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Biomedical subjects

F A Mann

Publications and source records attributed to F A Mann.

At least 19 recordsLinked to original sources
PubMed2002

Measurement of body temperature by use of auricular thermometers versus rectal thermometers in dogs with otitis externa.

OBJECTIVE: To compare measurements of body temperature obtained with auricular thermometers versus rectal thermometers in dogs with otitis externa. DESIGN: Prospective study. ANIMALS: 100 client-owned dogs: 50 with and 50 without clinical evidence of otitis externa. PROCEDURE: Dogs were evaluated for the presence of otitis externa on the basis of clinical signs, otoscopic examination, and cytologic evaluation of ear exudate. Auricular and rectal temperatures were obtained simultaneously in all dogs prior to and following ear examination. RESULTS: There was a high correlation between auricular and rectal temperatures in dogs with otitis externa both prior to and after ear manipulation. Significant differences were not detected in temperature measurements among dogs with different degrees of otitis externa. CONCLUSIONS AND CLINICAL RELEVANCE: Auricular temperature readings obtained by use of an auricular thermometer in dogs with otitis externa are accurate measurements of body temperature, compared with rectal temperature measurements. Temperature measurements are reliable before and after examination of the ear canal.

Animals↗
PubMed2002

Cervical spine injuries in patients 65 years old and older: epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuries.

OBJECTIVE: Our objective was to describe types and distribution of cervical spine injuries in elderly patients in regard to causative trauma mechanism and patient age. MATERIALS AND METHODS: The distribution and type of 225 cervical spine injuries in 149 consecutive patients 65 years old and older over a 5-year interval were retrospectively assessed. For each patient, initial admission imaging studies were reviewed, and injuries were classified. Trauma mechanism (falls from standing or seated height vs higher energy mechanisms) and initial clinical and neurologic status were recorded. Data were correlated according to patients' age (65-75 years and >75 years) and causative trauma mechanism. RESULTS: Ninety-five (64%) of 149 patients had upper cervical spine injuries. Fifty-nine (40%) of 149 patients had multilevel injuries. Main causes for cervical spine injuries were motor vehicle crashes in "young elderly" (65-75 years old; 36/59, 61%) and falls from standing or seated height in "old elderly" (>75 years old; 36/90, 40%). Fracture patterns at risk for neurologic deterioration were common (>50%), even in the absence of acute myelopathy or radiculopathy. Patients older than 75 years, independent of causative mechanism, and patients who fell from standing height, independent of age, were more likely to have injuries of the upper cervical spine (p = 0.026 and p = 0.006, respectively). CONCLUSION: Cervical spine injuries in elderly patients tend to involve more than one level with consistent clinical instability and commonly occur at the atlantoaxial complex. Old elderly patients and patients who fall from standing height are more prone to injuries of the upper cervical spine.

Accidental Falls↗
PubMed2002

Radiologic and clinical spectrum of occipital condyle fractures: retrospective review of 107 consecutive fractures in 95 patients.

