Tuberculosis control-dream or probability?
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Humans↗
Biomedical subjects
C H Rorabeck
Publications and source records attributed to C H Rorabeck.
Tuberculosis control--the great delusion.
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Canada↗
Addition of morphine to intra-articular bupivacaine does not improve analgesia following knee joint replacement.
BACKGROUND AND OBJECTIVES: In an effort to further decrease postoperative opioid requirements and improve analgesia in patients undergoing elective knee joint replacement, a study was made of the effectiveness of adding morphine to an intra-articular bupivacaine injection given immediately following surgery. METHODS: In random, double-blind fashion, 75 patients received a 31-mL intra-articular injection consisting of either 30 mL 0.5% bupivacaine with 1:200,000 epinephrine and 1 mL normal saline (group BUP), 30 mL 0.5% bupivacaine with 1:200,000 epinephrine and 1 mg (1 mL) preservative-free morphine (group BUP-MORPH), or 30 mL normal saline with 1:200,000 epinephrine and 1 mg preservative-free morphine (group MORPH). Postoperative analgesia was supplied by patient controlled analgesia (PCA) with morphine. Patients were assessed at 1, 2, 4, and 24 hours for pain (visual analog and verbal rating scales), morphine utilization, and side effects. Knee range of motion was measured before operation and at hospital discharge. RESULTS: There was no difference among the three groups in PCA morphine requirements, pain scores by either scale, range of motion, or incidence of side effects, including somnolence, urinary retention, nausea and vomiting, and pruritus. CONCLUSION: The addition of 1 mg morphine to an intra-articular injection of 30 mL 0.5% bupivacaine with 1:200,000 epinephrine given at wound closure does not improve analgesia in patients undergoing elective knee joint replacement.
Adult↗
The pathophysiology of the anterior tibial compartmental syndrome.
Based on a clinical review of 45 patients with acute anterior tibial ischemia, four different conditions were identified. Three were related to increased pressure within the compartment and were called anterior compartmental syndromes. They followed exercise, trauma, and ischemia. The fourth entity was anterior tibial ischemia due to anterial occlusion. An experimental investigation demonstrated that increased pressure within the anterior compartment slows blood flow to the enclosed tissues.
Anterior Compartment Syndrome↗
Unilateral facet dislocation of the cervical spine. An analysis of the results of treatment in 26 patients.
Twenty-six patients with unilateral facet dislocation of the cervical spine were analyzed to determine the best method of treatment of this injury, the incidence of late pain and instability, and the indications for surgical stabilization. This review showed that all patients with a unilateral facet dislocation of the cervical spine should be treated initially with halo traction in an attempt to obtain reduction. If reduction is obtained, then nonoperative treatment in the form of a halo thoracic apparatus may be the best method of treatment. Failure to obtain reduction with axial traction is an indication for open reduction and one-level posterior cervical fusion. Patients left in the displaced position and allowed to heal in that position usually develop late pain as a complication of this method of treatment.
Adult↗
Tourniquet-induced nerve ischemia complicating knee ligament surgery.
Five patients developed paralysis to the sciatic nerve after the application of a pneumatic tourniquet for knee ligament surgery. Four of these patients made a complete neurologic recovery within 6 months. A subsequent experimental investigation has demonstrated that some degree of impaired function in the sciatic nerve of a dog occurs with every tourniquet application. On the basis of this experimental work, it is recommended that a pneumatic tourniquet not be left inflated for periods longer than 1 hr and 15 min. In addition, it is suggested that once a tourniquet has been deflated during an operative procedure, that it should not be reinflated because of the excessive length of time required for the sciatic nerve conduction velocity to return to normal. Tourniquets should also be checked for calibration before use at time of an operation.
Animals↗
The measurement of dynamic compartment pressure during exercise.
Anterior tibial compartment pressures have been examined during exercise in nine healthy university students. Six male and three female subjects weighing 140 to 160 pounds and between 18 and 25 years of age were tested. A slit catheter was introduced into the muscle belly of the subjects' right anterior tibial compartment and dynamic compartment pressures measured using an F.M. telemetry system. Subjects were exercised on a treadmill at speeds from 1 to 6 mph and the variations in compartment pressure during one exercise cycle (one stride length) and over the course of the exercise period examined. Results have shown that both average and peak to peak pressures measured during exercise are much higher than those recorded at rest, and compartment pressures rose with increasing speed.
Adolescent↗
The tibialis posterior muscle compartment. An unrecognized cause of exertional compartment syndrome.
