Biomedical subjects

J B Bennett

Publications and source records attributed to J B Bennett.

At least 37 records · Page 2Linked to original sources

PubMed1991

Rigid internal fixation for shoulder arthrodesis.

Fifteen patients underwent a shoulder arthrodesis utilizing standard dynamic compression plate fixation, but with limited postoperative immobilization with only an abduction pillow. In each case, the position of the extremity relative to the scapula and trunk was recorded immediately postoperatively, at regular intervals until fusion, and at follow-up evaluations. Thirteen of 15 shoulders fused without change of intraoperative position after an average postoperative period of 4 months. One patient lost position in the early postoperative period secondary to inadequate fixation, but subsequently fused. Another who demonstrated a persistent non-union at 2 1/2 years was subsequently explored and underwent a bone graft. Four patients complained of residual symptomatic hardware, with two requiring surgical removal of the plate and screws. All but one patient were satisfied with the clinical result at follow up. Only two patients were within 5 degrees of the preoperatively determined position of 30 degrees abduction, 30 degrees forward flexion, and 30 degrees internal rotation. However, almost all were able to function satisfactorily. The authors concluded that shoulder arthrodesis utilizing rigid internal fixation without postoperative cast or brace immobilization maximizes patient comfort without compromising the success of arthrodesis. However, control of arm position remains inexact and additional modifications are needed to ensure fusion position and to minimize disability.

Adolescent↗

PubMed1990

Failure of trapeziometacarpal arthrodesis with use of the Herbert screw and limited immobilization.

Eighteen patients with trapeziometacarpal joint arthritis had arthrodesis with use of the 1.9 mm Herbert screw for internal fixation. Thumb spica cast immobilization was maintained for an average of 8 weeks, followed by thumb spica orthoplast splintage on a part time basis. Fourteen patients had radiographic follow-up an average of 12 months after operation. Seven had union and seven had a nonunion. There were three fixation-related complications and two nonfixation-related complications. Eleven patients had clinical follow-up an average of 12 months after operation. Four patients had no pain, five had mild pain, and two had moderate pain after operation. All had severe pain before operation. All were satisfied with the procedure. Although subgroups of patients had a higher rate of union with bone grafts or with immobilization over 8 weeks, the theory that arthrodesis with 1.9 mm Herbert screws does not require external splintage and allows early mobilization is not supported by this series.

Adult↗

PubMed1990

Arthritis of the hand and wrist. Management options for some common arthritic conditions.

Many arthritic conditions can affect the small joints of the hand and wrist. An understanding of the disease process helps in managing the problem. Conservative care generally consists of rest, splinting, use of anti-inflammatory drugs, intra-articular injection with corticosteroids, and rehabilitation therapy. Surgical procedures for the arthritic hand are reserved for persistent cases of pain or instability that do not respond to conservative treatment.

Arthritis↗

PubMed1990

Brachial plexus injury associated with chest restraint seatbelt: case report.

Rapid deceleration while wearing a lap-shoulder strap seatbelt may result in a traction injury to the brachial plexus on the side of the shoulder strap. Occult vascular injury should be considered in patients with this injury pattern. The deficit will recover after a neuropraxic type injury.

Accidents, Traffic↗

PubMed1990

A general practice based survey of bronchial hyperresponsiveness and its relation to symptoms, sex, age, atopy, and smoking.

The prevalence and associations of bronchial hyperresponsiveness were investigated in a general practice population. The sample was obtained by using every 12th patient on the practice age-sex register, replacing non-responders with corresponding age and sex matched individuals from up to two further 1 in 12 samples. The response rate was 43%; 366 patients were studied. Doubling concentrations of methacholine were given to a maximum of 32 mg/ml or until a 20% fall in forced expiratory volume in one second (FEV1) occurred (provocation concentration, PC20FEV1). Bronchial hyperresponsiveness was defined arbitrarily as a PC20FEV1 of 2 mg/ml or less (or 11 mumol cumulative dose, PD20FEV1). The prevalence of bronchial hyperresponsiveness was 23%. Bronchial hyperresponsiveness was not associated with age but was more prevalent in women than men (31%:13%). It was also more common in those who had ever wheezed (39%) and in those who had had an attack of rhinitis in the preceding month (45%, p less than 0.1), in atopic individuals (30%), and in smokers (32%), but it was not associated with cough or dyspnoea. There was a positive correlation between PC20FEV1 and resting FEV1 (r = 0.288) and a negative correlation between PC20FEV1 and mean daily peak flow variability (r = -0.356). Stepwise binary logistic regression analysis showed significant independent effects on PC20FEV1 for mean daily peak flow variability, gender, number of positive skin test responses, resting FEV1, and mean histamine skin weal area, but no relation with smoking or mean allergen weal area. The prevalence of bronchial hyperresponsiveness was much higher than the prevalence of diagnosed asthma in the practice in 1984 (4.9%). Analysis of case notes of 169 individuals showed that those with bronchial hyperresponsiveness had not attended the practice more frequently for respiratory complaints during the previous five years.

