Flexor Digitorum Superficialis Opposition Transfer for Augmenting Function in Types II and IIIA Thumb Hypoplasia.

PURPOSE: To report the functional outcomes associated with the flexor digitorum superficialis (FDS) opposition transfer for types II and IIIA thumb hypoplasia and determine if there is any noteworthy difference in the outcome dependent on the pulley used. METHODS: We included patients who underwent a ring FDS opposition transfer and had at least 2 years follow-up. The study group consisted of 36 patients with 40 treated thumbs. All patients underwent follow-up examination and standardized testing. Outcome functional measures were recorded using the Pediatric Outcomes Data Collection Instrument (PODCI). There were 9 type II and 31 type IIIA hypoplastic thumbs. All patients underwent a ring FDS opposition transfer and a 4-flap z-plasty for first web space deepening. The pulley for opposition was flexor carpi ulnaris in 19 and the transverse carpal ligament in 21. Thirty-six thumbs had ulnar collateral ligament reconstructions, with 5 of the 36 undergoing combined ulnar collateral ligament/radial collateral ligament stabilizations. Average follow-up was 7.6 years (range, 2-16 years). RESULTS: Average postoperative Kapandji score was 8 (range, 4-10). Grip, lateral pinch, and tripod pinch strengths averaged 46%, 49%, and 48% of age- and sex-matched normal controls, respectively. There was no significant difference between surgical pulleys used. The Pediatric Outcomes Data Collection Instrument global was 91 (range, 53-100), and PODCI happiness was 87 (range, 15-100). CONCLUSIONS: We found the ring FDS opposition transfer to be an effective method for providing opposition for both type II and IIIA thumb hypoplasia. At follow-up, excellent opposition function and PODCI scores were noted, with no difference related to the type of pulley used. Type II thumbs had significantly greater grip and pinch strengths when compared with type IIIA thumbs.

My wound and I: patients' perspective.

Clinical photography is beneficial to clinicians and healthcare teams in the care of patients and wound management. The aim of this study was to investigate patients' perspective of wound photography in an NHS hospital outpatient clinic, assessing its personal benefits and wider applications. Patients were asked to participate in a questionnaire, to identify information about their wound(s), investigate their perspective of the benefits and uses of wound photography, as well as their preference regarding imaging operators and devices. Results showed that all participants thought that clinical images offer a more comprehensive record of their wound when used in conjunction with measurements and written descriptions. The majority of patients considered wound photography of benefit to them, to monitor their healing and they also appreciated the wider uses of these images. Clinical photographers were the preferred choice as the image operator, whereas the preference for the imaging device used was not as significant. In conclusion, participants considered wound photography to be beneficial for personal and broader purposes, with the current clinical photography service being rated highly. These findings give an insight into the patients' perspective of wound photography, which can be useful when developing and delivering services within the NHS.

Colour imaging in the monitoring and documentation of choroidal naevi. Are Optomap colour images adequate for this purpose?

An audit project to evaluate and compare three different imaging systems used to photograph choroidal naevi and to determine whether the Optos Optomap(®) can be used as the only colour image capture system for monitoring and documenting choroidal naevi. A further aim was to assess whether existing protocols could be improved to accurately document position and appearance of choroidal naevi. Twenty patients with choroidal naevi were photographed on three different colour image capture systems. Colour images were taken on the Optomap(®) wide field P200MA camera; the Zeiss FF450plus(®) mydriatic camera and the Topcon TRC-NW6S(®). All images were reviewed retrospectively by a medical retina consultant (SD) who completed a questionnaire to determine the most effective photographic system(s) in demonstrating the location of the naevi and the features of the condition. The Optomap(®) was the most effective in pinpointing the location of the naevus and the Zeiss FF450plus mydriatic camera best captured the features of the naevus. The non-mydriatic camera was rated the least satisfactory for both tasks. The location of the naevus on the retina should determine the choice of modality. If it is possible to photograph the lesion and include the optic disc or central macula, then the mydriatic camera is considered the best modality for recording both the position and features of the pathology. However, if it is not possible, because of the location, to include both the disc or central macula with the lesion in the same frame, then the Optomap(®) should be used to photograph the naevus to record its position and ideally a colour image on the mydriatic camera should also be taken to record the appearance of the lesion.

