Normal tendons and palmar aponeuroses from patients with carpal tunnel syndrome and tissues of the palmar aponeuroses from patients with Dupuytren's contracture were subjected to biomechanical tests. Several parameters characterizing the viscoelastic load response of the tissues were investigated. The tissues from patients with Dupuytren's contracture were classified according to their macroscopic and histological appearance into apparently normal palmar aponeuroses, thickened fibre bundles and contracture bands. There were biomechanical differences between the normal palmar aponeuroses and the apparently normal palmar aponeuroses indicating that biomechanical changes occur before thickening of fibres or cellular proliferation can be observed. Significant biomechanical changes occurred between apparently normal palmar aponeuroses and thickened fibre bundles. Journal of Hand Surgery (British and European Volume, 1997) 22B: 4:510 517

1507 Background: Erlotinib (Tarceva) is an orally active, highly potent and selective inhibitor of the epidermal growth factor receptor (EGFR). Preliminary results from this phase II trial of erlotinib for GBM in first relapse have been reported (ASCO 2004, Abs#1555). Updated clinical results and molecular characterization of archival tissue samples are now available. Methods: A multi-institutional phase II clinical trial of single agent erlotinib until disease progression enrolled GBM patients with measurable disease in first relapse. Individual dose titration until dose-limiting toxicity (diarrhea, rash, other) was allowed in 2 dose cohorts: patients taking enzyme-inducing anti-epileptic drugs or not. Subjects were evaluated for response every 8 weeks. Submission of archival tissue was mandatory. Depending on the amount of tissue available, the following assays were performed: EGFR amplification by FISH (Vysis); and EGFR, EGFRvIII (Zymed) and PTEN expression by IHC. Results: Forty-eight subjects (19 female, 29 male) with a median age of 51 years (37–73) were enrolled over 3 months from 4 centers. The investigator determined response rate (WHO criteria) was 8.4% (3 PR, 1CR), with SD as the best response in 37.5% (n=18). One SD patient who died of an MI at day 84 had only microscopic foci of viable tumor amidst significant necrosis on autopsy. The 6 month PFS rate was 17% and median survival was 10 months. Tissue is missing from 1 PR with the longest ongoing response. EGFRvIII analysis is ongoing. Conclusions: Erlotinib is active in recurrent GBM, with a promising response rate, 6 m PFS and median survival. Molecular analyses show a slight trend towards better outcome with EGFR expression however, the differences are not significant due to the small numbers. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Genentech

This work describes the first thermoelectric devices based on the V-VI-compounds Bi/sub 2/Te/sub 3/ and (Bi,Sb)/sub 2/Te/sub 3/ which can be manufactured by means of regular thin film technology in combination with microsystem technology. Fabrication concept, material deposition for some 10-μm-thick layers and the properties of the deposited thermoelectric materials will be reported. First device properties for Peltier-coolers and thermogenerators will be shown as well as investigations on long term and cycling stability. Data on metal/semiconductor contact resistance were extracted form device data. Device characteristics like response time for a Peltier-cooler and power output for a thermogenerator will be compared to commercial devices.

The association of French professional football undertook a 18 months epidemiological study. Player injuries (more than 7 days) were noticed by physicians. Eleven clubs during 6 months and 10 clubs during one season participated in the study. The injury incidence varied throughout the season and with teams. The peak of injuries was noticed before the season, in November, and between February and March. Training injuries were very low. Strains and sprains (ankle and knee), were the major injury types. We noticed a dramatic increase of hamstring lesions for the field players. Rupture of achille tendon represented 15% of all tendon lesions (with more than 90 days for absence). Reinjuries were correlated with total number of injuries, in regard with bad cicatrisation and poor rehabilitation protocols. Professional football players are exposed to a high risk of injury during the matches. Most attention must be pointed about prevention, training programs and rehabilitation time. (C) 2004 Elsevier SAS. Tous droits reserves.

