Biomedical subjects

D Ashmead

Publications and source records attributed to D Ashmead.

16 recordsLinked to original sources

PubMed1999

Brief antiepileptic drug withdrawal prolongs interval to next seizure.

OBJECTIVE: To evaluate the course of seizure control after reinstitution of antiepileptic drugs (AEDs) in patients whose AEDs were discontinued during inpatient EEG-video monitoring. METHODS: The authors studied prospectively patients with intractable epilepsy admitted for EEG-video monitoring with AED withdrawal. They examined seizure diaries in the 2 months preceding admission and recorded the number of seizures during hospitalization and for 2 months after discharge. They also recorded the interval between the last two seizures preceding admission (S-S pre), from the last seizure to admission (S-A), from discharge to the first seizure after discharge (D-S), and between the first and the second seizures following discharge (S-S post). RESULTS: Sixty patients qualified for the study. There was a significant decrease in seizure frequency in the 2 months after discharge compared with baseline (p = 0.02). For patients who had at least two seizures during follow-up, the mean D-S interval was significantly longer than mean S-S pre and S-S post (p < 0.005), whereas the latter two intervals were comparable. Prolongation of D-S was related to duration off AEDs and to the AED restarted, but not to the number or severity of seizures during monitoring. CONCLUSION: Seizure improvement after reinstitution of antiepileptic drugs (AEDs) is due primarily to prolongation of the interval from reinstitution of AEDs to the next seizure. This may reflect increased patient responsiveness to AED therapy after a drug "holiday" and has implications for experimental AED testing in the setting of presurgical evaluation.

Adolescent↗

PubMed1999

One thousand intercarpal arthrodeses.

Limited wrist arthrodesis is a useful method for treating specific carpal disorders that maximizes residual wrist motion and strength while eliminating pain. Selective fusion of specific carpal units can be used in degenerative arthritis, rotary subluxation of the scaphoid, midcarpal instability, scaphoid nonunion, Kienbock's disease, and congenital synchondrosis or partial fusion of specific carpal joints. This report presents our experience with more than 1000 limited wrist arthrodeses, and provides a review of the indications and technical considerations for specific intercarpal fusions, and subsequent results. To date this is the largest series of intercarpal arthrodeses and the study has demonstrated that these techniques are reliable and effective in dealing with a wide range of wrist disorders.

Adolescent↗

PubMed1998

Persistent or recurrent carpal tunnel syndrome following prior endoscopic carpal tunnel release.

A retrospective review of patients with carpal tunnel syndrome (CTS) identified 20 patients (26 wrists) who had persistent or recurrent CTS after having undergone endoscopic carpal tunnel release (ECTR). Seven wrists never had relief of the original CTS symptoms; for the remaining 19 wrists, the average time to recurrence of CTS following ECTR was 4.8 months. All cases recurred within 12 months from the ECTR. All but 1 patient reported nocturnal pain. All patients experienced morning numbness and stiffness. All wrists had positive Phalen's test results. Once diagnosed with persistent or recurrent CTS, each of the wrists underwent open carpal tunnel release (OCTR). Twenty-two wrists were available for follow-up, with all patients reporting greater satisfaction and relief after the OCTR compared with the ECTR. It is important to recognize that CTS may persist or recur after ECTR. These patients should be treated with OCTR to provide symptomatic relief and prevent the sequelae of ongoing CTS.

Adult↗

PubMed1996

The fate of teeth transfixed by osteosynthesis screws.

Rigid internal fixation with plates and screws for osteosynthesis of facial fractures and osteotomies in the cranio-maxillofacial skeleton is often undertaken in situations in which the exact position of the underlying tooth roots cannot be determined. Therefore, a screw may be inadvertently placed into a root. There is scant data in the literature addressing the consequences of tooth impingement. This 5-year retrospective study documents the long-term outcome of teeth transfixed by osteosynthesis screws in a series of 387 consecutive facial fractures at a Level I trauma center. The incidence of root impingement per screw was 0.47 percent (13 transfixed teeth per 2340+ screws). Mandibular teeth were more "at risk" than maxillary teeth by a ratio of 10:3. No transfixed teeth became infected or required extraction in this series. In conclusion, inadvertent tooth root impingement by osteosynthesis screws appears to have minimal adverse consequences.

Adult↗

PubMed1995

Tissue expansion for Apert's syndactyly.

Tissue expansion is useful in post-traumatic reconstruction in the upper extremity. Its use has also been proposed in congenital syndactyly. Expanded local skin flaps would in theory provide locally appropriate cover, obviating the need for skin grafts. We report a retrospective assessment of tissue expansion in the management of Apert's syndactyly. Despite theoretical benefits, tissue expansion significantly increased the required number of operations. The technique was associated with an unacceptable rate of complications, and generated inadequate skin flaps, and web spaces requiring a higher rate of revision than traditional techniques. Despite expectations, tissue expansion for Apert's syndactyly proved disappointing and is not advocated.

