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Biomedical subjects

A M Fitzgerald

Publications and source records attributed to A M Fitzgerald.

13 recordsLinked to original sources
PubMed2000

Long-term sequelae of fasciotomy wounds.

A retrospective study of patients admitted to an Orthopaedic Trauma Unit over an 8-year period requiring fasciotomies, of either upper or lower limb, to reduce the risk of compartment syndrome was performed. Sixty patients were studied, of which 49 had an underlying fracture. The long-term morbidity of the wounds was studied. Ongoing symptoms such as pain related to the wound occurred in six patients (10%) and altered sensation within the margins of the wound occurred in 46 patients (77%). Examination revealed 24 patients (40%) with dry scaly skin, 20 patients (33%) with pruritus, 18 patients (30%) with discoloured wounds, 15 patients (25%) with swollen limbs, 16 patients (26%) with tethered scars, eight patients (13%) with recurrent ulceration, eight patients (13%) with muscle herniation and four patients (7%) with tethered tendons. The appearance of the scars affected patients such that 14 (23%) kept the wound covered, 17 (28%) changed hobbies and seven (12%) changed occupation. This study reveals a significant morbidity associated with fasciotomy wounds. In light of these findings, further consideration should be given to techniques that reduce both the symptoms and examination findings mentioned above and the aesthetic insult to the affected limb.

Adolescent↗
PubMed2000

Volar metacarpophalangeal joint dislocation.

Volar dislocation of the metacarpophalangeal joint is a very rare clinical finding. A volar dislocation of the metacarpophalangeal joint of the left index finger in a 44 year old man is reported. Closed reduction proved unsuccessful requiring subsequent open reduction and internal fixation via a combined dorsal and volar approach. The presentation, mechanism of injury and treatment of this case and other previously reported cases are discussed.

Adult↗
PubMed1999

Colonic perforation following prolonged hypovolaemia in a major burns injury.

Perforation of the lower gastrointestinal tract is rare in burns patients. A 41-year-old male, who sustained 40% total body surface area burns and subsequently developed an acute abdomen on day 15 postburn, is presented. Emergency management included a subtotal colectomy and ileostomy formation performed to repair a perforated transverse colon found at laparotomy. The burns were debrided and grafted and the patient required cardiac, renal and respiratory support initially in the ITU setting before making a complete recovery. It is suggested that ischaemia caused the perforated transverse colon due to a prolonged low flow state. This was not detected until invasive cardiovascular catheterisation was performed and revealed a hypovolaemic state, which was corrected by fluids and noradrenaline. Both the previous cardiac history of the patient (Fallot's Tetralogy repair) and the noradrenaline may have exacerbated the low flow state within the mesenteric circulation leading to ultimate perforation. This case highlights the difficulties that may arise in resuscitating a patient who has previously had a cardiac defect repaired. Despite repair, abnormal physiology may persist resulting in misleading observations that produce undetected hypovolaemia with subsequent adverse events, as in this case. In such patients, early invasive cardiovascular monitoring should be considered.

Adult↗
PubMed1999

Use of Western-based HIV risk-reduction interventions targeting adolescents in an African setting.

PURPOSE: To evaluate an intervention (based on one which had previously been successful in reducing adolescent human immunodeficiency virus (HIV) risk behaviors in the United States) among adolescents residing in Namibia, a country located in sub-Saharan Africa. METHODS: A randomized trial of a 14-session face-to-face intervention emphasizing abstinence and safer sex was conducted among 515 youth (median age 17 years; median grade 11) attending 10 secondary schools located in two districts in Namibia. Knowledge, attitudes, intentions, and HIV risk behaviors were assessed at baseline and in the immediate postintervention period. RESULTS: Knowledge increased significantly among intervention compared to control youth (88% vs. 82%; correct responses, p < .0001). At postintervention follow-up, more intervention than control youth believed that they could be intimate without having sex, could have a girlfriend or boyfriend for a long time without having sex, could explain the process of impregnation, knew how to use a condom, and could ask for condoms in a clinic. Fewer intervention than control youth believed that if a girl refused to have sex with her boyfriend it was permissible for him to strike her, and that condoms took away a boy's pleasure. More intervention than control youth anticipated using a condom when they did have sex, and fewer expected to drink alcohol. Finally, after intervention, there was a trend for increased condom use. There were significant gender-related differences at baseline, although intervention impact was generally equivalent. CONCLUSIONS: These findings provide support for the judicious adaptation of successful Western HIV prevention programs in other cultural settings. A single intervention approach appears to be effective in short-term follow-up with both genders.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Dupuytren's disease. The way forward?

