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Biomedical subjects

H S Gates

Publications and source records attributed to H S Gates.

10 recordsLinked to original sources
PubMed1995

Severe open subtalar dislocations. Long-term results.

Fifteen adolescents and adults were assessed an average of eighteen years after a type-III open subtalar dislocation. There were ten lateral and five medial dislocations. Associated injuries included ten injuries of the tibial nerve, seven of which were complicated by causalgia; five ruptures of the posterior tibial tendon; five lacerations of the posterior tibial artery; twelve articular fractures involving the subtalar joint; three articular fractures of the talonavicular joint; three fractures of the talar dome; and three malleolar fractures. Osteonecrosis of the body of the talus was found in five of the fifteen patients. It was treated with a triple arthrodesis in all five patients, one of whom had a subsequent conversion to a pantalar arthrodesis. Subtalar arthrodesis was done, because of post-traumatic osteoarthrosis, in two other patients. On functional assessment at the long-term follow-up examination, all patients reported some pain in the ankle, nine had difficulty climbing stairs, fourteen had difficulty walking on uneven surfaces, and eleven wore modified shoes. The patients who had had a tarsal arthrodesis returned to their pre-injury occupation or to a less strenuous job. Four patients who had persistent causalgia did not return to work. We concluded that open subtalar dislocation is a distinctly severe injury and that only fair functional and poor anatomical results can be expected in most patients.

Adolescent↗
PubMed1993

Pneumocystis carinii pneumonia in pregnancy. A case report.

The association of human immunodeficiency virus (HIV) infection and pregnancy has become more common. This virus has become a factor in the social affairs of even small, rural communities. We present a case in which the diagnosis of HIV was made during admission for Pneumocystis carinii pneumonia (PCP). The patient's condition worsened rapidly, necessitating delivery at 31 weeks' gestation by cesarean section followed by the patient's death from PCP. The infant survived and was healthy at 1 year of age.

AIDS-Related Opportunistic Infections↗
PubMed1992

Anterior capsulotomy and continuous passive motion in the treatment of post-traumatic flexion contracture of the elbow. A prospective study.

Thirty-three patients who had a post-traumatic flexion contracture of the elbow were managed consecutively with anterior capsulotomy without tenotomy of the biceps tendon or myotomy of the brachialis muscle. The first fifteen patients (Group I) did not receive continuous passive motion postoperatively. Preoperative active extension for Group I was to an average of 48 degrees short of full extension, which improved to 19 degrees at a mean follow-up time of forty-five months. Subsequently, eighteen patients (Group II) received continuous passive motion postoperatively for a mean of six weeks. Preoperative active extension for Group II was to an average of 55 degrees short of full extension, which improved to 23 degrees at a mean duration of follow-up of thirty-five months. The mean preoperative arc of motion for Group I was 69 degrees, which improved to 94 degrees postoperatively. The mean preoperative arc of motion for Group II was 48 degrees, which improved to 95 degrees postoperatively. Five patients in Group I and six patients in Group II had severe preoperative heterotopic ossification. There was no correlation, however, between preoperative heterotopic ossification and the amount that extension of the elbow improved postoperatively. There was no postoperative increase in heterotopic ossification. Four patients in Group I and six patients in Group II had severe post-traumatic osteoarthrosis preoperatively. Anterior capsulotomy is an effective treatment of post-traumatic flexion contracture of the elbow. Although the postoperative use of continuous passive motion did not significantly improve mean active extension, it did improve active flexion and the total arc of motion.

Adolescent↗
PubMed1990

The use of magnetic resonance imaging in the diagnosis of pigmented villonodular synovitis.

