A technique for identification of the long thoracic nerve during axillary dissection.
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Female↗
Biomedical subjects
S J Snyder
Publications and source records attributed to S J Snyder.
Arthroscopy--"no-problem surgery". An analysis of complications in two thousand six hundred and forty cases.
In a retrospective review of 3,261 arthroscopic procedures on the knee, 2,640 met the criteria for inclusion in this analysis. The patients' ages ranged from eight to eighty-three years. There were 1,541 male and 1,099 female patients. Eight hundred and ninety-five of the injuries were work-related. A tourniquet was used in 1,175 procedures and the average tourniquet time was thirty minutes. There were 216 complications over-all (8.2 per cent), 126 being designated as major and ninety-seven, as minor. The major complications that were evaluated were infections, hemarthrosis, adhesions, effusions, cardiovascular, neurological, reflex sympathetic dystrophy, and instrument breakage, and the minor complications were difficulties with wound-healing and ecchymosis. Chi-square analysis showed the following factors to be significant (p less than 0.05). Patients with an industrial injury had a higher rate of neurological complications and reflex sympathetic dystrophy. Diagnostic arthroscopy had the lowest over-all complication rate. Partial medical meniscectomy was associated with a higher over-all complication rate and the highest hemarthrosis rate, and partial lateral meniscectomy was associated with the highest rate of instrument breakage. Abrasion arthroplasty had the highest rate of complications of wound-healing, and subcutaneous lateral release was associated with the most adhesions. The sex of the patient and whether or not a tourniquet had been used had no effect on complications. The experience of the surgeon with arthroscopic procedures also had no correlation with the complication rate. Multiple regression analysis showed that two factors (age and, if a tourniquet was used, the tourniquet time) were dominant predictors of complications. From these data, a model was devised for predicting which patients were at risk for complications and their relative levels of risk. Certain complications may be preventable, and for others the risk factors can be reduced. The high-risk patients in our series were fifty years old or older and had a tourniquet time of sixty minutes or longer.
Adolescent↗
Arthroscopic partial medial meniscectomy: an analysis of unsatisfactory results.
Results of 150 arthroscopic partial medial meniscectomies were analyzed by computer to identify the factors that lead to an unsatisfactory (fair or poor) outcome. The average follow-up for the group was 36 months (range 24-60 months). One-hundred ten men and 40 women were involved, with an average age of 48 years. The overall results were 58% excellent-good, 28% fair, and 14% poor. Most tears involved the posterior horn (76%). Bucket-handle, longitudinal, and flap tears were rated 88% excellent-good, whereas horizontal cleavage and degenerative and complex tears had only 45% excellent-good scores. The results were adversely affected by the severity of the chondromalacia, work-related injury, prior knee surgery, simultaneous lateral meniscectomy, and increased knee laxity. Because degenerative posterior horn tears had such a high percentage of unsatisfactory results, the question remains as to whether all these tears need to be removed.
Adult↗
Autogeneic anterior cruciate ligament (ACL) anterior reconstruction of the knee. A review.
Anterior cruciate ligament (ACL) reconstruction with patellar-tendon-bone, semitendinosus/gracilis, iliotibial band, and meniscus have all given "success" rates between 75% and 85% with reasonably short (less than three years) follow-up periods. A 7.9-year average follow-up evaluation of patellar tendon ACL reconstruction would probably represent the overall success rate of the above procedures at 69% good or excellent. All of these procedures require significant dissection and lengthy rehabilitation periods of six months to a year. In attempting to compare these various reconstructions, it is obvious that it will be necessary to develop a consistent and reproducible subjective and objective knee rating system that is presently not used by these authors. Prior to the use of the various prosthetic ACL reconstructions, careful follow-up analysis of the existing body of autogenous ACL reconstructions must be constantly reviewed and assessed in light of the newer data. As Ivar Palmer stated in 1938, "However, it cannot be denied that interferences of this kind are extensive, time-consuming and rather risky, and at the best of times, they cannot result in a restitutio ad integrum."
Bone Transplantation↗
A series of ten discoid medial menisci.
In a retrospective study, 14,731 menisci were examined to determine the incidence of discoid medial and lateral menisci. Of 8040 medial menisci, ten (0.12%) were discoid. Of 6691 lateral menisci, 102 (1.5%) were discoid. Only 22 discoid medial menisci have been reported in the medical literature. The previously reported cases were analyzed as one series and compared with the present series of ten cases as another. The incidence rate of symptoms in patients older than 18 years of age was 62% in the present series and 65% in the other series. The male to female ratio was three to one in both series. In 38% of the patients in this series trauma preceded meniscal symptoms, as compared with 66% in the literature series. Radiographic abnormalities had been reported in two of the patients reported in the literature, but none were noticed in our series. In both series, all patients recovered following meniscectomy, with the exception of one patient in our series, who developed chondromalacia patella from an unrelated patellar abnormality.
Adolescent↗
An analysis of 140 injuries to the superior glenoid labrum.