Hand therapy following elbow release for passive elbow flexion and long head of the triceps transfer for active elbow flexion in children with amyoplasia.

Children born with the Amyoplasia form of arthrogryposis multiplex congenita (AMC) who lack elbow flexor muscles and have elbow extension contractures usually require assistance in performing ADL's that require reaching their hand to their face, head, and upper body. For tasks involving the UE, the elbow is the key to functional independence. Children born with Amyoplasia may benefit from selective surgeries to enhance functional independence and improve quality of life. Home therapy and splinting following these surgeries is an important part of gaining motion and improving function. This abstract will review the rehab and splinting following an elbow release to gain passive elbow flexion, and a long head of the triceps transfer for active elbow flexion in children with Amyoplasia.

Dermoscopy: to cross-polarize, or not to cross-polarize, that is the question.

Dermoscopy is a non-invasive technique that visualizes the epidermal and dermal layers of the skin, identifying features that are not evident to the naked eye, making it a useful diagnostic technique in differentiating between benign and malignant skin lesions. There are two methods of dermoscopy, non-polarized and cross-polarized; both are perceived to give visual differences in lesion characteristics. The aim of this literature review is to identify the advantages and limitations between non-polarized, cross-polarized and also contact and non-contact techniques. This research confirms that there are similarities, as well as differences, in the visualization of lesions between non-polarized and cross-polarized dermoscopy. Non-polarized dermoscopy reveals superficial features and polarized dermoscopy shows deeper structures, concluding that the use of both methods can provide complementary information.

Serial photography and Wood's light examination as an aid to the clinical diagnosis of dermatitis artefacta.

A patient is described with dermatitis artefacta, which is a common psychocutaneous disorder whereby a fully-aware patient self-inflicts injury to their skin. The motives for their behaviour can vary and the patient always tries to hide the responsibilities for their actions. In this case report, serial use of standardised photography provided strong evidence to support the diagnosis of dermatitis artefacta. The fluorescent properties of Trimovate® Cream under Wood's light examination corroborated the diagnosis. Trimovate® Cream was applied to the skin surrounding the injuries and the limb was occluded with four layers of bandages. Traces of Trimovate® Cream were seen under Wood's light on the outer layers of the bandage. This suggested transfer of the cream from the occluded skin surface by the patient's fingers whilst tampering with the dressings. This case report shows how serial photography and imaging using ultraviolet (UV) fluorescence can provide evidence to support the diagnosis of dermatitis artefacta.

The role of photography in dermatology research.

This article discusses the role of clinical photography in dermatology research and the value of healthcare professionals engaging with clinical photographers when planning and undertaking clinical photography. It is not always feasible to use a clinical photographer, or clinicians may not have access to such a service, but with advice, support and training from clinical photographers, clinicians can take good clinical photographs with easy-to-use low cost equipment. This article provides an exemplar where good quality clinical photographs have been obtained of congenital erythropoietic porphyria (CEP) patients for dermatology research. The images have been taken by a dermatologist, with guidance from trained clinical photographers. The photographs played a valuable role in providing a visual, comparative and comprehensive description of this extremely rare multi-system disease.

Calibrating lenses for standard scales of reproduction with digital SLR cameras.

This paper is an update of previous work undertaken by one of the authors (SY) that outlined a method for establishing standard scales of reproduction with digital SLR cameras for clinical photography. Recent experience in the authors' department has raised some issues with using the published formulae for calculating subject and working distances to achieve accurate magnifications. The authors explain a more pragmatic approach to calibrating lenses used on a range of Nikon digital SLR cameras.

Review of Therapeutic Interventions for the Upper Limb Classified by Manual Ability in Children with Cerebral Palsy.

The aim of this literature review was to assemble an inventory of intervention strategies utilized for children diagnosed with cerebral palsy (CP) based on the Manual Ability Classification System (MACS). The purpose of the inventory is to guide physicians and therapists in intervention selection aimed at improving upper limb function in children with CP. The following databases were searched: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Database of Systematic Reviews, ERIC (Educational Research Information Center), Google Scholar, OTSeeker (Occupational Therapy Systematic Evaluation of Evidence), OVID (Ovid Technologies, Inc.), and PubMed. Inclusion criteria were whether the study (1) identified MACS levels of participants, and (2) addressed the effectiveness of intervention on upper limb function. Overall, 74 articles met the inclusion criteria. The summarized data identified 10 categories of intervention. The majority of participants across studies were MACS level II. The most frequently cited interventions were constraint-induced movement therapy (CIMT), bimanual training, and virtual reality and computer-based training. Multiple interventions demonstrated effectiveness for upper limb improvement at each MACS level. However, there is a need for additional research for interventions appropriate for MACS levels IV and V. To fully develop an intervention inventory based on manual ability, future studies need to report MACS levels of participants, particularly for splinting and therapy interventions used in combination with surgery.

