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Biomedical subjects

S E Varitimidis

Publications and source records attributed to S E Varitimidis.

At least 19 recordsLinked to original sources
PubMed2001

Findings of exploration of a vein-wrapped ulnar nerve: report of a case.

A 54-year-old woman underwent a revision procedure after failure of 3 previous procedures for recalcitrant cubital tunnel syndrome. She underwent neurolysis and vein wrapping of the ulnar nerve during the fourth procedure. Two years later she developed a neuroma of the medial antebrachial cutaneous nerve necessitating a fifth procedure. At the time of neuroma relocation we noted that the vein was intact around the ulnar nerve and that there was no scarring between the vein and nerve.

Cubital Tunnel Syndrome↗
PubMed2001

Treatment of recurrent compressive neuropathy of peripheral nerves in the upper extremity with an autologous vein insulator.

The treatment of entrapment neuropathy in the upper extremity with surgical decompression has generally provided good results. Recurrence of symptoms, however, is not uncommon and its management is both challenging and difficult. Nineteen patients with recurrent carpal tunnel and cubital tunnel syndrome were treated with the vein wrapping technique using the autogenous saphenous vein. The average number of surgeries before vein wrapping was 3.3. The mean patient age was 53 years (range, 28-75 years) and the mean follow-up period was 43 months (range, 24-78 months). All patients reported reduction in pain and the sensory disturbances secondary to the compression of the median or ulnar nerve. Two-point discrimination and electrodiagnostic findings also improved.

Adult↗
PubMed2001

Vascularized orthotopic osteochondral transplantation of the canine proximal femur.

Osteochondral vascularized proximal femoral allografts were orthotopically transplanted in five adult beagles (four experimental and one control). The experimental animals were placed on 0.1 mg/kg of FK506 intravenously for 7 days, and then converted to 1.0 mg/kg orally. Biopsies of the femoral heads were taken at 3 weeks postoperatively and at 1-month intervals thereafter. The specimens were studied histologically with a hemotoxylin and eosin staining technique. Bone biopsies showed no microscopic evidence of rejection, and only minimal evidence of necrosis. Patency of the microvascular anastomosis was confirmed with bone scanning, using technitium 99m phosphate, arteriograms, and by Doppler flowmeter. All animals had an uneventful postoperative course, with achievement of full weight-bearing status by postoperative day 10, and normal activity by 1 month postoperatively. There were no infections or hip dislocations. One animal sustained a femoral neck fracture and was sacrificed at 4 months. At 6 months, the remaining animals were sacrificed. At necropsy, the experimental animals and the normal dog showed viable chondrocytes and osteocytes, with minimal bone necrosis. No dislocations or allograft rejections were observed. Based on this small series, a successful technique has been developed for orthotopic transplantation of a vascularized hip joint in a canine model.

Anastomosis, Surgical↗
PubMed2001

Classification of osteonecrosis of the femoral head. Reliability, reproducibility, and prognostic value.

The purpose of the current investigation was to determine interobserver and intraobserver reliability of the classification system of Steinberg et al for osteonecrosis of the femoral head. Sixty-five anteroposterior and lateral radiographs of hips were selected randomly from a pool of patients with confirmed osteonecrosis of the femoral head. Six fellowship-trained observers viewed the radiographs (Reading 1). The observers used six main stages of the classification excluding A, B, and C subgroups. The same observers viewed the radiographs 4 months later in reverse order (Reading 2). Reading 1 was used to calculate interobserver kappa values. Reading 2 was used to calculate intraobserver kappa values. Stage-specific kappa values for interobserver variation between all viewers were as follows: Stage I, k = 0.64; Stage II, k = 0.51; Stage III, k = 0.21; Stage IV, k = 0.49; Stage V, k = 0.36; and Stage VI, k = 0.80. Stage-specific kappa values for intraobserver variation between all viewers were as follows: Stage I, k = 0.74; Stage II, k = 0.60; Stage III, k = 0.46; Stage IV, k = 0.59; Stage V, k = 0.27; and Stage VI, k = 0.78. An average of 10 of 21 (48%) of these errors involved Stage III. An average of 6.3 of 21 (30%) intraobserver errors involved Stage V. The presence of the crescent sign in Stage III and joint space narrowing in Stage V markedly diminished the overall reliability of any four- to six-stage classification system. Based on the authors' experience and analysis of the current classifications of osteonecrosis of the femoral head, an easy and reproducible Pittsburgh classification system is proposed.

