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Biomedical subjects

S Zimbler

Publications and source records attributed to S Zimbler.

26 records · Page 2Linked to original sources
PubMed1976

Comprehensive health care clinic for hemophiliacs.

One hundred hemophiliacs were examined at a formal comprehensive health care clinic. Sixty-eight percent had abnormal results of liver function tests, and 26% had spleens that were palpable. Measurement of range of motion of knees, ankles, hips, shoulders, and elbows showed a high incidence of hemophilic arthropathy and established a precise baseline by which to judge efficacy of therapy. Results of dental examination disclosed a 14% incidence of multiple severe caries, which is an incidence lower than that of the population as a whole. Examples of inadequate dosage of replacement therapy (16%) and chronic delay in application of self-therapy (14%) were discovered. An 8% incidence of hypertension was noted; prior experience suggests that the combination of hypertension and hemophilia may be lethal. Other clinical and laboratory data also illustrate the importance of a periodic, formally structured, comprehensive examination of hemophiliacs.

Adolescent↗
PubMed1976

Hemophilic arthropathy of the foot and ankle.

The major deformities in hemophilic arthropathy of the foot and ankle fall into the three groups of equinus, varus, and cavus. These pathologic positions develop through a repetitive pattern of intra-articular and intramuscular bleeding within the area of the distal calf, foot, and ankle. Appropriate infusion therapy with factor VIII concentrate and factor IX concentrate plus splinting, bracing, and logical rehabilitative maneuvers can delay or prevent the advent of permanent deformity. The actual articular damage seems to be directly related to the release of digestive enzymes from leukocytes, synovial cells, and other blood products. These pathologic mechanisms appear to be similar to those recently described in explaining joint destruction in rheumatoid and degenerative arthritis. The indication for certain reconstructive orthopedic procedures in these situations are given and case examples provided. Total joint replacement in the area of the foot and ankle in hemophilia has been considered for certain patients by the authors but not attempted as yet.

Adolescent↗
PubMedDate not supplied

The arthrogrypotic foot plan of management and results of treatment.

Fifty-one arthrogrypotic feet have been treated and followed by the Pediatric Orthopaedic Unit, Tufts New England Medical Center, (1970-1980). Forty of the 51 feet presented as equinovarus with the residual divided among metatarsus adductus, vertical tali, and calcaneovalgus. Equinovarus deformities are the most resistant in all cases. Corrective casts are applied for at least the first 3 months of life. Surgical procedures were then initiated with any evidence of lack of progression of treatment. Varus and equinus were treated by an extensive posterior and medial release. Lateral soft tissue releases in addition to calcaneocuboid fusion or cuboid osteotomy were necessary in 24 of the 70 operations. Recurrence rate has been a problem in the simple type of posterior release including only an Achilles tendon lengthening, and posterior capsulotomy of the ankle and subtalar joint. Talectomy has been carried out in four feet and appears to be one type of reasonable salvage procedure in smaller children with recurrent varus. Treatment is difficult in these patients but a plantigrade foot should be achieved in all cases.

Arthrogryposis↗
PubMedDate not supplied

Giant synovial cyst of the calf and thigh in a patient with granulomatous synovitis.

A giant synovial cyst with granulomatous synovitis was removed from the thigh and calf in an 80-year-old woman. The lesion included necrotizing, epitheloid cell granulomata with Langhans' type giant cells. Chest X-ray, tuberculin testing, cultures for Acid Fast bacilli, as well as aerobic, anaerobic and fungal cultures were all negative. The treatment consisted of synovectomy and total knee arthroplasty with an uneventful recovery. A giant calf cyst, usually associated with rheumatoid arthritis, but in this situation, noted in granulomatous synovitis seems not to have been reported previously.

Granuloma↗
PubMedDate not supplied

Subtalar arthrodesis for stabilization of valgus hindfoot in patients with cerebral palsy.

All patients with spastic cerebral palsy who underwent correction of valgus hindfoot by Grice extraarticular subtalar arthrodesis between 1971 and 1986 performed by two surgeons using an identical technique were reviewed. Twenty-nine patients (53 feet) were followed at an average of 8.9 years after operation. Traditional radiographic criteria for measurement of hindfoot alignment in skeletally mature individuals have poor reliability. Talar head uncovering is a useful and reproducible method for evaluation of hindfoot valgus in these patients. Five patients had progressive hindfoot or ankle deformity at latest follow-up. All five of these patients were spastic quadriplegics. There was no recurrence in the 17 patients who were less severely involved than the quadriplegic patients.

Arthrodesis↗