Over a period of twelve months, 116 cases of mallet finger were allocated randomly to treatment with either a Stack or Abouna splint. The two splints were equally effective, producing a cure or a significant improvement in approximately 50% of cases. However, the Stack splint was much preferred by the patients, who found it more comfortable, more robust and easier to keep clean.
Sixty-nine patients with mallet finger who failed to be cured by a period of splintage were offered either tenodermodesis or Kirschner wire fixation of the DIP joint. Eleven (16%) accepted the offer and eight of these were significantly improved. Of those patients declining surgery, 30 were available for review after a minimum period of six months; of these 13 (43%) had undergone a significant spontaneous improvement.
The circulation of six hands from four human cadavers was washed out, the hand then being injected with contrast material to provide 24 fingers for analysis under the dissecting and light microscopes. The microvascular anatomy of the distal part of the extensor tendon was outlined and is described, with particular emphasis on the fine vessels within the tendon and on the tendon surface. An area of deficient blood supply was shown within the tendon which may have implications in the aetiology and treatment of mallet finger.
Clostridioides difficile infection (CDI) is one of the most common health care-associated infections, resulting in significant morbidity, mortality, and economic burden. Diagnosis of CDI relies on the assessment of clinical presentation and laboratory tests. We evaluated the clinical performance of ultrasensitive single-molecule counting technology for detection of C. difficile toxins A and B. Stool specimens from 298 patients with suspected CDI were tested with the nucleic acid amplification test (NAAT; BD MAX Cdiff assay or Xpert C. difficile assay) and Singulex Clarity C. diff toxins A/B assay. Specimens with discordant results were tested with the cell cytotoxicity neutralization assay (CCNA), and the results were correlated with disease severity and outcome. There were 64 NAAT-positive and 234 NAAT-negative samples. Of the 32 NAAT+/Clarity− and 4 NAAT−/Clarity+ samples, there were 26 CCNA− and 4 CCNA− samples, respectively. CDI relapse was more common in NAAT+/toxin+ patients than in NAAT+/toxin− and NAAT−/toxin− patients. The clinical specificity of Clarity and NAAT was 97.4% and 89.0%, respectively, and overdiagnosis was more than three times more common in NAAT+/toxin− than in NAAT+/toxin+ patients. The Clarity assay was superior to NAATs for the diagnosis of CDI, by reducing overdiagnosis and thereby increasing clinical specificity, and the presence of toxins was associated with negative patient outcomes.
Sixty-nine patients with mallet finger who failed to be cured by a period of splintage were offered either tenodermodesis or Kirschner wire fixation of the DIP joint. Eleven (16%) accepted the offer and eight of these were significantly improved. Of those patients declining surgery, 30 were available for review after a minimum period of six months; of these 13 (43%) had undergone a significant spontaneous improvement.
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