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Biomedical subjects

E E Almquist

Publications and source records attributed to E E Almquist.

17 recordsLinked to original sources
PubMed1998

Epicondylar resection with anconeus muscle transfer for chronic lateral epicondylitis.

A retrospective evaluation of 61 patients surgically treated for persistent lateral epicondylitis, covering the 8-year period between 1982 and 1990, was conducted. The study compared a group of patients treated by limited surgical resection of the lateral extensor aponeurosis with a group of patients treated by wide surgical excision of the aponeurosis and coverage by a vascularized rotational pedicle flap of the anconeus muscle. This is a new procedure that uses the vascular pedicle of the anconeus muscle, rotating it into the defect created by the wide excision. Evaluation at an average of 48 months after surgery indicates that compared with the limited surgical resection group, a higher percentage of patients in the anconeus muscle transfer group were able to perform strenuous activities with complete or near-complete pain relief. A higher percentage also returned to work or to normal activities; 94% of the patients were satisfied with the results of the procedure. This study indicates that this is an effective primary operative treatment for lateral epicondylitis when conservative treatment has failed. It also is effective in patients who continue to have persistent pain and inability to perform normal activities after previous lateral epicondylar release or resection.

Adult↗
PubMed1993

Capitate shortening in the treatment of Kienböck's disease.

The goal of the technically simple procedure of capitate shortening with capitate-hamate fusion is revascularization of the lunate, and on radiographic evaluation, the results have been satisfactory (Figs. 9 through 11). This surgical procedure offers the advantage of direct vision and, therefore, direct staging of the aseptic process. The procedure is designed for patients with early Kienböck's disease who have relatively minor architectural changes in the aseptic lunate, no arthritic changes, and no ulnar-minus variance. When these criteria are met, the clinical results have been encouraging and lasting.

Carpal Bones↗
PubMed1992

Evolution of the distal radioulnar joint.

The evolution of the wrist joint began 400 million years ago with the pectoral fins in primitive fish. The five-rayed extremity with 13 carpal bones and a syndesmotic distal radioulnar joint first appeared in the primitive amphibian, Eryops, some 230 million years ago. These characteristics remained similar through the evolution of the amphibians and of mammals and were retained when primates evolved to hominids. As later-developing, larger-sized hominids began competing for food, brachiation (the ability to swing from tree branch to tree branch) became more important, and a synovial distal radioulnar joint evolved, allowing pronation/supination of the wrist. The development of bipedalism freed the upper extremity from the requirements of locomotion, placing greater emphasis on increasing wrist mobility. The ability to supinate and pronate was an immense advantage to hominids in caring for their young, defending themselves, and gathering food. It was also critical in efficient tool handling, which developed two million years ago. The mobility of the distal radioulnar joint, along with the prehensile thumb and increasing brain function, are hallmarks of the late-evolving hominids.

Adaptation, Physiological↗
PubMed1991

Proximal row fusion as a solution for radiocarpal arthritis.

A retrospective study evaluated the function of thirty-six patients treated by radius-scaphoid-lunate arthrodesis for painful posttraumatic radiocarpal arthritis from 1982 through 1987, and determined whether the procedure created arthritis or other functional problems in the remaining joints. Thirty-one men and five women with a mean age of 41 years were studied. The standard surgical technique employed iliac crest bone graft and internal fixation. Seven patients required revision of the proximal fusion to complete wrist fusion because of pain; arthritic changes in the midcarpal joint had been noted in these patients at the time of the limited fusion. The remaining twenty-nine patients required no further surgical treatment. Grip strength averaged 70% of the uninvolved side. The average arc of wrist flexion and extension was forty-eight degrees. Eighteen patients returned to their original employment, in many cases to heavy labor. Five did not return to work because of wrist problems. We conclude that the probability of a good functional result is high for this procedure if there is no midcarpal arthritis.

Adult↗
PubMed1991

Four-bone ligament reconstruction for treatment of chronic complete scapholunate separation.

This study reviews the results of a four-bone ligamentous weave reconstruction for treatment of chronic complete scapholunate separation. This reconstruction between the radius, lunate, capitate, and scaphoid employs a dorsal and palmar approach weaving a long strip of the extensor carpi radialis brevis through the four bones reducing and stabilizing the scaphoid and lunate with a wire loop. Thirty-six consecutive cases of operated chronic complete scapholunate separation were evaluated in a 2- to 10-year follow-up. Average length of follow-up was 4.8 years. Average age was 34 years. Average postoperative range of motion was 52 degrees extension and 37 degrees flexion. Grip strength averaged 73% of the noninvolved side. All preoperative scapholunate gaps seen on radiographs were greater than 4 mm, at surgery greater than 1.0 cm, and the postoperative gaps radiographically averaged 3.3 mm. Eighty-six percent of patients returned to preinjury activities including heavy labor. The most significant finding was no x-ray evidence of advancing arthritic changes.

Adult↗
PubMed1988

Nerve repair by laser.

The unique properties of lasers have made their applicability to clinical medicine, particularly reconstructive surgery, a subject of continuing interest. Some studies have shown their potential usefulness in peripheral nerve repairs.

Humans↗
PubMed1987

Desmoid tumors in childhood.

