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Biomedical subjects

J Stothard

Publications and source records attributed to J Stothard.

At least 19 recordsLinked to original sources
PubMed2006

Two significant complications following percutaneous needle fasciotomy in a patient on anticoagulants.

Percutaneous needle fasciotomy treatment of Dupuytren's disease has been used on the continent for over two decades but has only recently gained popularity in the UK. The National Institute for Clinical Excellence published guidance in February 2004 stating that the procedure is safe and effective. We report a case of two complications in the same patient following the use of the technique, on only one occasion, in a patient who was anticoagulated. We believe that it is the first time that a false aneurysm has been reported following the procedure and that this was probably related to the inhibited coagulation cascade. The patient also sustained an injury to flexor digitorum profundus but had an intact superficialis tendon and we find it difficult to explain this occurrence. We report the above complication as we feel this technique may be chosen specifically in patients with co-existing medical problems such as anticoagulation.

Aged↗
PubMed2006

Local anaesthesia for carpal tunnel decompression: a comparison of two techniques.

Carpal tunnel decompression is mostly performed as a day case procedure using local anaesthesia. The local anaesthetic is commonly administered by subcutaneous infiltration alone (the Gale technique) or by infiltration of the local anaesthetic into the carpal tunnel in addition to the subcutaneous infiltration (the Altissimi and Mancini technique). The intention of this study was to compare the efficacy of anaesthesia using these two techniques. Twenty patients with bilateral carpal tunnel syndrome were recruited. One side underwent surgery at a time. Patients were randomised to receive anaesthesia by one technique on the first side and the other on the second. Pain was evaluated using the numerical rating pain scale (0-10). Six patients experienced intraoperative pain with the Gale technique, while none had pain with the Altissimi and Mancini technique (P = 0.02). The postoperative pain was not significantly different between the two groups, although the patients anaesthetised by the Altissimi and Mancini technique required significantly lower numbers of analgesic tablets.

Adult↗
PubMed2004

A randomized controlled trial of knifelight and open carpal tunnel release.

A randomized controlled trial was done to compare the results of carpal tunnel decompression using the standard open approach and the Knifelight technique. Twenty-six patients with bilateral carpal tunnel syndrome requiring operation were selected for the study and the operative technique was randomized for the first hand. Six weeks later, the second hand was operated upon using the alternate technique. There was little difference between the two techniques with regard to time taken to return to work, return of grip strength, symptom relief, complications, incidence of pillar pain and patient preference. However, the incidence of scar tenderness was significantly lower with the Knifelight technique.

Carpal Tunnel Syndrome↗
PubMed2003

A clinical questionnaire for the diagnosis of carpal tunnel syndrome.

This prospective study compared the sensitivities of a scored questionnaire and electrophysiological examination in the diagnosis of carpal tunnel syndrome. Patients were assessed by a hand surgeon using a scored questionnaire, and then underwent an electrophysiological assessment by an experienced neurophysiologist (blinded to the questionnaire results). Patients diagnosed as having carpal tunnel syndrome by either the questionnaire, the electrophysiological examination or both underwent decompression. Symptom relief was taken as the "gold standard" for true carpal tunnel syndrome. The results showed a sensitivity of 85% for the scored questionnaire and 92% for nerve conduction studies with a positive predictive value of 90% for the scored questionnaire and 92% for nerve conduction studies. The authors recommend that a scored questionnaire can replace nerve conduction studies in the initial assessment of whether patients presenting with dysaesthesiae in the fingers should undergo surgery. This will give major time, personnel and cost benefits.

Carpal Tunnel Syndrome↗
PubMed1999

Genetic diversity and genetic exchange in Trypanosoma cruzi: dual drug-resistant "progeny" from episomal transformants.

Extensive characterisation of Trypanosoma cruzi by isoenzyme phenotypes has separated the species into three principal zymodeme groups, Z1, Z2 and Z3, and into many individual zymodemes. There is marked diversity within Z2. A strong correlation has been demonstrated between the strain clusters determined by isoenzymes and those obtained using random amplified polymorphic DNA (RAPD) profiles. Polymorphisms in ribosomal RNA genes, in mini-exon genes, and microsatellite fingerprinting indicate the presence of at least two principal T. cruzi genetic lineages. Lineage 1 appears to correspond with Z2 and lineage 2 with Z1. Z1 (lineage 2) is associated with Didelphis. Z2 (lineage 1) may be associated with a primate host. Departures from Hardy-Weinberg equilibrium and linkage disequilibrium indicate that propagation of T. cruzi is predominantly clonal. Nevertheless, two studies show putative homozygotes and heterozygotes circulating sympatrically: the allozyme frequencies for phosphoglucomutase, and hybrid RAPD profiles suggest that genetic exchange may be a current phenomenon in some T. cruzi transmission cycles. We were able to isolate dual drug-resistant T. cruzi biological clones following copassage of putative parents carrying single episomal drug-resistant markers. A multiplex PCR confirmed that dual drug-resistant clones carried both episomal plasmids. Preliminary karyotype analysis suggests that recombination may not be confined to the extranuclear genome.

