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Biomedical subjects

J E Kuhn

Publications and source records attributed to J E Kuhn.

At least 19 recordsLinked to original sources
PubMed1999

Prospective analysis of ice hockey injuries at the Junior A level over the course of one season.

OBJECTIVE: This study was conducted to identify the circumstances, timing, frequency, and types of injuries for a Junior A hockey team in an attempt to develop injury prevention strategies. DESIGN: This study was a prospective review of injuries sustained by a hockey team during one season. SETTING: Players were evaluated in a private practice clinical setting and during practices and games. PARTICIPANTS: Twenty-two hockey players (16-20 years old) were evaluated. An injury was defined as any event requiring the attention of a physician or trainer. The players sustained 83 injuries throughout the course of the season. Seventy-four were considered independent events. MAIN OUTCOME MEASURES: The effects of the following variables on injury rates were analyzed: position, game situation versus practice, and timing of injury during the game. RESULTS: Players were 20 times more likely to injure themselves during a game than practice. Although forwards sustained the highest total percentage of injuries, defensemen had the highest incidence of injury in games. More injuries occurred in the later periods and in the later minutes of each period. Injury incidence decreased for the second half of the season compared with the first half. CONCLUSION: Our data suggest goaltenders are at the lowest risk of sustaining an injury, but forwards appear to be at a higher risk in practice situations and defensemen in games. Game situations place players at a much greater risk of injury than practice sessions, particularly in the later portions of each period and toward the end of the game. Given the propensity for injury in the early season and later in the game, endurance training before and during the season may be important in injury prevention.

Adolescent↗
PubMed1998

Assessment of outcome in shoulder arthroplasty.

This article discusses outcome measures for the patient requiring shoulder arthroplasty and the weakness and strengths of various assessment tools in current use. The optimal method to measure the outcome of patients with shoulder arthroplasty is yet to be defined; however, the ideal assessment should include measures of general health, a shoulder-specific assessment, and an assessment that is specific to the disease state for which shoulder arthroplasty is indicated. The authors also provide appendices with their recommended calculations for the elevation of the shoulder arthroplasty patient.

Arthroplasty, Replacement↗
PubMed1998

Cervical spine alignment in immobilized hockey players: radiographic analysis with and without helmets and shoulder pads.

OBJECTIVE: To establish the appropriate technique for cervical immobilization of the hockey player with an acute neck injury, we analyzed the alignment of the cervical spine in healthy volunteers with combinations of applied hockey equipment and assessed the amount of cervical spine motion possible in a secured hockey helmet. Our hypothesis was that there is a significant difference among various positions of the cervical spine with and without equipment and with active motion in a secured helmet. DESIGN: We analyzed lateral cervical spine radiographs of eight healthy male volunteers immobilized on a backboard with the following combinations of hockey equipment: shoulder pads and helmet, shoulder pads only, helmet only, no equipment, and neck flexion and extension with helmet and shoulder pads on and helmet secured to the backboard. SETTING: Large university hospital, tertiary care center. RESULTS: Cervical lordosis without equipment (control) was not significantly different than cervical lordosis with shoulder pads and helmet applied (p=0.31). Subjects with shoulder pads averaged 8.9 degrees more lordosis than did controls (p= 0.0002) and 6.6 degrees more lordosis than did subjects with shoulder pads and helmets (p=0.027). Subjects with shoulder pads and a helmet secured to the backboard were able to flex and extend the cervical spine 12.9 degrees compared with the control position (p =0.009). CONCLUSIONS: In an acute cervical spine injury involving an ice hockey player, we recommend immobilization in both the helmet and the shoulder pads, with removal of both pieces of equipment in a controlled hospital setting and only after initial radiographic examination. We also recommend securing the player's chin to prevent as much head and neck motion as possible during transport and transfers.

Adult↗
PubMed1996

Arthroscopic intra-articular biopsy using a suction trap device.

Biopsy of the synovium and other intra-articular structures is frequently performed arthroscopically. We describe a technique of arthroscopic biopsy using a suction punch device linked in series with a Lukens tube suction trap. This technique allows for the controlled biopsy of intra-articular pathology, collects material in a tube which is convenient for handling, prevents the loss of biopsy material in the joint or portal tracks, and saves time by limiting the number of instrument passages into the joint.

Arthroscopes↗
PubMed1996

Allograft meniscus transplantation.

