RESUMEN
Access to the proximal interphalangeal joint of the finger for arthroplasty is difficult without detaching its stabilizers or dividing the tendons that cross it, which then require repair and slow rehabilitation. We describe a method that conserves both, so facilitating post-operative rehabilitation.A C-shaped incision is made on the dorsum of the finger. The lateral bands of the extensor expansion are separated from the central slip proximally to the extensor hood. They are then retracted to expose the condyles of the proximal phalanx, which are excised. The PIP joint is then dislocated between the central slip and a lateral band allowing the remainder of the head to be excised. The middle and proximal phalanges are then prepared to accept the prosthesis. The prosthesis is then inserted and the joint is reduced. The lateral bands of the extensor mechanism are sutured back to the central slip before the skin is closed.
Asunto(s)
Artroplastia de Reemplazo/métodos , Articulaciones de los Dedos/cirugía , Prótesis Articulares , Ligamentos Colaterales/cirugía , HumanosRESUMEN
Thirty-four patients with a Dupuytren's contracture in excess of 70 degrees of the proximal interphalangeal (PIP) joint were treated by preliminary palmar fasciotomy, release of the accessory collateral ligaments and PIP joint distraction using the S-Quattro for 6 weeks. A formal fasciectomy with full thickness skin graft was then performed 2 weeks after removal of the fixator. There was a mean residual flexion deformity of the PIP joint of 22 degrees (mean correction of 67 degrees) at an average follow-up of 30 months. There were no infections or amputations. We recommend this technique for the management of severe Dupuytren's contracture of the PIP joint.
Asunto(s)
Contractura de Dupuytren/cirugía , Articulaciones de los Dedos/cirugía , Anciano , Fasciotomía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trasplante de PielRESUMEN
We have used the "S" Quattro Turbo to treat four neglected dorsal interphalangeal joint dislocations. At an average follow up period of 45 months, there was a mean increase in the range of movement of the PIP joints by 74 degrees and of the IP joint of the thumb or DIP joints by 45 degrees. We recommend this technique for treating dorsal dislocations of the interphalangeal joints of more than 3 weeks duration.
Asunto(s)
Fijadores Externos , Traumatismos de los Dedos/cirugía , Fijación Interna de Fracturas , Luxaciones Articulares/cirugía , Adulto , Hilos Ortopédicos , Enfermedad Crónica , Traumatismos de los Dedos/diagnóstico por imagen , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía , ReoperaciónRESUMEN
The "S" Quattro has proved its value in the treatment of acute displaced comminuted intraarticular phalangeal fracture dislocations. We have used the system to treat five cases of chronic fracture-dislocation or subluxation of the PIP joint. At an average follow-up period of 16.4 months, there was a mean increase in the range of movement of the injured joint by 75 degrees. We recommend this technique for selected cases.
Asunto(s)
Traumatismos de los Dedos/cirugía , Fracturas Cerradas/cirugía , Fracturas Conminutas/cirugía , Luxaciones Articulares/cirugía , Adulto , Anciano , Enfermedad Crónica , Femenino , Traumatismos de los Dedos/diagnóstico por imagen , Fracturas Cerradas/diagnóstico por imagen , Fracturas Conminutas/diagnóstico por imagen , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
The 'S' Quattro is a dynamic external fixator which has been designed to treat displaced comminuted intraarticular fractures of the phalanges. This type of fracture is commonly the result of a sports injury. We present a follow-up study of 11 cases.
Asunto(s)
Traumatismos en Atletas/cirugía , Fijadores Externos , Traumatismos de los Dedos/cirugía , Fijación de Fractura/métodos , Fracturas Óseas/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We studied prospectively the relationship between serum lipids and Dupuytren's disease of the hand in 85 patients, 65 men and 20 women. The Dupuytren patients had significantly higher fasting serum cholesterol and triglyceride levels than did the controls (p < 0.001). The raised levels of serum lipids appeared to be associated with the pathogenesis of Dupuytren's disease, and this may help to explain the high incidence of Dupuytren's disease in alcoholic, diabetic and epileptic patients, since these conditions are also associated with raised serum lipid levels.