OBJECTIVE: We proposed to characterize the radiologic spectrum of occipital condyle fractures in a large series of patients and to correlate fracture pathology with neurosurgical treatment and patient outcome. MATERIALS AND METHODS: We conducted a retrospective review of the findings on conventional radiography, CT, and MR imaging in 95 patients with 107 occipital condyle fractures. We described fracture patterns according to two previously published classification systems. Clinical findings, neurosurgical management, and patient outcome were obtained from the medical records. RESULTS: Inferomedial avulsions (Anderson and Montesano type III) were the most common type of occipital condyle fracture, constituting 80 (75%) of 107 overall fractures. Unilateral occipital condyle fractures were found in 73 (77%) of 95 patients, and 58 patients were treated nonoperatively; occipitocervical fusion was required in nine patients for complex C1-C2 injuries, and six patients died. Bilateral occipital condyle fractures or occipitoatlantoaxial joint injuries were seen in 22 (23%) of 95 patients. Occipitocervical fusion or halo traction for the craniocervical junction was required in 12 patients, all of whom had CT evidence of bilateral occipitoatlantoaxial joint disruption and six of whom showed normal craniocervical relationships on conventional radiographs. Six patients with nondisplaced fractures were treated nonoperatively, and four patients died. Thirty (32%) of 95 patients showed continued disability, whereas 55 (57.5%) of 95 patients had good outcomes at 1 month. Associated cervical spine injuries were present in 29 (31%) of 95 patients. CONCLUSION: Given their associated traumatic brain and cervical spine injuries, occipital condyle fractures are markers of high-energy traumas. That conventional radiographs alone may miss up to half of the patients with acute craniocervical instability has not been well established. Avulsion fracture type and fracture displacement are associated with both injury mechanism and the need for surgical stabilization. In this series, most unilateral occipital condyle fractures were treated nonoperatively, whereas bilateral occipitoatlantoaxial joint injuries with findings of instability usually required surgical stabilization.

Adolescent↗
PubMed2002

Determination of serum organic acids in puppies with naturally acquired parvoviral enteritis.

The purpose of the present study was to investigate the acid-base status and the serum concentration of organic acids in puppies with naturally occurring canine parvoviral enteritis. Between July 1999 and July 2000, 25 client-owned puppies admitted to the St. Louis Animal Emergency Clinic South for treatment of enteritis caused by parvovirus infection were used in our study. Control blood samples were collected from 22 healthy puppies less than 9 months of age. Serum organic acid concentrations were quantitatively determined by HPLC. Puppies infected with parvovirus had significantly lower plasma concentrations of sodium, potassium, chloride, and bicarbonate than controls. Although serum L-lactate tended to increase in some puppies with canine parvoviral enteritis, our study demonstrated that most affected puppies developed only mild compensated metabolic acidosis. None of the affected puppies had an elevated serum D-lactate concentration at admission.

3-Hydroxybutyric Acid↗
PubMed2002

Validation of chest X-ray comparisons for unknown decedent identification.

Comparing skeletal structures between antemortem and postmortem chest radiographs is widely used by forensic specialists from many disciplines to positively identify unknown decedents. However, validity assessments of this method have been fairly limited. This study had three objectives: 1) to quantify the reliability of ante- and postmortem chest radiograph comparison for decedent identification; 2) to identify useful radiologic features supporting decedent identification; and 3) to recognize sources of error in decedent identification related to use of comparative radiographs. A forensic pathologist, a forensic anthropologist, and two radiologists participated in the study. Our results showed that chest radiograph comparisons proved reliable, if basic decedent information was provided, and antemortem and postmortem radiographs were adequately positioned and exposed. A "morphological approach" using normal anatomical structures for comparison may provide the most efficient method for accurate identification.

Adult↗
PubMed2001

Trends in case-mix-adjusted use of radiology resources at an urban level 1 trauma center.

OBJECTIVE: The objective of our study was to determine the utilization rates of diagnostic radiology services at an urban level 1 trauma center. MATERIALS AND METHODS: This was an observational study of imaging use patterns from 1993 to 1998. Data were segregated by patient type and imaging procedure. Annual hospital admissions were adjusted for severity of illness using the Health Care Financing Administration's case-mix index. Per-patient imaging trends for the emergency department and outpatients were assessed using a ratio of the total number of procedures to the number of patient visits. Linear regression models were used to assess the strength of associations between resource use, measured as relative value units (RVUs), and independent variables (calendar year, patient type, and examination type). RESULTS: The RVUs for all imaging increased 53% for inpatients, 69% for outpatients, and 85% in the emergency department. No significant trend for use was found for the aggregate of inpatient imaging. There was a significant increase in the inpatient MR imaging RVUs (p = 0.04). No significant trend was found for the aggregated outpatient imaging RVUs. The trends were significant for angiography (p = 0.006), MR imaging (p = 0.002), and sonography (p = 0.04). The aggregated emergency room imaging RVUs showed a significant increase over time (p < 0.03). CONCLUSION: The number of imaging procedures increased during the study period. There was no overall trend toward increasing use of imaging in inpatients once an adjustment for severity of illness was made. Increases in patient visit-adjusted emergency department use of CT, sonography, and nuclear medicine procedures resulted from changes in practice patterns. For emergency department and outpatient settings, adjusting for the number of patient visits explains a significant portion of the increase in utilization.