Hand therapy for children with congenital hand differences.

Children with congenital hand anomalies benefit from a surgeon's partnership with a hand therapist, who can help the child and their family achieve goals of independence and improved self-esteem. Topics are addressed by age group and include evaluation of children with hand anomalies, splinting the child's hand after injury or surgery, treatment plans geared specifically for children, achieving increased independence with activities of daily living, and a discussion of how to support families as they adjust to life with a child who has a congenital hand anomaly.

A training programme for clinical photographers - theCardiff experience.

The formal training and education of trainee clinical photographers started in Cardiff in 1969. Between 1974 and 1995 the trainees' foundation knowledge and skills were taught in purpose built accommodation, but since then has been in the main department, the Media Resources Centre, at the University Hospital of Wales. Prior to 1990 the trainee intake undertook the British Institute of Professional Photographers (BIPP) Qualifying Examination in Medical Photography, and between 1990 and 2001 they undertook this together with the Master of Science (MSc) in Medical Illustration. In preparation for state registration the Postgraduate Certificate (PGC) in Medical Illustration was developed with content that was appropriate to new entrants into the profession, and trainees were registered for this rather than the MSc in Medical Illustration. Since 2003 the on-job training scheme has been developed to follow a more formal structure closely integrated with the PGC. The authors describe the rationale for and implementation of these changes.

Contributions of E1A to mouse adenovirus type 1 pathogenesis following intranasal inoculation.

We investigated the role of mouse adenovirus type 1 (MAV-1) early region 1A (E1A) protein in adenovirus respiratory infection. Intranasal (i.n.) inoculation of mice with wild type (wt) virus induced chemokine and cellular inflammatory responses in the lung. We observed similar responses in mice infected with an E1A-null mutant virus at the same dose, although the magnitude of these responses was lower. Levels of viral hexon gene expression were lower in the lung following infection with E1A-null virus than with wt virus. When input doses were adjusted so that equivalent viral loads were present following infection with varying doses of wt and E1A-null virus, we observed equivalent chemokine upregulation in the lung. Dissemination to the brain occurred following i.n. inoculation with equal doses of wt or E1A-null virus, but viral gene expression and viral loads were lower and the magnitude of chemokine responses was lower in brains of E1A-null virus-infected mice. CD4 and CD8 T cells and neutrophils were recruited to the brains of mice infected with either wt or E1A-null virus. Together, these data suggest that MAV-1 E1A makes important contributions to viral replication in the lung and the brain following i.n. inoculation. However, E1A is not essential for the induction of inflammatory responses in the lung or for viral dissemination out of the lung.

Dermatology--here and now.

Dermatology is a branch of medicine that benefits from the use of photography, to assist in diagnosis and teaching through clinical discussion of the physical signs of a disease, and thereafter, for the monitoring of the condition throughout treatment. This paper describes the development of a dedicated medical photography service in the Welsh Institute of Dermatology at the University Hospital of Wales, Cardiff and Vale NHS Trust. As a consequence, a close working relationship has developed between the dermatologists and the photographers, leading to some interesting new approaches in the use of photography to enhance patient care.

Tribal benefits counseling program: expanding health care opportunities for tribal members.

American Indian tribal clinics hired benefits counselors to increase the number of patients with public and private insurance coverage, expand the range of health care options available to tribal members, and increase third-party revenues for tribal clinics. Benefits counselors received intensive training, technical assistance, and evaluation over a 2-year period. Six tribal clinics participated in the full training program, including follow-up, process evaluation, and outcomes reporting. Participating tribal sites experienced a 78% increase in Medicaid enrollment among pregnant women and children, compared with a 26% enrollment increase statewide during the same period. Trained benefits counselors on-site at tribal clinics can substantially increase third-party insurance coverage among patients.