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Biomedical subjects

G M Rayan

Publications and source records attributed to G M Rayan.

At least 19 recordsLinked to original sources
PubMed1997

Scaphoid fractures in soccer goalkeepers.

The growing popularity of soccer in this country has led to an increasing number of soccer-related injuries. Epidemiologic studies report that soccer-related musculoskeletal injuries most frequently involve the lower extremities. These range from 56% to 95% of soccer injuries and player-to-player contact is the most common mechanism of injury. Upper extremity musculoskeletal injuries are less frequent, but have been reported, with goalkeepers being the most susceptible. There is a paucity in the literature regarding bony injuries about the wrist and hand among goalkeepers. The purpose of this article is to report three soccer-related scaphoid fractures and nonunions in two goalkeepers.

Adolescent↗
PubMed1996

Treatment of spastic thumb-in-palm deformity: a modified extensor pollicis longus tendon rerouting.

Fourteen patients (15 hands) with spastic thumb-in-palm deformities were treated with a modified technique of extensor pollicis longus tendon rerouting. Twelve patients obtained satisfactory correction of their deformities. Although functional improvement was not always anticipated, it was achieved to some degree in 12 patients. Extensor pollicis longus tendon rerouting can provide satisfactory correction of severe thumb-in-palm deformity especially when combined with other procedures such as metacarpophalangeal joint arthrodesis and thumb intrinsic muscle release. The modified rerouting technique can be done with a single incision and allows easy adjustment of tension.

Adolescent↗
PubMed1996

Pharmacologic regulation of Dupuytren's fibroblast contraction in vitro.

Dupuytren's disease is associated with contraction of specialized fibroblasts present in the diseased palmar fascia. Pharmacologic agents were evaluated for their ability to promote or inhibit contraction of Dupuytren's fibroblasts in vitro using a collagen lattice contraction assay. In the first part of the study, lysophosphatidic acid (LPA), serotonin, angiotensin II, and prostaglandin F2 alpha were tested for their ability to promote Dupuytren's fibroblast contraction. Lysophosphatidic acid was found to significantly promote Dupuytren's fibroblast contraction as compared with controls. This response to LPA is dose dependent, with a half-maximal response of 0.07 microM. Angiotensin II, serotonin, and prostaglandin F2 alpha at 1 mM, induced a significant amount of contraction as compared to controls, but the amount of contraction was at least six times less than that observed for LPA. In the second part of the study, prostaglandins E1 and E2 or the calcium blockers nifedipine and verapamil were tested for their ability to inhibit LPA-promoted contraction. It was found that both types of inhibitors partially block LPA-promoted contraction of Dupuytren's fibroblasts. The effect of the various pharmacologic agents on normal palmar fibroblasts was not evaluated. The focus of this study was to examine the regulation of contraction of Dupuytren's fibroblasts. This study demonstrates that LPA is a potent agonist of Dupuytren's fibroblast contraction and that this contraction can be inhibited by specific pharmacologic agents. These findings provide a rational basis for investigating further the clinical use of the calcium channel blockers nifedipine or verapamil and prostaglandins E1 and E2 to control Dupuytren's disease and possibly other fibrotic conditions.

Alprostadil↗
PubMed1996

Recurrent dislocation of the pisiform bone.

A 17-year-old man had chronic pain and recurrent radial dislocation of the pisiform bone following a fall on his outstretched arm. The bone was excised, along with a 3 x 4-mm osteocartilaginous fragment from the distal triquetrum. Pisotriquetral joint instability should be considered in the differential diagnosis of palmar-ulnar wrist pain.

Adolescent↗
PubMed1996

Fractures and nonunions of the scaphoid.

Fractures of the scaphoid are the most common of all fractures of the carpal bones. Scaphoid collapse and angular deformity may develop after fractures. Scaphoid nonunion often complicates scaphoid fractures especially if the diagnosis is missed initially, and adequate timely treatment is not provided. Displaced unstable fractures also have a tendency to develop nonunion. The tenuous vascular anatomy of the scaphoid, the inherent biomechanical instability of scaphoid fractures, and the difficulty of radiographic diagnosis are the culprits of nonunion. Established scaphoid nonunion is a challenging and difficult problem to treat and more so is the treatment of failed nonunion after grafting. New methods of diagnosis and treatment of scaphoid injuries are constantly evolving. One common method of treating scaphoid nonunion with angular deformity is length restoration using a wedge bone graft and Herbert screw fixation through a palmar approach. Early diagnosis and attention to details of surgical technique are necessary for successful treatment outcome. The purpose of this report is to review the basic science, diagnosis, and treatment of scaphoid fractures and nonunions.

Adolescent↗
PubMed1995

Anterior submuscular transposition of the ulnar nerve for cubital tunnel syndrome.

