Cannabinoid Use in Musculoskeletal Illness: a Review of the Current Evidence.

PURPOSE OF REVIEW: The use of cannabinoids has increased since legalization of recreational and medical use in the USA. It is likely that many orthopaedic patients consume cannabinoid products during the traumatic or perioperative period. The purpose of this study was to investigate the pre-clinical data evaluating the mechanism of action of cannabidiol (CBD) and Δ9-Tetrahydrocannabinol (Δ9-THC) and to evaluate the current clinical data on the use of cannabinoids in musculoskeletal illness. RECENT FINDINGS: Recent pre-clinical studies have demonstrated that cannabinoid use and the endocannabinoid system (ECS) has an important role in bone healing and bone homeostasis. There is data that suggests that the use of cannabidiol (CBD) may increase bone healing, whereas the use of Δ9-Tetrahydrocannabinol (Δ9-THC), the major psychoactive ingredient in marijuana, likely inhibits bone metabolism and repair. The clinical implications and consumption of marijuana by orthopaedic patients have not been thoroughly evaluated. Studies have demonstrated concern for negative cardiovascular and psychiatric effects caused by marijuana use, but have not yet elucidated outcomes in the orthopaedic literature. With the recent increase in advertising of CBD products and legalization of marijuana, it is likely that many orthopaedic patients are consuming cannabinoid products. The clinical implications and consumption of these products are unclear. We need more robust and well-designed clinical studies prior to making further recommendations to our patients on the consumption of these products.

Identifying the Causes of Nutrition Inadequacy in Vietnamese Married Immigrant Women and Korean Spouses through Qualitative Research

This study examined the possible causes of nutritional inadequacy in Vietnamese immigrant women married to Korean husbands. Qualitative in-depth interviews were conducted with a sample of 34 Vietnamese marriage immigrant women and 17 Korean spouses participating in or having experienced Nutrition Plus from four Community Health Centers in Seoul, Korea. The study results showed that the nutritional staus of the Vietnamese marriage immigrant women was affected by the unfamiliar Korean food (cultural factor), low household income (economical factor), difficulty in purchasing Vietnamese food (environmental factor), and low accessibility to nutrition support systems (social factor). The Korean husbands' nutritional status was affected by the unfamiliar Vietnamese food (cultural factor), low household income (economic factor), and irregular working conditions (social factors). Nutritional interventions as a public service to the community needs to be developed and applied. Suggestions are presented regarding the future efforts to better understand and meet the nutrition needs of intermarried couples to respond to their heterogeneous needs and deliver adequate nutrition service to ever increasing intermarried families.

An X-band Bi-Directional Transmit/Receive Module for a Phased Array System in 65-nm CMOS.

We present an X-band bi-directional transmit/receive module (TRM) for a phased array system utilized in radar-based sensor systems. The proposed module, comprising a 6-bit phase shifter, a 6-bit digital step attenuator, and bi-directional gain amplifiers, is fabricated using 65-nm CMOS technology. By constructing passive networks in the phase-shifter and the variable attenuator, the implemented TRM provides amplitude and phase control with 360° phase coverage and 5.625° as the minimum step size while the attenuation range varies from 0 to 31.5 dB with a step size of 0.5 dB. The fabricated T/R module in all of the phase shift states had RMS phase errors of less than 4° and an RMS amplitude error of less than 0.93 dB at 9⁻11 GHz. The output 1dB gain compression point (OP1dB) of the chip was 5.13 dBm at 10 GHz. The circuit occupies 3.92 × 2.44 mm² of the chip area and consumes 170 mW of DC power.

Development of Nutrition Education Program for Vietnamese Female Marriage Immigrants in Korea Based on the Health Belief Model

This study was conducted to develop a nutritional education program based on the health belief model to improve nutritional status among Vietnamese female marriage immigrants in Korea. The education program was developed through literature review, focus group interviews, expert consultation, and pilot tests. Based on theoretical requirements and needs of beneficiaries, the education program was consisted of 16 sessions with nine topics: ‘how to evaluate own dietary habits and nutritional status’, ‘health problems according to dietary habits and nutritional status’, ‘understanding six food groups’, ‘healthy eating plan’, ‘understanding food cultures of Korea and Vietnam’, ‘traditional and seasonal Korean foods’, ‘how to cook Korean food’, ‘nutrition management of family members’, and ‘practicing of healthy dietary life’. Program contents in each session consisted of activities that could induce outcome and value expectations, self-efficacy, perceived benefits, and barriers and cues to actions regarding dietary behavior. This nutritional education program based on the health belief model would be helpful to implement healthy diet behaviors in Vietnamese marriage immigrants and their families. Extension of these nutritional education programs to health centers and multicultural family support centers would improve the current poor nutrition status of Vietnamese marriage immigrant women. Further studies are needed to validate our program.

