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Biomedical subjects

S R Hurwitz

Publications and source records attributed to S R Hurwitz.

36 records · Page 2Linked to original sources
PubMed1995

Use of an articulated external fixator for fractures of the tibial plafond.

We performed a prospective study of forty-nine displaced fractures of the tibial plafond in forty-eight patients managed, at three centers, with an articulated external fixator placed medially across the ankle joint. Forty ankles had interfragmental screw fixation of a reduced articular fracture, and fourteen ankles had bone-grafting. The average duration of external fixation was twelve weeks. All of the fractures healed (one after delayed bone-grafting). There were no infections in any of the operative or traumatic wounds over the tibia. Two wound infections over the fibula resolved with treatment. Eight patients were managed with antibiotics for a pin-site infection, and two patients had curettage and débridement of a pin site in the hindfoot after removal of the fixator. Thirty patients (thirty-one ankles) completed two-year data sheets at an average of thirty months after the injury. The average ankle score was 67 points. Twenty-one patients had grade-0 or 1 osteoarthrosis and nine had grade-2 or 3. One ankle had been treated with an arthrodesis. These data suggest that the prevalence of early complications associated with severe fractures of the tibial plafond and their treatment can be decreased with use of an articulated external fixator combined with limited internal fixation. We concluded that this technique of external fixation is a satisfactory technique for the treatment of these fractures.

Adolescent↗
PubMed1993

Effects of parathyroid hormone-related peptide on chick growth plate chondrocytes.

Parathyroid hormone-related peptide (PTHrP) and parathyroid hormone (PTH) have similar biological effects in vitro that are mediated through the PTH receptor. PTH receptors have been demonstrated in the zone of provisional calcification and the hypertrophic zone of the cartilaginous growth plate. The current study examined the biological effects of PTHrP on chick growth plate chondrocytes. Chondrocytes were exposed to varying doses of PTHrP for 24 h, and the incorporation of radioactive thymidine into DNA was used as an index of proliferation. A dose-dependent stimulation of proliferation was seen, with a maximal 27-fold increase at 50 nM PTHrP. A dose-dependent stimulation of cAMP was seen, with a maximal effect at a dose of 50 nM. Proteoglycan synthesis, measured by incorporation of radioactive sulfate, was stimulated, with a maximal effect of 65% at 1 nM. Collagen synthesis and alkaline phosphatase activity from both cellular and matrix vesicle sources decreased in a dose-dependent fashion, with a maximal inhibition of approximately 50% of the control value. The physiologic significance of the PTH and PTHrP-responsiveness of growth plate chondrocytes is uncertain at the present time. It is possible that PTH or PTHrP, or both, act as a systemic, developmental modulator of cellular proliferation and differentiation in the growth plate.

Alkaline Phosphatase↗
PubMed1993

Extension of limb salvage by combined vascular reconstruction and adjunctive free-tissue transfer.

PURPOSE: Vascular reconstruction alone can be insufficient for extremity salvage in some patients with severe soft-tissue wounds. We present our experience in 20 patients with vascular reconstruction for ischemic disease and free-tissue transfer for limb-threatening soft-tissue wounds. METHODS: Nineteen patients underwent autogenous venous bypasses and one patient underwent an aortobifemoral bypass. Ten soft-tissue reconstruction were performed at the time of the vascular reconstruction and 10 were delayed. Free-tissue transferred included muscle, fasciocutaneous flaps, and omentum. Inflow to the flap was from the bypass graft (n = 12) or the distal tibial artery. RESULTS: One free flap and graft failed immediately in the same patient. One successful flap and graft required a below-knee amputation for ongoing infection in the surrounding soft tissues. Eighteen of 20 patients have had free-flap and graft patency during the mean follow-up period of 17 months (range 6 to 33 months). These 18 patients ambulate independently. CONCLUSIONS: In patients with arterial insufficiency and severe soft-tissue wounds, combined vascular reconstruction and free-tissue transfer permits extended limb salvage with excellent functional results.

Aged↗
PubMed1992

Bilateral sacroiliac joint fracture-dislocation requiring late coccygectomy: a case report.

Associated injuries often prevent aggressive management of bilateral sacroiliac fracture-dislocations, although excellent results have been reported with nonsurgical treatment. We report a case of bilateral sacroiliac joint fracture-dislocation in a patient with multiple injuries which was managed with the placement of an external fixation frame. This patient developed a prominent and painful coccyx and ultimately required a coccygectomy. The excellent final result demonstrates the therapeutic role of coccygectomy as a late treatment for this injury.

Accidents, Occupational↗
PubMed1989

Amniocentesis needle with improved sonographic visibility.

A new amniocentesis needle was developed to be more clearly depicted during sonographic monitoring. Side holes in the aspiration cannula are designed to reduce the number of "dry" taps. The diameter of each side port approaches the wavelength of a standard 3.5-MHz beam, making the needle shaft more easily imaged with real-time ultrasound. The spherical wavefront of isotropic diffraction is clearly seen, even outside the transducer focal plane.

Amniocentesis↗
PubMed1989

Mechanical considerations for the syndesmosis screw. A cadaver study.

