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Biomedical subjects

J Aronson

Publications and source records attributed to J Aronson.

At least 91 records · Page 5Linked to original sources
PubMed1986

Field triage for on-scene helicopter transport.

This prospective study evaluated the use of basic vital signs, two mechanisms of injury, and time-distance factors as field triage criteria for on-scene helicopter transport of 130 patients to a trauma center serving a rural area. The vital signs criteria included any one or more of the following: level of consciousness (LOC) less than or equal to unresponsive to verbal stimulation; respiration rate (RR) less than or equal to 10 or greater than or equal to 30; systolic blood pressure (BP) less than or equal to 90; pulse (P) less than or equal to 60 or greater than or equal to 120. The flight crew recorded vital signs taken by the first responder capable of basic assessment. Entrapment and associated fatalities in motor vehicular accidents were recorded and flight logistics were examined. The presence of one or more abnormal signs identified a group of seriously injured trauma patients (mean Injury Severity Score = 29.1) with 24% mortality compared to a predicted mortality of 32% (p less than 0.02). Unresponsiveness to verbal stimulation in the field was the single most predictive criterion, yielding sensitivity of 93% and specificity of 85%. Time-distance criteria were helpful to determine helicopter use.

Adolescent↗
PubMed1986

Osteoarthritis of the young adult hip: etiology and treatment.

Childhood hip disorders contribute to a significant proportion of young adults with painful osteoarthritis of the hip. Prosthetic hip replacement rarely is indicated for active young adults with osteoarthritis of the hip because of high failure rates without subsequent solutions. Modern osteotomies provide a viable alternative for these individuals. Recently published data indicate that the osteotomy can have reliable results with more modest expectations. Four requirements must be met. The orthopaedist should grasp the modern principles of osteotomy and be willing to carry out more involved operative planning. The patient should exhibit a mature understanding of alternatives and long-range goals of treatment. Both orthopaedist and patient should commit themselves to a long-term relationship, beyond the 6-month rehabilitation period. The patient should be willing to compromise some motion (hip mobility) for pain relief and increased function.

Adult↗
PubMed1985

Timentin therapy for bone, joint, and deep soft tissue infections in children.

Timentin, a combination of clavulanic acid (0.1 g) and ticarcillin (3.0 g), has proved effective in vitro against bacterial pathogens that produce beta-lactamases. The usual etiologic bacteria of osteochondritis of the foot (Pseudomonas species) and osteomyelitis/septic arthritis (Staphylococcus aureus) are commonly resistant to penicillins. To date, we have used Timentin to treat 30 children with bone, joint, and deep soft tissue infections. Timentin was administered intravenously at an average dosage of 207 mg/kg per day for mild to moderate infection and 310 mg/kg per day for bone and joint infections with systemic signs (sepsis). The lower dose was used in 24 patients and the other six patients, who had signs of sepsis, received the higher dose. All patients received Timentin intravenously over 30 minutes every four to six hours for a minimum of five days (mean 6.6 +/- 2.6 days, range five to 14 days). The mean time to defervescence and/or reduction in clinical symptoms was 1.6 +/- 1.3 days (range zero to four days). Osteochondritis due to P. aeruginosa was diagnosed in six patients, and septic bursitis, osteomyelitis, or septic arthritis due to S. aureus (13 patients) or Staphylococcus species and group A streptococci (four patients) was diagnosed in 17 patients. All isolates were susceptible to Timentin in vitro by disk-diffusion analysis. All patients showed a response to therapy with Timentin, with or without surgical intervention. All patients had clinical and microbiologic cures; no adverse reactions or side effects were observed. There have been no clinical or microbiologic relapses to date. Timentin may prove to be useful in specific bone and joint infections in children.

Arthritis, Infectious↗
PubMed1983

Antibodies reactive with liposomal phospholipids are produced during experimental Trypanosoma rhodesiense infections in rabbits.

