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Biomedical subjects

J H Dobyns

Publications and source records attributed to J H Dobyns.

90 records · Page 5Linked to original sources

Diphtheroid osteomyelitis.

Isolates of either Corynebacterium diphtheriae or Propionibacterium acnes from osteomyelitis are not necessarily contaminants, as shown by the cases of three patients who had bone and joint infections in which these organisms were pathogenic (one in pure culture and two in mixed cultures). Previous operation or other factors that compromise host resistance create the setting for these opportunistic organisms. Penicillin with or without streptomycin is the treatment of choice, but if penicillin or streptomycin cannot be used then the cephalosporins, clindamycin, and erythromycin are acceptable alternatives (depending on susceptibility studies). In general, the prognosis is good.

Aged↗

Review and analysis of silicone-rubber metacarpophalangeal implants.

A series of 530 consecutive arthroplasties using silicone-rubber implants in 119 patients was reviewed. Clinical and roentgenographic evaluations were completed on sixty patients and 254 implants, with an average follow-up of two and a half years; the remaining fifty-nine patients were evaluated by questionnaire. All but three patients had rheumatoid disease, usually with severe deformity, and many of the patients underwent other procedures on the upper extremity; these procedures often precluded early motion after the arthroplasties. Three prostheses (0.6 per cent) were removed because of infection, and reoperation was required in 2.4 per cent of the joints. Detailed clinical follow-up of 254 prostheses revealed the following: for Swanson prosthesis-average motion 38 degrees, fracture rate 26.2 per cent, and recurrence of clinical deformity 11.3 per cent; for Neibauer prostheses-average motion 35 degrees, fracture rate 38.2 per cent, and recurrence of clinical deformity 44.1 per cent. It should be noted that use of early implant types and some variations from the designer's recommended rehabilitation protocols were features of this series.

Adolescent↗

Common and uncommon infections of the hand.

Most serious hand infections are preventable at this time if proper prophylaxis is maintained with regard to the hands and if the precursor conditions-mild inflammations and infections-are quickly and appropriately treated. In those few serious hand infections that still occur, a judicious combination of medical, surgical, and rehabilitative measures should preserve normal or at least reasonable function in practically all instances.

Abscess↗

Congenital duplication of the thumb.

Duplication or polydactyly of the thumb is among the most common congenital deformities that involve the hand. The purpose of this presentation is to review the Mayo Clinic experience with thumb duplication and to present preferred operative procedures to achieve the best clinical outcome and esthetic appearance for the hand. We propose that a combination or "best of parts", utilizing the components of both duplicates with retention of the ulnar duplicate as the base for reconstruction will provide the most functional clinical result. A clinical grading system and analysis of results from our personal experience during two different time frames provides the scientific support for our conclusions that combination procedures are preferred to simple excisions or to central joining of parts as in the Bilhaut-Cloquet procedure.

Child↗

Sports stress syndromes of the hand and wrist.

Many injuries to the hand and wrist may be seen in the practice of sports medicine. Most of these injuries are well known and the details of their diagnosis and treatment are well documented. However, even among this group, certain injuries frequently escape detection or are not monitored carefully enough to detect their frequent residual complications. These injuries are particular sources of problems. Some little known diagnoses are seldom considered, but any diagnosis, even a presumptive one, is better than applying vague, descriptive, but nondefinitive terms to an athlete's injury. Although the ideal treatment is not yet available for any of these injuries, a lack of diagnosis will often mean that treatment is haphazard or nonexistent.

Athletic Injuries↗