Background Currently, there are no tests that have been proven to be capable of rating an individual's grip force measurement as sincere or insincere. However, different parameters have been found to vary in grip force testing for maximal versus submaximal effort. A novel data analysis and processing approach might be key to improving these measurements. This study explores the use of a machine learning (ML) algorithm as a means to more accurately determine the sincerity or insincerity of grip force testing. The ML algorithm compares the hand's load distribution pattern with the information generated using conventional statistical methods. Methodology This study uses manugraphy data collected as part of a previous investigation that analyzed load distribution patterns of the right and left hands of 54 healthy subjects. The subjects underwent grip force testing using maximal or submaximal effort, and the percentage contributions of each of the seven defined anatomical areas of the hand were calculated with respect to the total load applied. The predictions based on the load distribution and its use for rating individual grip force measurements as sincere or insincere were compared with the results of conventional statistical methods (thresholds for a bi-manual area-to-area comparison) and an ML algorithm. Results Based on an area-to-area comparison, our method achieved a sensitivity of 54% and a specificity of 78% to detect insincere effort. A predictive ML model developed using these data was capable of recognizing submaximal effort based on the hand's load distribution pattern, determining a sensitivity of 94% and a specificity of 99%. Conclusions Compared to conventional methods, the use of an ML algorithm considerably improved the validity of manugraphy results in discerning the sincerity or insincerity of grip effort.

A 49-year-old man with a family history of diabetes was evaluated because of hypoglycemia. Two hours earlier, he had been found on the floor, obtunded and making nonpurposeful movements. A diagnostic test was performed.

mit großem Interesse habe ich in Heft 1 Februar 2021 die Arbeit von Stang F, Schleußer S, Liodaki ME et al. [1] gelesen. Die Arbeit zeigt interessante Aspekte der Erlössituation auf. Für mich ergeben sich aus der Arbeit jedoch einige Fragen.

DOI: http://dx.doi.org/10.24018/ejmed.2020.5.2.203 1 Abstract—Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, etiology, and treatment. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms and most cases are diagnosed at emergency laparotomy. Treatment entails simple bowel resection in most cases. Reduction of the intussusception before resection is controversial, but there is a shift against this, especially in colonic cases. This paper presents the diagnosis and management of three cases of adult intussusception, in our hospital.

Machine learning (ML) is the ability of computers to learn from data without being programmed explicitly for that purpose, and to apply the acquired knowledge to unknown cases. The application of ML in medicine will increase exponentially in the years to come. Doctors should have some basic knowledge of ML. Only then will they be able to use ML optimally and to recognise the limits and difficulties of ML.

Objective The aim of this study was to investigate the diagnostic performance of abdominopelvic computed tomography (CT) images reconstructed using filtered back projection (FBP) and iterative reconstruction (IR) algorithms in morbidly and super obese patients. Materials and Methods One hundred eighty-seven abdominopelvic CT examinations in portal venous phase were performed between February 2015 and February 2016 in 182 patients (mean age = 52 years, mean body mass index = 45.5). One hundred fourteen of 187 examinations were reconstructed using IR and 73 examinations were processed using FBP. Patients were further stratified based on body mass index. Sixty CT scans were reviewed by a single reader for image quality, image noise, and artifacts. Objective noise and attenuation were also determined. Size-specific dose estimate and CT dose index volume were compared and statistically analyzed. Results A diagnostic interpretation was rendered for all 187 examinations. A single-reader review of 60 cases showed greater diagnostic acceptability for IR when compared with FBP (image quality = 4.2 and 3.8 [ P = 0.035], noise = 1.5 and 1.6 [ P = 0.692], artifact = 1.4 and 1.5 [ P = 0.759], respectively). For all examinations, the IR group had lower objective image noise (IR = 9.3 and FBP = 14.3; P < 0.001) and higher contrast-to-noise ratio (IR = 17.2 and FBP = 11.7; P < 0.001) without increase in radiation dose (size-specific dose estimate [IR = 15.1, FBP = 16.5 mGy; P = 0.045] and CT dose index volume [IR = 17.6, FBP = 18 mGy; P = 0.62]). Conclusions In morbidly and super obese patients, diagnostic quality images could be reliably generated with minimal artifacts and noise using newer generation scanners integrated with IR without increasing radiation dose.