Histologically, Dupuytren's disease has been compared to the process of neoplasia because of fibroblast proliferation, recurrence, chromosomal abnormalities and antigenic profiles. However, a comparison of Dupuytren's tissue with the granulation tissue formed in wound healing could be more valid. Histology reveals similarities in cell types, proliferation, vascularity and collagen morphology. Pharmacologically, both tissues have a similar range of agonist and antagonist responses. Biochemical analysis reveals new collagen synthesis, an increased ratio of type III to type I collagen, and similar changes of the ground substance in both processes. Considering such similarities perhaps it is possible to regard some of the models used for the investigation of wound healing and granulation tissue as the missing experimental "model" for the study of Dupuytren's disease. Recently great strides have been made in the basic understanding of wound biology, and such a comparison might well provide novel therapeutic options for Dupuytren's disease.

Dupuytren Contracture↗
PubMed1999

HIV risk behaviors, intentions, and perceptions among Namibian youth as assessed by a theory-based questionnaire.

Considerable progress has been made in the United States and Europe regarding HIV risk prevention efforts targeting adolescents. However, in Africa less progress has been made to date. This article address three questions: Can risk assessment questionnaires developed in Western countries be modified so as to be appropriate for use in African countries? Are social cognitive models appropriate in African settings? Does covariation among risk behaviors occur among youth residing in African countries? The data was obtained from a cross-sectional survey conducted among 922 youth ages 12 to 18 years living in school-based hostels in Namibia. Data were collected using a theory-based risk assessment questionnaire. One third of the youth were sexually experienced, three quarters of whom had engaged in sexual intercourse in the previous 6 months. Over one third of these youth had had more that one sexual partner in the previous 6 months and over one half had not used a condom at last episode of intercourse. The psychometric properties of the questionnaire and the relationship between perceptions and behaviors provide evidence that theory-based questionnaires developed in Western countries can be modified for use in different cultural settings. The data also provide strong evidence of covariation between risk behaviors among Namibian youth.

Adolescent↗
PubMed1998

Increased protected sex and abstinence among Namibian youth following a HIV risk-reduction intervention: a randomized, longitudinal study.

OBJECTIVE: To evaluate an HIV risk-reduction intervention among Namibian adolescents. METHODS: A randomized trial of a 14-session face-to-face intervention emphasizing abstinence and safer sexual practices conducted among 515 youths (median age 17 years and median grade 11) attending 10 secondary schools located in two districts in Namibia. Youths were randomly assigned to the intervention or control condition at the level of the individual. HIV risk behaviours, intentions and perceptions were assessed at baseline, immediately post-intervention and at 6 and 12 months post-intervention. RESULTS: Among all 515 youths who enrolled in the programme, rates of either abstinence or sex with a condom were not different between control and intervention youths at baseline or in the follow-up period. However, analyses conducted among the subset of youths who were sexually inexperienced at baseline (n = 255) revealed that a higher percentage of intervention youths (17%) than control youths (9%, P<0.05) remained sexually inexperienced one year later. Moreover, in the immediate post-intervention period, among baseline virgins who subsequently initiated sex, intervention youths were more likely than control youths to use a condom (18 versus 10%, P<0.05). Additional HIV-related risk behaviours (failure to discuss previous HIV risk exposure with one's sexual partner and alcohol use), intentions to use condoms, and perceptions of the ability to use condoms were positively affected by the intervention. CONCLUSIONS: There is evidence that the 'My Future is My Choice' (MFMC) intervention is reducing HIV risk behaviours among sexually inexperienced participants aged 15-18. Related risk behaviours and perceptions are also positively impacted by the intervention.

