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Biomedical subjects

H S Matloub

Publications and source records attributed to H S Matloub.

At least 91 records · Page 5Linked to original sources
PubMed1990

Use of a portable floor crane as an aid to resection of the massive panniculus.

Resection of the massive abdominal panniculus is technically difficult due to the weight of the tissue and the difficulty in controlling the tissue during surgery. The authors describe the use of a portable floor crane that facilitates resection by reducing the number of assistants required, increasing exposure, and providing for adequate control of the specimen, which assures proper preoperative markings and sterile preparation. Blood loss is reduced, as is operating time. The portable floor crane is usually available in hospital maintenance departments and can be easily modified for intraoperative use.

Abdomen↗
PubMed1990

The lateral arm fascial free flap: its anatomy and use in reconstruction.

Free fascial transfer has been used for reconstruction of gliding surfaces of the upper and lower extremities or when thin, pliable coverage is required (hand, heel, nose, and ear). In our experience with the lateral arm fasciocutaneous flap, we have found that the fascia alone is an excellent source of tissue for free flap transfer. A thorough investigation of the microscopic, gross, and radiographic anatomy of the lateral arm fascia was undertaken by the study of 25 fresh cadavers. Vascular pathways were mapped, their locations were analyzed, and then they were correlated with the elevation, design, and transfer of the flap. The lateral arm has a large fascial component located anterior and posterior to the lateral intermuscular septum, which itself lies between the triceps and the brachialis and brachioradialis muscles. It is perfused by the posterior radial collateral artery (PRCA), one of the terminal branches of the profunda brachii. This vessel (PRCA) provides at least four fascial branches from 1 to 15 cm proximal to the lateral epicondyle, the largest of which is located an average of 9.7 cm superior to the lateral epicondyle. Fascia up to 12 x 9 cm may be used with good axial perfusion. The histologic cross sections demonstrate the complex anatomy of the fascia itself, as well as its relation to the nutrient vessels. We have applied the lateral arm fascial flap in five cases of upper extremity reconstruction. We have also found this flap valuable in preservation of underlying anatomic detail for total reconstruction of the ear and nose when local tissue and more conventional flaps were not available.

Adult↗
PubMed1990

Reliability of sensory threshold measurement using a digital vibrogram.

Loss of vibratory sensation has been suggested as an early symptom in the diagnosis of compression neuropathies. The use of a digital vibrogram has recently been examined as a means of evaluating vibratory sensation thresholds over a range of frequencies from 8 to 500 Hz. Although this instrument does yield useful clinical information, little is known about the test-retest reliabilities of the thresholds obtained. To learn more about this, we assessed a total of 76 hands--32 normal and 44 with suspected carpal tunnel syndrome. The average sensory thresholds for onset and cessation of vibratory sensation were obtained. Pearson product-moment correlation coefficients were computed, and demonstrated improvement if an initial practice trial was administered. Our findings suggest that the vibrogram can be a reliable, clinical assessment when an initial practice trial is included as part of the standard administration.

Carpal Tunnel Syndrome↗
PubMed1989

On-site work evaluations: desensitisation for avoidance reactions following severe hand injuries.

This study examined on-site work evaluations as an environmental exposure strategy to promote return to work in 15 recalcitrant patients who had failed to benefit from established methods of reducing post-traumatic stress disorder symptoms. Following the on-site work evaluation, 87% of these patients were able to use visualisation of the work setting to further desensitize themselves and returned to work within the next eight weeks. All 87% have continued to be employed at six and twelve month follow-ups. This approach holds promise for assisting patients with hand injuries who develop post-traumatic stress disorder and fail to respond to traditional psychological strategies.

Behavior Therapy↗
PubMed1989

Aeromonas hydrophila upper extremity infection.

