Nerve grafts bridging the thenar branch of the median nerve to the ulnar nerve to enhance nerve recovery: a report of three cases.

We report a nerve graft procedure bridging the thenar branch of the median nerve to the ulnar nerve in three patients with ulnar nerve transection and defect at the mid-forearm. Ulnar nerve function was evaluated with electroneurography and quantitative sensory-motor testing before and after surgery, and at a 6-year follow-up. After surgery all patients showed electroneurographic evidence of median nerve innervation of the intrinsic muscles normally innervated by the ulnar nerve. The average strength was Grade 4 in the intrinsic muscles originally supplied by the ulnar nerve at the final follow-up. Our results indicate that the thenar branch of the median nerve may support ulnar nerve regeneration and so help prevent intrinsic muscles from irreversible atrophy, but our report is preliminary. This procedure should be validated by future clinical data, especially those with complete ulnar nerve transection at or above the elbow. LEVEL OF EVIDENCE: IV.

Thermal effects of diagnostic ultrasound in an anthropomorphic skull model.

PURPOSE: Exposure to diagnostic ultrasound (US) can significantly heat biological tissue although conventional routine examinations are regarded as safe. The risk of unwanted thermal effects increases with a high absorption coefficient and extended insonation time. Certain applications of transcranial diagnostic US (TC-US) require prolonged exposure. An anthropomorphic skull model (ASM) was developed to evaluate thermal effects induced by TC-US of different modalities. The objective was to determine whether prolonged continuous TC-US application results in potentially harmful temperature increases. MATERIALS AND METHODS: The ASM consists of a human skull with tissue mimicking material and exhibits acoustic and anatomical characteristics of the human skull and brain. Experiments are performed with a diagnostic US device testing four different US modalities: Duplex PW (pulsed wave) Doppler, PW Doppler, color flow Doppler and B-mode. Temperature changes are recorded during 180 minutes of insonation. RESULTS: All measurements revealed significant temperature increases during insonation independent of the US modality. The maximum temperature elevation of + 5.25° C (p < 0.001) was observed on the surface of the skull exposed to duplex PW Doppler. At the bone-brain border a maximum temperature increae of + 2.01 °C (p < 0.001) was noted. Temperature increases within the brain were < 1.23 °C (p = 0.001). The highest values were registered using the duplex PW Doppler modality. CONCLUSION: TC-US induces significant local heating effects in an ASM. An application duration that extends routine clinical periods causes potentially harmful heating especially in tissue close to bone. TC-US elevates the temperature in the brain mimicking tissue but is not capable of producing harmful temperature increases during routine examinations. However, the risk of thermal injury in brain tissue increases significantly after an exposure time of > 2 hours.

The effects of low-dosed and high-dosed low-frequency electromagnetic fields on microcirculation and skin temperature in healthy subjects.

The purpose of this randomized double-blind cross-over study was to investigate whether a low-dosed pulsed low-frequency magnetic field or a high-dosed pulsed low-frequency magnetic field improves the cutaneous microcirculation and alters the temperature of the foot. Twelve healthy subjects (five women, seven men) aged on average 25.8 years participated in the trial. Based on a randomization list, one of the following three interventions was applied for 30 min through a cushion placed below the non-dominant foot: either a pulsed low-dosed magnetic field (100 uT, basic frequency 30 Hz with a frequency modulation) or a pulsed high-dosed magnetic field (8.4 mT, 10 Hz), or sham treatment. The individual treatment sessions were applied in intervals of one week, at the same time of the day. Cutaneous microcirculation (laser Doppler flowmetry) and temperature (infra-red thermovision) were measured in the dorsum of the foot and the great toe every 5 min during the intervention, and 5 and 10 min post-intervention. With both pulsed low-dosed magnetic field and pulsed high-dosed magnetic field, just as with the sham treatment, a minor drop in temperature and decrease in microcirculation took place. A two-way repeated-measures analysis of variance revealed no significant difference between the interventions for any parameter. It was concluded that a local application of a pulsed low-frequency magnetic field to the foot did not enhance temperature or cutaneous microcirculation in healthy subjects.

A comparison of the donor-site morbidity after using the prelaminated fasciomucosal flap and the fasciocutaneous radial forearm flap for intraoral reconstruction.

