PubMed Health⌕ Search

Biomedical subjects

E C Rodriguez-Merchan

Publications and source records attributed to E C Rodriguez-Merchan.

44 records · Page 3Linked to original sources
PubMed1999

Correction of fixed contractures during total knee arthroplasty in haemophiliacs.

Encouraging clinical experience has increased the indications for prosthetic knee arthroplasty in haemophiliacs. The medical status, physical disability, age and projected activity levels are the major factors in determining treatment for the patient with unilateral or bilateral haemophilic arthropathy of the knee. In more severely involved knees of patients with haemophilia, flexion contracture is a common deformity. In addition, valgus, external rotation deformity and posterior subluxation of the tibia may exist. The surgeon must have the expertise and experience to correct these deformities sufficiently when performing a total knee arthroplasty. A properly performed soft-tissue release which achieves balance between the medial and lateral ligamentous structures and posterior capsule can provide stability to the knee with a semiconstrained prosthesis. In cases with severe deformity requiring resection of the posterior cruciate ligament a posterior cruciate substituting prosthesis may be necessary.

Arthroplasty, Replacement, Knee↗
PubMed1999

Common orthopaedic problems in haemophilia.

The most important fact in patients with haemophilia is the avoidance of recurrent haemarthroses by means of haematological prophylaxis. Unfortunately this is not currently possible in the majority of countries around the world. When only on-demand haematological treatment is available, frequent evaluations are necessary for the early diagnosis and treatment of intra-articular bleeding episodes. The typical outcome of these patients is towards the development of chronic synovitis, and later on to haemophilic arthropathy, if the state of synovitis is not promptly and adequately controlled. Once arthropathy develops the functional prognosis is poor, although haemophilic patients use to tolerate very well their tremendous joints destructions. Treatment of these patients should be performed in a comprehensive basis within a multidisciplinary haemophilia unit.

Hemarthrosis↗
PubMed1998

Intraoperative transmission of blood-borne disease in haemophilia.

Because HIV and hepatitis B and C infection can be transmitted by exposure to infected blood or blood components, orthopaedists are at risk for HIV and hepatitis infection during surgical procedures. Thus, care must be taken to protect themselves from transmission of HIV and the hepatitis virus. The following precautions are recommended: double latex gloves, changed hourly, or a combination of cloth and latex gloves, enclosed hood and face-masks and operative isolator with umbilical-cord aspirator; knee-length impermeable gowns of high-count polyester weave or plastic-lined nonwoven spun-lace polyester; a combination of shoe-covers that provide waterproof coverage as high as the knee; and disposable drapes. If a member of the operating team is inadvertently pricked or cut, the wound should be washed immediately with iodine, soap and water. If the injured person has been immunized for the hepatitis B (and has adequate titres), or is positive for hepatitis B surface antigen or antibody, no further treatment is necessary. Otherwise, two doses of hepatitis B immune globulin should be given, 5 mL immediately and 5 mL after 1 month. Because HIV infection can be transmitted by exposure to infected blood, orthopaedic surgeons are also at risk for HIV infection. Prospective studies suggest that this risk is very low; nevertheless, healthcare workers need to adhere rigorously to the aforementioned infection-control precautions to minimize the risk of exposure to blood.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The destructive capabilities of the synovium in the haemophilic joint.

The pathogenesis of chronic haemophilic synovitis and the destructive capabilities of the synovium are multifactorial. As a result of repeated haemarthroses, synovial hyperthrophy occurs, iron and cellular debris are phagocytized, and hydrolytic enzymes synthesized by the proliferating synovium are released into the joint. An inflammatory process develops, and the nutrition of the articular cartilage is affected by the abnormal synovial fluid, immobilization of the joint, and the presence of fibrous adhesions. Chronic hypertrophic synovitis is a progressive destructive condition in the joint and, unless it is treated, the joint is doomed. With the development of cartilaginous destruction, progressive chondrolysis and eventual osteoarthritis set in.

Adult↗
PubMed1996

Hackethal nailing in closed transverse humeral shaft fractures after failed manipulation.

A study has been carried out of retrograde intramedullary fixation with flexible Hackethal nails for closed transverse fractures through the middle third of the humerus. Thirty fractures were treated during a period of 12 years. The average age of the patients was 45 years. After operation, a brace was used for an average of 4 1/2 months. Union occurred at an average of 10 weeks with one case of delayed union. There were no infections or nerve palsies. Hackethal nailing is effective for this type of fracture when manipulative reduction has failed.

Adult↗
PubMed1995

Cerebral embolism during revision arthroplasty of the hip.

Cerebral embolism poses one of the most perplexing problems in cerebrovascular disease; fat emboli and marantic air emboli occur occasionally. However, the most common cause for a cerebral embolism is degenerative changes in the central arteries. The authors report the case of a 75-year-old female suffering from ischemic cerebrovascular disease of the left dominant hemisphere during a revision arthroplasty of the right hip (cementless Austin Moore hemiarthroplasty to a cemented Charnley total hip replacement); a cement gun was used to introduce the cement; both the induction of anesthesia and the surgical procedure were uneventful. The patient awoke slowly, and when awake she showed a combination of contralateral hemiplegia, and right hemianesthesia with global aphasia; the CT scan showed an ischemic lesion in the territory of the middle cerebral artery; during the following two weeks the patient showed complete recovery from the clinical syndrome. This complication must be recognized by every orthopedic surgeon, and a high clinical index of suspicion remains essential to early diagnosis.

Aged↗