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PubMed1977

Hypoplasia of the fibula.

Fibular hypoplasia occurs in differing degrees of severity with fibular hemimelia as its most severe form. Normally the distal epiphyseal plate of the fibula is at the same level as the distal end of the distal tibial epiphysis, whereas the tip of the proximal fibular epiphysis is level with the proximal tibial epiphyseal plate. Varying degrees of shortening of the fibula in relation to the tibia were found in 14 children, 6 of them boys. Shortening at the distal end of the tibia leads to instability of the ankle. Shortening at the proximal end of the fibula leads to hypoplasia of the lateral tibial plateau and valgus deformity of the knee. Syme type ankle disarticulation became necessary in five cases of fibular hemimelia because of leg length discrepancies or ankle instability.

Ankle Joint↗
PubMed1996

Anatomic considerations of an anterior approach to the sacroiliac joint.

This anatomic study was performed on 25 disarticulated pelves and 10 embalmed cadavers to evaluate an anterior approach to the sacroiliac joint. The angle of inclination of the superior limb of the sacroiliac joint was 15 degrees superolateral to inferomedial in the sagittal plane, and the inferior limb was parallel to the sagittal plane. The cranial lateral part of the ala overlapped the joint space and the adjacent part of the ilium. Elevation of a rectangular bone block on the cranial part of the ala removed the joint space from the superior limb and provided direct access to the joint space of the inferior limb.

Anthropometry↗
PubMed1996

Restriction fragment length polymorphism (RFLP) analysis on DNA from human compact bone.

DNA typing techniques primarily identify specific genetic markers that are highly polymorphic within a population and have found great utility in forensic science. The established DNA identification protocol, termed restriction fragment length polymorphism (RFLP), has been admitted as physical evidence in the investigation of crimes such as assault, sexual assault, and homicide. The limitation associated with this procedure concerns the integrity of the genetic material. This study sought to evaluate human bone as a source material for DNA identification following exposure to common forensic field conditions. Often, with the onset of decomposition and eventual disarticulation of a body, soft tissues, hair and teeth may not be recovered. The significance of this study lies in the fact that, within forensic anthropology, human bone represents the most biologically stable evidence and is sometimes all that remains after periods of exposure. Genomic DNA was extracted from human bone following exposure to surface deposit, shallow burial, and fresh water immersion. Samples were collected over a three month time course and analyzed by spectrophotometry and agarose gel electrophoresis as well as RFLP analysis. The data suggest that high molecular weight DNA may indeed be extracted from human bone and typed by RFLP analysis for use in forensic identification. Under simulated forensic field conditions, the severity of DNA degradation was in the order of fresh water immersion > shallow burial > surface deposit. Genomic DNA from bone deposited on the desert surface for up to 4 weeks was detected by RFLP analysis. No spurious bands were detected in any specimens, and to the extent that bands were still present, the RFLP patterns matched. These findings demonstrate that human bone can be a reliable source of genomic DNA, and that bone recovered from surface deposit is the most desirable for use in forensic identification.

Bone and Bones↗
PubMed1997

Free composite serratus anterior and rib flaps for tibial composite bone and soft-tissue defect.

Open fracture in the lower extremity often involves composite bone and soft-tissue defects. For patients with extensive segmental bone defects, vascularized fibular transfers can be utilized and are generally accepted as one of the best options for reconstruction of intercalary defects. In some cases, either bilateral tibias and fibulas are fractured or the contralateral fibula is traumatically damaged or absent, precluding free fibular transfer. If an osteocutaneous fibular flap cannot be used to manage such a defect, a composite serratus anterior and rib flap may be considered. Nine composite serratus anterior and rib flaps, with or without latissimus dorsi transfers, were performed in eight patients between August of 1993 and March of 1994. One patient sustained a left knee disarticulation and underwent reconstruction for a right tibial defect. He failed to achieve lower extremity function within 2 years and was considered a failure. One flap failed, and the patient underwent a below-knee amputation. The remaining six patients received seven composite flaps for tibial and calcaneal defects and could ambulate without assistance. Based on this review, we conclude that the composite serratus anterior and rib flap with optional latissimus dorsi muscle can be used for (1) bilateral tibial fibular fractures, (2) contralateral lower limb amputation with fillet of the amputated leg if the leg is present for harvest, (3) contralateral middle-third fracture of the fibula, (4) patients in whom iliac bone is not suitable because of either a bone defect greater than 10 to 12 cm or previous harvest of bone graft, and (5) extensive composite bone and soft-tissue defects.