Since 1996 we have performed mucosal prelamination of the distal radial forearm flap for functional reconstruction of defects of the intraoral lining. This study was undertaken to demonstrate that the prelaminated fasciomucosal radial forearm flap can provide physiological oropharyngeal reconstruction with mucus-producing tissue, while avoiding the donor-site complications of the fasciocutaneous radial forearm flap. We examined the donor hand at least 6 months postoperatively in 20 patients after using a prelaminated fasciomucosal radial forearm flap and in 15 patients after harvesting a classical fasciocutaneous radial forearm flap. The evaluation of hand function included range of motion, grip power, pinch power, sensibility and vascular analysis in both hands. The patients were asked about cold intolerance, pain and any restrictions in daily life, and the cosmetic appearance of the donor hand was noted. In the prelaminated-flap group (n 20), two patients had decreased wrist extension, and one of these patients also had reduced strength and mild hypaesthesia in the donor hand. In the classical-fasciocutaneous-flap group (n 15), six patients had decreased wrist extension, five patients had reduced strength and four patients had diminished sensibility in the donor hand. Painful neuromas were found only after fasciocutaneous flaps (three cases). Subjective assessment revealed restricted hand function in one patient in the prelaminated-flap group, and in five patients who had undergone fasciocutaneous flap transfer. The results of this study show that using the prelaminated fasciomucosal radial forearm flap minimises the donor-site morbidity. Furthermore, we were able to improve the cosmetic appearance of this very exposed region.

[Clinical effectiveness of magnetic field therapy--a review of the literature]. / Klinische Wirksamkeiten der Magnetfeldtherapie--eine Literaturübersicht.

To verify the efficacy of electromagnetic fields on various diseases we conducted a computer-assisted search of the pertinent literature. The search was performed with the aid of the Medline and Embase database (1966-1998) and reference lists. Clinical trials with at least one control group were selected. The selection criteria were met by 31 clinical studies. 20 trials were designed double-blind, randomised and placebo-controlled. The studies were categorised by indications. Electromagnetic fields were applied to promote bone-healing, to treat osteoarthritis and inflammatory diseases of the musculoskeletal system, to alleviate pain, to enhance healing of ulcers and to reduce spasticity. The action on bone healing and pain alleviation of electromagnetic fields was confirmed in most of the trials. In the treatment of other disorders the results are contradictory. Application times varied between 15 minutes and 24 hours per day for three weeks up to eighteen months. There seems to be a relationship between longer daily application time and positive effects particular in bone-healing. Patients were treated with electromagnetic fields of 2 to 100 G (0.2 mT to 10 mT) with a frequency between 12 and 100 Hz. Optimal dosimetry for therapy with electromagnetic fields is yet not established.

Thermographic parameters in the diagnosis of secondary Raynaud's phenomenon.

OBJECTIVE: To determine the major infrared thermographic parameters in discriminating between patients with and without secondary Raynaud's phenomenon. DESIGN: A cross-sectional study. SETTING: Outpatient clinic of a university department of physical medicine and rehabilitation in Vienna. PATIENTS: Consecutive sample of 86 patients (72 women, 14 men) referred from the Division of Rheumatology for the clarification of a possible secondary Raynaud's phenomenon. MAIN OUTCOME MEASURES: According to color changes induced by cold exposure, clinical classification of Raynaud's phenomenon was performed as follows: no, unlikely, probable, and definite Raynaud's phenomenon. The following thermographic parameters were applied to a stepwise logistic regression analysis: the absolute temperature of the fingertips before, 10, and 20 minutes after cold challenge (Tpre, T10, T20); the longitudinal temperature difference before, 10, and 20 minutes after cold challenge (LTDpre, LTD10, LTD20); the mean area under the rewarming curve of the fingertips; the recovery index 20 minutes after cold challenge (RI20); and the most rapid phase of rewarming of the fingertips of both hands (Gmax right, Gmax left). The sensitivity of thermographic classification into the 4 groups of clinical evaluation was assessed by discriminant analysis using significant parameters from logistic regression analysis. RESULTS: Only LTDpre reached the level of significance (p < .0001). Using LTDpre, 22 of 23 subjects without clinical Raynaud's phenomenon and 20 of 26 patients with definite clinical Raynaud's phenomenon were classified correctly. Patients with unlikely or probable Raynaud's phenomenon were classified as no Raynaud's phenomenon or definite Raynaud's phenomenon. CONCLUSION: LTDpre is the major thermographic parameter to discriminate between patients with and without definite Raynaud's phenomenon by clinical history.