Qualitative Study on Improvement of Operating System and Tailored Nutrition Education Program for Marriage Immigrants to Korea: Program Providers' Perspective / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study is to analyze the current status of nutrition education programs for multicultural families and to provide policy suggestions for improvement. METHODS: In-depth interviews of a total of 21 multicultural experts were conducted; 15 people were interviewed individually, while 6 people were interviewed in groups of three. RESULTS: In-depth interviews revealed various problems related to the operation of nutrition education programs. The causes of problems were analyzed and categorized as four factors: systemic, practical, environmental and cultural. As for the systematic factors, insufficient linkage between related organizations and duplicate performance of several projects were identified as concerns Establishment of a control tower and strengthening the linkage among the related organizations may be needed to address this concern. With regard to practical factors, the study identified that language barriers, and lack of nutritional education media and tools translated into multicultural languages were limiting factors. These limitations the development of nutrition education materials that aretranslated into multiple languages, implementation of education programs that are different from the Korean education, and by providing interpreters. As for the environmental factors, low educational level and poor nutritional knowledge of multicultural women made it difficult for them to understand the contents of the education. Demonstration, practical training and urgent education on pregnancy and childbirth nutrition were identified as needs to address these concerns. Withregard to cultural factors, food culture conflict with Korean families, and difficulties in home practices were detected as concerns. Participants in the study suggested that getting education with family and facilitation of weekend and nighttime programs health of this community. CONCLUSIONS: Further studies are needed to adopt more effective and efficient nutrition intervention to promote the healthy eating of the married immigrant women based on the study results.

REDUCE-PCP study: radiographs in the emergency department utilization criteria evaluation-pediatric chest pain.

BACKGROUND: Many emergency physicians order chest x-rays (CXRs) for pediatric patients who present with a chief complaint of chest pain despite a paucity of research to support this testing, which exposes patients to radiation, cost, and delays. OBJECTIVES: This study aimed to begin development of a decision making tool that will allow emergency physicians to selectively obtain CXR films in pediatric patients presenting with chest pain. METHODS: We performed a retrospective cohort study of 400 consecutive pediatric patients with a chief complaint of chest pain and reviewed charts to determine how many received a CXR and which clinical characteristics were present in all patients. Chest radiograph findings were graded for significance as follows: (1) no or minor clinical significance: normal result in the CXR film without effect on the immediate evaluation of a patient; (2) moderate clinical significance: only impact on plan for follow-up; and (3) major clinical significance: result in the CXR film directly affects immediate management. We then evaluated each chart for historical or examination findings that might identify criteria associated with positive radiographic findings to propose a set of criteria that could lead to the development of a decision rule that allows a reduced utilization while having a high sensitivity for clinically significant positive findings on CXR film. RESULTS: Of the 400 pediatric patients reviewed, 63.5% (n = 254) received a CXR in the emergency department (ED). Of those receiving a CXR, only 8.26% (n = 21) had a finding that affected either ED management or follow-up planning. The criteria that would have identified all patients with positive results in the CXR films were abnormal vital signs, shortness of breath, palpitations, presence of comorbidities, abnormal or unilateral breath sounds, history of trauma, murmur, or cough. CONCLUSIONS: This pilot study demonstrates the potential for a decision rule to eliminate both cost and radiation exposure by using defined criteria to determine the need for a CXR in pediatric ED patients. We identified 8 simple criteria that would have identified all children who benefited from a CXR in this study. The next phase of this study will prospectively evaluate the utility of each of the criteria as part of a draft decision rule.

Identification, validation and high-throughput genotyping of transcribed gene SNPs in cassava.