Animals↗
PubMed1998

Anterior interosseous nerve syndrome: appearance at MR imaging in three cases.

Three patients with symptoms attributable to anterior interosseous nerve syndrome underwent forearm magnetic resonance (MR) imaging. In all patients, short inversion time inversion-recovery, or STIR, images depicted increased signal intensity from some or all muscle groups innervated by the anterior interosseous nerve. In one patient, atrophy was depicted in these muscles. MR imaging may serve as a useful adjunct to electromyography in the investigation of anterior interosseous nerve syndrome.

Adult↗
PubMed1997

Open carpal tunnel release. Does a vascularized hypothenar fat pad reduce wound tenderness?

Carpal tunnel decompression gives relief of symptoms of tingling and numbness in the fingers in around 90% of carpal tunnel syndrome cases. The most common complaint after operation is pain and tenderness about the operation scar. The normal median nerve slides back and forth during wrist movement. Loss of this movement due to scar adhesion is suggested as a cause of wound pain and residual symptoms. We performed a controlled, blinded study of bilateral primary carpal tunnel releases comparing standard closure with a hypothenar fat pad flap modified closure. No significant differences in pain or other symptoms were found.

Adipose Tissue↗
PubMed1995

What do doctors mean by tenosynovitis and repetitive strain injury?

Confusion exists in both the scientific and the lay press on the meaning of the terms tenosynovitis and repetitive strain injury. The courts are increasingly being asked to make judgements on individual cases but this gives little in the way of guidance to doctors producing reports for the Department of Social Security or solicitors. The aim of this study was to document what such doctors mean by these terms, what diagnostic criteria they use, and to make any necessary recommendations. The diagnostic criteria for DSS industrial conditions A8 (tenosynovitis) and A4 (professional cramp) varied greatly and what the experts understood by the term 'repetitive strain injury (RSI)' was so variable that the term is meaningless. Half of the doctors who responded felt that there was no genuine organic condition corresponding to their assessment of what the term means. As half of the doctors providing reports believe that 'repetitive strain injury' is not a genuine disease entity and the other half do, court cases will continue. The dilemma appears to be that completely different meanings are ascribed to the same term. Therefore, the term 'repetitive strain injury' should no longer be used.

Cumulative Trauma Disorders↗
PubMed1994

A safe percutaneous procedure for trigger finger release.

A safe and easily performed method for percutaneous release of trigger digits is described which is performed in the outpatient clinic within a few minutes, without requiring any special instrument. Results in terms of abolishing triggering immediately and patient acceptance are excellent. No important complications have been observed in our first 38 procedures.

Ambulatory Surgical Procedures↗
PubMed1991

Correction of ulnar drift during silastic metacarpo-phalangeal joint arthroplasty.

In previous published accounts of silastic replacement arthroplasty of the M.P. joint of the finger in rheumatoid disease, dynamic splintage has been used for up to six months after operation to ensure correction of ulnar drift. We have investigated two methods of surgical correction in a prospective trial in consecutive patients. No dynamic splintage was used. Both resulted in correction of ulnar drift from an average of 34 degrees (maximum 92 degrees) to 8 degrees (maximum 32 degrees) in 86 fingers. The two methods both corrected ulnar drift well, but crossed intrinsic transfer gave a better range of active movement and is recommended as an alternative to dynamic splintage.

Activities of Daily Living↗
PubMed1990

Why all finger fractures should be referred to a hand surgery service: a prospective study of primary management.

The quality of the treatment of finger fractures by Accident and Emergency Department staff has been prospectively assessed during a six-month period. 678 finger fractures were seen in the A. & E. Department. The primary treatment of 624 of these was performed by the A. & E. staff, but in 169 of these (27%), the treatment was inappropriate. Most management errors were elementary; they included failure to prescribe antibiotics for compound fractures, failure to reduce displaced fractures accurately and unsatisfactory splintage. It is recommended that all finger fractures should be assessed and treated by surgeons with training in the management of hand injuries.

Adolescent↗
PubMed1989

Double fractures of AO intramedullary femoral nails.

We report two cases of double fractures of AO intramedullary femoral nails, with metallurgical analysis of one of the nails. Technical errors were noted in both cases and in these circumstances careful assessment of fracture union is required because double fracture can lead to potentially difficult revision surgery.

Adult↗