Adolescent↗
PubMed1996

[Failures after tympanoplasty].

Failures and pitfalls in chronic ear surgery have been studied. The material consists of a retrospective study of 616 cases of tympanoplasty. The results were mainly analysed into cases of iatrogenic cholesteatoma (23), labyrinthine fistulae (25) and disruption of ossicular chain (46). The incidence of fistula into the semi-circular canal is high with cholesteatoma, and careful removal of the matrix is recommended to prevent sensorineural hearing loss. Disarticulation of the incudo-stapedial joint is performed to eradicate attic cholesteatoma and protect the cochlea. However, this procedure gives a risk of damage to the inner ear. The frequency and nature of sensorineural losses following chronic ear surgery have been discussed. Surgical precautions are advocated to prevent inner ear damage or other iatrogenic complications.

Chronic Disease↗
PubMedDate not supplied

[Ulcerated carcinoma of the breast in an elderly woman. An unusual clinical case report].

The authors analyze the most current methods for the treatment of ulcerated breast cancer in the elderly. They describe a peculiar case recently observed, characterized by an ulcerative lesion spreading from the hemiclavicle to the foreaxilla including the axillary cavity, causing a large phlebo-lymphaedema, anaesthesia and paresis of the homoteral upper limb. After an initial treatment with tamoxifen a scapulo-humeral disarticulation and a suture of the cutaneous wide defect were performed using a myo-skin graft which included the deltoid muscle. A radiotherapeutic treatment followed by tamoxifen therapy was carried out. No distant metastases and no local relapses were registered in the one year follow up. The Authors on the basis of their experience and according to the review of the Literature suggest that age itself is not a limiting factor to the therapeutic approach of ulcerated breast cancer.

Age Factors↗
PubMed1976

Surgical treatment of laryngeal stenosis.

In this study of the surgical treatment of acquired definite stenoses and atresia of the larynx, the author made the following classification: (i) stenoses due to bilateral paralysis of the recurrent nerve; (ii) stenoses caused by cicatrization of endolaryngeal structures, complete atresia of the larynx with obliteration of the lumen (a) the cartilaginous skeleton of the larynx is still preserved, (b) cases in whom for various reasons the cartilaginous skeleton had been destroyed and the lumen of the larynx assumed the shape of a narrow fissure covered with mucosa; and (iii) cases without cartilaginous skeleton or mucosa where only a cicatricial tissue has remained. As a basis for this research 120 cases were used. Two surgical techniques in bilateral paralysis of the recurrent nerve are described in detail. A combined extra- and intralaryngeal method of submucosal exenteration of the larynx and arytenoidectomy on one half, and cordopexy and disarticulation of the arytenoid was carried out on 30 patients. The second technique, which is still in a clinically experimental phase, is called arytenoidectomy and cordopexy via intercricothyroidolaryngotomy. It was used on only two patients, while greater experience has been gained through experiments carried out on animals (horses and dogs). In 22 patients treated for cicatricial stenoses and atresia various kinds of plastic reconstructive procedures were used. In all 22 patients treated for cicatricial stenoses and atresia various kinds of plastic reconstructive procedures were used. In all 120 cases the respiratory function of the larynx was satisfactorily restored. The voice of all these patients was altered and the phonatory function in 65 per cent of cases remained significantly impaired.

Cicatrix↗
PubMed1997

The role of mucopolysaccharide induction in treatment of experimental osteoarthritis in rats by ultrasound.