Female↗
PubMed2000

The effect of wrapping scarred nerves with autogenous vein graft to treat recurrent chronic nerve compression.

The purpose of this study was to determine the efficacy of vein wrapping of scarred nerves in a chronic nerve compression model in rats. The ultimate goal was to provide experimental evidence for application of the technique of vein wrapping of nerves for the treatment of recurrent compressive neuropathy. The chronic nerve compression model was created in 100 rats. After 8 months the nerves were decompressed. In 50 rats the nerves were wrapped with an opened femoral vein graft; the remaining 50 animals served as controls. The sciatic nerves of both groups were evaluated at 4, 8, 12, 24, and 48 weeks after surgery. Functionally, the sciatic nerves in the vein-wrapped group showed greater improvement than those in the non-vein-wrapped group. For electrophysiologic testing the latency was significantly shorter in the vein-wrapped group. Histologic evaluation showed marked nerve degeneration and scar tissue formation around the nerves in the non-vein-wrapped group but not in the vein-wrapped group. The results indicate that the vein graft could improve the recovery of nerve function by protecting the nerve from surrounding scar and is an effective and feasible technique for the surgical treatment of recurrent compressive neuropathy. (J Hand Surg 2000; 25A:93-103.

Action Potentials↗
PubMed2000

Treatment of chronic injuries of the ulnar collateral ligament of the thumb using a free tendon graft and bone suture anchors.

We report the results of a simple technique, using bone suture anchors and free tendon graft, for the reconstruction of chronic injuries of the ulnar collateral ligament complex at the thumb metacarpophalangeal (MP) joint. Our series includes 20 patients, with a mean age of 29 years. The mean follow-up period was 42 months. Using the Glickel grading system, 14 patients had excellent results and six had good results. Seventeen patients had no pain and three complained of mild pain with weather changes. Fourteen patients regained full stability of the MP joint and six had mild laxity. The mean loss of pinch strength was 18% compared with the contralateral thumb. The mean loss of motion at the metacarpophalangeal joint was 21%.

Adolescent↗
PubMed2000

Recurrent compressive neuropathy of the median nerve at the wrist: treatment with autogenous saphenous vein wrapping.

Recurrence of symptoms occurs in a significant number of patients after surgical decompression for carpal tunnel syndrome, and its management is both challenging and difficult. Fifteen patients with recurrent carpal tunnel syndrome were treated with a vein wrapping technique using the autologous saphenous vein. A total of 48 operations had been performed on these patients before wrapping the median nerve with a saphenous vein graft. At a mean follow-up of 43 months all patients reported significant pain relief and improvement in their sensory disturbances. Two-point discrimination and the findings of nerve conduction studies also improved.

Adult↗
PubMed2000

Ulnar nerve elongation and excursion in the cubital tunnel after decompression and anterior transposition.

We studied the elongation and excursion of cadaveric ulnar nerves during elbow flexion in control conditions and after in situ decompression and anterior subcutaneous transposition. We found that the normal nerve had the greatest elongation (23%) and excursion (14 mm) in the epicondylar groove. Decompression did not alter the excursion, but significantly reduced the elongation in the groove (6%) and increased it proximally (19%). After anterior subcutaneous transposition, the nerve segment which was originally in the groove elongated with elbow extension to the same extent as occurred with the normal nerve during flexion.

Aged↗
PubMed2000

The Compass Elbow Hinge: indications and initial results.