BACKGROUND Primary finger and thumb joint arthritis is common, with a markedly rising prevalence from age 50 onward. As the population as a whole ages, the need for effective, stage-appropriate treatment of this condition is increasing. METHODS This review is based on pertinent publications retrieved by a selective search in the PubMed and Cochrane Library databases. RESULTS Pain on movement and morning stiffness are commonly reported symptoms. Thorough physical examination and plain x-rays are mandatory. In the early stages of primary finger and thumb joint arthritis, a conservative, multimodal treatment approach involving the use of splints, physiotherapy, and non-steroidal anti-inflammatory drugs can be helpful. The intraarticular injection of hyaluronic acid or cortisone seems to relieve pain in the short term, but its long-term efficacy in primary finger and thumb joint arthritis is questionable. Arthrodesis (joint fusion) is a reliable surgical treatment option for arthritis of the metacarpophalangeal and interphalangeal joints of the thumb. For mobility-preserving surgery of the metacarpophalangeal joints of the second through fifth fingers, silicone implant arthroplasty remains the gold standard. Symptomatic, advanced arthritis of the distal interphalangeal joint is most effectively treated with arthrodesis. CONCLUSION The efficacy of conservative treatment has been documented in high-quality clinical trials, while that of surgical treatment has not. The various surgical methods have yielded benefits in routine clinical use, but these remain to be assessed in randomized and controlled trials.

Due to the exposure of the hands in the daily routine, defect wounds of the hand are common. The injury severity varies and ranges from small fingertip defects to large soft tissue lesions with exposed tendons, nerves and vessels. The complete extent of the soft tissue defect is often only recognizable after meticulous debridement. A considerable variety of techniques for defect coverage are available to the surgeon but the actual challenge is to select the most appropriate procedure which will result in the smallest possible residual defect. This review article presents the diagnostic approaches to soft tissue defects of the hand and current treatment options.

Purpose This study aims to investigate if the hands' load-distribution pattern differs during maximal and submaximal grip. Methods Fifty-four healthy subjects used the 200-mm Manugraphy cylinder to assess the load-distribution pattern of both hands. On 2 testing days, the subjects performed grip-force testing: 1 hand with maximal effort and the other with submaximal effort. Sides changed for the second testing day. The whole contact area of the hand was sectioned into 7 anatomical areas, and the percent contribution of each area, in relation to the total load applied, was calculated. Maximal and submaximal efforts were compared across the 7 areas in terms of load contributions. Results Comparing maximum effort of the left and right hand, the load distribution was very similar without statistically significant differences between the corresponding areas. Comparing the maximal and the submaximal effort for each hand, 4 (left) and 5 (right) of the 7 corresponding areas showed statistically significant differences. Comparing the right hand, performing with maximal effort, with the left hand, performing with submaximal effort, 5 areas varied significantly. With the right hand performing submaximal effort, all 7 anatomical areas were significantly different. Conclusions The load distribution of a healthy hand is different when performing with submaximal effort compared with maximal effort. To analyze a hand's load-distribution pattern, the opposite hand can be used as a reference. Copyright (C) 2018 by the American Society for Surgery of the Hand. All rights reserved.

Die Messung der Griffkraft ist eine weitverbreitete Methode, sowohl für klinische als auch für wissenschaftliche Belange. In der Handchirurgie ist sie ein wesentlicher Bestandteil der Evaluation von Erkrankungen und Therapieerfolgen sowie der Begutachtung. In epidemiologischen Studien ist sie ein guter Vorhersagewert für gesundes Altern oder für den Verlauf von Erkrankungen.

Durch die Exposition der Hände im Alltag sind Defektverletzungen häufig. Die Verletzungsschwere reicht von kleinen Fingerkuppen- bis hin zu großen Hautweichteildefekten mit freiliegenden Sehnen, Nerven und Gefäßen. Meist ist das Ausmaß der Verletzung erst nach dem sorgfältigen Débridement einzuschätzen. Dem Chirurgen steht eine große Zahl an Verfahren zur Defektdeckung zur Verfügung. Daher stellt es auch die eigentliche Herausforderung dar, aus diesen das sinnvollste Deckungsverfahren zu wählen, das mit dem kleinstmöglichen Hebedefekt einhergeht. Der vorliegende Beitrag stellt die diagnostische Herangehensweise bei Weichteildefekten an der Hand dar und zeigt Behandlungsstrategien auf.