A severe soft tissue infection of the upper extremity caused by Aeromonas hydrophila followed a water skiing injury in which a tow rope caused degloving of a portion of the skin and severe contusion to underlying muscle. Infection was established within 36 hours of the injury, accompanied by fever, leukocytosis, and a foul odor. Rapid clinical improvement occurred following radical debridement of all nonviable tissue and antibiotic therapy. In cases involving water contamination, Aeromonas hydrophila infection should be suspected with the onset of a rapidly developing infection with a febrile response. Rapid surgical intervention and treatment with an aminoglycoside or a third-generation cephalosporin antibiotic is the treatment of choice.

Adult↗
PubMed1989

Successful replantation of the heel pad: a seven-year follow-up.

The authors present a case of successful replantation of the soft tissue of the heel. Circulation was restored by the use of a vein graft from the posterior tibial artery to an arterial branch of the subcutaneous plexus found on the medial aspect of the heel. Two small veins were anastomosed at the edge of the defect. The heel lacks sensation, but the patient has been able to return to work as a heavy laborer in a steel foundry and is walking without the use of orthotics or modified shoes seven years later. This is the first reported case of successful replantation of only the soft tissue of the heel.

Adult↗
PubMed1988

Identifying motor and sensory myelinated axons in rabbit peripheral nerves by histochemical staining for carbonic anhydrase and cholinesterase activities.

Carbonic anhydrase (CA) and cholinesterase (CE) histochemical staining of rabbit spinal nerve roots and dorsal root ganglia demonstrated that among the reactive myelinated axons, with minor exceptions, sensory axons were CA positive and CE negative whereas motor axons were CA negative and CE positive. The high specificity was achieved by adjusting reaction conditions to stain subpopulations of myelinated axons selectively while leaving 50% or so unstained. Fixation with glutaraldehyde appeared necessary for achieving selectivity. Following sciatic nerve transection, the reciprocal staining pattern persisted in damaged axons and their regenerating processes which formed neuromas within the proximal nerve stump. Within the neuromas, CA-stained sensory processes were elaborated earlier and in greater numbers than CE-stained regenerating motor processes. The present results indicate that histochemical axon typing can be exploited to reveal heterogeneous responses of motor and sensory axons to injury.

Animals↗
PubMed1988

Early psychological aspects of severe hand injury.

We investigated the incidence and nature of psychological symptoms occurring during the first two months after severe hand injuries. 94% of patients had significant symptoms at some point early in rehabilitation, including nightmares (92%), flashbacks (88%), affective lability (84%), preoccupation with phantom limb sensations (13%), concentration/attention problems (12%), cosmetic concerns (10%), fear of death (5%), and denial of amputation (3%). Two months later, flashbacks (63%) remained pronounced. Nightmares (13%), affective lability (48%), concentration/attention problems (5%), fear of death (0%), and denial of amputation (0%) declined markedly, while cosmetic concerns (17%) and preoccupation with phantom limb sensations (17%) increased. Based on these findings, we believe that psychological treatment should often be given as part of the rehabilitation process.

Affective Symptoms↗
PubMed1988

Flashbacks after traumatic hand injuries: prognostic indicators.

Flashbacks of a traumatic hand injury may compromise a patient's rehabilitation process. This study examined the nature and significance of these flashbacks in a work-injured population. We also evaluated the ability of these patients to return to work at the site of the original injury. Sixty-one patients with work-related, traumatic hand injuries received psychological evaluation and treatment. All patients experienced flashbacks. The following three types of flashbacks were identified: (1) a replaying of the events occurring just before the accident and continuing until the injury (replay flashbacks), (2) an image of the injured hand just after the trauma occurred (appraisal flashbacks), and (3) images in which an injury that was more severe than the one that actually occurred were perceived (projected flashbacks). Regardless of the result of injury, patients with replay flashbacks were the most likely to return to their former employment (95.2%) after only 4.8 1-hour sessions of psychotherapy for control of symptoms. Patients with a combination of appraisal and projected flashbacks were the least likely to return to work (10.3%), despite the fact they received an average of 13.1 1-hour sessions of psychotherapy.

