In response to article by Ebraheim et al.
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Humans↗
Biomedical subjects
E C Merchan
Publications and source records attributed to E C Merchan.
Long term follow up of haemophilic arthropathy treated by Au-198 radiation synovectomy.
Intra-articular injection of Au-198 (gold synoviorthesis) has been used in the treatment of repeated haemarthroses of the elbows, knees, or ankles in 64 haemophiliacs. These patients had continued to have joint haemorrhages despite appropriate, episodic, substitutive therapy over a period of more than six months. Follow-up for an average period of 14 years in one knee in 38 male haemophiliacs showed 8 good, 23 fair, and 7 poor results with regard to their joint scores. It is concluded that Au-198 is an effective agent for radiation synovectomy, particularly in the early stages of the disease with minimal radiographic changes. It appears to reduce the incidence of haemarthrosis and to slow the rate of evolution of radiographic changes.
Adolescent↗
Prognostic factors for bone metastases in breast cancer.
Two hundred and sixty-nine patients with breast cancer were assessed with regard to multiple parameters at the time of initial diagnosis. Over a follow-up period of 6 or 7 years, 84 patients developed skeletal metastases and in 42 they were symptomatic. Symptomatic bone metastases were related to lytic metastases and an elevated sedimentation rate. The significant parameters predisposing to the development of bone metastases were the presence of adenopathies or metastases at the time of initial diagnosis. The number of axillary nodes involved was related to the number of bone metastases, the number of spontaneous abortions, and the gonadal endocrine function. The adherence of axillary nodes was related to the number of bone metastases, an elevated sedimentation rate and the serum calcium level.
Bone Neoplasms↗
Arthroscope-guided surgery versus nonoperative treatment for limited degenerative osteoarthritis of the femorotibial joint in patients over 50 years of age: a prospective comparative study.
Thirty-five patients with limited extent of degenerative osteoarthritis of the femorotibial joint treated by arthroscope-guided surgery were compared after 1-3 years with 38 patients with a similar condition treated conservatively. In selecting a patient for arthroscope-guided surgery, the most important considerations were a normal mechanical axis, a limited extent of the degenerative process, and a femorotibial pain of sudden onset or that had been present for < 6 months. Clinical evaluation was undertaken using a modification of the Hospital for Special Surgery Knee Rating Score. The surgical procedure included partial meniscectomy, limited debridement of loose articular cartilage and removal of loose bodies. In the operated group, 26 patients (75%) showed improvement, five (14%) remained unchanged, and four (11%) were worse than before surgery. The average age of patients was 57 years. In the nonoperated group, six patients (16%) were improved, 12 (31%) unchanged, and 20 (53%) worse than before treatment. The average age of patients was 56 years. Arthroscope-guided surgery for limited degenerative osteoarthritis of the femorotibial joint with normal limb alignment or for degenerative meniscal tears has proven to be a useful technique.
Aged↗
Circumscribed myositis ossificans. Report of nine cases without history of injury.
The clinical features of 9 patients with circumscribed myositis ossificans (CMO) are described and the effects of treatment with surgical removal of ectopic bone are assessed. The average age of these patients was 24.4 years, and the average follow-up period was 7.4 years. Early correct diagnosis remains unusual, mainly because myositis may be mistaken for bruising, sarcoma or mumps. Once histological diagnosis was established in biopsy, surgical resection of the mass was found in these series. Although spontaneous recurrence was found in this series. Although spontaneous regression of the clinical findings has been reported, we consider surgery to be necessary in CMO in order to establish the diagnosis; furthermore, when the clinical and radiological diagnosis is uncertain or when the lesion causes pain or mechanical blocking of a joint, the removal of the mass is mandatory.
Adolescent↗
Iatrogenic Z-deformity of the proximal femur in an osteoarthritic hip. Subtrochanteric osteotomy with intramedullary fixation for arthroplasty of the hip. A case report.
Hip osteoarthritis in its final stage may require arthroplasty. Sometimes an extreme Z-deformity of the proximal femur is present, if a previous valgus trochanteric osteotomy has been performed. To correct a Z-deformity of the proximal femur during total hip arthroplasty, a subtrochanteric corrective osteotomy was performed in a 52 year-old woman. Intramedullary fixation of the osteotomy was secured using a standard long-stem isoelastic femoral component alone.
Female↗
Secondary chondrosarcoma. Four cases and review of the literature.
The authors present four new cases of chondrosarcoma secondary to multiple osteochondromatosis (MOC). As MOC is a familiar and hereditary condition, the patients should be evaluated throughout their lives, from childhood to adulthood. Because of the risk of malignant transformation in this condition, any adult patient complaining of pain and excessive increase in tumor size should be investigated for sarcomatous degeneration. Wide resection, when possible, must be the elected treatment in this type of patient, in order to avoid the risk of local recurrence.
Adolescent↗
Septic arthritis in HIV positive haemophiliacs. Four cases and a literature review.
Septic arthritis is rare in haemophiliacs. Four new cases who were also HIV positive are reported. In three, the knee was involved, and in the fourth the elbow. The organism was streptococcus pneumoniae and staphylococcus aureus in one patient each, and salmonella in two. Although all the patients were human immunodeficiency virus (HIV) positive at the time of diagnosis, only two patients developed autoimmune deficiency syndrome (AIDS) after their septic arthritis. These two died later due to AIDS complications. Treatment was conservative in all cases with antibiotic therapy and prompt rehabilitation. The results were fair in two and good in two. Therefore nonoperative management is advocated before surgical drainage is considered. It seems likely that a positive HIV status is related to the appearance of septic arthritis in haemophiliacs.
