Biomedical subjects
Publications and source records attributed to M L Ramsey.
Dermatologic surgery can be enjoyable and rewarding, particularly if one constantly seeks ways to improve service and efficiency. Although new technology provides opportunities to expand and improve one's skills, the importance of courtesy, common sense, and creativity should not be overlooked as tools to perfect one's practice.
Explore the source record for details and available documents.
BACKGROUND: Arthroscopic capsular release is used to treat idiopathic adhesive capsulitis (frozen shoulder) that is refractory to nonoperative treatment or manipulation under anesthesia. The role of arthroscopic capsular release in the treatment of frozen shoulder after shoulder surgery or fracture is less clearly understood. The purposes of this study were to define the outcome of arthroscopic capsular release in the management of frozen shoulder after surgery or fracture and to compare these results with those of arthroscopic capsular release in the treatment of idiopathic frozen shoulder. METHODS: We evaluated the results of arthroscopic capsular release in three different groups of patients with shoulder contracture refractory to nonoperative management and manipulation under anesthesia. The three groups consisted of patients who had an idiopathic frozen shoulder, shoulder stiffness after surgery, or shoulder stiffness after fracture. We evaluated pain, function, patient satisfaction, and range of motion in all three groups before and after the study treatment. RESULTS: At a mean of twenty months (range, twelve to forty-six months) after the operation, fifty patients were available for assessment of function and range of motion of the involved shoulder. At the time of follow-up, each group had a significant improvement in the scores for pain, patient satisfaction, and functional activity as well as in the overall outcome score (p < 0.01). Comparison of the scores among the different groups revealed that all had a similar degree of improvement in range of motion of the involved shoulder, but patients with postoperative frozen shoulder had significantly (p < 0.05) lower scores for pain (p < 0.03), patient satisfaction (p < 0.004), and functional activity (p < 0.002) than did those with idiopathic or post-fracture frozen shoulder. CONCLUSIONS: Arthroscopic capsular release was as effective for improving range of motion in patients with postoperative contracture of the shoulder as it was in patients with idiopathic and post-fracture contracture. However, there was less improvement in the subjective scores for pain, function, and patient satisfaction in the postoperative group.
The functional outcome of operative and nonoperative treatment of suprascapular neuropathy was compared to determine the preferred method of treatment for each etiology of nerve injury. The predictive value of preoperative electromyography also was studied. Fifty-three patients were evaluated at least 1 year (average, 28 months) from the time of operative (n = 36) or nonoperative (n = 17) treatment. A modified American Shoulder and Elbow Surgeons self-assessment score was obtained at presentation and at final followup. Electromyography data were obtained at initial presentation. Minimal electromyographic changes associated with denervation were associated with a limited response to treatment, especially in patients with nerve compression secondary to spinoglenoid notch cysts. Pretreatment electromyographic findings, therefore, were predictive of treatment response. Overall, operative and nonoperative treatment of these suprascapular nerve injuries resulted in significant functional improvement, but the results varied depending on the etiology of the injury. Spinoglenoid notch cysts responded significantly better to operative treatment, with the results for open surgery being the same as the results for arthroscopic decompression. In addition, compressive lesions attributable to suprascapular notch entrapment had the best improvement with surgical decompression. Traumatic lesions, including traction and direct closed injuries, had an equal response to operative and nonoperative treatment. Overuse injuries did not improve with operative treatment. Viral neuritis improved with nonoperative treatment and never was treated with surgery. Overall, traumatic injuries resulted in significantly worse final outcomes than any other etiologic processes. In the nonoperative group, neuropathy secondary to spinoglenoid cysts resulted in significantly worse function. The outcome of treatment is dependent on the severity and etiology of the nerve injury, and the method of treatment.
BACKGROUND: Surgical defects of the alar lobule can be difficult to repair with aesthetically pleasing results. Full-thickness skin grafts are often smoother than the sebaceous skin of the ala. Random patterned flaps from the cheek or proximal nose usually bridge and obliterate the supra-alar crease and may cause nasal valve malfunction. OBJECTIVE: We describe and illustrate a technique to repair subtotal alar lobule defects within the cosmetic unit of the alar lobule. METHODS: Twenty-three consecutive alar lobule rotation flaps for repair of Mohs surgical defects were reviewed by patient examination and interview. RESULTS: Twenty-one of 23 patients were contacted. Patients rated cosmetic results as excellent (18), good (2), or fair (1), and no patients graded their results as poor. Six patients reported "a little" breathing difficulty in the postoperative period that resolved within 6 months. Anesthesia reported by 11 of 21 patients resolved within 5 years in 8 of 9 patients available for follow-up. CONCLUSION: Rotation of the ala combined with cheek advancement is a cosmetically pleasing and functional method to repair deep defects of the ala.