Although the clinical and radiographic features of pigmented villonodular synovitis (PVS) have been well described, diagnosis is often delayed and high rates of recurrence after synovectomy are reported. Magnetic resonance imaging (MRI) has been shown to be useful in the diagnosis of soft tissue masses. Three patients with biopsy-proven PVS and radiographs showing only effusion underwent MRI in the axial, coronal, and sagittal planes. The margins of the diseased synovium were best demonstrated on long TR/TE (T2-weighted) images. The synovium contained areas of void signal intensity felt to be due to hemosiderin, interspersed with increased signal from both inflammation and fat. In all cases, the margins of the diseased synovium were clearly delineated, allowing classification as nodular or diffuse. No appreciable change in signal intensity was seen when comparing nodular and diffuse forms. MRI is useful but not specific for PVS, since rheumatoid synovitis may show a similar signal pattern. However, MRI in patients with suspected PVS may decrease the time until diagnosis, aid in preoperative planning and obtaining adequate margins of resection, and may be a non-invasive method of long-term follow up for possible recurrence.

Adolescent↗
PubMed1990

Talar impingement by the anteroinferior tibiofibular ligament. A cause of chronic pain in the ankle after inversion sprain.

Seven patients who had pain in the anterior aspect of the ankle were found to have a thickened distal fascicle of the anteroinferior tibiofibular ligament. Each patient had a history of an inversion sprain of the ankle followed by chronic pain in the anterior aspect of the ankle. The thickened distal fascicle was resected without loss of stability of the ankle. Five patients needed débridement of an area of abraded hyaline cartilage on the anterolateral aspect of the talus. Six patients were followed for a mean of thirty-nine months (range, twenty-four to fifty-nine months). Four of them had no pain in the ankle or limitation in activities, and two reported marked improvement, with only occasional pain in the ankle related to overuse. A separate distal fascicle of the anteroinferior tibiofibular ligament is present in most human ankles and can be a cause of talar impingement, abrasion of the articular cartilage, and pain in the anterior aspect of the ankle. Resection of this ligament usually will alleviate the pain caused by the impingement.

Adult↗
PubMed1990

Bone-grafting in total hip arthroplasty for protrusio acetabuli. A follow-up note.

The results of total hip arthroplasty with the use of medial and superior bone-graft augmentation in thirty-nine hips (thirty-two patients) that had protrusio acetabuli were previously reported after two to eight years (mean, 4.7 years) of follow-up. We followed the surviving patients for 10.9 to 17.4 years (mean, 12.8 years). The average Harris hip-rating was 72 points--an average drop of 17 points since the previous report. The average was 64 points for patients who had rheumatoid arthritis and 83 points for those who had another diagnosis. Radiographic evaluation demonstrated definite, probable, and possible loosening in about 20, 10, and 60 per cent of the hips, respectively. Of the six hips that had definite loosening, four (10 per cent of the total series) had progression of the protrusion (acetabular migration); operative revision was performed on two of those four hips and on two other hips, in which progression had ceased. Hips that had progressive protrusion demonstrated superior migration more often than medial migration. The rates of loosening and revision were similar to those in hips that did not have protrusio acetabuli. We concluded that augmentation of total hip arthroplasty with bone-grafting is effective in arresting the progression of protrusio acetabuli in most hips (90 per cent in our series).

Acetabulum↗
PubMed1989

Radiographic measurements in protrusio acetabuli.

The radiographic data of 48 hips in 40 patients with painful, progressive protrusio acetabuli treated with cemented total hip arthroplasty and medial acetabular reinforcement using autologous or homologous bone grafts were reviewed. Twelve separate measurements were performed on the preoperative, postoperative, and most recent radiographs of each case to determine which measurements were the most useful in diagnosing protrusio acetabuli and in following preoperative and postoperative migration. The minimum follow-up period was 10 years (mean, 12.3 years). Vertical migration and horizontal distance, two measurements utilizing an X-Y coordinate system based on the acetabular teardrop, were found to be most useful. The cases with postoperative progression demonstrated vertical migration more often than medial migration.

Acetabulum↗
PubMed1984

Uterine cancer screening by the family physician.

Endometrial diagnostic techniques available to the family physician for office use have a high degree of accuracy in identifying intrauterine pathology. Recent refinements in endometrial sampling devices have made their use cost-effective and complication rates minimal. These methods can be utilized annually for screening asymptomatic women at high risk of developing uterine cancer. Detection of endometrial hyperplasia has improved with the newer samplers. Patient acceptance is excellent, especially with the cytologic devices.

Adult↗