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Cox SC, Smith Lyttle B, Elkind S, Smith Siddoway C, Morin P, Capponi G, Abu-Alam T, Ballinger M, Bamber L, Kitchener B, Lelli L, Mawson J, Millikin A, Dal Seno N, Whitburn L, White T, Burton-Johnson A, Crispini L, Elliot D, Elvevold S, Goodge J, Halpin J, Jacobs J, Martin AP, Mikhalsky E, Morgan F, Scadden P, Smellie J, Wilson G. A continent-wide detailed geological map dataset of Antarctica. Sci Data 2023; 10:250. [PMID: 37202393 DOI: 10.1038/s41597-023-02152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/12/2023] [Indexed: 05/20/2023] Open
Abstract
A dataset to describe exposed bedrock and surficial geology of Antarctica has been constructed by the GeoMAP Action Group of the Scientific Committee on Antarctic Research (SCAR) and GNS Science. Our group captured existing geological map data into a geographic information system (GIS), refined its spatial reliability, harmonised classification, and improved representation of glacial sequences and geomorphology, thereby creating a comprehensive and coherent representation of Antarctic geology. A total of 99,080 polygons were unified for depicting geology at 1:250,000 scale, but locally there are some areas with higher spatial resolution. Geological unit definition is based on a mixed chronostratigraphic- and lithostratigraphic-based classification. Description of rock and moraine polygons employs the international Geoscience Markup Language (GeoSciML) data protocols to provide attribute-rich and queryable information, including bibliographic links to 589 source maps and scientific literature. GeoMAP is the first detailed geological map dataset covering all of Antarctica. It depicts 'known geology' of rock exposures rather than 'interpreted' sub-ice features and is suitable for continent-wide perspectives and cross-discipline interrogation.
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Affiliation(s)
- Simon C Cox
- GNS Science, Private Bag 1930, Dunedin, 9054, New Zealand.
| | | | - Samuel Elkind
- Department of Geology, Colorado College, Colorado Springs, CO, 80903, USA
| | | | - Paul Morin
- Polar Geospatial Center, University of Minnesota, St Paul, MN, 55108, USA
| | - Giovanni Capponi
- DISTAV, Università degli Studi di Genova, Corso Europa 26-16132, Genova, Italy
| | - Tamer Abu-Alam
- Norwegian Polar Institute, P O Box 6606 Stakkevollan, N-9296, Tromsø, Norway
- Department of Arctic and Marine Biology, UiT The Arctic University of Norway, P O Box 6050 Langnes, N-9037, Tromsø, Norway
| | - Matilda Ballinger
- Institute for Marine and Antarctic Studies, University of Tasmania, Private Bag 129, Hobart, TAS 7001, Australia
| | - Lauren Bamber
- University of Edinburgh, Old College, South Bridge, Edinburgh, EH8 9YL, UK
- Great Boulder Resources, 51 Colin Street, West Perth, WA, 6005, Australia
| | - Brett Kitchener
- Institute for Marine and Antarctic Studies, University of Tasmania, Private Bag 129, Hobart, TAS 7001, Australia
| | - Luigi Lelli
- DISTAV, Università degli Studi di Genova, Corso Europa 26-16132, Genova, Italy
| | - Jasmine Mawson
- University of Otago, P O Box 56, Dunedin, 9054, New Zealand
| | - Alexie Millikin
- Department of Geology, Colorado College, Colorado Springs, CO, 80903, USA
| | - Nicola Dal Seno
- DISTAV, Università degli Studi di Genova, Corso Europa 26-16132, Genova, Italy
| | - Louis Whitburn
- University of Otago, P O Box 56, Dunedin, 9054, New Zealand
| | - Tristan White
- Department of Geology, Colorado College, Colorado Springs, CO, 80903, USA
| | - Alex Burton-Johnson
- British Antarctic Survey, High Cross, Madingley Road, Cambridge, CB3 0ET, UK
| | - Laura Crispini
- DISTAV, Università degli Studi di Genova, Corso Europa 26-16132, Genova, Italy
| | - David Elliot
- Ohio State University, 125 South Oval Mall, Columbus, OH, 43210, USA
| | - Synnøve Elvevold
- Norwegian Polar Institute, P O Box 6606 Stakkevollan, N-9296, Tromsø, Norway
| | - John Goodge
- Department of Earth and Environmental Sciences, University of Minnesota Duluth, Duluth, MN, 55812, USA
| | - Jacqueline Halpin
- Institute for Marine and Antarctic Studies, University of Tasmania, Private Bag 129, Hobart, TAS 7001, Australia
| | - Joachim Jacobs
- University of Bergen, PO Box 7803, NO-5020, Bergen, Norway
| | - Adam P Martin
- GNS Science, Private Bag 1930, Dunedin, 9054, New Zealand
| | - Eugene Mikhalsky
- Gramberg Institute for Geology and Mineral Resources of the World Ocean (VNIIOkeangeologia), Angliiskii pr. 1, St Petersburg, 190121, Russia
| | - Fraser Morgan
- Manaaki Whenua Landcare Research, Private Bag 92170, Auckland, 1142, New Zealand
| | - Phil Scadden
- GNS Science, Private Bag 1930, Dunedin, 9054, New Zealand
| | - John Smellie
- University of Leicester, University Road, Leicester, LE17RH, UK
| | - Gary Wilson
- GNS Science, P O Box 30368, Lower Hutt, 5040, New Zealand
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Leggett C, Ritchie U, Costi L, Borg C, Elliot D, Mangoni AA, Hague WM. Response to Dr. Anderson's Letter to the Editor: Modafinil and Armodafinil in Human Milk. J Hum Lact 2023; 39:224-225. [PMID: 37073875 DOI: 10.1177/08903344231156443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
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Leggett C, Ritchie U, Costi L, Elliot D, Mangoni AA, Hague WM. Infant Exposure to Armodafinil Through Human Milk Following Maternal Use of Modafinil. J Hum Lact 2022; 39:218-222. [PMID: 36384330 DOI: 10.1177/08903344221134273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Narcolepsy, a condition adversely affecting psychological, social, and cognitive function, is more prevalent in females of childbearing age than the general population. Modafinil and armodafinil are central nervous system stimulants approved for treatment of narcolepsy. Infant exposure to these agents through human milk has not been investigated. Poor quality medication safety information during lactation is associated with early cessation of breastfeeding and suboptimal healthcare for the breastfeeding family. MAIN ISSUE In this case study, we measured the concentration of armodafinil (the most active form of modafinil) in human milk and infant plasma to quantify infant exposure. MANAGEMENT The participant was a 30-year-old primipara with narcolepsy, taking modafinil (300 mg morning, 100 mg noon) while breastfeeding her 6-week-old infant despite the paucity of safety information. Armodafinil concentrations were measured in eight serial human milk samples collected over a 26-hr period and in single maternal and infant plasma samples using ultra performance liquid chromatography - tandem mass spectrometry. The average concentration of armodafinil in human milk was 1.96 mg/L; the relative infant dose was 4.85%; the theoretical infant dose was 0.294 mg/kg/day. Maternal and infant plasma concentrations of armodafinil were 12.02 mg/L and 0.19 mg/L, respectively. The participant continued to exclusively breastfeed the infant, who had normal growth and development. CONCLUSION Based on these findings, relatively small amounts of armodafinil pass into human milk, with consequent limited infant exposure. Consideration can be given to the use of modafinil or armodafinil during breastfeeding, provided the infant is monitored. Further studies are needed to confirm these findings.
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Affiliation(s)
- Catherine Leggett
- SA Pharmacy, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Usha Ritchie
- SA Pharmacy, Women's and Children's Hospital, North Adelaide, SA, Australia.,SA Pharmacy, Royal Adelaide Hospital, Port Road, SA, Australia
| | - Lynn Costi
- SA Pharmacy, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - David Elliot
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA, Australia.,Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - William M Hague
- Robinson Research Institute, University of Adelaide, North Adelaide, SA, Australia
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Singh H, Bista A, Baggott J, Unnithan A, Sobti A, Farook M, Jacob J, Khaleel A, Elliot D. 234 Outcomes of Periprosthetic Femoral Fractures Between 2011–2021: An Observational Study. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Periprosthetic femoral fractures (PPFF) present a significant burden on the health services due to an increase in the ageing population and the number of hip and knee arthroplasties performed. This study observed how this burden changed between 2011 and 2021 and the outcomes for these patients undergoing an operation.
Method
Ten-year retrospective observational study assessing the variance depending on the fracture/operation, ASA scores, time to operation, length of stay and mortality.
