Biomedical subjects

J R Sanger

Publications and source records attributed to J R Sanger.

At least 91 records · Page 5Linked to original sources

PubMed1991

Effects of axotomy on the cholinesterase and carbonic anhydrase activities of axons in the proximal and distal stumps of rabbit sciatic nerves: a temporal study.

The temporal changes in transected sciatic nerves of rabbits were studied using recently developed histochemical techniques for discriminating between sensory and motor axons. A segment of the nerve was removed to inhibit spontaneous regeneration across the gap. Staining characteristics of the proximal and distal nerve stumps were studied at 1, 2, 3, 4, 9, and 35 days following axotomy and compared with control sciatic nerves. In the control and test nerves, subpopulations of myelinated sensory axons were identified histochemically by carbonic anhydrase (CA) staining, and a subset of alpha motor axons were visualized by cholinesterase (CE) staining. Axon staining patterns were reciprocal; i.e., sensory axons were CA-positive and CE-negative, whereas motor axons were CE-positive and CA-negative. Histochemical activities persisted at day 35 after axotomy in the proximal stump and until day 9 after axotomy in the distal stump. This implies that these techniques may aid in both immediate and delayed primary nerve repair. With time, there is buildup of scar tissue adding to the proximal and distal stumps. Therefore, sections for demonstrating sensory and motor axons must be taken progressively further back from the nerve stump ends. Histochemical axon typing indicated that sensory axons regenerated earlier and to a greater degree than motor axons in the developing neuroma. Use of both the carbonic anhydrase and cholinesterase staining methods is more accurate than either technique alone as an adjunct for examining normal and injured peripheral nerves.

Animals↗

PubMed1990

Proximal phalangeal fracture after tendon pulley reconstruction.

A case is presented in which an A2 pulley reconstruction was done, encircling a previously fractured, multiply-operated proximal phalanx. Bone resorption occurred directly under the pulley, and the bone then fractured. It is postulated that the cumulative effect of these operations on the blood supply to the bone and abnormal pressure forces led to resorption of bone and subsequent fracture.

Bone Resorption↗

PubMed1990

Treatment of posttraumatic stress disorder after work-related hand trauma.

Posttraumatic stress disorder frequently accompanies severe work-related hand trauma and, when a patient attempts to return to work it can potentially be as debilitating as the hand injury. Four techniques were examined for their effectiveness in the treatment of the symptoms of posttraumatic stress disorder. Confronting and reprocessing of intrusive thoughts, combined with coping skills training, effectively reduced all symptoms except avoidance reactions. An early return to the worksite was useful with those patients who experienced mild avoidance reactions, although many patients were not able to use this. Graded work exposure was a highly successful technique for those patients with moderate avoidance reactions. For those with severe avoidance reactions, on-site job evaluations were used with good success. We believe that actual exposure to the worksite greatly enhances the ability of occupationally hand-injured patients to return to work for their previous employer. An algorithm for treatment is proposed.

Employment↗

PubMed1990

Sequential connection of flaps: a logical approach to customized mandibular reconstruction.

Microsurgery has improved the success rate for reconstruction of composite defects in the head and neck. Restoration of mandibular continuity alone is not adequate for reconstruction. Replacement of the oral lining with thin tissue is necessary to improve tongue mobility and to set the stage for later dental restoration. There is currently no ideal osteocutaneous free flap that provides unlimited length of bone, can undergo multiple osteotomies to produce the proper curve to the reconstructed mandible, and provides thin skin for oral lining. Combining free flaps can take advantage of the strengths of the individual donor sites and eliminate some of the problems with current osteocutaneous flaps. In six patients, a fibular osseous free flap was combined with either a radial forearm flap or a lateral arm flap to provide bone and oral lining in reconstruction of mandibular composite defects. In these selected patients, the fibula provided the blood supply for the second free flap, which was placed sequentially. The distal peroneal vessels were used to anastomose to the radial forearm vessels or the lateral arm pedicle. This approach allows the surgeon to customize the defect by improving both the functional and aesthetic aspects of reconstruction and is of use in cases where vascular access is limited, such as following head and neck surgery and radiation.

Bone Plates↗

PubMed1990

Thermal self-regulation for pain control in reflex sympathetic dystrophy syndrome.

