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Biomedical subjects

V E Meyer

Publications and source records attributed to V E Meyer.

At least 19 recordsLinked to original sources
PubMed1996

Surgical treatment of the ulnar nerve entrapment neuropathy: submuscular anterior transposition or simple decompression of the ulnar nerve? Long-term results in 79 cases.

The surgical treatment of the ulnar nerve entrapment neuropathy at the elbow is controversial. None of the presently advocated procedures (simple decompression of the ulnar nerve, medial epicondylectomy, subcutaneous or submuscular anterior transposition of the ulnar nerve) has proven optimal regarding long-term results. We studied the outcome in 79 patients whose ulnar nerve had been operated on for the first time, either by simple decompression (31 cases) or by submuscular anterior transposition (48 cases). The mean follow-up was 76 months. Patients were classified according to McGowan pre- and postoperatively; we also applied a more detailed scoring system of our own. Preoperatively, the patients were distributed almost equally between the three McGowan classes. Postoperatively, about one out of three patients in both treatment groups experienced a distinct improvement, i.e. was upgraded to a better McGowan class. Using our own scoring system, the overall rate of objective improvement was 73% after transposition and 55% after simple decompression. Irrespective of the surgical method, roughly 90% of the patients considered their postoperative condition to be improved. However, one specific group of patients (people with habitual ulnar luxation or subluxation of the ulnar nerve) experienced a distinctly better result when treated by anterior transposition than by simple decompression. Our results show that simple decompression of the ulnar nerve can be recommended in all patients without cubital (sub)luxation of the nerve, whereas people with a tendency of cubital (sub)luxation of the ulnar nerve should be treated by submuscular anterior transposition.

Adolescent↗
PubMed1996

[Ulnodorsal impingement syndrome: meniscus lesions of the wrist].

In a consecutive series of 166 wrist arthroscopies, a lesion of the meniscus was found in 16 patients. All of them complained of ulnar wrist pain evoked by axial load in extension. 14 patients had previous wrist trauma. The preoperative physical examination showed marked ulnodorsal tenderness on palpation and the examiner could feel crepitation by passive motion in the radial-ulnar direction. The meniscus represents a part of the triangular fibrocartilage complex (TFCC). At this time it is not possible by magnetic resonance imaging (MRI) to differentiate between articular disc and meniscus lesion. In contrast the two structures are clearly identifiable by arthroscopy especially if there is a radial tear through the meniscus or even a complete avulsion from its insertion on the palmar aspect of the triquetrum. The avulsed part of the meniscus can prolapse into the ulnocarpal joint, causing an impingement phenomenon.

Adolescent↗
PubMed1995

Soft tissue infections of the upper extremities with special consideration of abscesses in parenteral drug abusers. A prospective study.

Despite surgical advances and new antibiotics, upper extremity infections continue to present a serious problem. Soft tissue infections of the upper extremities were prospectively examined to elucidate incidence, cause, bacterial pathogens involved, and treatment. Special attention was paid to infections associated with parenteral drug abuse. During an 18-month period all patients over 16 years of age presenting for treatment of an established infection were included in the study. Conservative treatment consisted of immobilization and antibiotics. Radical débridement with removal of all necrotic tissue was the guideline for operative care. In addition, for both regimens a penicillinase-resistant antibiotic was administered. A total of 415 patients (271 men and 144 women; mean age 36.7 +/- 14.5 years) were enrolled into the study, 55 of whom were parenteral drug abusers; 45 of these were HIV-reactive. Infections of fingers (excluding paronychia), paronychia and abscesses at injection sites were the most common diagnoses. Operative and conservative treatment were performed in 285 and 130 patients respectively. Staphylococcus and streptococcus species were the predominant organisms recovered from 212 specimens of pus. Anaerobic bacteria and yeasts were of minor importance. Therefore, a penicillinase-resistant antibiotic is a good initial choice.

Abscess↗
PubMed1995

[Nerve compression syndromes of the extremities].

Peripheral entrapment neuropathies occur in high frequency and present clinically with a wide range of variations. They need to be recognized early enough in order to initiate correct therapy and so to obviate serious nerve lesions and possible neurological sequelae. This paper overviews the essentials of the compression neuropathies as they are encountered in both upper and lower extremities. Pathomechanisms , pathogenesis, evaluation considerations as well as differential diagnosis and basic treatment algorithms are emphasized.

Carpal Tunnel Syndrome↗
PubMed1994

[Is the "classical" release of the flexor retinaculum in carpal tunnel syndrome obsolete?].

