Thermodynamic temperature assignment to the point of inflection of the melting curve of high-temperature fixed points.

The thermodynamic temperature of the point of inflection of the melting transition of Re-C, Pt-C and Co-C eutectics has been determined to be 2747.84 ± 0.35 K, 2011.43 ± 0.18 K and 1597.39 ± 0.13 K, respectively, and the thermodynamic temperature of the freezing transition of Cu has been determined to be 1357.80 ± 0.08 K, where the ± symbol represents 95% coverage. These results are the best consensus estimates obtained from measurements made using various spectroradiometric primary thermometry techniques by nine different national metrology institutes. The good agreement between the institutes suggests that spectroradiometric thermometry techniques are sufficiently mature (at least in those institutes) to allow the direct realization of thermodynamic temperature above 1234 K (rather than the use of a temperature scale) and that metal-carbon eutectics can be used as high-temperature fixed points for thermodynamic temperature dissemination. The results directly support the developing mise en pratique for the definition of the kelvin to include direct measurement of thermodynamic temperature.

Hypothenar hammer syndrome. A case report. / Síndrome del martillo hipotenar. A propósito de un caso.

Hypothenar hammer syndrome is an uncommon injury of the ulnar artery in its passage through Guyon's canal, and has been associated with repetitive trauma. Its diagnosis requires of a high level of suspicion and a careful clinical interview. The appropriate treatment is not well defined in the literature, ranging widely from medical treatment to reconstructive surgery. A clinical case is presented of a 52 year-old healthy male, who presented with numbness of his fourth and fifth fingers after a trauma at the hypothenar eminence. The Allen test highlighted an absence of vascularisation from the ulnar artery, thus suspecting an ulnar artery thrombosis, which was later confirmed by angio-MRI. The thrombosed segment was resected and a by-pass with a forearm vein was performed to reconstruct the distal arterial flow, presenting with a good functional outcome at 6months follow-up.

Reconstruction of fingertip defects with the neurovascular tranquilli-leali flap.

For many years, bipedicled palmar advancement flaps were used rarely in fingers because they sacrificed the dorsal branches of the digital arteries, risking dorsal skin necrosis. In 1995, a short bipedicled neurovascular VY advancement flap raised distally to the PIP flexion crease, which spared the dorsal blood supply, was described by Elliot et al. (1995). This paper includes an anatomical study on 28 fresh cadaver fingers to evaluate the advancement potential of this flap. It also reviews 22 fingertip reconstructions in 22 patients using this flap. The mean advancement of the flap in the cadaver study was 14 (range 10-16) mm. This procedure gave good clinical results in respect of healing, sensibility, bone cover and appearance. Complications occurred in four fingers (18%), viz. two infections, one neuroma and one stiff proximal interphalangeal joint. Our study suggests that this flap can be used to treat fingertip defects of a size of approximately half of the pulp of the distal phalangeal segment of the finger.

Conservative treatment versus scaphotrapeziotrapezoid arthrodesis for Kienbock's disease. A retrospective study.

Efficiency of surgical treatment in Kienböck's disease has never been proven in the long term. We retrospectively reviewed the charts of the 104 patients treated by various techniques for Kienböck's disease from 1981 to 1999 in our unit. A comparison was made between 19 cases treated conservatively (amongst 59) and 11 cases (amongst 25) treated by scaphotrapeziotrapezoid (STT) arthrodesis with a mean follow-up of 13 years. The two groups were statistically comparable in stage, age, sex ratio, number of manual workers. STT arthrodesis was responsible for an increased loss of mobility, an increase of barometric pain, a longer rehabilitation time and more fractures of lunatum than conservative treatment. Those results question about indications for STT in Kienböck's disease.

Bilateral carpal tunnel surgery in one operation: Retrospective study.