Results
From January 2011 to March 2021, we identified 209 operations for femur periprosthetic fractures. The mean age was 83 with a female preponderance of 76%. There was a significant change in the ASA scores of the patients, with the proportion of ASA 3 or more increasing from 43% (2011–2016) to 73% (2017–2021), and ASA 4 or greater increasing from 10% to 17% respectively. There were 68 periprosthetic hip arthroplasty fracture fixations, 81 periprosthetic hip arthroplasty fracture revisions, 45 periprosthetic total knee replacements, and 15 inter-prosthetic fractures. One year mortality rates were 24.6%, 6.7%, 16.3% and 13.3% respectively. The average times to operation were 2.5 days, 4.5 days, 2.1 days, and 1.7 days respectively. The average lengths of stay were 20.8 days, 19.8 days, 12.1 days, and 13.1 days respectively.
Conclusions
PPFF carry a significant mortality risk and ASA scores have increased. Mortality rates were better in the periprosthetic hip arthroplasty patients who had revisions rather than fixations (representing different cohort). one year mortality figures were comparable to similar studies in Ireland and USA.
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Abstract
This article summarizes the current views and proposed approaches to treating soft tissue defects of the hand. The article also outlines some key considerations of digital reconstruction. There are many options in treating soft tissue defects. For defects of the hand, local flaps are primarily considered if the defects are small or moderate in size. A vascularized free flap is only considered for a defect of large size (3 cm long or larger). Thumb reconstruction is of primary importance, while reconstruction of two fingers is necessary when all fingers are lost. Reconstructions of a missing distal part of a finger or reconstruction of an entire finger if only one finger is lost are cosmetic restorations; functionally these defects do not need reconstruction. Sensation is of great importance in repair or reconstruction of the tip of the thumb or finger. Therefore, sensory evaluation is a key factor in assessing and selecting the best options of surgery.
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Affiliation(s)
- Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - David Elliot
- St Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, UK
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Jiang CY, El-Kouri NT, Elliot D, Shields J, Caram MEV, Frankel TL, Ramnath N, Passero VA. Telehealth for Cancer Care in Veterans: Opportunities and Challenges Revealed by COVID. JCO Oncol Pract 2020; 17:22-29. [PMID: 32970512 DOI: 10.1200/op.20.00520] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The Veterans Health Administration system is one of the largest integrated health care providers in the United States, delivering medical care to > 9 million veterans. Barriers to delivering efficient health care include geographical limitations as well as long wait times. Telehealth has been used as a solution by many different health care services. However, it has not been as widely used in cancer care. In 2018, the US Department of Veterans Affairs (VA) Pittsburgh Healthcare System expanded the use of telehealth to provide antineoplastic therapies to rural patients by creating a clinical video telehealth clinic of the Virtual Cancer Care Network. This allows oncologists located at the tertiary center to virtually deliver care to remote sites. The recent COVID-19 pandemic forced oncologists across the VA system to adopt telehealth to provide continuity of care. On the basis of our review and personal experience, we have outlined opportunities for telehealth to play a role in every step of the cancer care journey from diagnosis to therapy to surveillance to clinical trials for medical, surgical, and radiation oncology. There are many advantages, such as decreased travel time and potential cost savings; however, there continues to be challenges with veterans having access to devices and the Internet as well as understanding how to use telehealth equipment. The lessons learned from this assessment of the VA telehealth system for cancer care can be adopted and integrated into other health systems. In the future, there needs to be evaluation of how telehealth can be further incorporated into oncology, satisfaction of veterans using telehealth services, overcoming telehealth barriers, and defining metrics of success.
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Affiliation(s)
- Cindy Y Jiang
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | - David Elliot
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | | | - Megan E V Caram
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, Ann Arbor, MI.,VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Timothy L Frankel
- Division of Surgical Oncology, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Nithya Ramnath
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Rogel Cancer Center, Ann Arbor, MI.,VA Ann Arbor Healthcare System, Ann Arbor, MI
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Affiliation(s)
- Anne-Marie Kennedy
- St. Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex, United Kingdom
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Affiliation(s)
- Dimitris Reissis
- St Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, UK
| | - David Elliot
- St Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, UK
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Reid AWN, Elliot D. 'Monk's head' osteoarthritis of the middle finger metacarpophalangeal joint. J Hand Surg Eur Vol 2019; 44:648-649. [PMID: 30909781 DOI: 10.1177/1753193419838199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Alex W N Reid
- St Andrews Unit for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - David Elliot
- St Andrews Unit for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
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Donaldson P, Enticott P, Albein-Urios N, Kirkovski M, Hoy K, Fitzgibbon B, Elliot D, Wambeek L, Fitzgerald P. A clinical trial comparing intermittent theta burst stimulation to dorsomedial prefrontal cortex and right temporoparietal junction in autism spectrum disorder. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Franchi A, Häfeli M, Scaglioni MF, Elliot D, Giesen T. The use of chimeric musculocutaneous posterior interosseous artery flaps for treatment of osteomyelitis and soft tissue defect in hand. Microsurgery 2019; 39:416-422. [PMID: 30779433 DOI: 10.1002/micr.30434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/30/2018] [Accepted: 01/25/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION There is growing evidence of the superior ability of muscular tissue to clear bacterial bone infection. Unfortunately, in the hand, there are almost no small local muscular flaps, and muscular transfers to the hand are mainly microsurgical free transfers. In this report, we present the results of the use of a chimeric posterior interosseous flap including part(s) of the forearm muscles to treat osteomyelitis and soft tissue defect of hand from a series of patients. PATIENTS AND METHODS Four male patients with an average age of 32 years (range 20-46 years), were affected by acute osteomyelitis in hand. Previous fracture fixation with percutaneous K-wires was the cause of bone infection in three case. In one case, the osteomyelitis was a consequence of an open fracture. The bones affected were four metacarpals and one proximal phalanx, all with a minimal cortical defect (from the K-wire) obscuring a larger medullary infection, which required extensive bone and overlying soft tissue debridement, leaving a soft tissue defect to be reconstructed of size ranging from 2 x 4 cm to 5 x 7 cm. The soft tissue defects were due to concomitant superficial infection and consequent debridement. All patients were treated with bone debridement and a chimeric posterior interosseous flap, which included part of the extensor digiti minimi and/or extensor carpi ulnaris to fill the intramedullary canal of the bones. No fixation of bone was necessary. RESULTS The skin paddle of the flaps ranged from 2 x 5 cm to 5 x 6 cm, replicating the defect area, plus a teardrop tail of skin circa 1.5 cm wide and as long as the pedicle of the flap. The muscular components of the flaps used to fill the intramedullary canals ranged from 1 x 1 x 1.5 cm to 1.5 x 1.5 x 4 cm. All flaps survived and osteomyelitis resolved in all cases without major complications. At the final follow-up at 16 months (range 12-26 months), assessment of the hands using TAM, Power Grip and Key Pinch Strength measurements and, where appropriate, Kapandji scores, demonstrated satisfactory hand function. CONCLUSION The chimeric posterior interosseous flap including part of the muscles of the forearm may be a robust solution for augmenting the flap bulk and may be used in cases of severe osteomyelitis of the hand.
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Affiliation(s)
- Alberto Franchi
- Kantonsspital Luzern, Klinik für Hand-und Plastische Chirurgie, Lucerne, Switzerland
| | - Mathias Häfeli
- Kantonsspital Graubünden, Departement Chirurgie, Handchirurgie, Chur, Switzerland
| | - Mario F Scaglioni
- Kantonsspital Luzern, Klinik für Hand-und Plastische Chirurgie, Lucerne, Switzerland
| | - David Elliot
- Broomfield Hospital, St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, United Kingdom
| | - Thomas Giesen
- Swissparc AG, Hand Surgery Service, Zürich, Switzerland.,Clinica Ars Medica, Centro Manoegomito, Gravesano, Switzerland
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Hulin JA, Tommasi S, Elliot D, Mangoni AA. Small molecule inhibition of DDAH1 significantly attenuates triple negative breast cancer cell vasculogenic mimicry in vitro. Biomed Pharmacother 2019; 111:602-612. [PMID: 30611984 DOI: 10.1016/j.biopha.2018.12.117] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/14/2018] [Accepted: 12/29/2018] [Indexed: 12/21/2022] Open
Abstract
Dimethylarginine dimethylaminohydrolase 1 (DDAH1) is a key enzyme involved in the metabolism of the endogenous nitric oxide synthase (NOS) inhibitors asymmetric dimethylarginine (ADMA) and monomethyl arginine (L-NMMA). Increased DDAH1 expression and subsequent increased NO production have been recently linked to cancer. Specifically, DDAH1 is implicated in establishment of a vascular network by tumour cells, vasculogenic mimicry (VM), which is strongly associated with tumour progression and poor patient prognosis. The use of DDAH1 inhibitors as potential therapeutic agents thus represents a growing field of interest. Here we describe a UPLC-MS assay to quantify stability and intracellular concentration of two small molecule DDAH1 inhibitors synthesised by our group, ZST316 and ZST152, following incubation with MDA-MB-231 breast cancer cells. In an in vitro assay of VM, both DDAH1 inhibitors significantly attenuated formation of capillary-like tube structures in a dose-dependent fashion. This was not due to cell toxicity or altered cell proliferation, but may be due in part to inhibition of cell migration. Mechanistically, we demonstrate significant modulation of the endogenous DDAH/ADMA/NO pathway following exposure of 100 μM ZST316 or ZST152: a 40% increase in the DDAH1 substrate ADMA, and a 38% decrease in the DDAH1 product l-citrulline. This study represents the first evidence for therapeutic inhibition of DDAH1 by small molecules in breast cancer.