Carpal tunnel release used to be the standard treatment for carpal tunnel syndrome. However, some authors now prefer reconstruction of the transverse carpal ligament, due to suspected palmar dislocation of the median nerve in wrist flexion after simple ligament release. In this retrospective study the topographic location of the median nerve after release is investigated and an attempt made to find a correlation with the postoperative clinical outcome. In computed tomography no palmar subluxation of the nerve was found, even in a patient with a poor clinical result.

Adult↗
PubMed1993

Fiber regeneration in nerve grafts without connection to a target muscle: an experimental study in rabbits.

In 30 rabbits, both saphenous nerves were harvested as autografts and coapted to the branch for the rectus femoris muscle without connection to any distal target muscle. The graft from the right thigh was led to the contralateral extremity (crossover grafting). The graft on the left side remained on the same extremity (ipsilateral grafting). Animals were separated into four groups and were sacrificed 3, 6, 9, and 12 months after grafting. Specimens of the grafts and the donor motor branches were harvested for histomorphometric examination. The number of myelinated nerve fibers in the distal end of the nerve grafts was significantly increasing from 3 to 6 months after grafting and remained on a relatively constant level in the long-term groups. Three months after the first operation, greater numbers of myelinated nerve fibers were counted after ipsilateral grafting than after crossover grafting. In the long-term groups, this difference could not be observed.

Animals↗
PubMed1993

Silicone cuffs for peripheral nerve repair: experimental findings.

The effectiveness of silicone cuffing in peripheral nerve repairs was assessed in a comparative study in rats. The femoral nerve was dissected out and severed bilaterally. The nerve ends were brought together with four epineural sutures on one side, while only one epineural suture was used on the other side, placing a silicone cuff around the junction site. Initially, nerve regeneration appeared to be improved by the cuff, with electrophysiologic parameters and histologic studies 6 weeks after the procedure yielding better results for the tubulated nerves. Subsequently, however, conductivity was less in the tubulated nerves, and results were clearly inferior to sutured nerves at 4 months after the operation. The deterioration was due to nerve compression caused by the cuff, which prevented axons from penetrating into the distal nerve stump, and resulted in axon fragmentation in the compressed nerve segment. The risk of nerve compression makes the use of silicone cuffs of doubtful value.

Animals↗
PubMed1993

Prefabrication of a skin axial flap in experiment.

Flap prefabrication was studied on the rat thigh by implanting femoral vessels into the flap's subcutaneous tissue. The aim of the experiment was to determine optimal prefabrication time, and to monitor, using contrast staining, the dynamics and morphology of the neovascularization process. The minimal time for successful prefabrication was 14 days in our experimental model. The potential of physiological and pharmacological regulation of the process of capillary neoformation is discussed. A successful attempt at free transfer of a prefabricated flap to the contralateral thigh and at femoral vessel anastomosis by microsurgery was also made as part of the experiment.

Animals↗
PubMed1993

[Relations between donor nerve size and degree of neurotization in the nerve transplant--an experimental study].

The present study was undertaken to investigate whether the number of myelinated fibers in a sensory nerve used as an autograft influences the result of nerve fiber regeneration in the graft. In 30 rabbits, the left saphenous nerve was used as an autograft. It was coapted to the motor branch to the rectus femoris muscle. Biopsies from both ends of the graft were taken. Animals were separated into four investigation groups, which were reexamined 3, 6, 9 and 12 months after the grafting procedure. Biopsies for histological and morphometric examination were again taken from the proximal and the distal part of the grafts. Thus, the number of myelinated nerve fibers in the different specimens could be obtained by computer-assisted image analysis. At the proximal end of the original saphenous nerve, the number of fibers varied between 1032 and 3100 (mean 2145). Corresponding data obtained from the distal end ranged from 1044 to 3084 myelinated nerve fibers (mean 1724). Fiber numbers in the proximal and distal parts of the grafts before and after regeneration were correlated to each other. In the whole population of specimens (correlation coefficient +/-0) as well as in the experimental subgroups, the quantitative success of neurotization in the grafts did not depend to a high degree upon the fiber numbers in the original saphenous nerve. The correlation coefficient for the proximal part of the graft exceeded 0.5 to only three and twelve months after grafting, but did not reach a level of statistical significance. In the distal part of the graft, the coefficient for a linear correlation was always less than 0.45.

Animals↗
PubMed1993

[Results of surgical therapy of ulnar sulcus syndrome. Submuscular anterior transposition versus simple decompression of the ulnar nerve].