Carpal tunnel syndrome is the most common entrapment syndrome. The incidence of a bilateral condition varies between 22% and 87%. The aim of our study was to assess the level of satisfaction and the clinical outcomes in a group of patients operated on through a bilateral neurolysis on the median nerve in the carpal tunnel, in one operating session. This is a retrospective study involving patients with an electromyographic and clinical diagnosis of bilateral carpal tunnel syndrome. Patients were treated on an outpatient basis and the bilateral neurolysis was performed by endoscopy. The postoperative data was collected during consultation by a senior surgeon or during telephone interviews. Patients were asked to respond to a satisfaction questionnaire and the functional outcome was assessed through the Quick-Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) questionnaire. Twenty-nine patients with bilateral carpal tunnel syndrome were operated on in single operating sessions between January 2009 and January 2014. The average follow-up was 46 months. The average age at the time of the intervention was 45 years. Two patients were lost to follow-up, and 27 were able to be assessed. In relation to the clinical and functional outcomes, the average Quick-DASH score was 6.78 (ranges: 0-43.2). Twenty-five patients (92.5%) were satisfied with this simultaneous treatment and 26 patients (96%) would choose the same technique again. One-stage surgery in cases of bilateral carpal tunnel syndrome appears to constitute a benefit for the patient, the surgeon and the anaesthetist, but it is reserved for patients who request it and who are motivated by this type of intervention.

Effectiveness of controlled and spontaneous modes in nasal two-level positive pressure ventilation in awake and asleep normal subjects.

STUDY OBJECTIVES: The purpose of the present study was to compare in awake and asleep healthy subjects, under nasal intermittent positive pressure ventilation (nIPPV) with a two-level intermittent positive pressure device (two-level nIPPV), the efficacy of the controlled and spontaneous modes, and of different ventilator settings in increasing effective minute ventilation (VE). PARTICIPANTS: Eight healthy subjects were studied. SETTING: In the controlled mode, inspiratory positive airway pressure (IPAP) was kept at 15 cm H2O, expiratory positive airway pressure (EPAP) at 4 cm H2O, and the inspiratory/expiratory (I/E) time ratio at 1. The respirator frequencies were 17 and 25/min. In the spontaneous mode experiment, IPAP was started at 10 cm H2O and progressively increased to 15 and 20 cm H2O; EPAP was kept at 4 cm H2O. MEASUREMENTS AND RESULTS: We measured breath by breath the effective tidal volume (VT with respiratory inductive plethysmography), actual respiratory frequency (f), and effective VE. Using the controlled mode, effective VE was significantly higher on nIPPV than during spontaneous unassisted breathing, except in stage 2 nonrapid eye movement sleep at 17/min of frequency; increases in f from 17 to 25/min led to a significant decrease in VT reaching the lungs, during wakefulness and sleep; effective VE was higher at 25 than at 17/min of frequency only during sleep; periodic breathing was scarce and apneas were never observed. Using the spontaneous mode, with respect to awake spontaneous unassisted breathing, two-level nIPPV at 10 and 15 cm H2O of IPAP did not result in any significant increase in effective VE either in wakefulness or in sleep; only IPAP levels of 20 cm H2O resulted in a significant increase in effective VE; during sleep, effective VE was significantly lower than during wakefulness; respiratory rhythm instability (ie, periodic breathing and central apneas) were exceedingly common, and in some subjects extremely frequent, leading to surprisingly large falls in arterial oxygen saturation. CONCLUSIONS: It appears that two-level nIPPV should be used in the controlled mode rather than in the spontaneous mode, since it seems easier to increase effective VE with a lower IPAP at a high frequency than at a high pressure using the spontaneous mode. We suggest that the initial respirator settings in the controlled mode should be an f around 20/min, an I/E ratio of 1, 15 cm H2O of IPAP, and EPAP as low as possible.

Effects of nasal positive-pressure hyperventilation on the glottis in normal awake subjects.

We have recently observed obstructive apneas during nasal intermittent positive-pressure ventilation (nIPPV) and suggested that they were due to hypocapnia-induced glottic closure. To confirm this hypothesis, we studied seven healthy subjects and submitted them to nIPPV while their glottis was continuously monitored through a fiber-optic bronchoscope. During wakefulness, we measured breath by breath the widest inspiratory angle formed by the vocal cords at the anterior commissure along with several other indexes. Mechanical ventilation was progressively increased up to 30 l/min. In the absence of diaphragmatic activity, increases in delivered minute ventilation resulted in progressive narrowing of the vocal cords, with an increase in inspiratory resistance and a progressive reduction in the percentage of the delivered tidal volume effectively reaching the lungs. Adding CO2 to the inspired gas led to partial widening of the glottis in two of three subjects. Moreover, activation of the diaphragmatic muscle was always associated with a significant inspiratory abduction of the vocal cords. Sporadically, complete adduction of the vocal cords was directly responsible for obstructive laryngeal apneas and cyclic changes in the glottic aperture resulted in waxing and waning of tidal volume. We conclude that in awake humans passive ventilation with nIPPV results in vocal cord adduction that depends partly on hypocapnia, but our results suggest that other factors may also influence glottic width.

