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Biomedical subjects

K E Bos

Publications and source records attributed to K E Bos.

At least 37 records · Page 2Linked to original sources
PubMed1996

Carpal Box radiography in suspected scaphoid fracture.

We have assessed the value of using a simple apparatus,the Carpal Box, in patients with suspected scaphoid fracture, to produce elongated and magnified radiographs of the carpus. The interobserver agreement between 60 observers of standard scaphoid radiographs and longitudinal and transverse Carpal Box radiographs (X-CB) was compared in 11 patients. Three-phase bone scanning was used as a comparative standard. If at least 75% of the observers agreed and the result was confirmed by three-phase bone scanning, the outcome was termed reliable. Scaphoid radiographs and the longitudinal X-CB films were reliable in four patients and the transverse X-CB films in six patients. The bone scan suggested a scaphoid fracture in five of the 11 patients. Agreement in the interpretation of the standard scaphoid radiographs was acceptable in only 36% of patients: in interpretation of transverse Carpal Box radiographs this figure increased to 55%.

Adult↗
PubMed1995

[Surgical possibilities in spastic paralysis of arm and hand].

OBJECTIVE: To determine the results of surgical correction of spastic paralysis of the hand due to cerebral palsy. DESIGN: Descriptive. SETTING: Academic Medical Centre, Amsterdam, the Netherlands, and rehabilitation centre De Trappenberg. METHOD: From 1-1-1990 until 1-6-1994 twenty patients with spastic upper limb in cerebral palsy were operated in our hospital. They were all seen preoperatively by our multidisciplinary team, and selected according to the Zancolli classification. Seventeen operations were aimed at improving hand function, the other three were performed for contractures or for cosmetic/hygienic reasons. Surgery was aimed at correcting the muscular imbalance, by weakening spastic muscles via tenotomy or lengthening and by reinforcing paralysed muscles via tendon transfer or rerouting. Often stabilisation of joints by tenodesis, capsulodesis or arthrodesis was necessary as well. RESULTS: Eighteen of the twenty patients were (very) happy with the results. In two patients there was no functional gain. Only once was a postoperative complication seen: pseudarthrosis of the first carpometacarpal joint. This was corrected successfully by rearthrodesis. We found we were able to predict the functional outcome fairly accurately. CONCLUSION: With accurate patient selection, surgical intervention in patients with cerebral palsy may restore hand function adequately and predictably.

Activities of Daily Living↗
PubMed1995

An anomalous flexor digitorum superficialis to the index finger.

An anomalous, digastric flexor digitorum superficialis in addition to a normal flexor digitorum superficialis to the index finger, is reported. To our knowledge, this is an anatomic variation never described before. The anomalous muscle belly presented as a progressive pseudotumor of the palm and needed exploration to provide the final diagnosis.

Adult↗
PubMed1995

The ulno-carpal abutment syndrome. Follow-up of the wafer procedure.

Seven wrists in six patients with ulno-carpal abutment syndrome were treated by a subchondral distal ulna resection (wafer procedure). The average follow-up was 36 months. Wrist function was evaluated using a clinical scoring chart. The parameters were pain, range of motion, grip strength and activities. One patient had a poor result, one a fair result and the remaining had good to excellent results. In all cases grip strength showed dramatic improvement. Complications were limited to palpable subcutaneous nylon sutures requiring removal in three patients and extensor carpi ulnaris tendinitis in one.

Adult↗
PubMed1995

Report of a symposium on diagnosis and treatment of adult soft tissue sarcomas in the head and neck.

A series of presentations and discussions was held during a symposium on the diagnosis and treatment of adult soft tissue sarcomas in the head and neck (HNSTS). The purpose of this meeting was to define guidelines on diagnosis and treatment of HNSTS. The results of this symposium are summarized and condensed in this report. Recommendations are made for diagnostic strategies and for treatment. Diagnostic efforts in PET scanning and dynamic MRI need to be expanded to detect early recurrences. Firm pathological diagnosis remains the basis for further treatment strategy. Wide surgical excision, if feasible, in combination with radiotherapy is the treatment of choice.