The Compass Elbow Hinge uses Illizarov's methods of fixation to externally hold the elbow reduced and allow both passive and active motion. Eleven patients with degenerative disease, contracture or instability were treated with the Compass Elbow Hinge and were retrospectively evaluated at an average follow-up of 29 months (range: 18-62 months). One was lost to follow-up. Patients with degenerative changes underwent fascia lata interposition while those treated for contractures underwent anterior and posterior capsular release with or without fascia lata interposition. Those with elbow instability underwent ligament reconstruction. The device was removed after 6 weeks and seven of the 11 patients were satisfied with the outcome of the operation. Stability could not be achieved in two patients with coronoid fractures that were not reconstructed. One patient did not tolerate the device and requested its removal with subsequent subluxation. We conclude that patient selection and compliance are key elements in achieving a satisfactory outcome with the device.

Adult↗
PubMed2000

Recalcitrant post-surgical neuropathy of the ulnar nerve at the elbow: treatment with autogenous saphenous vein wrapping.

Surgical decompression or transposition is generally efficacious for cubital tunnel syndrome. However, recurrence is not rare and its management is both challenging and difficult. Four patients with refractory cubital tunnel syndrome were operated on with the vein-wrapping technique, using the autologous saphenous vein. A total of 16 operative procedures were performed on these patients prior to wrapping the ulnar nerve with a saphenous vein graft. The mean patient age was 43 years (range: 30 to 54 years) and the mean follow-up was 34 months (range: 24 to 44 months). All patients reported significant pain relief and improvement in sensation. Two-point discrimination and EMG findings also improved. This is the first study reporting long-term results of the vein-wrapping technique for the treatment of recalcitrant cubital tunnel syndrome.

Adult↗
PubMed2000

Trapeziometacarpal arthroplasty using the entire flexor carpi radialis tendon.

Fifty-eight patients (62 joints) with arthritis of the thumb carpometacarpal joint were treated with resection arthroplasty, ligament reconstruction, and tendon interposition with the entire flexor carpi radialis tendon. The mean age of the patients at the time of surgery was 58.4 years (range, 28-80 years), and the average followup was 42.5 months (range, 21-86 months). The entire flexor carpi radialis tendon was used for reconstruction and interposition. In 32 of the 62 joints, a partial trapezoidectomy was performed for scaphotrapezoidal arthritis. Finger-tip pinch improved by 88%, key pinch improved by 86%, and grip strength improved by 69%. Palmar and radial abduction also improved by 8% and 10%, respectively. Fifty-five (95%) patients reported excellent pain relief, whereas three patients reported only mild pain. No patients experienced an increase in pain. All thumbs were stable radiographically. This study indicated ligament reconstruction with tendon interposition, accompanied by partial trapezoidectomy when indicated, provides excellent pain relief and restoration of function. No morbidity was observed with use of the entire flexor carpi radialis tendon.

Adult↗
PubMed2000

Partial nerve injuries in the upper extremity.

The level of injury of a peripheral nerve is a critical factor that has a great impact on the result of the repair. At the level of the wrist, the median and ulnar nerves have pure motor and sensory fascicular groups. Proximal to the wrist, the motor fascicular groups combine with sensory fascicles and become mixed nerves. Mapping the fascicular orientation with electrical stimulation is indicated for injuries located from the wrist to the distal third of the forearm. Successful application of this technique depends on the level of injury, anesthetic technique, and careful patient selection. Children and patients with other serious coexisting injuries are not candidates for this technique. The depth of anesthesia must provide adequate analgesia while allowing the patient to communicate and cooperate with the surgeon during the procedure. There are few reports in the literature about repair of partially injured nerves in the upper extremities and the comparison of functional outcomes with or without the use of nerve grafts is not easy. Even under ideal operative conditions and with ideal indications, the outcomes are not always satisfactory. Hurst et al reported very good results using end-to-end repair of fascicular groups in their series. Using the rating system of the British Medical Research Council, they reported motor values of 4.0 (normal 5.0), and sensory values of 3.8 (normal 4.0). Kato et al reported very good results in their series of 51 cases with group fascicular end-to-end suture using orientation with electrical stimulation. In this series, there were five patients with partial nerve laceration and end-to-end coaptation of the fascicular groups provided very satisfactory outcome. End-to-end repair of the fascicular groups seems to provide better results than repair of the nerve using nerve grafts. It is desired, however, that the nerve gap be less than 2 cm for the application of end-to-end repair of the nerve.