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Affiliation(s)
- Julie-Ann Hulin
- Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, Australia; Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia.
| | - Sara Tommasi
- Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - David Elliot
- Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Arduino A Mangoni
- Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, South Australia, Australia
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Bailey NW, Hoy KE, Rogasch NC, Thomson RH, McQueen S, Elliot D, Sullivan CM, Fulcher BD, Daskalakis ZJ, Fitzgerald PB. Differentiating responders and non-responders to rTMS treatment for depression after one week using resting EEG connectivity measures. J Affect Disord 2019; 242:68-79. [PMID: 30172227 DOI: 10.1016/j.jad.2018.08.058] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/30/2018] [Accepted: 08/12/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Non-response to repetitive transcranial magnetic stimulation (rTMS) treatment for depression is costly for both patients and clinics. Simple and cheap methods to predict response would reduce this burden. Resting EEG measures differentiate responders from non-responders, so may have utility for response prediction. METHODS Fifty patients with treatment resistant depression and 21 controls had resting electroencephalography (EEG) recorded at baseline (BL). Patients underwent 5-8 weeks of rTMS treatment, with EEG recordings repeated at week 1 (W1). Forty-two participants had valid BL and W1 EEG data, and 12 were responders. Responders and non-responders were compared at BL and W1 in measures of theta (4-8 Hz) and alpha (8-13 Hz) power and connectivity, frontal theta cordance and alpha peak frequency. Control group comparisons were made for measures that differed between responders and non-responders. A machine learning algorithm assessed the potential to differentiate responders from non-responders using EEG measures in combination with change in depression scores from BL to W1. RESULTS Responders showed elevated theta connectivity across BL and W1. No other EEG measures differed between groups. Responders could be distinguished from non-responders with a mean sensitivity of 0.84 (p = 0.001) and specificity of 0.89 (p = 0.002) using cross-validated machine learning classification on the combination of all EEG and mood measures. LIMITATIONS The low response rate limited our sample size to only 12 responders. CONCLUSION Resting theta connectivity at BL and W1 differ between responders and non-responders, and show potential for predicting response to rTMS treatment for depression.
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Affiliation(s)
- N W Bailey
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia..
| | - K E Hoy
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - N C Rogasch
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton 3168, Victoria, Australia
| | - R H Thomson
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - S McQueen
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - D Elliot
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - C M Sullivan
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - B D Fulcher
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton 3168, Victoria, Australia
| | - Z J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - P B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia.; Epworth Healthcare, The Epworth Clinic, Camberwell 3004, Victoria, Australia
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Abstract
We review recent developments in using occlusive dressings, dermal templates, and venous flaps for less invasive approaches to treat soft tissue defects of the forearm and fingers. Occlusive dressings can be used for thumb tip or fingertip trauma with soft tissue defects of small or moderate sizes. They permit skin regeneration without use of skin graft or a flap transfer. This is currently a popular way to treat tip soft tissue defects in European countries. Extensive soft tissue defects in the thumb, fingers, hand and forearm require flap transfers traditionally, but in recent years, surgeons use dermal templates to cover the defect site to allow regeneration of subcutaneous tissues, over which a skin graft is used in lieu of a flap. Transfer of a venous flap is currently a reliable procedure and is less invasive compared with conventional flaps, which usually damage a named artery in the donor. We advocate that less invasive methods should be considered for soft tissue defects in the hand and forearm.
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Affiliation(s)
- David Elliot
- 1 Hand Surgery Department, Broomfield Hospital, Chelmsford, UK
| | - Roberto Adani
- 2 Department of Hand and Microsurgery, University Hospital Modena, Modena, Italy
| | - Sang Hyun Woo
- 3 W Institute for Hand & Reconstructive Microsurgery, W Hospital, Daegu, Korea
| | - Jin Bo Tang
- 4 Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
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Hocking AJ, Elliot D, Hua J, Klebe S. Administering Fixed Oral Doses of Curcumin to Rats through Voluntary Consumption. J Am Assoc Lab Anim Sci 2018; 57:508-512. [PMID: 30157991 DOI: 10.30802/aalas-jaalas-17-000143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Curcumin, a polyphenol derived from turmeric, has a wide variety of therapeutic benefits including antiinflammatory, antioxidative, and chemopreventative effects. Oral gavage is widely performed to administer curcumin in laboratory rodents in several experimental models. Although effective, this method can increase stress in the animal, potentially influencing experimental results. Moreover, oral gavage can result in mortality due to accidental instillation of fluid into the lungs, serious mechanical damage, and gavage-related reflux. Here we describe a method for the administration of fixed dosages of curcumin to rats through voluntary consumption of peanut butter, to reduce gavage-related morbidity and distress to animals and to provide environmental enrichment. Fischer 344 (n = 6) rats received 1100 mg/kg of a commercial curcumin product (equivalent to approximately 200 mg/kg of curcumin) in 8 g/kg of peanut butter daily for 5 wk. Curcumin concentrations in rat plasma were measured by using UPLC-MS at 2 to 4 h after administration. All rats voluntarily consumed the peanut butter-curcumin mixture consistently over the 5-wk period. Total curcumin concentrations in plasma samples collected 2 to 4 h after curcumin consumption were 171 ± 48.4 ng/mL (mean ± 1 SD; range, 103 to 240 ng/mL). This noninvasive curcumin delivery method was effective, eliminated the stress caused by daily oral gavage, and added environmental enrichment.
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Affiliation(s)
- Ashleigh J Hocking
- Department of Anatomical Pathology, Flinders University, Flinders Medical Centre, Adelaide, South Australia;,
| | - David Elliot
- Department of Clinical Pharmacology, Flinders Medical Centre, Adelaide, South Australia
| | - Jin Hua
- Department of Anatomical Pathology, Flinders University, Flinders Medical Centre, Adelaide, South Australia
| | - Sonja Klebe
- Department of Anatomical Pathology, Flinders University, Flinders Medical Centre, Adelaide, South Australia
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Fitzgerald PB, Hoy KE, Elliot D, McQueen S, Wambeek LE, Daskalakis ZJ. Exploring alternative rTMS strategies in non-responders to standard high frequency left-sided treatment: A switching study. J Affect Disord 2018; 232:79-82. [PMID: 29477588 DOI: 10.1016/j.jad.2018.02.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/12/2018] [Accepted: 02/15/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND High-frequency left-sided repetitive transcranial magnetic stimulation (rTMS) is now commonly used treatment for patients with depression. However, there are several other forms of rTMS (low-frequency right-sided and sequential bilateral rTMS) which have also been shown to be effective. No information has been systematically gathered on the likelihood of response to alternative forms of rTMS in patients who do not improve after an initial course of left-sided treatment. OBJECTIVE To evaluate whether there are differences in antidepressant response between switching to either low-frequency right sided or sequential bilateral stimulation or continuing high-frequency left-sided TMS following non-response to an initial course of high-frequency left-sided rTMS. METHODS 113 rTMS naïve patients were provided with an initial three-week course of high-frequency left-sided rTMS. Non-responders were then randomised to receive another three weeks of left-sided treatment (n = 21), right-sided low frequency stimulation (n = 18) or sequential bilateral rTMS (n = 20). RESULTS Although there was an overall improvement in depressive symptoms in the randomised phase of the study, no significant differences in response was seen between the three treatment groups on Montgomery Asberg Depression Rating Scale or Hamilton Depression Rating Scale scores. LIMITATIONS The main limitation of the study was the duration of treatment provided in both the lead in and random treatment phases. CONCLUSION This study does not provide evidence for differences in response to different forms of rTMS in initial non-responders to left-sided stimulation. However, further studies with longer periods of treatment and a larger sample size are required to definitively establish or exclude between group differences in rTMS response in initial non-responders to treatment.