Antibodies against phospholipids appeared spontaneously during the course of experimental Trypanosoma rhodesiense infections in rabbits. These antibodies were observed in rabbits infected either with a lethal strain or with a strain newly discovered to give a spontaneous self-cure. Serum antibodies reacting with liposomes containing dimyristoyl phosphatidylcholine (DMPC), phosphatidylinositol (Pl), phosphatidylinositol phosphate (PlP), or cardiolipin were detected at 3 to 4 wk by complement-mediated release of trapped marker from liposomes. Antibodies were also detected against a trypanosomal lipid fraction (TrF2) that contained Pl as a major constituent. The antibody activities against DMPC, Pl, or TrF2 all reacted (or cross-reacted) with DMPC, and were removed from the serum by adsorbing with liposomes containing DMPC as the only phospholipid. Phosphocholine inhibited the antibodies reactive with liposomes containing either DMPC or DMPC and Pl as phospholipids. Antibodies against PlP, however, reacted only with liposomes containing PlP and were not removed by adsorbing with liposomes lacking PlP. We conclude that anti-phospholipid antibodies appear during the course of trypanosomal infections that either undergo apparent self-cure or are lethal, and at least two anti-phospholipid antibody specificities can be detected.

Animals↗
PubMedDate not supplied

Is a slow pulse-rate a reliable sign of digitalis toxicity?

64 of 910 hospital patients taking digoxin had a ventricular rate of less than 60 beats/min. In only 6 out of 57 of those investigated further could a diagnosis of digoxin toxicity be made on clinical, electrocardiographic, and biochemical grounds. No reason for the slow heart-rate could be found in 42 patients. Excessive vagal effects of digoxin in resting subjects may cause the bradycardia found in these in patients in the absence of digitalis toxicity.

Adolescent↗
PubMedDate not supplied

Normal radiographic values for cartilage thickness and physeal angle in the pediatric hip.

Ninety-three standing anteroposterior (AP) pelvis roentgenograms in 87 patients were measured for a total of 186 normal hips in children aged 1-17 years. For each hip, the physeal angle relative to the floor, the physeal angle relative to the pelvis, the cartilage thickness perpendicular to the floor, and the cartilage thickness perpendicular to the physis were measured and recorded. The physeal angle varied from ages 1-7 years, stabilizing at age 8 at a mean of 23 degrees . Physeal angle is best measured relative to the floor because pelvic obliquity introduces significant variability to the measurements. Cartilage thickness ("joint space") declined after age 7 years, with measurements in three statistically distinct groups. There was a statistically significant difference between cartilage-thickness measurements of boys versus girls, with girls showing a slightly smaller cartilage thickness than boys. Cartilage thickness measured perpendicular to the floor was not statistically significantly different from that measured perpendicular to the physis. We describe and recommend standard measurement techniques for physeal angle and cartilage thickness. These established normal values may be helpful in the diagnosis and evaluation of coxa vara and chondrolysis, and in identifying the head at risk for slipped capital femoral epiphysis or Legg-Calvé-Perthes disease.

Adolescent↗
PubMedDate not supplied

Early results of the modified Peterson bunion procedure for adolescent hallux valgus.

Adolescent hallux valgus has a high recurrence rate after conventional surgical corrections. Excellent results have been reported with a double osteotomy of the first metatarsal fixed with a 3/16" transarticular pin. The present study reports the early results of using a medial plate and screws with an osteoperiosteal distally based flap to correct metatarsophalangeal joint subluxation, decrease recurrence from laxity in the medial capsular repair, and avoid intra-articular damage. The study included 18 feet in 16 patients (8 males, 8 females). All osteotomies healed primarily without complications, though there was recurrence in 3 undercorrected feet (2 patients). The average preoperative hallux valgus angle of 34 degrees was reduced to 16 degrees at a minimum 1-year follow-up. The average intermetatarsal angle improved from 14 degrees (before operation) to 6 degrees. No patient has requested plate removal.

Adolescent↗
PubMedDate not supplied

Mechanical induction of osteogenesis: the importance of pin rigidity.

