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At least 1,009 records · Page 56Linked to original sources
PubMed1987

Management of soft-tissue infections of the upper extremity in parenteral drug abusers.

Management of extensive soft-tissue infections of the upper extremity in 23 parenteral drug abusers was reviewed. Bacterial cultures most often revealed oral flora, including streptococcal species in 77 percent of patients and anaerobes in 59 percent. Staph. aureus was present in only one patient. Ninety percent of the organisms were sensitive to penicillin and 98 percent to first-generation cephalosporins. Blood culture specimens, obtained at admission, were negative in 15 patients. All patients responded well to operative debridement, excision of involved veins, and local wound care. Surgical debridement is the mainstay of therapy. We believe that intravenous antibiotic therapy with a first-generation cephalosporin should be used in the acute phase for control of surrounding cellulitis and prevention of bacteremia.

Abscess↗
PubMed1993

Abscesses of the upper extremity from drug abuse by injection.

A 4-year retrospective review of 59 consecutive upper extremity abscesses associated with drug abuse by injection is reported. There were 57 patients, with the most common location being the forearm. All abscesses were treated with incision, drainage, and intravenous antibiotics. Seventeen patients required more than one debridement; nine were complicated by fasciitis, osteomyelitis, septic arthritis, or septic tenosynovitis. Thirty-one patients had human immunodeficiency virus testing, and nine results were positive. Bacteriology showed the most common organisms to be streptococcus, Staphylococcus aureus, and Eikenella corrodens. Nineteen percent of the abscesses had anaerobes cultured. Most of the organisms cultured were common oral or skin flora.

Abscess↗
PubMed1993

Color flow Doppler: imaging the upper extremity.

Dynamic values of key vessel diameter, blood velocity, and flow rate in the upper extremity were obtained in 20 healthy volunteers by means of color flow Doppler imaging with a 7.5 MHz transducer. Recordings were made of the brachial, radial, posterior radial recurrent, ulnar, and digital arteries. Radial and ulnar vessels were evaluated at both wrist and midcarpal levels. Diameter and velocity changes were followed throughout the cardiac cycle, and a true mean flow was computed. Mean diameters of the digital vessels ranged from 0.9 mm in the small finger to 1.3 mm in the thumb. Brachial flows ranged from 4.6 to 89.9 ml/min, radial flows from 0.9 to 15.3 ml/min, and ulnar flows from 0.6 to 79.9 ml/min. At the midcarpal level, flows ranged from 0.2 to 68.4 ml/min for the ulnar artery and from 0.8 to 42.9 ml/min for the radial artery. Variability between individuals was also demonstrated in artery dominance: eleven ulnar dominant, seven radial dominant, and two equal (within 25% of each other). The accuracy and ease of use of this technique in measurement of vessels are limited when vessels are less than 1.5 mm in diameter although the technique provides quantitative values to 0.5 mm.

Adult↗
PubMed1994

Atypical Mycobacterium infections of the upper extremity.

Thirty-three patients with culture-positive atypical Mycobacterium infections of the upper extremity underwent surgical debridement and antimicrobial therapy. The causative atypical organism was M. marinum in 12 cases, M. avium-intracellulare in 7, M. terrae in 4, M. chelonei in 4, M. kansasii in 3, M. fortuitum in 2, and M. ulcerans in 1. The tenosynovium was the most common location of infection (14 patients). The average follow-up period was 36 months. Duration of antimicrobial therapy averaged 10 months. The average delay between onset of symptoms to correct diagnosis was 1 year. There were seven superficial infections; six were caused by M. marinum and one was caused by M. ulcerans. All of these cutaneous infections resolved following incisional or excisional biopsy and pharmacologic therapy. The remaining 26 infections involved the deeper tissues, and M. avium-intracellulare was the most common organism. The immune status of the host was an overwhelming predictor of eventual outcome. In the 15 patients with competent immune systems, resolution occurred in 13. However, in the immunocompromised patient population, only 4 of the 10 had resolution of deep infection at time of the follow-up evaluation.

Adolescent↗
PubMed1995

Shoulder complaints in patients with reflex sympathetic dystrophy of the upper extremity.