D ie Arthrose ist weltweit die führende Gelenk erkrankung im Erwachsenenalter (1). Das Handskelett ist am häufigsten betroffen von der distalen Interphalangealgelenk(DIP)-Arthrose, gefolgt von der Rhizarthrose, der Metakarpophalangealgelenk(MCP)-Arthrose und letztlich der proximalen Interphalangealgelenk(PIP)-Arthrose (e1, e2). Radiolo gische Zeichen einer Arthrose können bei bis zu 81 % der alternden Bevölkerung festgestellt werden (e1, e3). Heberden-Knoten am DIP-Gelenk wurden in 58 % und Bouchard-Knoten am PIP-Gelenk in 30 % der Fälle bei Menschen über 60 Jahre in der US-amerikanischen Bevölkerung nachgewiesen (e4).

Die Dupuytren-Kontraktur ist eine gutartige, fibroproliferative Erkrankung der Hohlhandaponeurose, die teilweise mit erheblichen funktionellen Einschränkungen für die Betroffenen einhergeht. Die limitierte Aponeurektomie ist als Primäreingriff der Referenzstandard. Aufgrund der Minimalinvasivität, der kürzeren Rekonvaleszenz und der niedrigen Komplikationsraten gewinnt die perkutane Nadelaponeurotomie in den letzten Jahren unter Berücksichtigung der spezifischen Indikationen zunehmend an Bedeutung.

Trotz der Fortschritte in Diagnostik und Primärbehandlung von Handgelenkverletzungen spielen (Teil‑)Arthrodesen zur sekundären Rekonstruktion weiterhin eine wichtige Rolle. Teilarthrodesen stabilisieren den Karpus und ermöglichen über die verbleibenden Handgelenkanteile eine zufriedenstellende Restbeweglichkeit. Durch die Ausschaltung der schmerzhaften Gelenkbereiche kann eine Schmerzreduktion erreicht werden. Teilweise wird der Arthroseprozess am Handgelenk durch Teilarthrodesen verzögert oder gestoppt. Die vorliegende Übersichtsarbeit gibt einen Eindruck über die häufigsten angewandten (Teil‑)Arthrodesen, führt Indikationen sowie Kontraindikationen auf und stellt typische Komplikationen dar.

Versteifung des Fingerendgelenks bzw. Interphalangealgelenks des Daumens zur Wiedererlangung einer stabilen und funktionell günstigen Gebrauchsfähigkeit.

Das Trichorhinophalangeal-Syndrom (TRPS) wurde 1966 von Andres Giedion, einem Schweizer Kinderradiologen, beschrieben 1, jedoch publizierte Klingmüller bereits 1956 eine Beobachtung über diese Anomalie 2. Der Typ 1 ist gekennzeichnet durch kolbenförmig aufgetriebene Epiphysen (Phalangeal), spärlich dünnes Haupthaar (Tricho), eine Ausdünnung der seitlichen Augenbrauen, birnenförmiger Nase (Rhino) und eine unterschiedliche Wachstumsretradierung 3. Beim Typ 2 finden sich zusätzlich multiple Exostosen, Mikrozephalgie und geistige Retradierung 4, dem sogenannten Langer-Giedion-Syndrom. Weiterhin finden sich bei Typ 2 große Fledermausohren, Hypermobilität der Gelenke und Perthes-ähnliche Hüftkopfveränderungen. Beim Typ 3 sind die Hand- und Fußanomalien stärker ausgeprägt als bei Typ 1 und 2. An der Hand zeigt sich meist eine generelle Verkürzung der Phalangen und Metakarpalknochen. Grobe Achsenabweichungen treten bei allen 3 Typen hauptsächlich am Zeigefinger auf, gefolgt vom Mittel- und Ringfinger in annähernd gleicher Häufigkeitsverteilung, hingegen am Kleinfinger nur selten 5. Das TRPS Typ 1 und 3 wird meist autosomal-dominant vererbt, Typ 2 tritt sporadisch durch eine Deletion des langen Arms von Chomosom 8 auf 3 5 6 7. Typische Merkmale des TRPS kraniofazial sind in Tab. 1 dargestellt.