[Value of impedance rheography as a screening method in comparison with Doppler index in peripheral arterial occlusive disease]. / Wertigkeit der Impedanzrheographie als Screeningmethode im Vergleich zum Doppler-Index bei peripherer arterieller Verschlusskrankheit.

BACKGROUND: Determination of the ankle-arm-index (AAI) by Doppler ultrasound is the method of choice as a screening test for peripheral arterial occlusive disease (PAOD). The easily performed Impedance Rheography (IR) may serve as an alternative screening method. This study investigates the correlations between parameters obtained by IR curve to the AAI. METHODS: 56 patients (62.8 +/- 13 years, m = 37, f = 19) were included in the study. IR was performed on both shanks using ring electrodes below the knee and above the ankle (bipolar leads, frequency 90 kHz, test voltage 2.5 Vpp). The AAI was obtained by a 8 Mz ultrasound probe. RESULTS: AAI < or = 0.85 showed significant correlations (p < 0.0001) to parameters of the IR curve: Crest Time (GZ, r = 0.67), Rise of the Pulse Wave (PA, r = 0.82), Relative Pulse Volume (RP, r = 0.82) and the Rheographic Quotient (RQ, r = 0.86). AAI > 0.85 showed no or only weak correlations to RI parameters. Underlying the following limits for rheographic parameters (GZ = 159 ms, PA = 3.3, RP = 0.43 vp/s and RQ = 0.4 vp), sensitivity and specify was determined: GZ: 68% and 100%, PA: 84% and 88%, RP: 68% and 92%, RQ: 77% and 88%. CONCLUSIONS: Impedance rheography correlates significantly with the AAI. Therefore this method seems to be well suited as a screening test for PAOD.

[Therapy relevant aspects of anatomy, pathophysiology and diagnosis of urinary incontinence in women]. / Therapierelevante Aspekte der Anatomie, Pathophysiologie und Diagnostik der weiblichen Harninkontinenz.

Many aspects of the pathogenesis of urinary incontinence are poorly understood. Most studies show good results for physical therapy for instance for pelvic floor exercises and biofeedback. Unfortunately most of these studies lack an objective diagnostic and neurophysiological assessment. This could be one reason for the strongly divergent therapeutical success rates reported (30 to 90%). We recommend the use of objective parameters, for instance the PAD test with standardized bladder volume and a neurophysiological and short urodynamic assessment as well as subjective parameters [satisfaction with the outcome of treatment measured with the VAS (visual analog scale), documentation of the changes in ADL (activities of daily living)] in future therapeutical studies. A more precise assessment of the pathological cause of the impairment will help to develop optimal therapeutic procedures. Because of poor documentation in the past the analysis of therapeutic failures and the decision if mono-or complex physiotherapy is more appropriate has not been possible. This aspect will become even more important as the cost-effectiveness of treatments becomes a more important issue.

[Iontophoresis in the treatment of pain]. / Iontophorese zur Behandlung von Schmerzzuständen.

UNLABELLED: The objective has been to verify the effectiveness of iontophoresis in alleviating conditions of pain by means of a computer-assisted search of the pertinent literature. The search was performed with the aid of the Medline database (1984 bis 1993) and reference lists (studies from 1954). SELECTION CRITERIA: all clinical trials performed with at least one control group as well as all experimental studies conducted within the same period. The selection criteria were met by 10 experimental and 15 clinical studies. The studies were categorized by substance group. The following groups of substances were applied (experimentally/clinically): local anaesthetics (0/6), non steroidal anti-inflammatory drugs (2/3), vinca-alkaloids (1/2), corticosteroids (3/1), morphine (0/1), iodide (4/1) and fluoride (0/1). Both short-term effects (lidocaine, procaine, flufenamic acid, morphine) and long-term effects (benzocaine-salicylamide, diclofenac, Mobilat, vinca-alkaloids, dexamethasone-lidocaine, iodide, fluoride) were studied. Comparisons were made against placebo iontophoresis (lidocaine, procaine, flufenamic acid, diclofenac, Mobilat, vinca-alkaloids, dexamethasone-lidocaine, morphine, fluoride), solely topical administration (procaine, benzocaine-salicylamide, flufenamic acid), placebo administration without current (procaine, flufenamic acid), and other methods (lidocaine, iodide). With one single exception (lidocaine), none of the studies included groups without treatment.(ABSTRACT TRUNCATED AT 250 WORDS)