Endoscopic sphincterotomy and cholecystectomy.
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Cholecystectomy↗
Biomedical subjects
R E Leach
Publications and source records attributed to R E Leach.
Selective embryo reduction of an interstitial heterotopic gestation.
A case of combined interstitial and intrauterine pregnancy is described. The sonographic finding of a thick myometrial bridge separating a twin pregnancy may be unique to heterotopic cornual pregnancies and is illustrated. The method of selective embryo reduction with potassium chloride to terminate the interstitial pregnancy without damage to the intrauterine pregnancy is also described. The intrauterine pregnancy continued successfully to term.
Adult↗
Long-term results of surgical management of Achilles tendinitis in runners.
Achilles tendinitis is a common occurrence in long-distance runners. Although most respond well to conservative therapy, there are some who require operative intervention. The short-term results of surgical treatment are good, with a success rate more than 85%. The authors present nine successful long-term results in runners. However, in two of the runners who continued to compete and train at long distances, symptoms recurred. Reoperations were performed to permit successful running careers for five and nine years. Runners resumed their careers after the second operation by supervised training and long-distance, competitive activities.
Achilles Tendon↗
The senior tennis player.
Mature athletes playing tennis can sustain both acute and chronic injuries. A number of the injuries are related to a gradual loss of flexibility and strength. Much of this is reversible with properly directed conditioning and rehabilitative programs.
Aged↗
Plantar fasciitis. Etiology, treatment, surgical results, and review of the literature.
Plantar fasciitis is a common orthopedic syndrome among athletes and nonathletes. The etiology of the pain is multifactorial but usually involves inflammation and degeneration of the plantar fascia origin. The majority of patients will respond to conservative measures. Surgical treatment is reserved for those patients who do not respond. A complete plantar fascia release is performed through a medial longitudinal incision. Prominent heel spurs and degenerated areas in the plantar fascia are resected. Of 27 surgically treated cases followed from one to three years, satisfactory results were obtained in 24 cases. Histologically, localized fibrosis or granulomatous changes or both were noted in several cases.
Adolescent↗
Reduction of postoperative adhesions in the rat uterine horn model with poloxamer 407.
Adjuvants shown to have significant adhesion prevention capabilities have been based on barrier separation of deperitonealized surfaces. We investigated the adhesion prevention properties of poloxamer 407. This polyol, in the proper concentration, is fluid at room temperature and becomes a firm gel at body temperature. The prevention of postoperative adhesions was evaluated in the rat uterine horn model. Twenty-two rats underwent bilateral surgical injury to the uterine horn and the parietal peritoneum. A random side was treated with a 30% solution of poloxamer 407. Twenty-one days later the animals were sacrificed and evaluated for the presence of adhesions. A highly significant reduction in adhesion formation was documented on the treated side.
Animals↗
Absence of antisperm antibodies and factors influencing sperm motility in the cul-de-sac fluid of women with endometriosis.
No detrimental effect on sperm motility characteristics by PF from women with low-stage endometriosis was documented when incubated for 3 to 6 hours. Although 1 of 31 women with endometriosis possessed IgA and IgG to sperm in her PF, its significance remains undetermined.
Antibodies↗
Management of ectopic pregnancy.
Risk factors for ectopic pregnancy include previous ectopic pregnancy, current intrauterine device use, prior fallopian tube surgery, previous pelvic inflammatory disease and a prior history of infertility. Abdominal pain is the most common symptom, followed by amenorrhea or vaginal bleeding, nausea, vomiting, syncope and dizziness. Referred shoulder pain following the onset of abdominal pain is characteristic of intraperitoneal bleeding and, in the appropriate clinical setting, strongly suggests a ruptured ectopic pregnancy. A coordinated evaluation includes measurement of serum human chorionic gonadotropin concentration and transabdominal or, preferably, transvaginal ultrasonography. Treatment is primarily by one of a variety of surgical techniques. Medical therapy with methotrexate or other drugs is currently under investigation.
Chorionic Gonadotropin↗
The role of closed reduction in tibial shaft fractures.
Although several methods of treating difficult tibial shaft fractures have been introduced in the past few decades, closed reduction remains the cornerstone of treatment. The physician must be able to recognize those tibial fractures suitable for treatment by this method, as opposed to fractures that have the potential to cause problems and would be better handled initially by other means. Properly performed, closed reduction in conjunction with early weight bearing accomplishes the goals of solid bony union, normal function, and a cosmetically acceptable appearance. This nonoperative approach avoids the potential morbidity associated with surgery and has been shown to give excellent results in the hands of a number of different physicians.
