Biomedical subjects
Publications and source records attributed to R M Curtis.
A 14-year-old girl presented with hallucinations and bizarre behaviour 3 days following the institution of cimetidine therapy for acute gastritis. She had no history of drug abuse or psychiatric disorders, and physical examination and laboratory investigations yielded no abnormalities. Within 24 hours after cimetidine therapy was discontinued her behaviour returned to normal and the hallucinations stopped.
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One hundred fifteen cases of localized nodular synovitis (giant cell tumor of the tendon sheath) were reviewed. The optimal treatment for these lesions is unknown, and a high recurrence rate exists. Growths arose from most of the synovial sites of the hand, including joints, capsular ligaments, and tendon sheaths. Deformation of the bone surface was commonly seen; however, bone invasion was uncommon. The histologic features may vary, but the lesions are always benign and do not metastasize. Treatment consisted of thorough local excision and adjacent joint exploration when appropriate. Recurrence occurred in 10 cases (9%) with one to five additional surgical procedures needed to eradicate the lesion.
A step-by-step approach to the systematic management of chronic boutonniere deformity due to trauma is presented. If surgical intervention is necessary, the problem should be approached one step at a time. The following stages are described: stage I, tendolysis of the extensor tendon and freeing of the transverse retinacular ligament; stage II, sectioning of the transverse retinacular ligament; stage III, tendon lengthening of the lateral bands over the middle phalanx; and stage IV, repair of the central extensor tendon. After managing 23 patients according to this plan, we have concluded that it is frequently unnecessary to automatically go through all four stages in treating chronic traumatic boutonniere deformity. We found that 17 patients were successfully managed by some combination of stages I, II, and III, and six patients received adequate treatment with stages I, II, and IV.
Osteocartilaginous lesions, which are considered to be one of the most common neoplasms of bone, are seldom found in the hand. These are distinct from subungual exostoses or turret exostoses. When present in the hand in children, these lesions may limit function, cause cosmetic deformity, alter the growth of a digit, and pose a problem in diagnosis. Experience with these osteocartilaginous lesions in 10 children, (nine boys and one girl) is reviewed. Six patients had some degree of deviation or early rotation of the involved digit secondary to abnormal bone growth. There was no definite history of antecedent trauma; however, most parents assumed this to be a causative factor. Patients were treated by excision of the lesion and joint contouring when necessary. Follow-up ranged from 1.5 to 13 years, and there was good functional restoration, minimal growth disturbance, and no recurrence in any patient.
Fifteen patients with a diagnosis of peritendinous fibrosis of the dorsum of the hand (Secretan's disease) were treated between 1958 and 1980. Thirteen patients had excision of a dorsal fibroma with extensor tendolysis when necessary. Preoperative findings included a hard dorsal mass and limitation of motion. Postoperative courses were characterized by prolonged periods of rehabilitation and recurrent episodes of swelling. Twelve of 15 patients returned to work 3 to 30 months postoperatively. Permanent disability was substantial. None of these patients had significant wound healing problems, and all had improved range of motion. The question of self-inflicted injury was raised in five cases but could not be demonstrated.
One hundred cases of isolated flexor profundus tendon laceration or rupture were repaired by tendon graft over a 30-year period. Thirteen patients were over 40 years of age with the age range in the study from 1 1/2 to 60 years. Unless the flexor profundus tendon remained in the decussation of the superficialis, all grafts were placed around the superficialis tendon decussation. Measurements of passive tendon excursion were considered critical in the selection of a motor for the tendon graft. All but two profundus graft motors could be passively extended to 30 mm. Average active distal interphalangeal (IP) joint flexion was 48 degrees following surgery. In thirteen patients the results were considered unsuccessful, with loss of greater than 20 degrees from preoperative proximal IP joint flexion or distal IP joint flexion less than 20 degrees. We suggest that, in properly motivated patients, tendon graft replacement of isolated profundus tendon injuries can give satisfactory results even in the older age group.
