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Biomedical subjects

F Schuind

Publications and source records attributed to F Schuind.

At least 19 recordsLinked to original sources
PubMed2006

Hand transplantation: the state-of-the-art.

The feasibility of hand transplantation has been demonstrated, both surgically and immunologically. Levels of immunosuppression comparable to regimens used in solid organ transplantation are proving sufficient to prevent graft loss. Many patients have achieved discriminative sensibility and recovery of intrinsic muscle function. In addition to restoration of function, hand transplantation offers considerable psychological benefits. The recipient's pre-operative psychological status, his motivation and his compliance with the intense rehabilitation programme are key issues. While the induction of graft specific tolerance represents a hope for the future, immunosuppression currently remains necessary and carries significant risks. Hand transplantation should, therefore, only be considered a therapeutic option for a carefully selected group of patients.

Feasibility Studies↗
PubMed2006

The first Belgian hand transplantation--37 month term results.

The first Belgian hand transplant was a 22 year-old man with a traumatic amputation of his dominant hand at the junction of the middle and distal thirds of the forearm. The donor and recipient had three HLA mismatches. The cross-match was negative. The total ischaemic time was slightly over 6 hours. Immunosuppression included antithymocyte globulins at induction and tacrolimus, mycophenolate mofetil and prednisolone as induction and maintenance therapy. There has been no episode of rejection. The only significant complications, except for transient hyperglycaemia, were psychological. At 37 months post-transplantation, the patient has fully incorporated his transplant into his self-image and is back at work. He has good sensibility (two-point discrimination of 6mm at the thumb and index finger pulps), acceptable wrist and finger motion with functioning intrinsic muscles. According to Chen's criteria, the result is good to excellent.

Adult↗
PubMed2005

Functional MRI activation of somatosensory and motor cortices in a hand-grafted patient with early clinical sensorimotor recovery.

The aim of this study was to investigate somatosensory and motor cortical activity with functional MRI (fMRI) in a hand-grafted patient with early clinical recovery. The patient had motor fMRI examinations before transplantation, and motor and passive tactile stimulations after surgery. His normal hand and a normal group were studied for comparison. A patient with complete brachial plexus palsy was studied to assess the lack of a fMRI signal in somatosensory areas in the case of total axonal disconnection. Stimulating the grafted hand revealed significant activation in the contralateral somatosensory cortical areas in all fMRI examinations. The activation was seen as early as 10 days after surgery; this effect cannot be explained by the known physiological mechanisms of nerve regeneration. Although an imagination effect cannot be excluded, the objective clinical recovery of sensory function led us to formulate the hypothesis that a connection to the somatosensory cortex was rapidly established. Additional cases and fundamental studies are needed to assess this hypothesis, but several observations were compatible with this explanation. Before surgery, imaginary motion of the amputated hand produced less intense responses than executed movements of the intact hand, whereas the normal activation pattern for right-handed subjects was found after surgery, in agreement with the good clinical motor recovery.

Adult↗
PubMed2005

Septic monoarthritis of the first carpo-metacarpal joint caused by Mycobacterium kansasii.

A case of septic carpal monoarthritis due to Mycobacterium kansasii developing 16 months after accidental inoculation in a healthy laboratory technician is reported. No predisposing factor such as immunosuppression, preexisting degenerative, inflammatory arthritis or cortisone injection was present. Treatment with antituberculous oral medication alone resulted in resolution of the disease. Synovectomy was unnecessary. Ten years after the initial causative event, the patient remains free of symptoms.

Adult↗
PubMed2004

[Semiconstrained total elbow arthroplasty for severe post traumatic ankylosis of the elbow: a case-report].

Post traumatic stiffness in young subjects has been long considered a bad indication for total elbow arthroplasty. We present the case of a 48 year old woman with an elbow fracture, operated in childhood who developed progressive painful stiffness. After treatment with a cemented semi constrained Coonrad-Morrey total arthroplasty, we have obtained a good result at over 4 years follow-up. The gain of ROM is 40 degrees, the analogue scale for pain is 2.5/10 and the Mayo Clinic Performance Index for the Elbow is 80/100. The subjective impression is excellent and there were no complications.

Age Factors↗
PubMed2004

[Contribution of comparative x-rays for infantile traumatology].