At this time, meniscal allograft transplantation remains an investigational procedure with very limited indications. To date, no work has shown that the transplanted meniscus is capable of protecting and, preserving the hyaline cartilage of the knee joint. The technical aspects of the procedure have been established and are reproducible. Furthermore, it is apparent that a systemic rejection phenomenon does not seem to occur, and the transplanted meniscus is capable of healing. MR imaging appears to be the best method of assessing postoperative position of the transplanted meniscus in the knee. If the transplanted meniscus cannot be maintained in an anatomic position during weight bearing, it is unlikely to have any functional role. Questions remain with regard to the best way to preserve and sterilize the meniscus and whether the transplanted allograft meniscus is capable of assuming the multifaceted role of the normal meniscus in the knee. As more work is conducted, these questions will be answered, and a better understanding of the efficacy of this novel technique will be achieved.

Biomechanical Phenomena↗
PubMed1995

A nurse's right to refuse a patient care assignment.

Ethics is a set of moral principles or values--a guiding philosophy for behavior. Ethical dilemmas in the health care setting occur daily. Perioperative nurse managers need to consider basic ethical principles when resolving these dilemmas, and they must keep in mind that solutions need to serve the best interests of all people involved in given situations. This article discusses criteria by which a nurse can refuse a patient care assignment and those by which a nurse manager can require that a nurse perform a patient care assignment.

Blood-Borne Pathogens↗
PubMed1995

Divergent single-column fractures of the distal part of the humerus.

We report an unusual intra-articular fracture of the distal part of the humerus that was seen in five patients, including one who had the fracture bilaterally. The fractures were characterized by three features. First, the fractures were initiated in the trochlear groove as a result of a direct impact on the olecranon, which divided the trochlea and then split the two columns of the humerus divergently. Second, the fractures occurred exclusively in adolescents and young adults (average age, fifteen years old; range, thirteen to twenty years old). Third, all of the fractures were seen in patients who had a large fossa or septal aperture between the coronoid and olecranon fossae. Four of the fractures involved the right side and two, the left. There were three fractures of the lateral column and three of the medial column. Because the periosteum, the capsule, and the ligaments remained intact despite intra-articular displacement of the distal part of the humerus, these fractures were also characterized by inherent proximal stability. The fractures were treated with closed reduction and percutaneous internal fixation to reduce the displacement between the two halves of the trochlea. All of the fractures united. Four patients (five elbows) regained full motion by eight months; one patient was lost to follow-up. Current classification systems that describe single-column fractures of the distal part of the humerus should be modified to include this unusual fracture pattern.

Adolescent↗
PubMed1995

Measuring outcomes in shoulder arthroplasty.

No standard assessment for the patient with a shoulder arthroplasty has been universally accepted to date. Traditional assessment tools can be divided into three levels of resolution including: (1) assessments of the quality of life and general health, (2) global shoulder assessments, and (3) assessments for a particular disorder of the shoulder. In this article, examples of each of these groups are discussed. Each of these levels of sensitivity offers a different perspective on the outcome of shoulder arthroplasty and until the ideal, universal outcome measure is developed, outcomes should be reported using assessments in each of these levels.

Activities of Daily Living↗
PubMed1995

Surgical treatment of shoulder injuries in tennis players.

There are a number of disorders that affect the shoulder of the tennis player. The majority of these disorders are approached conservatively at first, and surgery is generally reserved for those with advanced stages of disease, or those who fail conservative treatment. Most surgical procedures for the shoulder are done open; however, arthroscopic techniques are advancing rapidly, and are expected to eventually supersede open surgical procedures. In either case, the postoperative rehabilitation program is an essential part of the surgical treatment of these disorders, and should not be neglected.

Acromioclavicular Joint↗
PubMed1994

Fractures of the acromion process: a proposed classification system.

A review of 27 fractures of the acromion process during a 15-year period revealed five distinct types that were classified into three groups. Stress fractures are rare, do not result from acute trauma, and gain little benefit from nonoperative treatment. Type I fractures are minimally displaced. Type IA fractures are avulsion fractures and heal rapidly. Type IB fractures result from direct trauma to the extremity, and are minimally displaced. Most heal with nonoperative treatment. Type II fractures are displaced laterally, superiorly or anteriorly and do not reduce the subacromial space. Most are pain free with full motion after 6 weeks of nonoperative treatment. Type III fractures reduce the subacromial space. This may occur by an inferiorly displaced acromion fracture, or an acromion fracture associated with an ipsilateral, superiorly displaced glenoid neck fracture. Patients in this group sustained significant trauma to the involved extremity. All type III fractures treated nonoperatively develop significant limited shoulder motion with pain, suggesting that early surgical intervention may be indicated.

Acromion↗
PubMed1991

Airway compromise as a result of retropharyngeal hematoma following cervical spine injury.

