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The Journal of the American Academy of... Dec 2006The neurovascular and muscular anatomy about the humerus precludes the use of a truly "safe" fully extensile approach. Working around a spiraling radial nerve at the... (Review)
Review
The neurovascular and muscular anatomy about the humerus precludes the use of a truly "safe" fully extensile approach. Working around a spiraling radial nerve at the posterior midshaft requires either a transmuscular dissection or a triceps-avoiding paramuscular technique. To gain maximal exposure, the radial nerve must be mobilized at the spiral groove. For exposure of only the proximal humeral shaft, many surgeons prefer the anterolateral approach because it uses the internervous plane between the axillary and deltoid nerves proximally and the radial and musculocutaneous nerves distally. Proximally, the deltopectoral approach to the shoulder continues to be the most widely used. However, the lateral deltoid-splitting approach is a viable, less invasive approach for both rotator cuff repair and fixation of valgus-impacted proximal humeral fractures. Distally, intra-articular exposure is dependent on triceps mobilization, either by olecranon osteotomy or triceps release; this exposure can be coupled with either a triceps-splitting or a paratricipital approach for proximal extension.
Topics: Arthroplasty; Brachial Artery; Fracture Fixation, Internal; Humans; Humeral Fractures; Humerus; Osteotomy; Radial Nerve; Rotator Cuff Injuries; Rupture; Ulnar Nerve
PubMed: 17148623
DOI: 10.5435/00124635-200612000-00007 -
Foot & Ankle International Feb 1997We retrospectively evaluated the results of 50 hallux valgus reconstructions in 36 patients for moderate to severe deformities, performed by the senior author (F. M.... (Comparative Study)
Comparative Study
We retrospectively evaluated the results of 50 hallux valgus reconstructions in 36 patients for moderate to severe deformities, performed by the senior author (F. M. T.). All feet were treated at the metatarsophalangeal joint with a distal soft tissue realignment. The first 25 feet were corrected proximally with a crescentic osteotomy fixed with an AO screw; these cases had an average follow-up of more than 5 years (range, 40-141 months). The second 25 feet underwent a basal osteotomy with a proximally directed chevron osteotomy; these cases had an average follow-up of 21.4 months (range, 12-33 months). The average hallux valgus correction in the crescentic osteotomy group went from 37.6 degrees to 11.4 degrees, and in the chevron osteotomy group, the hallux valgus angle was reduced from 31.3 degrees to 11.6 degrees. The intermetatarsal angle in the crescentic group was corrected from 16.2 degrees to 6 degrees, and in the chevron group the intermetatarsal angle was reduced from 15.1 degrees to 5.4 degrees. The fibular sesamoid subluxation was reduced from 92% to 24% in the crescentic group and from 88% to 18% in the chevron group. All patients were assessed using the American Orthopaedic Foot and Ankle Society scale, in which 100 points are used to compare pre- and postoperative pain, function and range of motion, shoewear comfort and activity levels, and alignment. In the crescentic group, the score improved from 46.8 points to 93.1 points; in the chevron group, the score changed from 53.4 points to 92.7 points. In all parameters studied, there were no statistically significant differences using the Student's t-test. We conclude that the two operative techniques offer equivalent results, which are excellent and predictable. The proximal chevron osteotomy is technically easier, eliminates the proximal dorsal scar, and does not require postoperative metal removal.
Topics: Adult; Aged; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Middle Aged; Osteotomy; Postoperative Complications; Radiography; Retrospective Studies
PubMed: 9043877
DOI: 10.1177/107110079701800205 -
Journal of Hepato-biliary-pancreatic... Jun 2014Endoscopic pancreatic stenting (EPS) is used for various pancreatic conditions. With the increasing use of pancreatic stents, many complications have been observed.... (Comparative Study)
Comparative Study Review
Endoscopic pancreatic stenting (EPS) is used for various pancreatic conditions. With the increasing use of pancreatic stents, many complications have been observed. Especially, proximal stent migration presents a more serious condition because of the possibility of pancreatic duct (PD) damage. However, the removal of proximally migrated stents is technically challenging because of the small PD diameter, the bended PD course, the presence of PD strictures, and the lack of suitable devices for stent removal. Thus, few cases of surgical intervention have been encountered. In this study, we review the endoscopic treatment of proximally migrated pancreatic plastic stents. We classify migrated stent conditions into four types according to stent and PD conditions. In Type A, the main pancreatic duct (MPD) has no stricture. In Type B, the stent is positioned across the stricture on the MPD. In Type C, the stent is positioned further away from the stricture on the MPD. The tip of the proximal stent is located in the MPD in types A thru C. In Type D, the tip of the proximal stent is located in a branch duct. We introduced the strategy of endoscopic removal technique of each type of migrated plastic stents.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Device Removal; Endosonography; Female; Foreign-Body Migration; Humans; Male; Minimally Invasive Surgical Procedures; Pancreatic Diseases; Pancreatic Ducts; Plastics; Prosthesis Design; Stents; Treatment Outcome
PubMed: 24535753
DOI: 10.1002/jhbp.94 -
Journal of Visualized Surgery 2018
PubMed: 29780729
DOI: 10.21037/jovs.2018.04.03 -
The Journal of Hand Surgery Nov 1985Four methods were used to identify the vascular branches that supply the proximal interphalangeal joint in 55 cadaver fingers. They were intra-arterial injection of...