Reflex sympathetic dystrophy syndrome is comprised of a variety of changes in vasomotor and trophic responsivity, as well as, stiffness, edema and severe pain. This study examined 20 patients with reflex sympathetic dystrophy syndrome who had failed to respond to a variety of techniques commonly used to treat this disorder. These patients had documented histories of reflex sympathetic dystrophy syndrome ranging from 18 to 60 months. All had been referred for psychological evaluation and provision of pain management. A combination of thermal biofeedback, relaxation training, and supportive psychotherapy were used to reduce subjective pain. The results indicate that patients were able to significantly increase their initial (p less than 0.0001) and postrelaxation (p less than 0.0001) hand temperatures, as well as to significantly reduce their subjective pain ratings (p less than 0.0001). This reduction in pain was maintained at 1-year telephone follow-up, with 14 of the 20 patients returning to work by that time. This intervention was effective as a pain reduction strategy for our patients with reflex sympathetic dystrophy syndrome who had failed to benefit from other treatments.

Adult↗

PubMed1990

Use of a portable floor crane as an aid to resection of the massive panniculus.

Resection of the massive abdominal panniculus is technically difficult due to the weight of the tissue and the difficulty in controlling the tissue during surgery. The authors describe the use of a portable floor crane that facilitates resection by reducing the number of assistants required, increasing exposure, and providing for adequate control of the specimen, which assures proper preoperative markings and sterile preparation. Blood loss is reduced, as is operating time. The portable floor crane is usually available in hospital maintenance departments and can be easily modified for intraoperative use.

Abdomen↗

PubMed1990

The lateral arm fascial free flap: its anatomy and use in reconstruction.

Free fascial transfer has been used for reconstruction of gliding surfaces of the upper and lower extremities or when thin, pliable coverage is required (hand, heel, nose, and ear). In our experience with the lateral arm fasciocutaneous flap, we have found that the fascia alone is an excellent source of tissue for free flap transfer. A thorough investigation of the microscopic, gross, and radiographic anatomy of the lateral arm fascia was undertaken by the study of 25 fresh cadavers. Vascular pathways were mapped, their locations were analyzed, and then they were correlated with the elevation, design, and transfer of the flap. The lateral arm has a large fascial component located anterior and posterior to the lateral intermuscular septum, which itself lies between the triceps and the brachialis and brachioradialis muscles. It is perfused by the posterior radial collateral artery (PRCA), one of the terminal branches of the profunda brachii. This vessel (PRCA) provides at least four fascial branches from 1 to 15 cm proximal to the lateral epicondyle, the largest of which is located an average of 9.7 cm superior to the lateral epicondyle. Fascia up to 12 x 9 cm may be used with good axial perfusion. The histologic cross sections demonstrate the complex anatomy of the fascia itself, as well as its relation to the nutrient vessels. We have applied the lateral arm fascial flap in five cases of upper extremity reconstruction. We have also found this flap valuable in preservation of underlying anatomic detail for total reconstruction of the ear and nose when local tissue and more conventional flaps were not available.

Adult↗

PubMed1989

On-site work evaluations: desensitisation for avoidance reactions following severe hand injuries.

This study examined on-site work evaluations as an environmental exposure strategy to promote return to work in 15 recalcitrant patients who had failed to benefit from established methods of reducing post-traumatic stress disorder symptoms. Following the on-site work evaluation, 87% of these patients were able to use visualisation of the work setting to further desensitize themselves and returned to work within the next eight weeks. All 87% have continued to be employed at six and twelve month follow-ups. This approach holds promise for assisting patients with hand injuries who develop post-traumatic stress disorder and fail to respond to traditional psychological strategies.

Behavior Therapy↗

PubMed1989

Aeromonas hydrophila upper extremity infection.

A severe soft tissue infection of the upper extremity caused by Aeromonas hydrophila followed a water skiing injury in which a tow rope caused degloving of a portion of the skin and severe contusion to underlying muscle. Infection was established within 36 hours of the injury, accompanied by fever, leukocytosis, and a foul odor. Rapid clinical improvement occurred following radical debridement of all nonviable tissue and antibiotic therapy. In cases involving water contamination, Aeromonas hydrophila infection should be suspected with the onset of a rapidly developing infection with a febrile response. Rapid surgical intervention and treatment with an aminoglycoside or a third-generation cephalosporin antibiotic is the treatment of choice.