Casts, Surgical↗
Modern management of ectopic pregnancy.
The modern management of ectopic pregnancy has been influenced greatly by recent advances in human chorionic gonadotropin determination and ultrasound. Serum progesterone determination holds promise as a means of identifying abnormal gestations. Early diagnosis of tubal pregnancies has prompted conservative surgical treatment and the use of medical therapy in selected cases. Because of the improvement in diagnostic aids and conservative treatment, we are documenting a change in epidemiologic profiles. The incidence of ectopic pregnancy has increased, with a concomitant decrease in mortality. Fertility after conservative surgical procedures appears improved over that with radical treatment. However, women with ectopic pregnancies continue to have reduced fertility potential.
Chorionic Gonadotropin↗
Reconstruction of malunited fractures of the lateral malleolus.
The cases of twenty-six patients who had a reconstructive surgical procedure for treatment of a malunion of a displaced fracture of the fibula were evaluated. In these patients, who had pain, swelling of the ankle, and stiffness at an average of six years after the injury, the malunions were classified radiographically as either occult (eighteen patients) or overt (eight patients). An occult malunion was one in which the talus remained in its normal position, but the lateral malleolus showed residual displacement, characterized by external rotation and shortening. In an overt malunion, there were similar changes in the lateral malleolus, but the talus was displaced. All of the patients were treated by osteotomy of the lateral malleolus to correct the external rotation and shortening, to reduce the lateral subluxation of the anterior aspect of the tibiofibular joint, and to restore the stability of the talus. At an average follow-up of seven years (range, six months to eleven years), twenty of the twenty-six patients were able to resume the preinjury level of activity; three had improvement in the ability to walk and in the level of functional activity, although they still had intermittent pain; and three had not benefited from the procedure.
Adolescent↗
Leg and foot injuries in racquet sports.
Injuries to the lower extremity are common in racquet sports. The acute injuries usually respond well to treatment. Chronic injuries may require more patience and sometimes a change of playing habits on the part of the player. Some chronic injuries will respond well to operative intervention but most will do well with conservative care.
Achilles Tendon↗
Lateral and medial epicondylitis of the elbow.
Tennis elbow is a common condition, with the extensor carpi radialis brevis attachment being the usual site of pain. Conservative care including decreased activity, ice, nonsteroidal anti-inflammatory medications, and muscle strengthening will help most people. The small percentage of cases that require surgery usually benefit from debridement of the damaged portion of the extensor carpi radialis brevis attachment. The postoperative course must include muscle strengthening and a gradual return to activity.
Athletic Injuries↗
Injury and disability in the professional athlete.
An injury at work affects the professional athlete more than his nonathlete counterpart because it may portend the end of his playing career. The pertinent issues that concern the injured athlete are initial assessment of the injury, regulations governing treatment and rehabilitation of the injury, criteria for return-to-play status, determination of permanent impairment, and the athlete's rights. Permanent impairment determination procedures and compensation mechanisms are well established in each of the major professional leagues in the United States.
Athletic Injuries↗
Results of surgery in athletes with plantar fasciitis.
Plantar fasciitis is a common cause of pain, particularly in runners and certain other athletic groups. This syndrome must be distinguished from certain other conditions, such as the tarsal tunnel syndrome and achillodynia. Conservative therapy including rest, orthotics, heel cups, anti-inflammatory agents, and icing reduce symptoms in most patients. A few athletes may need surgery to continue running. The authors released the plantar fascia and excised areas of mucinoid degeneration in 15 athletes. Fourteen returned to full athletic activity.
Athletic Injuries↗
Ankle injuries in skiing.
With the development of new ski equipment and improvement in skiing techniques and slope grooming, the incidence, mechanism, and type of ankle injuries suffered during skiing have changed. Ankle sprains, peroneal tendon dislocations, Achilles tendon ruptures, and ankle fractures all can happen as the result of skiing. However, the incidence of these injuries has been dramatically lowered in the past two decades. All of these injuries should be treated aggressively to allow the skier to return to skiing. The early functional treatment of acute ankle sprains will return many skiers to activity quickly. With ankle fractures, lateral subluxation of the talus must be diagnosed and will be the determinant as to whether nonoperative or operative treatment is necessary. Open reduction with plating of the fibula and early weight-bearing in a brace allows early functional return to the ankle.
Achilles Tendon↗