Effects of nasal positive-pressure hyperventilation on the glottis in normal sleeping subjects.

We have previously observed that, in normal awake subjects passively hyperventilated with intermittent positive-pressure ventilation delivered through nasal access (nIPPV), the glottis could interfere with the ventilation. We report on data obtained in the same subjects during stable sleep. In all cases, the glottis was continuously observed through a fiber-optic bronchoscope, and other indexes were also continuously recorded. Mechanical ventilation was progressively increased up to 30 l/min. We have observed during passive nIPPV in stable sleep that increases in delivered minute ventilation (VEd) resulted in progressive narrowing of the glottic aperture, with increases in inspiratory resistance and progressive reductions in the percentage of the delivered tidal volume effectively reaching the lungs. For a given level of VEd, comparisons showed that the glottis was significantly narrower during sleep than during wakefulness and that the glottis was significantly narrower during stage 2 than during stages 3/4 non-rapid-eye-movement sleep. Moreover, when CO2 is added to the inspired air, glottic aperture increased in five of nine trials without changes in sleep stage. We also observed a significant negative correlation between glottic width and the VED, independent of the CO2 level. We conclude that during nIPPV glottis narrowing results in a decrease in the proportion of the delivered tidal volume reaching the lungs.

Effects of Breathe Right on snoring: a polysomnographic study.

The nasal vestibule is a major site of resistance to airflow in healthy subjects. A high nasal resistance may increase snoring. Activation of the alae nasi and alar retraction reduce resistance to airflow and improve ventilation. The Breathe Right (BR) device has been proposed to reduce or eliminate snoring by improving nasal breathing. We assessed the efficacy of BR on sleep quality and snoring during 2 full-night polysomnographies, the first without and the second with BR. Ten non-apnoeic snorers were studied. Snoring was present during 22-98% of total sleep time during the control night. Ear-nose-throat examination disclosed a nasal valve anomaly in five subjects, objectivated by anterior and posterior rhinomanometry. Quality of sleep and snoring were not influenced by BR, even when different sleep stages were analysed separately. No difference in snoring index was found between snorers with or without nasal valve anomaly. We conclude that BR is ineffective in relieving snoring in non-apnoeic snorers.

Conservative versus operative treatment for Kienböck's disease. A retrospective study.

In this retrospective study on Kienböck's disease, a comparison was made between 21 cases operated on by various techniques and 22 cases treated conservatively, with a mean follow-up of 65 months. Operative management of the disease did not show any superiority over conservative treatment. Moreover, surgery was responsible for a loss of mobility of 24%, and for a change in social activities in about a quarter of the patients, while grip strength was only slightly improved. Surgical indications for Kienböck's disease should be carefully considered, keeping in mind their side-effects, and the relative benignity in some cases of the natural course of the disease.

Joint reconstruction following trauma: comparison of microsurgical transfer and conventional methods: a report of 61 cases.

Joint reconstruction at the metacarpophalangeal or proximal interphalangeal levels remains a difficult problem in hand surgery. The authors reviewed sixty-one joints reconstructed acutely or electively allowing to compare Swanson spacer (30 joints), interpositional arthroplasty (4), non vascularized joint transfer (5) and vascularized joint transfer (21). Among these, two different techniques have been used: island compound transfer from a finger bank (10) and free vascularized transfer from the second toe (10) or from a non replantable finger (1). It is not worth while comparing different techniques applied to different indications. The only point which can be stressed is the better average range of movement of metacarpophalangeal reconstruction compared to that obtained at the proximal interphalangeal level.

[Nail recession emergency treatment: a new technique for the repair of fingertip amputations]. / Recul unguéal en urgence: nouvelle technique de prise en charge des amputations digitales distales.

