Biomedical subjects

D J Courtemanche

Publications and source records attributed to D J Courtemanche.

9 recordsLinked to original sources

PubMed1995

Revascularization of a seven-week-old infant lower extremity: case report.

A seven-week-old infant suffered a closed segmental fracture of the left tibia and fibula complicated by vascular disruption and a secondary compartment syndrome. Initial orthopedic assessment revealed a clinically mottled, cool, pulseless extremity 4 hr post-injury. Radiologic investigations showed multiple displaced fractures of both the tibia and fibula. The infant underwent four compartment fasciotomies and intramedullary nailing of the tibial fractures. The vascularity of the limb failed to improve significantly. Angiograms done 22 hr post-injury revealed disruption of arterial inflow just distal to the bifurcation of the tibial peroneal trunk and posterior tibial artery. Urgent revascularization utilizing a contralateral greater saphenous vein graft was undertaken with a successful outcome. Despite delay in transport from the community hospital and lack of definitive management of the vascular injury, the infant has had a good-to-excellent functional outcome.

Compartment Syndromes↗

PubMed1995

Lower extremity burns and Unna paste: can we decrease health care costs without compromising patient care?

OBJECTIVE: To compare an alternative treatment for lower extremity burns with the standard in-hospital treatment, in an attempt to shorten hospital stay. DESIGN: A case-control series. SETTING: A university-affiliated hospital. PATIENTS: All patients with a burn isolated to a lower extremity were treated over an 8-month period with split-thickness skin grafting (STSG), Unna paste dressing, immediate mobilization and early discharge. This group was compared with matched controls from the preceding 8 years treated with STSG, occlusive burn gauze dressing, bed rest and hospitalization. MAIN OUTCOME MEASURES: Duration of hospital stay and graft viability. RESULTS: Thirteen patients with an average wound size of 131 cm2 were treated with Unna paste and had a graft viability of greater than 95% and a burn-scar rating equivalent to that of patients treated with the earlier regimen. The duration of hospital stay decreased from a mean of 12.9 days to 1.4 days, with no complications. This translated into a saving of $10,350 per patient. CONCLUSIONS: This alternative treatment is safe, inexpensive and effective and is recommended as the treatment of choice for uncomplicated, noncircumferential lower extremity burns.

Adolescent↗

PubMed1995

Osseointegration in sinus-forming bone.

Osseointegration, using bone-anchored titanium fixtures, is a well-established technique for both intraoral and craniofacial prosthetic rehabilitation. The use of this technique in children can be complicated by craniofacial growth and sinus development. This study evaluates the effects of sinus formation and growth on the fate of osseointegrated titanium fixtures in the growing porcine model. At 3 weeks of age, six Landrace White cross male pigs had a 3.75 x 3.0 mm titanium fixture (Noblepharma) inserted into their right frontal bone where the right frontal sinus would subsequently develop. Preoperative CT scans with three-dimensional reconstructions were used to determine the insertion site. To follow the effects of growth and sinus formation, CT scans with three-dimensional reconstructions and cephalometric radiographs were taken at 1, 3, 6, and 9 weeks postoperatively and at sacrifice. The pigs were sacrificed serially, and direct osteometric measurements were taken to determine skull symmetry. All skulls were sectioned, and osseointegration was determined clinically, radiologically, and histologically with light and scanning electron microscopy. Five of the six fixtures osseointegrated. There were no apparent growth disturbances due to the fixtures. As growth progressed, the osseointegrated fixtures submerged into the frontal bone in a posteroinferior direction to become completely intraosseous 14 weeks after insertion. As the frontal sinus pneumatized, the fixtures remained osseointegrated, but progressive amounts of the fixtures became exposed in the sinus. From this study it would appear that osseointegrated titanium fixtures do not have any effect on calvarial growth and gradually submerge into the growing bone. As sinus development ensues, the fixtures remain integrated but become partially exposed within the sinus.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1992

Experimental calvarial growth disturbance by micro-plate and screw fixation.

A study was designed to help ascertain the effects of rigid internal fixation in the growing skull. Five piglets underwent plating of the left coronal suture at 3 weeks of age. At the time of surgery metal markers were placed to follow bone growth. Cephalometric radiographs, direct osteometry at sacrifice, gross pathological examination and specimen radiography revealed a localized disturbance of growth. There was a restriction of sutural displacement and appositional bone growth at the site of the plate. Local restriction of sutural growth was almost complete during the experimental period. There was an alteration to a 'mature' suture morphology, without synostosis, of the suture on the plated side not seen on the control side. A plagiocephalic pig was not produced nor was there an orbital deformity. A large local contour deformity developed and by the end of the experimental period the plate had become completely incorporated in bone. These effects were statistically significant as well as clinically significant. The clinical use of this type of fixation in reconstructive surgery of the infant craniofacial skeleton is questioned in light of the result.