Child, Preschool↗

PubMed1994

Scapholunate advanced collapse wrist salvage.

Patients with scapholunate advanced collapse (SLAC) wrist do not have to undergo total wrist arthrodesis; the SLAC pattern spares the radiolunate articulation, providing a basis for salvage. We report the results of 100 cases in which a technique comprised of scaphoid excision and limited wrist arthrodesis was used. The average followup period of 44 months revealed excellent functional status and a high rate of patient satisfaction. The majority of employed patients were able to return to their original jobs, and many chose to resume wrist-related recreational activities. Pain relief was good to excellent in most cases. Extension/flexion averaged 72 degrees (53% of a normal opposite wrist), radioulnar deviation 37 degrees (59%), and grip strength 80% of the opposite side. X-ray films revealed only two instances of radiolunate destruction, both in conjunction with ulnar translation of the carpus. The other 98 patients demonstrated a well-preserved radiolunate joint regardless of followup interval. Complications were few. Nonunion occurred in three cases. A dorsal impingement of the capitate and radius (12%) was felt to be technique-related and avoidable by careful capitolunate alignment.

Adult↗

PubMed1993

Radial and ulnar artery repairs: assessing patency rates with color Doppler ultrasonographic imaging.

This study was undertaken to evaluate the patency rate of radial and ulnar artery repairs performed with use of the magnification afforded by the operative microscope. Color Doppler ultrasonographic imaging was chosen as a reproducible, noninvasive technique to evaluate patency and graphically display vascular flow characteristics. Twenty-eight consecutive patients with 35 arterial injuries form the study group. Twenty-four patients with 31 arterial lacerations were available for enrollment in the protocol. Follow-up ranged from 1 to 40 months (average, 10 months). Eighteen male and six female patients sustained 13 radial and 18 ulnar artery lacerations, all sharp. Four patients required interposition vein grafting. Overall patency after repair was found to be 84%, with 82% of single vessels and 86% of double vessels patent. The patency of single vessels repaired without the use of vein grafts was 100%. These results indicate that microscope-assisted repairs of the radial and ulnar arteries remain patent at a higher rate than is commonly cited.

Color↗

PubMed1993

Dorsal approach to scaphoid nonunion.

The surgical approach for treatment of scaphoid nonunion usually involves various combinations of screws and Kirschner wires, with or without bone grafts. This article reports our results with 36 dorsal-approach bone grafting procedures for treatment of scaphoid nonunion with Kirschner wires. Union was achieved in 89%. The average follow-up was 5 years. Flexion/extension averaged 76% of the opposite wrist, and grip strength was 88% of the opposite hand. Ninety-one percent of the employed patients returned to their original jobs. The dorsal approach provides satisfactory exposure for fragment reduction and bone grafting.

Activities of Daily Living↗

PubMed1992

Treatment of hand injuries by external fixation.

Thirty-five consecutive applications of external fixation to the hand, including 27 acute cases and 8 reconstructive procedures, were studied. In both settings, external fixation was used not only for skeletal stabilization but also for management of the soft tissues. Twenty of the 22 acute fractures healed, and six arthrodeses with interposition bone grafts resulted in fusion. Three septic nonunions resolved, and two united successfully. There were no complications. We recommend external fixation systems in the hand, and several case reports are included in the study to illustrate the various applications.

Adolescent↗

PubMed1989

Reevaluation of the cause of the wrist ganglion.

The cause of the wrist ganglion is uncertain. We reviewed our experience with rotary subluxation of the scaphoid after ganglion excision. Seventeen patients had triscaphe arthrodesis for treatment of rotary subluxation of the scaphoid at an average of 35 months (range, 6 to 130 months) after ganglion excision. In addition, dynamic or static rotary subluxation of the scaphoid was found in 8 of 10 patients who were examined at an average of 16 years (range, 11 to 19 years) after excision of a ganglion. These patients had no symptoms at the time of review. Only single case reports of rotary subluxation of the scaphoid after ganglion excision have been previously reported. We believe our data supports a hypothesis that the ganglion is a secondary manifestation of underlying periscaphoid ligamentous injury. Persistent symptoms after ganglion excision should lead one to suspect underlying scaphoid instability.

Adolescent↗

PubMed1988

Examination of the scaphoid.

Scaphoid manipulation is an important part of the examination of the wrist. The "scaphoid shift" is a maneuver that is helpful in assessing scaphoid stability and in identifying scaphoid and periscaphoid pathology. The anatomic basis of the maneuver is explained and its performance and interpretation discussed.

Carpal Bones↗

PubMed1977