Biomedical subjects
Publications and source records attributed to E R Guise.
This is a retrospective study of 23 infrapatellar tendon ruptures in 22 patients seen at Henry Ford Hospital from 1969 to 1980. Two of the patients had a systemic disease known to predispose to tendon ruptures, while the remainder of the tendon ruptures occurred in otherwise normal individuals as the result of either repetitive or isolated trauma.
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Six metastatic tumors of the hand of mammary, renal, pulmonary, colonic, and humeral origins are described. The areas involved were the distal phalanges, the metacarpal bones, a carpal bone, the nail bed, and the soft tissue of the dorsum of the hand. All six patients died within a few months after the metastatic lesions were diagnosed correctly. Metastases to the bone can cause destruction, pain, and swelling and may be misdiagnosed before operation as osteomyelitis. Metastases to the soft tissues tend to be asymptomatic and can closely mimic benign soft tissue tumors.
Four metastatic tumors of the foot, of colonic, renal and humeral origin, are described. They involved three calcanei and two tali. All four patients died within a few months after the appearance of metastasis to the foot. Bony destruction, pain, and swelling can closely resemble the clinical signs and symptoms of osteomyelitis. Diagnostic roentgenograms must be obtained to rule out the possibility of metastatic disease, and biopsies are usually required for accurate diagnosis.
An extremely rare case of osteochondroma arising from the right lateral mass of an atlas was successfully treated by a complete removal through an oblique high cervical incision coupled with a transection of the underlying sternocleidomastoid muscle and careful freeing and retraction of the adjacent vital neurovascular structures.
The surgical technique for hindquarter amputation is described in a step-by-step manner. Since 1955 we have performed 19 such operations for eradication of malignant bone and soft tissue tumors in the pelvic, hip and upper thigh regions. Three hindquarter amputations were performed for local recurrence following initial wide excision. The overall 5-year survival rate for our 19 patients was 42.1 per cent. Malignant soft tissue tumors appear to have a much better 5-year survival rate than malignant bone tumors (60 per cent vs. 22.2 percent). We feel that surgery is still the treatment of choice. However, in the presence of proper indications, chemotherapy and radiotherapy should be added to surgery in order to prolong survival time and save lives.
Osteonecrosis of the femoral head results in an increased uptake of 18F due to a reparative reaction in the necrotic area and its surroundings. Twenty hemodialysis and twenty-seven post-transplant patients were studied serially. In the hemodialysis group, nine patients had positive scintigraphs and eleven had negative studies. All were asymptomatic. In the transplant group, twelve were positive and fifteen were negative. Four patients with positive scans later developed unequivocal clinical and radiographic evidence of osteonecrosis. Patients with negative scans have been asymptomatic and without radiological abnormalities. Age, sex, duration of dialysis, bone mineral densitometry, total steroid dose, duration of hospitalization after transplantation, and serum chemistries were not different in positive and negative patients. All patients on alternate-day steroids have negative scans. A positive 18F scintigraph antedates the occurrence of clinical and radiological findings of osteonecrosis.
It is the author's belief that supination injuries with tear of the talofibular ligament are the most frequent ankle ligamentous injuries encountered on the football field (Figure 4). However, the author believes that the more significant injury is the rupture of the tibiofibular ligament and interosseous ligament incurred in pronation and external rotation. (Figure 5). Twenty time-loss injuries of significance, encountered over a five year period in one football team, are presented. The mechanism of injury and the force encountered at the ankle during an interruption of the normal sequence of running and turning on the football field are presented. It is the author's opinion that rigid immobilization of the more significant injury is necessary in order to return the participant to active athletics within a reasonable length of time. It is hoped that this report will stimulate others to closely evaluate ankle injuries occurring on the football field.
The surgical technique for temporarily occluding the common iliac artery during hemipelvectomy has been described. Not only can this technique significantly reduce the blood loss and operative time, but it may also minimize postoperative complications and increase the chances of a complete eradication of the primary malignant disease.