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Biomedical subjects

H J Belcher

Publications and source records attributed to H J Belcher.

At least 19 recordsLinked to original sources
PubMed2001

Adverse effect of porcine collagen interposition after trapeziectomy: a comparative study.

Twenty-six hands in 26 adults with osteoarthrosis of the thumb trapeziometacarpal joint were randomised to undergo either trapeziectomy alone (control) or with the interposition of porcine dermal collagen xenograft (Permacol). The study was terminated prematurely because of apparent reactions to the implants in six of 13 patients. The collagen interposition group required more frequent review on clinical grounds and were discharged later after surgery. Three of the implants have been removed and histology revealed foreign body reactions in all. There was no difference in thumb movement or power after surgery between the two groups. However, improved grip strength was observed and improved function were reported only in the control group. Permacol patients reported greater pain and were less satisfied with their operations than control patients. We conclude that interposition of Permacol is detrimental to the results of trapeziectomy.

Aged↗
PubMed2001

A comparison of metacarpophalangeal joint silastic arthroplasty with or without crossed intrinsic transfer.

Forty-three hands in 36 adults undergoing Silastic interposition arthroplasty of the index, middle, ring and little finger metacarpophalangeal joints for rheumatoid arthritis were randomly allocated to undergo replacement with or without crossed intrinsic transfer. The patients were reviewed at a median of 17 (range, 7-50) months after surgery. The demographic characteristics and pre-operative clinical measurements of the two groups were indistinguishable. Both groups showed improvement in ulnar drift and an altered arc, but no change in total range of motion at the metacarpophalangeal joints. Grip strength and pulp to pulp pinch were significantly and comparably improved in both groups. There was no difference in pain scores or perceived function between the treatment groups. It is concluded that crossed intrinsic transfer does not significantly affect the outcome of Silastic interposition arthroplasty of the metacarpophalangeal joints in rheumatoid patients.

Aged↗
PubMed2000

Injuries to the hand from dog bites.

A review of dog bite injuries referred to one surgeon over a 12 month period demonstrated a significant association between a delay in referral and a prolonged period of subsequent in-patient treatment. Two patients sustained injuries when delivering material through a letter-box.

Adolescent↗
PubMed2000

Centro-central union for the prevention of neuroma formation after finger amputation.

Sixty digits undergoing terminalization were randomized to undergo either simple transection of the digital nerves (control) or direct suture of the nerves to each other (centro-central union, CCU). Thirty-one digits were available for review with a minimum follow-up of one year following the surgery. Assessment was by visual analogue scales (VAS) and clinical examination. Measurements included static two-point discrimination (S2PD) for sensation, dolorimetry for stump tenderness and grip-strength.Resting pain, cold intolerance and perceived tenderness were comparable in the two groups. Perceived and observed touch sensitivity were better in the control group but the stumps in this group were more tender than those in the CCU group. We conclude that CCU results in more comfortable stumps but causes greater loss of sensitivity. It is a simple and worthwhile adjunct to digital amputation.

Adult↗
PubMed2000

A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition.

Forty-three patients were randomly allocated to undergo either trapeziectomy alone (control) or with a ligament reconstruction and tendon interposition (LRTI) using an abductor pollicis longus tendon slip. The patients were reviewed at a median 13 (range, 7-29) months after surgery. The demographic characteristics, severity of disease and pre-operative clinical measurements of the two study groups were indistinguishable but LRTI lengthened the operation by approximately 15 minutes. Both groups expressed equal satisfaction with the operation and there were no significant differences between the two treatment groups. Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb and the addition of a ligament reconstruction was not shown to confer any additional benefit.

Carpal Bones↗
PubMed2000

Endoscopic carpal tunnel release in selected rheumatoid patients.

Twenty endoscopic carpal tunnel releases were performed in 15 patients with quiescent seropositive rheumatoid arthritis using the Agee technique. Patients were not considered for endoscopic carpal tunnel release if there was florid synovitis with crepitus or loss of active finger flexion, if there was evidence of flexor tendon rupture or if they had previously undergone surgery in the region. Access to the tunnel was significantly easier than normal and visualization of the flexor retinaculum was satisfactory in all cases. There were no complications. We conclude that endoscopic carpal tunnel release can be safely performed in selected patients with rheumatoid arthritis. The absence of a palmar scar can be a great advantage to these disabled patients.

Arthritis, Rheumatoid↗
PubMed1999

Anthropometry and endoscopic carpal tunnel release.

A prospective study was performed in 100 consecutive endoscopic carpal tunnel releases (ECTR) to assess the effect of a number of anthropometric measures on the ease of introduction of the ECTR system into the carpal tunnel. Ease of access to the carpal tunnel correlated with the wrist circumference, height and age of patients. Surgeons should be aware that ECTR is likely to be more difficult in small patients with small wrists and should have a higher threshold for conversion to the open technique to avoid neurological complications.

Adolescent↗
PubMed1999

Endoscopic release of the carpal tunnel: a technical note.

The Agee technique is a standard approach for the endoscopic release of the carpal tunnel. We describe a modification of the technique. This involves dilatation of the path for the blade assembly with urethral dilators. This permits a graded dilatation of the path. We believe it creates a track of more uniform width. It also provides more accurate information about the tightness of the carpal tunnel. Its adoption may reduce the chance of nerve injury.

Carpal Tunnel Syndrome↗
PubMed1999

Hand surgery and quality of life.

The outcome in patients having surgery to the hand was assessed subjectively using a questionnaire that covered activities of daily living (ADL), hand pain and psychological well-being. The questionnaires were completed on average 6.9 months preoperatively and 20.6 months postoperatively by 15 patients with osteoarthritis undergoing trapeziectomy and 25 patients with rheumatoid arthritis undergoing Swanson arthroplasties of the metacarpophalangeal joints. Surgery resulted in significant improvements in reported ADL and hand pain, in both groups. Improvement in perception of hand function and health was only seen in the osteoarthritic group. There was no improvement in arthritis activity, mood or quality of life in either group. These results confirm that surgery for arthritis of the hand relieves pain and improves ADL. However, it has a greater effect in patients with localized osteoarthritis than in those with rheumatoid arthritis.

Activities of Daily Living↗
PubMed1992

Intra-arterial 4-hydroxyanisole chemotherapy for locally recurrent malignant melanoma: a re-appraisal.

Ten female patients with recurrent cutaneous malignant melanoma (MM) confined to the lower limb were treated with 4-hydroxyanisole (4HA) infused intra-arterially. 10 g of 4HA was infused twice per day up to a maximum dose of 80 g. 4HA infusion caused significant alterations in liver function which precluded completion of the treatment regimen in all but two patients. No tumour regression was observed in any patient. We cannot recommend this technique for managing patients with recurrent cutaneous MM.

Aged↗