Accidents, Occupational↗
PubMed1988

Enhancement of rehabilitation by use of implantable adjuncts with vascularized bone grafts for mandible reconstruction.

Restoration of mandibular continuity after trauma or cancer by means of vascularized bone grafts, as described by Taylor and coworkers in 1979, has become an established method of oral rehabilitation. Still considered by some an endpoint in reconstruction, we have found that the judicious application of newly described dental prosthetic materials can provide the patient with improved appearance and function associated with a fully restored mandible. Twelve patients who underwent vascularized bone grafting for mandibular reconstruction had adjunctive implantation to improve either dentition or to reconstruct the temporomandibular joint. Nine patients had dental implants to restore permanent stable dentition either by placement of the mandibular bone staple plate or osseointegrated implants. Three additional patients underwent placement of metallic condylar head prostheses placed on the vascularized bone graft at the time of transfer. These patients demonstrated good mastication and an excellent incisal opening which was maintained in the late postoperative period. Vascularized bone transfer for restoration of continuity of the mandible should not be considered an endpoint in and of itself. By using implantable dental devices to restore dentition and condylar head prostheses to improve both the aesthetic result and function of the mandible to complement the vascularized osteocutaneous flap, we can bring our patients closer to the goal of total rehabilitation. The majority of these patients would otherwise never have been offered a chance at restoration of dentition. All had beneficial effects with regard to mastication and the majority also had improved speech.

Biomechanical Phenomena↗
PubMed1988

Eccrine porocarcinoma.

Eccrine porocarcinoma is a rare malignancy of the eccrine sweat duct unit. This article brings to 79 the number of cases reported. Our report and a review of the literature illustrate the natural history and pathological findings of this disease. Patients' ages at the time of appearance for treatment range from 19 to 90 years. The lesions show no predilection for site; their location follows the distribution of sweat glands in the body. Thirty-nine percent of all patients had cutaneous, regional lymph node, or visceral metastases. Primary treatment is wide surgical excision. The value of adjunctive therapy has not been proved.

Adenocarcinoma↗
PubMed1988

Sexual dysfunction following traumatic hand injury.

The purpose of this study was to examine the frequency and nature of sexual dysfunction present in a population with traumatic hand injuries. One hundred twenty patients were seen for psychological evaluation during the first two months postinjury. Forty-nine percent (59) reported sexual dysfunction during the initial two months. Six months postinjury 19% (23) continued to have sexual dysfunction. At that time a more extensive sexual history was obtained. Three categories of sexual dysfunction were identified following interviews: (1) impotence (35% or 8 patients), (2) reduced sexual desire (65% or 15), and (3) rejection of sexual contact by the partner (39% or 9). Four major causes of impaired sexual functioning were reported: (1) pain (22% or 5 patients), (2) deformity anxiety (52% or 12), (3) replant anxiety (9% or 2), and (4) contagious anxiety (39% or 9). The results of this study indicate that persistent sexual dysfunction may be a major difficulty following hand trauma. The type of dysfunction as well as the perceived cause of dysfunction are not the same for each case. Consideration of each is necessary to design efficacious intervention strategies.

Adult↗
PubMed1987

Warm ischemic damage to the epiphyseal growth plate: a rabbit model.

Warm ischemic growth plate damage was produced in the hindlimbs of 33 New Zealand white rabbits, who were 7 weeks old, by isolating the knee joint on a popliteal vascular pedicle. Zero, 3, 7, and 12 hours of warm ischemia were produced by pedicle occlusion. The 0- and 3-hour ischemic groups showed mild growth disturbances related to the surgical model and were not statistically different at 90 days postoperatively. The 7- and 12-hour ischemia groups showed severe growth disturbances and were statistically different from the 0- and 3-hour groups at all periods measured (p less than 0.05). Large central growth plate lesions were apparent by histologic examination. Twelve hours of ischemia produced a histologic picture identical to growth plate infarction. Increased warm ischemic time correlated with more severe growth retardation and evidence of increased damage to the central area of the growth plate histologically.

