Biomedical subjects
Publications and source records attributed to J Stuyck.
We present two cases of acute colonic pseudo-obstruction, one complicated with perforation. Orthopedic surgery was the pathogenetic factor in both cases. Recovery was successful in both patients after appropriate treatment. The importance of conventional X-ray techniques, and more specially the plain X-ray of the abdomen, is stressed regarding early diagnosis and follow-up.
Sixty-two tibial diaphyseal nonunions in 60 patients were treated with a posterolateral bone graft over an 18-year period (1969-1987). The majority were complicated by severe soft tissue damage or segmental bone loss. Thirty-four had a deep infection. Primary healing was achieved in 92%. Three types of bone grafts have been used: from 1969 to 1978 either a whole iliac bone graft (10 tibiae) or a nonvascularized fibular graft (11 tibiae) was used. Since 1978 small iliac cancellous bone chips (41 remaining tibiae) were applied to the posterior surfaces of tibia and interosseous membrane. In three tibiae with major bone defects, cancellous allografts were added to the autogenous bone. The use of cortico-cancellous bone chips resulted in a shorter healing time, compared to a nonvascularized fibular graft or a massive corticocancellous bone block.
An analysis of the results of 9 patients with a post-traumatic malalignment of the tibia, treated by an osteotomy and immediate bone grafting through a posterolateral approach is presented. Fixation was obtained with an external fixator in 8 cases and with a fibular plate in one case. Union was obtained in all cases after an average of 4.8 months. A significant improvement in the malalignment was obtained, especially in the frontal plane and somewhat less in the sagittal plane. Permanent sequellae due to the procedure were not noted.
Syme's amputation was performed in one stage in 8 and in two stages in 13 patients. Failures were defined as those requiring a more proximal amputation and were present in patients with vascular disease only. The failure rate was 38% in the group with vascular disease and 24% in the total group. Syme's amputation provides the patient with a durable end-bearing stump, even in insensitive feet.
The use of labelled granulocyte scintigraphy is recognized as a reliable method for detecting osteomyelitis and other skeletal sepsis. Tc-99m hexamethyl propyleneamine oxime (Tc-99m HM-PAO), a lipophilic chelate offers the advantages of availability, lower radiation dose and higher image resolution, compared to other labelling agents. We have scanned 36 orthopedic patients with suspected infection, using autologous granulocytes labelled with Tc-99m HM-PAO. In all cases, scans were compared with clinical, microbiological and/or surgical findings. Sensitivity was 94% and specificity was 80%. We therefore believe that Tc-99m HM-PAO leucocyte scanning provides a useful method for detecting osteomyelitis and other skeletal infections.
The functional integrity of white blood cells labeled with [99mTc]d,1-HM-PAO containing variable amounts of the ligand or of the 99mTc activity was evaluated by enzymatic tests and by measuring random migration, chemotaxis, phagocytosis, killing, and adhesion. The ultrastructure of labeled cells was studied by electron microscopy. The tracer dose and the HM-PAO concentration did not significantly affect phagocytosis and killing. The results of the other tests remained normal. A maximum labeling efficiency of 80% was reached by incubating the granulocytes for 20 min with 10-20 mCi of [99mTc]d,1-HM-PAO containing 50 micrograms of the ligand in 1 ml of saline. There was only a slow washout of 20% of activity from the labeled cells in 24 hr. The ultrastructure was not influenced by the labeling technique. Proven infection sites of 17 orthopedic patients were clearly visualized. After a short transient lung uptake, there was a clear spleen and moderate liver uptake with early bladder and late prominent colon visualization. Because of the lower cost, favorable radiation dose and more suitable tracer characteristics, this technique is a promising alternative for 111In labeling of white blood cells.
