[Neuropathy of the median nerve caused by intraneural haematoma after carpal tunnel release in an anticoagulated patient]. / Neuropathie des Nervus medianus durch intraneurale Blutung bei einem antikoagulierten Patienten nach Karpaltunnelspaltung.

We report about the sudden onset of a median nerve neuropathy in an anticoagulated patient eight weeks after uneventful carpal tunnel release. Several differential diagnosis have to be considered: compression syndrome as well as iatrogenic damage of the median nerve due to the preliminary procedure or even concomitant disease can generate symptoms of peripheral neuropathy. We diagnosed an intraneural haematoma through surgical exploration. This rare complication of oral anticoagulation therapy occurred spontaneously and was treated successfully by interfascicular neurolysis.

[Infections of flexor tendon sheath - treatment and results]. / Die Behandlung der Beugesehnenscheidenphlegmone - Behandlungsstrategie und Ergebnisse.

Infections of the flexor tendon sheath are rare. We report on 49 patients who were treated in a five-year period from 1996 to 2000. The follow-up period was 45 months on average. We used an extensive skin incision for revision and regularly placed gentamycin-PMMA-chains in the wound. All patients were treated as inpatients. We achieved good and excellent results in 85% of patients.

[Operative treatment of vulnerable scars and deep soft-tissue defects of the thumb with a free toe pulp neurovascular flap]. / Die Deckung ausgedehnter instabiler Narben und tiefer Haut-Weichteildefekte an der Daumenkuppe mit der Grosszehen-Pulpa-Lappenplastik1.

Because of the capability of opposition, the thumb is the most important digit of the hand. In case of deep soft-tissue defects of the pulp, it is necessary to reconstruct the palmar surface of the distal phalanx of the thumb using tissue with good sensibility. Between 1982 and 1998 at the Department of Hand Surgery, Plastic and Microsurgery of the Berufsgenossenschaftliche Unfallkrankenhaus Hamburg, we used a free toe pulp neurovascular flap for reconstruction of the pulp of the thumb in nine patients. All flaps healed without complications. Indications, operative techniques, and results of this procedure are described.

The functional neuroanatomy of target detection: an fMRI study of visual and auditory oddball tasks.

The neuronal response patterns that are required for an adequate behavioural reaction to subjectively relevant changes in the environment are commonly studied by means of oddball paradigms, in which occasional 'target' stimuli have to be detected in a train of frequent 'non-target' stimuli. The detection of such task-relevant stimuli is accompanied by a parietocentral positive component of the event-related potential, the P300. We performed EEG recordings of visual and auditory event-related potentials and functional magnetic resonance imaging (fMRI) when healthy subjects performed an oddball task. Significant increases in fMRI signal for target versus non-target conditions were observed in the supramarginal gyrus, frontal operculum and insular cortex bilaterally, and in further circumscribed parietal and frontal regions. These effects were consistent over various stimulation and response modalities and can be regarded as specific for target detection in both the auditory and the visual modality. These results therefore contribute to the understanding of the target detection network in human cerebral cortex and impose constraints on attempts at localizing the neuronal P300 generator. This is of importance both from a neurobiological perspective and because of the widespread application of the physiological correlates of target detection in clinical P300 studies.

[The supinator syndrome]. / Das Supinatorsyndrom.

BACKGROUND: The posterior interosseous nerve syndrome is a rare compression neuropathy of the upper limb, which must be differentiated from tennis elbow. The aim of our study is to show etiology, symptoms, and diagnostic methods, and to illustrate the common operative techniques. PATIENTS AND METHODS: We examined retrospectively all patients of the Department for Hand Surgery, Plastic and Microsurgery of the Berufsgenossenschaftlichen Unfallkrankenhaus Hamburg, who underwent operative treatment because of posterior interosseous nerve syndrome between 1984 and 1992. Mobility of the elbow joint, postoperative complaints and patient's satisfaction were analysed. RESULTS: 23% of patients suffered a reduction of motion of the elbow joint, 87% had less pain, and 83% were satisfied with the result of treatment. CONCLUSIONS: The value of preoperative neurophysiological examination for diagnosis of posterior interosseous nerve syndrome is not clear. Clinical examination will allow to differentiate between posterior interosseous nerve syndrome and tennis elbow. To prevent incomplete decompression of the deep radial nerve, multiple locations of compression must be considered.