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Biomedical subjects

D S Louis

Publications and source records attributed to D S Louis.

At least 19 recordsLinked to original sources
PubMed1992

Embryologic development and variations in the anatomy of the ulnocarpal ligamentous complex.

Eighteen fetal hand specimens were reviewed in an effort to clarify variations in reports of the ligamentous anatomy of the ulnar side of the wrist. Sizes ranged from 45 mm crown-rump length (CRL) to 325 mm CRL. Representative coronal sections from the 2779 sections available were reviewed. Significant variations in size of triquetral attachment and thickness and consistency of the ulnocarpal ligamentous complex (UCLC) were observed. Each of the specimens exhibited one of four UCLC variations: (1) 5 of 18 (28%) with an average CRL of 187 mm had a dense, thin UCLC, with a focal triquetral attachment; (2) 7 of 18 (39%) with an average CRL of 209 mm had a focal, dense attachment of a thick UCLC to the triquetrum; (3) 5 of 18 (28%) with an average CRL of 220 mm exhibited a thick, dense UCLC with a broad attachment to the triquetrum; and (4) 1 of 18 (5%) with a CRL of 166 mm was unique, with a loose, areolar UCLC broadly attached to the triquetrum.

Embryonic and Fetal Development↗
PubMed1992

Perineural hemangiomas of the upper extremity: report of four cases.

Perineural hemangiomas in the upper extremity have been the subject of few reports. We found only eight such cases reported in the literature. We report four additional cases in which there were neurologic symptoms. The specific diagnosis of cavernous hemangioma was not made preoperatively in any of the patients. The greater the extent of intrafascicular involvement, the more difficult is total eradication of the hemangioma.

Adolescent↗
PubMed1991

Neurofibrosarcomas of the upper extremity.

A retrospective review of all malignant hand tumors seen at the University of Michigan from 1950 to 1987 demonstrated six biopsy-proven cases of neurofibrosarcoma involving the upper extremity. There were four male and two female patients; average age at presentation was 37 years and ages ranged from 15 to 63 years. All patients had a history of von Recklinghausen's disease. Three patients were seen initially with painful enlarging masses, one with a painful mass with a neurological deficit, and two with painless enlarging masses. Three patients had radical excisions requiring upper extremity or forequarter amputation, and three patients received limited or no surgical treatment. Five patients died of metastases an average of 3 years after diagnosis. One patient remains alive 18 years after upper extremity amputation despite an early local recurrence. Early diagnosis and radical surgical excision offer the best chance of long-term survival from this highly lethal cancer.

Adult↗
PubMed1990

Evolving concerns relating to occupational disorders of the upper extremity.

Occupational disorders of the upper extremity have become a problem of increasing concern around the world. The management of these problems must be understood in light of current social trends that influence patient management. Workers' compensation is one of these continually developing trends. This article describes the historical aspects of compensation and bodily injury or loss occurring in the work place. Changes in workers' attitudes during the development of workers' compensation have been observed since the turn of the century. The influence of the legal system in this regard is also noteworthy. The modern surgeon is faced with these confounding influences when treating a patient with a work-related injury or cumulative trauma disorder.

Arm Injuries↗
PubMed1990

Ischemia-reperfusion in humans. Appearance of xanthine oxidase activity.

We evaluated effluent blood from extremities of human patients undergoing reconstructive surgical treatment, which is routinely accompanied by upper-extremity exsanguination and application of a tourniquet, resulting in total interruption of arterial blood flow to one upper extremity. After tourniquet release (reperfusion), there were immediate increases in the plasma levels of xanthine oxidase activity, uric acid, and histamine in the ipsilateral limb and much smaller increases, if any, in levels of the same materials in plasma obtained from the contralateral extremity. There was no detectable xanthine dehydrogenase activity in plasma from either limb. Plasma also contained evidence of products consistent with the formation of oxygen-derived free radicals, namely, the appearance predominantly in the reperfused limb of hemoglobin and fluorescent compounds. These data indicate for the first time in humans that ischemia-reperfusion events are associated with the appearance of xanthine oxidase activity and its products in the plasma effluent.

Adult↗
PubMed1989

Magnetic resonance imaging of the collateral ligaments of the thumb.

Injury to the ulnar collateral ligament of the metacarpal phalangeal joint of the thumb can usually be diagnosed on the basis of a combination of history, radiographic examination, and clinical stress testing of the joint when appropriate. Occasionally, when the patient is seen late and the diagnosis is doubtful, stress evaluation may be ill-advised because a nondisplaced ligament may be displaced in the process. We had recent experience with three patients in whom the use of magnetic resonance imaging was helpful in diagnosing a displaced ulnar collateral ligament in two cases, and an intraligamentous injury in the other. These studies were conducted at no charge to the patient as part of institutional investigational research. The current cost of this technology is prohibitive for routine use; however, when it becomes less expensive, it may be helpful as a diagnostic tool.

