Laser Doppler flowmetry (LDF) and transcutaneous carbon dioxide tension measurements (PtcCO2) were performed on fingers of healthy volunteers subjected to a sequence of hydrostatic and thermal stimuli. LDF response using an unheated probe agreed well with measurements made with Xenon133 clearance and strain gauge plethysmography in a previous work. The PtcCO2 results, however, were found not in any way to reflect changes in skin blood flow.

This paper examines whether the adoption of stock option plans results in changes in shareholders’ wealth, and whether the stock market reactions to ESOP announcements could be explained by the target group of ESOP and the dilution effect. Short-horizon test methods are applied for this purpose. The sample consists of ESOP announcements of Finnish publicly quoted companies on the Helsinki Stock Exchange during the time period 1988–1998. The event study results show a slightly positive market reaction to announcements of ESOPs targeted to management and a negative market reaction in the case of ESOPs targeted to all employees. The results of regression analysis show that the ESOPs with limited dilution convey positive information to the stock market and the dilution effect has a negative impact on stock returns, especially in the case of ESOPs targeted to all employees.

With the cliché of allegedly “primitive” cinema spectators fleeing the theatre in fear of onrushing train as a point of departures, this article investigates various immersive and stereoscopic strategies in early cinema. Although the three-dimensional or virtual qualities of, for example, phantom rides, Hale’s Tours, and early tracking shots have often been discussed, the notion of a “virtual realityavant la lettre” merits a fuller investigation. Through different technological, textual and discursive strategies, much early cinema can be seen to create a strong sense of presence or immersion that is, with the use of spectacle and engagement radically different than the sense of “identification” crucial to the later classical style.

We describe a case of bilateral congenital hypoplastic finger pulps of the little finger in a 6-year-old girl in whom reconstruction with a neurovascular step-advancement flap was used to restore soft tissue padding of the pulps.

Cold sensitivity is a common problem after all types of hand injuries. The aim of the present study was to assess possible effects of treatment by Pavlovian conditioning, a behavioural treatment method for digital cold sensitivity where whole body cold exposure becomes associated with warm hands. Eighteen hand-injured patients and nine patients with vibration-induced problems in their hands completed the treatment. Questionnaires and questions, assessment of perception of touch/pressure and skin temperatures after cold provocation, was made before and after the completed period of treatment and after 6 and 12 months. The results indicated subjective improvement in the hand-injured group in contrast to a lack of response in the vibration group. An increased digital skin temperature after treatment was noted for the vibration-exposed group only, which however did not persist at 6 and 12 months' follow-up.

Fifteen patients (10 women and 5 men; median age 46 years; range 28-55), with recurrent severe carpal tunnel syndrome, were operated on with re-exploration and cover of the median nerve with free or pedicled flaps (five pedicled ulnar flaps, one pedicled dorsal forearm flap (served by the posterior interosseus artery), one groin flap, three free scapular flaps, and five free lateral arm flaps). The patients were followed up by a self-administered questionnaire at 3 months-14 years (median 8.5 years) after operation and replies were obtained from 14 patients. There was a significant improvement in pain ( p = 0.01) and percussion tenderness at the wrist ( p = 0.02), but no significant improvement in allodynia and cold intolerance in the hand as evaluated by the use of a visual analogue scale (VAS). Three of the 14 patients had less numbness/paraesthesiae and four had subjectively improved sensory function in the hand and fingers since the procedure. Ten patients had problems from the donor site, including a cosmetically unacceptable scar, allodynia, and itching. Four patients had worked before the operation and nine patients returned to ordinary or light work afterwards. In conclusion, 10/14 patients considered themselves as somewhat better, better, or cured, while four felt that they were unchanged or worse. We conclude that cover with vascularised fat may be worthwhile in some patients with recurrent severe carpal tunnel syndrome, preferably with a simple pedicled ulnar flap.

