel syndrome 24,0%. With the technique, 24,0% median nerve neuroadhesiolysistype surgical procedures were performed, 22,0% exeresis. Surgical time from 5 to 10 minutes in 56,9% of cases. A VAS tip was found: preoperative 56,0% 7-10 points, intraoperative 64,0% 0 points and postoperative 66,0% 0 points. Rescue analgesia 92,0%. 88,0% without complications. Hospital stay in 92,0% of cases was 1 hour. Refund to their activities 90,0%. Refund time in 46,0% of cases from 1-5 days. 86,0% of the patients felt satisfied. In conclusion, the WALANT Technique in post-COVID-19 patients is very useful for performing low-risk outpatient hand surgeries, it presented few complications, the surgical time was short, the return to their activities was fast and the satisfaction of the patient. patient was good(AU)

Satisfaction of Patients Undergoing Hand Surgery / Satisfação dos pacientes submetidos à cirurgia de mão

Abstract Objective To assess the satisfaction of patients undergoing hand surgery in relation to their hospitalization, their feelings, and the consequences resulting from the surgical procedure as well as to evaluate their opinion and feelings in relation to the surgical procedure and to detect possible weaknesses in the health care of patients undergoing hand surgery. Method Cross-sectional observational clinical study, with a quali-quantitative focus, carried out in an outpatient clinic of a teaching hospital specialized in hand care, with patients of both genders, aged 18 to 75 years, who have undergone corrective surgical procedures of hand pathologies in the last 5 years. Results We obtained a total of 54 participants, 26 females and 28 males, with a minimum age of 18 years and a maximum of 73 years. Patient satisfaction for the 11 moments evaluated had means between 8 and 10, showing great satisfaction. For the other five moments evaluated, the means were between five and eight. We did not get any satisfaction average below fivr. Conclusion The absolute satisfaction of patients undergoing hand surgery is dependent on the humanization of health care, especially in relation to surgical consequences, which require further follow-up. The surgical consequences that require greater follow-up and hinder the routine activities of patients are pain on hand mobilization, limitation of the range of motion, and parathesthesia; thus, proper management of these complaints leads to greater satisfaction.

Resumo Objetivo Determinar a satisfação dos pacientes submetidos a cirurgia de mão em relação a sua internação, seus sentimentos, e as consequências decorrentes do procedimento cirúrgico bem como avaliar sua opinião e seus sentimentos em relação ao procedimento cirúrgico e detectar possíveis fragilidades na atenção à saúde do paciente submetido a cirurgia de mão. Método Estudo clínico observacional de corte transversal, com enfoque quali-quantitativo, realizado em um ambulatório especializado em cuidado da mão de um hospital de ensino, com os pacientes de ambos os gêneros, com idade de 18 a 75 anos, que tenham sido submetidos a procedimentos cirúrgicos corretivos de patologias da mão nos últimos 5 anos. Resultados Obtivemos o total de 54 participantes, sendo 26 do sexo feminino e 28 do sexo masculino, com idade mínima de 18 anos e máxima de 73 anos. Em relação à satisfação dos pacientes em 11 momentos avaliados, as médias foram entre 8 e 10, mostrando grande satisfação. Para os outros cinco momentos avaliados, as médias ficaram entre cinco e oito. Não obtivemos nenhuma média de satisfação abaixo de cinco. Conclusão A satisfação absoluta dos pacientes submetidos à cirurgia de mão é dependente da humanização da assistência à saúde, principalmente em relação às consequências cirúrgicas, que demandam maior acompanhamento. As consequências cirúrgicas que demandam maior acompanhamento e que dificultam as atividades rotineiras dos pacientes são dor à mobilização da mão, limitação do arco de movimento, e parestesia; assim, o manejo adequado dessas queixas leva à maior satisfação.