Biomedical subjects

J D Zuckerman

Publications and source records attributed to J D Zuckerman.

At least 127 records · Page 7Linked to original sources

PubMed1988

Clostridial septic arthritis: case report and review of the literature.

We describe a patient who had septic arthritis caused by Clostridium perfringens. Clostridial organisms are very uncommon causes of septic arthritis. Only 13 cases have been reported previously. The diagnosis should be suspected in patients with a history of penetrating joint trauma and in immunocompromised patients. Successful treatment has usually consisted of surgical synovectomy in combination with high-dose intravenous penicillin therapy. Multiple aspirations of affected joints as a definitive treatment should be used with caution and only in patients who are not candidates for surgery.

Adult↗

PubMed1988

Repeat radiation synovectomy with dysprosium 165-ferric hydroxide macroaggregates in rheumatoid knees unresponsive to initial injection.

Because of failure to fully respond to an initial intraarticular injection of dysprosium 165-ferric hydroxide macroaggregates, 17 patients with seropositive rheumatoid arthritis underwent repeat radiation synovectomy using this agent. Of the 13 patients who were evaluated 1 year later, 54% (7 knees) had good results, 31% (4 knees) had fair results, and 15% (2 knees) had poor results. The initial lack of significant benefit from radiation synovectomy did not appear to preclude a favorable response to a second injection.

Adult↗

PubMed1988

Hip pain in the elderly: evaluation and diagnosis.

Hip pain in the elderly can result in severe disability with compromise of independence. The causes of hip pain include many intrinsic and extrinsic disorders. Evaluation of the geriatric patient with pain in the vicinity of the hip requires a complete history and physical, radiographic evaluation and appropriate laboratory studies in order for proper management to be instituted.

Aged↗

PubMed1988

Geriatric knee disorders, Part I: Evaluative techniques.

It is important to remember that knee disorders seen in the elderly are distinctly different from those seen in the younger individual. In the elderly, the problems are generally the result of chronic processes and, occasionally, an acute process on top of a chronic disorder. A careful history and physical examination should enable the physician in most cases to make the correct diagnosis. However, at times, specific laboratory studies may be ordered to confirm the diagnosis. In part I of this two-part review of geriatric knee disorders, the authors will focus on the anatomy, history, and physical examination of the knee joint. Common knee disorders specific to the elderly will be discussed in part II.

Aged↗

PubMed1988

Benign solitary schwannoma of the foot. A case report and review of the literature.

Benign solitary schwannomas of the foot are a rare occurrence; only four cases have been previously reported. A schwannoma associated with the medial plantar nerve present for more than 40 years before the onset of symptoms was diagnosed in a 73-year-old man. Excision of the mass, with preservation of the involved nerve, was possible and successfully relieved symptoms.

Aged↗

PubMed1988

Geriatric knee disorders, Part II: Differential diagnosis and treatment.

Part II of this two-part article reviews differential diagnosis of common geriatric knee disorders. Differentiating extra-articular from intra-articular causes of knee pain is stressed, since treatments and prognoses can be quite different. Referred pain from the ipsilateral hip and spine should also be kept in mind. The diagnostic approach to knee pain can be categorized anatomically and according to etiology: Is the pain coming from the bone (patella, femur, tibia, fibula), or the soft tissue (ligament, tendon, capsule, synovium, meniscus, muscle)? Is it degenerative, inflammatory, metabolic, traumatic, infectious, or neoplastic? These issues are included in the discussion.

Aged↗

PubMed1987

Treatment of rheumatoid arthritis using radiopharmaceuticals.

One hundred and twenty one knees in 97 patients with seropositive rheumatoid arthritis and persistent knee synovitis were treated with the intra-articular injection of 270 mCi (30 GBq) of dysprosium-165 (165Dy) bound to ferric hydroxide macroaggregates. Of 81 knees evaluated at one year, 61% had good results, 23% had fair results and 16% had poor results. Of 44 knees evaluated at two years, 64% had good results, 16% had fair results and 20% had poor results. Knees with Stage I radiographic changes showed 72 and 81% good results at one and two years, respectively. Knees and Stage II radiographic changes showed 53 and 48% good results at one and two years, respectively. Leakage of radioactivity from the injected joint was minimal. Mean leakage to the venous blood was 0.15% of the injected dose. Mean leakage to the liver 24 h after injection was 0.64% of the injected dose. Mean leakage to the draining inguinal lymph nodes was 0.17% of the injected dose. These results indicate that 165Dy-ferric hydroxide macroaggregate is an effective agent for radiation synovectomy, particularly in knees with Stage I radiographic changes. The minimal leakage rates observed offer a definite advantage over previously used agents.

Adult↗

PubMed1987

Treatment of unstable femoral shaft fractures with closed interlocking intramedullary nailing.