Therapeutic ultrasound has been used in the treatment of osteoarthritis for the relief of symptom and improvement of functional status. In recent study, we found that ultrasound enhances cartilage repair in experimental early stage osteoarthritis, and prevents deteriorative changes in later stages. In the present study, we further investigate the bioeffects of ultrasound on cartilage matrix of experimental arthritis. Fifty-four rats with three different degrees of papain induced osteoarthritis classified by 99m-Tc pertechnetate bone scan were collected for ultrasound treatment. The changes in their arthritic severity after sonication treatment and two months after treatment were measured using 99m-Tc bone scan. The histopathological changes were evaluated through light microscope after disarticulation sections (H.E. stain), and the changes in mucopolysaccharide density in cartilage matrix were measured using a Optimas scanner analyzer after Alcian blue staining. The results showed that the density of mucopolysaccharide rose in the initial stage of induced arthritis, and decreased progressively in the later stage. The density of mucopolysaccharide increased upon complete sonication more for the treated rats than for the controls, and this was closely related with the improvement in histopathological findings, but inversely with the changes in arthritic severity. In conclusion, therapeutic ultrasound enhances mucopolysaccharide synthesis of arthritic cartilage, and results in the repair of arthritic cartilage in the early stage of induced arthritis and the prevention of deteriorative changes in later stages.

Animals↗
PubMedDate not supplied

[An atraumatic approach in stapes reconstruction].

In order to prevent complications which occur in classical stapedoplasty, authors applied a new atraumatic procedure in 138 patients with otosclerosis. Along with preserved ossicular chain, stapedotomy was performed and a piston-wire prosthesis placed. Disarticulation of incudostapedial joint was the next part of the procedure with removal of suprastructure of the stapes. Early and late cochlear disorders were rare while the final functional effects were much better. This paper analyzes numerous advantages of this procedure with directives for promotion of our work in the future.

Humans↗
PubMed1994

A disclusion appliance to eliminate occlusally generated TMD symptoms prior to, and during, fixed orthodontic therapy.

Temporomandibular disorders are of multifactorial origin. If it is determined that the patient's occlusal scheme is a contributing factor to his/her TMD symptoms, it is accepted that reversible, noninvasive procedures be instituted at the outset of treatment. Splint therapy conforms to this guideline and serves to provide temporary, reversible alteration of the occlusal scheme in order to provide this relief. In a mutually protected occlusion, the posterior teeth accept the occlusal force of closure, while the anterior teeth serve to separate the dentition during excursive movements. The purpose of the disclusion splint described in this article is to eliminate muscle hypertonicity, along with its ensuing problems, by establishing a mutually protected occlusion via the guide planes created by the acrylic portions of the splint. Simultaneously, it does not compromise the patient's freeway space but acts as a preorthodontic, adjunctive-orthodontic, or post-TMD "stabilization-retentive" appliance because of its inherent ability to promote disarticulation of occluding dental surfaces during function.

Dental Occlusion↗
PubMed1978

Functional morphology of forelimb joints in the woolly monkey Lagothrix lagothricha.

This gross anatomical study of embalmed forelimb joints of the South American woolly monkey Lagothrix lagothricha focuses on the problem of determining in osteoligamentous preparations how the disposition of the capsular apparatus and the geometry of the articular surfaces govern the amount and types of movement permitted at a joint, and then correlates these findings with the use of the forelimb in the positional capabilities of captive wooly monkeys observed by this author. Data collection was by dissection, quantitative range of motion studies on osteoligamentous preparations, and by qualitative manipulations of these preparations and of disarticulated bones. Supplemental evidence was obtained from radiographs and from an estimate of angular values of articular surfaces. Presented for the shoulder, elbow, radioulnar, and hand joint complexes are the functional anatomy of the capsular apparatus and articular surfaces, the quantitative range of motion data, and proposed mechanisms of movement that combine the functional morphology with the observed use of the forelimb in activities by the animal. The structurofunctional framework of MacConaill is the basis for the joint analysis. The evidence suggests that the functional anatomy of these joints correlates well with the possible positional capabilities of Lagothrix. The morphology of the capsular apparatus and joint surfaces reflect both the arboreal quadrupedalism and forelimb suspension of the woolly monkey. The positions of maximum congruency and close-pack approximate the forelimb's weight-bearing stance during palmigrade arboreal quadrupedalism. During forelimb suspension, the taut and twisted capsular apparatus of close-packed joints maintains the integrity of forelimb links in tension. This is the first known report of the internal band of the collateral ligament of the proximal interphalangeal joints of the second through fifth digits being incorporated into the terminal tendon of the extensor assembly. This author believes this is a mechanism not only for maintaining the integrity of these joints during forelimb suspensory activities when the body is supported by the middle phalanges, but also for helping to coordinate the flexion-extension actions of the phalanges for smooth grasping and release maneuvers in an arboreal environment. When sufficient comparative data have been collected, such correlations of the functional morphology of joints with positional behavior may be used to postulate positional capabilities of fossil primates.