Asunto(s)
Contractura de Dupuytren/sangre , Lípidos/sangre , Adulto , Anciano , Anciano de 80 o más Años , Colesterol/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Triglicéridos/sangreRESUMEN
The "S" Quattro has shown its value in the management of displaced comminuted intra-articular phalangeal fracture dislocations. Since then the system has been used as a dynamic flexible external fixator in the treatment of five maluniting phalangeal fractures, five comminuted condylar and four severe compound fractures. These challenging fractures have been dealt with by easy operations, taking full advantage of the versatility of the "S" Quattro to achieve good results.
Asunto(s)
Fijadores Externos , Traumatismos de los Dedos/cirugía , Fracturas Óseas/cirugía , Adulto , Femenino , Traumatismos de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , RadiografíaRESUMEN
Fifty arthrodeses of the digital joints using the Harrison-Nicolle peg in 22 patients have been reviewed at a mean of 8.5 years after operation. 96% of these operations were judged to have been successful by our patients, most of whom were suffering from inflammatory joint disease. 66% went on to bony union, 30% to fibrous union and 4% to non-union. There was no difference in clinical outcome between the bony and fibrous union groups and only those with non-union were disappointed. All arthrodeses remained in the same angle of flexion as that in which they were originally fixed.
Asunto(s)
Artrodesis/instrumentación , Articulaciones de los Dedos/cirugía , Adulto , Anciano , Artrodesis/métodos , Femenino , Humanos , Artropatías/cirugía , Masculino , Persona de Mediana Edad , Polipropilenos , Cuidados Preoperatorios , Factores de TiempoRESUMEN
There is universal agreement that microvascular repair is the only way to salvage class II ring avulsion injuries. We report on two patients who sustained this type of injury and were treated successfully by extensive fasciotomy. The circulatory compromise following class II ring injuries deteriorates rapidly due to the tourniquet-like effect by the progressive swelling of the soft tissue envelope. Fasciotomy eliminates this effect and allows adequate inspection of the neurovascular bundles. Microvascular repair is still feasible if considered necessary.
Asunto(s)
Fasciotomía , Traumatismos de los Dedos/cirugía , Dedos/cirugía , Adulto , Dedos/irrigación sanguínea , Humanos , Masculino , Flujo Sanguíneo RegionalRESUMEN
A new system has been designed to treat displaced comminuted intra-articular phalangeal fractures and 20 such fracture-dislocations were treated by it. Nineteen of the patients were satisfied at an average follow-up period of 13.6 months, with a mean total active motion of 226 degrees. The results are rewarding considering the gravity of the injuries.
Asunto(s)
Traumatismos de los Dedos/cirugía , Fijación Interna de Fracturas/instrumentación , Fracturas Óseas/cirugía , Hilos Ortopédicos , Diseño de Equipo , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , HumanosAsunto(s)
Quiste Sinovial/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Niño , Terapia Combinada , Femenino , Humanos , Inyecciones Intraarticulares , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/análogos & derivados , Metilprednisolona/uso terapéutico , Acetato de Metilprednisolona , Persona de Mediana Edad , Succión , Quiste Sinovial/tratamiento farmacológicoRESUMEN
The use of an intramedullary alignment rod in the distal part of the femur is an important step in performing total knee-replacement arthroplasty. On the basis of our observation of a sudden decrease in oxygen saturation in some patients after insertion of the rod, a prospective study was done of the circulatory and blood-gas changes that were associated with insertion in thirty-five patients. We examined the effects of the use of an eight-millimeter solid alignment rod, with and without venting; an eight-millimeter fluted alignment rod, with venting; and an eight-millimeter fluted or solid alignment rod, inserted through a 12.7-millimeter drill-hole, but without other venting. A statistically significant reduction in oxygen saturation, arterial oxygen tension (PaO2), and end-tidal carbon-dioxide tension (PETCO2) occurred after insertion of both solid and fluted eight-millimeter alignment rods through an eight-millimeter hold in both vented and unvented femoral canals, in association with a significant increase (p less than 0.01) in intramedullary pressure. Bone-marrow contents and fat were retrieved from samples of blood from the right atrium, indicating that embolization of marrow contents had occurred during insertion of the alignment rod. A small decrease in systemic blood pressure and heart rate also occurred. These changes were completely eliminated by the use of a 12.7-millimeter drill-hole as the entry site of the eight-millimeter fluted rod. We concluded that insertion of an intramedullary alignment rod in the femur causes embolization of marrow contents, which decreases arterial oxygen tension, oxygen saturation, end-tidal carbon-dioxide tension, arterial blood pressure, and heart rate.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Dióxido de Carbono/sangre , Hemodinámica , Prótesis de la Rodilla , Oxígeno/sangre , Anciano , Anciano de 80 o más Años , Función Atrial , Presión Sanguínea , Médula Ósea/fisiología , Femenino , Frecuencia Cardíaca , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , PresiónRESUMEN