Four methods were used to identify the vascular branches that supply the proximal interphalangeal joint in 55 cadaver fingers. They were intra-arterial injection of radiopaque dyes, microscopic dissections of the arterial system, selective injection of specific branches followed by sectioning of the joints and examination of the areas stained, and histologic sectioning. Our studies show that the major branches of the digital artery to the joint arise from the dorsal aspect of the vessel, while smaller branches that run to the soft tissue arise from the palmar side. Three branches supply the proximal interphalangeal joint. The first arises 1.5 to 2.5 cm proximal to the joint and divides into branches to the dorsal skin, the bone proximally, the vincular system, the lateral surface of the joint, and the palmar plate. The other two branches arise distal to the joint space; the first has branches to the palmar aspect of the joint of the middle phalanx and the vincular system. The most distal of the three perfuses the dorsal surface of the joint.
Topics: Arteries; Cadaver; Coloring Agents; Dissection; Finger Joint; Humans; Radiography
PubMed: 4078268
DOI: 10.1016/s0363-5023(85)80161-1 -
Electromyography and Clinical... 1996Can proximal nerve lesions cause a distal "Tinel-like" sign? We present the case studies of two patients with documented cervical root lesions who exhibited percussion... (Review)
Review
Can proximal nerve lesions cause a distal "Tinel-like" sign? We present the case studies of two patients with documented cervical root lesions who exhibited percussion paresthesiae distally in the absence of any clinical or nerve conduction evidence of distal pathology. The possible mechanisms underlying such manifestation, which has been previously reported in the literature, are explored, and a case is made for the phenomenon being related to the "distortion" of a normal sensory signal when it encounters an area of spatial inhomogeneity proximally along the nerve.
Topics: Adult; Axons; Cervical Vertebrae; Female; Fingers; Forearm; Humans; Intervertebral Disc Displacement; Male; Middle Aged; Nerve Regeneration; Neurologic Examination; Paresthesia; Physical Stimulation; Spinal Nerve Roots; Ulnar Nerve
PubMed: 8737939
DOI: No ID Found -
Radiology Sep 1978A case is described in which extensive embolization of the hepatic artery to reduce insulin production by a metastatic islet-cell tumor resulted in liver failure,...
A case is described in which extensive embolization of the hepatic artery to reduce insulin production by a metastatic islet-cell tumor resulted in liver failure, intrahepatic abscesses, and death. The difference between proximal and peripheral hepatic artery obstruction was investigated in monkeys by embolizing hepatic arterial beds with Gelfoam and silicone. Gelfoam obstructed proximally, arterial collaterals developed rapidly, and liver function remained normal. Peripheral hepatic artery embolization with silicone produced liver infarction and severe functional abnormalities. Peripheral hepatic artery occlusion was more effective in preventing the development of collateral circulation but involved a significant risk of hepatic failure or abscess.
Topics: Adenoma, Islet Cell; Angiography; Animals; Embolization, Therapeutic; Haplorhini; Hepatic Artery; Humans; Liver; Liver Neoplasms; Macaca mulatta; Male; Middle Aged; Neoplasm Metastasis; Palliative Care; Pancreatic Neoplasms
PubMed: 79188
DOI: 10.1148/128.3.577 -
The American Journal of Medicine Dec 2012Quantifying the risk of advanced proximal colorectal neoplasia might allow tailoring of colorectal cancer screening, with colonoscopy for those at high risk and less...
BACKGROUND
Quantifying the risk of advanced proximal colorectal neoplasia might allow tailoring of colorectal cancer screening, with colonoscopy for those at high risk and less invasive screening for very low-risk persons.
METHODS
We analyzed findings from 10,124 consecutive adults aged≥50 years who underwent screening colonoscopy to the cecum. We quantified the risk of advanced neoplasia (tubular adenoma≥1 cm, a polyp with villous histology or high-grade dysplasia, or adenocarcinoma) both proximally (cecum to splenic flexure) and distally (descending colon to anus). The prevalence of advanced proximal neoplasia was quantified by age, gender, and distal findings.