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Affiliation(s)
- Paul B Fitzgerald
- Epworth Healthcare, The Epworth Clinic, Camberwell, Victoria, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Victoria, Australia.
| | - Kate E Hoy
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Victoria, Australia
| | - David Elliot
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Victoria, Australia
| | - Susan McQueen
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Victoria, Australia
| | - Lenore E Wambeek
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Victoria, Australia
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Ontario, Canada
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18
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Fitzgerald PB, Hoy KE, Elliot D, McQueen S, Wambeek LE, Chen L, Clinton AM, Downey G, Daskalakis ZJ. A pilot study of the comparative efficacy of 100 Hz magnetic seizure therapy and electroconvulsive therapy in persistent depression. Depress Anxiety 2018; 35:393-401. [PMID: 29329499 DOI: 10.1002/da.22715] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 11/19/2017] [Accepted: 12/11/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Magnetic seizure therapy (MST) is a novel brain stimulation technique that uses a high-powered transcranial magnetic stimulation device to produce therapeutic seizures. Preliminary MST studies have found antidepressant effects in the absence of cognitive side effects but its efficacy compared to electroconvulsive therapy (ECT) remains unclear. The aim of this study was to investigate the therapeutic efficacy and cognitive profile of MST compared to standard right unilateral ECT treatment. METHODS Thirty-seven patients completed a course of at least nine ECT or MST treatments in a randomized double-blind protocol. Assessments of depression severity and cognition were performed before and after treatment. RESULTS No difference in the antidepressant effectiveness between the treatments was seen across any of the clinical outcome measures, although the overall response rates in both groups were quite low. In regards to cognition, following MST there were significant improvements in tests of psychomotor speed, verbal memory, and cognitive inhibition, with no reductions in cognitive performance. Following ECT there was significant improvement in only one of the cognitive inhibition tasks. With respect to the between-group comparisons, the MST group showed a significantly greater improvement on psychomotor speed than ECT. CONCLUSIONS MST showed similar efficacy to right unilateral ECT in patients with treatment-resistant depression without cognitive side effects but in a sample that was only of sufficient size to demonstrate relatively large differences in response between the two groups. Future research should aim to optimize the methods of MST administration and compare its efficacy to ECT in large randomized controlled trials.
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Affiliation(s)
- Paul B Fitzgerald
- Epworth Healthcare, Epworth Clinic, Camberwell, Victoria, Australia.,Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - Kate E Hoy
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - David Elliot
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - Susan McQueen
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - Lenore E Wambeek
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - Leo Chen
- Epworth Healthcare, Epworth Clinic, Camberwell, Victoria, Australia.,Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | | | - Glenn Downey
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital & Monash University Central Clinical School, Victoria, Australia
| | - Zafiris J Daskalakis
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Ontario, Canada
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Fitzgibbon B, Hoy K, Knox L, Guymer E, Littlejohn G, Elliot D, Wambeek L, McQueen S, Elford K, Lee S, Enticott P, Fitzgerald P. Evidence for the improvement of fatigue in fibromyalgia: A 4‐week left dorsolateral prefrontal cortex repetitive transcranial magnetic stimulation randomized‐controlled trial. Eur J Pain 2018. [DOI: 10.1002/ejp.1213] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- B.M. Fitzgibbon
- Monash Alfred Psychiatry Research Centre (MAPrc) the Alfred and Central Clinical School Monash University Melbourne VIC Australia
| | - K.E. Hoy
- Monash Alfred Psychiatry Research Centre (MAPrc) the Alfred and Central Clinical School Monash University Melbourne VIC Australia
| | - L.A. Knox
- Monash Alfred Psychiatry Research Centre (MAPrc) the Alfred and Central Clinical School Monash University Melbourne VIC Australia
| | - E.K. Guymer
- Department of Rheumatology Monash Health Clayton VIC Australia
- Department of Medicine Monash University Clayton VIC Australia
| | - G. Littlejohn
- Department of Rheumatology Monash Health Clayton VIC Australia
- Department of Medicine Monash University Clayton VIC Australia
| | - D. Elliot
- Monash Alfred Psychiatry Research Centre (MAPrc) the Alfred and Central Clinical School Monash University Melbourne VIC Australia
| | - L.E. Wambeek
- Monash Alfred Psychiatry Research Centre (MAPrc) the Alfred and Central Clinical School Monash University Melbourne VIC Australia
| | - S. McQueen
- Monash Alfred Psychiatry Research Centre (MAPrc) the Alfred and Central Clinical School Monash University Melbourne VIC Australia
| | - K.A. Elford
- Department of Rheumatology Monash Health Clayton VIC Australia
| | - S.J. Lee
- Monash Alfred Psychiatry Research Centre (MAPrc) the Alfred and Central Clinical School Monash University Melbourne VIC Australia
- Department of Psychiatry Alfred Health Melbourne VIC Australia
| | - P.G. Enticott
- Deakin Child Study Centre School of Psychology Deakin University Burwood VIC Australia
| | - P.B. Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc) the Alfred and Central Clinical School Monash University Melbourne VIC Australia
- Epworth Clinic Epworth Healthcare Camberwell VIC Australia
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21
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Da Boit M, Tommasi S, Elliot D, Zinellu A, Sotgia S, Sibson R, Meakin JR, Aspden RM, Carru C, Mangoni AA, Gray SR. Sex Differences in the Associations between L-Arginine Pathway Metabolites, Skeletal Muscle Mass and Function, and their Responses to Resistance Exercise, in Old Age. J Nutr Health Aging 2018; 22:534-540. [PMID: 29582894 DOI: 10.1007/s12603-017-0964-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The current study was designed to explore the associations between L-arginine metabolites and muscle mass and function in old age, which are largely unknown. DESIGN The study used a randomised, double-blind, placebo-controlled design. SETTING The study was carried out in a laboratory setting. PARTICIPANTS 50 healthy older adults [median age 70 years (IQR 67-73); 27 males]. INTERVENTION Participants undertook an 18-week resistance exercise program, and a nutritional intervention (fish oil vs. placebo). MEASUREMENTS Serum homoarginine, ornithine, citrulline, asymmetric dimethylarginine (ADMA), NG-monomethyl-L-arginine (L-NMMA), and symmetric dimethylarginine (SDMA), maximal voluntary contraction (MVC) and isokinetic torque of the knee extensors at 30° s-1 (MIT), muscle cross sectional area (MCSA) and quality (MQ) were measured at baseline and after the intervention. RESULTS No significant exercise-induced changes were observed in metabolite concentrations. There were significant sex differences in the associations between metabolites and muscle parameters. After adjusting for age, glomerular filtration rate and fish oil intervention, citrulline (P=0.002) and ornithine (P=0.022) were negatively associated with MCSA at baseline in males but not females. However, baseline citrulline was negatively correlated with exercise-induced changes in MVC (P=0.043) and MQ (P=0.026) amongst females. Furthermore, amongst males, baseline homoarginine was positively associated with exercise-induced changes in MVC (P=0.026), ADMA was negatively associated with changes in MIT (P=0.026), L-NMMA (p=0.048) and ornithine (P<0.001) were both positively associated with changes in MCSA, and ornithine was negatively associated with changes in MQ (P=0.039). CONCLUSION Therefore, barring citrulline, there are significant sex differences in the associations between L-arginine metabolites and muscle mass and function in healthy older adults. These metabolites might enhance sarcopenia risk stratification, and the success of exercise programs, in old age.
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Affiliation(s)
- M Da Boit
- Dr Stuart Gray, BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland, G12 8TA, United Kingdom. Tel: 0141 330 2569
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22
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Bailey NW, Hoy KE, Rogasch NC, Thomson RH, McQueen S, Elliot D, Sullivan CM, Fulcher BD, Daskalakis ZJ, Fitzgerald PB. Responders to rTMS for depression show increased fronto-midline theta and theta connectivity compared to non-responders. Brain Stimul 2018; 11:190-203. [PMID: 29128490 DOI: 10.1016/j.brs.2017.10.015] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/11/2017] [Accepted: 10/15/2017] [Indexed: 02/01/2023] Open
Affiliation(s)
- N W Bailey
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia.
