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Biomedical subjects

S F Gunther

Publications and source records attributed to S F Gunther.

At least 19 recordsLinked to original sources
PubMed1998

Diabetic hand infections.

Compared with the limited experience reported in the literature to date, analysis of the authors' clinical series of hand infections demonstrates that more than one third of the patients are diabetic. This can be attributed to the population of African-Americans in Washington, DC, the high incidence of diabetes in this particular race, and the inherent susceptibility of diabetics to develop an infection of the hand. The most severe infections occur in insulin-dependent diabetic patients or those with chronic renal failure because of protein depletion, poor wound healing, neuropathy, and ischemia. Although a similar spectrum of infections is encountered in diabetic and nondiabetic patients, some characteristic presentations are somewhat unique to the diabetic population. Gram-negative and mixed organism infections are particularly common in diabetic patients. Despite the poor prognosis of diabetic hand infections in general and the unsatisfactory outcome in patients on renal dialysis, most diabetic patients successfully heal following early and appropriate intervention. Early diagnosis and aggressive and adequate surgical drainage and tissue excision or amputation (if indicated) are key principles. The authors have learned that the surgical incision must extend along the entire area of erythema and induration because the infection often is more extensive than suspected both before and during the initial surgery. Observation, local wound care, and the administration of antibiotic agents are not acceptable substitutes for surgical decompression in the diabetic patient with a hand infection. In the subgroup of diabetic patients most prone to develop hand infections (i.e., associated renal dialysis), the surgeon must recognize that ongoing tissue loss is commonplace, repeat wound debridements are required, and an eventual amputation is highly likely.

Adult↗
PubMed1996

Orthopedic trauma surgeons' attitudes and practices towards bloodborne pathogens.

A survey was conducted to determine orthopedic trauma surgeons' attitudes and practices towards occupational exposures to bloodborne pathogens. The survey was distributed to orthopedic trauma surgeons either by mail or through participation at the annual 1993 OTA meeting or the 1994 update meetings. Of the 1,058 surveys distributed, 504 were successfully completed (48%). The majority of respondents were attendings (72%) who performed at least 100 orthopedic procedures annually. Of the respondents, 74% reported they were moderately to very concerned about acquiring HIV at work. Despite their concern, 42% reported not routinely wearing gloves when changing would dressings. Of the 340 respondents who have access to maximum barrier protection, 83% reported not wearing it to nail a femur fracture and 33% reported not wearing it when operating on an HIV+ patient. At an institutional level, almost one-third of those surveyed did not believe their facility promoted safe work practices. Facilities judged by respondents to promote safe practices were significantly more likely to have resources available and infection control policies in place compared to facilities judged not to promote safe practices. Orthopedic trauma surgeons need to improve their compliance with infection control recommendations. Further efforts by individuals and their institutions are warranted.

Blood-Borne Pathogens↗
PubMed1992

The internal anatomy of the median nerve in the region of the elbow.

The internal anatomy of the median nerve in the region of the elbow has been studied by microdissection in 20 cadavers. Gross branching patterns were studied in an additional 14 cadavers. There are four major branches or branch groups: I to pronator teres, II to flexor carpi radialis, flexor digitorum superficialis, and palmaris longus; III to the anterior interosseous nerve; and IV to flexor digitorum superficialis. Three of these could be traced proximally within the main trunk of the median nerve, the average being I-10 cm; III-7.5 cm; IV-2 cm. This information should have clinical applications in repair and grafting of the median nerve near the elbow and in understanding clinical nerve compression sydromes.

Cadaver↗
PubMed1991

Carpometacarpal dislocations. Long-term follow-up.

Twenty patients who had a dislocation of one or all of the medial four carpometacarpal joints were followed for an average of 6.5 years (range, 1.5 to 20.5 years). Fifteen patients were treated with open reduction and internal fixation during the first three weeks after injury and the long-term result was excellent in thirteen of them. Three of the four unsatisfactory results were in patients who had injuries to the normally rigid second and third carpometacarpal joints or had a concomitant ulnar-nerve injury.

Adolescent↗
PubMed1990

The role of Ender rodding in tibial fractures with an intact fibula.

Thirty-three patients with tibia fractures and intact fibula were studied to determine the efficacy of Ender rod fixation in preventing a varus deformity of the tibia. Twenty-one patients were treated nonoperatively with five (23.8%) developing a significant varus angulation (greater than five degrees). No varus malunions were noted in those patients treated with Ender rods. Those patients treated with Ender rods and early weight-bearing had a shorter average time to union than those treated nonoperatively. We therefore feel that Ender rod fixation is a viable treatment modality in tibia fractures with an intact fibula. In these fractures the use of Ender rods helps prevent significant varus malunion and allows early weight-bearing, thus permitting early mobilization of the traumatized patient.

Adult↗
PubMed1990

Chronic infections.

