Biomedical subjects
Publications and source records attributed to T R Waugh.
Suppurative arthritis can be a complex and vexing problem. Formal arthrotomy is among the many successful approaches for the treatment of septic joints in the adult, however, it is not without morbidity and may not always be required. The clinical features, pathophysiology, and treatment of this disorder are reviewed.
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Cervical spine injuries pose devastating potential problems for surgeon and patient alike. This review will stress the early diagnosis of cervical spine injuries, with emphasis on early suspicion of injury. This review will focus on the radiology and types of lesions found with cervical spine injury.
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Free flap transfer for soft tissue defects involving the sole of the foot have been important in limb salvage. The functional capacity of 16 patients is documented. From our data, free flaps to weightbearing surfaces of the foot give satisfactory results in patients less than 40 years old and salvage is rewarding. Older patients had less than satisfactory results. When the only alternative is an amputation, free flap salvage may still be indicated.
Bilateral simultaneous Achilles tendon ruptures are rare, with only ten cases reported in the English literature. Our case is that of a 44-year-old woman, along with a review of the literature. Affected persons usually are on chronic steroid treatment and in the fifth to seventh decades of life. The patient may have concomitant systemic disease, and the injury occurs with relatively mild trauma. The goals of treatment are mainly preventative, i.e., cessation of steroids as soon as possible and protective bracing of the remaining intact Achilles tendon.
A close relation exists among the alterations in the lumbosacral spine designated as spondylolysis, isthmic spondylolisthesis, degenerative spondylolisthesis, and prespondylolisthesis. While the former two conditions are probably caused by faulty development and subsequent minor traumata or repeated stresses, the third condition is caused by degenerative changes associated with anatomic variations; the fourth condition is a static insufficiency leading to faulty alignment. In 105 patients, the initial preferred management of these conditions was conservative. Thirty-four patients who developed persistent symptoms of spinal instability and/or intractable neurologic deficits were treated surgically. The results were generally successful.
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Twenty-five postoperative lumbar laminectomy and diskectomy patients were administered the MMPI and evaluated by physical examination which included the Burns' Bench Test. In this test the patient is asked to kneel on a bench with knees and hips flexed and place his fingers on the floor. The kneeling position relieves stress on the low back and tension on the siatic nerve, so that patients with organic causes of low back pain are able to perform the test. Conversely, inability to perform the test is indicative of functional symptoms as in hysteria. All patients were males and the average age was 54. The average interval from surgery was 2 1/2 years. Sixty-seven per cent of those patients unable to perform the Burns' test were classified as hysterical on the basis of the MMPI, while 73% of patients classified as hysterical using the MMPI criteria failed to perform the Burns' test. The correlation between the Burns' test and hysteria as determined by the MMPI was 0.48. In terms of sensitivity and specificity, the sensitivity of the Burn's test in distinguishing patients with an hysterical MMPI was 73%. The specificity for normal subjects was 71%. The Burns' test is a useful clinical test for differentiating between organic and non-organic causes of low back pain. However, the test by itself should not be construed as an unequivocal measure of hysteria as defined psychologically by the MMPI. Failure to perform the test indicates a need for further psychological study.
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Primary coccidioidal synovitis of the knee is a rare disorder and controversy exists in the literature over the efficacy of treatment with synovectomy and Amphotericin B therapy. Four cases are presented illustrating features of the natural history, diagnosis, and treatment of the disease.
Although malignant cartilage tumors of the foot and especially of the talus are uncommon, the treating physician must become suspicious when a "simple ankle sprain" is resistant to standard treatment. In such a case, the comparison of serial radiographs may reveal subtle changes and the use of a radioactive bone scan may be of diagnostic value.
In a lateral dislocation that is unreducible by closed methods, one should suspect that the tendon of the tibialis anterior muscle may be preventing reduction because of its interposition. In such a situation an open reduction is mandatory.
A compartmental syndrome can occur in any space limited by fascia or skin. A case of a gluteal compartment syndrome is reported, apparently from prolonged pressure after a drug overdose. Clinical features were a painful expanding gluteal mass with sciatic nerve dysfunction. Fasciotomy of the tensor fascia lata and the overlying fascia of the gluteus maximus resulted in rapid relief of symptoms.
This is a case report of a 21 year old man with a unicameral bone cyst of the scapula. The occurrence here, as in other flat bones, is rare. The unusual location presents a diagnostic problem, but as in other flat bones, the prognosis after treatment by bone grafting is very good.
An evaluation of 0.2% buffered glutaraldehyde fixed tendon as a potential tendon replacement prosthesis was evaluated in rabbit and chicken models. In vivo implantations were done to determine compatability, function, and strength of grafts. Autogenous fresh grafts were used as controls in the strength evaluations. The fixed tendon elicits no cellular rejection response, is invaded and replaced by host tissues, and anastomosis strength in tension compares favorably to a fresh autogenous control. These preliminary evaluations indicate a useful potential for this fixed biomaterial as a tendon prosthesis.
Between March 9, 1972 and December 31, 1973, a total of 103 UCI knee replacements were performed. Follow-up data are available on 83 knees with an average follow-up of 33 months. Patient evaluation of the end results indicates that 78.3 per cent were better, 9.6 per cent unchanged, and 12.1 per cent worse. Patient evaluation of their own knee function averaged 55 per cent preoperatively and 79 per cent postoperatively. Patients were also evaluated on a 100 point Modified Larson Analysis Form. The average preoperative score was 46, and the average postoperative score was 70. There were six (5.8%) biological complications in the 103 knee replacement. Biological complications included infections, wound healing problems and unexplained pain. Mechanical complications were seen in 18 (17.4%) knees, and included knee instability, tibial component loosening or deformation, and patellar problems. Additional surgery was required in 18 (17.4%) knees. Failure of the procedure eventually requiring removal of the prosthesis and fusion or amputation occurred in 4 (3.9%) knees. The intermediate-term results of UCI knee replacement have been clinically satisfactory. We currently recommend consideration of this procedure for patients with disabling arthritis of the knee.
Management of a traumatized elbow or intra-articular fracture with concomitant upper extremity long bone fracture is tedious, especially when early elbow motion is desirable. An adaptation of the lower extremity hinged cast brace to the elbow provides controlled flexion while protecting against varus/valgus stress and translation forces. A cast brace is constructed from readily-available materials, and can be applied in an out-patiet clinic. The functional results obtainable in a variety of upper extremity injuries are excellent, and the patients generally accept the elbow cast brace very well.