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PubMedDate not supplied

[The Cockett syndrome among the syndromes caused by compression of the common iliac vein].

A short account of the aetiopathogenesis of the iliac vein compression syndrome is followed by a description of a little-known form, called Cockett's syndrome, due to compression of the left iliac vein by the right common iliac artery. This syndrome should be looked for with care. If diagnosed in the "functional" stage, it can be ameliorated by means of a special surgical treatment known as "venous stocking plasty".

Femoral Vein↗

PubMedDate not supplied

Management of penetrating injuries of the knee.

One hundred and two patients with 121 known or suspected penetrating wounds of the knee demonstrated that successful results are dependent upon early diagnosis and surgical treatment. The willingness to act immediately on the basis of clinical judgment alone is important in order to avoid irreparable damage damage to the joint. The knee should be debrided and thoroughly irrigated. The menisci, articular cartilage and bony stock should be preserved as much as possible. The joint and skin are left open. If joint surfaces are damaged or infection is grossly purulent, the synovium is also left open. The dressing is dry fluff gauze, and a Jones compression dressing which allows drainage and prevents fluid accumulation. Early active mobilization of the joint is important.

Adolescent↗

PubMed2000

The use of interlocked 'customised' blade plates in the treatment of metaphyseal fractures in patients with poor bone stock.

Balanced and stable fixation in metaphyseal fractures and nonunion can be difficult because of osteoporosis, disuse osteopenia, comminution, joint proximity or malignant infiltration. Five patients with nonunion and four with comminuted or pathological acute fractures of metaphyseal areas of the tibia or humerus were treated with a 'customized' interlocked blade plate. The plates are standard AO dynamic compression plates of a suitable length that are bent to an acute angle in an industrial vice and 'interlocked'. The nine patients with a mean age of 62.2 years (range 30-91) were followed up for a mean of 7.2 months. At follow-up all fractures had healed with a single complication of subacromial impingement in a patient with a proximal humeral fracture.

Adult↗

PubMed1993

The effectiveness of intermittent plantar venous compression in prevention of deep venous thrombosis after total hip arthroplasty.

The purpose of this study was to investigate the effectiveness of intermittent pneumatic compression of the plantar venous plexus with the newly developed arteriovenous impulse system. Seventy-four patients about to undergo primary unilateral total hip arthroplasty for osteoarthrosis, all receiving a standard thrombosis prophylaxis regime of thigh-length anti-embolic stockings, 5,000 IU heparin delivered subcutaneously twice daily, and 400 mg hydroxychloroquine sulfate delivered twice daily, were entered in a prospective trial. The patients were allocated at random to also receive the arteriovenous impulse system on the foot of the operated side. On approximately postoperative day 12 bilateral ascending venography was performed. There were 44 patients in the nonpumped group and 30 patients in the pumped group. The incidence of deep venous thrombosis was 6.6% in the pumped group and 27.27% in the nonpumped group. The incidence of thrombosis was significantly lower in the pumped group (P < .025). The authors conclude that chemical prophylaxis plus the use of the mechanical, pneumatic, and arteriovenous impulse system reduces the incidence of thromboembolic complications further than chemical prophylaxis alone.

Aged↗

PubMed2000

Extended hindfoot fusions and pantalar fusions. History, biomechanics, and clinical results.

Contemporary techniques of hindfoot and ankle arthrodesis can result in a high rate of osseous union, pain relief, and patient satisfaction. Methods range from open approaches to fully arthroscopic surgical techniques. Arthrodesis should be limited to the joints involved with the arthritic, deforming, or neuromuscular process because the rate and severity of progressive adjacent joint degeneration appear related to the number of joints fused initially. Appropriate joint position, maintained with stable internal fixation applied in compression and augmented with bone-graft material when necessary, should be considered the gold standard for most hindfoot and ankle arthrodeses. External fixation may be used in the revision or salvage setting if needed or when soft tissues or bone stock do not permit stable internal fixation. Meticulous attention must be given to the handling of soft and hard tissues as well as to correction of the underlying deformity and to appropriate positioning of the joints in question. Newer techniques, such as intramedullary fixation, arthroscopic or arthroscopically assisted ankle arthrodesis, and total ankle arthroplasty, have shown some promise and warrant more extensive study.