| | - K E Hoy
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - N C Rogasch
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, 3168 VIC, Australia
| | - R H Thomson
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - S McQueen
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - D Elliot
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - C M Sullivan
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia
| | - B D Fulcher
- Brain and Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, 3168 VIC, Australia
| | - Z J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - P B Fitzgerald
- Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, Commercial Rd, Melbourne, Victoria, Australia; Epworth Healthcare, The Epworth Clinic, Camberwell, 3004, Victoria, Australia
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Hocking A, Elliot D, Hua J, Michael M, Marri S, Klebe S. P1.09-012 A Pre-Clinical Investigation of Intrapleural Curcumin Treatments as an Adjunct Therapy for Malignant Pleural Mesothelioma. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Conyers R, Costello B, La Gerche A, Tripaydonis A, Burns C, Ludlow L, Lange P, Ekert P, Mechinaud F, Cheung M, Martin M, Elliot D. Chemotherapy‐related cardiotoxicity: are Australian practitioners missing the point? Intern Med J 2017; 47:1166-1172. [DOI: 10.1111/imj.13481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/13/2017] [Accepted: 05/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Rachel Conyers
- Children's Cancer Centre, The Royal Children's Hospital Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Ben Costello
- The Baker IDI Institute The Alfred Hospital Melbourne Victoria Australia
| | - Andre La Gerche
- The Baker IDI Institute The Alfred Hospital Melbourne Victoria Australia
| | - Anne Tripaydonis
- Melbourne Medical School Melbourne University Melbourne Victoria Australia
| | - Charlotte Burns
- Children's Cancer Centre, The Royal Children's Hospital Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Louise Ludlow
- Children's Cancer Centre, Tissue Bank Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Peter Lange
- Department of General Medicine The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Paul Ekert
- Children's Cancer Centre, The Royal Children's Hospital Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Francoise Mechinaud
- Children's Cancer Centre, The Royal Children's Hospital Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Michael Cheung
- Cardiology Unit, The Royal Children's Hospital Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Michelle Martin
- Children's Cancer Centre, The Royal Children's Hospital Murdoch Children's Research Institute Melbourne Victoria Australia
| | - David Elliot
- Cardiac Development Laboratory Murdoch Children's Research Institute Melbourne Victoria Australia
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25
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Abstract
The protocol for primary flexor tendon repair in zones 1 and 2 of the hand is changing. This article discusses recent changes. Immediate repair within 48 hours is performed whenever possible. A 6-strand core suture is performed using the M modification of Tang's technique. The pulleys are divided to allow free excursion of the repaired tendon within the tendon sheath. To avoid repaired structures within the sheath being too bulky, the authors generally repair only half of the flexor digitorum superficialis. In some cases, the flexor digitorum superficialis is excised completely. Rehabilitation remains based on controlled active motion.
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Affiliation(s)
- Thomas Giesen
- Plastic Surgery and Hand Surgery Division, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland.
| | - Maurizio Calcagni
- Plastic Surgery and Hand Surgery Division, University Hospital Zurich, Raemistrasse 100, Zurich 8091, Switzerland
| | - David Elliot
- St. Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Court Road, Broomfield CM1, UK
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26
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Mangoni AA, Baghdadi LR, Shanahan EM, Wiese MD, Tommasi S, Elliot D, Woodman RJ. Methotrexate, blood pressure and markers of arterial function in patients with rheumatoid arthritis: a repeated cross-sectional study. Ther Adv Musculoskelet Dis 2017; 9:213-229. [PMID: 28932292 DOI: 10.1177/1759720x17719850] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 06/15/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Methotrexate (MTX) treatment in rheumatoid arthritis (RA) has been associated with lower cardiovascular risk compared to other disease-modifying antirheumatic drugs (DMARDs). We sought to identify whether the MTX-associated cardioprotection involves changes in blood pressure (BP) and/or arterial function. METHODS Clinic and 24-hour peripheral and central systolic and diastolic BP (SBP and DBP), augmentation index (AIx), pulse wave velocity (PWV) and plasma asymmetric dimethylarginine (ADMA) were assessed in RA patients on stable treatment with either MTX ± other DMARDs (MTX group, n = 56, age 61 ± 13 years, 70% females) or other DMARDs (non-MTX group, n = 30, age 63 ± 12 years, 76% females). Measurements were performed at baseline and after 8 months. RESULTS After adjusting for visit, age, gender, body mass index, folic acid use and 28-joint disease activity score, the MTX group had significantly lower clinic peripheral SBP (-7.7 mmHg, 95% CI -13.2 to -2.3, p = 0.006) and DBP (-6.1 mmHg, 95% CI -9.8 to -2.4, p = 0.001) and clinic central SBP (-7.8 mmHg, 95% CI -13.1 to -2.6, p = 0.003) and DBP (-5.4 mmHg, 95% CI -9.1 to -1.6, p = 0.005) versus the non-MTX group. Furthermore, the MTX group had significantly lower 24-hour peripheral and central SBP and DBP and PWV versus the non-MTX group (p < 0.01 for all comparisons). By contrast, there were no significant between-group differences in AIx and ADMA. CONCLUSIONS RA patients on MTX treatment had significantly lower clinic and 24-hour peripheral and central BP compared to those who did not take MTX. The lower BP with MTX may be related to differences in PWV, but not in AIx or ADMA concentrations. Further longitudinal studies including randomized controlled trials are warranted to confirm these findings, to identify other possible mechanisms responsible for the effects of MTX on BP and PWV, and to establish whether these effects might account for the reduced cardiovascular risk with MTX.
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Affiliation(s)
- Arduino A Mangoni
- Department of Clinical Pharmacology, School of Medicine, Flinders University and Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Leena R Baghdadi
- Department of Clinical Pharmacology, School of Medicine, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - E Michael Shanahan
- Department of Rheumatology, Flinders University and Southern Adelaide Local Health Network, Adelaide, Australia
| | - Michael D Wiese
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Sara Tommasi
- Department of Clinical Pharmacology, School of Medicine, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - David Elliot
- Department of Clinical Pharmacology, School of Medicine, Flinders University and Flinders Medical Centre, Adelaide, Australia
| | - Richard J Woodman
- Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Adelaide, Australia
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27
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Laing TA, Sierakowski A, Elliot D. Management of painful scar-tethered cutaneous nerves of the upper limb. Hand Surg Rehabil 2017; 36:208-214. [PMID: 28465200 DOI: 10.1016/j.hansur.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/26/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Abstract
We report the results of treatment by division and proximal relocation of 44 painful, scar-tethered cutaneous nerves of the upper limb in 22 patients. In all patients, neuropathic pain had developed either following surgery or trauma, but without apparent direct nerve injury. The mean duration of pain symptoms prior to relocation was 17 (range 7-44) months. Adequate treatment involved relocation of 35 nerves at a first operation for each of the 22 patients, with six patients requiring further surgery to relocate 9 nerves. At a minimum follow-up of 6 months, nerve relocation resulted in complete resolution of all forms of pain at the primary site in 21/22 (95%) patients and no pain or hypersensitivity at the final relocation site in 19 of the 22 patients (86%).
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Affiliation(s)
- T A Laing
- Hand Surgery Department, St Andrew's Centre for plastic surgery, Broomfield Hospital, Chelmsford, Essex, United Kingdom.
| | - A Sierakowski
- Hand Surgery Department, St Andrew's Centre for plastic surgery, Broomfield Hospital, Chelmsford, Essex, United Kingdom
| | - D Elliot
- Hand Surgery Department, St Andrew's Centre for plastic surgery, Broomfield Hospital, Chelmsford, Essex, United Kingdom
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28
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Abstract
Doctors and psychologists often use 'well-being' and 'quality of life' interchangeably, with quality of health overdetermining both. Insights from virtue ethics and St. Thomas Aquinas challenge this. Well-being has a primary 'eudaimonic' dimension, and an accompanying 'subjective' dimension. The 'eudaimonic' consists in a virtuous way of life in which our affective, cognitive, and other capacities are developed in pursuit of worthwhile aims. The 'subjective' consists in attaining and enjoying the goods necessary and fitting to a full human life. Does health - extended to include mental and physical health - account for the 'eudaimonic'? The result would problematically collapse ethics into medicine, and well-being into health. Rather, it is argued that health is a 'subjective' and not an 'eudaimonic' good, and that to a significant degree eudaimonic well-being can persist amid ill-health. Attending to the eudaimonic dimension helps us to overcome characteristic gaps in 'quality of life' discourse.
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Khandwala AR, Blair J, Harris SB, Foster AJ, Elliot D. Immediate Repair and Early Mobilization of the Extensor Pollicis Longus Tendon in Zones 1 to 4. ACTA ACUST UNITED AC 2017; 29:250-8. [PMID: 15142696 DOI: 10.1016/j.jhsb.2003.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2003] [Accepted: 12/18/2003] [Indexed: 11/19/2022]
Abstract
We present the results of repair and early mobilization of 100 extensor pollicis longus (EPL) tendon injuries in zones 1 to 4 in 100 patients using a dynamic outrigger splint which controlled metacarpophalangeal joint movements but allowed free movement of the interphalangeal joint. Eighty-two were complete divisions of the tendon and 18 were 80% to 99% tendon divisions. Analysis of measurements obtained routinely at 8 weeks showed 81% excellent and good results using the TAM system. There were 90% excellent and good results in the 72 patients who were followed-up and received therapy for 12 weeks. Except on the rare occasion when the repair ruptures, loss of thumb extension was not a common functional problem, but scar tethering of the repaired tendon can result in loss of thumb flexion. While loss of metacarpophalangeal joint flexion appeared to have little functional importance, loss of interphalangeal joint flexion and slowing of the movements of this joint can cause functional problems. When interphalangeal joint hyperextension is present before the injury, it is frequently lost but this generally goes unnoticed by the patients. The problems of analysing the EPL injury using the methods of assessment available are discussed.