Adult↗

PubMed1989

Adherence of microorganisms to breast prostheses: an in vitro study.

The quantitative and morphological characteristics of microbial adherence of four organisms--Staphylococcus epidermidis, S. aureus, Escherichia coli and Candida albicans--to the surfaces of different breast prostheses were observed. Semiquantitative adherence studies based on a modification of Maki's roll culture technique even after short contact times showed (1) increased microbial adherence at higher concentrations of the organisms and (2) differences in adherence properties between gram-positive bacteria and other organisms tested, noted also at lower organism concentrations. Scanning electron microscopy (SEM) to identify microorganisms on foam-covered prostheses, however, revealed organisms in the interstitial spaces that were not recovered by the plating technique. Other features on SEM were extracellular "slime" produced by S. epidermidis, which appears to act as a cement by which bacteria are held against prosthetic surfaces. These in-vitro findings suggest that brief exposure of the prostheses to a few organisms, particularly gram-positive bacteria, at the time of implantation would be sufficient inoculum for bacterial adherence to prosthetic surfaces.

Bacterial Adhesion↗

PubMed1989

Successful replantation of the heel pad: a seven-year follow-up.

The authors present a case of successful replantation of the soft tissue of the heel. Circulation was restored by the use of a vein graft from the posterior tibial artery to an arterial branch of the subcutaneous plexus found on the medial aspect of the heel. Two small veins were anastomosed at the edge of the defect. The heel lacks sensation, but the patient has been able to return to work as a heavy laborer in a steel foundry and is walking without the use of orthotics or modified shoes seven years later. This is the first reported case of successful replantation of only the soft tissue of the heel.

Adult↗

PubMed1988

Identifying motor and sensory myelinated axons in rabbit peripheral nerves by histochemical staining for carbonic anhydrase and cholinesterase activities.

Carbonic anhydrase (CA) and cholinesterase (CE) histochemical staining of rabbit spinal nerve roots and dorsal root ganglia demonstrated that among the reactive myelinated axons, with minor exceptions, sensory axons were CA positive and CE negative whereas motor axons were CA negative and CE positive. The high specificity was achieved by adjusting reaction conditions to stain subpopulations of myelinated axons selectively while leaving 50% or so unstained. Fixation with glutaraldehyde appeared necessary for achieving selectivity. Following sciatic nerve transection, the reciprocal staining pattern persisted in damaged axons and their regenerating processes which formed neuromas within the proximal nerve stump. Within the neuromas, CA-stained sensory processes were elaborated earlier and in greater numbers than CE-stained regenerating motor processes. The present results indicate that histochemical axon typing can be exploited to reveal heterogeneous responses of motor and sensory axons to injury.

Animals↗

PubMed1988

Early psychological aspects of severe hand injury.

We investigated the incidence and nature of psychological symptoms occurring during the first two months after severe hand injuries. 94% of patients had significant symptoms at some point early in rehabilitation, including nightmares (92%), flashbacks (88%), affective lability (84%), preoccupation with phantom limb sensations (13%), concentration/attention problems (12%), cosmetic concerns (10%), fear of death (5%), and denial of amputation (3%). Two months later, flashbacks (63%) remained pronounced. Nightmares (13%), affective lability (48%), concentration/attention problems (5%), fear of death (0%), and denial of amputation (0%) declined markedly, while cosmetic concerns (17%) and preoccupation with phantom limb sensations (17%) increased. Based on these findings, we believe that psychological treatment should often be given as part of the rehabilitation process.

Affective Symptoms↗

PubMed1988

Flashbacks after traumatic hand injuries: prognostic indicators.

Flashbacks of a traumatic hand injury may compromise a patient's rehabilitation process. This study examined the nature and significance of these flashbacks in a work-injured population. We also evaluated the ability of these patients to return to work at the site of the original injury. Sixty-one patients with work-related, traumatic hand injuries received psychological evaluation and treatment. All patients experienced flashbacks. The following three types of flashbacks were identified: (1) a replaying of the events occurring just before the accident and continuing until the injury (replay flashbacks), (2) an image of the injured hand just after the trauma occurred (appraisal flashbacks), and (3) images in which an injury that was more severe than the one that actually occurred were perceived (projected flashbacks). Regardless of the result of injury, patients with replay flashbacks were the most likely to return to their former employment (95.2%) after only 4.8 1-hour sessions of psychotherapy for control of symptoms. Patients with a combination of appraisal and projected flashbacks were the least likely to return to work (10.3%), despite the fact they received an average of 13.1 1-hour sessions of psychotherapy.

