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Biomedical subjects

E N Hanley

Publications and source records attributed to E N Hanley.

At least 37 records · Page 2Linked to original sources
PubMed1996

Vascularized fibular grafting compared with core decompression in the treatment of femoral head osteonecrosis.

A prospective study was undertaken to compare vascularized fibular grafting (VFG) with core decompression for Ficat Grade II and III femoral head osteonecrosis. The study group included 39 hips in 34 patients-20 VFGs and 19 core decompressions. Independent evaluation of results was performed by an orthopedic surgeon and a radiologist at a minimum of 2 years postoperatively (range: 2 to 5 years). Disease extent was assessed by Ficat radiographic gradings. VFGs failed (conversion to total hip arthroplasty for functionally incapacitating pain) at a rate of 20%, significantly lower than the 58% failure rate of core decompressions (P = .025). Complications included 2 proximal femur fractures in each group, ankle pain in 6 VFGs, and graft vessel thrombosis in 1 VFG. Vascularized fibular grafting appears superior to core decompression in prolonging hip joint survivorship for Ficat Grades II and III femoral head osteonecrosis.

Adult↗
PubMed1996

Cigarette smoking and its orthopedic consequences.

Cigarette smoking and its ramifications are coming under increasing scrutiny in the field of orthopedic surgery. Smoking has been implicated in impeding bone metabolism and fracture repair, and increasing the rate of postoperative infection and the incidence of nonunion. This article reviews the current body of knowledge on these topics, as well as the potential adverse effects of smoking on wound healing and microsurgical procedures. An in-depth discussion on the pathophysiologic mechanisms of nicotine is also included.

Humans↗
PubMed1996

Indications for fusion in the lumbar spine.

A wide variety of lumbar spinal conditions have been managed by spinal fusion. Results appear better when the diagnosis is specific and related to definable instability or deformity in patients with a stable psychologic state. Success rates are higher in isthmic spondylolisthesis, unstable spinal stenosis syndromes (degenerative spondylolisthesis, degenerative scoliosis), and in patients with objective segmental instability. Variable success rates are reported for disk-related low back pain conditions and in patients with failed previous surgery. Instrumentation appears to be beneficial in situations in which complex deformities or obvious instability are present.

Humans↗
PubMed1996

Distinguish the specific from non-specific low back pain.

The diagnosis of low back pain is common and non-specific. While many theories exist concerning the etiology of low back pain, most attribute the condition to degenerative conditions of the spine with superimposed chemical and inflammatory factors. Acute low back pain is generally self-limited if treated in a supportive fashion. Certain factors such as constitutional symptoms and rest or night pain may implicate a more serious condition and possibly warrant early investigation. Chronic conditions generally relate to "segmental instability" or discogenic causes. Diagnosis and treatment of these conditions are controversial.

Acute Disease↗
PubMed1995

The indications for lumbar spinal fusion with and without instrumentation.

STUDY DESIGN: Literature review. OBJECTIVES: A review, analysis, and discussion of the extensive literature on lumbar spinal fusion were done to attempt to place in perspective the indications and success rate for lumbar spinal fusion with and without instrumentation. SUMMARY OF BACKGROUND DATA: A wide variety of lumbar spinal conditions have been managed by spinal fusion. Results appear better when the diagnosis is very specific and related to definable instability or deformity in patients with a stable psychologic state. METHODS: Search of literature. RESULTS: Success rates are higher in isthmic spondylolisthesis, unstable spinal stenosis syndromes (degenerative spondylolisthesis, degenerative scoliosis), and in patients with objective segmental instability. Variable success rates are reported for disc-related low back pain conditions and in patients with failed previous surgery. Instrumentation appears to be beneficial in situations where complex deformities or obvious instability is present. When applied for other diagnoses (e.g., internal disc disruption), results appear no better than with traditional surgical techniques. CONCLUSIONS: The outcome of lumbar spinal fusion depends on careful assessment of the anatomic cause of pain and of the patient's functional state and expectations.

Humans↗
PubMed1995

Nonoperative treatment for low back pain. Rest to restoration.

Pain and disability due to disorders of the lumbar spine are endemic in industrialized society. Nonoperative management of low back pain syndromes is most often successful but is complicated by myriad of unproven treatment options. Recent studies have shown that the natural history favors recovery regardless of the type of treatment. With increasing time from onset of symptoms, therapeutic interventions shift from rest and applied therapies to exercise and physical restoration. This also requires an evolution from passive to active participation by the patient. This article outlines current trends and recommendations for the application of various nonoperative treatment methods as low back pain persists through time.