Acromioclavicular Joint↗
PubMedDate not supplied

Elective stenting of unprotected left main coronary artery ostial stenoses: short- and mid-term results.

Elective stenting as a primary strategy for non-surgical revascularisation was performed in five patients with symptomatic unprotected left main coronary artery ostial stenoses. Their ages ranged from 24 to 57 years (mean: 44.6 +/- 14.4 years). Left ventricular ejection fraction ranged from 35 to 55 percent. All patients underwent successful stenting for left main ostial stenoses using a disarticulated 7 mm Palmaz-Schatz stent. Luminal diameter stenosis reduced from 74 +/- 10.8 to 10 +/- 7.2 percent after the procedure. One patient developed recurrence of angina on the 7th day due to marked recoil of the left main coronary artery with possible thrombosis, requiring immediate coronary artery bypass graft surgery without any sequelae. Remaining four patients were asymptomatic over a mean follow-up of 54 +/- 36 weeks (range: 25-96) and none developed angiographic restenosis at six months. Our preliminary observations therefore suggest that primary stenting is a feasible alternative to bypass graft surgery in patients with unprotected left main coronary artery ostial stenoses.

Adult↗
PubMed1998

The Madura foot: an "innocent foot mycosis"?

With the increased movement of the world population, acquaintance with the clinical picture of the Madura foot is of growing importance beyond its original endemic areas. The characteristic triad of symptoms consists of indurated swelling, multiple sinus tracts with purulent discharge filled with grains and localization at the foot. An increasing number of new etiologic agents are recognized today. For a better choice of therapy an adequate diagnostic procedure is essential ; a deep biopsy for histology appears to give a more substantial contribution to identification of the causal organism than culture. The treatment which should be started early, is at first essentially a drug treatment. However, in spite of high expectations with regard to new antimycotic drugs, amputation or disarticulation is often inevitable even today, particularly when the lesion is caused by Eumycetes. The first two documented patients with this disease in the Netherlands are described. They developed serious deformities of the lower extremity despite long-term use of antimycotic and antibiotic medication.

Adult↗
PubMed1998

Airbag mediated death of a two-year-old child wearing a shoulder/lap belt.

Airbag injuries have resulted in the deaths of several infants and small children, and such deaths are generally associated with rearward-facing infant seats or unrestrained children in front passenger seats of cars equipped with airbags. An airbag can also cause death in a small child wearing a shoulder/lap belt, however, as this case report illustrates. A two-year-old female was involved in a low-speed collision while riding in the front passenger seat of a dual-airbag-equipped automobile. Secondary impact with the airbag caused catastrophic occipitoatlantoaxial disarticulation with traumatic spinal cord separation, thermal injury and abrasions of the right forearm and distinctive patterned abrasions of the face. The possibility of airbag injury should be considered in all low-speed traffic fatalities, and the confirmatory injuries sought at postmortem examination.

Accidents, Traffic↗
PubMed1998

Percutaneous coronary angioplasty of radial artery conduits.

The higher long-term patency of internal mammary artery grafts has stimulated the search for alternative conduits in order to achieve a complete arterial myocardial revascularization. Percutaneous angioplasty is often the preferred strategy for the treatment of recurrent ischemia in patients who previously underwent bypass surgery, but there is limited experience in the treatment of arterial grafts. We describe two cases of percutaneous treatment of diseased radial artery (RA) grafts. In the first case, two disarticulated stents were deployed through an RA graft: half stent inside the anastomosis to the left anterior descending (LAD) artery, and half stent in the distal LAD artery. Diffuse spasm of the RA graft, resistant to ic nitrates, was successfully reversed after ic calcium antagonists. Absence of restenosis was confirmed two years later. In the second case, after simultaneous catheterization of both the left coronary artery and RA graft, two long stents were implanted in the LAD artery and a final "reversed" kissing-balloon dilation through the stent struts was performed; four months later the patient showed proximal occlusion of the LAD artery and the stenotic RA distal anastomosis was successfully dilated.