Adult↗
PubMed1989

Diagnosis and treatment of obscure ulnar-sided wrist pain.

Thirty-seven patients were followed for symptoms of chronic ulnar-sided wrist pain in which specific physical examination and standard radiographs were unrevealing. Initial conservative treatment did not relieve the pain. The patients underwent further diagnostic studies including dynamic cineroentgenographic evaluation and radiocarpal arthrography. Nineteen of the 37 patients were demonstrated to have a triangular fibrocartilage complex (TFCC) tear on arthrography; 18 had a normal examination. The average follow up was 23 months. Seven of the 19 patients with TFCC tears have undergone operative treatment, and 5 (71%) remain symptomatic. Of the remaining 12 patients with TFCC tears treated nonoperatively, eight (67%) have persistent symptoms. Of the 18 patients whose arthrograms were normal, five eventually underwent surgical exploration, four of which remain symptomatic. Of the 13 patients without TFCC tears treated nonoperatively, seven (54%) continue to have symptoms. In our experience, both surgical exploration and nonoperative treatment have been less than satisfying. In addition, treatment results could not be correlated with arthrographic findings.

Adolescent↗
PubMed1989

Rehabilitation of the injured hand.

The gradual development of hand surgery as an area of specialization has led to the development of rehabilitative efforts that have complemented this trend. This had led to further specialization in hand therapy as a primary endeavor. Specific efforts in the areas of rehabilitation for soft tissue, bone, tendon, and nerve injuries have facilitated functional restoration of the injured hand.

Hand Injuries↗
PubMed1988

Rupture of flexor tendons to the little finger due to bony irregularities in the carpal tunnel.

Rupture of a finger flexor tendon occurs most commonly in the patient with rheumatoid arthritis. We have treated two patients who suffered rupture of the flexor tendons to the little finger due to bony irregularities in the carpal tunnel unrelated to rheumatoid disease. Each irregularity was removed and the rough surface covered with a portion of the flexor retinaculum. This resurfacing affords protection against recurrent abrasion and rupture. Tendon function was restored by suturing the ruptured profundus tendon to the adjacent intact profundus tendon of the ring finger. Satisfactory function of the little finger was achieved in both patients. Neither patient has experienced recurrent rupture.

Adult↗
PubMed1988

Poland's syndrome: variable expression and associated anomalies.

Poland's syndrome is a well-known constellation of congenital anomalies that includes varying degrees of hypoplasia involving the thoracic cage in association with anomalies of the hand. Although the latter are most frequently described as syndactyly with short or absent middle phalanges, many forms of expression were seen in a series of 20 patients. Thirty-one other anomalies were seen in this group in addition to those usually considered as part of the syndrome. Of special interest are those involving the spine and genitourinary tract that require special studies for early detection.

Abnormalities, Multiple↗
PubMed1988

Silicone wrist implant: long-term follow-up study.

Nineteen patients with 20 silicone rubber wrist implants of the Swanson design were followed for an average of 6 years. Sixty-five percent of the patients experienced little or no wrist pain after the operation. There was an average of 24 degrees of wrist flexion and 21 degrees of extension. Implant fracture occurred in 65% of the patients. This was not necessarily correlated with clinical symptoms. Subsidence of the implant occurred 100% of the time. Revision procedures were done after six (30%) of the procedures. There was no evidence of radiographic change suggesting silicone synovitis. There is a progressive deterioration in the radiographic appearance and the clinical result after use of this implant. Salvage by means of radiocarpal arthrodesis, or a soft tissue arthroplasty, has been successful in our patients.

Arthritis↗
PubMed1988

Barton's and Smith's fractures.

Smith's and Barton's fractures are discussed in light of their original descriptions and current experience. Included here are excerpts from the original descriptions of Smith and Barton as well as the management of these two kinds of fracture.

Eponyms↗
PubMed1988

Retraction.

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Retraction Notice↗
PubMed1987

'Kissing lesions' of the thorax and upper extremity.

An upper extremity compressed beneath the body of a comatose individual can contribute to the development of a compartmental syndrome. Crushing injuries such as these can result in skin necrosis at the sites of contact between the chest wall and the compressed limb. These "kissing lesions" must be recognized as indicators of a severe crush injury and impending compartmental syndrome, as fasciotomy is urgently required.

Arm Injuries↗