The operative treatment of the ulnar neuropathy at the elbow is controversial. We studied the course of 79 patients who had been operated for the first time, either by simple decompression (31 cases) or by submuscular anterior transposition (48 cases) of the ulnar nerve. Our results show that the simple decompression can be recommended in all patients without cubital (sub)luxation of the ulnar nerve. The submuscular anterior transposition should be preferred if a tendency of cubital (sub)luxation of the ulnar nerve has been found.

Adult↗
PubMed1992

[Prospective analysis of infections of the upper extremity].

In a prospective investigation infections of the upper extremity are examined with respect to incidence, bacterial pathogens, operative or conservative treatment, and duration of disability for work. A total of 255 patients (pts) (170 men, 85 women; mean age 37 years, range 16-85) were entered into the study. In a 12-month period 163 (64%) were treated as outpatients, the condition of 92 pts (36%) required hospitalisation. Conservative and operative treatment was performed in 82 (32%) and 173 (68%) pts, respectively. Conservative treatment included fixation by cast as well as antibiotics (penicillinase resistant penicillin), usually given by the oral route for a mean of 4 days. Surgical procedures consisted of excision and debridement. Intraoperatively intravenous antibiotics were instituted for a mean of 3 days, followed by oral application for another 4 days. In 135 of 173 pts who underwent surgery, sufficient material for bacterial culture was obtained. There was a polymicrobial infection in 50% of pts. Most common isolated pathogens were Staphylococcus aureus, beta-hemolytical streptococci group A, and indigenous skin flora in 34%, 21%, and 11%, respectively. Among the 255 pts there were 26 HIV-positive iv drug abusers, who suffered from abscesses at injection sites. The infections in these immunocompromised HIV-positive pts did not reveal differences with respect to number and species of isolated pathogens as compared to immunocompetent pts. Resistant bacteria were not found. Response to treatment was satisfactory usually within a few days in all but 12 pts (4.7%) in which the failure could be attributed to inadequate primary debridement.

Adolescent↗
PubMed1992

[Bone segment transport in femoral defects. Animal experiment study].

The aim of our experimental study was to realize the Ilizarov concept using a reamed intramedullary interlocking nail with an internal transport system. In 8 mature dogs a bone defect of 3 cm was performed at the femur. A distally osteotomized bone fragment (length 3.5 cm) was lowered through the bone defect. 4 times we had to exclude the animal from the evaluation. In this case the interlocking nails were broken within 6 weeks. In 3 dogs a regeneration of bone was found in the defect. In 6 dogs a deep infection along the transport system had developed.

Animals↗
PubMed1991

[Dupuytren contracture].

The paper is a summary of today's knowledge of Dupuytren's contracture and describes in short the clinical aspect, the spontaneous course, the differential diagnosis and the pathophysiological factors. It shows that during the last 100 years there has only been little progress in the fundamental understanding. The pathophysiological discoveries still have no consequence for the practical treatment. Until now, there is no alternative to surgical therapy in the sense of a therapy of causes; however, thanks to a number of technical refinements, the results of surgical treatment could be substantially improved, even in patients of old age.

Diagnosis, Differential↗
PubMed1991

Epithelioid sarcoma mimicking angiosarcoma: the value of immunohistochemistry in the differential diagnosis.

Epithelioid sarcoma (ES) is a rare malignant tumour of young adults, usually presenting as a skin ulcer or subcutaneous nodule in the distal portion of the upper limb. Multiple recurrences and late metastases are typical, leading to fatality in a third to one-half of all cases. The slow evolution of the tumour is one reason for its delayed recognition. The other is its frequent histological misinterpretation, in particular, as a peculiar granulomatous reaction. In our case, the primary tumour presented a variant morphological pattern so closely mimicking a cavernous angiosarcoma as to mislead several reputable opinions. Later recurrences and metastases were typical of ES, while a focal angiomatoid pattern was maintained. The morphology and immunoreactivity to a wide spectrum of tumour markers is compared with that of six file cases of classical ES. Retrospectively, all neoplastic lesions in our patient were ES. In young adults, lesions of the upper extremity, even when angiomatoid or haemorrhagic, should raise a suspicion of ES. Once epithelioid sarcoma is suspected, the differential diagnosis can be elucidated on immunohistochemical grounds. Early diagnosis provides the best opportunity for radical surgery at a stage when the tumour has not spread locally or disseminated systemically.

Adult↗