Adolescent↗

PubMed1990

Recurrent carotid stenosis: a consequence of local or systemic factors? The influence of unrepaired technical defects.

To determine the influence of unrepaired technical defects as well as systemic risk factors for atherogenesis on carotid artery healing after endarterectomy, we conducted a prospective study using intraoperative duplex scanning with spectral analysis to establish the initial status of the artery (N = 131 arteries), and then we studied these vessels at regular postoperative intervals with the same technique (N = 108 arteries, 265 studies). The vessels were divided into the operated and nonoperated segments of the common, internal, and external carotid arteries, and both intraoperative image and flow data were tabulated by artery segment. The technical factors that were analyzed included defect size, defect type, adjacent segment defects, number of defects, shunt use, vessel reopening, and peak, mean, and end-diastolic frequency and velocity. The systemic risk factors studied were sex, hypertension, diabetes, smoking, randomly drawn total serum cholesterol and triglyceride levels, and perioperative aspirin and dextran use. Data were analyzed by linear logistic regression analysis. Among the technical factors, only intraoperative defect size was significantly associated with risk of recurrent stenosis (p = 0.0175). Although any defect size adversely affected the condition of the vessel during follow-up, the magnitude of this effect was small for smaller defects (size category 1: less than or equal to 40% stenosis or flap length less than or equal to 25% of vessel diameter). The systemic factors that were associated with risk of recurrent stenosis were hypertension (p = 0.0002), smoking (p = 0.0016), and randomly drawn total serum cholesterol level (p = 0.0116). The fact that the operated segments consistently fared worse during follow-up than did the nonoperated segments (p = 0.0044) undoubtedly reflects the inevitable trauma of the endarterectomy, but also emphasizes the important contribution of systemic risk factors in recurrent carotid stenosis. Risk factor modification may be the most effective method of ensuring the durability of carotid endarterectomy.

Carotid Artery Diseases↗

PubMed1988

Surgical correction of severe knee pterygium.

Knee flexion contracture secondary to a severe pterygium is a disabling condition. Full surgical correction has not been possible because of the sciatic nerve and its terminal branches. Our technique to obtain full correction is to divide the nerve near the neuromuscular junction and bridge the defect with multiple sural nerve cable grafts. Microscopic technique is used.

Acute Disease↗

PubMed1988

Repairing cuts and lacerations of the hand.

Cuts and lacerations of the hand require complete evaluation and care to ensure optimal healing. Contamination must be considered, and x-ray films should be taken to rule out the presence of foreign bodies, fractures, or joint injury in severe wounds. Irrigation and excision of nonviable tissue precede operative closure and graft placement. Puncture, gunshot, and bite wounds are left open to drain, and if necessary, tetanus and antibiotic prophylactic treatment is given. Appropriate immobilization and dressing with follow-up care are critical to the successful outcome of these injuries.

Finger Injuries↗

PubMed1988

A randomized double blind controlled trial comparing two amoxycillin regimens in the treatment of acute exacerbations of chronic bronchitis.

A randomized double blind trial comparing two amoxycillin regimens in the treatment of acute exacerbations of chronic bronchitis was performed. Forty-one patients were entered into the study. Twenty patients received amoxycillin sachets 3g twice daily for three days and 21 patients received amoxycillin capsules 500 mg three times daily for seven days. There was no significant difference between the two groups in terms of duration of hospital admission, reduction in sputum volume, clearance of pus from the sputum or the number of treatment failures. No patient developed unwanted effects from the treatment with high dose amoxycillin. Twenty-eight patients were followed for one year and there was no difference in the number of exacerbations experienced by patients treated with short course high dose therapy compared with low dose therapy. It is concluded that short course high dose amoxycillin may be as effective as conventional course amoxycillin in the treatment of acute exacerbations of chronic bronchitis.