Animals↗

PubMed1991

Detection of micrometastases from primary breast cancer.

The monoclonal antibody LICR-LON-M8 was used in a series of experiments to determine how an immunohistochemical technique could be used as a diagnostic test for micrometastatic disease in patients with operable, primary breast carcinoma. Optimal tissue and antigen preservation was obtained with fixatives containing either picric acid or a heavy metal such as mercury to allow staining with the monoclonal antibody diluted to 1:12,000 to 1:16,000 from unpurified mouse ascites. Tissue affected by primary and metastatic disease stains in a characteristic fashion, which is distinct from benign breast tissue. All the ductal tumours stained positively for malignant cells with the monoclonal antibody preparation. Within the bone marrow, occasional granulocytes and granulocyte precursors stained positively if the endogenous peroxidase activity was incompletely blocked. These cells were readily differentiated from tumour cells on cytologic examination. With these monoclonal antibody and immunohistochemical staining techniques it may now be possible to detect early micrometastatic disease in the bone marrow of patients with primary breast cancer.

Antibodies, Monoclonal↗

PubMed1991

Monoclonal antibody LICR-LON-M8 does not predict the outcome of operable breast cancer.

The prognostic value of the monoclonal antibody LICR-LON-M8, which has been shown to detect micrometastatic disease, was evaluated in a prospective, double-blind, clinical study of bone-marrow specimens from patients with operable breast cancer. Four bone-marrow specimens, obtained from each of 50 patients at the time of excision of the primary breast tumour, were examined immunohistochemically, with LICR-LON-M8 as the primary antibody. All of the primary tumour specimens demonstrated positive staining for malignant disease with LICR-LON-M8. The bone-marrow specimens of four patients demonstrated positive staining: three specimens were "suspicious" for malignant cells and one contained definite malignant cells on cytologic examination. This gave a 2% rate of detectable micrometastatic disease at the time the primary tumour was excised. Patient follow-up averaged 21.5 +/- 9.1 months. The test results did not correlate with outcome. A negative test result with LICR-LON-M8 did not imply a better prognosis. The authors conclude that examination of bone-marrow specimens stained with LICR-LON-M8 in patients with operable breast cancer is of no clinical value. Furthermore, the low rate of micrometastases detected is at variance with that reported by others. In view of the natural history of breast cancer, the authors believe that their results were not unexpected and they question the importance of other results.

Adult↗

PubMed1986

Myocardial infarction in a child with Salmonella enterocolitis.

The case history and findings of a seven-month-old North American Indian girl with myocardial infarction following a prolonged febrile seizure associated with Salmonella typhimurium enterocolitis are presented and discussed. This appears to be a unique observation not previously described in the literature.

Electrocardiography↗

PubMedDate not supplied

Recognition and treatment of the post-traumatic stress disorder in the burn victim.

In 1980 the third edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-III) provided the first descriptive classification for post-traumatic stress disorder as a unique diagnostic entity. Since then, many reports describing this condition in Vietnam War veterans have appeared, as well as occasional reports of the disorder after civilian trauma. We have found only one previous report of this disorder as a sequela to thermal injury. This article presents two illustrative case reports of burn victims suffering from post-traumatic stress disorder, highlighting the phenomenology leading to the diagnosis. The treatment and outcome are also presented. The importance of recognizing and treating this disorder in burn victims is discussed. Treatment results in improved compliance through all phases of therapy and an overall decrease in patient morbidity, especially psychologic problems. The need for psychiatric consultation, evaluation, and follow-up of the burn victim is emphasized.

Burns↗

PubMedDate not supplied

Rating the burn scar.

A reliable, objective, and universal method of assessing burn scars does not exist in today's burn literature. Such a method is necessary to provide a descriptive terminology for the comparison of burn scars and the results of treatment. The method should be applicable to patients both within an institution and between burn centers. A burn scar assessment has been devised based on physical parameters. These relate to the healing and maturation of wounds, cosmetic appearance, and the function of the healed skin. Pigmentation, vascularity, pliability, and scar height are assessed independently, with increasing score being assigned to the greater pathologic condition. Normal skin has a score of 0. Seventy-three patients were assessed by three separate occupational therapists and the findings subjected to statistical analysis for interrater reliability. For each parameter a Cohen's kappa statistic of approximately 0.5 +/- 0.1 indicates a statistically significant agreement between observers. These values were found to improve with time. This appears to be a useful tool for the assessment of burn scars, allowing objective comparison of the same scar by different observers.

Adolescent↗