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Biomedical subjects

J A Mathews

Publications and source records attributed to J A Mathews.

At least 19 recordsLinked to original sources
PubMed1998

Wasting of the small hand muscles in upper and mid-cervical cord lesions.

Four patients are described with destructive rheumatoid arthritis of the cervical spine and neurogenic wasting of forearm and hand muscles. The pathological connection is not immediately obvious, but a relationship between these two observations is described here with clinical, radiological, electrophysiological and necropsy findings. Compression of the anterior spinal artery at upper and mid-cervical levels is demonstrated to be the likely cause of changes lower in the spinal cord. These are shown to be due to the resulting ischaemia of the anterior part of the lower cervical spinal cord, with degeneration of the neurones innervating the forearm and hand muscles. These findings favour external compression of the anterior spinal artery leading to ischaemia in a watershed area as the likeliest explanation for this otherwise inappropriate and bizarre phenomenon.

Arthritis, Rheumatoid↗
PubMed1998

Combination endovascular and open treatment of peripheral arterial occlusive disease performed by surgeons.

The endovascular treatment of peripheral arterial occlusive disease has historically been performed by interventional radiologists and cardiologists. With additional training in endovascular techniques, surgeons become uniquely suited to manage arterial lesions with both endovascular and conventional surgical techniques. Over a 14-month period, 13 patients underwent combination endovascular and open reconstruction on limbs with peripheral arterial occlusive disease. There were 10 males and 3 females. The mean age was 66 years. All procedures were performed in the operating room by surgery residents under the direct supervision of vascular surgeons. After intraoperative angiography, 26 arterial lesions underwent percutaneous transluminal angioplasty (aorta, 1; common iliac, 14; external iliac, 10; superficial femoral, 1). Twenty-five of 26 lesions were further treated with intraluminal stent placement, the lone exception being a case of superficial femoral artery angioplasty. Concomitant open reconstruction was performed on all limbs, 14 as outflow and 1 as inflow. There were two cases of procedural morbidity and one perioperative death secondary to myocardial infarction. There were no wound-related complications. The mean ankle-brachial index of the affected lower extremity improved from 0.41 (+/- 0.15) to 0.74 (+/- 0.14) at 30 days. Mean follow-up was 8 months (range, 2-14). Based on our early experience, simultaneous combination endovascular and open reconstruction of multisegment arterial occlusive disease can be performed safely and efficiently by surgeons.

Aged↗
PubMed1997

Stereotactic and ultrasound core needle breast biopsy performed by surgeons.

BACKGROUND: The authors evaluated outcomes and treatment costs of stereotactic core needle biopsy (SCNB) and ultrasound core needle biopsy (UCNB), and needle localization biopsy (NLB) in managing patients with mammographic abnormalities presenting to the surgeon. METHODS: Data for all patients with mammographic lesions who underwent SCNB or UCNB since their introduction at this institution were prospectively collected over 17 months. Mean inclusive costs of the three procedures were accumulated and compared. RESULTS: Stereotactic core needle biopsy was performed for 342 lesions in 319 women, for a malignancy rate of 19%; UCNB was performed for 157 lesions in 144 patients, yielding a malignancy rate of 17%. With a mean follow-up of 13.5 months, 1 patient with in situ carcinoma was diagnosed late. Absolute cost savings for the period studied was $721,963. CONCLUSIONS: Minimally invasive breast biopsy procedures can safely and reliably be performed by surgeons in clinical practice with increased patient convenience and decreased costs.

Adult↗
PubMed1993

Proposals for health care reform: how do we evaluate them?

The Society for Academic Emergency Medicine suggests a systematic approach to evaluating proposals for reform of the medical care system. Described are the three components of the problem--access, cost, and quality. Then, goals are proposed for health care reform. With this background, we describe the major questions that reform proposals must address and the potential impact of reform on emergency medicine. Emergency physicians must actively support health reform legislation that is in the over-all best interest or our patients and our specialty, and work with the new federal administration to evaluate proposed changes.

Cost Control↗
PubMed1993

Transient regional osteoporosis presenting as a septic arthritis.

A 52 year old man developed a painful swollen left knee. Clinically there was an effusion and radiographs showed local osteoporosis. Sepsis was suspected but tests proved negative and the symptoms gradually settled. During the course of the following year he developed similar pain migrating from the left foot to the right knee then to the right foot. Investigations showed a right knee effusion and 'punctate' radiographic lucencies in the patellae thought to be erosions. A bone scan demonstrated increased uptake at all four sites and sepsis was once again suspected. Biopsies and culture proved negative and a computed tomographic scan confirmed that the lucencies were due to focal osteoporosis rather than erosions. This case of transient regional osteoporosis illustrates two unusual features of this condition which resulted in diagnostic difficulty with respect to sepsis.

Arthritis, Infectious↗
PubMed1991

The progressive systemic sclerosis/systemic lupus overlap: an unusual clinical progression.

Three patients with the unusual combinations of discoid lupus, systemic lupus erythematosus (SLE), and progressive systemic sclerosis (PSS) are reported. The first patient developed PSS eight years after a diagnosis of discoid lupus had been made and this was complicated by myositis six years later. The second patient developed PSS more than 20 years after being diagnosed as having SLE. The third patient developed SLE with predominant features of urticarial vasculitis six years after PSS. Mild myositis also ensued. There were no antibodies to U1RNP demonstrable in any of these patients. The clinical progression of SLE to PSS or vice versa in the absence of features of mixed connective tissue disease is distinctly uncommon.

Adolescent↗
PubMed1988

Life threatening acute pneumonitis during low dose methotrexate treatment for rheumatoid arthritis: a case report and review of the literature.

A patient is described with definite rheumatoid arthritis (RA) who developed life threatening acute pneumonitis after receiving a total dose of only 12.5 mg methotrexate (MTX). This complication has been previously described, but this is probably the lowest reported dose before development of pneumonitis in a patient with RA. The possible significance of this case is discussed in the light of recent reports suggesting an increased susceptibility of patients with RA to the pulmonary toxicity of MTX.

Alveolitis, Extrinsic Allergic↗
PubMed1987

Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections.

Four treatment regimens for patients with specified combinations of low back pain and sciatica were evaluated. The largest group studied had low back pain with limited straight-leg raising (SLR) and in them the beneficial effect of manipulation in hastening pain relief was highly significant. In similar patients without limitation of SLR, the effect was of borderline significance. In all the other groups, treated patients also recovered more quickly than their controls. Traction, for patients with low back pain and sciatica, and epidural injections when a root palsy was present also produced some significant pain relief. The effect of sclerosants for back pain was less clear.

Adolescent↗
PubMed1986

Lack of correlation between clinical disease activity and erythrocyte sedimentation rate, acute phase proteins or protease inhibitors in ankylosing spondylitis.

Disease activity was assessed clinically and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), orosomucoid, alpha 1-antitrypsin (alpha 1AT) and alpha 2-macroglobulin (alpha 2M) were measured in 65 patients with ankylosing spondylitis (AS). Positive correlations were found between ESR and the acute phase proteins (APP), CRP, orosomucoid and alpha 1AT, but none of these variables correlated with the clinical assessment of activity. No relationship was demonstrated between the protease inhibitor, alpha 2M and clinical activity, ESR or any of the APP. While the treatment of AS remains predominantly symptomatic, routine management of patients should continue to be founded on the clinical assessment of disease activity rather than on laboratory indices of inflammation.

Acute-Phase Proteins↗