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Thirty supraclavicular traction injuries of the brachial plexus are reported. Young motor cyclists are frequently involved. Recovery is slow and often incomplete. Myelography remains the most useful investigation for prognostic purposes. The management of intractable pain is discussed. An early assessment of prognosis is an important fact in planning and supervising the long-term management of these patients.
Local pressure for the control of venous haemorrhage during the performance of surgery is the primary method of control of bleeding when ligation is technically impossible. A method of catheter traction for the control of profuse bladder neck venous haemorrhage is described.
A technique is described and illustrated of how a surgeon working by himself may use the fingers of his free hand to provide what an assistant ordinarily does by way of supplying traction in all necessary directions in order to make sharp and clean incisions.
Traction alopecia in black women is a pervasive condition. It arises from cultural, social, and cosmetic considerations. The etiology and historical aspects are reviewed. Treatment, which has not been previously reported, is presented, although Norwood has published on the treatment of androgenic alopecia in women.
Two sisters had an unusual constellation of findings, including telangiectases [corrected] involving the face and limbs, unclassifiable spondyloepiphyseal dysplasia, hypothyroidism, and tractional retinal detachment preceded by retinal and iris neovascularization. To our knowledge, this combination of defects has not been previously documented in the literature.
A case of an acute traction apophysitis, "little league elbow", in an adolescent badminton player is presented. After a period of intense badminton activity, the patient developed typical signs of inflammation related to his elbow. X-ray showed soft tissue calcifications and ultrasound showed intra-articular swelling and a possible apophysitis related to the elbow. After a period of immobilization followed by low activity he could return to normal sports activity.
Young patients with sub-optimal visual acuity and no obvious ophthalmic pathology were found to complain of a 'shadow' or decreased brightness, with no metamorphopsia, at the point of regard, suggesting a pathology anterior to the neuroepithelium of the retina. Examination of fourteen such patients with a fundus contact lens revealed a focal vitreo-foveal detachment in eleven patients. Nine patients had a white plaque attached to this detachment, with a corresponding visible loss of superficial retinal tissue in one case. One patient had minute lamellar holes bilaterally. We feel that tenuous attachments of the vitreous body to the fovea could exert traction on the vitreo-retinal interface or shrinkage of a fibrocellular membrane on the inner foveal surface could lead to the observations made by us. The diagnosis of such lesions could be used to determine the cause of a sudden loss of vision in young patients, preventing the needless use of expensive and invasive investigations.
The unrestrained, traction-free vibrations of finite elastic cylinders with trigonal material symmetry are studied using two approaches, based on the Ritz method, which formulate the weak form of the equations of motion in cylindrical and rectangular coordinates. Elements of group theory are used to divide approximation functions into orthogonal subsets, thus reducing the size of the computational problem and classifying the general symmetries of the vibrational modes. Results for the special case of an isotropic cylinder are presented and compared with values published by other researchers. For the isotropic case, the relative accuracy of the formulations in cylindrical and rectangular coordinates can be evaluated, because exact analytical solutions are known for the torsional modes. The calculation in cylindrical coordinates is found to be more accurate for a given number of terms in the series approximation functions. For a representative trigonal material, langatate, calculations of the resonant frequencies and the sensitivity of the frequencies on each of the elastic constants are presented. The dependence on geometry (ratio of length to diameter) is briefly explored. The special case of a transversely isotropic cylinder (with the elastic stiffness C14 equal to zero) is also considered.
A variational method is developed to study the traction-free vibration of layered rectangular elastic and piezoelectric parallelepipeds. The weak form of the equations of motion and the charge equation are formulated in rectangular Cartesian coordinates. Approximate solutions to these equations are sought in a form that combines piecewise linear or quadratic Lagrange basis functions through the layered dimension of the solid with continuous global polynomial or trigonometric functions in the plane. This allows for the necessary discontinuity in the shear strain and normal potential gradient across the interface between layers caused by the mismatch in material properties. Numerical results compare very well with those computed by other techniques for layered elastic and piezoelectric plates with simple support and homogeneous parallelepipeds under stress-free conditions.
Peripheral, spinal and cortical somatosensory evoked potentials were recorded in 26 patients with unilateral traction injuries of the brachial plexus ganglia. Of 10 cases explored surgically the recordings correctly anticipated the major site of the lesion in eight.
Pharyngeal complications due to anterior cervical spine surgery (ACSS) are not rare. We describe the case of a traction diverticulum of the hypopharynx after ACSS, a complication that has not yet been reported. We discuss the possible mechanism. A review of the complications of ACSS that are of interest to the otolaryngologist is included.
Subtotal tympanic membrane perforations are very common in Micronesia. The great distance between the islands, primitive conditions, and shortages of medical facilities and supplies must all be considered when a technique is designed for the closure of these perforations. Such a technique, using dissolvable sutures to position and support a medial temporalis fascia graft, is presented. A suture is used to place traction on the graft to assure proper placement under the anterior remnant or anterior canal wall skin. The graft is placed medial to the remnant but lateral to the malleus handle, which has been carefully dissected free of epithelium. Two hundred eighty-one cases were followed for 6 months or more, with a success rate of slightly more than ninety-five percent. Complications of blunting, lateralization, reperforation of the graft, and cholesteatoma formation are discussed.
A rare case of esophagopleural fistula following spontaneous rupture of a traction diverticulum of the esophagus in a 25-year-old man was successfully treated by diverticulectomy.
The mesenteric traction syndrome (MTS) remains, seventeen years after its first designation as a distinct pathologic entity, an aspect of surgical practice that has received limited attention. Apart from its symptomatology, there is mostly speculation about its exact causes and pathophysiologic mechanisms. Even though full-blown MTS is rather rare, the advent of laparoscopic surgery has indicated that there are different stages of stress associated with open abdominal surgery. Some evidence points to the involvement of mast cell derived vasoactive mediators and suggests possible pharmacologic management.
Thrombospondin (TSP), an adhesive integrin-binding protein of plasma and platelets, was detected in preretinal traction membranes from patients with idiopathic (8/8) and traumatic (7/8) proliferative vitreoretinopathy (PVR) and proliferative diabetic retinopathy (PDR) (6/8). TSP immunoreactivity was compared to the pattern of von Willebrand factor, plasma transglutaminase (blood coagulation factor XIII), fibronectin, and mononuclear phagocytes, using double-label immunofluorescence microscopy. TSP was partially colocalised with the endothelial cell marker, von Willebrand factor, in PDR. The codistribution of catalytic factor XIII and two cross-linking substrates, fibronectin and TSP, suggests a functional role of the enzyme in the extracellular matrix build-up in PVR and PDR. No significant TSP synthesis by mononuclear phagocytes was observed. Western blotting indicated a plasmin-mediated intravitreal breakdown of presumably plasmatic TSP in PVR and PDR.
The implantation of an artificial iris diaphragm is described in a case of aniridia and traumatic aphakia with a relapsed, tractional retinal detachment. The addition of heparin and dexamethasone to the infusion liquid is useful to reduce the fibrinous exudation which seems to be the main cause of diaphragm obliteration.
The methods of orthodontic management of unerupted teeth are critically discussed. The indications and contra-indications of the relatively new technique of gold chain traction via a directly bonded attachment are given. Three case reports illustrate different aspects of the technique.
In those cases judged to be suitable for treatment by extractions in both arches and the use of upper removable appliances alone, the closure of excess residual space relies on mesial drift of the buccal segments. If opposing residual spaces are unequal in extent, there is a risk that space closure will be incomplete. Two cases are presented where a removable appliance was used to move a buccal segment mesially using a traction screw, and thereby close the excess residual space.