Exertional compartment syndrome in the deep posterior compartment of the leg is well recognized. This paper reports investigations which were performed to prove that the tibialis posterior muscle is contained in its own osseofascial compartment, separate from the rest of the deep posterior compartment. Radiographs following the injection of radio-opaque dye into the tibialis posterior muscle demonstrated the fluid-impermeable, osseofascial boundaries surrounding this muscle. Compartment syndromes created in cadaver legs reveal that traditional techniques of fasciotomy of the deep posterior compartment are inadequate in decompressing the tibialis posterior muscle. Intracompartmental pressure measurements in athletes with a clinical diagnosis of exertional compartment syndrome proved the existence of isolated exertional compartment syndrome in the tibialis posterior muscle. From these results we may conclude that the tibialis posterior muscle is contained in a separate osseofascial muscle compartment which may be the site of an isolated exertional compartment syndrome and that common techniques of fasciotomy of the deep posterior compartment do not decompress the tibialis posterior muscle.
Adult↗
The role of tissue pressure measurement in diagnosing chronic anterior compartment syndrome.
Pressure studies were performed in 55 patients (24 with chronic anterior leg pain and 31 asymptomatic recreational athletes). Pressure measurements were recorded at rest, during, and after exercise, using the slit catheter system. Seventeen of the twenty-four patients with symptomatic anterior leg pain were diagnosed on the basis of tissue pressure studies as having chronic exertional compartment syndrome. The increased tissue pressures at rest and after exercise are most helpful in distinguishing those patients likely to benefit from a surgical fasciotomy.
Adult↗
The results of fasciotomy in the management of chronic exertional compartment syndrome.
Twenty-five patients with well-documented clinical history and elevated tissue pressures were subjected to surgical fasciotomy of the respective compartment (anterior, 13; anterior and posterior, 4; deep posterior, 8). The indications for surgery were resting pressures in excess of 15 mmHg and elevated postexercise pressure measurements with delayed normalization. Twenty-two patients were satisfied with the procedure and were able to return to athletics. There were three failures, all of whom had decompression of the deep posterior compartment. This study has demonstrated that fasciotomy of the anterior compartment, when done with the correct indications, gives excellent relief of chronic anterior leg pain. It is recommended that fasciotomy of the deep posterior compartment include a formal release of the tibialis posterior at the time of decompression.
Adult↗
The use of magnetic resonance imaging in exertional compartment syndromes.
This prospective, double-blind study was carried out to assess the usefulness of magnetic resonance imaging (MRI) as a noninvasive method in the diagnosis of chronic compartment syndrome (CCS). As well, a new radiopharmaceutical known as methoxy isobutyl isonitrile that has been shown to be taken up by muscle in direct proportion to its blood flow was used to illustrate the possible pathophysiology of this syndrome. Twenty patients with a history of chronic leg pain and possible diagnosis of CCS and five normal volunteers had preexercise and postexercise MRI, nuclear medicine imaging, and static and dynamic slit catheter pressure studies. Nine patients had classic symptoms; only five of these nine had abnormal pressure studies. The other 11 patients had an element of pain at rest and had normal pressure studies. The nuclear blood flow studies were normal in all 25 legs tested in this study. Measurement of intrinsic MRI parameters T1 and T2 in the normal legs as well as in those with an atypical history showed a marked elevation with exercise and a gradual return to baseline postexercise that was similar to the pressure curves. In the five patients with a clinical history and elevated pressures, four had abnormal MRI studies with failure of T1 to return to baseline values. Although these results demonstrate the potential of MRI as a tool for noninvasively monitoring muscle status, clinical history and examination remain important in the diagnosis of CCS. This study indicates that the pathophysiology of exertional compartment syndrome does not appear to be related to ischemia.
Adolescent↗
Tibial plateau fractures. An analysis of the results of treatment in 60 patients.
Sixty patients with fractures of the tibial plateau were reviewed and assessed in terms of fracture type, treatment method, adequacy of reduction, immobilization time, associated ligamentous and meniscal injury, and overall result in an attempt to define factors important in the prediction of outcome. Comminuted bicondylar fractures (Type IV) were the most common (39%). Thirty-eight of the 60 fractures were treated by open reduction and internal fixation, and 22 were treated by closed methods. Overall, 75% of the patients had a satisfactory result. Ligamentous and meniscal injuries were treated surgically and did not influence the final outcome. The single most important factor in predicting outcome in a patient with a tibial plateau fracture was the adequacy of reduction. The method of achieving the reduction and the length of the immobilization period of the knee were not as crucial. A residual step of greater than 5 mm on the weight-bearing area was universally associated with an unsatisfactory result.
Adolescent↗