The availability of genomic resources can facilitate progress in plant breeding through the application of advanced molecular technologies for crop improvement. This is particularly important in the case of less researched crops such as cassava, a staple and food security crop for more than 800 million people. Here, expressed sequence tags (ESTs) were generated from five drought stressed and well-watered cassava varieties. Two cDNA libraries were developed: one from root tissue (CASR), the other from leaf, stem and stem meristem tissue (CASL). Sequencing generated 706 contigs and 3,430 singletons. These sequences were combined with those from two other EST sequencing initiatives and filtered based on the sequence quality. Quality sequences were aligned using CAP3 and embedded in a Windows browser called HarvEST:Cassava which is made available. HarvEST:Cassava consists of a Unigene set of 22,903 quality sequences. A total of 2,954 putative SNPs were identified. Of these 1,536 SNPs from 1,170 contigs and 53 cassava genotypes were selected for SNP validation using Illumina's GoldenGate assay. As a result 1,190 SNPs were validated technically and biologically. The location of validated SNPs on scaffolds of the cassava genome sequence (v.4.1) is provided. A diversity assessment of 53 cassava varieties reveals some sub-structure based on the geographical origin, greater diversity in the Americas as opposed to Africa, and similar levels of diversity in West Africa and southern, eastern and central Africa. The resources presented allow for improved genetic dissection of economically important traits and the application of modern genomics-based approaches to cassava breeding and conservation.

Enhanced adaptive loop filter for motion compensated frame.

We propose an adaptive loop filter to remove the redundancy between current and motion compensated frames so that the residual signal is minimized, thus coding efficiency increases. The loop filter coefficients and offset are optimized for each frame or a set of blocks to minimize the total energy of the residual signal resulting from motion estimation and compensation. The optimized loop filter with offset is applied for the set of blocks where the filtering process gives coding gain based upon rate-distortion cost. The proposed loop filter is used for the motion compensated frame whereas the conventional adaptive interpolation filter (AIF) is applied to the reference frames to interpolate the subpixel values. Another conventional scheme adaptive loop filter (ALF), is used after deblocking filtering to enhance quality of reconstructed frames, not to minimize energy of residual signal. The proposed loop filter can be used in combination with the AIF and ALF. Experimental results show that proposed algorithm provides the averaged bit reduction of 8% compared to conventional H.264/AVC scheme. When the proposed scheme is combined with AIF and ALF, the coding gain increases even further.

Development and Evaluation of a Transitional Care Program for Patients Discharged from Military Hospitals

PURPOSE: The purpose of this study was to develop and evaluate a transitional care program for patients discharged from military hospitals. The study consists of two phases: developing the program and evaluating its effectiveness. METHODS: The conceptual framework used to guide the development of the program was Meleis's transition theory. A quasi-experimental design was employed for this study. Participants were recruited from patients discharged from one military hospital, 72 in the control group and 56 in the experiment group. Data were analyzed using SPSS WIN 12.0 program with chi-square, Fisher's exact test, independent t-test, and mixed model. RESULTS: Participants in the transitional care program reported promoting a positive personal condition, and more healthy patterns of response in the first week after being discharged and a smoother discharge transition. CONCLUSION: The transitional care program developed for discharge patients from military hospital promoted discharge readiness and promoted smooth discharge transition.

A Clinical Study on the Treatment of Tibial Shaft Fracture in Adult / 대한정형외과학회잡지

Sixty four cases of tibial shaft fracture in adult were treated by various methods at Department of Orthopedic Surgery, Koryo General Haspital during 3 years from March 1983 to Feb. 1986. The resuIts of 'treatment of these cases were analysed according to method of treatment, type and level of fracture, and degree of injury, in attempt to seek the most suitable method of treatment. The following results were observed 1. Of 64 cases of tibial shaft fracture, 24 cases were treated by cast immobilization, 16 cases by 0/ R and plate, screw fixation, 17 cases by Ender I-M nailing, 7 cases by Hoffmans ext. fixator. 2. The most common site of fracture was middle 1/3 of the shaft (62.5%). 3. On the union time of fracture, I-M nailing by use of Ender nail was more rapid than other methods of treatment. (average: 16.2 Wks. POD) 4. On the time of weight bearing, earlier weight bearing was possible by Ender I-M nailing than other method of treatment. 5. On the complications of fracture, fewer complications were developed after Ender I-M nailing than other method of treatment. 6. According to Modified Ellis classification, more rapid union was obtained by C/R and cast imm-obilization in the case of Minor degree, no significant difference among each group in the case of Moderate degree.