The purpose of this study was to examine the mechanical necessity of using a syndesmosis screw to supplement rigid internal fixation of the fibula and medial malleolus in the treatment of pronation-external rotation fractures. The legs of thirty embalmed and five fresh cadavera were dissected and mounted through the tibia to a frame so that multiple radiographs could be made with a constant relationship between the specimen and the x-ray apparatus. A standardized pronation-external rotation load was applied to the foot, and widening of the syndesmosis was studied on mortise radiographs that were made after each experimental step. On the basis of previous investigations, we developed a model for pronation-external rotation injuries that included disruption of the syndesmosis and interosseous membrane up to the level of the fibular fracture. Accordingly, multiple repaired fibular fractures could be simulated at several levels in the same specimen by incremental proximal division of the interosseous membrane. Specimens were separated into two groups. Group I consisted of thirteen specimens in which the deltoid ligament, syndesmosis, and interosseous membrane were serially sectioned in 1.5-centimeter increments. Group II (ten sections) was subjected to the same protocol, except that the deltoid ligament was kept intact until the final step. The five fresh specimens were sectioned in the same way as those in Group I. In Group I, since the simulated pronation-external rotation injury included a deltoid tear, rigid medial fixation was not possible; accordingly, there was rigid fibular fixation only.(ABSTRACT TRUNCATED AT 250 WORDS)

Ankle↗
PubMed1989

Atriopeptin in the twin transfusion syndrome.

Atriopeptin, a peptide produced by mammalian atria that promotes diuresis, natriuresis, and vascular changes, was in much higher concentration in the recipient twin than in the donor in two cases of severe twin transfusion syndrome. This finding suggests a possible etiology for the changes seen in twin transfusion syndrome.

Adult↗
PubMed1987

Hindfoot pain treated by a leg-hindfoot orthosis. A case report.

This case report describes an orthotic management option for the treatment of persistent subtalar and ankle joint pain in a patient with rheumatoid arthritis. Orthotic design, principles of control, and methods of application are discussed in addition to the advantages and disadvantages of prefabricated and custom-formed orthotic devices.

Ankle Joint↗
PubMed1986

Yolk sac sign: sonographic appearance of the fetal yolk sac in missed abortion.

With improving technology, the fetal yolk sac can be routinely visualized sonographically in all living gestations of six to ten weeks. The minimal growth of the yolk sac during this interval and its subsequent obscuration by the growing amniotic sac are verified in this study. An important new sign of missed abortion has been inferred by Bernard and Cooperberg (AJR 144:597, 1985), and is titled in this article the "yolk sac sign." A gestational sac of 25 mm or more in mean diameter and empty except for the yolk sac is highly suspicious for nonviable gestation. This one-year prospective study adds nine such cases. To enhance specificity of this sign, additional criteria specify a yolk sac measuring 4 mm, a free-floating position within the gestational sac, and evacuation of the yolk sac on follow-up scan. However, when a ring-like structure measures 3 mm or less and lies peripherally in the gestational sac, this must be presumed to be a potential fetal pole.

Abortion, Missed↗
PubMed1980

Aspiration of metrizamide following lumbar myelography.

When metrizamide was aspirated at the termination of lumbar myelography in 117 patients, 20% complained of a headache and 9% complained of nausea. There were no episodes of seizures. Chemical analysis of aspirated cerebrospinal fluid showed that 66% of the injected contrast material was recovered. Little additional effort is required to reduce the incidence of minor but frequent adverse reactions to metrizamide myelography.

Contrast Media↗
PubMed1976

Gallium-67 imaging to localize urinary-tract infections.

To differeniate upper from lower-tract urinary infections, 73 patients were imaged with 67Ga citrate. Renal uptake of the radioisotope occurred in pyelonephritis (documented in 47 patients by ureteral cathieterization, bladder washout, or histology) with an accuracy of 86%. There were 15% false-positives and 13% false-negatives. 67Ga may prove to be a clinically valuable test in the diagnosis of pyelonephritis. Results are promptly available 24 hours after injection, and it is non-invasive test that can safely be repeated to follow recurrent infections.

Adolescent↗
PubMed1975

Diminished uptake of 67Ga-citrate in a case of pseudarthrosis.

A 22-year-old man with pseudarthrosis and infection of the right hip was referred for a 67Ga-citrate scan. A striking decrease was seen in normal bone and soft-tissue uptake in the entire right leg compared with the normal limb. Aortic injection of 99mTc-labeled microspheres showed increased trapping in the region of the hip but contrast angiography was unremarkable. Despite clinical imporvement, 67Ga uptake by the right leg on a repeat scan did not return to normal. This case represents the first report of a "photon-deficient" body part on 67Ga scanning.

Adult↗
PubMed1974

Gallium-67 scans in the diagnosis of pyelonephritis.

Gallium-67 ((67)Ga) citrate was administered intravenously (50 microcuries per kg of body weight) to patients in whom acute and chronic urinary tract infections were suspected. Scanning was done, using both the Anger-type scintillation camera and the rectilinear scanner, 24 to 78 hours after injection of the isotope. The preliminary results imply that (67)Ga renal uptake is present in patients with pyelonephritis whether overt or silent, as well as in patients with uretero-sigmoidostomies. However, (67)Ga renal uptake is not present in patients with radiographic evidence of chronic pyelonephritis without active infection and in patients without renal disease.

Acute Disease↗