INTRODUCTION: In spite of the recent advances made in microsurgery, the reconstruction of oblique fingertip amputations remains problematical. In cases where reimplantation is technically impossible, the surgeon can utilize a number of different flaps to preserve digital length. METHODS: In certain cases, instead of local flap repair using an advancement flap, the nail complex can be recessed so that after bone shortening of the distal phalanx the free edge of the nail can be stitched to the skin without resulting tension. Two longitudinal incisions are made, and a flap including the nail complex is obtained from the distal phalanx. The dissection is made as far as the base of the middle phalanx, and is superficial so that it does not affect the distal branches of the middle phalangeal arteries. This technique was used consecutively in three cases of oblique fingertip amputations. RESULTS: The average shortening required was 10 mm. In all three cases, the nail was preserved, and pulp sensitivity was excellent (mean static two-point discrimination of 5 mm, Semmes-Weinstein monofilaments of 2.83-3.61). The mean period before return to work was 5 weeks. No proximal interphalangeal joint stiffness was noted. However, all the patients complained of pain upon exposure to cold. DISCUSSION: This technique is simple to use, and combines the advantages of bone shortening with the esthetic aspect of preserving the nail complex. No palmar dissection is necessary, and the standard risks associated with advancement flap techniques are thus avoided. Although this reconstruction method results in a shorter finger, good functioning and good immediate sensitivity are maintained.

[Wedge excision: a new reconstructive technique after longitudinal nail biopsy]. / L'excision cunéiforme: une nouvelle technique de reconstruction après biopsie unguéale longitudinale.

A biopsy is needed when a solitary melanonychia striata in a white patient remains unexplained after careful clinical examination in order to rule out the development of a malignant melanoma. The ideal biopsy has to excise entirely the lesion and to provide enough tissue for pathological examination. The authors describe a new method of excisional biopsy based on primarily closure using a longitudinal closing wedge osteotomy of the distal phalanx. The longitudinal elliptical resection extended from the distal interphalangeal joint to the hyponychium with en bloc resection of the entire thickness of the nail complex, including the periosteum. A longitudinal closing wedge osteotomy was then performed in the distal phalanx allowing primarily closure with precise alignment of the nailbed edges. After suture of the nailbed, a tension band nail synthesis was performed. Four consecutive melanonychia striata of 2 to 3 mm were consecutively operated on using this technique. Postoperative cares were uneventful in all the cases. The pathological examination confirmed the diagnosis of melanoma in one case, Bowen's disease in one and junctional nevus in two. Cosmetic and functional assessment at a mean follow-up of 12 months evidenced light nail dystrophy in all the cases. Our method offers to the pathologist enough tissue with preserved architecture for precise pathological examination. The technically simple closing wedge osteotomy never complicated the postoperative course. These preliminary results are encouraging and allow us to recommend this technique for the diagnosis of all suspect melanonychia striata between 2 and 3 mm wide.

[Trapeziometacarpal denervation. Description of surgical technique and preliminary results from a prospective series of 14 cases]. / Dénervation trapézométacarpienne. Description de la technique chirurgicale et résultats préliminaires dans une série prospective de 14 cas.

INTRODUCTION: The main goal of first carpometacarpal arthritis surgical treatment is to relieve pain. The main disadvantages of the usual techniques (trapeziectomy, implant arthroplasty) are loss of strength or presence of a prosthetic device. It is difficult to propose such extensive surgery at an early stage of the disease. Selective denervation of the first carpometacarpal joint seems to be an interesting choice. We propose a new technique of denervation based on our previous anatomical investigations. TECHNIQUE: Two incisions are needed to cut all the articular branches derive from the superficial branch of the radial nerve, the palmar cutaneous branch of the median nerve, the thenar branch of the median nerve and the lateral ante brachial cutaneous nerve. MATERIAL: Fourteen patients were prospectively included in our study with a mean follow-up of 5 months. RESULTS: Pain relief was very satisfying in 12 cases (mean decrease 84%). An increase in grip and key pinch strength was noted. Complications were uncommon, excepted temporary paresthésia in the radial nerve area. DISCUSSION: This technique seems to be promising and a good indication for patients with no disabling deformity, but only long-term results will confirm the place of denervation in the treatment of first carpometacarpal arthritis.

