Biomedical subjects
Publications and source records attributed to Aaron Daluiski.
Atypical hand infections with Mycobacterium species are uncommon, and Mycobacterium scrofulaceum infections are rare. We present a case of flexor tenosynovitis caused by M scrofulaceum in a 66-year-old man with hypertension and diabetes.
BACKGROUND: Post-traumatic elbow stiffness can be caused by a tether and/or a block, and these structures can exist both anteriorly and posteriorly about the joint to prevent motion. The purpose of this article is to report the outcome of elbow release performed for post-traumatic stiffness by a single surgeon. METHODS: A retrospective review of charts and radiographs was performed on 52 case of patients who underwent open surgical treatment for post-traumatic elbow contracture by the senior author (RHN). The mean age of the group was 35.1 years. There were 32 men and 20 women. Contracture release surgery was performed at an average of 14 months from the time of injury. Indication for operative release was functional loss of elbow arc of motion that failed nonoperative therapy and splinting program. Follow-up was 18.7 months. Comparison of ranges of motion was performed with Student's paired t tests. RESULTS: The average extension-flexion arc of motion improved from 57 to 116 degrees and forearm rotation improved from 119 to 145 degrees postoperatively. Fourteen patients (27%) required closed manipulation under anesthesia, in the early postoperative period. Five patients required a second contracture release at an average of 12 months after the index release. Four patients failed because of painful motion (n = 2) and elbow instability (n = 2). Other complications included wound infection (n = 3), cubital tunnel syndrome (n = 3) and reflex sympathetic dystrophy (n = 1). CONCLUSIONS: Open elbow release with excision of tethers and blocks is a valuable procedure for post-traumatic stiffness. Recurrence in postoperative period is common but is responsive to manipulation under anesthesia and repeat releases.
This article identifies the underlying molecular events responsible for fracture nonunions in a subset of fracture patients. Expression profiling of fracture callus tissue from both uneventful fracture repair and nonunion outcomes showed a decrease of COX-2 expression and an inability to mount an immune response in nonunion fractures. Validation in vitro with Saos-2 osteoprogenitor cell lines showed a decrease in osteogenesis potential after the cells were treated with celecoxib, a COX-2 specific inhibitor and anti-inflammatory agent. This article recapitulates that an initial immune response is crucial to fracture healing and suggests limited usage of COX-2 inhibitors in patients with healing fractures.
Hinged external fixation of the elbow joint can play an important role in managing complicated fracture-dislocations, joint instability after extensive contracture release, and distraction interposition arthroplasty. Application of these devices requires accurate alignment of the fixator axis with the anatomic axis of the elbow. The primary therapeutic goal is to allow joint motion while protecting the healing ligaments. Common complications include pin loosening, injury to adjacent neurovascular structures, cellulitis, and loss of reduction. Although reported data are limited, this technique is a useful adjunct in patients with complex elbow instability.
Subcutaneous anterior ulnar nerve transposition has been advocated by many surgeons as simple and effective. Techniques to maintain the nerve anterior to the medial epicondyle include subcutaneous pocket, subcutaneous-fascia tunnel, and fascial and fasciodermal sling. We describe a modified technique that uses the medial intermuscular septum as a sling to allow a more gentle transition of the ulnar nerve as it enters into the flexor carpi ulnaris muscle belly.
PURPOSE: An accurate listing of cited references in journal articles is important for the reader. Many studies have revealed errors in the references cited in a variety of subspecialty journals. We believe that a similar amount of errors, relative to other subspecialty journals, exists in the Journal of Hand Surgery. METHODS: One hundred randomly selected references from each of the 1985 and 1995 Journal of Hand Surgery volumes were analyzed for accuracy of the journal name, title, author name(s), year, volume, and page number(s). References were considered without error if they matched the original article exactly. RESULTS: In 1985, 30% of the references examined contained one or more errors as compared with 11% in 1995. CONCLUSIONS: These error rates are similar to those found in studies of other biomedical journals. Perhaps the decrease in the quantity of errors present in 1995 versus that of 1985 is related to the implementation of a more stringent, revised set of instructions to submitting authors imposed in 1995.
Coordinated production and remodeling of the extracellular matrix is essential during development. It is of particular importance for skeletogenesis, as the ability of cartilage and bone to provide structural support is determined by the composition and organization of the extracellular matrix. Connective tissue growth factor (CTGF, CCN2) is a secreted protein containing several domains that mediate interactions with growth factors, integrins and extracellular matrix components. A role for CTGF in extracellular matrix production is suggested by its ability to mediate collagen deposition during wound healing. CTGF also induces neovascularization in vitro, suggesting a role in angiogenesis in vivo. To test whether CTGF is required for extracellular matrix remodeling and/or angiogenesis during development, we examined the pattern of Ctgf expression and generated Ctgf-deficient mice. Ctgf is expressed in a variety of tissues in midgestation embryos, with highest levels in vascular tissues and maturing chondrocytes. We confirmed that CTGF is a crucial regulator of cartilage extracellular matrix remodeling by generating Ctgf(-/-) mice. Ctgf deficiency leads to skeletal dysmorphisms as a result of impaired chondrocyte proliferation and extracellular matrix composition within the hypertrophic zone. Decreased expression of specific extracellular matrix components and matrix metalloproteinases suggests that matrix remodeling within the hypertrophic zones in Ctgf mutants is defective. The mutant phenotype also revealed a role for Ctgf in growth plate angiogenesis. Hypertrophic zones of Ctgf mutant growth plates are expanded, and endochondral ossification is impaired. These defects are linked to decreased expression of vascular endothelial growth factor (VEGF) in the hypertrophic zones of Ctgf mutants. These results demonstrate that CTGF is important for cell proliferation and matrix remodeling during chondrogenesis, and is a key regulator coupling extracellular matrix remodeling to angiogenesis at the growth plate.
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