Ankle Joint↗

PubMed1997

Hip fusion through an anterior approach with the use of a ventral plate.

A new technique to achieve a reliable fusion of the hip joint through an anterior approach with use of a ventral low contact dynamic compression plate and a lateral 6.5 mm lag screw is presented in detail. The advantages of this technique are that the approach does not jeopardize the vascularity of the femoral head, that the fixation on the pelvic side uses the strong bone stock of the sciatic buttress, and that the hip abductor muscles and greater trochanter are preserved. The authors also present the indications and the results of their experience with 12 patients. The followup period averaged 24.8 months (range, 10-42 months). Ten patients (83%) achieved a solid fusion by radiologic and clinical criteria. Although a moderately symptomatic nonunion developed in 1 patient, another patient went on to a painful nonunion to whom another attempt for fusion has been recommended. According to the hip score of Merle d'Aubigné and Postel, the average figures for pain and ambulation increased from 3.2 points to 5.0 points and from 2.7 points to 4.5 points, respectively, after surgery. Six of the 12 patients regained the ability to work in their former jobs or in new occupations. Eight patients felt no or minor restrictions in doing their former sports activities. Patient satisfaction was high with a majority reporting minor discomfort mainly around the fused hip.

Activities of Daily Living↗

PubMed1979

[The treatment of varicose veins].

In the treatment of varicose veins and their complications most European phlebologists use today, unlike the past, surgery, sclerotherapy and compression without any preconceived preference, guided solely by the indications of choice of each method. Within this framework, it is generally admitted that surgery is by far the best treatment for incompetent saphenous terminations, main saphenous trunks and insufficient bulky perforating veins. Sclerotherapy, on the other hand, is given the task of eliminating the varicose tributaries of the removed saphenous conduits, as well for treating reticular non-saphenous varices, dermal varicosities and recurrent varicose veins after correct operations. As far compression treatment, it requires today respect for "posology" that is expressed in terms of mmHg of pressures to be exerted at different levels of the extremity; depending on venous and skin changes, semi-stiff sticky bandages or various types of elastic stockings will be chosen. Often two or more of the methods listed are used during the same treatment or in successive stages.

Bandages↗

PubMed1988

Abnormal development of the notochord and perinotochordal sheath in duplicitas posterior, patch and tail-short mice.

Interest in developmental interactions involving the notochord and perinotochordal sheath led to a comparative investigation of these structures in three mouse mutants. Alcian blue or periodic acid-Schiff staining of 9 1/2-13 days' gestational age embryos revealed a supernumerary notochordal-like mass of cells or a deflected notochord in association with duplication of the neural tube in mice of the duplicitas posterior stock. The perinotochordal sheath and basement membrane of the accessory notochordal masses were frequently defective. Patch and Tail-short embryos were also utilized for study by means of light microscopy using Alcian blue staining. In Patch embryos, although the notochord was sometimes compressed dorso-ventrally, it had an intact perinotochordal sheath and a defined, but undulated, basement membrane. Mesenchymal cells between the notochord and neural tube were occasionally replaced by cell-free space. In contrast, in Tail-short embryos a poorly formed, lightly staining or totally absent notochordal sheath was revealed. Indeed, it was sometimes difficult to distinguish the notochord from surrounding mesenchymal cells. In both the Patch and Tail-short embryos the notochord was also deflected from its medial position. In the three mutants studied, the direct or indirect effect of gene action appeared to be on the notochord and perinotochordal sheath, and the important role of these structures in abnormal axial development was established.

Animals↗

PubMed1987

[Arthrodesis following knee arthroplasty].