Five hundred forty-one patients with reflex sympathetic dystrophy (RSD) of the upper extremity were prospectively studied. One hundred fifteen patients complained of pain and/or limited range of motion in the shoulder. Shoulder complaints more often occurred in women (p = .01); age and etiology were not different from patients with RSD without shoulder complaints. Physical examination showed a tendinitis of one or both tendons of the biceps muscle in 109 patients. Seventy one patients were treated with local injection of bupivacaine followed by methylprednisolone. This resulted in permanent relief of complaints in 34 patients, temporary or moderate relief in 31, no difference in 3, increase of complaints in 1 patient, and in 2 patients results were not documented. We conclude that shoulder complaints in RSD occur in a minority of patients and more often in female patients. There are no predisposing factors. The pathophysiologic mechanism for developing shoulder complaints remains unknown. In most cases complaints can be attributed to a bicipital tendinitis for which local injection of bupivacaine followed by prednisolone are both diagnostic and therapeutic.

Adolescent↗
PubMed1991

A protocol for tissue expansion in upper extremity reconstruction.

Twenty tissue expanders were used in twelve patients for reconstruction of the upper extremity after trauma or burns with extensive soft tissue loss. A protocol, designed to avoid complications, included defects not exceeding thirty percent of the arm circumference, use of low-profile expanders, and slow expansion. Attention to these details avoided all complications except for transient neuropathies.

Adult↗
PubMed1998

Upper extremity infections in patients with the human immunodeficiency virus.

Twenty-eight patients with upper extremity infections and positive for the human immunodeficiency virus (HIV) were identified. The risk factor for HIV infection was intravenous drug injection in 24 patients, homosexual contact in 3, and heterosexual contact in 1. Eight of the patients had the acquired immunodeficiency syndrome. Two of the cases were prolonged herpetic infections of more than 6 months' duration that did not respond to oral acyclovir. The other 26 cases were bacterial in origin. Twenty-six of 28 cases responded to therapy with resolution of the infection. One patient refused surgical treatment and one died of systemic illness before resolution of the hand infection.

AIDS-Related Opportunistic Infections↗
PubMed1999

Nerve entrapments of the upper extremity: A surgical perspective.

The surgeon's perspective of nerve entrapment lesions in the upper extremity is discussed in this article. The focus is on the most common lesions of the median, ulnar, and radial nerves. An understanding of the anatomy and the potential pathologies provide the basis for surgical treatment. Current treatment protocols are discussed with the authors' recommendations that are based upon experience and literature review.

Arm↗
PubMed2000

Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities.

Over the last eight years, the authors analyzed obstructive lymphedema of a unilateral upper extremity in a total of 27 females, comparing the use of supramicrosurgical lymphaticovenule anastomoses and/or conservative treatment. The most common cause of edema was mastectomy, with or without subsequent radiation therapy for breast cancer. As an objective assessment of the extent of edema, the circumferences of the affected and opposite normal forearms were measured at 10 cm below the olecranon of the arm. Twelve of these patients received continual bandaging. In these patients, the average excess circumference of the affected arm was 6.4 cm over that of the normal forearm; the average duration of edema before treatment was 3.5 years; the average period for conservative treatment was 10.6 months; and the average decrease in circumference was 0.8 cm (11.7 percent of the preoperative excess). Twelve patients underwent surgery and postoperative continual bandaging. In these patients, the average excess circumference was 8.9 cm; the average duration of edema before surgery was 8.2 years; the average follow-up after surgery was 2.2 years; and the average decrease in circumference was 4.1 cm (47.3 percent of the preoperative excess). These results indicated that supermicrolymphaticovenular anastomoses with postoperative bandaging have a valuable place in the treatment of obstructive lymphedema.

Adult↗
PubMed2002

Multiple neurilemmomas of the median and ulnar nerves with a communicating branch in the same upper extremity.

A 30-year-old woman presented with multiple neurilemmomas in the same upper extremity. One originated from the main trunk of the ulnar nerve and two others from the sensory branch of the median nerve. A communicating branch in the palm from the ulnar nerve to the median nerve was confirmed. All the tumours were successfully enucleated and she made a satisfactory recovery.

Adult↗
PubMed1999

Upper extremity vein thrombosis: etiologic categories, precipitating causes, and management.