Adult↗
PubMed1993

[Reconstructive surgery of the head and neck region using free muscle flaps].

Twenty-seven patients who underwent microvasculosurgical free tissue transfers for head and neck reconstruction with a M. rectus abdominis or M. latissimus dorsi flap are reviewed. In this series the flap reconstruction was completed in 15 patients with extraoral defects, in six patients with an intraoral defect and in six patients with a combined intra and extraoral defect. Split thickness skin graft coverage was used in all cases. All free muscle grafts survived and good take of the split skin was obtained. In extraoral defects coverage of free muscle transfer with split thickness skin grafts results in a better color match than with musculocutaneous flaps and complements the appearance and pliability of the free muscle flap. Reshaping and three-dimensional positioning made reconstruction of every intraoral defect and combined intra and extraoral defects possible. In skilled hands, free tissue transfer provides a reliable method for reconstruction of almost every defect in the head and neck.

Abdominal Muscles↗
PubMed1993

An intravascular oxygen tension monitoring device used in myocutaneous transplants: a preliminary report.

An intravascular oxygen tension (PO2) sensor (Continucath 1000) was used to assess flap viability in microsurgically revascularized free flaps for 36 hours postoperatively. In vitro, long term stability, linearity, and response time of the PO2 sensor proved to be excellent. In 14 patients with sound flaps tissue PO2 values were found to be between 15 and 35 mm Hg. In three cases a failing flap needed reexploration. In these cases the PO2 sensor was accurate in detecting circulatory failure while in other cases it traced a number of physiological changes. The device holds promise for free flap monitoring but further studies are indicated.

Adult↗
PubMed1993

Reconstruction of congenital tibial pseudarthrosis by revascularized fibular transplants.

Seven patients with congenital Boyd type II pseudoarthrosis of the tibia and fibula were treated with a revascularized osteocutaneous fibular graft from the contralateral side. Follow-up ranged from 20 to 96 months (mean 67 months). All patients had previously undergone major surgery (mean three operations). Union was successful in all patients although three required further surgery. At follow-up all patients were able to walk without external support. The results were classified as good in two cases and fair in five cases. The postoperative period was, however, often complicated by stress-fracture and nonunion. Leg length discrepancy and valgus deformity are still unsolved problems in some cases. It seems probable that a primary reconstruction at an early age will prevent many of these subsequent problems.

Adolescent↗
PubMed1993

Carpal instability, the missed diagnosis in patients with clinically suspected scaphoid fracture.

To determine the incidence of carpal instability and its relation to clinical findings in patients with suspected scaphoid fracture, we performed a long-term follow-up investigation in a consecutive series of 160 patients who were treated in our department of traumatology for suspected scaphoid fracture after a fall on the outstretched hand. Radiography of the carpus was obtained. Bone scintigraphy was performed in all patients with negative initial radiographs. Follow-up investigation was performed in 100 patients and consisted of history, clinical examination, including measurement of grip strength and wrist movement, synovia stress test, Watson's scaphoid test, and radiographic examination. In 22 patients, clinical or radiological signs of carpal instability were found. The incidence of complaints and a positive synovia test were significantly higher in patients with suspected carpal instability. The bone scan was not useful for the detection or exclusion of carpal instability. The three-phase bone scan gave no additional information in the diagnosis of carpal instability.

Accidental Falls↗
PubMed1993

Treatment of volar instability of the metacarpophalangeal joint of the thumb by volar capsulodesis.

The metacarpophalangeal joint bears most of the stresses to which the thumb ray is subjected. Instability of this joint results in considerable functional impairment of the hand. Volar instability may be secondary to trauma, rheumatoid arthritis, or adduction spasms in cerebral palsy. The resulting hyperextension causes pain and weakness of pinch (Fig. 1). Various techniques have been described to correct this deformity. We prefer a volar capsulodesis as first described by Filler (1976), in which the whole volar plate is reinserted. Detailed knowledge of the complicated volar anatomy is essential. We have treated eight patients (two bilaterally) with this technique, all with satisfactory results.