In 44 failed total arthroplasties of the knee joint, arthrodesis was attempted (1970-1986). The interval between implantation of the total knee arthroplasty and diagnosis of infection was more than 2 years on average. Removal of the arthroplasty and arthrodesis was performed about 1 year later. In 80% of the knees, compression arthrodesis using an AO plate was used 34 times, with solid fusion occurring after 6 months. External fixation was used in 10 patients; rate of solid fusion was only 60%. The reasons for delayed union or failure had to do with reduced bone stock in the metaphysis with poor bone quality, inadequate fixation, and uncontrolled infections.

Arthritis, Rheumatoid↗

PubMed1999

[Complications of plastic surgery of the abdomen].

Plastic surgery of the abdomen remains difficult and is therefore associated with a number of complications of varying severity, but whose global incidence appears to justify a separate chapter. The most serious complications of abdominoplasty are thromboembolic complications, which may be life-threatening. The incidence of these complications must be minimized by rigorous preventive measures. Prevention is based on early mobilization of the patient, perioperative treatment with low molecular weight heparin and wearing of anti-thrombosis stockings. Skin necrosis is generally associated with one or several aetiological factors: excessive tension at the end of the operation, development of a haematoma, excessive or too superficial detachment. The so-called "Morel-Lavallée" fluid collection is best prevented by well performed postoperative compression applied continuously for three weeks after the operation. Complications of isolated abdominal liposuction are exceptional, or at least they should be, when the indication and technique are rigorously respected. The combination of liposuction and abdominoplasty does not add any complication not already described in the case of abdominoplasties and does not increase the incidence of these complications. Liposuction appears to decrease the number of abdominoplasties, but also their extent, which is beneficial in terms of the quality and safety of the postoperative course. A better definition of indications and improvement of techniques have therefore markedly decreased the severity and incidence of complications of plastic surgery of the abdomen. Truly effective preventive measures are available for each of these complications.

Abdominal Muscles↗

PubMed1995

Telemedicine: where is technology taking us?

Five years ago, a few zealots in Switzerland, at the CERN Laboratory, were contemplating using the Internet for hypertext and for transfer of still images, recorded sounds, and compressed video files. Five years later, the World Wide Web defines a set of standards for packaging and routing information over the Internet that involve millions of people and personal computers and that allowed a start-up Netscape to enjoy a capitalization of more than $2 billion when it sold stock to the public recently. Now, video-conferencing and multimedia electronic mail over the Internet are the fascinations of engineers at NASA, and the MBONE Information Web, the province of technophiles with UNIX workstations. Five years from now, you may be participating in telemedicine sessions frequently, from your workstation, and think nothing of it.

Computer Communication Networks↗

PubMed2004

Slipped capital femoral epiphysis. The mechanical function of the periosteum: new aspects and theory including bilaterality.

This particular ailment has many designations in the literature but none is quite adequate. Here we use the terminology slipped capital femoral epiphysis (SCFE). The anatomy of the proximal femur in all mammals reflects their growth and function. The main forces acting on the head are perpendicular to the growth plate. The thick tear-proof perichondrium-periosteum on the femoral neck is like a stocking attached to the epiphysis and the trochanter region. Growth in length causes a strong tensile stress in the periosteum, pressing the epiphysis against the metaphysis and thus stabilizing the vulnerable growth plate-the periosteum theory. Several factors may diminish the stability of the growth plate. SCFE begins with fissures, which coalesce to a fracture in the growth plate, invisible on a radiograph. As the slip progresses, an increasing angulation between the epiphysis and the remainder of the femur occurs. Weight and muscular forces displace the epiphysis posteriorly in a flexed hip. A rift in the ventral half of the periosteal stocking occurs at the border to the perichondrium and, after that, a longitudinal rift in the periosteum at the anterior midline of the femoral neck. This rift becomes broader as the epiphysis slips posteriorly, withdrawing the ruptured periosteum. Displacement of the epiphysis is due to a rotational slip and tilt, made possible by a compression fracture in the posterior part of the metaphysis. Parts of the periosteum function as reins steering the slip direction and counteracting the displacement. SCFE may be regarded as a pseudoarthrosis in the growing cartilage of the plate. The periosteum theory extended to a pseudoarthrosis theory has been supported by findings at surgery and on true lateral radiographs of usual and unusual cases of SCFE presented in this opus. On a true lateral view, the displacement can be measured as the slipping angle (SA) based on anatomical and geometrical considerations. SA values from 95 normal hips and from 22 contralateral asymptomatic hips from SCFE patients are presented in a histogram and bar graph. Statistically, SCFE is always bilateral, but in about 1/3 of the asymptomatic, contralateral hips, the physis ossifies and closes with SA below 13 degrees, and surgery is not necessary. It is most important that the position of the femur on the X-ray table is exactly defined in two dimensions: 1) the angle between the femoral shaft and the tabletop (angle of elevation), 2) the degree of rotation of the femur around its axis. A precisely defined positioning of the femur is a prerequisite for an exact reproducible measurement of the SA on a true lateral view and is also valuable for the evaluation of radiographic "signs". An aid, the Youth Hip Triangle (YHT), has been designed to facilitate positioning of the femur and measurement of SA. YHT is recommended for routine use in every X-ray facility. The method is quick, cost effective and makes it possible to diagnose SCFE in the contralateral hip before clinical signs or symptoms have occurred.