Acute Disease↗

PubMed1988

Simple dislocation of the elbow in the adult. Results after closed treatment.

The long-term results after treatment of simple dislocation of the elbow in fifty-two adults were evaluated with regard to limitation of motion, pain, instability, and residual neurovascular deficit. All patients were treated with traditional closed reduction, but the duration of immobilization before commencement of active motion varied. Goniometric, photographic, and radiographic data were compiled for these patients, who had an average follow-up of 34.4 months. Despite the generally favorable prognosis for this injury, 60 per cent of the patients reported some symptoms on follow-up. A flexion contracture of more than 30 degrees was documented in 15 per cent of the patients; residual pain, in 45 per cent; and pain on valgus stress, in 35 per cent. Prolonged immobilization after injury was strongly associated with an unsatisfactory result. The longer the immobilization had been, the larger the flexion contracture (p less than 0.001) and the more severe the symptoms of pain were. The results indicate that early active motion is the key factor in rehabilitation of the elbow after a dislocation.

Adolescent↗

PubMed1987

A comparison of histamine and methacholine bronchial challenges using the DeVilbiss 646 nebulizer and the Rosenthal-French dosimeter.

We have compared bronchial challenge with both histamine and methacholine for the tidal breathing method and dosimeter method, using the DeVilbiss 646 nebulizer, in 18 patients with asthma. There was a significant difference between the PC20 FEV1 but not the PD20 FEV1 when either agonist was administered by the different techniques but not by the same method.

Adult↗

PubMed1987

Intraoperative assessment of renal and visceral artery reconstruction: the role of duplex scanning and spectral analysis.

To refine our ability to assess intraoperatively renal and visceral reconstructions, we have investigated the usefulness of combined duplex scanning and Doppler spectral analysis to determine the technical adequacy and flow characteristics of these repairs. We studied 62 patients (116 arteries) who underwent renal (83 arteries) or visceral (13) reconstruction by transaortic endarterectomy (76), autogenous graft (12) or prosthetic (5) bypass, reimplantation (2), and dilation (1). Twenty-six nonreconstructed vessels were also studied, including preoperative arteries (6), unrepaired arteries (14), and normal renal arteries (donor nephrectomies) (6). Duplex scanning was performed by means of a 7.5 or 10 MHz probe placed in a sterile glove and plastic sleeve. Peak (Vs) and mean (Vm) velocities measured in meters per second were subsequently calculated from frequency spectral analysis. Spectral broadening (SB) and aortic inflow data were also collected and analyzed. There were no complications related to ultrasound scanning. Mean scan time was 7.8 minutes. Fourteen of 26 nonreconstructed vessels (54%) appeared normal by duplex scanning, including all six control (normal) renal arteries. Sixty-five reconstructed arteries (68%) appeared normal, 27 had various minor defects, and four had major defects (three occlusions and one floating thrombus). The major defects were repaired, whereas minor ones were not. Confirmatory studies were obtained in 19 (73%) nonoperated and 73 (76%) operated vessels. There were two false negative duplex studies (sensitivity 89%) and 17 false positive duplex studies--all minor defects (specificity 77%). The predictive value of duplex scans in detecting the presence of confirmed defects was Tau = 0.47 (p = 0.01). Although SB correlated with B-mode imaging alone (Tau = 0.21, p = 0.07), it added no independent value in predicting the results of a confirmatory study. No other variable (Vs, Vm, or aortic inflow) added to the duplex scan in predicting an abnormal confirmatory study. Detailed renal and visceral artery spectral analysis data are provided for validation of this technique and comparison with transcutaneous studies. These data suggest that the requirement for reliable and immediate assessment of renal and visceral reconstructions, particularly those involving transaortic extraction endarterectomy, is satisfied by duplex scanning.

Endarterectomy↗

PubMed1987

Intraarticular fractures of the distal humerus in the adult.