Magnetic resonance images (MRIs) were obtained of 52 temporomandibular joints (TMJs) of 30 patients with TMJ disease, before insertion of an anterior repositioning splint. Ten TMJs showed a normal disc-condyle relationship. Pathological findings were partial or complete anterior disc displacement with disc reduction (n = 18), without (n = 7), or with partial reduction (n = 4) or non-reducing joints combined with osteoarthrosis (n = 13). Associated clinical findings were joint clicking, painful TMJ movements with or without condyle limitation, deviation, or crepitus. The clinical evaluation when compared with the MRIs correlated in 75 per cent of cases. Immediate post-insertion MRIs showed recapture of discs with a protrusive splint in 15 out of 18 reducing displacements. Recapture of the disc was seen in only two out of four joints with anterior disc displacement with partial disc reduction. There was no recapture in non-reducing joints. In severe cases of internal derangement with a wide range of disc displacement combined with changes of the osseous joint surfaces, the recapturing of the articular disc with an anterior repositioning appliance was unsuccessful (0 of 13). The follow-up for pain relief after one week showed a significant reduction of symptoms, despite the fact that recapture of the dislocated disc occurred in only 17 of the 42 pathological TMJs. The possibility for disc recapture depends on the disc-condyle position and configuration, the integrity of the posterior attachment, and the degree of degenerative changes of the intra-articular structures, such as osteophytosis, condylar erosion, or flattening of the articular disc. This diagnostic information influences the method of treatment of TMJ disorders. In non-reducing joints or in the later stages of internal derangement of the TMJ, it is not possible to achieve a normal disc-condyle relationship using protrusive splints.

Fifty-eight temporomandibular joints (TMJs) from 40 patients with TMJ-related symptoms were examined by means of magnetic resonance scans with modified gradient echo sequences and a special double coil. This technique yielded a good spatial resolution of the intra-articular soft tissues, especially the articular disc and the bone structure of the TMJ. In combination with an incremental jaw opener, the disc-condyle complex was analysed in various closed and open mouth positions, depending on the clinical examination. Open mouth movement with differentiation of disc-condyle rotational and translation movement was demonstrated. Disturbances of TMJ motion showed interrupted condylar translation combined with mandibular deviation during open mouth movement (n = 8/58). Early phases of internal derangement of the TMJ with partial anterior disc displacement with (n = 12/58) or without (n = 2/58) reduction, total anterior disc displacement without reduction (n = 10/58), disc deformation (n = 10/58), disc adhesion (n = 2/58), condylar hypermobility (n = 6/58), condylar displacement (n = 8/58), and late phases of internal derangement of the TMJ with osteoarthrosis (n = 14/58) were clearly identified. Bilateral TMJ disorder was found in 72.5 per cent of the patients. By using motion-adapted, semi-dynamic magnetic resonance imaging (MRI), it is possible to improve the understanding of the complexity of TMJ movements.

According to several studies, results after reconstructive procedures in children are generally superior compared to those in adults. In the present retrospective study, 20 patients after reconstruction of one or more major nerves in the upper limb (median, ulnar, and radial nerves) were examined. At the time of operation, the patients' age was 8.9 years on the average, the follow-up time ranged between 29 and 173 months. In six cases the nerve lesion had been treated by direct nerve coaptation, in 14 patients a primary or secondary nerve grafting procedure had been applied. The results were classified according to Millesi's examination system, which takes several factors such as mobility, sensibility, skill, and force of the hand into account. Besides two patients, one after reconstruction of the median and ulnar nerves by grafts with significant destruction of the muscles in the lower arm, and the second one after primary coaptation of the median and ulnar nerves in the elbow region, all patients showed a hand function of more than 70% according to Millesi's scoring system. In patients older than ten years at the time of the reconstructive procedure, results were slightly worse than in younger individuals. Children up to ten years of age were nearly always able to move their hand and fingers normally. The results after nerve grafting were sometimes even superior to those after primary neurorrhaphy. Therefore, the present study supports the findings of previous authors describing the excellent regenerative potential of the growing peripheral nervous system. Furthermore, Millesi's scoring system better revealed some subtle differences in hand function when compared to other classifications.

Radiation-induced brachial plexus lesions are progressive and irreversible complications. Until now, there is no way to successful prevention and treatment of this problem. In our series, relief of pain could be achieved by neurolysis in some cases, but there was no recovery of sensory and motor function. In order to improve the vascularity and nerve tissue regeneration, we performed muscle or gliding tissue flaps after neurolysis in our department. Since 1975, 25 patients who developed radiation-induced plexopathy were treated in our department. We followed 18 patients to evaluate the benefits of our surgical intervention. None of the patients had improvement of their sensory or motor impairment. Relief of severe pain was achieved in 83% either by neurolysis only with or without muscle or gliding tissue flap. In some cases, paresis worsened postoperatively. We also observed a return of severe pain after the operation.