Eight cases of extraabdominal desmoid tumors in children are reviewed. Seven were located in the pelvis or forearm, and the most common presenting complaint was a slowly enlarging mass. In all cases, diagnosis was established by open biopsy, and initial treatment was by surgical excision. At follow-up (average, 5.8 years), six patients were tumor free. Desmoids are benign tumors that usually carry a good prognosis. There is no difference between the tumor behavior in children and adults. The treatment of choice is wide local excision. If vital structures are involved, it may be more appropriate to preserve function by performing partial tumor excision. For quiescent recurrent tumors, observation is appropriate management, but if further treatment is required, reexcision or radiotherapy may be tried.

Adolescent↗
PubMed1987

Kienböck's disease.

Kienböck's disease is a progressive disruption of the lunate secondary to avascular necrosis, which may be due to the lunate's precarious blood supply, external compression forces, and fractures of its surfaces. The treatment options for Kienböck's disease are based on the stage of the disease, defined by Stahl, and include immobilization, radial shortening or ulnar lengthening, intracarpal fusion, and prosthetic replacement. The prognosis for functional recovery is better in stage I and II disease, which emphasizes the need for early diagnosis.

Arthrodesis↗
PubMed1986

Hand injuries in children.

Hand injuries in children are seen frequently in the office and the emergency room. Basic principles determine which fractures, tendon injuries, dislocations, nerve injuries, fingertip injuries, infections, and amputations can be treated by the primary physician and which should be referred to a specialist.

Amputation, Traumatic↗
PubMed1986

Kienbock's disease.

Kienbock's disease (lunate malacia) is an unusual but not rare cause of wrist pain. It is manifested by avascular necrosis and subsequent disintegration of the lunate. Despite recognition of this disease entity for the past 70 years, its cause is still debated. Most investigators relate it to a stress fracture that leads to devascularization of the major segment of the lunate if the lunate is supplied by one volar vessel. The classification of Kienbock's disease is based on its roentgenologic appearance. Stage 1 consists of small fracture lines. Stage 2 is rarification along the fracture line, usually on the volar pole. Stage 3 shows sclerosis of the bone dorsal to the fracture site. Stage 4 shows sclerosis of the bone dorsal to the fracture site, and collapse and secondary fracture with loss of architectural integrity of the lunate. Stage 5 shows secondary arthritic changes of the radius. Treatment is categorized into two general types. The first is an attempt to allow revascularization of the lunate be relieving the compression forces. This is accomplished by lengthening the ulna and/or shortening the radius, with capitate-hamate fusion; or by shortening the capitate and fusing the capitate and hamate. These procedures are performed in the early stages of Kienbock's disease. The second type of treatment, used in more advanced cases, includes excision of the lunate: replacement of the lunate by prosthesis, with or without capitate shortening and/or capitate-hamate fusion; and various types of intercarpal fusion.

Adolescent↗
PubMed1985

Argon laser coagulation of blood for the anastomosis of small vessels.

A new technique is introduced in which an argon laser coagulates blood to form an adherent sleeve for the anastomosis of small vessels. The argon laser solidifies the blood into a dark tensile substance which supports the site of repair until vascular continuity is achieved. Laser pulses of 0.75 W and 0.5 seconds exposure are used, and damage to the underlying vessel wall is minimal. A histological analysis is performed and the results are examined qualitatively. The technique shows advantages of speed, reduced vascular trauma, and external protection at the site of vascular repair.

Animals↗
PubMed1984

Evaluation of the use of the argon laser in repairing rat and primate nerves.

The argon laser coagulates blood selectively, making it an adherent material. Argon laser energy is almost completely absorbed by red blood cells and does not seem to affect white nerve tissue. To demonstrate the technical feasibility of laser repair for severed nerves, we cut the sciatic nerves of rats and the median nerves of nonhuman primates and then repaired them by use of an argon laser beam delivered through a 400 microns optical fiber and handpiece that was developed in our laboratory. Autogenous blood was spread around the group of fascicles at the repair site and was then coagulated with the laser to form a minitubule around each fascicle group. Transmission and scanning electron microscopy showed that the repairs appeared technically superior to control sutured nerves and that the laser apparently had no untoward effects on either the repair site or on the control nerve. The minitubules seemed to channel the axon sprouts into the distal tubules extremely well and to prevent ingrowth of scar tissue at the juncture site.

Animals↗
PubMed1983

Nerve conduction velocity, microscopic, and electron microscopy studies comparing repaired adult and baby monkey median nerves.

Three to three and a half years after repair of monkey nerves, comparison of total myelinated nerves, electron microscopic sections, and nerve conduction velocities delineated no significant difference between nerves sutured in adult life and those sutured in infancy. Extrapolating these results to the human clinical situation, central nervous system adaption in young patients could explain the better clinical results.

Age Factors↗
PubMed1982

Radial shortening for the treatment of Kienböck's disease--a 5- to 10-year follow-up.

Kienböck's disease is probably caused by microfractures or stress fractures developing within the lunate. In about 32% of the population, the vascular pattern to the lunate is such that after fracture they are vulnerable to a secondary aseptic necrosis of the lunate. The high incidence of Kienböck's disease in patients with an ulnar minus variant wrist may be explained by an increased stress on the lunate in dorsiflexion and ulnar deviation. This study is a 5- to 10-year follow-up of patients with early stages of Kienböck's disease and ulnar minus variant treated by radial shortening procedures. Eleven of the 12 patients were satisfied with their treatment and showed functional improvement. These patients returned to their normal activities. Grip strength was satisfactory, and range of motion improved following surgery.

Adult↗