Intraarticular fractures of the distal humerus are notoriously difficult to treat. Three basic treatment methods are available: closed reduction, traction, and open treatment. In the past, functional results with all these methods generally have been poor because of disabling limitations of elbow motion. Thirteen adult patients were treated by open reduction and application of medial and lateral buttress plates providing rigid internal fixation and early motion. The patients were evaluated for range of motion, infection, nerve injury, avascular necrosis, myositis ossificans, varus/valgus deformity, pain, instability, weakness, and degenerative changes. Ten of the 13 patients were available for follow-up study for an average of two years. Nine of the ten achieved good or excellent results. Based on these observations, the treatment of choice is internal fixation with dual plates combined with early active postoperative motion.

Adolescent↗

PubMed1986

Carpal arch alteration after carpal tunnel release.

A retrospective clinical study quantitated postoperative widening of the transverse carpal arch after carpal tunnel release in a group of 50 patients. The relationship of this widening with postoperative pain, forearm circumference, grip strength, and wrist range of motion was evaluated. Mean widening of the transverse carpal arch after carpal tunnel release is 10.4% or 2.7 mm. A direct relationship exists between widening of the transverse carpal arch and loss of grip strength. Residual pain, forearm circumference, and wrist range of motion are not related to widening of the transverse carpal arch.

Adult↗

PubMed1986

Florid reactive periostitis.

A case of florid reactive periostitis of the thumb is reported. This rare, benign, bone-producing lesion is easily confused with osteosarcoma. It is also known as parosteal or nodular fascitis. Careful histologic and radiographic evaluations are needed to establish the diagnosis and avoid unnecessary amputation. Marginal excision seems to be adequate treatment.

Adult↗

PubMed1986

Exercise training-induced alterations of cardiac morphology.

The data to date are ambivalent regarding exercise-induced cardiac enlargement in previously sedentary individuals. The training regimens used in previous longitudinal studies probably did not provide an optimum training stimulus. Accordingly we studied echocardiograms of the left ventricle of 11 relatively inactive individuals pre and post an intense endurance training program, when intensity was increased relative to improvement, thereby providing an optimum training stimulus. Subjects trained 6 days/wk for 7 wk, alternating days of continuous cycling (40 min) and interval running (5 5-min bouts). Exercise intensity was maintained at 85-90% of peak cycle ergometer O2 uptake (VO2) for cycle training by increasing power output approximately 11 W/wk and at approximately 100% of VO2max for run training by increased (P less than 0.01) approximately 950 ml/min (approximately 32%) and was correlated with training duration (r = 0.91; P less than 0.01). Training-induced increases (P less than 0.05) in interventricular septal thickness (IVS, mm) during both systole (13.4 +/- 0.9 to 14.9 +/- 0.8) and diastole (10.4 +/- 0.6 to 11.5 +/- 0.7) and in left ventricular end-diastolic dimension (4.96 +/- 0.16 to 5.13 +/- 0.19 cm). The absolute values of left ventricular end diastolic volume (LVEDV), stroke volume, ejection fraction, and left ventricular mass (LVM) increased (P less than 0.05) after training. Increases (P less than 0.05) in LVEDV index (64.3 +/- 3.3 to 69.0 +/- 3.4 ml/m2) and LVM index (114.1 +/- 6.5 to 124.5 +/- 7.3 g/m2) were also evident.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological↗

PubMed1984

Acute shoulder dislocations: factors influencing diagnosis and treatment.

The Bankart lesion is the most important single causative factor in traumatic anterior shoulder dislocations (85%). Capsular rupture occurs in approximately 15% of traumatic anterior shoulder dislocations and may or may not heal with redundancy. If so, recurrent dislocation in possible. Surgical repair of traumatic anterior dislocations requires that the capsule be opened for correct identification of the lesion and correct repair. Limitation of external rotation is not necessary for repair of anterior shoulder dislocations and should be considered as an untoward complication. While multiple procedures are available, all of which may be satisfactory at one time or another, no one procedure repairs all traumatic anterior shoulder dislocations.

Arthrography↗

PubMed1984

Management of concomitant ipsilateral fractures of the humerus and forearm.

We treated nineteen patients with concomitant ipsilateral fractures of the humerus and forearm resulting in a so-called floating elbow. The injuries that were treated without open reduction and internal fixation had a high incidence of non-union of the humerus. This has led us to prefer open reduction and internal fixation of both the humerus and the forearm fracture.

Adolescent↗