Improvements in activities of daily living following functional hand surgery for treatment of lesions to the cervical spinal cord: self-assessment by patients.

STUDY DESIGN: Tetraplegic patients were tested for hand strength before and after hand surgery. They also answered questions about how they rated the results of surgery. OBJECTIVES: Presentation of the efficacy of reconstruction of hand raising, lateral grip, and cylindrical grip in the tetraplegic hand. SETTING: The study was conducted in the Werner Wicker Clinic, Bad Wildungen, Germany, from 1991 to 1998. METHODS: The results of reconstruction surgery performed on 23 tetraplegic hands, as reflected in lifting the hand (n=3), lateral grip (n=21), and cylindrical grip (n=14), are presented. In a follow-up study in 22 patients, their management of activities of daily living 34.1 months (9-51 months) after the surgery is compared with the preoperative situation. Subjective satisfaction levels were elicited for each of the 22 patients by means of a questionnaire. RESULTS: The gain in force corresponded to 893 g (150-1500 g) for cyclindrical grip and 488 g (100-1200 g) for lateral grip, while they were able to develop grade 4 force for lifting the hand. After the operation 28 aids/appliances that patients had formerly used regularly were no longer necessary. There were 75 separate activities listed in the questionnaire, and on average the 22 patients were able to perform 8.7 (0-20) more of these. Most patients (19) said they would advise others to have the operation and 18, that they would have the operation again. There were 12 complications in nine patients. CONCLUSION: Reconstructive surgery on the hands of tetraplegic patients leads to gains in both cylindrical grip and lateral grip force and to increased manual dexterity. Patient satisfaction with the procedure is high.

Monitoring and analysis of occupational exposure to chain saw exhausts.

The extent of inhalation exposure to loggers from two-stroke chain saws was measured and evaluated under various conditions. Carbon monoxide, measured by personal air monitoring and determination of carboxyhemoglobin levels of the loggers, was used as an indicator of exhaust exposure. Video recordings were made to analyze the influence of varying working conditions and the individual handling of the chain saw on the amount of pollutants inhaled. The American Conference of Governmental Industrial Hygienists biological exposure index (BEI) for carboxyhemoglobin (3.5%) was exceeded during logging in heavy timber stands. When workers were paid on a piecework basis, carboxyhemoglobinemia increased to its maximum level in the first 2-3 hours of the shift and then declined. After 8 hours carboxyhemoglobin levels were 20-30% lower compared with the maximum. Increased exhaust inhalation with short-term exposures to carbon monoxide up to 400 ppm was observed in the following conditions: (1) felling operations, (2) other operations performed in a leaning of squatting position, (3) limbing in thick tops of coniferous trees, (4) working at low wind velocity, and (5) working in thick forest stands. Maximum allowable blood concentrations for carboxyhemoglobin are exceeded in chain saw operators in logging operations. Blood sampling at the end of the workday is not always suitable for determining the highest carboxyhemoglobin levels in loggers during the shift. The exposure of chain saw operators to exhaust increases under certain conditions.