Biomedical subjects
Publications and source records attributed to B F Jones.
Interphalangeal joint fusion is a salvage procedure to achieve stability and pain relief and to correct deformity. The multiple fixation techniques for fusion are outlined. Paramount to successful arthrodesis are appropriate preparation of the joint surfaces and careful positioning and coaptation of the bone ends. If this is not accomplished, regardless of fixation technique, a pseudoarthrosis will ensue.
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Explore the source record for details and available documents.
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We report a case of biopsy-proved acute pyelonephritis which caused acute renal failure. Despite appropriate antibiotic therapy, recovery of renal function was slow and incomplete. Renal papillary necrosis was an apparent complication, which the patient may have been predisposed to by alcoholism. Although rare, acute pyelonephritis is an important consideration in the differential diagnosis of acute renal failure because of the need for specific therapy.
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The assessment of videotaped genuine consultations in order to provide feedback to the learner is now a well accepted part of postgraduate training for general practice. This article reports on a pilot study which investigates the adaptation of videotape assessment of genuine patient consultations as an alternative to the present simulated patient interview segments of the examination for Fellowship of the Royal Australian College of General Practitioners. In particular, the study addresses: the feasibility and cost of collecting and assessing a suitable range of videotaped consultations using portable videocamera equipment and remote examiners; the interobserver reliability of four independent examiners; and the correlation between scores on two different rating scales. The results demonstrate that the assessment of videotaped genuine consultations has the potential to become a means of end-point assessment of clinical competence. The problem of how to collect videotapes of a suitable range and number of consultations to permit a candidate to demonstrate proficiency needs to be addressed and will be followed up in a trial of the method during 1990.
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We report a case of xanthogranulomatous pyelonephritis in a renal allograft. The kidney was not removed and there was an initial response to antibiotic therapy, with amelioration of toxicity and improvement in renal function. However, the kidney failed 10 months later in association with histological changes of chronic rejection.
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The radiological features, clinical findings and mortality rates of patients with ankylosing spondylitis complicated by cervical trauma have been reviewed. All patients had long-standing disease and half had sustained their fractures as a result of trivial accidents. There were 19 cervical fractures in 18 patients, which were chalkstick in type and occurred predominantly at the 6th and 7th cervical levels. Ten fractures passed through the upper part of the vertebral body, one through the mid-vertebral body and the final eight were through the disc space. The site of the fracture line was related to neurological outcome. Those patients whose fracture line ran through the disc space had significantly less neurological injury and a much better prognosis. Distraction at the fracture site had some relation to prognosis but horizontal displacement and angulation were not found to be of importance. This study confirms that cervical fracture with neurological complications may follow minor trauma in ankylosing spondylitis. The site of the fracture in relation to the vertebral bodies and discs appears to be of some prognostic relevance and careful radiological assessment of all patients with ankylosing spondylitis and cervical injury should be undertaken.
Considerable attention has been given recently to antepartum Rh immunoprophylaxis. We report here a case of serum sickness due to repeated administration of Rh (anti-D) immunoglobulin.
A patient with post-obstructive diuresis is described. Inappropriate losses of salt and water occurred, with urine volume exceeding half the glomerular filtration rate. Additionally, excessive urinary excretion of potassium, bicarbonate, calcium, phosphate, magnesium and urate took place in the presence of subnormal blood levels. Transient proteinuria was also observed. This case demonstrates that serious electrolyte disturbances can occur after relief of urinary tract obstruction and the evidence suggests these may be due to disordered proximal tubule function.
We report 2 cases that fulfill some of the criteria for the diagnosis of Bartter's syndrome and were associated with marked radiological changes. Both patients demonstrated distortion of the caliceal pattern with medullary cavities and loss of cortical substance in the absence of vesicoureteral reflux. However, the glomerular filtration rate was well preserved. It seems unlikely that known organic renal disease was responsible for these changes and the potassium-losing state. These radiological findings also do not appear to be a consequence of hypokalemia and their pathogenesis remains uncertain.
Clinically silent cervicodorsal fracture may occur following upper-thoracic injury in the presence of a characteristic buckling injury to the sternum. Failure to recognise the association may result in gross kyphotic deformity. Three examples are provided, illustrating the role of radiology in the management of this complex traumatic lesion.