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Biomedical subjects

H Nigst

Publications and source records attributed to H Nigst.

At least 19 recordsLinked to original sources

[History of the carpus and carpal instability].

A concise history of our understanding of the wrist and carpal instability is presented. During the Middle Ages, the wrist is sometimes depicted as consisting of only one bone; Galen, however, showed that there are eight. At first, the carpal bones were simply numbered from one to eight. Only in the 17th century did Lyser of Leipzig suggest naming the individual bones, something first done by Monro of Edinburgh. Landsmeer's concept of intercalated bones in the wrist is already suggested in Galen's work. The ligaments of the wrist were described in detail by Weitbrecht in 1742. Copper plate engravings attest to the accuracy of his anatomical dissections. Progress in the understanding of carpal kinematics followed the discovery of X-rays by Röntgen, in 1895. The columnar carpus concept was to be replaced by the carpal-link concept, demonstrating the interdependent intercalary articulation of the carpal bones. The discovery of X-rays was also followed by the discovery of many post-traumatic disorders of the wrist. Following these European and particularly French contributions, further recent investigations, most notably by American authors, have led to the development of new concepts of carpal instability and carpal collapse.

History, 15th Century

[Spontaneous rupture of the extensor pollicis longus].

A review of the literature is followed by the analysis of a series of forty-four patients who were treated by extensor indicis transposition. Twenty-five patients could be reached for a clinical follow-up examination, nine further patients were interviewed by telephone; of the remaining ten patients, seven could not be reached and three had died. Excluded from the series were patients with rheumatoid arthritis. Results were evaluated according to the scheme suggested by Geldmacher and coworkers. According to their evaluation scheme, we can report fourteen excellent, eight good, three satisfactory, and no bad results. Subjectively, the results were even better, with twenty-eight patients reporting excellent, four good, and two satisfactory results, including those nine patients contacted by telephone only. Strength of extension of the index finger was not diminished after the extensor indicis transposition when all fingers were extended simultaneously. However, there was a deficit of extension in a few cases when the remaining fingers were clenched to a fist. This indicates that an alternative method should probably be recommended in patients with professions where individual extension of the index finger is of paramount importance. It is also suggested that additional functional tests, convertible into score points, might render the evaluation more realistic than measurements only. Inclusion of these additional functional tests might also give an explanation for the discrepancy between patients' subjective results and those as a result of measurement only.

Follow-Up Studies

[Soft tissue tumors of the hand].

This paper is based on the author's experience and a review of the most recent literature. First, the five most common tumors are discussed: ganglia, giant cell tumor, mucous cyst, hemangioma, and epithelial inclusion cyst. The less-common lesions are then discussed that present special problems in the hand, such as the glomus tumor or recurring digital fibromatosis of childhood among others. Lastly, the general guidelines for treatment of malignant tumors of the soft tissue tumors of the hand are presented, followed by a description of a selection of lesions (epitheloid sarcoma, subungual malignant tumors, Kaposi's sarcoma).

Diagnosis, Differential

Reoperation for carpal tunnel syndrome. A retrospective analysis of forty cases.

The causes of unsatisfactory results after surgery for carpal tunnel syndrome were retrospectively analysed in forty cases. The most common pathological finding was fibrosis and adhesions in the carpal canal. Technical errors were found in 43%. In 30% other neuropathies were present and bilateral operations had been performed in 55%. It is possible that there is a tendency to develop CTS in these patients. The results after epineural dissection or internal neurolysis were comparable to those after external neurolysis.

Adult

[Ganglion in the discus triangularis. First description].

A fifty-four year old patient had persisting pain in the wrist following a distal radius fracture two years previously. A perforation of the discus triangularis was confirmed by arthrography, and the disc removed. Gelatinous fluid was found in the joint at operation. Histologically, a ganglion was present in the disc, close to an old tear. As far as we know, this is the first report of a disc ganglion. Disc ganglia probably occur more frequently than is recognized and could be responsible for pain, swelling and recurrent wrist ganglia.

Cartilage, Articular

[Motor, sensory electroneurographic and electromyographic results as well as somatosensory evoked potentials in comparison to clinical findings following nerve suture].

A group of 37 patients (total 41 nerves) with a traumatic transection of median or ulnar nerves at the wrist were reinvestigated clinically and electrophysiologically 4-59 months after primary or secondary suture or grafting. Clinically there was no relation between the time after the operation, and sensory recovery determined according to the schedule of Nicholson and Seddon (1957), two-point discrimination, vibration threshold. There was also no relationship between the time after suture, and the motor latencies as well as amplitudes of evoked muscle action potentials from the abductor pollicis brevis or hypothenar muscles. In sensory nerve fibres there was a statistically significant increase of the maximum amplitude and of the cumulative amplitude during the period after operation, due to an increasing number of regenerated nerve fibres. Sensory nerve conduction velocities showed no relation to the time after suture. Cumulative amplitudes were significantly related to two-point discrimination and to restitution of sensibility. As indicated by the great scatter, however, this parameter is merely a moderate predictor for the degree of clinical recovery. Somatosensory evoked potentials can be helpful in some cases to indicate nerve regeneration when nerve action potentials in peripheral nerves cannot be recorded. However, latencies and amplitudes of the individual peaks did not reveal any relationship to either clinical findings or to period of time after operation. Needle electromyography also yielded highly variable findings. A constant finding was a persistent loss of motor units. Most of these were increased sin size, as indicated by prolonged duration of their action potentials during slight voluntary effort.