From 1979 to 1982, 64 femoral shaft fractures in 62 patients were treated by closed interlocking nailing at Harborview Medical Center, Seattle, WA, U.S.A., and Parkland Memorial Hospital, Dallas, TX, U.S.A. Twenty-nine patients sustained multiple system injuries and 29 of the involved extremities (45%) had at least one additional injury. There were 17 (26%) open fractures. Static mode nailing was used to treat 52 fractures; dynamic mode nailing was performed for 12 fractures. Patient follow-up averaged 17 months (range 7-41 months). The average time to union was 13.5 weeks. Normal femoral length within 1 cm was achieved in 97% of cases. Knee range of motion averaged 127 degrees. Complications (9%) included two delayed unions, one nonunion, two cases of shortening or lengthening of more than 1 cm, and one case of malunion with angulation or more than 10 degrees. The delayed unions and nonunions healed after one additional procedure. This study shows that closed interlocking nailing is a safe, effective technique that provides stable fixation in most unstable femoral shaft fractures. This technique represents a major advance in the treatment of difficult femoral shaft fractures that would be poorly suited for standard closed nailing.

Adolescent↗

PubMed1987

Geriatric shoulder pain: common causes and their management.

Shoulder pain in the geriatric patient is a common presentation encountered by primary care physicians. Proper evaluation requires an understanding of the pertinent anatomy, a thorough physical examination, and a knowledge of common shoulder disorders that occur in this population. This article provides information needed to evaluate the geriatric patient with shoulder pain. Common causes of shoulder pain--both intrinsic and extrinsic--and their management will be reviewed.

Aged↗

PubMed1987

Synovectomy of the rheumatoid knee using intra-articular injection of dysprosium-165-ferric hydroxide macroaggregates.

One hundred and eleven patients who had seropositive rheumatoid arthritis and persistent synovitis of the knee were treated with intra-articular injection of 270 millicuries of dysprosium-165 bound to ferric hydroxide macroaggregates. A two-year follow-up was available for fifty-nine of the treated knees. Thirty-nine had a good result; nine, a fair result; and eleven, a poor result. Of the twenty-five knees that had Stage-I radiographic changes, nineteen had a good result. Of the thirty-four knees that had Stage-II radiographic changes, twenty showed a good result. Systemic spread of the radioactivity from the injected joint was minimum. The mean whole-body dose was calculated to be 0.3 rad and that to the liver twenty-four hours after injection, 3.2 rads. The results indicated that dysprosium-165-ferric hydroxide macroaggregate is an effective agent for performing radiation synovectomy, particularly in knees that have Stage-I radiographic changes. Because of the minimum rate of systemic spread of the dysprosium-165, it offers a definite advantage over agents that previously have been used.

Adult↗

PubMed1987

Biomechanical evaluation of anatomic reduction versus medial displacement osteotomy in unstable intertrochanteric fractures.

The biomechanical characteristics of anatomic reduction versus medial displacement osteotomy were compared for four-part intertrochanteric fractures experimentally produced in cadaver femurs. Eighteen pairs of femurs were assigned randomly to either the anatomic (A) or the medial displacement (MD) group and instrumented with multiple strain gauges. The femurs in the MD group were tested while intact and following four-part fracture with fixation. The femurs in the A group were first tested intact, followed by a stable two-part fracture with fixation, and then by a four-part fracture with fixation and perfect reduction of the posteromedial fragment (PMF) with a lag screw, partial reduction of the PMF, and with the PMF omitted. All fractures were fixed with a 135 degrees, four-hole, sliding hip screw. The strain distribution in the MD group changed significantly after fracture. The plate tensile strain increased by 360% while the compressive calcar strain decreased 85%. The plate tensile strain in the A group also increased significantly after four-part fracture when the PMF was perfectly reduced (160%), partially reduced (290%), or discarded (275%); the calcar compressive strains for these subgroups decreased approximately 50%. This laboratory study indicates that anatomic reduction of four-part intertrochanteric fractures with the sliding hip screw, regardless of the presence or position of the PMF, provides significantly higher compression across the calcar region and significantly lower tensile strain on the plate than fractures reduced by medial displacement osteotomy. The more physiologic strain distribution and the increased medial load transmission support the use of anatomic reduction for the treatment of unstable intertrochanteric fractures.

Biomechanical Phenomena↗

PubMed1986

Treatment of rheumatoid synovitis of the knee with intraarticular injection of dysprosium 165-ferric hydroxide macroaggregates.

One hundred eight knees of 93 patients with seropositive rheumatoid arthritis and persistent synovitis of the knee were treated with an intraarticular injection of 270 mCi of dysprosium 165 bound to ferric hydroxide macroaggregate. Leakage of radioactivity from the injected joint was minimal. Mean leakage to the venous blood 3 hours after injection was 0.11% of the injected dose; this corresponds to a mean whole body dose of 0.2 rads. Mean leakage to the liver 24 hours after injection was 0.64% of the injected dose; this corresponds to a mean liver dose of 3.2 rads. In 7 additional patients examined, there was negligible or near negligible activity found in the draining inguinal lymph nodes. One-year followup was possible for 74 knees (63 patients). Sixty-one percent of the knees had good results, 23% had fair results, and 16% had poor results. There was a direct correlation between the radiographic stage and response to treatment. In knees with stage I radiographic changes, 72% showed good results; 93% showed improvement. In knees with stage II changes, 59% showed good results; 81% showed improvement. These preliminary results indicate that dysprosium 165-ferric hydroxide macroaggregate is an effective agent for radiation synovectomy. The low leakage rates observed offer a definite advantage over agents previously used.