Adolescent↗

PubMed2002

Predictors of residual venous obstruction after deep vein thrombosis of the lower limbs: a prospective cohort study.

INTRODUCTION: Delayed thrombus regression after deep vein thrombosis (DVT) of the lower limbs is associated with increased risk of DVT recurrence. Predictors of residual venous occlusion are unknown. We hypothesized that obesity, which causes reduced fibrinolytic activity, can predict delayed thrombus regression. MATERIALS AND METHODS: In a prospective cohort study, 98 patients with objective diagnosis of DVT underwent compression ultrasonography (CUS) after 6 and 12 months. Persistent occlusion was arbitrarily defined as a thrombus occupying, at maximal point of compressibility, more than 20% of the vein area in the absence of compression. The body mass index (BMI) and waist circumference were measured at baseline and at follow up to assess individual patterns of body fat distribution. Information on antithrombotic treatment, family history of varicose veins, cigarette smoking, concomitant disorders, the presence of known risk factors for DVT, the duration of anticoagulant treatment and the use of elastic stockings was collected. RESULTS: Post-thrombotic recanalization was documented in 34 patients (34.7%) at 6 months and in 44 patients (44.9%) at 12 months. There was no difference in the mean BMI (p=0.469 at 12 months), in the prevalence of obesity (p=0.479) and visceral pattern of body fat distribution (p=0.239) between patients who did and did not show thrombus regression. The presence of a permanent risk factor for DVT was the only predictor of delayed thrombus regression (OR 11.0, 95% CI 1.359-61.978). CONCLUSIONS: Despite consistent evidence of impaired fibrinolysis, obesity is not associated with persistent venous obstruction.

Body Mass Index↗

PubMed1984

Clinical comparison of elastic supports for venous diseases of the lower limb.

Compression garments for the lower limb were tested in two groups--general support garments and anti-embolism supports. A total of 98 patients was examined. The method used was by the interposition of partly fluid-filled pressure sensors between garment and skin. A combination of roller bandage with shaped tubigrip (SBB--Seton) and Sigvaris stockings afforded effective pressure in the general support group but only the roller bandage plus pressure garment (Seton) did so in the anti-embolism group, both in the acute and prolonged studies.

Clothing↗

PubMed2006

Epitaxial stabilization of ferromagnetism in the nanophase of FeGe.

Epitaxial nanocrystals of FeGe have been stabilized on Ge(111). The nanocrystals assume a quasi-one-dimensional shape as they grow exclusively along the <110> direction of the Ge(111) substrate, culminating in a compressed monoclinic modification of FeGe. Whereas monoclinic FeGe is antiferromagnetic in the bulk, the nanowires are surprisingly strong ferromagnets below approximately 200 K with an average magnetic moment of 0.8 microB per Fe atom. Density functional calculations indicate an unusual stabilization mechanism for the observed ferromagnetism: lattice compression destabilizes the antiferromagnetic Peierls-like ground state observed in the bulk while increased p-d hybridization suppresses the magnetic moments and stabilizes ferromagnetism.

