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Biomedical subjects

J A Boswick

Publications and source records attributed to J A Boswick.

At least 37 records · Page 2Linked to original sources
PubMed1980

Wounds of the hand contaminated by human or animal saliva.

A prospective and retrospective evaluation of 75 patients with hand wounds contaminated by human saliva (35) or animal saliva (40) demonstrates that a program of outpatient management can be sufficient for optimal care in many patients. This series challenges the proposition that hospitalization, radiographs, and surgical debridement are necessary for most such wounds. Sixty-seven per cent did not have surgical intervention and no complications resulted. Ninety-two per cent received antibiotics. Radiographs were obtained only when bony injury or entry into a joint was suspected. Delay in seeking treatment until obvious signs of infection or pain are present is common. Literature review details the anatomic factors important in the natural history and control of these infections, and the changes with respect to modes of treatment for these potentially dangerous wounds. The injury is caused by bites with the hand extended or, in fight-bite wounds, with the metacarpal-phalangeal and interphalangeal joints flexed, allowing deeper penetration and then sealing of the wound when the first is opened. Staphylococcus and Streptococcus are the organisms most frequently found in human bites, and in animal bites; Pasteurella multocida should be considered in dog and cat bites.

Adult↗
PubMed1979

Control of vasospasm following trauma and microvascular surgery.

Vasospasm may result in marked reduction of blood flow through injured or revascularized tissues. Neurogenic vasoconstriction is mediated through sympathetic pathways which may be blocked by long-acting local anesthetics resulting in optimal intravascular pressures and elevated flow. An experimental study performed on normal human volunteers has shown that distal sympathetic blockade using Bupivacaine protects the digital circulation against vasospasm elicited by a strong stimulus for a minimum of 7 to 8 hours. A catheter, placed adjacent to the median or ulnar nerve at the wrist level after digital microvascular reconstruction, facilitates continuous Bupivacaine sympathetic blockade. This technique has been used clinically and appears to improve the circulation of replanted or revascularized tissues and protects against vasospasm caused by a variety of stimuli.

Blood Pressure↗
PubMed1979

Accidental hydrofluoric acid burns of the hand.

A case report of accidental hydrofluoric acid burns that involve dermal tissue of the hand is presented. Prompt medical treatment for this accident resulted in minimal disfigurement and minimal paresthesia and disability. Protocols for essential treatment and precautions for personnel working in dental laboratories where hydrofluoric acid is used have been discussed.

Burns, Chemical↗
PubMed1979

The role of soft tissue reconstruction in flexible implant arthroplasty of the metacarpophalangeal joint.

In 116 hand metacarpophalangeal joint arthroplasties of the flexible type, the operative technique did not include reconstruction of capsular or ligamentous structures, but employed meticulous relocation of the common extensor tendons, and a modification of the metacarpal osteotomy plane and shape. A closely supervised program of splintage and therapy was instituted postoperatively. This series does not vary significantly with respect to range of motion or recurrence of ulnar drift (seen only when patients failed to wear splints as directed) in comparison to other reports. The results, therefore, fail to support the concept that radial capsular and ligamentous reconstruction is an essential part of this procedure.

Arthroplasty↗
PubMed1978

Traumatic false aneurysm of the hand in hemophilia.

An unusual case of traumatic false aneurysm following a puncture wound in the hand of a hemophiliac, despite Factor VIII replacement, demonstrates the necessity for careful evaluation of such patients when there is profuse and continued bleeding. Following surgical repair of the false aneurysm and the ulnar proper digital nerve of the thumb 17 days postinjury the patient had an uncomplicated recovery. Partial arterial laceration, the underlying pathology of this lesion, may be demonstrated by arteriography or surgical exploration.

Adult↗
PubMed1978

Staged reconstruction of flexor tendons with a silicone rod and a "pedicled" sublimis transfer.

We report the results in 11 cases of secondary flexor tendon reconstruction, employing a silicone rubber rod and a sublimis/profundus tenorrhaphy in the first stage, then hinging out the sublimis tendon on the profundus motor at the second stage. Achievement of a healed proximal tenorrhaphy before the second stage allows (1) inspection of the proximal tenorrhaphy (with assessment of its location, apperance, and strength) and (2) early postoperative motion in a controlled range (with greater confidence in the proximal tenorrhaphy, as rupture after free tendon grafting is not uncommon. The functional results attained were comparable to those in other series of secondary flexor tendon reconstructions.

