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Biomedical subjects

J P Moermans

Publications and source records attributed to J P Moermans.

At least 19 recordsLinked to original sources
PubMed2002

Single injection digital block: comparison between three techniques.

INTRODUCTION: Regional anesthesia of a single finger is commonly achieved by the traditional ring block. The major drawback of this technique is the need for at least two painful injections in the digit. Single injection techniques have been described. A comparison of their results could help health professionals select the most appropriate technique. MATERIAL AND METHODS: A prospective randomized study was designed to compare three techniques in term of patient tolerance, distribution of anesthesia and efficiency: the modified transthecal digital block, the subcutaneous digital block and a combination of the two. Digits were randomized in three groups (n = 30). Blocks were performed by a single investigator. A visual analogic scale was used to evaluate pain associated with the injection. Prick-testing was used to evaluate anesthesia at the volar and dorsal aspects of the phalanxes. Statistical analysis of the results was performed. RESULTS: All techniques allowed surgery to be performed without complementary injection most of the time (25/30). The dorsum of the proximal phalanx, however, was unpredictably included in the anesthetized territory. The highest rate of full digital block was achieved with the combined technique. DISCUSSION: The least invasive of equally effective techniques should be considered as the first choice. The subcutaneous single injection digital block is safe, efficient and easy to perform. It allows treatment of all conditions on the volar aspect of the finger and on the dorsal aspect of the distal and middle phalanxes. For surgery on the dorsal aspect of the proximal phalanx, a supplementary dorsal block should be used.

Anesthesia, Conduction↗
PubMed2002

Percutaneous Herbert screw fixation for fractures of the scaphoid: review of 30 cases.

INTRODUCTION: The purpose of this study was to evaluate the results of percutaneous fixation of undisplaced or minimally displaced fractures of the scaphoid using the first generation Herbert screw in terms of union, functional results and scaphoid mobility. METHODS: 30 of the 50 patients operated on in our department between 1995 and 2000 were available for evaluation by an independent observer. Wrist mobility, grip strength and key pinch were measured. Scaphoid mobility was evaluated by measuring radioscaphoid angles in flexed and extended positions on dynamic X-rays. RESULTS: The union rate was comparable to that achieved by non-operative management (90%). Resumption of professional activities was possible long before bony union because immobilization was short. Grip strength, wrist and scaphoid mobilities were comparable to the controlateral sides except for scaphoid flexion. Persistent symptoms were found in 30% of the patients despite union of their fracture. DISCUSSION: Our results demonstrate that percutaneous stabilization of undisplaced or minimally displaced fractures of the scaphoid preserves the mobility of the wrist and minimally alters the normal dynamics of the carpus. The duration of work inability is short.

Adult↗
PubMed2001

Atypical mycobacterial infections of the hand: report of eight cases and literature review.

INTRODUCTION: Atypical mycobacteria are an uncommon cause of hand infections in immunocompetent patients. Diagnosis is often delayed, with consequent increased morbidity. Better awareness would allow earlier diagnosis and treatment. MATERIAL AND METHODS: Eight patients with atypical mycobacterial hand infections treated in our department over a 21 year period have been retrospectively identified. Their charts have been searched for the general characteristics of these infections, treatment and outcome. Our findings have been compared to the data collected from a literature review. RESULTS: These pathogens have caused soft tissue infections in otherwise healthy patients. Clinical signs were those of chronic finger or wrist synovitis or skin granulomas. Carpal tunnel syndrome was a common finding. Diagnosis relied on surgical biopsy. Germ identification required specific incubation temperature and media. Antibiotics and synovectomy have been the mainstay of therapy. DISCUSSION: In a patient with achronic, relapsing, superficial or deep skin infection or tenosynovitis, aquatic and farm exposures are important anamnestic keys to diagnosis. Extensive synovectomy is both diagnostic and therapeutic. Specific cultures should be ordered without delay. Oral pharmacotherapy should be initiated upon clinical suspicion.

Adult↗
PubMed1996

Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint of the thumb.