Academic Medical Centers↗
PubMed2000

Helical CT in the primary trauma evaluation of the cervical spine: an evidence-based approach.

This review provides a summary of the cost-effectiveness, clinical utility, performance, and interpretation of screening helical cervical spine CT for trauma patients. Recent evidence supports the use of helical CT as a cost-effective method for screening the cervical spine in high-risk trauma patients. Screening cervical spine CT can be performed at the time of head CT to lower the cost of the evaluation, and when all short- and long-term costs are considered, CT may actually save money when compared with traditional radiographic screening. In addition to having higher sensitivity and specificity for cervical spine injury, CT screening also allows more rapid radiological clearance of the cervical spine than radiography. Patients who are involved in high-energy trauma, who sustain head injury, or who have neurological deficits are candidates for CT screening. Screening with CT may enhance detection of other potentially important injuries of the cervical region.

Cervical Vertebrae↗
PubMed2000

Communicating with the family: the risks of medical radiation to conceptuses in victims of major blunt-force torso trauma.

BACKGROUND: Trauma surgeons must balance the risk and benefits of diagnostic radiographic procedures on potentially pregnant patients and should know the range and likelihood of effects that radiation might have on pregnancy. METHODS: We present guidelines for assessing such radiation risks. Knowledge of a patient's pregnancy status and an estimate of radiation dose to the conceptus (low, < 10 mGy [milligray]; intermediate, 10-250 mGy; high, > 250 mGy) allow provisional assessment of radiation-induced risks. RESULTS: Dose estimates may be estimated at 2 mGy per exposure (radiographs), 5 mGy per slice (computed tomography), and 10 mGy per minute of fluoroscopy, when the conceptus is within the x-ray field. A formal radiation exposure assessment is appropriate when provisional estimates exceed 10 mGy. CONCLUSION: A simple qualitative dose assessment can inform clinical decisions and guide appropriate triage to more formal quantitative assessment.

Family↗
PubMed2000

Radiologic spectrum of craniocervical distraction injuries.

Injuries to the atlanto-occipital region, which range from complete atlanto-occipital or atlantoaxial dislocation to nondisplaced occipital condyle avulsion fractures, are usually of critical clinical importance. At initial cross-table lateral radiography, measurement of the basion-dens and basion-posterior axial line intervals and comparison with normal measurements may help detect injury. Computed tomography (CT) with sagittal and coronal reformatted images permits optimal detection and evaluation of fracture and luxation. CT findings that may suggest atlanto-occipital injury include joint incongruity, focal hematomas, vertebral artery injury, capsular swelling, and, rarely, fractures through cranial nerve canals. Magnetic resonance (MR) imaging of the cervical spine with fat-suppressed gradient-echo T2-weighted or short-inversion-time inversion recovery sequences can demonstrate increased signal intensity in the atlantoaxial and atlanto-occipital joints, craniocervical ligaments, prevertebral soft tissues, and spinal cord. Axial gradient-echo MR images may be particularly useful in assessing the integrity of the transverse atlantal ligament. All imaging studies should be conducted with special attention to bone integrity and the possibility of soft-tissue injury. Atlanto-occipital injuries are now recognized as potentially survivable, although commonly with substantial morbidity. Swift diagnosis by the trauma radiologist is crucial for ensuring prompt, effective treatment and preventing delayed neurologic deficits in patients who survive such injuries.