Arm↗
PubMed1999

Results of surgical treatment for radial tunnel syndrome.

We reviewed the outcome of radial nerve decompression in 28 patients with an average 28-month follow-up period. The outcome was determined by both subjective (ie, questionnaire) and objective assessments. Only 11 of the 28 patients (39%) had excellent or good results. However, 64% subjectively assessed their results as excellent or good. Results were worse in patients receiving workers' compensation or who were in litigation. The difference was statistically significant. Although previous studies have found a high rate of good results, we believe that a high rate of morbidity is associated with both the disease and its treatment. Based on our results we suggest that great caution be taken before performing radial tunnel release and strict adherence to the indications noted during the preoperative examination.

Adult↗
PubMed1999

Posterior interosseous nerve palsy in a patient with rheumatoid synovitis of the elbow: a case report and review of the literature.

A 54-year-old woman with rheumatoid arthritis developed loss of finger extension in the left hand. History, physical examination, and electromyography led to the diagnosis of posterior interosseous nerve palsy secondary to synovitis of the elbow. Anterior decompression and synovectomy resulted in a complete recovery. A literature review describes similar cases and compares outcomes.

Arthritis, Rheumatoid↗
PubMed1999

Failed endoscopic carpal tunnel release. Operative findings and results of open revision surgery.

From 1994 to 1997, 22 patients (24 wrists) underwent open revision carpal tunnel release for persistent carpal tunnel syndrome after a primary endoscopic release. The age range was from 21 to 77 years. At the time of revision surgery, 22 wrists had an incomplete release of the flexor retinaculum and two patients had median nerve transection (one partial and one complete). One patient had release of Guyon's canal and not the carpal tunnel. After the open revision carpal tunnel release, 20 patients returned to work with five patients returning to jobs of lighter duty. In addition, these 20 patients had significant improvement in symptoms. The remaining two patients had sustained a median nerve injury and did not return to work. One of these patients developed a painful neuroma in continuity of the median nerve which required vein wrapping with a saphenous vein graft. This study indicates that endoscopic release of the flexor retinaculum holds the same risks and complications as open release. Based on our study we believe that patients with persistent carpal tunnel syndrome after failed endoscopic flexor retinaculum release can be successfully treated with open release.

Adult↗
PubMed1998

Difficulties and early results of the endoscopic carpal tunnel release using the modified Chow technique.

In reporting on the preliminary results of our series of 76 patients, this paper aims to identify potentially complicating aspects of endoscopic carpal tunnel release (ECTR) using the two-portal Chow technique, and to recommended solutions, based on our early experience, which enhance the ease and safety of this minimally invasive technique. Of the first 24 patients, 16 cases required conversion to an open procedure. Based on these initial cases, we developed certain modifications of the Chow technique which precluded any need for open conversion in the 60 remaining cases. During a follow-up interval ranging from 4 to 24 months, there was no recurrence of carpal tunnel symptoms, and the average time to resumption of work activity was 14 days. The complication rate was 5% and included one case of transient hypesthesia, one case of extended hematoma, and one hypersensitive scar. All complications resolved at subsequent follow-up. In our experience, correct positioning of the hand, proper injection of local anesthetic, use of magnifying loupes, and correct use of instruments are essential for a safe and successful procedure.

Carpal Tunnel Syndrome↗
PubMedDate not supplied

Reconstruction of the elbow: surgeons' perspective.

Great progress has been made in surgery of the elbow during the past decade. Better definition of ligamentous anatomy, recognition of previously undescribed instability patterns, and development of ligament reconstruction techniques have helped improve surgery designed to restore stability of the elbow. Surgical release of elbow contractures helps patients with stiffness gain very satisfactory range of motion. New techniques and advances in prostheses have broadened the indications for total elbow arthroplasty, and cases that were previously considered inoperable can now be treated surgically with excellent outcomes. Elbow surgery enters the new millennium having accomplished much, but problems and challenges remain.

Arthroplasty, Replacement↗