Síndrome del martillo hipotenar. A propósito de un caso / Hypothenar hammer syndrome. A case report

El síndrome del martillo hipotenar es una infrecuente lesión de la arteria cubital a su paso por el canal de Guyon relacionada con los traumatismos repetitivos. Su diagnóstico requiere un elevado índice de sospecha y una adecuada historia clínica. Su tratamiento no está bien definido en la literatura, y va desde tratamiento médico hasta cirugía reconstructiva. Presentamos el caso de un varón de 52 años con parestesias de los dedos cuarto y quinto tras un traumatismo en la eminencia hipotenar. En el test de Allen destacó la ausencia de vascularización por parte de la arteria cubital, por lo que se sospechó una trombosis de la arteria que se confirmó mediante angiorresonancia. Se realizó resección del fragmento trombosado y bypass con una vena antebraquial para reconstruir el flujo distal. Presentó una evolución satisfactoria a los 6meses de seguimiento (AU)

Hypothenar hammer syndrome is an uncommon injury of the ulnar artery in its passage through Guyon's canal, and has been associated with repetitive trauma. Its diagnosis requires of a high level of suspicion and a careful clinical interview. The appropriate treatment is not well defined in the literature, ranging widely from medical treatment to reconstructive surgery. A clinical case is presented of a 52 year-old healthy male, who presented with numbness of his fourth and fifth fingers after a trauma at the hypothenar eminence. The Allen test highlighted an absence of vascularisation from the ulnar artery, thus suspecting an ulnar artery thrombosis, which was later confirmed by angio-MRI. The thrombosed segment was resected and a by-pass with a forearm vein was performed to reconstruct the distal arterial flow, presenting with a good functional outcome at 6months follow-up (AU)

Free compound transfer of the distal interphalangeal joint. A case report.

The first case of free vascularized transfer of a distal interphalangeal (DIP) joint, used to replace a severely damaged proximal one, is presented. The case is interesting not only for the procedure used, but it also illustrates the principle by which useful components of nonsalvageable digits are used to reconstruct other damaged, but still salvageable, parts of the hand.

[Revascularization of digital avulsion injuries caused by rings]. / La revascularisation des arrachements digitaux par bagues.

The authors describe an original technique of ring fingers revascularization, avoiding two chief dangers met in the double vein grafts: the one of the joint and tendinous devascularization with its risks of stiffness, and the other one of the devascularization of the skin sheath with secondary necrosis or trophic trouble. The worse artery is resected and the defect is bridged by a long venous graft, the skin of the distal fingers being provided by the backflow.

A trial of 5-fluorouracil and Corynebacterium parvum in advanced colorectal carcinoma.

This study has confirmed that patients who have advanced colorectal carcinoma have impaired responsiveness to delayed-hypersensitivity skin testing, and also have elevated levels of serum IgM. Serial observations of delayed-hypersensitivity skin tests, total lymphocyte counts, T-lymphocyte counts, B-lymphocyte counts, and serum immunoglobulin levels failed to reveal any consistent pattern of responses in patients treated with either chemotherapy alone or chemoimmunotherapy. In 33 patients chosen at random to receive either 5-FU alone or 5-FU in combination with intramuscularly administered C. parvum, there was no evidence of objective response or influence on survival. Intramuscularly administered C. parvum, in the dose and schedule used, produced no evident immunologic or therapeutic effect.

A trial of imidazole carboxamide and corynebacterium parvum in disseminated melanoma: clinical and immunologic results.

Nonspecific immunotherapy with monthly intramuscular (IM) injections of Corynebacterium parvum has been investigated in patients with disseminated melanoma. Forty-nine patients were randomized to receive either imidazole carboxamide (DTIC) alone or DTIC plus C parvum. A 24% overall objective response rate was observed, with no significant difference between the response rate or survival of the two treatment groups. Immunologic studies revealed no significant difference between the two groups. One patient undergoing chemoimmunotherapy demonstrated profound pancytopenia which responded to cessation of therapy, but toxic reactions were otherwise minimal. No advantage was obtained by adding IM injected C parvum to standard chemotherapy in the treatment of disseminated melanoma.