Explore the source record for details and available documents.
OBJECTIVE: MR imaging is the optimal imaging technique to study the normal and abnormal conditions of the pectoralis major muscle and tendon unit. The purpose of this study was to use MR imaging to provide an anatomic survey of the normal pectoralis major tendon and its insertion and to compare these findings with surgically proven cases of rupture. CONCLUSION: MR imaging shows the normal pectoralis major myotendinous unit has low signal intensity on both T1- and T2-weighted images. Reliable anatomic landmarks for visualization and examination of injuries to the muscle and myotendinous unit include the quadrilateral space, or the origin of the lateral head of the triceps, as the superior boundary and the deltoid tuberosity as the inferior boundary of the intact tendon of insertion. Failure to visualize a normal insertion within these boundaries should prompt a dedicated search by the radiologist for rupture and retraction of the tendon medially.
BACKGROUND: A positive temporal artery biopsy (TAB) is essential to the diagnosis of temporal arteritis. Both this relatively common disease and its prolonged treatment with corticosteroids are associated with serious sequelae. Therefore, accurate and timely diagnosis is critical. The dermatologic surgery literature lacks a description of this straightforward surgical technique, as TABs are most often performed by ophthalmologists. OBJECTIVE: As a service to our rheumatology department we began performing TABs on a same-day on-call basis in July 1996. METHODS: We have performed 45 TABs in a 22-month period using a simple, safe, time-efficient technique. We review the surgical anatomy and danger zone of the temporal region and potential complications. We describe the biopsy technique which aims at safely obtaining a greater than 2 cm segment of a peripheral branch of the superficial temporal artery (STA), identified preoperatively by doppler ultrasonography. RESULTS: The procedure was performed on the day requested in all cases. Intraoperative time ranged from 20 to 40 minutes. TAB established the diagnosis of temporal arteritis in 8 of 44 biopsies (18%) and in 7 of 35 patients (20%), including 1 of 9 patients in whom we performed bilateral TAB. One patient was diagnosed with small-vessel polyarteritis nodosa by TAB. The mean formalin-fixed length of the arterial specimen was 2.2 cm. The length did not vary between positive and negative specimens. There were no complications and the cosmetic results were excellent. CONCLUSION: TAB is a quick, safe, straightforward, and gratifying office procedure which dermatologic surgeons are very qualified to perform.
The results of nineteen semiconstrained modified Coonrad-Morrey total elbow arthroplasties performed in nineteen patients to treat instability were evaluated at an average of seventy-two months (range, twenty-five to 128 months) postoperatively. Preoperatively, all patients had either a flail elbow or gross instability of the elbow that prevented useful function of the extremity. The instability of sixteen elbows was the result of a traumatic injury or of the treatment of such an injury. The most recent result was satisfactory for sixteen elbows and unsatisfactory for three. The average overall Mayo elbow performance score increased from 44 points preoperatively to 86 points postoperatively. At the most recent follow-up examination, no elbow was unstable. The average arc of flexion was from 25 degrees (range, 0 to 60 degrees) to 128 degrees (range, 30 to 142 degrees), which represented a 58-degree increase from the preoperative average arc. Sixteen patients had little or no pain after the arthroplasty. There were four complications in four patients. Three complications (loosening of the humeral component in one patient and a fracture of the ulnar component in two) occurred postoperatively; all three were treated with a revision procedure. The other complication (a fracture of the olecranon) occurred intraoperatively and was treated with tension-band fixation; the most recent outcome was not affected. Radiographically, one patient had complete (type-V) radiolucency about the humeral component. None of the nine patients for whom true anteroposterior radiographs were available had evidence of wear of the bushings. The bone graft behind the anterior flange of the humeral prosthesis was mature in fourteen elbows, incomplete in two, and resorbed in two. One patient was excluded from this analysis because radiographs were not available. Instability of the elbow resulting in the inability to use the extremity is a challenging clinical situation. However, in patients who are more than sixty years old and in selected patients who are less than sixty years old but who have extensive loss of bone as a result of severe injury, have had multiple operations, or have rheumatoid arthritis, total elbow arthroplasty with a linked, semiconstrained prosthesis reestablishes a mobile, stable joint without premature loosening or failure of the components. In our experience, the use of customized implants, maintenance of the muscular attachments to the epicondyles, and reconstruction of the epicondyles to the implant were unnecessary.