To quantitate the importance of cardiac dysfunction as a stimulus for plasma immunoactive beta-endorphin (iBE) secretion, we measured iBE and hemodynamic indices in 65 patients prior to anesthetic induction for coronary artery bypass grafting or valve replacement. Linear regression analysis for the group as a whole showed significant correlations between iBE and stroke index (SI), pulmonary artery wedge pressure (PCW), and right atrial pressure (RAP), but not mean arterial pressure (MAP). Two patient subgroups were identified (P less than 0.001 by F-test): those with low SI and high iBE, or those with high SI and low iBE (cutoffs at 40 ml/m2 and 35 pg/ml, respectively). Correlations between hemodynamics and iBE were always stronger within the low-SI than the high-SI subgroups. These correlations were greater for patients with coronary artery than with valvular heart disease. Cardiac output (CO) and cardiac index (CI) correlated with iBE in valve-replacement and coronary-grafting groups. These findings were not an artifact of impaired iBE clearance due to renal dysfunction. Our results quantitate the importance of hemodynamic dysfunction for iBE secretion, and indicate that this relationship is particularly strong when stroke index declines below 40 ml/m2.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Hemodinámica , betaendorfina/sangre , Adulto , Anciano , Factor Natriurético Atrial/metabolismo , Humanos , Persona de Mediana Edad , Cuidados Preoperatorios , betaendorfina/inmunologíaRESUMEN
In a randomized study, labetalol-induced hypotension and nitroprusside-induced hypotension were compared in 20 patients (10 in each group) scheduled for major orthopedic procedures. Each patient was subjected to an identical anesthetic protocol and similar drug-induced reductions in mean arterial blood pressure (BP) (50 to 55 mmHg). Nitroprusside infusion was associated with a significant (p less than 0.05) increase in heart rate and cardiac output; rebound hypertension was observed in three patients after discontinuation of nitroprusside. Labetalol administration was not associated with any of these findings. Arterial PO2 decreased in both groups. It was concluded that labetalol offers advantages over nitroprusside.
Asunto(s)
Ferricianuros/uso terapéutico , Hipotensión Controlada , Labetalol/uso terapéutico , Nitroprusiato/uso terapéutico , Adulto , Gasto Cardíaco/efectos de los fármacos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Labetalol/efectos adversos , Masculino , Persona de Mediana Edad , Nitroprusiato/efectos adversos , Oxígeno/sangre , Presión Parcial , Ensayos Clínicos Controlados Aleatorios como Asunto , Estimulación QuímicaRESUMEN
Transcutaneous oxygen tension (TCPO2) is a useful noninvasive technique for monitoring arterial oxygen tension under stable circulatory conditions. This study was undertaken to determine if TCPO2 is also reliable during sodium nitroprusside-induced hypotension under general anesthesia. Arterial blood gases and TCPO2 were measured prior to inducing hypotension (baseline), at 20-min intervals during hypotension, and when systemic arterial pressure had returned to within 10% of the control (pre-hypotension) value. With induced hypotension, PaO2 and TCPO2 decreased significantly (P less than 0.05), and were well correlated by linear regression (r greater than 0.85); however, regressions were strongly dependent on the individual patient. The mean regression line for all patients as a group was given by TCPO2 = 0.69 PaO2 + 20.7 mmHg (r = 0.93, P less than 0.01); significantly different regressions were obtained for each patient (P less than 0.0001). Comparing changes in TCPO2 versus those in PaO2 (relative change from baseline values) did not substantially reduce the variability among patients. It is concluded that TCPO2 reliably reflects changes in arterial oxygen tension during controlled hypotension under general anesthesia, but that a separate calibration of TCPO2 vs. PaO2, obtained prior to inducing hypotension, may be required for each individual patient.