PURPOSE OF THE STUDY: There is a controversy over whether or not routine comparative x-rays should be prescribed for young children with bone and joint trauma. We conducted a retrospective analysis to assess the contribution of such x-rays. MATERIAL AND METHODS: The series included 203 children aged less than fifteen years who had experienced bone and joint trauma. Two junior orthopedic surgeons, two senior orthopedic surgeons and two pediatric radiologists reread the x-rays to establish the diagnosis, using comparative x-rays to make any necessary correction of the diagnosis. The surgeons were asked to propose a therapeutic strategy for each diagnosis and the radiologists were asked to judge the value of the comparative x-rays. RESULTS: The comparative x-rays were found to be reliable in only 87.5% of the cases, and were useful for diagnosis in only 8.8%. There were statistically significant differences depending on the localization, the patient's age, and the physician's experience. DISCUSSION: Systematic use of comparative x-rays should be discouraged. Only trauma affecting the elbow in older children can, in particular cases, warrant prescription of comparative x-rays.

Adolescent↗
PubMed2002

[The orthopedics-traumatology department].

The Department is involved in clinical and research activities. We pioneered the clinical application of "smart of Orthopaedic implants". The monitoring concept, bringing a high added value, helps in assessing fracture healing or implant fixation. The technique, featuring the 21st century, also requires advanced knowledge in biomaterials. Such implants have been used during the ESA Parabolic Flight Campaigns. These measurements are a prerequisite to establish prevention programs of the bone demineralisation during space flights but also in disuse osteoporosis. The Department is deeply involved in external fixation. In vitro studies of the mechanical insertion and holding parameters of external fixation pins have been performed to produce new implants, which efficiency has been proved by a clinical study. We defined original clinical principles of external fixation as its use in upper limb indications, to maintain microsurgery transplant, preserving devascularization and providing adequate fixation. Our biomechanical approach of the upper limb, now confirmed by others research groups, questioned old clinical concepts. The isokinetic evaluation assesses the dynamic function of articulations, i.e. after arthroplasty, and is also used for medico-legal evaluation. The clinical research touches orthopaedic (or systemic) diseases as algodystrophy, Kienböck disease, Kashing Beck. We conducted a multidisciplinary research on the effect of electromagnetic fields (EMF) on cells differentiation. In addition to possible healing properties, it helps as an objective support to analyse the exposure to the environmental EMF.

Belgium↗
PubMed2002

[Orthopedic immobilization].

The classical plaster bandage was devised in the mid 19th century. Until recently, osteoarticular trauma has been treated mostly by plaster cast immobilisation using plaster of Paris. Synthetic materials have been introduced on the market place in the seventies, but they have not superseded the traditional plaster of Paris. The more recent thermoplastic materials are used to make splints and orthoses, particularly at the wrist and hand. The present review of the literature confirms that synthetic materials present better physical and mechanical properties than the traditional plaster of Paris. In addition, they are lighter, they are more resistant to humidity, they are more radiotransparent and they generate less dust when removed. However, they are less malleable and cause higher pressure in case of limb edema. Plaster of Paris therefore remains indicated in the acute posttraumatic or postoperative period. This material is also cheaper, but the pecuniary benefit is limited for several reasons, particularly because plaster of Paris is associated with a higher rate of cast replacement.

Casts, Surgical↗
PubMed2001

[Corrective osteotomy using Hoffmann II external fixators for extra-auricular malunion of the distal radius].

The authors present the technique and clinical results of a corrective osteotomy for malunion following extra-articular fractures of the distal radius. External fixation allows restoration of the length of the radius with minimal damage to the periosteum. It allows early mobilization of the radiocarpal joint. The position of the distal pins provides intraoperative visual control of the angular correction. The minimal invasive approach decreases the risk of iatrogenic lesion of an extensor tendon or a sensitive branch of the radial nerve. This technique is easy and reliable.

Adult↗
PubMed1999

Prognostic factors in the treatment of carpal scaphoid nonunions.

The aim of this multicenter study of 138 patients with scaphoid nonunions was to assess the prognostic factors of bone healing or failure after curative surgical treatment options: isolated bone grafting (30%), internal fixation (23%), or combined bone grafting and internal fixation (47%). Bone healing occurred in 75% of cases. Persistent nonunion was evident in 20% of cases; it was possible in 6%. The clinical and radiologic results were worse in the group of failures. Stepwise multiple logistic regression analysis was conducted to identify the factors of prognosis toward bone healing or failure. In univariate analysis, professional heavy work, age of the nonunion of over 5 years, associated radial styloidectomy, and duration of postoperative immobilization were associated with a significantly decreased likelihood of healing of the scaphoid nonunion. In multivariate analysis, the only remaining predictor was the delay between the initial trauma and the treatment of the nonunion. Among the cases of internal fixation (with or without bone grafting), the only predictor in multivariate analysis was the importance of bone resorption. The dorsal approach resulted in a more pronounced loss of wrist flexion and extension amplitudes. If the time elapsed between the initial fracture and the treatment of the nonunion exceeds 5 years, the chances of healing of the nonunion are decreased.