Eight dogs, divided into two groups of four by varying pin rigidity, underwent 15% left tibial lengthening by the Ilizarov method. In group I, "tensioned" 1.6-mm wires maintained a rigidity approaching that of 4.0-mm pins. In group II, the wires, maintained at half the tension, averaged 45% of the rigidity measured in group I. All dogs in group I filled the experimental gap with de novo osteogenesis, whereas all of the dogs in group II prematurely bridged the gap, arresting the process of osteogenesis. From these experimental results, clinical trials have been started using commercially available external fixation devices utilizing pins with equivalent rigidity.

Adolescent↗
PubMedDate not supplied

External fixation of femur fractures in children.

Forty-two children (44 femur fractures) were treated by primary external fixation and early weightbearing (1984-1989). The fractures were reduced anatomically when possible. Average age at fracture was 9 years 7 months (range, 2 years 5 months to 17 years 8 months). Duration of external fixation averaged 70 days (range 42-117 days). Of 176 pins, 15 (8.5%) were inflamed and five (2.8%) required intravenous antibiotics; none resulted in osteomyelitis. Most patients returned to school by 4 weeks, and all had full knee motion 6 weeks after fixator removal. Of 16 patients with documented follow-up of at least 18 months, only six (38%) had overgrowth from 2 to 10 mm (average 5.8 mm).

Adolescent↗
PubMedDate not supplied

Lateral talocalcaneal angle in assessment of subtalar valgus: follow-up of seventy Grice-Green arthrodeses.

To determine whether definitive radiographic criteria could be elucidated for the Grice-Green extra-articular subtalar arthrodesis, all 70 cases performed at the Shriner's Hospital for Crippled Children, Erie, Pennsylvania, from 1972 to 1980 were reviewed. Patients were followed both clinically and radiographically an average of 4 years and 11 months. Major conclusions were as follows: 1) the standing lateral talocalcaneal angle is the most reliable measurement for operative selection and assessment of postoperative success; and 2) by using strict operative techniques and proper patient selection, a 90% success rate can be expected.

Ankle Joint↗
PubMedDate not supplied

Deformity and disability from treated clubfoot.

To identify disability associated with treated unilateral, idiopathic clubfoot deformity, 29 patients and 23 controls were compared by morphometry, radiography, and performance testing. The average period following definitive treatment was greater than 10 years. Treatment regimens varied from prolonged casting to early posteromedial release. The most significant limitations in these treated clubfeet averaged (a) a 42% decrease in normal ankle motion, specifically lacking 65% of normal dorsiflexion, a consistent finding independent of treatment; (b) a 24% decrease in normal plantarflexor muscle strength, correlating directly to the number of heelcord lengthenings per foot; and (c) a noticeable 10% decrease in calf girth, unrelated to total time spent in cast.

Activities of Daily Living↗
PubMedDate not supplied

Mechanical induction of Osteogenesis. Preliminary studies.

The animal model developed in the Soviet Union by Ilizarov has been reliably reproduced by us for the mechanical induction of osteogenesis using slow distraction. Our preliminary studies in six adult dogs indicate that this osteogenesis originates from well-structured intramembranous ossification, with rapid maturation to lamellar bone, indistinguishable from surrounding host bone. Mineralization increases steadily, reaching critical levels for radiographic visualization between Days 21 and 28. In this model, the osteogenic area then exceeds normal bone density temporarily but returns to normal density within three months. Distraction for 28 consecutive days (at 0.25 millimeters every six hours using rigid transfixion wires, as Ilizarov describes) reliably lengthened the tibiae by 12 percent, increasing mass by 27 percent, and volume by 26 percent with only a one percent change in overall density. The process required four months to add 24 millimeters of mature, lamellar bone capable of full weight-bearing by the dogs. This rate of osteogenesis, estimated at 202 microns per day, is four times faster than a human's fastest growth plate (child's distal femur at 50 microns per day). Calcium/collagen ratios did not differ significantly from normal bone controls.

Animals↗