In nine patients with obstetric brachial plexus lesions (Klumpke type), an impingement of the bicipital tuberosity on the ulna was the main cause for the forearm and hand to be fixed in supination. A surgical technique using reinsertion of the biceps tendon on the bicipital tuberosity is described in detail. It has substantially improved all patients. After a mean follow-up of 29.4 months the hand was in a more functional position than preoperatively in all patients. In seven cases pronation could be increased by contraction of the biceps muscle. By relaxing the biceps muscle and by contraction of the supinator muscle a limited active supination was possible in six cases.

Normal tendons and palmar aponeuroses from patients with carpal tunnel syndrome and tissues of the palmar aponeuroses from patients with Dupuytren’s contracture were subjected to biomechanical tests. Several parameters characterizing the viscoelastic load response of the tissues were investigated. The tissues from patients with Dupuytren’s contracture were classified according to their macroscopic and histological appearance into apparently normal palmar aponeuroses, thickened fibre bundles and contracture bands. There were biomechanical differences between the normal palmar aponeuroses and the apparently normal palmar aponeuroses indicating that biomechanical changes occur before thickening of fibres or cellular proliferation can be observed. Significant biomechanical changes occurred between apparently normal palmar aponeuroses and thickened fibre bundles.

Twenty-five patients with severe brachial plexus lesions (having a rather poor prognosis in general), were subjected to a variety of split nerve graft procedures, with 22 achieving useful functional recovery. Thirty-eight nerves were reconstructed, with 32 of them achieving useful recovery. Results in these patients were no better nor worse than those obtained with other types of nerve grafts (e.g., free cutaneous nerve grafts, vascularized nerve grafts, etc.). The technique of splitting the nerve for the use of split fascicle groups as free nerve grafts is nevertheless recommended as an alternative to the application of the ulnar nerve as a vascularized nerve graft. The plexiform arrangement of the fascicles within the ulnar nerve apparently does not preclude the possibility of harvesting sufficiently long nerve grafts.

Amorphous silicon photodetectors are attractive transducers for integrated optical devices on dielectrics. Frequency-dependent admittance analysis is used to analyze the material properties of such detectors. The photodetectors are laterally coupled to channel waveguides in glass substrates. Admittance values are recalculated using a six element small-signal equivalent circuit model. Space charge capacitances, series resistances, residual contact conductances and inductive reactance contributions are evaluated for 633 nm TE and TM modes as well as for dark current conditions.

The prognosis of surgical treatment of the tarsal tunnel syndrome (TTS) with regard to total pain relief is worse than following surgery of the carpal tunnel syndrome. In TTS, additional static factors play a role. The indication for surgery, therefore, is made with utmost reluctance. The surgical strategy is described extensively. In the majority of patients a considerable improvement of symptoms can be achieved. There are, however, individual patients in whom surgical intervention is followed by increased pain. Three such patients are reported. This pain syndrome is caused and increased by recurrent fibrosis of the nerve bed, eventually including the integument and inducing entrapment neuropathy by the contracted dermal covering. Surgical resolution of this problem is transplantation of soft tissues to surround the nerve and skin grafting to augment the covering dermal layer.

The prognosis of surgical treatment of the tarsal tunnel syndrome (TTS) with regard to total pain relief is worse than following surgery of the carpal tunnel syndrome. In TTS, additional static factors play a role. The indication for surgery, therefore, is made with utmost reluctance. The surgical strategy is described extensively. In the majority of patients a considerable improvement of symptoms can be achieved. There are, however, individual patients in whom surgical intervention is followed by increased pain. Three such patients are reported. This pain syndrome is caused and increased by recurrent fibrosis of the nerve bed, eventually including the integument and inducing entrapment neuropathy by the contracted dermal covering. Surgical resolution of this problem is transplantation of soft tissues to surround the nerve and skin grafting to augment the covering dermal layer.