Atlanto-Axial Joint↗
PubMed2000

Determining risk of traumatic aortic injury: how to optimize imaging strategy.

OBJECTIVE: Our objective was to develop and validate a clinical prediction rule that determines patient probability of traumatic aortic injury to guide selection of optimal screening imaging strategy. MATERIALS AND METHODS: A 2-year, single-institution retrospective case-control study was conducted of 31 cases of traumatic aortic injury and 171 random major trauma control subjects. The presence of potential injury predictors was determined from chart review. Logistic regression was used to determine injury predictors, and clinically similar predictors were combined into composite predictors. The composite predictors were used to develop a seven-point injury index clinical prediction rule using multivariate logistic regression. Injury probabilities were determined through Bayes' theorem. Bootstrap validation was performed. RESULTS: Predictors of aortic injury included head injury (odds ratio, 18.3; 95% confidence interval [CI], 7.3-46), pelvic fracture (odds ratio, 27.3; 95% CI, 8.8-85), pneumothorax (odds ratio, 27.3; 95% CI, 8.8-85), and lack of seat belt use (odds ratio, 6.8; 95% CI, 2.6-17). The seven composite predictors of age, unrestrained vehicle occupant, hypotension, thoracic injury, abdominopelvic injury, extremity fracture, and head injury, were combined into the seven-point injury index. In the injury index, each composite predictor had an adjusted odds ratio of 7.1 (95% CI, 3.7-13.5), and the odds ratios were additive. The injury index prediction rule had an area under the receiver operating characteristic curve of 0.97. All injured patients had at least one composite predictor. CONCLUSION: The probability of traumatic aortic injury can be estimated from the injury index prediction rule. Because cost-effectiveness of various imaging strategies depends on probability of injury, the prediction rule can guide imaging selection.

Aorta↗
PubMed2000

Cervical spine injury: a clinical decision rule to identify high-risk patients for helical CT screening.

OBJECTIVE: We aimed to validate the routine use of a clinical decision rule to direct diagnostic imaging of adult blunt trauma patients at high risk for cervical spine injury. MATERIALS AND METHODS: We previously developed and have since routinely used a prediction rule based on six clinical parameters to identify patients at greater than 5% risk of cervical spine injury to undergo screening helical CT of the cervical spine. During a 6-month period, 4285 screening imaging studies of the cervical spine were performed in adult blunt trauma patients. Six hundred one patients (398 males, 203 females; age range, 16-100 years; median age, 38 years) underwent helical CT, and the remainder underwent 3684 conventional radiographic examinations. Clinical and report data were extracted from the radiology department database, medical records, and the hospital trauma registry. Abnormal findings were independently confirmed by additional imaging studies, autopsy results, or clinical outcome. RESULTS: The true-positive cervical spine injury rates in helical CT- and conventional radiography-screened patients who presented directly to our trauma center were 40 (8.7%) of 462 and seven (0.2%) of 3684, respectively. The cervical spine injury rate in patients who were transferred from outside institutions to our trauma center and who underwent helical CT was 37 (26.6%) of 139. This figure included 20 patients already known to have cervical spine fracture. CONCLUSION: The clinical decision rule can distinguish patients at high and low risk of cervical spine injury, thus supporting its validity.

Adolescent↗
PubMed2000

Use of structural allografts in spinal osteomyelitis: a review of 47 cases.

