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Biomedical subjects

D F Martin

Publications and source records attributed to D F Martin.

213 records · Page 12Linked to original sources
PubMedDate not supplied

Endoscopic and percutaneous intervention in malignant obstructive jaundice.

Most patients with malignant obstructive jaundice have inoperable disease at presentation. There is debate regarding the best approach to palliate these patients, i.e., surgical versus endoscopic versus percutaneous drainage. The purpose of this article is to review the current literature in an unbiased fashion, and to present a rationale for management. A multi-disciplinary approach is needed if we are to provide the best care for patients with standardization of definitions, complications, and outcomes between specialities such that meaningful comparisons can be made between studies. The need for prospective randomized trials is clear from the currently deficient literature.

Bile Duct Neoplasms↗
PubMedDate not supplied

Needle knife papillotomy for endoscopic sphincterotomy and cholangiography.

Needle knife papillotomy (NKP) was used to achieve diagnostic endoscopic cholangiography in 39 patients and endoscopic sphincterotomy in 24 patients when conventional endoscopic methods had failed. These patients represent 2.2% (cholangiography) and 4.2% (sphincterotomy) of the total number of patients undergoing these procedures during the same period. Cholangiography was achieved in 37 of 39 patients and sphincterotomy was successfully accomplished in all 24 patients with the assistance of NKP. Complication rates of 2.5% for cholangiography and 12% for sphincterotomy are higher than our own rates for non-NKP-assisted procedures, but the clinical benefits obtained were considered to outweigh these increases or the risks of alternative procedures. NKP is an effective endoscopic tool, allowing endoscopic sphincterotomy to be performed when conventional techniques fail. In addition, in carefully selected cases, NKP is helpful in allowing diagnostic cholangiography when other endoscopic methods fail.

Aged↗
PubMedDate not supplied

Operative ankle arthroscopy. Long-term followup.

Ankle arthroscopy has become an accepted procedure for the treatment of various intraarticular disorders. More than 100 ankle arthroscopies have been performed at our institution since 1983. To better define the role of arthroscopic surgery in the treatment of ankle disorders, we evaluated the preoperative examination and indications, operative data, and radiographs of those patients with a minimum of 1 year of followup. Fifty-eight ankles in 57 patients were identified; their average follow-up period was 25 months (range, 12 to 49 months). Preoperative diagnoses were synovitis (26), transchondral defects of the talus (17), degenerative joint disease (8), and osteophytes or loose bodies (7). Subjective results were good or excellent in 64% of cases. The best overall results were achieved in patients with synovitis (77%) and transchondral defects of the talus (71%). Degenerative joint disease patients did not do well. They had only 12% good or excellent results and a 43% rate of subsequent fusion. Complications included superficial and deep infections, temporary and permanent paresthesias, and hemarthroses; the overall complication rate was 15%. In conclusion, operative ankle arthroscopy can be useful in selected patients. It is an effective surgical procedure in patients with synovitis and transchondral defects of the talus. The benefits and long-term results are less predictable with loose bodies and impinging osteophytes; the results are poor with degenerative joint disease. There appears to be a significant risk of complication with ankle arthroscopy; however, with proper indications, a thorough knowledge of anatomical landmarks, and meticulous technique, good results can be obtained.

Adolescent↗
PubMedDate not supplied

Magnetic resonance imaging of iliotibial band syndrome.

Seven cases of iliotibial band syndrome and the pathoanatomic findings of each, as demonstrated by magnetic resonance imaging, are presented. These findings were compared with magnetic resonance imaging scans of 10 age- and sex-matched control knees without evidence of lateral knee pain. Magnetic resonance imaging signal consistent with fluid was seen deep to the iliotibial band in the region of the lateral femoral epicondyle in five of the seven cases. Additionally, when compared with the control group, patients with iliotibial band syndrome demonstrated a significantly thicker iliotibial band over the lateral femoral epicondyle (P < 0.05). Thickness of the iliotibial band in the disease group was 5.49 +/- 2.12 mm, as opposed to 2.52 +/- 1.56 mm in the control group. Cadaveric dissections were performed on 10 normal knees to further elucidate the exact nature of the area under the iliotibial band. A potential space, i.e., a bursa, was found between the iliotibial band and the knee capsule. This series suggests that magnetic resonance imaging demonstrates objective evidence of iliotibial band syndrome and can be helpful when a definitive diagnosis is essential. Furthermore, correlated with anatomic dissection, magnetic resonance imaging identifies this as a problem within a bursa beneath the iliotibial band and not a problem within the knee joint.

Adult↗
PubMedDate not supplied

Ankle flexibility and injury patterns in dancers.

Lower-extremity injuries are common among dancers and cause significant absences from rehearsals and performances. For this study of lower-extremity injuries in 101 ballet and 47 modern dance students, injuries requiring medical attention sustained over 1 academic year were associated with the following data obtained at the beginning of the school year: ankle flexibility, sex, dance discipline, previous injury, body mass index, and years of training. Eighty-three of the 148 students (age range, 12 to 28 years) reported prior lower-limb injuries, the most common being ankle sprains (28% of all dancers). Previous leg injuries correlated significantly with lower dorsiflexion measurements and with more new injuries. Female students had greater ankle and first metatarsophalangeal flexibility. Modern dancers had greater ankle inversion. Ninety-four students sustained 177 injuries during the study, including 75 sprains or strains and 71 cases of tendinitis. Thirty-nine percent (N = 69) were ankle injuries; 18% (N = 33) were knee injuries; 23% (N = 40) were foot injuries; and 20% (N = 35) were either hip or thigh injuries. Sixty-seven percent (N = 78) of the injured students were ballet dancers. Age, years of training, body mass index, sex, and ankle range of motion measurement had no predictive value for injury; previous injury and dance discipline both correlated with increased risk of injury.

Adolescent↗