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Biomedical subjects

C Fisher

Publications and source records attributed to C Fisher.

513 records · Page 29Linked to original sources
PubMedDate not supplied

Osteochondral lesions of the talus.

We report demographic, clinical, and imaging data on 92 patients with osteochondral lesions of the talus collected in one center between 1981 and 1992. All patients reported pain as their primary symptom. Ninety-four percent of the patients reported pain with activity. Physical examination was unhelpful. Using newer imaging techniques (bone scan and computed tomography) and with increased awareness, we have observed a sevenfold increase in the diagnostic frequency of osteochondral lesions of the talus between the years 1981 to 1986 and 1987 to 1992. Bone scan is an excellent screening tool for patients with chronic ankle pain and has 99% sensitivity in depicting osteochondral lesions. Computed tomography demonstrated a previously unclassified lesion, the radiolucent defect, which accounts for 77% of the lesions in this series. We have therefore modified the Berndt and Harty classification system, basing it on radiographic appearance (principally computed tomography) and adding the radiolucent lesion. Fifty-eight patients were treated surgically. Anterior and midtalar lesions are now approached arthroscopically. Surgical treatment of the radiolucent lesion, consisting of curettage and drilling, gives 42% excellent and 32% good results. Pain relief often occurs within months of surgery, but healing of the lesion requires years, and some may persist indefinitely.

Adolescent↗
PubMedDate not supplied

Commentary: applying hospital quality indicators to clinical practice.

Hospitals use various methods to establish performance benchmarks. This may include cooperative data shared between organizations to allow broad, general comparisons. These can, however, be misinterpreted as representing standards of patient care. In the authors' institution, a more complete examination was made of one of these quality indicators when it appeared quality indicator standards were in conflict with standards of patient care. The authors conclude that quality indicators are valuable when screening a hospital, just as we utilize screening tests to identify patients at potential risk. Neither should we apply broad quality indicators as standards of care without a full understanding of their strengths and weaknesses and the foundation on which they are built.

Accreditation↗
PubMedDate not supplied

Ossifying fibromyxoid tumor of soft parts with stromal cyst formation and ribosome-lamella complexes.

Ossifying fibromyxoid tumor of soft parts (OFMT) is a recently named soft tissue tumor of uncertain nature. A case is described that presented in a 13-year-old boy as a discrete mass in the muscles of the lower abdominal wall. Light microscopy showed, in addition to the typical features of this entity, microcysts formed by accumulations of the myxoid stroma. Bone formation was lacking. Tumor cells were strongly immunoreactive for vimentin and glial fibrillary acidic protein and weakly so for S-100 protein. A few cells stained for desmin and alpha-smooth muscle actin. Ultrastructurally, there were abundant, patternless cytoplasmic intermediate filaments; short, poorly interdigitating processes; and discontinuous segments of thick external lamina. In addition, several cells contained typical ribosome-lamella complexes in small groups. Ribosome-lamella complexes occur in neoplastic hematopoietic cells but are uncommon in solid tumors, particularly those affecting the soft tissues. These findings extend the range of appearances described for OFMT, which is added to the list of tumors in which ribosome-lamella complexes have been demonstrated. The balance of evidence suggests that OFMT may represent a peripheral nerve sheath tumor of low-grade malignancy, although the picture is incomplete.

Adolescent↗
PubMedDate not supplied

Non-invasive ultrasonic biopsy in the classification of early arterial lesions and in the evaluation of the rate of progression of arteriosclerosis.

The evaluation of early arterial lesions and the follow-up of the progression of arteriosclerotic wall changes is possible with high resolution ultrasound. While dynamic (duplex scanning) data are suitable for the follow-up of advanced stenosis and plaques, the morphological evaluation performed using the technique of non-invasive ultrasonic biopsy may be used to follow-up early lesions and their progression. The data obtained by ultrasonic biopsy are related to the incidence of occult coronary ischemia and to the occurrence of cardiovascular events in 4 years. The rate of progression (ROP) to the next, more advanced UB class can be also evaluated by ultrasonic biopsy. It has been shown that in diabetic and hyperlipidemic subjects the ROP is higher. Also in interventional studies using lipid lowering agents (with a four-year follow-up) a reduction in ROP in treated asymptomatic hyperlipidemic subjects in comparison with controls has been documented. The combination of dynamic data and morphological data gives us a complete evaluation of the vascular system both for the assessment of single individuals and for large population studies.

Adult↗
PubMedDate not supplied

Web-based courses. More than curriculum.

Online program development depends on an educationally and technologically sound curriculum supported by a solid infrastructure. Creation of a virtual environment through design of online registration and records, financial aid, orientation, advisement, resources, and evaluation and assessment provides students with access and program integrity.The planning of an academic support system as an electronic environment provides challenges and institutional issues requiring systematic analysis.

Curriculum↗
PubMedDate not supplied

Surveillance of in situ infrainguinal bypass grafts: conventional vs. color flow duplex ultrasonography.

Surveillance of in situ saphenous vein bypass grafts with duplex scanning detects graft abnormalities which may lead to graft thrombosis. Correction of these defects, while grafts are still patent, potentially improves overall graft patency. In this study we compared color flow and conventional duplex to determine whether color flow provided additional information not obtainable by conventional duplex examination. The primary patency rate (patency maintained without intervention) for all 51 cases was 76% (39/51). The secondary patency rate (patency maintained by identification and correction of graft defects before failure) was 88% (45/51). Duplex scanning reduced the graft failure rate by 50%. Color flow and conventional duplex examination provided the same information regarding incipient graft failure. In 20 patients monitored with both techniques, the same number of proximal (100%) and distal (90%) anastomoses were imaged. The same number of graft defects (three vein graft stenoses, one proximal femoral artery stenosis) were identified. Velocity data obtained using the two techniques (peak systolic velocity in an area of stenosis and the duplex velocity ratio) were not always the same, making calculation of percent stenosis from this data inaccurate. Color flow duplex is useful in monitoring graft patency, but provides no additional information over that provided by conventional scanning.

Blood Flow Velocity↗