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Ganglion cysts causing suprascapular nerve compression are an uncommon cause of suprascapular nerve compression. The advent of magnetic resonance imaging (MRI) and its application in patients with shoulder pain has improved the ability to diagnose cystic lesions causing extrinsic compression of the suprascapular nerve. Traditionally, treatment of suprascapular nerve compression by a ganglion cyst has required open cyst excision through either a deltoid and infraspinatus muscle takedown or a muscle splitting approach. We present three cases of suprascapular nerve compression by a ganglion cyst in which the cyst was decompressed arthroscopically. In each case the patient's symptoms resolved after arthroscopic cyst decompression, and a postoperative MRI does not demonstrate reaccumulation of the cyst fluid. Arthroscopic ganglion cyst decompression is a well-tolerated approach to this problem that avoids the morbidity of an open surgical procedure. The absence of recurrent cyst formation combined with resolution of the symptoms attests to the success of this method.
BACKGROUND: The cutaneous surgeon commonly encounters defects of the helix, as 2-4% of all skin cancers occur at this site. OBJECTIVE: We report our experience with 47 patients using the chondrocutaneous helical rim advancement flap of Antia and Buch. METHODS: Incisions are made from the defect inferiorly into the lobule and, when necessary, superiorly along the helical sulcus into the helical crus. The postauricular skin is extensively undermined to allow maximal movement of the resulting broadbased, well-vascularized flap(s). RESULTS: We experienced very favorable results using this technique with our patients. No necrosis due to ischemia occurred in any of our cases. Hematomas formed postoperatively in two patients, but healing proceeded uneventfully after removal of coagulated blood. CONCLUSION: This technique is an excellent method of repairing many defects of the helical rim. Its advantages include technical simplicity, little risk of tip necrosis, patient convenience, and superior cosmesis.
Modular total shoulder systems offer many advantages over nonmodular designs. Modularity facilitates precise placement of the humeral head with respect to the rotator cuff and tuberosities, allows for soft tissue tensioning and balance with variable neck lengths, and simplifies revision surgery by allowing removal of the humeral head while maintaining a well-fixed humeral stem. This review includes 47 total shoulder arthroplasties performed in 40 patients from 1986 to 1991. The average patient age was 62.3 years, with followup averaging 54 months. Seventeen patients had rheumatoid arthritis, and 22 had osteoarthritis. In the remaining 8 patients, 5 had posttraumatic arthritis, 2 had avascular necrosis, and 1 had cuff tear arthropathy. Glenoid revision was required in 3 patients, and symptomatic loosening occurred in only 1. Pain relief was achieved in 93.5% of patients. Range of motion improved 34.9 degrees in forward flexion, 18.1 degrees in external rotation, and 4 vertebral levels of internal rotation. Lucent lines were evaluated on the anteroposterior (AP) and axillary radiographs. On the AP radiograph, 16 shoulders demonstrated lucency about the glenoid component. Progression beyond 2 mm occurred in 5 shoulders, and symptoms requiring revision developed in one patient. Twenty-two patients demonstrated a lucency on the axillary radiograph, and 9 patients progressed beyond 2 mm. None required revision. The authors present the results and discuss surgical and design considerations of modular total shoulder arthroplasty.
Explore the source record for details and available documents.
Lipoid proteinosis is a rare autosomal recessive disorder that can affect the majority of organ systems, but most frequently presents due to its characteristic skin and mucous membrane changes. This was illustrated in a 27-year-old patient. Because its manifestations are easily misinterpreted, one might reasonably assume that the incidence of lipoid proteinosis may be higher than previously reported.
Explore the source record for details and available documents.
First described by Hutchinson in 1878, erythema elevatum diutinum (EED) is a rare disease characterized by persistent red, raised nodules and plaques in a symmetrical, acral distribution. The disease occurs equally in the sexes, primarily in the 30- to 60-year age group. We report a representative case of EED which responded to current agents, and briefly review the status of the disease.