48 patients with 50 involved limbs were retrospectively analyzed to determine factors influencing the outcome of surgical treatment for cubital tunnel syndrome. All patients were treated by anterior submuscular transposition of the ulnar nerve with Z-lengthening of the flexor-pronator origin. There were 24 men and 24 women with an average age of 42 years +/- 16.4 years (range, 5-75 years). The average follow-up time was 58 months (range, 12-156 months). A grading system was used pre- and post-operatively based on the severity of subjective complaints and objective findings. 92% of the patients were satisfied, or satisfied with some reservations, and only 8% were dissatisfied. All patients had either fair or poor pre-operative grades. 84% had excellent or good post-operative grades and only 16% had fair grades. There were no recurrences or poor post-operative grades in our series. Workers' compensation status had no statistically significant adverse effect on post-operative patient satisfaction or post-operative grade. Anterior submuscular transposition of the ulnar nerve in this series provided satisfactory subjective outcome, relief of symptoms and adequate decompression of the ulnar nerve at the elbow.

Activities of Daily Living↗
PubMed1995

Ligamentous and tendinous support of the pisiform, anatomic and biomechanical study.

Twenty-five formalin preserved cadaveric wrists were dissected and the relationship of the piso-triquetral joint and its surrounding soft tissue structures were defined. An additional 4 fresh frozen wrists were examined in longitudinal and transverse sections. These anatomical studies showed the extensor retinaculum to have a complex insertion into the pisiform, flexor carpi ulnaris, fifth metacarpal, piso-metacarpal ligament, and the abductor digit minimi muscle. A capsulo-ligamentous structure on the medial aspect of the piso-triquetral joint was also identified. Bio-mechanical testing was performed on 12 fresh cadaver wrists and the results were compared to the anatomical findings to determine the contribution of surrounding soft tissue structures to piso-triquetral joint stability. Mechanical testing showed the soft tissues around the piso-triquetral joint to be strongest proximally and distally and weakest medially. Transection of the transverse carpal ligament resulted in increased lateral motion of the pisiform, but there was no significant decrease in stiffness. This study provides insight into the etiology of piso-triquetral joint instability and dysfunction.

Biomechanical Phenomena↗
PubMed1995

Correlation of alpha-smooth muscle actin expression and contraction in Dupuytren's disease fibroblasts.

We studied 11 nodules from patients with Dupuytren's contracture to determine whether alpha-smooth muscle actin expression in Dupuytren's fibroblasts is related to the generation of contractile force. Tissue was placed into explant culture and fibroblast strains were obtained. The mean percent of cultured Dupuytren's fibroblasts expressing alpha-smooth muscle actin, as determined by immunofluorescence, was 14 +/- 8 and ranged from 1% to 26%. The ability of Dupuytren's fibroblasts to generate contractile force was determined by using a previously described collagen lattice contraction assay. We observed a significant positive correlation between the expression of alpha-smooth muscle actin and the generation of contractile force in cell strains of Dupuytren's fibroblasts. In addition, six fibroblast strains from palmar fascia of individuals undergoing carpal tunnel release were examined. In six strains of palmar fibroblasts the mean percent of cells expressing alpha-smooth muscle actin was 5 +/- 3 and ranged from 1% to 9%. Six Dupuytren's fibroblast strains, in which more than 15% of the cells expressed alpha-smooth muscle actin, were significantly more contractile than the palmar fibroblasts. These results suggest that Dupuytren's fibroblasts can acquire smooth muscle characteristics and that the acquisition of a smooth muscle-like phenotype correlates with increased contractility.

Actins↗
PubMed1995

Vasoactive intestinal peptide and nerve growth factor effects on nerve regeneration.

Sixty rat sciatic nerves were used to study the effects of vasoactive intestinal peptide (VIP) and nerve growth factor (NGF) on nerve regeneration. They were divided into three groups. Groups 1 and 2 were treated with VIP and NGF, respectively, after dividing the nerves without repair and placing them in silastic chambers. Group 3 served a control. The rate and quality of nerve regeneration were compared among the groups using caliper measurements and histologic evaluation. Both VIP and NGF groups showed an enhanced rate of regeneration at three weeks as compared to controls (p < 0.05). The quality of nerve regeneration histologically and by axonal counting was not significantly different among the three groups, except for the presence of less vascularity in the VIP as compared with the NGF group. In addition to NGF, VIP appears to increase the rate of nerve regeneration as compared to controls.

Animals↗
PubMed1995

Ligamentous and tendinous support of the pisiform: anatomic and biomechanical study.