Adolescent↗
PubMed1993

Radiography and scintigraphy of suspected scaphoid fracture. A long-term study in 160 patients.

Radiographs of the scaphoid after injury are difficult to interpret, and bone scintigraphy is widely used to increase the accuracy of diagnosis, though many fractures suspected on scintigraphy cannot be confirmed radiologically. We have reviewed the clinical consequences, after one year, of managing suspected scaphoid fractures according to the bone-scan results. We studied 160 patients, 35 of whom had initially positive radiographs and were treated in a cast for 12 weeks. The other 125 had bone scintigraphy and were managed according to the result. After a minimum of one year 119 patients were reviewed. Scintigraphically suspected scaphoid fracture could not be confirmed radiologically in 25%. There were no cases of nonunion. The long period of immobilisation in patients with positive radiographs or positive bone scans did not influence the frequency or severity of late symptoms compared with those with a normal bone scan.

Adolescent↗
PubMed1993

Galactorrhea after reduction mammaplasty.

A case of extremely painful swelling of the breasts following a reduction mammaplasty is presented. There were no signs of an abscess or hematoma. A milky white fluid due to galactorrhea was evacuated at operation, and further galactorrhea was inhibited by medication. The pathogenesis of galactorrhea and its treatment are discussed.

Adolescent↗
PubMed1993

Proximal interphalangeal joint arthrodesis using powered staple fixation. Observations on autopsy specimens.

A new method for internal fixation using power-driven staples was recently developed. In theory, this new technique should be ideal in performing small joint arthrodesis. In autopsy specimens, the biomechanical properties were observed in simulated proximal interphalangeal joint arthrodesis (PIP). The tension-band technique, acting as a control, was significantly superior. The two techniques had similar biomechanical properties. The three 7- x 7-mm staples is recommended. The tension-band technique remains the technique of choice in small joint arthrodesis.

Arthrodesis↗
PubMed1991

Laser Doppler bone probe: an experimental study in dogs.

Immediate reintervention is necessary when vascular insufficiency is suspected in free bone transfers. We tested the reliability of the laser doppler bone probe in recording steady state and arterial and venous occlusion. During steady state the flux signal was not constant but fluctuated. During arterial occlusion an immediate and reproducible decrease in flux signal was seen. No evident changes were seen during venous occlusion. These results have clinical importance in monitoring free bone transfers.

Animals↗
PubMed1991

A very large neurilemmoma of the anterior interosseous nerve.

A very large neurilemmoma of more than 15 years duration, arising from the anterior interosseous nerve, is reported. To our knowledge, this is the largest ever described. While the symptoms and all other diagnostic findings suggested that the neurilemmoma originated from the median nerve, it needed angiography to provide the final diagnosis.

Female↗
PubMed1991

Free muscle transfer with split thickness skin graft coverage in head and neck reconstructive surgery.

Sixteen patients (eight females and eight males) who underwent microsurgical free tissue transfers for head and neck reconstruction are reviewed. In this series, the flap reconstruction was completed on eleven patients with extra-oral defects and five with intra-oral defects. Split thickness skin graft coverage was used in all cases. The rectus abdominis free muscle flap was used in nine patients and the latissimus dorsi free muscle flap in seven patients. The choice of tissue reconstruction was decided by the size of the surgical defect. There were no failures of the tissue transfers and skin grafts. In skilled hands, free tissue transfer provides a reliable method of head and neck reconstruction, with a low incidence of recipient and donor site complications. In extra-oral defects, coverage of free muscle transfer with split thickness skin grafts, results in a better colour match than musculocutaneous flaps, and complements the appearance and pliability of the free muscle flap.

Adult↗