Between 1985 and 1993 140 injuries of the superior glenoid labrum were identified on arthroscopic evaluation and were recalled from a data bank of 2375 shoulder procedures performed during that time. The average patient age was 38 years, and 91% of the patients were men. The most common problem was pain, with 49% of all patients noting mechanical catching or grinding in their shoulders. No preoperative imaging modality consistently defined disease in the superior labral area. Fifty-five percent of all lesions were type II, 21% were type I, 10% were type IV, 9% were type III, and 5% were complex. Twenty-nine percent of lesions were associated with a partial-thickness tear of the rotator cuff, 11% with a full-thickness tear, and 22% with an anterior Bankart lesion. Twenty-eight percent of the superior labral lesions seen were isolated and did not have any associated rotator cuff or anterior labral disease. Type I lesions were debrided. Fifty-six percent of type II lesions were debrided in conjunction with an abrasion of the underlying glenoid rim. More recently suture anchors have been used to stabilize type II lesions. Treatment of type III and IV lesions depended on the extent of labral tissue disruption and involved either debridement or suture repair. Repeat arthroscopies were performed on 18 shoulders. Three of five type lesions treated with debridement and glenoid abrasion were healed. Four of five type II lesions treated with an absorbable anchor were healed. Three type III and one type IV lesion treated with debridement had normal superior labrums. Two type IV injuries treated with suture repair had completely healed. Two complex type II and III injuries treated with debridement and anchor fixation were healed.
Adolescent↗
A soluble fumarate reductase in Trypanosoma brucei procyclic trypomastigotes.
The enzyme NADH-fumarate reductase associated with the membrane fraction of Trypanosoma brucei procyclic trypomastigotes, can be solubilized by more than 50% when increasing the ionic strength to the equivalent of 150 mM KCl. The apparent KMs for NADH (125 microM) and fumarate (50 microM) remain close to those previously reported for the membrane-bound form of this enzyme. Other electron acceptors (i.e. oxygen or cytochrome c) appear to accept electrons in the absence of fumarate (KM for cytochrome c = 50 microM). The drug L-092,201 (Merck, Sharp and Dohme Research Laboratories, Rahway, NJ), an inhibitor of the membrane-bound fumarate reductase, also blocked the solubilized enzyme. Given the relatively high ionic strength of the intracellular environment we propose that, in vivo, the enzyme fumarate reductase is in the mitochondrial matrix or in the soluble fraction of another intracellular compartment.
Animals↗
Triceps tendon avulsion in a professional body builder. A case report.
We have reported a case of triceps tendon avulsion in a professional body builder, treated successfully by delayed repair, allowing him to return to competition. Triceps tendon ruptures, besides being rare injuries, differ from tendon ruptures in other locations. First, the injury can occur through healthy tissue. Second, the time of delay, from injury to repair, seems to have little effect on the functional outcome, as we demonstrated in our patient.
Adult↗
Arthroscopic "second look" at the GORE-TEX ligament.
We performed an arthroscopic "second look" in 21 knees (20 patients) that had arthroscopic implantation of the GORE-TEX prosthesis for chronic ACL insufficiency. Arthroscopy was done on eight knees at the time of screw removal, eight for knee pain, two for giving way, and three for recurrent effusions. The degree of synovial joint reaction, graft synovial ingrowth, and graft rupture was graded. Microscopic examination was carried out on all biopsies of the GORE-TEX ligament. The average patient age was 30 years and the average time interval from original implantation to second look was 11 months. The GORE-TEX was intact in 11 knees, 10% ruptured in 6, and completely ruptured in 4. There was no correlation between number of GORE-TEX strands ruptured and synovial reaction. No particles of the graft were noted in the synovium if the implant was intact, but particles were noted with graft rupture. We conclude that the intact GORE-TEX ligament is an inert substance and does not cause significant joint reaction. Impingement in the intercondylar notch appeared to be the most common cause of graft failure. Further study is critical to determine the natural history of the GORE-TEX ligament and the knees' response to this prosthetic device.
Arthroscopy↗
Superior labral lesions in the shoulder: pathoanatomy and surgical management.
Progress in shoulder arthroscopy has led to the identification of previously undiagnosed lesions involving the superior labrum and the biceps tendon anchor. Additional research has substantiated the role of the long head of the biceps tendon in anterior and rotational glenohumeral stability. Careful attention to the history and physical examination and directed diagnostic imaging may arouse suspicion of injury to the biceps tendon and the superior labral complex. Identification of injuries to the superior labrum extending from anterior to posterior, or "SLAP" injuries, can be made with diagnostic glenohumeral arthroscopy. Appropriate treatment can then be based on the type of lesion encountered (generally, debridement of most type I and III lesions and repair of type II and many type IV lesions).
Arthroscopy↗
Preliminary results with abrasion arthroplasty in the osteoarthritic knee.
A retrospective survey of 110 patients treated by arthroscopic debridement of the knee joint was conducted; 73 of 100 operations included abrasion arthroplasty. The average follow-up period was one year. All patients had Grade IV articular changes. Overall, 60% of the patients who underwent abrasion arthroplasty showed improvement, while the knee was unchanged in 34% and worse in 6%. The results were best in patients younger than 40 years of age. Forty-one patients had medial compartment abrasion in concert with pathologic medial meniscal conditions; 53% of these patients were improved. In a comparable group of 37 patients treated by medial compartment debridement and medial meniscectomy without abrasion only 32% showed improvement. Thus, tentative results in this small series of patients treated by abrasion arthroplasty are encouraging. Further investigations in a larger series are warranted to determine the long-term results of the procedure.
Adult↗