Asunto(s)
Anestesia General , Monitoreo de Gas Sanguíneo Transcutáneo , Prótesis de Cadera , Hipotensión Controlada , Adulto , Dióxido de Carbono/sangre , Femenino , Halotano , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Nitroprusiato , Óxido Nitroso , Oxígeno/sangreRESUMEN
The impact of oral captopril, 2 mg . kg-1, on the dose and on the hemodynamic and hormonal effects of nitroprusside was studied in seven patients (Group II). A comparable group (Group I, n = 7) received nitroprusside alone. In both groups, nitroprusside produced comparable decreases in mean arterial pressure, systemic vascular resistance, and right atrial pressure; cardiac output increased because of a significant change in heart rate. Although plasma renin activity increased significantly (compared with control values) in both groups, it was greater (p = 0.01) through the operative period in patients pretreated with captopril. Plasma aldosterone concentration increased in Group I (p = 0.01) but decreased in Group II (p = 0.01). Plasma catecholamine concentrations increased (p = 0.01) with nitroprusside alone but were unchanged in captopril-treated patients. Plasma converting enzyme activity was markedly inhibited (p = 0.001) by captopril. Following cessation of nitroprusside infusion in Group I, rebound hypertension occurred in conjunction with a significant (p = 0.01) increase in systemic vascular resistance; it was associated with elevated plasma renin activity, catecholamines, and aldosterone concentrations. In contrast, captopril-treated patients showed no rebound hemodynamic changes. Nitroprusside dose was less (p = 0.01) with captopril pretreatment (2.1 +/- 0.3 vs. 4.8 +/- 0.9 microgram . kg-1 . min-1). Thus, captopril is a useful adjunct to nitroprusside-induced hypotension.
Asunto(s)
Captopril/farmacología , Ferricianuros/farmacología , Hemodinámica/efectos de los fármacos , Hormonas/sangre , Nitroprusiato/farmacología , Adulto , Aldosterona/sangre , Presión Sanguínea/efectos de los fármacos , Epinefrina/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Norepinefrina/sangre , Renina/sangre , Factores de TiempoRESUMEN
Because of lack of direct evidence of histamine release by trimethaphan, the authors determined serum histamine levels and hemodynamic responses to trimethaphan administration in 19 consecutive patients. Group 1 patients (n = 7) received a single intravenous injection of trimethaphan, 0.5 mg X kg-1, while awake and again during stable halothane-nitrous oxide anesthesia. Group 2 patients (n = 6) were pretreated with intravenous H1 (chlorpheniramine, 0.1 mg X kg-1) and H2 (cimetidine, 4 mg X kg-1) receptor antagonists administered 15 min before trimethaphan, 0.5 mg X kg-1, in the awake and anesthetized states. In Group 3 (n = 6), the effects of infusion of trimethaphan, 3 mg X min-1 for 15 min, were studied during halothane-nitrous oxide anesthesia. In Group 1, bolus doses of trimethaphan were associated with maximal increases in serum histamine from 0.56 +/- 0.14 to 2.56 +/- 0.35 ng X ml-1 (P less than 0.01) and from 0.60 +/- 0.11 to 2.58 +/- 0.33 ng X ml-1 (P less than 0.01) 2 min after drug administration in the awake and anesthetized states, respectively; there were also clinical manifestations of histamine release. Mean arterial pressure decreased maximally after 5 min in the awake (from 92.0 +/- 3.4 to 69.9 +/- 2.2 mmHg; P less than 0.01) and anesthetized (from 82.6 +/- 3.7 to 57.3 +/- 2.5 mmHg; P less than 0.01) states, and was associated with increases in cardiac output and heart rate; stroke volume increased in the awake state only.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Hemodinámica/efectos de los fármacos , Histamina/sangre , Hipotensión Controlada , Trimetafan/farmacología , Adulto , Arterias , Gasto Cardíaco/efectos de los fármacos , Clorfeniramina/farmacología , Cimetidina/farmacología , Interacciones Farmacológicas , Frecuencia Cardíaca/efectos de los fármacos , Liberación de Histamina/efectos de los fármacos , Humanos , Persona de Mediana EdadRESUMEN