Aged↗
PubMed1998

Iatrogenic vertebrobasilar insufficiency after surgery of the subclavian or brachial artery: review of three cases.

OBJECTIVE AND IMPORTANCE: Vertebrobasilar insufficiency resulting from disease of the subclavian artery is well recognized. Usually, this occurs as the "subclavian steal" syndrome in the context of chronic subclavian stenosis and is consequently well tolerated because of collateralization. Acute disruption of the hemodynamics of the aortic arch vessels, however, can produce disastrous sequelae. CLINICAL PRESENTATION: We present three cases of iatrogenic vertebrobasilar insufficiency sustained as complications of surgery of the left subclavian artery or its distal continuation. The cases were chosen from a review of approximately 400 emergency neurosurgery consultations requested at the Los Angeles County Hospital between November 1995 and February 1996. INTERVENTION: The first patient underwent repair of a traumatic brachial artery occlusion and awoke postoperatively with bilateral cortical blindness, right hemiparesis, and multiple cranial nerve deficits that were most likely caused by acute subclavian steal. The second underwent removal of a subclavian embolus and developed bilateral cerebellar infarction leading to persistent coma, possibly from inadvertent embolization of the vertebral artery during surgery. The third underwent resection and bypass grafting of a subclavian aneurysm. Good backflow was reported when the vertebral artery was disarticulated from the subclavian artery, and this vessel was not reimplanted into the graft. The patient suffered massive cerebellar infarction leading rapidly to brain death. CONCLUSION: There are myriad ways in which the inherent redundancy of the vertebrobasilar system may be jeopardized, and when this protective mechanism fails, the results can be disastrous. Flow through the vertebral arteries may be compromised by thrombosis, embolization, dissection, inappropriate ligation, excessive head rotation, hypotension, vasospasm, or acute subclavian steal. These examples illustrate the importance of understanding the complex physiology of posterior fossa circulation as the basis of pre-, intra-, and postoperative management of patients undergoing surgery of the subclavian artery.

Acute Disease↗
PubMedDate not supplied

Uretero-arterial fistula: a case report and review of the literature.

We report the case of a uretero-arterial fistula (UAF) formation in a 68 years old male who had previously undergone an Aortobifemoral graft. He got complicated with occlusion and infection of the right lower extremity requiring a right hip disarticulation for its management. This was followed by groin infection and graft protusion, managed by transabdominal resection of the right graft limb, at which time the right ureter was lacerated and repaired. Several months later, he presented with gross hematuria found to be secondary to UAF. The diagnostic and management steps leading to this patient care will be reviewed, together with a review of the literature pertinent to this case report.

Aged↗
PubMed1999

Culture and characterization of equine terminal arch endothelial cells and hoof keratinocytes.

OBJECTIVES: To develop methods to isolate, culture, and characterize equine hoof endothelial cells (EC) and keratinocytes. SAMPLE POPULATION: Cells harvested from the forelimbs of 8 horses. PROCEDURE: EC were obtained via catheters placed in the palmar digital arteries of the disarticulated lower portion of the forelimbs from 4 horses that had been heparinized prior to euthanasia. Phosphate-buffered saline solution was used to remove and discard RBC from blood vessels, and collagenase was used to loosen and flush EC from the vasculature. Hoof keratinocytes were obtained from 4 recently euthanatized horses by use of dispase/trypsin dissociation of the coronary band epidermis. Use of an extracellular matrix gel as a culture flask attachment factor was important to the success of hoof keratinocyte cultures. RESULTS: EC from the palmar digital arteries were successfully cultured and characterized by in vitro morphology, uptake of a fluorescence-labeled acetylated-low density lipoprotein, and lack of expression of von Willebrand factor and smooth muscle actin. Hoof keratinocytes were characterized by morphology in culture and expression of keratin proteins, as determined by immunochemical reaction. Keratinocyte cultures were also positive for vimentin expression. CONCLUSIONS: Culture techniques to isolate and characterize hoof cells should aid investigators in their study of equine hoof pathobiologic features, especially as it relates to laminitis.

Animals↗