Injury to a peripheral nerve is followed by local synthesis and release of neurotrophic factors of importance for the regeneration process. This concept was adopted for repair of transected human median and ulnar nerves in the forearm. As an alternative to conventional microsurgical repair of the nerve trunk, silicone tubes of appropriate size were used to enclose the injury zone, intentionally leaving a gap measuring 3-4 mm between the nerve ends inside the tube. The early results from a prospective, randomized, clinical study comparing this principle with conventional microsurgical technique for repair of human median and ulnar nerves, is presented. Eighteen patients (14 men and 4 women), aged 12-72 (mean, 29.5) years, were randomized to either tubulization (11 cases) or conventional microsurgical repair (7 cases). A battery of tests for sensory and motor functions of the hand were carried out at regular intervals for up to 1 year after surgery. The results show no difference between the both techniques, with the exception of perception of touch, which showed a significant difference (p < .05) at the 3-month checkup in favor of the tubulization technique. At re-exploration 11 months after the initial procedure (1 case), the former gap was replaced by regenerated nerve tissue in direct continuity with the proximal and distal parts of the nerve trunk, the exact level of the former injury being impossible to identify. Study data demonstrate an intrinsic capacity of human major nerve trunks to reconstruct themselves in a preformed space when an optimal environment is offered and the surgical trauma is minimized.

Risk follow-up by probabilistic safety assessment (PSA) provides a systematic method to analyze incidents. Events can be evaluated from the safety point of view to get feedback from operating experience, for the identification of risk contributors and for the verification of PSA models. This paper is concerned with the risk follow-up methodology, which is based on a marked point process framework. This framework provides a theoretically rigorous method for retrospective risk evaluations. Basic concepts for the modelling and an evaluation of the operating history by PSA are presented, and a Finnish pilot study on risk follow-up is summarized. We recommend the 'total memory approach' for the assessment of the unavailability of the standby safety systems. According to our experience, accurate evaluations with time-dependent component models are not necessarily needed but simplifying approximations can be used. The modelling of common cause failures remains a problem in practice, however, because there are not enough data to distinguish them properly. (C) 1996 Elsevier Science Limited.

We construct a model for living probabilistic safety assessment (PSA) by applying the general framework of marked point processes. The framework provides a theoretically rigorous approach for considering risk follow-up of posterior hazards. In risk follow-up, the hazard of core damage is evaluated synthetically at time points in the past, by using some observed events as logged history and combining it with re-evaluated potential hazards. There are several alternatives for doing this, of which we consider three here, calling them initiating event approach, hazard rate approach, and safety system approach. In addition, for a comparison, we consider a core damage hazard arising in risk monitoring. Each of these four definitions draws attention to a particular aspect in risk assessment, and this is reflected in the behaviour of the consequent risk importance measures. Several alternative measures are again considered. The concepts and definitions are illustrated by a numerical example.

Replantation is a resource-consuming and expensive activity. The mean operation time is around 6 hours for one finger and it is not unusual for a multiple-finger replantation to take more than 24 hours. In most industrialized countries replantation surgery has become routine. It is reasonable to demand clear indications for this kind of surgery, but unfortunately these cannot yet be expressed in well documented distinct points. The patient, the mechanism of injury and the level and extent of amputation must be considered to balance the risks and costs of replantation against possible benefits. This is true also of recirculation for survival of partially amputated parts with interrupted circulation. A better result can be expected after recirculation than after replantation.

To test the hypothesis that cognitive capacity is correlated with the outcome of functional sensibility after nerve repair, 19 patients were evaluated 2 to 5 years after median or ulnar nerve repair at the distal forearm level. The sensory evaluation included tests for functional sensibility as well as assessments addressing perception thresholds for touch/pressure and vibration. Psychometric tests for cognitive capacity were also carried out.Multiple regression analysis, correcting for the effect of age and the ability to perceive touch/vibration, was used to investigate the relationship between functional sensibility and cognitive capacity, and to determine which of the tested central nervous factors had the greatest influence on the outcome of recovery of functional sensibility. On a ranking list of such factors verbal learning and visuo-spatial logic capacity were the most important ones, indicating significant correlations with functional sensibility. It is concluded that cognitive capacity factors may play an important role for the functional outcome following nerve repair and that variations in such factors may help to explain the variability in the outcome of nerve repair.