A Clinical Analysis of Treatment of Intertrochanteric Fractures between the Fixation with Ender Nail and Sliding Screw Plate / 대한정형외과학회잡지

The incidence of the interochanteric fracture of femur is increasing and this increase is likely to continue for many years due to increase of traffic accident and old people. The primary goal in the treament of an elderly patient with an intertrochanteric fracture is to return the patient to his prefracture activity as soon as possible. Rapid mobilization of a pain free patient helps to prevent skin ulceration, pneumonia, urinarystasis, thromboembolic disease and other complications of confinement to bed in the eldery. For there reasons, treatment of intertrochanteric fractures by surgical methods has become the standard procedure. The authors treated 53 cases of intertrochanteric fractures from March 1978 to February 1985 with Ender nail or sliding screw plate. The results obtained as follows: l. In the 34 cases where sliding screw plates were used, the patients average age was 49.4 years old and in the 19 cases where Ender nails were used, the average in age was 63.2 and therefore, compared to the sliding screw plate, the patients using Ender nails were about 13.8 years older. 2. In the cases where Ender nails were used, the average operation hours took in the average of 55 minutes and whereby, in the cases where sliding dcrew plates were used, took in the average of 125 minutes, and during the operation time, the amout of hemorrhage in the cases of Ender nail was about 150ml and the sliding scew plate resulted in about 610ml. 3. The average weight bearing period in the cases which Ender nails were used took in the average of 2.5 weeks, where by the sliding scew plates took in the average of 9.8 weeks. 4. In the cases where Ender nails were used, the radiological bony union time was about 12.7 weeks and the sliding screw plate took about 16.1 weeks. 5. In the cases of Ender nail, if, in the geriatric age, the indication is chosen well, it will result in a benefial treatment method.

Myotonia Dystrophica: A Case Report / 대한정형외과학회잡지

Myotonia dystrophica(Synonym: Myotonia atrophica, Dystrophia myotonia, Steinert's disease) is a autosomal dominant hereditary multisystemic disorder involving several organs besides skeletal muscle, and commonly called with myotonia congenita, paramyotonia congenita as myotonia. Although most cases are of adult onset, where a mother has the disease, neonatal dystrophia myotonia can occur in her offspring. The main feature is a steadily progressive muscle dystrophy, complicated by myotonia, which is a failure of muscles to relax normally after a forceful contraction. Steinert in 1909 was the first to report the finding of atrophic testes and baldness in patients with myotonia dystrophica, and the other clinical feature of myotonia dystrophica were reported by many authors after that time. We are reporting a case of myotonia dystrophica, which showing familial history with brief review of literature.

Poymyositis; A Case Report / 대한정형외과학회잡지

Polymyositis is uncommon, nonsuppurative Connective tissue disorder. We have experienced a case of polymyositis. Patient was a 20-y.ear old female in good healthy appearance with history of mild, progressive muscle weakness of lower extremities and inability to walk up and down of stairs in recent 3 weeks. Her symptoms were mainly subjective and individual muscle test revealed no abnormalities, but evidences of primary myopathy were easily obtained by muscle biopsy, electromyogram and several enzyme values. We are reporting a case of polymyositis with brief review of literature.

Etiologic Factors of Delayed and Non / 대한정형외과학회잡지

Delayed and non-union of the femur shaft fractures in adult have been increased in spite of improvement of method of treatment. In geheral, the principal factors predisposing to delayed and non-union have been known as infection, disturbances of the blood supply, poor immobilization (inadequate rigid fixation), distraction of fracture site. 43 cases of the femur shaft fractures in adult over 18 years old examined at the department of orthopedic surgery, Korea General Hosipital, during the period of January 1973 to January 1982, were divided into two Groups; Group A was 31 cases, which had been taken solid bony union as control group and Group B was 12 cases, which had been developed delayed and non-union. Group A and B were analysed to find out other etiologic factors such as liver function which were suspicious to result in delayed or non-union of the fracture except above mentioned principal factors. The results were as follows, l. In delayed and non-union group (Group B), the interval of age was 20 to 40 years of age, open fracture was 33.4% comparing to control(6.5%), comminuted fracture was 83%, comparing to control (42%), the time interval to operation was delayed over 2 weeks(18%) comparing to control(8%g), and gap between fractured ends after internal fixation was more than 2mm in 33% comparing to control(absent), and liver function, especially, SGOT, and SGPT was bad in 46% comparing to control(13.4%). 2. All 3 cases ot infection in fracture site were in delayed and non-union group, tracture level, associated injury and postoperative immobilization were not concerned with delayed and non-union between two groups.