AIDS-Related Opportunistic Infections↗
Subtalar dislocations: long-term follow-up of 39 cases.
A total of 39 cases of subtalar dislocations, treated during a 10-year period, have been reviewed retrospectively. The average age in this series was 35 years and the average follow-up period was 5.5 years (range 2-10 years); medial dislocations predominated (74 per cent) and a large percentage were open (41 per cent). Associated fractures were frequent (64 per cent). Treatment included closed manipulative reduction but if this was not successful, open reduction was performed followed by Kirschner (K)-wire fixation. Wound cleansing and excision were carried out on the open cases. Results were assessed according to Hardcastle's scoring system and 11 good, 7 fair and 21 poor results were obtained. Associated fractures and open injuries were strongly related to the poor results. Good results were associated with an accurate reduction. Open reduction with K-wire fixation is advocated if minor displacement persists.
Adolescent↗
Blade-plating of closed displaced supracondylar fractures of the distal femur with the AO system.
We reviewed a series of 42 closed and displaced supracondylar and intercondylar fractures of the distal end of the femur that were treated over a 7-year period by open reduction and internal fixation using the AO system (blade-plate). A strict rating scale incorporating subjective data and objective motion of the involved knee was used for the results. At a mean follow-up of 5 years, the results in eight patients were rated excellent, the results in 14 were rated as good, the results in 11 as fair, and the results in nine as poor. Complications were found in 15 patients (37.5%). Complications included postoperative osteomyelitis in two; nonunions in three; malunions in two; delayed unions in two; marked loss of knee motion in four; and superficial infection and wound hematoma in one patient each.
Adolescent↗
Quadricepsplasty: the Judet technique and results of 21 posttraumatic cases.
Twenty-one quadricepsplasty procedures were carried out on 21 patients over a 14-year period due to posttraumatic stiffness of the knee joint. Three patients (14.2%) required mobilization under anesthesia in the early postoperative period. The average interval between injury and quadricepsplasty was 18 months (range: 5 to 49 months). Preoperatively, all cases showed less than 90 degrees knee flexion. At follow up, 12 cases (57.2%) achieved more than 90 degrees flexion, while nine patients (42.8%) exhibited under 90 degrees flexion. Flexion gain was between 60 degrees and 90 degrees in six cases (28.5%) and less than 60 degrees in 15 cases (71.5%). Results were assessed according to Judet et al. There were 14 excellent and good (66.6%) and seven fair (33.3%) results. No poor results were found in this series.
Adolescent↗
Osteolysis of the distal clavicle in a woman. Case report and review of the literature.
An unusual case of osteolysis of the distal clavicle in a woman is presented. Although almost 100 cases of osteolysis of the distal clavicle have been reported in the literature, none have occurred in females (Neer and Rockwood, 1984). After acute acromioclavicular dislocation, surgical reduction was carried out by transferring the coracoid process to the clavicle. Three years later the osteolysis of the outer clavicle appeared to be related to pain and functional impairment of the joint. The pain is quite tolerable and surgical excision of the distal clavicle has not yet been necessary.
Accidents, Traffic↗
Plaster cast versus Clyburn external fixation for fractures of the distal radius in patients under 45 years of age.
In this prospective study, 70 patients between the ages of 20 and 45 years with comminuted intra-articular fractures of the distal radius of types III to VIII (graded according to Frykman) were treated either by closed reduction and forearm plaster (35 patients) or by application of a Clyburn dynamic external fixator (35 patients). The external fixator was more effective at holding the manipulated position, and the roentgenographic loss of position during fracture union was minimal compared with that seen in patients treated in plaster. Functional results in the fixator group were 18 excellent, 10 good, 6 fair, and 1 poor. The plaster group showed the following functional results: 12 excellent, 8 good, 10 fair, and 5 poor. The external fixator generated significantly better anatomical and functional results than did treatment with forearm plaster. A good anatomic position combined with early rehabilitation of the wrist function produced very favorable functional results in patients less than 45 years of age.
Adult↗
Ultrasound in the diagnosis of the early stages of hemophilic arthropathy of the knee.
We have studied the knees of 50 patients with hemophilia A, using ultrasound (US) when conventional radiology did not detect any secondary osseous changes. The sonographic images were compared with those obtained from 50 healthy controls. The mean age of this series was 14.6 years. Our results suggest that sonography as a diagnostic technique in the initial stages of hemophilia permits differentiation between suprapatellar effusion and synovial thickening. It also reveals early cartilaginous involvement.
Adolescent↗
Cannulated screw breaking in arthroscopic surgery of osteochondritis dissecans of the knee: a case report.
A 14-year-old boy with the diagnosis of osteochondritis dissecans was treated with screw fixation after a 4-year period of unsuccessful conservative care. When an attempt was made to remove the screw 12 weeks after its insertion, the screw broke at its neck releasing several small slivers of metal into the joint. The screw head was removed, but the metallic slivers were not found. The appearance of the screw at the time of partial removal suggests some type of metallurgical failure. Although the shaft of the screw remained in the bone, the lesion healed uneventfully, and the patient resumed his interest in sports.
Adolescent↗