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Affiliation(s)
- A R Khandwala
- Hand Surgery Department, St Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK
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30
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Abstract
Over a period of 4 years, in various circumstances commonly seen in hand surgery, 100 patients underwent 127 soft tissue attachments to bone using the Acufex wedge tag system (Acufex Microsurgical, Inc, Mansfield, MA), a non-metallic bone anchor. No failures to maintain the attachment of the desired soft tissue to bone were identified. While less robust than the Mitek anchor, the other commonly available system of bone anchoring, and therefore possibly inappropriate for general orthopaedics, the Acufex wedge tag proved adequate for the smaller forces of hand surgery.
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Affiliation(s)
- A R Khandwala
- Hand Surgery Department, St.Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex, CM1 7ET, England, UK
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31
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Giesen T, Adani R, Carmes S, Dumontier C, Elliot D, Calcagni M. IFSSH scientific committee on skin coverage: 2015 report. Hand Surg Rehabil 2016; 35:307-319. [PMID: 27781975 DOI: 10.1016/j.hansur.2016.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 05/15/2016] [Accepted: 07/26/2016] [Indexed: 11/20/2022]
Abstract
Skin coverage in hand reconstruction is a challenging and vast chapter in hand surgery; covering every aspect of it in a report is simply not feasible. Therefore, this report focuses on a few specific topics. The coverage of anatomical regions like the fingertips is common ground for hand surgeons worldwide, but in the last 10 years, various refinements have been published in order to optimize the reconstruction of this organ. Nevertheless, in many emergency departments, the amputation of badly injured fingertips, including the thumb, remains the preferred treatment. The main focus of this report is to counter this tendency by providing alternatives to surgeons. Large defects in the fingers involving more than one segment, defects in the palm and in the dorsum of the hand are currently debated in international meetings. The use of skin substitutes vs. the use of extremely refined microsurgical procedures vs. classic island flaps has generated animated discussions, which are also influenced by cultural and socioeconomic factors around the world. This report offers the views of six surgeons from four different countries, in the hope of animating discussions and suggesting new approaches.
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Affiliation(s)
- T Giesen
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - R Adani
- Department of Hand Surgery, University Hospital of Modena, Modena, Italy
| | - S Carmes
- Department of Plastic Surgery and Hand Surgery, Nice University Hospital, Nice, France
| | - C Dumontier
- Department of Plastic Surgery and Hand Surgery, Nice University Hospital, Nice, France
| | - D Elliot
- Hand Surgery Department, St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, Essex, UK
| | - M Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Elliot D, Lalonde DH, Tang JB. Commentaries on Clinical results of releasing the entire A2 pulley after flexor tendon repair in zone 2C. K. Moriya, T. Yoshizu, N. Tsubokawa, H. Narisawa, K. Hara and Y. Maki. J Hand Surg Eur. 2016, 41: 822-28. J Hand Surg Eur Vol 2016; 41:829-30. [PMID: 27655812 DOI: 10.1177/1753193416655932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- David Elliot
- Consultant Hand Surgeon, St Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, UK
| | - Donald H Lalonde
- Professor Surgery, Dalhousie University, Saint John, New Brunswick, Canada
| | - Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Sotgia S, Mangoni AA, Forteschi M, Murphy RB, Elliot D, Sotgiu E, Pintus G, Carru C, Zinellu A. Identification of the Main Intermediate Precursor of l-Ergothioneine Biosynthesis in Human Biological Specimens. Molecules 2016; 21:molecules21101298. [PMID: 27689978 PMCID: PMC6272924 DOI: 10.3390/molecules21101298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/10/2016] [Accepted: 09/23/2016] [Indexed: 12/26/2022] Open
Abstract
A capillary electrophoresis coupled to tandem mass spectrometry (CE–MS/MS) has been used to make a qualitative determination of hercynine—the main precursor of l-ergothioneine biosynthesis—in some key human biological specimens, such as urine, whole blood, plasma, and saliva. From semiquantitative analysis results, the highest concentrations of hercynine were detected in saliva and whole blood, whereas much lower concentrations were measured in urine and plasma. Whole blood was the biological matrix with the highest concentration of l-ergothioneine followed by plasma, saliva, and urine. The antioxidant effects attributed to l-ergothioneine, along with its peculiar antioxidant mechanism, offer a possible explanation for the presence of the hercynine, as well as its concentration, in the considered biological matrices.
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Affiliation(s)
- Salvatore Sotgia
- Department of Biomedical Sciences, School of Medicine, University of Sassari, Sassari 07100, Italy.
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, School of Medicine, Flinders University and Flinders Medical Centre, Adelaide SA 5042, Australia.
| | - Mauro Forteschi
- Department of Biomedical Sciences, School of Medicine, University of Sassari, Sassari 07100, Italy.
| | - Rhys B Murphy
- Department of Clinical Pharmacology, School of Medicine, Flinders University and Flinders Medical Centre, Adelaide SA 5042, Australia.
| | - David Elliot
- Department of Clinical Pharmacology, School of Medicine, Flinders University and Flinders Medical Centre, Adelaide SA 5042, Australia.
| | - Elisabetta Sotgiu
- Department of Biomedical Sciences, School of Medicine, University of Sassari, Sassari 07100, Italy.
| | - Gianfranco Pintus
- Department of Biomedical Sciences, School of Medicine, University of Sassari, Sassari 07100, Italy.
- Department of Biomedical Sciences, College of Health Sciences, Qatar University, Doha 2713, Qatar.
| | - Ciriaco Carru
- Department of Biomedical Sciences, School of Medicine, University of Sassari, Sassari 07100, Italy.
- Quality Control Unit, University Hospital Sassari (AOU), Sassari 07100, Italy.
| | - Angelo Zinellu
- Department of Biomedical Sciences, School of Medicine, University of Sassari, Sassari 07100, Italy.
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Figus A, Kanitkar S, Elliot D. Squamous Cell Carcinoma of the Lateral Nail Fold. ACTA ACUST UNITED AC 2016; 31:216-20. [PMID: 16356611 DOI: 10.1016/j.jhsb.2005.10.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Revised: 08/13/2005] [Accepted: 10/31/2005] [Indexed: 11/22/2022]
Abstract
The digital nail complex is occasionally involved by squamous cell carcinoma. The published literature has either been indiscriminating of the site of origin of this tumour within the nail complex or has concentrated attention on the nail bed as the site of pathology. Tumours originating in the lateral nail fold can be clearly differentiated from those of the nail bed itself. This study identifies six cases of squamous cell carcinoma arising in the lateral nail fold. While surgical convention remains to amputate the digital tip for squamous cell carcinoma of any part of the nail complex, the dermatological literature identifies that local surgery can be curative for these tumours, when presenting early and without bone involvement, although offering no discussion of reconstruction. Reconstruction is desirable and methods of achieving this following local excision of lateral nail fold tumours are illustrated in this series.
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Affiliation(s)
- A Figus
- Hand Surgery Department of St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, T, Essex, UK.
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Kulkarni M, Harris SB, Elliot D. The Significance of Extensor Tendon Tethering and Dorsal Joint Capsule Tightening After Injury to the Hand. ACTA ACUST UNITED AC 2016; 31:52-60. [PMID: 16290910 DOI: 10.1016/j.jhsb.2005.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Accepted: 09/26/2005] [Indexed: 11/20/2022]
Abstract
This paper examines the clinical problem of extensor tendon tethering and/or dorsal joint capsule tightening secondary to hand injury. One hundred and forty-one patients were examined 13 to 51 months after hand injuries of varying severity. Fifty-six patients (40%) had suffered simple and eighty-five patients (60%) complex injuries. Seventy-four (52%) of the 141 patients had no extensor tendon tethering and/or dorsal joint capsule tightening. In 30 (21%), the extensor tendon tethering and/or dorsal joint capsule tightening was considered to be “obvious” in that it was easily seen on examination using various commonly used clinical tests of finger flexion and extension. In 37 (26%), the extensor tendon tethering and/or dorsal joint capsule tightening was considered to be of “lesser degree” because it was only evident on application of specific tests which are described in this paper. Of the 37, 21 (56%) described themselves as being unable to make a “proper” fist with the injured hand, 33 (89%) had pain or discomfort on the dorsum of the injured hand and/or fingers on gripping ( P < 0.01) and 25 (70%) had weakness of power of gripping ( P < 0.01). Thirty-two (87%) complained of functional problems at work, with activities of daily living or with the pursuit of their hobbies.