Epidural Block for the Treatment of Low Back Pain and Sciatica / 대한정형외과학회잡지

In spite of numerous dinical and patho-anatomical studies made in the past, there are still different opinions concerning the mechanism of low back pain. The sciatic symptoms in degenerative lumbar disc disease may arise from the direct mechanical effect of pressure exerted by protruding disc material on nerve roots, and that such symptoms may therefore be relieved by surgical decompression of the nerve roots, has been widely accepted for nearly 40 years. There is, however, a good deal of evidence, both from operative and histological findings as well as from indirect sources, which suggests that inflammatory changes present in and around affected nerve roots may also be of importance in the production of sciatic symptoms in lumbar disc disease. The possibility that, at least in some cases, these inflammatory changes could contribute significantly or even predominantly to the production and persistence of sciatic symptoms, has stimulated many attempts to treat sciatica by means of local antiinflammatory measures in particular, corticosteroid injections. We have studied the effect of the injection of mixture triamcinolone and local anesthetic (1% xylocaine or 0.5% marcaine) comparing with the effect of usual conservative treatment of low back pain and sciatica. Of the 92 patients suffered from lumbago & sciatica, who were treated from 1979. 7 to 1981. 7 in Korea and Jae Il general hospital, 44 patients were treated with intermittent epidural block, 12 patients with continuous epidural block and 36 patients were treated only with usual conservative treatment. The results of clinical observation were as follows: 1. The causative disease were herniated nucleus pulposus in 60 patients (64%), lumbar sprain in 12 (13%), degenerative joint disease of spine in 11 (12%),… 2. The epidural block cases were divided into acute group (symptoms less than 3 months) and chronic group (symptoms longer than 3 months). The over all improvement of the acute group was 22 of 27(81%) and of the chronic group was 22 of 29(76%). The duration of symptoms didnt influenced significantly the effect of epidural block. 3. Therapeutic effect of epidural block was as follows; complete relief 22 of 56(39%), marked relief 13 of 56(23%), slight relief 9 of 56(16%), no improvement 12 of 56(22%). The over all improvement was resulted in 44 of 56(78%): intermittent epidural block 34 of 44(77%), continuous epidural block 10 of 12(83%). 4. Therapeutic effect of conservative treatment was as follows; complete relief 10 of 36(28%), marked relief 7 of 36(19%), slight relief 4 of 36(11%), no improvement 15 of 36(42%). The over all improvement of symptoms was resulted in 21 of 36(58%). 5. Follow up period of epidural block patients were 3 months in average, and persistent relief of symptom were obtained in 12 out of 20 patients(60%), and recurrence of symptom were in 6 of 20 patients(30%). It is considered that epidural block will shorten the time of recovery from severe pain, avoid hospitalization or long periods of bed rest and allow earlier physiotherapy. In addition it may avoid the need for surgical intervention to produce rapid relief of acute pain and give to patient economic, psychologic benefit.

Primary Malignant Fibrous Histiocytoma in the Long Bones: 2 Cases / 대한정형외과학회잡지

Malignant fibrous histiocytama is currently defined as a malignant primary bone tumor, and that may contain fibromatoua, xanthomatous, or histiocytic elementa, varing widely in the degree of anaplasia that is present. The principal lesions to be considered in the differential diagnoais of malignant fibrous histiocytoma are osteogenic sarcoma and fibrosarcoma. Malignant fibrous histiocytoma is more sensitive to chemotherapeutic ageata than are osteosarcama and fibrosarcama. In this paper 2 cases sre reported, including the one in which the tumor arose in a midahaft of the femur and the other one arosein the upper metaphyseal portion of the tibla.