RESULTS
The mean (standard deviation) age was 57.5 (6.0) years; 44% were women; 7835 (77%) had no neoplasia, and 1856 (18%) had 1 or more nonadvanced adenomas. Overall, 433 subjects (4.3%) had advanced neoplasia (267 distally, 196 proximally, 30 both), 33 (0.33%) of which were adenocarcinoma (18 distal, 15 proximal). The risk of advanced proximal neoplasia increased with age decade (1.13%, 2.00%, and 5.26%, respectively; P=.001) and was higher in men (relative risk [RR], 1.91; confidence interval [CI], 1.32-2.77). In women aged less than 70 years, the risk was 1.1% overall (vs 2.2% in men; RR, 1.98; CI, 1.42-2.76) and 0.86% in those with no distal neoplasia (vs 1.54% in men; RR, 1.81; CI, 1.20-2.74).
CONCLUSIONS
Risk of advanced proximal neoplasia is a function of age and gender. Women aged less than 60 to 70 years have a very low risk, particularly those with no distal adenoma. Sigmoidoscopy with or without occult blood testing may be sufficient and even preferable for screening these subgroups.
Topics: Adenocarcinoma; Adenomatous Polyps; Age Factors; Aged; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Assessment; Sex Factors
PubMed: 23062404
DOI: 10.1016/j.amjmed.2012.05.026 -
Knee Surgery, Sports Traumatology,... Jul 2010Subacromial impingement secondary to malunion of proximally displaced greater tuberosity fractures may be treated with arthroscopic acromioplasty in patients with slight...
Subacromial impingement secondary to malunion of proximally displaced greater tuberosity fractures may be treated with arthroscopic acromioplasty in patients with slight displacements, but open anatomical repositioning of the malunited fragment is recommended when more severe deformities exist. This deformity may also be addressed by abrading the protruding proximal portion of the greater tuberosity (tuberoplasty). However, this procedure would require full elevation of the rotator cuff insertion if performed with open surgery. This article reports a technique of arthroscopic tuberoplasty based on combined intra- and extra-articular transtendinous abrasion of the proximal end of the greater tuberosity for malunions with severe upward displacement of the greater tuberosity. This procedure allows for major preservation of the rotator cuff insertion.
Topics: Arthroplasty; Fractures, Malunited; Humans; Osteotomy; Shoulder Fractures; Shoulder Impingement Syndrome
PubMed: 19826787
DOI: 10.1007/s00167-009-0939-1 -
The Journal of Bone and Joint Surgery.... Jan 2004It remains controversial whether a proximal porous coating is superior to a grit-blasted surface with regard to providing femoral stem fixation in total hip... (Comparative Study)
Comparative Study
BACKGROUND
It remains controversial whether a proximal porous coating is superior to a grit-blasted surface with regard to providing femoral stem fixation in total hip arthroplasty. We examined the hypothesis that a proximal porous coating would provide better fixation than would a fully grit-blasted surface of otherwise identical proximally hydroxyapatite-coated stems.
METHODS
In a prospective study, seventeen patients (thirty-four hips) underwent bilateral sequential total hip replacement with the Anatomic Porous Replacement at the same operation. A proximally porous-coated femoral stem was implanted on one side, and a stem of the same design but with a proximal grit-blasted surface was implanted in the contralateral hip. A proximal hydroxyapatite coating was applied to the metallic substrate of both stems. The patients were followed for a mean 2.5 years and then were assessed radiographically and clinically with the Harris hip score.
RESULTS
With the numbers available, no significant clinical or radiographic differences were found between the two cohorts. Thirty of the thirty-four hips had an excellent result, two were rated good, and two were rated fair. All hips had stable osseous fixation of the stem radiographically. The two types of stems were associated with the same pattern of adaptive bone-remodeling.
CONCLUSIONS
In the first two years following total hip arthroplasty, hydroxyapatite-coated proximally porous-coated femoral stems do not provide fixation that is superior to that provided by hydroxyapatite-coated grit-blasted stems.
LEVEL OF EVIDENCE
Therapeutic study, Level II-1 (prospective cohort study). See Instructions to Authors for a complete description of levels of evidence.
Topics: Adult; Aged; Arthroplasty, Replacement, Hip; Chi-Square Distribution; Coated Materials, Biocompatible; Durapatite; Female; Hip Prosthesis; Humans; Male; Middle Aged; Prospective Studies; Prosthesis Design; Surface Properties; Treatment Outcome
PubMed: 14711954
DOI: 10.2106/00004623-200401000-00018