Adult↗
PubMed1998

Modifications of arterial blood flow to the hand after carpal tunnel release.

Any surgical procedure is followed by an inflammatory reaction, associated with arteriolar dilatation and increased capillary permeability. The normal evolution is in most cases a progressive decrease of the inflammatory signs. Some patients however, particularly after orthopedic trauma affecting the extremities, develop algodystrophy, initially characterized by arterial vasodilatation and low capillary flow. In an effort to better understand the normal phenomena seen after uncomplicated hand surgery, the authors have evaluated the postoperative arterial blood flow using the Duplex flowmetry ultrasound technique in 13 patients operated for carpal tunnel syndrome, who did not subsequently develop algodystrophy. After measurement of the transverse section of the ulnar and radial arteries, and longitudinal measurement of the mean velocimetry, the arterial blood flow was calculated. The measurements were done 1, 2 and 4 weeks after the operative procedure. The study demonstrated a moderate (15%-30%) but significant increase in the arterial blood flow to the hand, related to arterial dilatation of the vessels and to an increase in blood velocimetry.

Adult↗
PubMed1997

Magnetic resonance imaging for irreducible posterolateral knee dislocation.

Magnetic resonance imaging (MRI) of an irreducible knee dislocation can help physicians evaluate associated bone and ligamentous lesions. However, caution should be taken when interpreting the images because the capsuloligamentous interposition seen in irreducible knee dislocations may be misdiagnosed as a meniscal lesion.

Aged↗
PubMed1997

Can algodystrophy be prevented after hand surgery?

Algodystrophy is characterized initially by an increase in arterial flow, an increase in blood pool, a decrease in microcirculatory velocity, and a loss of thermoregulatory control. These changes, producing the typical symptomatology, associated diffuse hand pain, diminished hand function, edema, and abnormal color and temperature, are believed now to correspond in most cases to an exaggeration of the normal post-traumatic inflammatory responses and are not the consequence of sympathetic damage. Algodystrophy may be prevented in most hand surgery patients by minimizing the normal postoperative inflammation, by increasing venous return (especially by avoiding plaster casts and constrictive dressings), by controlling post-traumatic pain, by promoting early active mobilization, and by reassuring the patient. If there is any sign of algodystrophy, three-phase bone scintigraphy should be obtained and treatment instituted immediately.

Arm↗
PubMed1996

Glomus tumours of the hand. A retrospective study of 51 cases.

The authors report a series of 51 patients with glomus tumours in the hand. The duration of symptoms before treatment averaged 10 years. No one site or finger was more commonly involved. Objective features were limited to a blue discoloration in 29%, a pulp nodule or a nail deformity in 33%. An osseous defect was seen on plain X-ray films in 36%. Diagnosis depended on clinical suspicion in 90%. Careful dissection and complete excision of the tumour almost always offer permanent relief. A direct transungual approach was used in the subungual tumours with only one cosmetic problem. Recurrence of symptoms occurred in only two cases after a pain-free interval of 2 years.

Adult↗
PubMed1996

Does the normal contralateral wrist provide the best reference for X-ray film measurements of the pathologic wrist?

This study compares in normal subjects the variability of wrist x-ray film measurements between the right and left sides with the variability of the distribution of those measurements within the population. Additional purposes were to evaluate possible differences of these measurements according to sex, age, side, and hand dominance. The variability when comparing both sides was found to be statistically less for the carpal height, radiolunate, scapholunate, and capitolunate angles than within the whole group of subjects, and for those measurements, there was a high correlation (r > .88) between the right and left sides. In addition, the carpal height and the carporadial ratios were lower and the capitolunate angle was higher in women than in men. There was also a significant decrease of the scapholunate angle in older individuals. The clinical implication of these findings is that in unilateral wrist diseases, the normal wrist should be used to provide the reference values of the carpal height and of the carpal angles on profile x-ray films. However, for the radial inclination and palmar tilt of the distal radius and for the ulnar variance, the normal side does not provide a better reference than normal values obtained from databases.

Adult↗