Accidents, Occupational↗

PubMed1988

Enhancement of rehabilitation by use of implantable adjuncts with vascularized bone grafts for mandible reconstruction.

Restoration of mandibular continuity after trauma or cancer by means of vascularized bone grafts, as described by Taylor and coworkers in 1979, has become an established method of oral rehabilitation. Still considered by some an endpoint in reconstruction, we have found that the judicious application of newly described dental prosthetic materials can provide the patient with improved appearance and function associated with a fully restored mandible. Twelve patients who underwent vascularized bone grafting for mandibular reconstruction had adjunctive implantation to improve either dentition or to reconstruct the temporomandibular joint. Nine patients had dental implants to restore permanent stable dentition either by placement of the mandibular bone staple plate or osseointegrated implants. Three additional patients underwent placement of metallic condylar head prostheses placed on the vascularized bone graft at the time of transfer. These patients demonstrated good mastication and an excellent incisal opening which was maintained in the late postoperative period. Vascularized bone transfer for restoration of continuity of the mandible should not be considered an endpoint in and of itself. By using implantable dental devices to restore dentition and condylar head prostheses to improve both the aesthetic result and function of the mandible to complement the vascularized osteocutaneous flap, we can bring our patients closer to the goal of total rehabilitation. The majority of these patients would otherwise never have been offered a chance at restoration of dentition. All had beneficial effects with regard to mastication and the majority also had improved speech.

Biomechanical Phenomena↗

PubMed1988

Eccrine porocarcinoma.

Eccrine porocarcinoma is a rare malignancy of the eccrine sweat duct unit. This article brings to 79 the number of cases reported. Our report and a review of the literature illustrate the natural history and pathological findings of this disease. Patients' ages at the time of appearance for treatment range from 19 to 90 years. The lesions show no predilection for site; their location follows the distribution of sweat glands in the body. Thirty-nine percent of all patients had cutaneous, regional lymph node, or visceral metastases. Primary treatment is wide surgical excision. The value of adjunctive therapy has not been proved.

Adenocarcinoma↗

PubMed1988

Sexual dysfunction following traumatic hand injury.

The purpose of this study was to examine the frequency and nature of sexual dysfunction present in a population with traumatic hand injuries. One hundred twenty patients were seen for psychological evaluation during the first two months postinjury. Forty-nine percent (59) reported sexual dysfunction during the initial two months. Six months postinjury 19% (23) continued to have sexual dysfunction. At that time a more extensive sexual history was obtained. Three categories of sexual dysfunction were identified following interviews: (1) impotence (35% or 8 patients), (2) reduced sexual desire (65% or 15), and (3) rejection of sexual contact by the partner (39% or 9). Four major causes of impaired sexual functioning were reported: (1) pain (22% or 5 patients), (2) deformity anxiety (52% or 12), (3) replant anxiety (9% or 2), and (4) contagious anxiety (39% or 9). The results of this study indicate that persistent sexual dysfunction may be a major difficulty following hand trauma. The type of dysfunction as well as the perceived cause of dysfunction are not the same for each case. Consideration of each is necessary to design efficacious intervention strategies.

Adult↗

PubMed1987

Recurrent granulomatous synovitis due to Mycobacterium kansasii in a renal transplant recipient.

A 61-year-old woman received a cadaveric renal transplant in 1972 and was maintained on chronic immunosuppression. Nonspecific granulomatous synovitis of the left hand developed in 1982. After recurrence of synovitis in 1984, surgical exploration of the left hand demonstrated "rice bodies" in a region of chronic synovitis from which Mycobacterium kansasii was isolated. Despite therapy with isoniazid, rifampin, and ethambutol, to which the organism was susceptible in vitro, synovitis recurred. Recovery was completed after extensive synovectomies, decreased immunosuppression, and 24-months of therapy, with the drugs listed above; there was no evidence of mycobacterial infection at sites other than the left hand at any time. The occurrence of persistent Mycobacterium kansasii infection is distinctly unusual even in transplant recipients. In patients refractory to conventional antituberculous therapy, surgical management should be considered as an important therapeutic component.

Female↗