Pathogenesis of cumulative trauma.
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Biomedical subjects
Publications and source records attributed to M L Kasdan.
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The results of a surgical procedure for the treatment of mucous cysts of the hand are described. One hundred ninety-one mucous cysts from 178 patients were treated from 1973 to 1992. The average age of the study population was 57 years. The long finger was most frequently involved. There were only two recurrences and two postoperative infections. Both patients with recurrences presented more than 40 months after surgery. Sixty-four of the cysts had been previously treated elsewhere. The most common postoperative complaint was tenderness of the joint. Associated nail deformities were corrected in 40 of 46 cases.
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Carpal tunnel syndrome is all too frequently believed to be strictly a work related disease. A retrospective analysis of 1,884 carpal tunnel patients examined by one hand surgeon between 1977 and 1992 were evaluated for their rate of employment. Twenty-five percent of these CTS patients were not employed at the time their symptoms developed. We conclude that a significant rate of CTS illness exists in the nonemployed population.
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Hemangiopericytoma is a tumor that arises from primitive perivascular cells in many sites of the body. A painless tumor may be present for years. Malignant hemangiopericytoma of the upper extremity is rare, with only 14 cases previously reported in the English literature. Because of the often unpredictable behavior of this tumor, extended follow-ups are strongly recommended.
We complied a case series involving 556 employed patients who sustained unilateral hand fractures requiring open reduction and internal fixation and a modification of their normal work activities and schedules. Time from injury to limited duty averaged 5 days, with 62% of the patients returning to work 1 day after surgery. Time from injury to resuming regular duty averaged 56 days. Both sexes averaged a return to work on limited duty after 5 days, but women returned to regular duty an average 5 days later than men. Patients with workers' compensation injuries, joint fractures, multiple fractures, tendon and/or nerve disruptions, and fractures requiring metal fixation rather than periosteal sutures required longer periods on off-duty and limited-duty statuses.
A previously disabled family member is presented as a psychosocial determinant in the subsequent disability of the patient. Eighty-three disabled patients presented for an independent medical examination of the upper extremity. All were seeking a workers' compensation settlement or continued workers' compensation benefits. Patients were questioned regarding the current disability of any family member(s). Forty-four of the 83 had at least one family member who was disabled and 36 had experienced a traumatic incident or injury resulting in workers' compensation. Forty-seven had no objective impairment. These findings suggest a significant correlation between the "disabled" support system and subsequent disability of the patient (P < .001).
Management of nailfold deformity is a difficult problem, with only seven documented techniques of reconstruction to date. We report 17 who underwent nailfold reconstruction with use of a one-stage, dorsal rotational flap with full thickness skin graft. Results show increases in range of motion and improved nail appearance.
We conducted a retrospective chart review examining the frequency of local postoperative infection and poor wound healing of 15 methotrexate-treated rheumatoid arthritis patients undergoing 155 procedures during 39 surgeries. The patients were compared to a group of rheumatoid patients not on methotrexate who underwent similar reconstructive surgery of the hand. The patients taking methotrexate were followed postoperatively for a minimum of 10 weeks, with a mean follow-up time of 1 year, 42 weeks. There were no postoperative complications that would lead to the belief that the administration of methotrexate results in poor wound healing or leaves the patient more susceptible to postoperative infection. Our findings and a review of the literature support a continuation of methotrexate therapy in rheumatoid arthritis patients scheduled for reconstructive surgery of the hand and wrist.
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The management of fractures from the industrial setting is very similar to treatment of fractures that occur elsewhere. However, the surgeon must constantly be on guard for any associated injuries that may be unique to the workplace, such as exposure to heat, cold, chemicals, or electricity. An accurate medical history of the patient and etiology of the injury are necessary. The overall emphasis must be a return to gainful employment. Treatment should be managed from the beginning. The initial action should be an aggressive approach, whether management is conservative or surgical, with a minimum of secondary procedures. An active role by the physician and his or her staff, and especially that of the hand therapist, should emphasize to the employer the advantages of returning the patient to work as soon as possible.
We report a patient with sebaceous gland carcinoma of the finger. Sebaceous gland carcinomas located outside the ocular adnexa are rare, with fewer than 100 cases documented to date. The majority of these arise in the head and neck where sebaceous glands are plentiful. Because this tumor shows no pathognomonic characteristics, accurate histologic evaluation is essential to its diagnosis. Local excision may not be adequate treatment for a sebaceous gland carcinoma of the digit. Ray amputation was the treatment of choice for this patient.
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We reviewed 1075 patients presenting over a 12-year period with symptoms of carpal tunnel syndrome. A total of 994 had a final diagnosis of carpal tunnel syndrome. There were 444 male and 550 female patients with a mean age of 42 years. Three-hundred and ninety-five related symptoms to their job. Surgery was performed in 27 percent of the total diagnosed cases with approximately 97 percent relief of symptoms. Satisfactory alleviation of symptoms was obtained in 14.3 percent of patients treated conservatively prior to 1980, with one or a combination of splinting anti-inflammatory agents, job or activity change, and steroid injections. In 1980, vitamin B6 (pyridoxine) was added as a method of conservative treatment. Satisfactory improvement was obtained in 68 percent of 494 patients treated with a controlled dosage (100 mg b.i.d.). While our findings were not the result of a controlled scientific study, we feel they suggest that regulated use of vitamin B6 may be helpful in treating many cases of carpal tunnel syndrome.
Correct and immediate care can significantly reduce the debilitating effects of Scorpaenidae evenomation. The lack of immediate heat application to the wound in our case report may have contributed to the complications and eventual loss of motion in the affected area, since the toxic ingredient, a nondialyzable protein, remained active.