METHODS: The authors describe a modified second toe transfer that addresses cosmesis in six patients. These include (1) harvesting a flap from the adjacent side of the great toe and insetting it into the volar aspect of the second toe to give more bulk, (2) making skin excisions on each side of the tip to reduce the bulbous appearance, and (3) excising the eponychium to produce apparent lengthening of the nail.
RESULTS: The mean follow-up period was 18 months (range, 6 to 36 months). The procedure resulted in good function and improved cosmesis in all six cases. Part of the great toe flap was lost in one case. The mean two-point discrimination in the transferred toes was 10.1 mm, with protective sensation present in the flaps. The range of motion of the transferred toe was 14 to 38 degrees at the metatarsophalangeal joint, 16 to 55 degrees at the proximal interphalangeal joints, and 20 to 36 degrees in the distal interphalangeal joints. All patients except one were happy with the appearance of the transferred toe.
CONCLUSION: This novel approach will allow patients to take advantage of the lower morbidity to the donor site afforded by second toe-to-thumb transfer and provide the patients with a more aesthetic appearance of the new thumb.
METHODS: Quantitative and qualitative methods were used. The first phase was by structured interview using two standardized psychological scales: the 25-item Hopkins Symptom Checklist and Modified Fertility Adjustment Scale. Data were collected from 268 couples attending the combined infertility clinic, between October 2002 and September 2007. The second phase was a semi-structured interview of 10 clients who got pregnant following treatment. The interview explored their feelings and perception of the nurses' role. Interviews were transcribed verbatim and analyzed.
RESULTS: The average duration of infertility was 4 years; 65.7% of the women and 76.1% of men suffered from primary infertility. Emotional reactions experienced were: anxiety in women (12.7%) and men (6%), depression in women (5.2%) and men (14.9%) and reduced libido in women (6.7%) and men (29.9%). Also in men, 14.9% experienced premature ejaculation, 5.2% weak ejaculation and 7.9% had impotence although 4.9% were transient. In the semi-structured interviews, the emotions expressed were similar and in addition to anger, feelings of devastation, powerlessness, sense of failure and frustration. In the survey, 12.7% of the men were found to show more anxiety than women (6%). Although all the 10 women interviewed confirmed they were anxious; only 4 of their partners were reported to be sad or anxious. Successful clients' perception of nurses' roles included nurses carrying out basic nursing procedures, communicating, educating about investigative and treatment procedures, providing emotional support by listening, encouraging, reassuring and being empathetic.
CONCLUSIONS: This study illuminates the emotional reactions of infertile clients. Fertility nurses in Kuwait can provide emotional support through communication. The need for additional and continuous training for nurses employed in fertility settings in Kuwait is paramount.
MATERIALS AND METHOD: Automatic registration was performed on kVCBCT studies of the head and pelvis of a RANDO anthropomorphic phantom. Images were reconstructed with 1.0 ≤ Δτ (mm) ≤ 5.0 at 1.0 mm increments. The phantoms were offset by a known amount, and the suggested shifts were compared to the known shifts by calculating the residual error. A uniform cylindrical phantom with cylindrical inserts of various known CT numbers was scanned with kVCBCT at 1.0 ≤ Δτ (mm) ≤ 5.0 at increments of 0.5 mm. The contrast-to-noise ratios for the inserts were measured at each Δτ.
RESULTS: For the planning CT slice thickness used in this study, there was no significant difference in residual error below a threshold equal to the planning CT slice thickness. For Δτ > 3.0 mm, residual error increased for both the head and pelvis phantom studies. The contrast-to-noise ratio is proportional to slice thickness until Δτ = 2.5 mm. Beyond this point, the contrast-to-noise ratio was not affected by Δτ.
CONCLUSION: Automatic registration accuracy is greatest when 1.0 ≤ Δτ (mm) ≤ 3.0 is used. Contrast-to-noise ratio is optimal for the 2.5 ≤ Δτ (mm) ≤ 5.0 range. Therefore 2.5 ≤ Δτ (mm) ≤ 3.0 is recommended for kVCBCT patient registration where the planning CT is 3.0 mm.