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Affiliation(s)
- M Kulkarni
- St. Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK
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36
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Sirotakova M, Elliot D. Early Active Mobilization of Primary Repairs of the Flexor Pollicis Longus Tendon with Two Kessler Two-Strand Core Sutures and a Strengthened Circumferential Suture. ACTA ACUST UNITED AC 2016; 29:531-5. [PMID: 15542211 DOI: 10.1016/j.jhsb.2004.07.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2004] [Accepted: 07/12/2004] [Indexed: 11/26/2022]
Abstract
This study reports our treatment of divided flexor pollicis longus (FPL) tendons by primary repair from 1999 to 2002. Forty-eight FPL repairs were performed using two Kessler two-strand repairs with a cross-linked Silfverskiöld circumferential suture. All were rehabilitated by early active mobilization. Excellent or good results were observed in 73/77% of cases (White/Buck–Gramcko assessments, respectively). No patients (0%) ruptured their repair as a result of early active mobilization. Two patients (4%) developed post-operative infections with wound and tendon dehiscence. This combination of repairs addresses the problem of rupture of FPL during early mobilization which we experienced in previous studies. Its problems and alternatives are discussed.
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Affiliation(s)
- M Sirotakova
- Hand Surgery Department, St Andrew's Centre For Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK
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Hobby JL, Watts C, Elliot D. Validity and Responsiveness of the Patient Evaluation Measure as an Outcome Measure for Carpal Tunnel Syndrome. ACTA ACUST UNITED AC 2016; 30:350-4. [PMID: 15936130 DOI: 10.1016/j.jhsb.2005.03.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Accepted: 03/10/2005] [Indexed: 11/26/2022]
Abstract
The aim of this study was to assess the validity of the Patient Evaluation Measure questionnaire (PEM) as an outcome measure in carpal tunnel syndrome. The PEM was compared to the DASH questionnaire and to objective measurements of hand function. We also compared its responsiveness to changes following carpal tunnel release with that of the DASH score. Twenty-four patients completed the PEM and DASH questionnaires before and 3 months after open carpal tunnel release. Grip strength, static two-point discrimination and the nine-hole peg test were measured. There was a significant correlation between individual items of the PEM and the objective measures. There was also strong correlation between PEM and DASH scores. The PEM showed a greater responsiveness to change (effect size 0.97) than the DASH score (effect size 0.49). The PEM correlates well with objective measures of hand function and the DASH score when used in carpal tunnel syndrome. It is more responsive to change than the DASH score. It is very simple to complete and score and is an appropriate and practical outcome measure in carpal tunnel syndrome.
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Affiliation(s)
- J L Hobby
- North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire RG24 9NA, UK.
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Dowd MB, Figus A, Harris SB, Southgate CM, Foster AJ, Elliot D. The Results of Immediate Re-Repair of Zone 1 and 2 Primary Flexor Tendon Repairs which Rupture. ACTA ACUST UNITED AC 2016; 31:507-13. [PMID: 16930791 DOI: 10.1016/j.jhsb.2006.06.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 05/27/2006] [Accepted: 06/12/2006] [Indexed: 11/21/2022]
Abstract
This study reports the outcome of immediate re-repair of primary flexor tendon repairs in zones 1 and 2 of the fingers which had ruptured. Between June 1989 and May 2003, a total of 62 fingers in 61 patients presented with ruptured flexor tendon repairs within 48 hours from rupture. Immediate re-repair and rehabilitation was carried out in 44 fingers (71%) in 43 (70%) patients. Thirty-six patients completed the 8-week therapy programme after re-repair in 37 fingers. Nine (24%) had excellent, 10 (27%) good, 5 (14%) fair and 13 (35%) had poor results when assessed by the original Strickland method. Five fingers in five patients ruptured the re-repair. Poor results and second ruptures were particularly common after re-repair of ruptured tendon repairs in the little finger. In the light of these findings, a policy for dealing with ruptured primary flexor tendon repairs in the fingers is suggested.
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Affiliation(s)
- M B Dowd
- Hand Surgery Department, St. Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK
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39
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Elliot D, Ragoowansi R. Dupuytren’s Disease Secondary to Acute Injury, Infection or Operation Distal to the Elbow in the Ipsilateral Upper Limb – A Historical Review. ACTA ACUST UNITED AC 2016; 30:148-56. [PMID: 15757767 DOI: 10.1016/j.jhsb.2004.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Accepted: 08/13/2004] [Indexed: 10/25/2022]
Abstract
The aggregated total of 385 cases of Dupuytren’s disease arising after acute or specific injury, operation or infection of the forearm, wrist or hand between 1614 and 2003 are documented, including a personal series of 52 cases. The history of this relationship is recorded and the medico legal implications of the association are discussed.
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Affiliation(s)
- D Elliot
- Hand Surgery Department, St. Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK.
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40
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Fitzgerald PB, Hoy KE, Elliot D, McQueen S, Wambeek LE, Daskalakis ZJ. A negative double-blind controlled trial of sequential bilateral rTMS in the treatment of bipolar depression. J Affect Disord 2016; 198:158-62. [PMID: 27016659 DOI: 10.1016/j.jad.2016.03.052] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/22/2016] [Accepted: 03/11/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVE To explore the therapeutic benefit of sequential bilateral repetitive transcranial magnetic stimulation (rTMS) in the treatment of bipolar depression. METHOD A 2 arm randomized controlled parallel design trial comparing the use of active sequential bilateral rTMS to a sham form of stimulation in 49 patients with bipolar disorder and treatment resistant depression. RESULTS There was no significant difference in mean reduction in depression rating scale scores or response rates between active and sham stimulation. LIMITATIONS The study was of limited sample size and the use of bilateral rTMS limited generalizability to other forms of rTMS. CONCLUSIONS This study provides no support to the use of active sequential bilateral rTMS in the treatment of the depressive phase of bipolar affective disorder. Although this result is not definitive, we suggest that future research may be better focused on trials evaluating the use of unilateral types of rTMS.
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Affiliation(s)
- Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, St Kilda Road, Melbourne, Victoria 3004, Australia.
| | - Kate E Hoy
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, St Kilda Road, Melbourne, Victoria 3004, Australia
| | - David Elliot
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Susan McQueen
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Lenore E Wambeek
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Zafiris J Daskalakis
- Temerty Centre for Therapeutic Brain Intervention and the Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
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41
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Medina JA, Lorea P, Elliot D, Foucher G. Correction of Clinodactyly by Early Physiolysis: 6-Year Results. J Hand Surg Am 2016; 41:e123-7. [PMID: 26972556 DOI: 10.1016/j.jhsa.2016.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 01/28/2016] [Accepted: 02/04/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To review results at least 6 years after physiolysis for treatment of the delta phalanx associated with clinodactyly. METHODS We present 22 cases of clinodactyly treated with physiolysis in which we removed the central part of the epiphysis, which is the portion restricting longitudinal growth unilaterally and inducing progressive finger deviation, and placed a fat graft in the resultant defect. RESULTS This retrospective study reports the results of early physiolysis in 27 fingers with radial clinodactyly, including 17 fingers from 17 patients previously reported and 10 little fingers from 5 additional patients. All patients had a minimum follow-up of 6 years. Mean preoperative angle was 38° (range, 25° to 47°). At final follow-up, mean angle was 8° (range, 0° to 24°), a mean correction of 79%. Twelve fingers in 9 patients had more than 10° of deformity at final follow-up, whereas 15 fingers in 13 patients had a residual deformity of less than 10°, which is effectively full correction of a clinodactyly. No patient required a closing wedge osteotomy later for insufficient correction. CONCLUSIONS These accumulative findings confirm our previous preliminary report. Early physiolysis is a quick and simple procedure that allows for growth and partial but often adequate correction of the clinodactyly. The correction occurs slowly over a period of years, which can be seen as a disadvantage, and requires careful counseling of the parents. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jose A Medina
- Department of Orthopaedics, Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
| | - Patrick Lorea
- Department of Orthopaedics, Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
| | - David Elliot
- Department of Orthopaedics, Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain.
| | - Guy Foucher
- Department of Orthopaedics, Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
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Sierakowski A, Jing S, Poel J, Elliot D. Transcutaneous Peripheral Nerve Stimulation for the Treatment of Neuropathic Pain in the Upper Limb. J Hand Surg Asian Pac Vol 2016; 21:37-43. [DOI: 10.1142/s2424835516500041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: A small number of patients develop intractable peripheral nerve pain following injury or surgery to the upper limb that is refractory to pharmacological treatment. This study reports our results of using transcutaneous peripheral nerve stimulation (TPNS), a non-invasive form of neuromodulation, to treat this difficult problem. Methods: Seventy-two patients were treated for intractable pain in the upper limb using this technique. Electrical current was delivered transcutaneously through a handheld probe, placed on the skin overlying the affected peripheral nerve proximal to the site of pain. Pain severity was determined before and immediately after treatment by subjective patient self-assessment using a visual analogue pain scale. Pre-post treatment changes in pain severity were analysed by Student's test for paired data. Outcome in respect of overall effectiveness of this treatment, was graded according to the maximum duration of pain relief achieved. Results: Overall, TPNS reduced pain intensity from 8.4 (SD 1.6) before treatment to 4.2 (SD 3.5) immediately after treatment, a highly significant effect ([Formula: see text]). The treatment achieved cure in 8/72 (11%) of our patients and a useful therapeutic outcome (pain relief ≥ 1 day) in 27/72 (38%). The treatment failed in 37/72 (51%). Conclusions: TPNS warrants consideration as a therapy for neuropathic pain in the upper limb after drug treatment has failed and before offering surgery or spinal root stimulation.