Adolescent

[Osteotomy and osteosynthesis of the clavicle in brachial plexus surgery].

During the operative revision of the brachial plexus lesion the exposure is sometimes not wide enough without an osteotomy of the clavicle. The authors developed, therefore, a special technique consisting of internal fixation with a lag-screw prior to the oblique osteotomy of the clavicle. At the end of the operation stable internal fixation can be achieved within a few minutes. This internal fixation proved to be stable, even for passive mobilization in total plexus lesions in sixteen cases over a follow-up time over five years. Primary bone healing always occurred. The technique is described.

Bone Plates

[Carpal tunnel syndrome--a leading symptom in generalized tendomyopathy].

Among 75 of 100 patients with generalized tendomyopathy, carpal-tunnel syndrome developed in the course of the disease and was demonstrated both clinically and electromyographically, requiring operative intervention in 10%. Furthermore, 17 of 26 patients previously operated on for carpal-tunnel syndrome, had chronic tendomyopathy requiring treatment, and in six there was severe generalized tendomyopathy. Thus generalized tendomyopathy can be the precipitating underlying disease in a large number of cases with so-called idiopathic carpal-tunnel syndrome.

Adult

Sensory electroneurographic parameters and clinical recovery of sensibility in sutured human nerves.

A total of 37 patients with traumatic transection of median or ulnar nerves at the wrist (total 41 nerves) were examined clinically and electrophysiologically 4-59 months after primary or secondary suture or grafting. There was a significant increase of cumulative amplitude with the time after suture, whereas maximum sensory nerve conduction velocity and maximum amplitude of nerve action potentials did not reveal such a correlation. The recovery of two-point discrimination, vibration threshold and sensibility scored according to the scale of Nicholson and Seddon were also not related to the passage of time after operation. Though there were significant correlations between cumulative amplitude and both two-point discrimination and recovery of sensibility, electrophysiological parameters were shown to be inadequate predictors of clinical recovery.

Adolescent

[Interposition arthroplasties in the area of the proximal carpal row (lunate and scaphoid replacement/partial replacement].

Prostheses are recommended for replacement of the scaphoid. Results of tendon interposition after resection of small proximal fragments are unpredictable. Therefore alternative procedures like liquid silicone casts or replacement by a lunate prosthesis (or part of the prosthesis of the scaphoid) have to be evaluated. If after removal of the lunate a prosthesis does not fit into the cavity we recommend filling this cavity with liquid silicone.

Arthrodesis

[Results of the surgical treatment of ulnar nerve neuropathy in the elbow area].

Osborne's decompression operation is used only in selected cases of cubital tunnel syndrome, where compression is obviously caused by the aponeurotic arch between the heads of flexor carpi ulnaris. In all the other cases, when there is subluxation or chronic dislocation of the nerve over the medial epicondyle, when there are adhesions in the postcondylar groove, when any other local cause or no cause at all is found, anterior transposition is preferred. More and more often we tend to use a subcutaneous transposition except in those cases where kinking would be unavoidable due to hypertrophy of flexor muscles. Epicondylectomy has been employed only in a few instances of pseudarthrosis of the medial epicondyle combined with ulnar palsy. Subluxation or dislocation of the ulnar nerve has been found in our series in 36,5% of 338 cases, which is more than indicated by Childress for a normal population (16%) and more than indicated in most reports of operated cases. This may be due to the fact that we pay particular attention to subluxation, finding it at operation in many cases where the subluxation could not be demonstrated clinically. Other abnormalities encountered were: hypertrophy of the medial head of triceps (15%); an ulnar nerve buried in the triceps muscle (3%); abnormal septa inserting into the medial intermuscular septum and constricting the nerve (1%); an epitrochleo-anconaeal muscle in 31 cases (9%), less often than indicated by Mumenthaler as being the normal frequency (20%). The aponeurotic arch between the heads of flexor carpi ulnaris was missing in 5% of cases. With the techniques advocated, improvement and healing occurred subjectively in 78%, clinically in 92%, and neurographically in 63,5% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

[Split skin-mesh transplants to cover burned hands].

Nonexpanded autologous mesh grafts of split thickness skin provide optimal wound drainage through their cuts. They also minimize disability from contraction and scarring when combined with Jobst compressive dressings. These properties assure good functional and cosmetic results in reconstructive surgery after burns. Since 1970 we have treated 18 hands of 15 patients with this method. The follow-up evaluation was performed at least 2 to 3 years after the operation and showed good functional and esthetic results.

Burns

[Reoperation after surgery of flexor tendons].

After stabilizing operations such as tenodesis or arthrodesis used for lesions of flexor tendons in the hand, secondary operations to achieve more suitable angulation are mainly needed when there is elongation of the tenodesis. Complications are more frequent after mobilizing operations such as reinsertion, advancement, Z-lengthening, primary suture, tendon graft or tendon transfer. Tenolysis, the operation most frequently used, since contractures may occur after all the prementioned procedures, is treated in a separate paper. Tendon rupture, for instance after reinsertion or advancement operations may require repetition of the primary procedure. More often another procedure will be indicated, for instance a graft after rupture of a primary suture. Pulley reconstruction is necessary when correction of bow-stringing is the aim. Synovitis after the first stage of HUNTER's tenoplasty, a consequence of mechanical or chemical irritation from the silastic rod, is best treated by a short period of immobilisation. Tardy, secondary contractures after tendon graft are a real problem. If conservative treatment using splints is ineffective, either the hook-deformity has to be accepted or the finger amputated.

Contracture