The results of the treatment of twenty-one patients (age 22-66 years) with chronic bone or joint infections with ciprofloxacin were evaluated. The osteomyelitis was secondary to trauma in 12 patients, joint replacement in six, previous acute hematogenous infection in two and osteotomy in one. Stafylococcus aureus (11 times) and Pseudomonas aeruginosa (9 times) were most frequently cultured. The duration of ciprofloxacin therapy averaged 76 days. Concomitant antimicrobial drugs were used in one patient only. Fifteen patients were operated during treatment; in most cases the surgical procedure consisted of a thorough debridement. Nineteen patients could be evaluated. The bacteriological results were as follows: eradication 27; marked reduction 1; eradication with recurrence 1. Contamination occurred in five patients and superinfection in two, without much influence on the final outcome. The investigator's assessment at the end of the therapy was as follows: complete success in 14 patients and partial success in seven. During the follow-up (3-13 months) the therapy was judged completely successful in 16, partially successful in four and unsuccessful in one. Two patients had minor gastric complaints during therapy and one showed a temporary slight increase in the liver transaminases.
Of 1824 primary total hip replacements performed between April 1, 1979, and December 31, 1983, 1007 were reviewed at regular interval and provided sufficiently complete data with special emphasis on pre- and postoperative bacteriological examination and pre- and postoperative determination of the erythrocyte sedimentation rate. All patients with known superficial and deep infections were included. In all cases 2 g of cefamandole q.i.d. were administered within a 24-h period starting with the induction of the anesthesia. All procedures were performed in operating rooms equipped with a vertical laminar air flow. Other precautions included the use of Charnley gowns with a body exhaust system, special draping of the patient, and preoperative culture of the urine. As of June, 1981, gentamicin-loaded polymethylmetacrylate was used routinely. When positive cultures were found in the swabs taken from the tissues during the surgical procedure, appropriate antibiotics were started if the patient was still hospitalized. Follow-up showed two deep (0.2%) and four superficial infections (0.4%). Host factors may play a more important role than suspected, since one patient with a deep infection suffered from severe rheumatoid arthritis and the other from diabetes. Both these patients underwent bilateral hip replacement, the second intervention following the first within 5 weeks. In these two patients the deep infection became apparent 5 and 9 months after the second procedure. Only one of these patients developed a sinus (Staphylococcus aureus).(ABSTRACT TRUNCATED AT 250 WORDS)
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Mammary carcinoma tissue from 514 primary breast cancer patients were all biochemically and histochemically analyzed for both estrogen receptors and progesterone receptors. The dextran-coated charcoal (DCC) method measured the ER and PR as defined by Scatchard analysis, ligand competition experiments and target organ specificity. The ligands, estradiol-6-carboxymethyloxime-BSA-fluoresceine isothiocyanate and hydroxyprogesteronehemisuccinate-BSA-tetramethylrhodamine isothiocyanate, used for histochemistry, did not bind to either ER or PR and were mainly bound to the membrane fraction of isolated breast cancer cells. Fluorescence was not specifically inhibited by estrogens or progestogens. In addition, "estrogenic" always coincided with "progestogenic" fluorescence. The binding of the fluoresceine compounds to tissue slides depended on the large steroid hormone substitution on the bovine serum albumin molecule. Clinical parameters, known to be related to ER and PR did not correlate with the histochemical results. The observations indicated the impossibility of specific steroid receptor detection by the histochemical method. Therefore, up to the present, evaluation of hormone dependency and prognosis in human breast cancer cannot be based on this approach.
Slow phase horizontal eye movements, elicited by the vestibulo-ocular reflex (VOR) and/or visual pursuit (VP) systems, were examined in normal children (NC, 9-16 years) and normal adults (NA). At slow frequencies of sinusoidal stimulation of the body (with the head immobilized) and/or of a visual target, the NC (9-12 years) exhibited (a) immature VP and VOR Suppression and mature VOR Enhancement in the presence of a visual image; (b) immature VOR Suppression and mature VOR Enhancement in the presence of a non-visual image of the spatial location of a visual target, an extra-retinal signal; (c) inability to augment or depress the VOR gain with a non-visual image; (d) mature VOR Suppression ratios; and (e) adjustment of VOR gain to a high value. The maturational process was featured by (a) parallel development of VP and VOR Suppression; (b) modification of the VOR gain; and (c) an increasing ability to augment or depress the VOR with a non-visual image. The observations in NC (9-12) are ascribed to a maturational lag of an extra-retinal process interacting with mature retinal and vestibular processes and, hence, suggest that both the retinal and vestibular contributions to ocular stability predate the development of an extra-retinal signal. When mature, the central nervous system utilizes both extra-retinal and retinal signals to mediate adaptive regulation of VOR gain and to preserve stable visual pursuit motion and VOR Suppression. Our findings also suggest that during tasks requiring visual-vestibular interaction, VP and VOR mechanisms appear to be indirectly rather than directly coupled.