Mechanical airway obstruction secondary to prevertebral hematoma following cervical spine injury is a life-threatening emergency. We present eight cases of mechanical airway obstruction from prevertebral hematomas in patients with cervical spine injury. They are combined with 13 previously reported cases to produce a study population of 21 patients. Although it is a rare complication of cervical spine injury, swelling significant enough to cause airway obstruction should be anticipated in all patients, regardless of age, severity of trauma, or lack of symptoms. To date, this phenomenon has not been reported in injuries below C6. Additionally, because symptoms may take hours to develop, initial cervical radiographs may not show evidence of retropharyngeal swelling and impending airway obstruction.

Adult↗
PubMed1991

Primary hyperparathyroidism and monoclonal gammopathy.

Coexistent primary hyperparathyroidism and monoclonal gammopathy, although rare, has been reported previously by a number of investigators. We report four patients with such an occurrence who were seen between 1976 and 1988. Another patient with primary hyperparathyroidism also had multiple myeloma and was in remission for 12 years. These patients represent approximately 1% of the 386 patients with primary hyperparathyroidism seen during the same 12-year period. Although several mechanisms have been proposed to explain this concurrence, we believe it is the result of a chance occurrence. A review of the literature, an estimate of the chance occurrence of coincidental monoclonal gammopathy, benign or malignant, in patients with primary hyperparathyroidism, and some practical implications of this interesting coexistence are presented.

Aged↗
PubMed1986

Ibuprofen improves survival and neurologic outcome after resuscitation from cardiac arrest.

Post-ischemic inflammatory changes in the central nervous system (CNS) following cardiac arrest and resuscitation are potentially responsible for ultimate survival and much of the neurologic damage, producing greater morbidity and mortality in successfully resuscitated patients. This study was undertaken to assess the non-steroidal anti-inflammatory agent, ibuprofen, in a controlled and monitored experimental model of canine cardiac arrest and resuscitation. With the investigator blinded as to the intervention, eight of 21 dogs were randomly assigned to receive ibuprofen as an i.v. bolus (10 mg/kg) and a 6-h i.v. infusion (5 mg/kg per h). The other 13 dogs received an equivalent volume of 0.9% NaCl to serve as controls. No statistically significant differences between the two groups were detected in any pre-arrest variables. All 21 dogs were successfully resuscitated. At 24 h, dogs receiving ibuprofen exhibited 100% survival, while control dogs exhibited only 54% survival (P = 0.03). The majority of deaths for the control group occurred within the first 6 h. Neurologic deficit scores were assigned at 1, 2, 6 and 24 h after resuscitation. A general trend occurred such that dogs treated with ibuprofen improved over time, while the control dogs remained severely impaired. A significant difference in neurologic deficit score was detected at 6 h (P = 0.01). At 24 h the ibuprofen group exhibited minimal neurologic deficit (5.9 +/- 3.2), and the control group exhibited significantly more severe neurologic impairment (52.2 +/- 13.0, P = 0.01). These results suggest that ibuprofen may be helpful in the pharmacologic management of cardiac arrest as a means of increasing survival and decreasing neurologic impairment.

Animals↗
PubMedDate not supplied

The mechanism of creation of superior labrum, anterior, and posterior lesions in a dynamic biomechanical model of the shoulder: the role of inferior subluxation.

Lesions of the superior glenoid labrum are a source of shoulder disease. However, the mechanisms of injury to this region are unknown, and controversy exists regarding the role of shoulder instability in creation of this lesion. With a cadaver model that simulates physiologic rotator cuff forces and produces traction on the biceps tendon, the creation of type II superior labrum, anterior, and posterior (SLAP) lesions and the role of glenohumeral subluxation were investigated: Left and right shoulders from each of 8 paired cadavers (age 62 +/- 7.2 years, 5 male and 3 female) were randomized to be tested in either a 20 mm inferiorly subluxed position or in a reduced position. The long head of the biceps tendon was held near the musculotendinous junction with a novel cryogenic clamp. Traction on the long head of the biceps tendon was applied at a fast rate of 12.7 cm/sec with a servohydraulic testing machine. A load cell was used to monitor the biceps tendon load. After testing to failure, the presence or absence of a type II SLAP lesion was determined by 2 experienced shoulder surgeons masked to the test group. The production of type II SLAP lesions differed significantly (P = .03) between reduced shoulders (2 SLAP lesions out of 8 tests) and the shoulders with inferior subluxation (7 SLAP lesions out of 8 tests). This experiment has shown that traction on the biceps tendon in this biomechanical model can reproducibly create type II SLAP lesions, and inferior subluxation facilitates the generation of such lesions.

Aged↗