The fundamental principle in the safety technology of nuclear power is embodied in the strategy of defence in depth. Completed with PSA logic model and structure, it provides an appropriate framework for an identification and structuring of the safety performance areas. The following performance areas have been defined: Safety Management, Control of Operation, Safety Functions and Physical Barriers. Safety management includes that also approaches such as PSA and safety indicators are used for continuous monitoring and control the safety of a nuclear power plant. Their use would thus supplement the use of Technical Specifications. VTT has developed safety indicators and living PSA which are illustrated in this paper. It is recommended that living PSA and safety indicators become parts of the plant technical documentation and information system.

Sixty five isolated thumb replantations and revascularisations for survival done at our department between 1977 and 1991 were studied retrospectively. The overall failure rate was 20% (13/65). The most important influence on outcome was the mechanism of injury. The failure rate for avulsed thumbs was 38% (6/16), for all other mechanisms of injury 14% (7/49). The failure rates for replantations and revascularisations for survival were similar, 18% (6/33) and 22% (7/32), respectively. The survival rate was independent on the level of injury, the failure rates for amputations at the levels of the proximal and distal phalangeal levels being 19% (6/31) and 21% (7/33), respectively. The presence of two patent arteries at the end of the operation (n = 11) was favourable for the prognosis, as all these thumbs survived. There was no corresponding relationship on the venous side. The use of vein grafts on the arterial or venous side was not associated with lower failure rate. Nine patients were reoperated on, one of them twice. Reoperation was worthwhile, the failure rate in reoperated thumbs being only 11%.

Technical Research Centre of Finland (VTT) and Studsvik AB, Sweden, have simulated decision making of the Swedish Nuclear Power Inspectorate and a power company by applying decision models in a benchmark study. Based on the experience from the benchmark study, a decision analysis framework to be used in safety related problems is outlined. By this framework both the power companies and the safety authorities could be provided with a more rigorous, systematic approach in their decision making. A decision analytic approach provides a structure for identifying the information requirements of the problem solving. Thus it could serve as a discussion forum between the authorities and the utilities. In this context, probabilistic safety assessment (PSA) has a crucial role of expressing the plant safety status in terms of reactor core damage accident probability and of risk contributions from various accident precursors. However, a decision under uncertainty should not be based solely on probabilities, particularly when the event in question is a rare one and its probability of occurrence is estimated by means of different kinds of approximations.

19 patients with neuralgia in the upper limb after surgical or non-surgical trauma to peripheral nerves were treated by excision of the extraneural scar and surrounding hypersensitive skin and application of free or pedicle flaps. The subcutaneous fat of the flaps was wrapped around the affected nerves. After a mean follow-up time of 5.8 years the patients were sent a questionnaire. Only one patient considered herself cured, six were almost cured and seven improved. Two patients were unchanged and three worse. The results after three to four months appeared stable.

Although the transfer of free flaps is nowadays accomplished with an increasing degree of safety, thrombosis of the microvascular anastomoses is still a problem. In order to avoid delay in re-operating, various methods for objective blood flow monitoring have been tried, among them Laser Doppler Flowmetry (LDF). When one reviews the literature, it is apparent that opinions differ about whether or not LDF is a reliable technique for this purpose. To focus on the need to interpret continuous recordings, this paper reports our findings in six latissimus dorsi free flaps chosen from our series of LDF monitoring procedures. One uneventful flap, no. 1, had an immediate postoperative LDF value of 4.5 perfusion units (PU). LDF values improved during the recovery period and the graphic recording showed fluctuations due to normal physiological variations of the blood flow in the flap. Another uneventful flap, no. 4, showed the same pattern, though at an appreciably lower level, 2 PU, on average. Flap no. 2 had an acceptably high value of 3.5 PU despite suffering a venous thrombosis. However, the LDF recording showed no fluctuations and the value declined gradually. Another flap, no. 3, showed fluctuations and blood flow was normal although the value decreased to 2.5 PU. In flap no. 5, any value between 2 and 3.5 PU could be obtained merely by adjusting the position of the probe in the holder. In no. 6, the LDF value suddenly dropped, accompanied by a decrease in the total amount of backscattered light, indicating venous obstruction which was confirmed at re-operation.(ABSTRACT TRUNCATED AT 250 WORDS)