We assessed the results of 86 trapeziectomies in 83 patients. Simple excision of the trapezium was performed in 54 thumbs. This was combined with shortening of the abductor pollicis longus tendon in 14 thumbs and with soft-tissue interposition and/or ligamentous reconstruction in 17 thumbs. 88% of the patients were satisfied with the result, 76% had relief of pain and 74% had no functional disability. The subjective results achieved with the three different techniques were similar. Clinical assessment of 57 thumbs revealed no statistical difference in web span, thumb adduction-flexion, key pinch and grip strength between the three operative procedures, nor in comparison with the non-operated contralateral hand.

Adult↗
PubMed1996

Glomus tumours of the hand. A retrospective study of 51 cases.

The authors report a series of 51 patients with glomus tumours in the hand. The duration of symptoms before treatment averaged 10 years. No one site or finger was more commonly involved. Objective features were limited to a blue discoloration in 29%, a pulp nodule or a nail deformity in 33%. An osseous defect was seen on plain X-ray films in 36%. Diagnosis depended on clinical suspicion in 90%. Careful dissection and complete excision of the tumour almost always offer permanent relief. A direct transungual approach was used in the subungual tumours with only one cosmetic problem. Recurrence of symptoms occurred in only two cases after a pain-free interval of 2 years.

Adult↗
PubMed1996

Long-term results after segmental aponeurectomy for Dupuytren's disease.

Segmental aponeurectomy has been proposed as a less extensive procedure for the treatment of Dupuytren's disease to limit the incidence of wound complications and stiffness associated with wide dissections. Analysis of the late results showed that the operation brought a lasting correction of the contracture. In hands which did not show any sign of progression of the disease, the follow-up values were even slightly better than the immediate postoperative measurements. It also showed that the proportions of recurrences, extensions and hands free of the disease are similar to those after other procedures and that the type of operation does not appear to be related to the progression of Dupuytren's disease.

Disease Progression↗
PubMed1995

[Percutaneous Herbert screw osteosynthesis of the scaphoid bone].

Scaphoid fractures are the most common carpal fractures. Conservative treatment is long, and non-union is frequent after immobilization in a cast. The Herbert procedure is an improvement, but access to the scaphoid is through an extensive open exposure that damages the blood vessels and the anterior radiocarpal ligaments. In order to solve this problem we used the Herbert screw for percutaneous internal fixation resulting in minimal operative trauma. This procedure requires intraoperative x ray guidance and the use of the accessories of the Herbert set except the "Jick". We operated 23 patients for acute fracture (19 cases) or nonunion (4 cases) of the waist of the scaphoid. In this study, the average follow-up was 16 months and the average age was 32 years. There were 18 men and 5 women. In 18 cases the fracture occurred on the right side. The average immobilization was 15.5 days. Union was obtained in all patients. Postoperative range of motion was 95% of the unaffected side. Key pinch was 6% better than on the unaffected side (the dominant hand was affected in 81% cases). Patients returned to work after an average of 7 weeks.

Adolescent↗
PubMed1991

Segmental aponeurectomy in Dupuytren's disease.

We report 213 consecutive segmental aponeurectomies in 175 patients. Through several small curved skin incisions, segments of diseased tissue about 1 cm long were excised. No attempts were made to remove all the Dupuytren's tissue, the aim being to achieve discontinuity. The results are described in detail and compare well with conventional techniques of partial fasciectomy.

Adult↗
PubMed1989

Fingertip amputations: distal or advancement flaps.

Fingertip amputations treated with conventional flaps gave consistently good coverage, but the recovery of sensibility was superior in advancement flaps. Residual pain, however, was less frequent in distal flaps. Work incapacity averaged between 6 and 8 weeks.

Adolescent↗
PubMed1985

False aneurysm of the radial artery.

A 22-year-old man presented a large false aneurysm of the radial artery in the middle third of the forearm. A segment of the artery was resected and replaced with a vein graft. This lesion is uncommon, but should always be treated early because complications can be severe.

Adult↗
PubMed1984

Carpal tunnel syndrome: postsurgical course of symptoms.

The authors analyse the results obtained by the surgical treatment of 113 carpal tunnel syndromes. Performed under locoregional anesthesia, the operation has always been the same: transsection of the volar carpal ligament and epineurolysis on the volar aspect of the median nerve. The results obtained were excellent concerning paresthesia and hypoesthesia. The eventual pejorative influence of three factors, duration of symptoms of more than one year, motor nerve latency over 6 msec., and cyanotic appearance of the nerve, could not be established.

Adult↗