Combined Modality Therapy↗
PubMed1995

Extracting knowledge from large medical databases: an automated approach.

Tools which can uncover patterns in patients' records and then make predictions based on that knowledge are and will continue to be high priority in many medical informatics groups. These tools are impacting the performance of outcome studies by discovering patterns which can then be verified with standard statistical tools. This paper demonstrates INC2.5, a general classification system, as a tool for assisting physicians in the decision making process. INC2.5 gathers information from patient records and builds a decision tree which is used to assist physicians in predicting the outcome of new patients. The decision tree will also reveal any patterns which the system found in the data. Successful results of such a system can be used to enhance outcome studies as well as to spread clinical information to areas with fewer resources.

Algorithms↗
PubMed1994

Lumbar epidural varix as a cause of radiculopathy.

STUDY DESIGN: Venous outflow obstruction or congestion has been implicated in the etiology of some lumbar radicular syndromes. Ten cases of epidural varices or variants manifesting themselves as masses within the lumbar spinal canal or adjacent foramina have been seen. OBJECTIVES: Diagnosis was made by multiplanar cross-sectional magnetic resonance and computed tomography imaging and confirmed in five patients by operative findings. These venous abnormalities differ from cases of arteriovenous malformations described in the literature. METHOD: Surgical treatment consisting of coagulative oblation and/or excision of the lesion was consistently successful in the five patients who underwent operations for recalcitrant symptoms. The other five patients experienced spontaneous resolution of symptoms. Three distinctly different types of these abnormalities have been identified. RESULTS: The described entity may account for some previously unexplained or spontaneously resolving cases of lumbar radiculitis. CONCLUSIONS: Knowledge of the existence of this condition, its possible etiologies, and its imaging characteristics may assist in its recognition and improved management of patients with it.

Epidural Space↗
PubMed1994

Lumbar intervertebral disc transfer. A canine study.

STUDY DESIGN: Degenerative lumbar disc disease has been implicated as a cause of low back pain. Current treatment options for low back pain involve nonphysiologic fusion of the involved segments and have variable success rates. This is an experimental study of lumbar intervertebral disc transplantation using a canine surgical model. OBJECTIVES: This study evaluated the feasibility of lumbar disc transplantation and its effects on disc metabolism and morphology. METHOD: Eight mature mongrel dogs underwent disc transfer surgeries, in which the L2-L3 and L4-L5 intervertebral discs, with a small segment of adjacent superior and inferior vertebral body, were removed and transposed. The transplanted disc were stabilized by plates or by a flexible cable wire construct using Songer cables (DANEK, Inc., Memphis, TN). Unrestricted activity was allowed postoperatively. At 4 months, the spines were harvested, and the transplanted discs were evaluated biochemically and histologically. Intervening nontransplanted discs served as viable controls and thrice-frozen discs served as nonviable controls. Cell viability was assessed by measuring proteoglycan synthesis and DNA content. RESULTS: Proteoglycan synthesis (35S uptake normalized to DNA content) was maintained in transplanted anulus fibrosus tissue, but was decreased in nucleus pulposus samples (P < 0.05). DNA content was not altered significantly in the transplanted discs. Histologic analysis of the transplanted discs showed revascularization and remodeling of the bone adjacent to the disc and preservation of the lamellar architecture of the anulus fibrosus. The transplanted nucleus pulposus samples had chondrocyte-like cells present, but the staining characteristics of the nucleus material was variable. The contour of the transplanted disc endplates was irregular in all specimens. CONCLUSIONS: The structure and function of autograft intervertebral discs were maintained after disc transfer surgery; the transplant discs, however, were not completely normal in either their morphology or their metabolic functioning.

Animals↗
PubMed1994

Gunshot fractures: a medical, social, and economic analysis.

One hundred ten fractures due to gunshots were reviewed to examine the medical, social, and financial implants of such injuries. The population was predominantly male (91%), unemployed (56%), and uninsured (79%). Sixty-eight percent were documented substance abusers, and 65% of the injuries appeared to be related to illicit drug activities. There were 94 long bone fractures and 16 intraarticular fractures. Early operative treatment was employed in 64 patients (58%) with formal internal fixation in 31. There was no difference between type of treatment, associated injury variables, and outcome, and no increase in complications with acute operative management employing internal fixation. Medical charges averaged $13,108 per patient, a 1200% increase over injuries treated at this institution in 1972 and a rise far in excess of the medical care inflation rate (334%) during the same period.

Adolescent↗