Transfer of the flexor carpi radialis to the abductor pollicis brevis tendon for the restoration of tip-pinch in severe carpal tunnel syndrome.

In patients with severe thenar atrophy secondary to carpal tunnel syndrome, we hypothesize that following open carpal tunnel release, concomitant transfer of the abductor pollicis brevis (APB) origin to the flexor carpi radialis (FCR) tendon will lead to improved patient function restoring palmar abduction and thumb opposition. We evaluated 14 patients through questionnaires and seven patients through additional physical examination (thumb range of motion, ability to tip pinch, grip/pinch strength) for a mean follow-up of 2.8 years. All patients showed evidence of palmar abduction with 71% demonstrating the ability to oppose the thumb to the tip and base of the small finger. The transfer of the APB origin to the FCR tendon can restore thumb abduction and opposition for thenar paralysis secondary to severe carpal tunnel syndrome. Patients experience good functional outcomes with the majority experiencing restored thumb opposition.

Effect of broadband noise on the human brain stem auditory evoked response.

The purpose of this paper is to describe the effect of broadband continuous noise on brain stem auditory evoked responses elicited from normal-hearing and hearing-impaired individuals. The motivation for this study derives from the increasing use of noise masking paradigms in diagnostic electrophysiology, the universal presence of background noise in everyday listening environments, and the frequent observation that background noise is more detrimental to the performance of the hearing-impaired individual than to the normal-hearing individual. Four studies were designed to evaluate: (1) the sensitivity and specificity of the latency-intensity series, (2) the sensitivity and specificity of the latency-noise series, (3) the dependence of the latency-noise series on signal-to-noise ratio near electrophysiologic threshold, and (4) the dependence of the latency-noise index on the signal level at which the test is performed. The results of the studies reported herein show that the electrophysiological response to increasing masker levels is more sensitive for identifying inner ear pathology than previously used latency-intensity series measures, without compromising specificity. It is suggested that simultaneous broadband masking should be considered as a test for localization of pathology in those subjects for whom routine behavioral measurements are not possible or when the results of such measurements are equivocal.

Variability of most comfortable and uncomfortable loudness levels to speech stimuli in the hearing impaired.

Methods for determining hearing aid settings often incorporate measurements of most comfortable loudness (MCL) and uncomfortable loudness (UCL) levels. This study examined the variability of loudness measures and their correlation to threshold data, using speech stimuli presented to hearing-impaired subjects. MCLs, UCLs, speech reception, and speech detection thresholds were obtained from 50 subjects having sensorineural impairments. The stimuli were CID W-2 spondees spoken by three female clinicians. Three MCLs and UCLs were obtained within each session, using ascending runs and a closed-set response list. Fifteen subjects were retested twice over intervals ranging from a week to several months. Between-session variability for the loudness measurements was less than or equal to 10 dB across sessions and speakers for the majority of subjects, with a tendency for the MCL and UCL to increase slightly over time. Significant variability was attributed to the use of live-voice presentation by different clinicians. High positive correlation was found between threshold and loudness data for subjects with relatively flat audiometric configurations but not for subjects demonstrating sharply sloping hearing losses.

[Conduction anesthesia in operations on the limbs]. / Provodnikovaia anesteziia pri operatsiiakh na konechnostiakh.

Conduction anesthesia with 1-2% solution of trimekain or novokain with a vasoconstrictor was used in 142 operations on the upper and lower extremities. The technique of blockade of nerve trunks of the upper and lower extremities is described. Good results of the anesthesia were obtained. There were only two complications, no lethal outcomes.