Biomedical subjects
N D Reis
Publications and source records attributed to N D Reis.
Muscle microcirculatory impairment following acute compartment syndrome in the dog.
Visualization of the intramuscular microcirculation during and after compartmental syndrome was studied by microangiograms and histologic cross sections. A marked reduction in the circulation of the endomysial capillary network was found during compartment tamponade, whereas the perimysium arteriolar system was patent. Revascularization took place by formation of distorted blood vessels accompanied by intramuscular hematomas in muscles 7 and 14 days after the compartment insult. The cross sections show massive fibroblastic activity around blood vessels that caused concealed intramuscular pressure-ischemic contracture resulting in the foci of myofibrillar necrosis seen within normal muscle tissue. The muscle located in the tamponaded compartment profusely bleeds when it is touched, even though its viability is in doubt. The explanation for this clinical observation might be the abnormal intramuscular revascularization that was found in this work.
A philosophy of limb salvage in war: use of the fixateur externe.
Over the period 1973-1983, we treated by external fixation 110 severe grade three open or complicated fractures caused in war (minimum follow-up, 7 years). We present our data analyzed according to method, location, and type of fracture. The methods we have evolved over the years are described in detail: primary wound stabilization by fixateur externe; primary radical wound excision, repeated every 48 hours as required, including excision of dead bone; delayed primary vascular soft tissue cover; delayed primary or secondary skeletal and soft tissue reconstruction as dictated by local wound conditions; prophylactic antibiotics and intensive physiotherapy to the joints and muscles of the injured limb and as rapid an ambulation of the patient as possible. The advantages and limitations of external fixation are enumerated. It is possible to avoid the complications of pin tract infection and ring necroses, but care is required to avoid refracture after removal of the apparatus, since the quality of bone healing is not always good with the use of external fixation. External fixation has greatly facilitated the various methods for achieving delayed primary vascular soft tissue cover over severe open fractures, bringing about an improved prognosis; micro-vascular techniques hold great promise for wound cover and skeletal reconstruction. Similarly, the Ilizarov method of bone osteotaxis has opened up new vistas in the treatment of bone mass loss. The latter requires a sophisticated set-up which will not be available in most war zones. In spite of the advances in treatment and in the improved results achieved by modern techniques of wound stabilization, wound soft tissue cover, and bone and soft tissue reconstructions, the temptation to try to salvage useless limbs must be resisted. Amputation, judiciously adjudged and correctly timed, remains one of the most successful forms of treatment in these severe injuries, saving the casualty from a physical and spiritual via dolorosa. Enthusiasm for surgical endeavor must be well tempered with mature judgment and realistic clinical acumen.
Anatomy of the extrinsic spinal muscles related to the deformities of scoliosis.
The spatial displacement of vertebrae in idiopathic scoliosis is not explicable by forces created by the muscles which act upon the spine only (intrinsic muscles). The trapezius and latissimus muscles are attached to the spinous processes and the upper limb. In keeping with Newton's third law, these muscles act on the spine as well as upon the upper extremity. The peculiarity of the vertebral anatomy, together with the direction of pull of these muscles, permits an explanation of the biomechanics of the development of 'idiopathic' scoliosis.
Metatarsophalangeal joint dislocation after local steroid injection.
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[External fixation for open fractures of the femur].
32 cases of severe open fractures of the femur were treated by external fixation in 1 lateral plane with either the Wagner apparatus or the A.O. tubular system. 2/3 of the cases were war injuries and 1/3 were due to traffic accidents. In 1 case the broken limb was severely burned. In half the cases external fixation was changed for P.O.P. or internal fixation because of pin tract infection or delayed union. There were no non-unions or amputations, but 1 case had chronic post-traumatic osteomyelitis. We conclude that the method of choice for 3rd degree open fractures of the femur is external fixation. In the case of severe multitrauma and complex wounds with vascular injury or burns, external fixation is mandatory.
[Arthritis and secondary arthrosis of hallucal sesamoids after forefoot arthroplasty].
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Syncope as a premonitory sign of fatal pulmonary embolism. Two case reports.
Two patients suddenly died of massive pulmonary embolism 3 weeks after hip surgery. In retrospect, several episodes of syncope starting during the first postoperative week were recognized as premonitory signs of the fatal outcome.
Crush injury--crush syndrome.
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Osteochondritis dissecans of the dome of the talus. Computed tomography scanning in diagnosis and follow-up.
From 1977 through 1985, thirty-two patients were treated for osteochondritis dissecans of the dome of the talus. The diagnosis was established in two-thirds of the patients using ordinary roentgenograms, but it was established in all of them using computed tomography scans. After a mean length of follow-up of about five years, the results of surgical treatment were significantly better than those of conservative treatment. For twenty patients, computed tomography scans were superior to roentgenograms in showing healing of the lesion. We concluded that computed tomography is useful not only for diagnosis--that is, in determining the extent and precise location of the lesion--but also for follow-up.
Recurrence of Kienböck disease in a twelve-year-old after radial shortening. Report of a case.
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Idiopathic transient osteoporosis of the hip.
We have reviewed 11 patients with idiopathic transient osteoporosis of the hip; the six who were women all developed the condition during pregnancy. Both simultaneous and sequential bilateral involvement were seen, but biochemical studies were consistently normal and one synovial biopsy showed only non-specific inflammation. Radioisotope bone scans and CT scans were useful to aid diagnosis. Treatment by limiting weight-bearing relieved symptoms, and spontaneous resolution was paralleled by radiographic remineralisation, usually within a few months. One patient developed a stress fracture of the hip and other areas of transient osteoporosis. A hip involved by the condition should be protected from overloading until bone density has recovered.
[Malignant fibrous histiocytoma of bone].
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Fibular bowing due to tibial shortening in isolated fracture of the tibia: failure of late segmental fibulectomy to relieve ankle pain.
Fracture of the tibia with an intact fibula is prone to delayed and nonunion or varus malunion and, as a complication of the latter, late arthrosis of the ankle joint. A less well-known type of malunion is tibial shortening with fibular bowing due to relative fibular lengthening. We present such a case with chronic ankle pain. Late segmental fibulectomy failed to improve the symptoms. We recommend primary segmental fibulectomy in all isolated fractures of the tibial shaft in adults and adolescents, in order to forestall the early and late complications.
The medullary expanding compression nail: 50 femoral shaft fractures followed up for a minimum of 2 years.
The results of the first 50 patients who had fractures of the femur treated with a previously reported medullary expanding compression nail are described. The nail is considered ideal for the patient with multiple injuries. Four per cent of the fractures did not unite and the implant failed in 6 per cent.
Traumatic ulnar variance in Kienböck's disease.
A case of unilateral ulnar minus variant, almost certainly caused by trauma to the distal ulnar growth plate, and ipsilateral Kienböck's disease is described. The contralateral wrist was normal in all respects. This constitutes additional evidence for the etiologic relationship between Kienböck's disease and the presence of the ulnar minus variant.
Localization of a small tumor in the leg by magnetic resonance imaging. Case report.
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Crush injury to the lower limbs. Treatment of the local injury.
We treated fifteen patients who had been trapped under the masonry of collapsed buildings for various periods of time. In one group of patients who had been buried for twelve hours, treatment commenced only twenty-four hours after the injury, and the other group was treated more promptly. In the second group, the success of forced diuresis and alkalinization of the urine in preventing the renal complications of the crush syndrome was evident. A reassessment of the treatment of the local lesion was made and a scheme of treatment is proposed. The injury is essentially closed, and incomplete excision of the necrotic muscle is fraught with risk. Local rigor in the affected muscles is important.