Adult↗

PubMed1985

Total joint replacement: latest developments for the geriatric patient.

Total joint replacement has significantly improved the treatment of patients with severe, disabling arthritis. Following replacement of the hip, knee, shoulder, or elbow, the vast majority of patients can expect excellent pain relief and functional improvement. The components of a successful total joint replacement include proper patient selection, optimal preoperative and postoperative management of associated medical problems, meticulous surgical technique, a comprehensive rehabilitation program, and proper prophylaxis against infection.

Adrenal Cortex Hormones↗

PubMed1984

Bunion surgery in adolescents: results of surgical treatment.

The results of bunion surgery on 50 feet in 31 adolescents are reviewed. Average follow-up was 3 years 2 months. The failure rate was 36%. Fifty-one percent of the children had hypermobile flatfeet, and 32% had a long first ray. The recurrence rate in these groups was 56 and 50%, respectively. There were 20 reoperations for either recurrence (12) or hardware removal (eight). Elective bunion surgery in adolescents should only be performed in the face of progressive, painful deformity where both the patient and the patient's parents fully understand the goals and risks of surgery.

Adolescent↗

PubMed1984

Acetabular augmentation for progressive hip subluxation in cerebral palsy.

Between 1969 and 1981, 20 acetabular augmentations were performed on 17 cerebral palsied patients with progressive hip instability. Average follow-up was 41.5 months, with a range from 24 to 147 months. Evaluation of results was based on assessment of hip stability, center edge (CE) angle, range of motion, and postoperative complications. Eighteen hips were rated good, one fair, and one poor. Stability was achieved in 19 hips. The CE angle was increased from a preoperative mean of -17 degrees to a follow-up mean of 50 degrees. There was no significant difference between preoperative and follow-up hip range of motion. The only complication encountered was a supracondylar femur fracture sustained after spica cast immobilization. Acetabular augmentation can be used effectively in the treatment of progressive hip instability in patients with cerebral palsy.

Acetabulum↗

PubMed1984

Axillary artery injury as a complication of proximal humeral fractures. Two case reports and a review of the literature.

Proximal humeral fractures are commonly seen in orthopedic practice. The vast majority of these fractures are nondisplaced. Infrequently, displaced proximal humeral fractures have associated neurovascular injuries. Injury to the brachial plexus is uncommon; axillary artery injury is rare. This is a report of two displaced proximal humeral fractures in elderly, intoxicated patients following low-energy trauma. Both fractures resulted in axillary artery injury requiring vascular reconstruction. Only nine similar cases were found in a review of the literature. Displaced proximal humeral fractures should be carefully evaluated for vascular injury, and arteriography should be used when necessary. If vascular reconstruction is indicated, the fracture must be internally fixed to prevent redisplacement and potential compromise of the vascular repair. Serial postoperative Doppler examinations are necessary to detect thrombus formation. With prompt diagnosis and treatment, prolonged limb ischemia and its sequelae can be prevented.

Aged↗

PubMed1984

Complications about the glenohumeral joint related to the use of screws and staples.

Screws and staples are used frequently in the surgical treatment of glenohumeral joint problems. We analyzed a series of thirty-seven patients with complications related to the use of these implants. Twenty-one patients had problems related to the use of screws for affixing a transferred coracoid process to the glenoid. Sixteen patients had problems related to the use of staples: ten had undergone capsulorrhaphy, four had had advancement of the subscapularis, and two had had repair of a rotator cuff tear. The complaints at examination were shoulder pain (thirty-six patients), decreased glenohumeral motion (nineteen patients), crepitus with glenohumeral motion (sixteen patients), and radiating paresthesias (four patients). The time between placement of the implant and the onset of symptoms ranged from four weeks to ten years. The screws or staples had been incorrectly placed in ten patients, had migrated or loosened in twenty-four, and had fractured in three. Thirty-four patients required a second surgical procedure specifically for removal of the implant. At operation fourteen patients (41 per cent) were noted to have sustained a significant injury to the articular surface of the glenoid or humerus. The results in this group of patients indicated that screws and staples can produce complications that require reoperation and are capable of causing a permanent loss of joint function. Adequate surgical exposure and careful placement of the implant appear to be essential when these devices are used about the glenohumeral joint.

Adolescent↗

PubMed1983

Anterior glenohumeral instability.

Anterior glenohumeral instability is an important cause of shoulder disability in athletes. Recurrent glenohumeral instability can seriously impair the athlete's performance. Since the surgical repair of recurrent instability may result in a loss of flexibility, particularly in the thrower and gymnast, the physician must optimize both joint stability and joint flexibility.

Athletic Injuries↗