The surgeon is rarely the first physician to examine the hand with a chronic infection. In most cases, simple treatment has been tried and has failed. The surgeon must think of atypical mycobacteria and fungi and then systematically make a diagnosis by biopsy and culture and by excluding other diseases and conditions. Because these infections can be very damaging to the hand or wrist, treatment should be rendered promptly and adequately. These general principles are no different from those followed in treating acute hand infections or actually for any disease.

Chronic Disease↗
PubMed1989

Efficacy of cortisone injection in treatment of trigger fingers and thumbs.

One hundred eight trigger fingers and thumbs in 74 consecutive patients were treated by injections of triamcinalone and followed for an average of 3 1/2 years. Minimum follow-up was 1 year. Eighty four percent of trigger fingers and 92% of trigger thumbs were cured with a single injection, and a repeat injection for treatment of recurrent symptoms raised these figures to 91% and 97%, respectively. All injections were done by one physician. There were no complications. We conclude that intrasynovial injection of a steroid compound is the appropriate initial treatment for trigger fingers and thumbs.

Adolescent↗
PubMed1989

Mycobacterial infections.

Mycobacterial infections of the hand are increasing in frequency, and at least seven atypical mycobacteria have been reported in the hand. The authors present several types of atypical mycobacteria, the types of infections they cause, accurate diagnosis methods, and proper treatment protocols.

Diagnosis, Differential↗
PubMed1988

The effect of cryosurgery and polymethylmethacrylate in dogs with experimental bone defects comparable to tumor defects.

The effects of liquid nitrogen (LN) and polymethylmethacrylate (PMMA) on normal bone, bone graft incorporation, and reossification were evaluated by simulating a tumor in dogs with experimental bone cavity. Ten skeletally mature mongrel dogs (20 femora) were divided into three groups: Group I, controls; Group II, LN (with and without bone graft); and Group III, PMMA (with and without LN). Roentgenograms, whole-mount histology, and tetracycline fluorescence studies were performed on the distal femur. Correlation of these studies showed that (1) marked trabecular and bone necrosis, extending 7-12 mm around the circumference of the cavity, developed by three and seven weeks after LN but no bony necrosis occurred after PMMA; (2) the pattern of reossification following cryosurgery was delayed and abnormal, demonstrating increased calcification and metaplastic bone formation; (3) cryosurgery decreased the rate of bone graft incorporation; (4) the cryonecrotic rim following cryosurgery correlated with an abortive attempt at peripheral reossification; and (5) cryosurgery had no effect on the articular cartilage. Cryosurgery is effective in causing bone necrosis, whereas PMMA is not, and the pattern of reossification is delayed and altered by freezing. This study suggests that microvascular thrombosis with subsequent ischemic infarction of bone is a major cause of bone necrosis following cryosurgery.

Animals↗
PubMed1986

Superficial epithelioid sarcoma: a clinical and histologic stimulant of benign cutaneous disease.

Epithelioid sarcoma, a distinctive clinicopathologic entity, typically arises in the deep soft tissues of the upper and lower extremities. Infrequently the tumor originates in the subcutis or dermis, whereby it may be confused both clinically and microscopically with a granulomatous or benign ulcerative process. A case of superficial epithelioid sarcoma, initially diagnosed as an atypical mycobacterial infection, is presented, and its histologic distinction from granulomatous and benign fibrohistiocytic lesions is discussed.

Adult↗
PubMed1985

Divergent dislocation of the carpometacarpal joints: a case report.

A motorcyclist presented for treatment with divergent dislocation of the bases of the four medial metacarpals, avulsion of the hook of the hamate, dislocation of the trapezium from the scaphoid, and palmar fracture-dislocation of the wrist. This constellation of injuries has never been described. The carpometacarpal joints were reduced at surgery and pinned. The patient is doing well 8 years later despite nonunion of the hook of the hamate.

Adult↗
PubMed1985

Dorsal wrist pain and the occult scapholunate ganglion.

Ten consecutive patients who presented with dorsal wrist pain, no history of trauma, and no physical signs other than local tenderness over the scapholunate ligament junction had surgery. The obvious pathologic finding in eight was ganglionic degeneration in a particular area on the dorsal scapholunate interosseous ligament. The operation resulted in dramatic relief of pain and return to full function for the duration of follow-up in most patients.

Adolescent↗
PubMed1984

A new technique for obtaining iliac bone grafts.

A new method for obtaining corticocancellous bone grafts for use in orthognathic and facial reconstructive surgery is presented. By raising an osteoperiosteal flap from the crest of the ilium and removing a medial corticocancellous bone block, graft site morbidity is minimized, the patient's return to ambulatory status is hastened, and an excellent graft is procured.

Adolescent↗
PubMed1984

The carpometacarpal joints.

Although less complex than the intercarpal joints, the carpometacarpal joints are very important to proper hand function, and their derangement can be very disabling. The anatomy and clinical problems of these joints are covered in this article.

Adult↗