Biomedical subjects
Publications and source records attributed to J L Posch.
The case of an infant with bilateral hand loss secondary to Kawasaki syndrome is presented. The peripheral changes in this patient are believed to be related to thrombosed aneurysms that are caused by vasculitis.
The case of a young female child with dermatomyositis and flexion contracture in the dominant hand secondary to calcinosis is presented. Function was improved by flexor tenosynovectomy and removal of calcium deposits.
Emergency care of the reimplantation candidate involves care of the patient as well as the severed part. The part should be cooled rapidly to 0-4 C (32-39.2 F) after gentle cleansing with normal saline solution or Ringer's lactate. The stump should be gently irrigated with normal saline and pressure dressing applied. The suitability of the reimplantation candidate, chances for survival of the amputated part, and likelihood of eventual rehabilitation should be evaluated.
Five cases are presented of hard, brawny edema of the dorsum of the hand, typical of Secretan's disease. We now believe splinting and active exercise to be the initial treatment of choice. Only after months of such conservative management should one resort to surgery.
The distal extent of the radius and ulna (ulnar variance) was compared on roentgenograms of normal wrists in randomly selected black and white patients and of fifteen affected wrists in patients with Kienbock's disease. The results establish a statistically significant association between negative ulnar variance and Kienbock's disease. Blacks have more positive ulnar variance and the disease is less likely to develop in them than in whites.
In high-pressure injection injuries to the hand the most commonly injected materials are automotive grease, diesel oil, and paint. We treated twenty-six patients with high-pressure injection injuries of the hand and found that the injection of paint resulted in a poorer prognosis than did the injection of grease. Amputation is often necessary with paint injections into a digit, while injections into the palm have a somewhat better prognosis. The disability time of patients with paint-injection injuries appeared to be directly related to the time elapsed until amputation of the involved digit. Although we were unable to specifically relate the ultimate result to the time elapsed between injury and proper treatment, we continue to recommend early aggressive wide débridement of these injuries.
Surgical decompression was performed in two hundred ninety one cases of carpal tunnel syndrome with good results in 80%, fair results in 10% and poor results in 10% of the cases.
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