Cooling the amputated part and the partially amputated devascularized extremity is critical for a successful replantation attempt. Cooling devascularized or amputated tissue is the simplest and most effective method for preventing the detrimental effects of ischemia. Successful microsurgical revascularization begins with proper treatment in the local referring emergency room. Proper care and transportation of the patient and his devascularized or amputated extremity are essential.
A work simulator is an electromechanical device used for rehabilitation of the upper extremity. Various tools have been designed to simulate the basic motions required of the upper extremity in the activities of daily living and most occupations. Provision has been made for varying levels of resistance to interchangeable tools for exercise and to allow evaluation of the patient's functional ability. Printed documentation is produced for each therapy session. Clinical use for a period of 20 months with 223 patients indicates that patients realize significant improvement in function and the ability to return to productive employment.
Intravascular coagulation is the final common pathway of failure in replanted digits and "free" tissue transfers. To address this clinical problem, a model based upon intimal damage and stasis in the rat femoral vein was developed. The ability of local, intraarterially administered Thrombolysin to achieve "local" clot lysis was investigated. "Systemic anticoagulation" was measured by standard hematologic monitoring and "systemic thrombolysis" by lysis of a contralateral standard femoral vein clot. The mean drug volume required for local clot lysis was proportional to the clots' duration time; 7.8 ml required for the 30-minute, and 17.0 ml required for the 60-minute clot (p less than 0.05). Lysis was achieved by local intraarterial Thrombolysin in 87% of the clots of 30 minutes' duration and in 94% of the clots of 60 minutes' duration. Overall, just 3.6% of contralateral clots lysed (p less than 0.001). Systemic anticoagulation did not occur.
A case with 1-cm distraction elongation of a child's thumb metacarpal 7 years after initial injury is presented. The thumb to long finger pinch was improved by this procedure. The metacarpal elongation has been maintained for 3 years. The mechanism of this repair appears to be ossification of connective tissue. Immobilization until bony union is complete is recommended to avoid loss of length gained.
In 28 patients with glomus tumors of the digits, 21 were relieved of symptoms by excision of a solitary tumor. Seven other patients had multiple tumors, four of which were the cause of recurrent symptoms. Three patients had multiple tumors--five in one patient, four in another, and two in a third, which had been found at the time of the first operation. A 25% incidence of multiple tumors and a 15% incidence of recurrent symptoms indicates that a careful search should be made for additional tumors.
An experimental model was developed that will produce femoral vein occlusion greater than 90% of the time in rats weighing less than 500 grams. This standard venous clot, produced by combining intimal trauma with local venous stasis, can simulate clinical crush and replantation problems. Using this standard clot model, Thrombolysin was injected in the femoral artery after trauma to the vein but before venous stasis. Femoral vein patency was determined at the end of the 30 minute period of venous stasis. With the appropriate dosage, ipsilateral venous occlusion was prevented (P less than 0.00001) without preventing contralateral venous occlusion (P less than 0.02). Except for decreased fibrinogen levels, there was no significant change in the factors studied between the control and experimental groups. It is possible, therefore, to prevent thrombosis in a vein with intimal damage, even in the presence of a low-flow state by the local injection of Thrombolysin, without producing systemic anticoagulation.
Three categories of membrane oxygenators are considered: passive flow, secondary flow induced by the mainstream, secondary flow induced by an external application of energy. The current status of mathematical methods for analysis of fluid mechanics, O2 and CO2 exchange for these categories are briefly reviewed. Emphasis is given to approximate methods for calculation of gas exchange. Practical methods for experimental design optimization studies are outlined; these methods are extended to evaluation of O2 and CO2 exchange in clinical operation. A new method for estimation of internal ventilation and perfusion maldistribution and diffusion resistance is described. A brief assessment of blood damage in clinical application of the oxygenator is presented from the point of view of deterioration of gas exchange performance.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.