Animals↗
PubMed1987

The anterior tibial artery flap: anatomic study and clinical application.

Satisfactory replacement of skin defects over the lower leg remains a difficult problem. Various forms of coverage, including, local rotation flaps, muscle flaps, and fascial and free flaps, have their specific indications and inherent disadvantages. In this work, a new axial skin flap based on perforating vessels in the territory of the anterior tibial artery is described. A series of 50 lower leg dissections was carried out in 25 fresh cadavers after latex injection into the femoral artery. Detailed studies of the cutaneous distribution of the anterior tibial artery showed that three main arteries perfuse the anterior lateral portion of the lower leg. The superior lateral peroneal artery and the inferior lateral peroneal artery interseptal cutaneous perforators arise at an average of 25.6 and 17.2 cm from the lateral malleolus, respectively. The superior lateral peroneal artery was present in 100 percent of the specimens, whereas the inferior lateral peroneal artery was present in 70 percent of the specimens. In their course, they give several muscular branches to the peroneus longus and brevis prior to perforating the fascia and arborizing in the subcutaneous tissues of the anterolateral portion of the leg. The average external diameter was 1.6 cm for the superior and 1.4 cm for the inferior lateral peroneal artery. The superficial peroneal nerve accessory artery is the third artery which contributes to the skin of the lower leg. It arises from the superior lateral peroneal artery in 30 percent of cases, from the inferior lateral peroneal artery in 40 percent, and from both in 30 percent. The artery runs along with the superficial peroneal nerve and gives several cutaneous perforators along its descending course. Several cutaneous axial flaps can be fashioned around this anatomy. The operative technique along with demonstrative clinical cases is presented followed by pertinent discussion.

Arteries↗
PubMed1985

Pseudo-anterior interosseous nerve syndrome.

The anterior interosseous nerve syndrome (AINS) is well known. A case is presented that had electromyographic findings limited to the distribution of the anterior interosseous nerve. A small area of sensory loss and slight asymmetry of amplitudes noted on median nerve conduction studies were inconsistent with an AIN syndrome. An antecubital level partial median nerve compromise primarily involving the bundles that form the anterior interosseous nerve was surgically noted. This case illustrates that localization of a peripheral nerve lesion must include consideration of the internal topography of peripheral nerves.

Electromyography↗
PubMed1985

The vascular supply to the proximal interphalangeal joint.

Four methods were used to identify the vascular branches that supply the proximal interphalangeal joint in 55 cadaver fingers. They were intra-arterial injection of radiopaque dyes, microscopic dissections of the arterial system, selective injection of specific branches followed by sectioning of the joints and examination of the areas stained, and histologic sectioning. Our studies show that the major branches of the digital artery to the joint arise from the dorsal aspect of the vessel, while smaller branches that run to the soft tissue arise from the palmar side. Three branches supply the proximal interphalangeal joint. The first arises 1.5 to 2.5 cm proximal to the joint and divides into branches to the dorsal skin, the bone proximally, the vincular system, the lateral surface of the joint, and the palmar plate. The other two branches arise distal to the joint space; the first has branches to the palmar aspect of the joint of the middle phalanx and the vincular system. The most distal of the three perfuses the dorsal surface of the joint.

Arteries↗
PubMed1985

Retardation of finger growth after injury to the flexor tendons.

The absence of any part of the total mechanical force (i.e., flexor tendons) may be responsible for retardation of bone growth during a child's growth phase. The cause of retardation may be dedifferentiation of cartilage cells at the epiphyseal plate. Four cases in which unrepaired flexor tendons in digits caused retardation of growth illustrate this possible phenomenon. We feel that this is not a well recognized problem and thus deserves mention to stimulate further study. We believe that meticulous primary repair in children is desirable not only to preserve function, but also to prevent growth disturbances.

Age Factors↗