OBJECT: The use of structural allografts in spinal osteomyelitis remains controversial because of the perceived risk of persistent infection related to a devitalized graft and spinal hardware. The authors have identified 47 patients over the last 3.5 years who underwent a surgical decompression and stabilization procedure in which fresh-frozen allografts were used after aggressive removal of infected and devitalized tissue. The patients subsequently underwent 6 weeks of postoperative antibiotic therapy (12 months for those with tuberculosis [TB]). METHODS: Follow-up data included results of serial clinical examinations, radiography, laboratory analysis (erythrocyte sedimentation rate and white blood cell count), and clinical outcome questionnaires. Of the original 47 patients (14 women and 33 men, aged 14-83 years), 39 were available for follow up. The average follow-up period at the time this article was submitted was 17 +/- 9 months (median 14 months, range 6-45 months). In the majority of cases (57%), a Staphylococcus species was the infectious organism. Predisposing risk factors included intravenous drug abuse (IVDA), previous surgery, diabetes, TB, and concurrent infections. During the follow-up period only two patients suffered recurrent infection at a contiguous level; both had a history of IVDA and one also had a chronic excoriating skin condition. No other recurrent infections have been identified, and no patient has required reoperation for persistent infection or allograft/hardware failure. CONCLUSIONS: It is the authors' opinion that the use of structural allografts in combination with aggressive tissue debridement and adjuvant antibiotic therapy provide a safe and effective therapy in cases of spinal osteomyelitis requiring surgery.

Adolescent↗
PubMed1999

Centrifugal pumps: description of devices and surgical techniques.

BACKGROUND: Because of simplicity of application, universal access, and low cost, centrifugal pumps are commonly used for short-term mechanical cardiac assist. Indications and techniques for application of this technology continue to evolve. METHODS: The clinical experience with 151 patients undergoing centrifugal mechanical cardiac assist at the University of Missouri-Columbia has been reviewed. We have compared commonly available centrifugal pumping systems in vitro and in vivo for characteristics that might distinguish them. RESULTS: Centrifugal pumps have been found to be well suited for use in surgery on the thoracic aorta, for extracorporeal membrane oxygenation and for postcardiotomy cardiac mechanical assist. Complications associated with centrifugal mechanical assist are predictable and common but potentially can be reduced by improved surgical techniques and anticoagulation strategies. In vitro and in vivo experimentation with available centrifugal pumps reveals nuances characteristic of each of the devices. CONCLUSIONS: All centrifugal pumps presently available are less destructive to blood cellular elements compared with roller pumps. With familiarity, all can function satisfactorily for short-term mechanical assist with no compelling evidence that favors any particular centrifugal pump system clinically available. Centrifugal pumps are ideally suited for left heart bypass during surgery on a thoracic aorta and for short-term application as may be required for postcardiotomy mechanical assist. Centrifugal pump technology should be part of the armamentarium of all cardiothoracic surgeons.

Animals↗
PubMed1999

Radiologic measurement of the scapholunate joint: implications of biologic variation in scapholunate joint morphology.

To determine the optimal location for measurement of the scapholunate (SL) joint intercortical width, normal biologic variation in SL joint morphology was evaluated in 40 normal, skeletally mature wrists (16 volunteers, 24 cadavers) using thin-section 1.5T magnetic resonance imaging performed in the axial and coronal planes. The integrity of the SL ligaments was confirmed by magnetic resonance imaging and verified with anatomic dissection of the cadaver wrists. Patterns of SL articular morphology were qualitatively determined using similarity grouping. Scapholunate interval measurements were made at 3 locations each on the mid-SL joint image from both the axial and coronal planes: the articular margins (dorsal-palmar and proximal-distal) and midjoint. Three patterns of midjoint space cortical conformation were observed: parallel congruent (78%), inverted Y (15%), and point-like (8%). The most consistent and narrowest distance between the scaphoid and lunate was found at midjoint: coronal 1.45 mm (44% coefficient of variation) and axial 1.00 mm (22% coefficient of variation). This study demonstrated that measurement of the apparent SL joint interval in an inappropriate site, as with extended or flexed clenched fist views, may provide inaccurate SL joint interval distance assessments. Regardless of SL joint configuration, the midportion of the SL joint shows only moderate biologic variation and the least absolute measurement variance in width and should be the most precise part of the joint to measure. On magnetic resonance imaging, the normal SL joint interval measures less than 2 mm.

Adolescent↗