Although an increasing incidence of upper extremity venous thrombosis (U/E-DVT) has been reported, a relative paucity of information regarding the etiologic categories, precipitating causes, and proper management for this disorder is available. To settle on a strategy for the management of U/E-DVT, retrospective analyses were performed using records from the authors' hospital. In 12 patients (seven men, five women), 61 (mean) years of age, diagnosed as having symptomatic venography-proved U/E-DVT and followed up for 41 (mean) months, etiologic factors, precipitating causes, treatments, and outcomes were retrospectively analyzed. As etiologic factors, five of the patients had neoplastic disease, one had hemodialysis, and two had transvenous pacemaker implantations. Among various precipitating causes of U/E-DVT, hypoproteinemia was most frequently noted (67%). Various types of therapeutic management were selected: from thrombolysis with urokinase in six, balloon angioplasty in two, thrombectomy in two, and venous bypass surgery in one patient. Pulmonary embolism did not occur in any of the patients and only three of them complained of mild intermittent arm swelling during the follow-up period. Four patients died of neoplastic disease or heart failure (three within the first 6 months). This study, though limited, suggests that the rate of mortality depends on multiple underlying medical problems in U/E-DVT patients. Low incidences of late postthrombotic sequelae and pulmonary embolism were noted in this series. Symptomatic U/E-DVT patients could be managed conservatively with a revised supplementary therapy for their precipitating causes of U/E-DVT.

Adult↗
PubMed2001

[Desympathyzation of arteries in blood circulation disorders of upper extremities].

Results of surgical treatment using the arteries desympathization in 47 patients with the upper extremities (UE) blood circulation disorder were studied. Artheriolysis was performed in 21, periarterial sympathectomy--in 26 patients. For obliterating disease 19 patients were operated, for Raynaud syndrome--9, for the traumatized vessel diseases--8, for the thoracic outlet compression syndrome--11. Desympathization of arteries secures significant improvement of blood circulation in distal parts of UE in terms up to 1 mo in 95.7% of the patients operated on.

Aged↗
PubMed1989

[Anterior shift of posterior lower cervical dura mater in patients with juvenile muscular atrophy of unilateral upper extremity].

Myelography was performed in 16 male patients with juvenile muscular atrophy of unilateral upper extremity. The age at onset ranged from 11 to 19 years (average, 16 years), and the age at study ranged from 15 to 38 years (average, 25 years). The most remarkable finding was an anterior shift of lower cervical dural canal during neck flexion, particularly of its posterior wall at around 6th vertebral level. The above finding was clearly shown in 12 patients whose duration of illness was under 20 years but not in 4 patients whose duration of illness was 20 years or over. And the rates of anterior shift of posterior lower cervical dura mater was inversely proportional to the duration of illness. There was a tendency that the greater the degree of the anterior dural shift and compression of the spinal cord, the greater the severity of the disease. We thought that the anterior shift of the posterior lower cervical dura mater provides the clue to understanding of its etiology and methods of arresting the progression of the disease.

Adolescent↗
PubMed1989

Evaluation and treatment of the upper extremity in the stroke patient.

Selected surgical procedures to correct specific deformities of the upper extremity in the stroke patient related to muscle imbalance, spasticity, contracture, and joint instability as seen in spastic hemiplegia are described. The postoperative rehabilitation is also discussed with regard to functional and anatomic disabilities, considering first the patient, then the extremity, and finally, the hand.

Arm↗
PubMed1987

[Late results following treatment of peripheral nerve injuries of the upper extremity].

The authors re-examine cases of complete peripheral nerve injury of the upper extremity. Motor activity and sensibility assessment make use of Highet's scale. Some general principles of surgical treatment of peripheral nerve injuries are presented and individual factors which influence its results are worked out, e.g. moment of diagnosis, kind of nerve suture, moment of operation, age of patient, grade of injury, concomitant injuries, and length of graft. Conclusions are drawn for the concept of treatment.

Adolescent↗
PubMed1987

Tissue expansion in the upper extremity.

The use of temporary inflatable implants to generate expanded skin flaps in the upper extremity is a useful reconstructive technique. Applications, technique, and complications are discussed and emphasized with case reports.

Adolescent↗