Twenty-five formalin-preserved cadaveric wrists were dissected and the relationship of the pisotriquetral joint (PTJ) and its surrounding soft tissue structures were defined. An additional 4 fresh frozen wrists were examined in longitudinal and transverse sections. These anatomical studies showed the extensor retinaculum to have a complex insertion into the pisiform, flexor carpi ulnaris, fifth metacarpal, pisometacarpal ligament, and the abductor digiti minimi muscle. A capsuloligamentous structure on the medial aspect of the pisotriquetral joint was also identified. Biomechanical testing was performed on 12 fresh cadaver wrists and the results were compared to the anatomical findings to determine the contribution of surrounding soft tissue structures to pisotriquetral joint stability. Mechanical testing showed the soft tissues around the pisotriquetral joint to be strongest proximally and distally and weakest medially. Transection of the transverse carpal ligament resulted in increased lateral motion of the pisiform, but there was no significant decrease in stiffness. This study provides insight into the etiology of pisotriquetral joint instability and dysfunction.

Biomechanical Phenomena↗
PubMed1995

Scaphoid fractures and nonunions.

Fractures of the scaphoid are the most common of all fractures of the carpal bones. Scaphoid collapse and angular deformity may develop after fractures. The tenuous vascular anatomy of the scaphoid, the inherent biomechanical instability of scaphoid fractures, and the difficulty of radiographic diagnosis are the culprits of nonunion. The treatment of established scaphoid nonunion is difficult, and more so is the treatment of failed nonunion after grafting. One common method for treating scaphoid nonunion with angular deformity is length restoration using a wedge bone graft and Herbert screw fixation through a palmar approach. Attention to details of surgical technique are necessary for successful treatment outcome.

Adolescent↗
PubMed1994

Distribution of ED-A and ED-B containing fibronectin isoforms in Dupuytren's disease.

Different fibronectin (FN) isoforms arise via alternate splicing of a single gene transcript in a cell- and tissue-specific manner. Antibodies were used to evaluate the presence and distribution of FN and its isoforms in Dupuytren's diseased and normal palmar fascia. Immunolocalization studies show extracellular FN fibrils, including FN isoforms containing extra domains A (A-FN) and B (B-FN), in proliferative and involutional stage Dupuytren's diseased tissue. However, B-FN appears less abundant and more restricted in its distribution as compared to A-FN or total FN. Total FN and A-FN are significantly reduced in residual tissue, while B-FN is not present. A-FN and B-FN are not present in normal palmar fascia, while total FN staining is slight and restricted to the loose connective tissue surrounding the large, parallel bundles of collagen fibers. The presence of A-FN and B-FN in Dupuytren's diseased palmar fascia represents a disease-induced appearance of these FN isoforms and further evidence of an association between Dupuytren's disease and wound healing.

Antibodies, Monoclonal↗
PubMed1994

Classification and treatment of closed sagittal band injuries.

Twenty-eight nonrheumatoid patients were treated for sagittal band injuries. The digits involved, in order of frequency, were long, small, index, and ring. We observed three clinical types of sagittal band injuries: type I, injury without extensor tendon instability; type II, injury with tendon subluxation; and type III, injury with tendon dislocation. Eight of nine patients with small finger involvement had radial sagittal band injuries; four of them presented with abduction deformity of the small finger. Satisfactory results were achieved with nonoperative treatment when it was initiated within 3 weeks of injury. Splinting was the initial treatment for all patients. Ten patients were treated either by centralization of the extensor tendon of the central two digits to provide pain-free stability or tendon transfer to correct small finger abduction deformity.

Adolescent↗
PubMed1994

Occult wrist pain due to capitate nonunion.

Capitate nonunion is an uncommon cause of occult wrist pain. History of wrist injury, tenderness in the distal carpal row, capitate-view x-rays, and special radiographic studies such as bone scan, CT scan, or magnetic resonance imaging can confirm the diagnosis.

Adult↗
PubMed1994

Complications after subfascial carpal tunnel release.

The two cases we report reiterate the dangers of performing a carpal tunnel release through a small transverse or longitudinal incision at the wrist crease. We concur with other authors that this method of carpal tunnel release has an unacceptably high complication rate, and its potential risks do not justify its use.

Adult↗
PubMed1994

Microbiological flora and nail polish: a brief report.

Removing nail polish and prosthetic nails from operating room (OR) personnel prior to scrubbing and from patients prior to hand surgery is recommended but not practiced in many hospitals. There is concern that nail polish can act as a vehicle for the transfer of infectious agents. This study was designed to determine the incidence of microbiological flora of nail polish in a clinical setting.

Acinetobacter↗
PubMed1994

Traumatic tenosynovitis and extensor tendon rupture.

Extensor tenosynovitis is caused by a variety of conditions, but most commonly is associated with inflammatory arthritis. Extensor tenosynovitis with secondary tendon rupture due to occupational repetitive direct trauma to the dorsal compartments of the wrist and hand is reported in a woman. Tenosynovectomy and tendon transfer were performed to relieve pain and restore hand function.

Adult↗