Journal Article↗

PubMed1999

Acetabular reconstruction with morcellized allograft and ring support: a medium-term review.

Acetabular bone stock deficiency is commonly encountered in revision hip surgery. A number of techniques are available to address this problem, including the use of particulate allograft with reconstruction rings in an effort to provide a stable construct and replenish bone stock. Our technique and results using such devices in complex acetabular deficiencies are described. In the setting of a large nmedial segmental or cavitary acetabular defect, morcellized bone-graft is used to reconstitute the acetabular floor. This graft is reverse reamed until its depth allows screw fixation of a metallic support ring. The screws also serve to compress the graft. A polyethylene acetabular component is then cemented into the reconstituted acetabulum with full freedom of orientation. A series of 48 patients in whom this technique was employed is presented. These cases have been clinically and radiologically reviewed with a mean follow-up of 64 months (range, 25-102 months). Good bony incorporation with stable acetabular components was seen in all but the two cases in which sepsis predominated.

Acetabulum↗

PubMed2004

Multi-layer compression: comparison of four different four-layer bandage systems applied to the leg.

OBJECTIVE: To compare performance of four commercial four-layer bandage systems when applied to the leg. METHODS: Four experienced bandagers applied each system: [Profore Regular (Smith and Nephew); Ultra-Four (Robinson); System 4 (Seton) and K Four (Parema)] to the same leg. Bandages were applied as single layers and as completed systems using standard techniques. For each application, 18 pressure measurements were taken using the Borgnis Medical Stocking Tester (MST) at three measuring points (ankle, gaiter and mid-calf) on medial and lateral aspects in three postures: (horizontal, standing and sitting). RESULTS: In all 2304 observations were made, 576 for each bandager, 576 for each bandaging system, 768 for each measuring point, 1152 for each aspect and 768 for each posture. The increase in pressure produced by each additional layer was 65-75% of the pressure of the same bandage when used as a single layer. There were significant differences in the final pressures achieved by the bandagers (means: 45-54 mmHg, p<0.001) and between bandage systems (means: System 4: 46 mmHg, Profore: 47 mmHg, K Four: 52 mmHg, Ultra-Four: 54 mmHg; p=0.005). The relationships between the final pressures achieved at each of the three measuring points, the three postures and the two aspects were not consistent among the bandage systems (p<0.01). CONCLUSIONS: When a bandage is applied as part of a multi-layered system it exerts approximately 70% of the pressure exerted when applied alone, thus challenging the commonly-held assumption that the final pressure achieved by a multi-layer bandaging system is the sum of the pressures exerted by each individual layer. Each of the four bandaging systems exerted different final pressures and gradients and different changes with posture change. These differences have important implications, which could influence the selection (or avoidance) of a particular bandage system according to a patient's condition and circumstances.

Bandages↗

PubMed2002

Migration of the femoral stem after impaction bone grafting. First results of an ongoing, randomised study of the exeter and elite plus femoral stems using radiostereometric analysis.

We report the initial results of an ongoing randomised, prospective study on migration of the Exeter and Elite Plus femoral stems after impaction allografting, as measured by radiostereometry. Clinically, the impaction technique gave good results for both stems. The mean subsidence in the first year was 1.30 mm and 0.20 mm for the Exeter and the Elite Plus stems, respectively. In the second year, the Exeter stem continued to subside further by a mean of 0.42 mm, while the Elite Plus stem did not do so. Subsidence of the Exeter stem correlated with deficiency of bone stock as graded on the Gustilo and Pasternak scale. This correlation was not found for the Elite Plus stem. None of the other parameters which were studied predisposed to subsidence. There was no significant association between the amount of subsidence and the radiological appearance of the graft for either stem. Our findings do not support the theory that radial compression, due to subsidence of the Exeter stem, is the essential stimulus for remodelling in impaction allografting.

Adult↗