Adult↗
PubMed1978

Common problems in clinical replantation and revascularization in the upper extremity.

The restoration of viability to damaged or amputated tissues may be associated with a variety of unique situational and technical problems. The replantation surgeon must be aware of the many pitfalls which can occur in the care of these serious injuries in order to make appropriate decisions and execute the techniques of microsurgery effectively. The care of these patients begins with an accurate assessment of the injury and the potential functional restoration which can be achieved. It ends following a long rehabilitative and reconstructive effort to maximize ultimate function. All phases of this care are the responsibility of the replantation surgeon who must identify and attempt to solve these unique problems as they arise.

Anesthesia↗
PubMed1977

The irrigation jet: an aid in microvascular surgery.

Techniques for manipulating and positioning blood vessels during microvascular surgery which utilize a jeweler's forceps tend to inflict significant trauma to the wall and to the intima of the vessel. An irrigation jet device was designed which allows atraumatic positioning of the vessel, gentle and controlled dilation , and better visualization. With this device rat arteries and veins with an external diameter of 0.6 mm. were joined. Upon examination 3 weeks later, over 95 percent remained patent. In addition, vessels of 0.2 to 0.4 mm. were anastomosed successfully with a long-term patency rate of approximately 50 percent. The device has been found to be useful in clinical replantation and revascularization problems in man.

Animals↗
PubMed1977

The influence of experimentally induced anemia on the patency of microvascular anastomoses.

Anemia, secondary to blood loss or hemodilution, causes reduction of blood viscosity and has been assumed to favor the long-term patency of microvascular anastomoses. This assumption was tested by performing arterial and venous anastomoses on rat vessels measuring 0.3 to 0.8 mm. in external diameter. A group of rats rendered experimentally anemic (whose blood viscocity was lowered by 37 percent) showed no higher patency rates when the involved vessels were examined 3 weeks later than did a control group. The hypothesis that anemia favors higher patency rates was not substantiated.

Anemia↗
PubMed1977

The diagnosis of factitious ulcer of the hand: a case report.

Factitious of the hand frequently is difficult to diagnose due to the cunning nature of patients with self-inflicted disease. A typical case of factitious ulcer is described in which the diagnosis was made with tetracycline fluorescence to demonstrate wound manipulation. Protective immobilization allowed healing of the ulcer and institution of appropriate psychiatric care and avoided more costly diagnostic studies and hospitalization.

Adult↗
PubMed1977

Systemic corticosteroid therapy for high-pressure injection injuries of the hand.

Two cases of high-pressure injection injuries of the hand have benefited from early administration of high doses of systemic corticosteroids. The pathophysiology of these injuries relates to: 1) Local mechanical tissue destruction from the injection; 2) Deleterious tissue responses to the injectant; and 3) Sequelae of secondary bacterial infection. Steroids have been shown experimentally to play a beneficial role in the second group of factors without increasing the incidence of secondary infection. The rapid favorable response to steroids demonstrated in the two reported cases suggests further use and investigation of this treatment modality is warranted.

Adrenal Cortex Hormones↗
PubMed1976

Cold injuries.

The management of patients with cold injuries of the hands may be extremely simple or relatively complex. The extent of the injury and the systemic response to the cold are the major influencing factors. In patients with extensive cold injuries, where all or a large portion of more than one extremity is cold or frozen and there has been a significant systemic response, treatment should be both systemic and local. Treatment should be directed toward both the preservation of tissue and maintenance of function of the damaged part. Minimal daily débridement and late amputation are important guidelines for care.

Critical Care↗
PubMed1975

Seizures following burns of the skin. III. Electroencephalographic recordings.

1. EEGs were recorded on 40 burned (acute) patients during their hospitalization. Abnormal records were seen in 88% of the 49 records, all showing slow waves and nearly 10% with epileptiform activity. EEG abnormality seems related to the combination of total body surface burned and time after burn and is maximal not immediately after the burn, but within 3-11 days after the trauma when hyperventilation, hypopotassemia and deaths tend to occur. 2. EEGs were also recorded on 27 (chronic) patients, 17 with seizures and 10 others with cognitive-behavior disorders. All showed an abnormal EEG. Patients with seizures showed slow waves in 82% of cases, often diffuse, usually more marked than those seen in the cognitive-behavior disorders; 41% of patients with seizures showed epiliptiform activity. Patients with cognitive-behavior disorders showed slow waves abnormalities, usually mild in degree of severity; positive spikes were found in patients specifically with a behavior disorder.

Adolescent↗