The Treatment of Femoral Shaft Fractures by Cast Brace / 대한정형외과학회잡지

10 cases of femoral shaft fractures were treated by cast brace during the past 5 years from May, 1975 to August, 1979 at the Department of Orthopedic Surgery, Korea General and Jae II Hospital, The results were summarized as follows; 1. Of the 10 cases, 8 cases were male and 2 were female, and age distribution was between 14 and 65. 2. 5 cases were treated by cast brace from the start as the primary treatment and the other 5 were by other method initially and followed by cast brace secondarily. 3. One of 5 cases treated by early cast brace developed delayed union and the other one of 5 cases treated by late cast brace secondarily developed non-union, which were treated by open reduction and internal fixation with cancellous bone graft. 4. The cast brace was applied within the first 6 weeks after fracture and average application time was 9. 7 weeks in the cases treated by early cast brace, which was compared with 12.5 weeks in the late cast brace group. 5. Average time of fracture healing was 13.5 weeks in the early cast brace group and 18. 5 weeks in the late cast brace group. 6. In three of 10 cases, counter traction was applied to reduce the limb shortening during bed rest.

Statistical Study of the Lumosacral Angles in Lumbago Patients / 대한정형외과학회잡지

The purpose of this study is to assess the differences of the lumbosacral angles between the lying and standing position among Iumbago patients. Among Iumbago patients the following diseases with known causes were exclused in this study; spondylolisthesis, spondylolysis, pure herniated nucleus pulposus, tuberculous spondylitis, congenltal anomalies, trauma and psychosis etc. Only the following with unknown causes were included; idlopatic lumbago, hernlated nucleus pulposus with bone and joint changes, instability and degenerative osteoarthritis. The following lumbosacral angles were measured and evaluated in 460 lumbago patients; 271 patients in the lying position and 189 patients in the standing position. 1. Ferguson angle 2. Sacrovertebral angle (Mitchell angle) 3. LS horlzontal angle 4. Promonotorium angle 5. Line of weight bearing The results were summarized as follows; 1. Ferguson angle Lying position 38.4 Standing positon 35.3 Sacrovertebral angle 140.7 142 L5 horizontal angle 20.4 17.4 Promontorlum angle 134.4 134.9 2. Ferguson and L5 horizontal angles in lumbago patients were increased in the lying position and decreased in the standing position as compared with the angles in normal individuals (control group). 3. Sacrovertebral angle In lumbago patients was decreased in the lying position. 4. Promonotorium angle in lumbago patients was increased in the lying and standing position. 5. Judging by the Iine of weight bearing, Iumbago patients in the:lying position showed more instability as compared with that in the standing position group.

Modified High Tibial Osteotomy / 대한정형외과학회잡지

Treatment of unstable cervical spine fracture by skull traction is time consuming procedure, and treatment by Halo appratus has many advantages but it is very expensive. Bone cement has been applied occasionally as an adjunct to metallic internal fixation in treating patient with malignancy, i.e. limited life expectancy. Internal fixation with bone cement in addition to routine posterior fusion with bone graft is tried eliminate the need of application of complicated external immobilization in treating unstable cervical spine fracture of young patient. We experienced two cases of posterior cervical fusion using bone cement with satisfactory results. The advantages of this method are: 1. Rapid and solid fixation 2. Early ambulation 3. Reduce complicated external support 4. Reduce the date of hospitalization.

Pollicization: Two Cases report / 대한정형외과학회잡지

Absence of the thumb, either traumatic or congenical, causes a severe deficiency in hand function; in fact grasp and pinch are almost impossible. Thus when the thumb is partially or totally absent, reconstructive surgery is appealing. Usually the thumb should be reconstructed only when amputation has been at the metacarpophal-angeal joint or at a more proximal level. The procedures for reconstruction of the thumb are well known. They include transposition of a digit, procedures to lengthen the thumb metacarpal and methods of total reconstruction including a pedicle graft to obtain sensibility. Although pollicization (transposition of a finger to replace an absent thumb) endangers the finger, that is worthwhile, especially in complete bilateral absence of the thumb or in bilateral traumatic amputation. The each finger with a part or the whole of the metacarpal, has been transplanted to the stump of the metacarpal of the thumb or the trapezium. When all of the fingers are normal, the index finger is the best choice for thumb replacement because of its circumferential size, phalangeal length, independent motion and proximity to the thenar eminence. Recently this operation has been done with conservation of all nerves, vessels, tendons and muscles. We have had two pollicization operations (transposition of index finger) in the patient of bilateral traumatic amputation of the thumbs. Four months later excellent pinch and grasp with normal sensibility in the reconstructed thumbs were obtained with all remaining digits.