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Affiliation(s)
- A. Sierakowski
- Department of Hand Surgery, St Andrew's Centre For Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK
| | - S.S. Jing
- Department of Hand Surgery, St Andrew's Centre For Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK
| | - J. Poel
- Department of Hand Surgery, St Andrew's Centre For Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK
| | - D. Elliot
- Department of Hand Surgery, St Andrew's Centre For Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, UK
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43
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Maller JJ, Thomson RHS, McQueen S, Elliot D, Fitzgerald PB. Factors to consider when applying transcranial magnetic stimulation of dorsolateral prefrontal cortex when resting motor threshold is asymmetric: A case study. Bioelectromagnetics 2016; 37:130-5. [PMID: 26866631 DOI: 10.1002/bem.21955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 01/09/2016] [Indexed: 11/09/2022]
Abstract
Transcranial magnetic stimulation (TMS) is an increasingly popular tool in treating psychiatric conditions. The dorsal lateral prefrontal cortex (DLPFC) is typically targeted for stimulation, with magnetic field intensity being calibrated by establishing resting motor threshold (RMT) at hand region of primary motor cortex (M1 hand). This presumes that scalp-to-cortex distance (SCD) and cortical thickness is similar at both sites. We present data from a patient who had very asymmetrical RMTs (47 and 78). We investigated SCDs in this patient at the M1 hand and DLPFC, and the M1 hand cortical thickness. We also investigated TMS electric field distribution. The M1 hand SCD and cortical thickness of the M1 hand was larger on the side with higher RMT. Electric field finite element modelling demonstrated the focal point did not effectively reach the M1 hand with higher RMT as the postcentral gyrus was shunting it. Hence, successful DLPFC treatment was based upon the side with lower RMT. This study highlights the importance of tailoring DLPFC treatment intensity not only based on RMT at the M1 hand, and upon the degree to which SCD distance differs between sites, but also based upon size, shape, and density of M1 hand, as well as electric field distribution.
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Affiliation(s)
- Jerome J Maller
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Richard H S Thomson
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Susan McQueen
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - David Elliot
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Victoria, Australia
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Abstract
In this review, an international group of senior hand surgeons was asked to provide their currently used methods, views, and advice on thumb and fingertip repair. The basic requirements and methods of thumb and fingertip repair are first outlined, followed by descriptions of the methods favored by individual units or surgeons. More recent innovative methods and modifications are described and challenging topics are discussed. This review ends by illustrating and discussing a few exploratory treatments that hold promise of greatly changing future perspectives of this common clinical problem.
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong University, 20 West Temple Road, Nantong, Jiangsu 226001, China.
| | - David Elliot
- Hand Surgery Department, St Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Verona Policlinico GB Rossi, Piazzale LA Scuro 10, Verona 37126, Italy
| | - Michel Saint-Cyr
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Felix Stang
- Plastic Surgery, Hand Surgery, and Burns Unit, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Luebeck 23538, Germany
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45
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Enticott PG, Fitzgibbon BM, Kirkovski M, Green A, Elliot D, Zangen A, Fitzgerald PB. Deep repetitive transcranial magnetic stimulation (rTMS) to bilateral dorsomedial prefrontal cortex in autism spectrum disorder. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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46
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Sierakowski A, Elliot D. Zigzag bipedicle flaps for closure of full-thickness longitudinal palmar defects. J Plast Reconstr Aesthet Surg 2014; 67:1684-7. [PMID: 25172436 DOI: 10.1016/j.bjps.2014.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 08/07/2014] [Indexed: 11/26/2022]
Abstract
This paper reports a new technique of closure of longitudinal full-thickness palmar defects with bipedicle flaps, used in six patients.
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Affiliation(s)
- A Sierakowski
- Hand Surgery Department, St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex, UK
| | - D Elliot
- Hand Surgery Department, St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex, UK.
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47
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Abstract
We recently reported a small study at the Federation of European Societies for Surgery of the hand, which was entitled ‘What is secondary flexor tendon surgery’? This study concluded that ‘secondary flexor tendon surgery’ was a generic name encompassing a multitude of pathologies. Between 10% and 15% of cases exhibited pathology of the skin and subcutaneous fat and required flap reconstruction of these tissues. Skin replacement may be used prophylactically at primary surgery or become necessary at secondary surgery after release of scar contractures, to achieve cover of vital structures. The long-term problem of skin deficiency relating to flexor tendon function is one of loss of extension from longitudinal scar shortening of the integument, even if the flexor tendons are primarily concerned with bending the digits, not straightening them. This loss of extension can only be tolerated in a hand to a certain degree without significant loss of function. This paper is largely an analysis of the flaps available and suitable for different degrees of skin deficiency and at different places along the course of the flexor system. It attempts to dispel the idea that ‘any flap will do’ provided the flexors are adequately covered.
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Affiliation(s)
- David Elliot
- Department of Hand Surgery, St. Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, United Kingdom
| | - Thomas Giesen
- Department of Hand Surgery, St. Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex, United Kingdom
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48
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Medina JA, Elliot D, Giesen T, Foucher G. Long-term function after pseudo-pollicization of the little finger. J Hand Surg Eur Vol 2014; 39:520-5. [PMID: 23877728 DOI: 10.1177/1753193413498191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This article presents a technique for facilitating use of pinch between the ring and little fingers for use in rare cases of congenital absence, or severe hypoplasia, of the thumb in which pollicization of the index finger is impossible, or not advised because the child is already pinching by scissor action between the ring and little fingers. The technique avoids drawing attention to the hand, as is the case after true pollicization of the little finger. The technique was used in five hands in five children. Three of the patients could only be followed for under 2 years. Two patients were available for longer follow-up of 6 years and 2 months and 3 years after surgery. The surgery was shown to facilitate opening of the web and pinch between the little and ring finger tips, and continues to be of functional value to the children as they grow.
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Affiliation(s)
- J A Medina
- Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
| | - D Elliot
- Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
| | - T Giesen
- Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
| | - G Foucher
- Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
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49
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Elliot D, Giesen T. Treatment of unfavourable results of flexor tendon surgery: Ruptured repairs, tethered repairs and pulley incompetence. Indian J Plast Surg 2014; 46:458-71. [PMID: 24459333 PMCID: PMC3897088 DOI: 10.4103/0970-0358.121931] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
As primary repair of divided flexor tendons becomes more common, secondary tendon surgery becomes largely that of the complications of primary repair, namely ruptured and adherent repairs. These occur with an incidence of each in most reported series world-wide of around 5%, with these problems having changed little in the last two decades, despite strengthening our suture repairs. Where the primary referral service is less well-developed, and as a more occasional occurrence where primary treatment is the routine, the surgeon faces different problems. Patients arrive at a hand unit variable, but longer, times after the primary insult, having had no, or bad, previous treatment. Sometimes the situation is the same, viz. an extended finger with no active flexion, but now no longer amenable to primary repair. Frequently, it is much more complex as a result of injuries to the other tissues of the digit and, also, as a result of the unaided healing process within the digit in the presence of an inactive flexor system. We present our experience in dealing with ruptured repairs, tethered repairs and pulley incompetence.
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Affiliation(s)
- David Elliot
- Department of Hand Surgery, St Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex
| | - Thomas Giesen
- Department of Hand Surgery, St Andrew's Centre for Plastic Surgery, Broomfield Hospital, Chelmsford, Essex
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Tang JB, Chang J, Elliot D, Lalonde DH, Sandow M, Vögelin E. IFSSH Flexor Tendon Committee report 2014: from the IFSSH Flexor Tendon Committee (Chairman: Jin Bo Tang). J Hand Surg Eur Vol 2014; 39:107-15. [PMID: 23962872 DOI: 10.1177/1753193413500768] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hand surgeons continue to search for the best surgical flexor tendon repair and treatment of the tendon sheaths and pulleys, and they are attempting to establish postoperative regimens that fit diverse clinical needs. It is the purpose of this report to present the current views, methods, and suggestions of six senior hand surgeons from six different countries - all experienced in tendon repair and reconstruction. Although certainly there is common ground, the report presents provocative views and approaches. The report reflects an update in the views of the committee. We hope that it is helpful to surgeons and therapists in treating flexor tendon injuries.
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Affiliation(s)
- Jin Bo Tang
- 1Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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