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A clinical study on the results of internal fixation of femoral neck fractures treated by multiple Knowles pinning was undertaken and correlated with the results of an experimental study. Experimentally, failures were produced by downwards migration of the Knowles pins. This phenomenon accounts for the settling of the femoral head on the neck and the frequency of non-union or malunion in patients with subcapital fractures. The type of fracture, type of reduction and age correlate with failure rate. This has to be explained by biomechanical considerations based upon the mode of failure of the internal fixation. A Garden stage III and IV, a varus or anatomical reduction of the fracture and an old age predispose to failure of the internal fixation and consequent non-union.
The relative strength and the failure mode of internal fixation by multiple pinning and nailing was investigated on 35 specimens. Internal fixation consisted of 3, 5 and 7 Knowles pins, a Smith-Petersen nail or a sliding nail plate. The strength of a specimen with a triflanged nail is only half of that with multiple Knowles pins. There is no significant difference in strength of 3, 5, or 7 pin specimens. The strength of an internal fixation with a sliding nail plate is not superior to the strength of multiple pinning. The mode of failure for the different types of internal fixation is primarily a crush fracture of the supporting trabecular bone at the femoral neck with downward and outward migration of the pins or nail. Except with the fixation with 3 pins where an initial bending could be observed, failure is not a plastic deformation of the internal fixation device.
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An etiologic concept linking an impaired axial motor control system to the structural deformity of idiopathic scoliosis (ISc) is proposed. Postural studies reveal that during quiet stance, adaptation is marked in conditions associated with visual control of sway, particularly of lateral sway; during imposed perturbations of the body, destabilized postural reactions are pronounced in tests requiring visual-vestibular coupling. Observations of visual and/or vestibular generated eye movements indicate ocular instability among a high proportion of the ISc. Previously, the authors argued that a direct relationship exists between visual and/or vestibular functioning and a disordered axial motor system. This was attributed to an aberrant brain stem mechanism. In this presentation, however, we propose that a higher level CNS disturbance may be responsible for reports of EEG abnormalities, visuo-spatial impairment, motor adaptation, and learning deficits. Among the wide range of visual-vestibular variables studied, those representing processing of vestibular signals within the CNS yield the highest degree of correlation with the magnitude of the curve. Moreover, differences in vestibular processing between two subsets of ISc, namely ISc with (70%) and without (30%) normal academic achievement are significant. Variables referable to both vestibular and visual processing correctly classify 87% of the ISc with normal academic achievement and 100% of the ISc with a history of academic problems. The association between learning deficits, altered processing of vestibular information, and ISc suggest a unique syndrome complex, and an important role of cortical structures in the etiology of this disorder. The presence of a visuo-spatial perceptual impairment may be the common feature of ISc. In an attempt to restore perceptual dysfunction (by rearrangement), the ISc adopts a new axial and vestibular motor control strategy based upon recalibration or reinterpretation of proprioceptive signals arising from the axial musculature.
Four patients with congenital pseudarthrosis in neurofibromatosis were treated with percutaneous transosseous fixation according to the Ilizarov method. Three tibias were first treated unsuccessfully with a Sofield procedure. After application of the Ilizarov fixator, consolidation was obtained in two cases after 6 and 19 months, respectively. A fourth case consisted of a congenital pseudarthrosis of the ulna, primarily treated with the Ilizarov system, which showed advanced consolidation after 4 months.