Adolescent↗
PubMed1996

Human skin histology as demonstrated by Herovici's stain: a guide for the improvement of dermal substitutes for use with cultured keratinocytes?

The potential for the widespread use of cultured keratinocytes for burns treatment is handicapped by practical problems such as fragility, poor take and, often, unsatisfactory cosmesis. Although dermal equivalents reduce these problems there remains a lack of consensus on what is the best structure of such equivalents. At present the commonest support is type I collagen. This histological study, however, using Herovici's stain, clearly shows that in human skin from a variety of anatomical sites the epidermis is not in direct contact with type I collagen but rather with a distinct layer of type III collagen. We suggest that dermal equivalents may have to be constructed so as to include a layer of type III collagen at the interface between the keratinocytes and a type I collagen neo-dermis, so mimicking normal skin structure more closely.

Adolescent↗
PubMed1995

A modern translation and interpretation of the treatise on burns of Fabricius Hildanus (1560-1634).

At the beginning of the seventeenth century, some surgeons were as interested in the classification, prognosis and treatment of burns as their successors are at the close of the twentieth century. We present extracts from our translation of the visionary treatise on Burns by Fabricius Hildanus (Wilhelm Fabry), the "Father of German surgery", and show how some of the present day approaches to burns have their origins almost 400 years ago.

Burns↗
PubMed1995

A picropolychrome staining technique applied to Dupuytren's tissue.

Although the histology of Duputyren's tissue is well-documented, conventional stains do not distinguish between the different types of collagen which biochemistry and immunochemistry suggest are present. Duputyren's specimens [nodules (n = 26), cords (n = 15) and dermofasciectomies (n = 6)] were stained with haematoxylin and eosin, Van Gieson's Mallory's, Masson's, and Herovici's picropolychrome stain, and examined for both cellularity and collagen staining characteristics. All stains illustrated the marked cellularity of the nodules, contrasting with a paucity of cells within the cords. The first four stains demonstrated uniformity of the collagen staining within the tissues. Herovici's picropolychrome, however, showed distinct staining patterns for the dermis, nodules and cords, with both purple/red and blue areas. Other studies suggest that those fibres stained purple/red and blue are types I and III collagens respectively. These findings may shed further light on the tissue of origin of Duputyren's disease.

Aged↗
PubMed1982

Newborn transport in South Australia, 1978-80: experience of the Queen Victoria Hospital, Adelaide.

389 infants were transported to the Queen Victoria Hospital, Adelaide between 1978 and 1980. Twenty-three percent (99) of the infants were ventilated, and 49% (189) received intravenous or intra-arterial therapy. Fifty-six percent (217) of the infants required transport because of prematurity; 11% (46) because of perinatal asphyxia in babies weighing more than 2,500 g. Only one baby died during transport, while 14% of the babies died subsequently. A core temperature of less than 36 degrees C in either hospital is important; a cold baby is 3.5 times more likely to die (X2=25.46, P less than 0.001). The transport of babies over distances greater than 300 kilometres is peculiar to Australia. Significantly more of these babies were cold than those retrieved from hospitals near Adelaide (X2=4.7, P less than 0.05), and significantly more died. Difficulty in transferring mothers in preterm labour may be another reason these babies did relatively badly. Better education and facilities will be important if we are to improve their survival chances.

Asphyxia Neonatorum↗
PubMedDate not supplied

Ambulation without legs.

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Activities of Daily Living↗