Changes in hemodynamic variables and whole blood cyanide and plasma thiocyanate concentrations associated with the infusion of sodium nitroprusside were compared with those during administration of a mixture of sodium nitroprusside (25 mg) and trimethaphan camsylate (250 mg) in a solution of 5% dextrose in water in twenty subjects who required deliberate hypotension for major orthopedic procedures. Subjects were randomly assigned to receive nitroprusside alone (group 1; n = 10) or the nitroprusside-trimethaphan mixture (group 2; n = 10). All subjects received a similar anesthetic technique, consisting of 5 mg/kg thiopental, 1 mg/kg succinylcholine, 1% halothane, 0.2 mg/kg metocurine, and 60% nitrous oxide in oxygen. Mean arterial pressure decreased and was maintained at 55 mm Hg for 258 +/- 4 and 266 +/- 8 minutes in groups 1 and 2. Arterial hypotension was associated with a rise in cardiac output and heart rate in group 1 but not in group 2. Subjects in group 2 required less nitroprusside than did those in group 1 (1.39 +/- 0.3 and 5.82 +/- 0.63 micrograms/kg/min) because of the synergistic or additive action of the combination. After 4 hours of hypotension, the whole blood cyanide level rose from 3.5 +/- 1.1 to 96.6 +/- 14.0 micrograms/dl (1.35 +/- 0.27 to 37.2 +/- 5.4 mumol/L) in group 1 and from 3.7 +/- 1.1 to 22.7 +/- 4.2 micrograms/dl (1.42 +/- 0.4 to 8.7 +/- 1.6 mumol/L) in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Cianuros/sangre , Ferricianuros/farmacología , Hemodinámica/efectos de los fármacos , Hipotensión/inducido químicamente , Nitroprusiato/farmacología , Ortopedia , Tiocianatos/sangre , Adulto , Anciano , Presión Sanguínea/efectos de los fármacos , Gasto Cardíaco/efectos de los fármacos , Combinación de Medicamentos , Evaluación de Medicamentos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Infusiones Parenterales , Masculino , Persona de Mediana Edad , Premedicación , Distribución Aleatoria , Resistencia Vascular/efectos de los fármacosRESUMEN
Hemodynamic and humoral events after intraoperative discontinuation of nitroprusside were studied in subjects without and with pretreatment with intravenous propranolol, 0.1 mg X kg-1. Nitroprusside-induced hypotension was associated with increases in heart rate, cardiac output, plasma renin activity (PRA), and catecholamine levels; these changes were prevented by propranolol. In subjects pretreated with propranolol, dose requirements of nitroprusside for hypotension of comparable degree and duration decreased 40%. On discontinuation of nitroprusside, mean systemic pressure rose to 100.2 mm Hg--a level higher than prehypotension and awake values--because of increased systemic vascular resistance. Hemodynamic events were associated with persistent elevations of PRA and catecholamine levels. These rebound changes were maximal 15 min after nitroprusside withdrawal and returned to control levels 30 to 60 min later. Pretreatment with propranolol completely prevented rebound hemodynamic events after nitroprusside. Persistent elevations of PRA and catecholamine levels after nitroprusside action subsided were responsible for the effects of withdrawal.