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Biomedical subjects

J G Kennedy

Publications and source records attributed to J G Kennedy.

At least 19 recordsLinked to original sources
PubMed2004

Anthropometrical analysis of cervical spine injuries.

UNLABELLED: To date the principal focus of the mechanism of cervical spine fracture has been directed towards head/neck circumference and vertebral geometric dimensions. However the role of other measurements, including chest circumference and neck length, in a standard cervical fracture population has not yet been studied in detail. Cervical fractures often involve flexion/extension type mechanisms of injury, with the head and cervical spine flexing/extending, using the thorax as an end point of contact. Thus, the thorax may play an important role in neck injuries. STUDY DESIGN: We prospectively studied all patients with cervical spine fractures who were admitted to the National Spinal Injuries Unit from 1 July 2000 to 1 March 2001. Anthropometrical measurement of head circumference, neck circumference, chest circumference, and neck length were analysed. Ages ranged from 18 to 55 years, and all patients with concomitant cervical pathology were excluded from the study. Mechanism of injury involved flexion/extension type injuries in all cases; those with direct axial loading were excluded. A control group of 40 patients (age 18-50 years) involved in high velocity trauma with associated long bone fractures, in whom cervical injury was suspected, but who were without any cervical fracture, or associated pathology, were similarly measured. RESULTS: Our analysis revealed a statistically significant increase in chest size in the male control group versus the male fracture group (97.89 cm versus 94.19 cm, P < 0.05, Student's t-test). There was a correspondingly significant increase in chest circumference between the female controls versus the female fracture group (92.33 cm versus 88.88 cm, P < 0.05, Student's t-test). Our results revealed no statistical difference in head circumference, neck circumference, or neck length between each of the groupings. These results indicate a proportionately larger chest may be a protective factor in cervical spine fractures.

Adolescent↗
PubMed2003

Metastatic breast carcinoma to bone disguised by osteopoikilosis.

A case of metastatic lobular carcinoma of the breast in conjunction with osteopoikilosis is described. Widespread diffuse sclerotic bone lesions were identified on radiographs in a patient with breast carcinoma. In addition computed tomography demonstrated discrete spherical areas of increased density throughout the skeleton manifest typically by osteopoikilosis. No systemic symptoms were evident, blood parameters were normal and the lesions did not demonstrate any increased uptake of technetium on bone scan. An iliac crest bone biopsy, however, revealed metastatic disease in addition to osteopoikilosis. Conventional radiological investigations may not delineate metastasis on a background of bone dysplasia.

Bone Neoplasms↗
PubMed2003

An outcomes assessment of intra-articular calcaneal fractures, using patient and physician's assessment profiles.

Thirty-six patients with intra-articular displaced calcaneal fractures were examined to determine both physician- and patient-based outcomes. Three groups were selected. Group A was treated with open reduction and internal fixation, group B was treated with open reduction internal fixation and supplemental bone graft augmentation and the patients in group C were treated with plaster cast immobilisation and no formal operative treatment. All cohorts were well matched for age, sex and severity of injury. Patients were evaluated using both the American Foot and Ankle Society Scoring System (AFASS) and the short form 36 (SF-36). Minimum time to follow up was 4 years. No significant difference was observed between the three groups with regards to pain and functional outcomes using the AFASS score (P>0.05). No difference was observed between the three groups using the SF-36 score (P>0.1). A statistically significant difference was observed, using radiological criteria, between both groups A and B when compared to the non-operative group C. The rate of wound infection in groups A and B was 31.5%. No correlation was found between the SF-36 score and the AFASS score. No correlation was found between the radiological score and either the SF-36 or the AFASS score. This study has found that the conservative treatment of calcaneal fractures can produce satisfactory outcomes with lower morbidity than surgically treated fractures.

Adolescent↗
PubMed2003

Vesicant characteristics of oxaliplatin following antecubital extravasation.

Oxaliplatin is a novel class of platinum chermotherapeutic agent used in refractory adenocarcinoma. It has previously been regarded as a non-vesicant, and as such was considered safe to administer through peripheral veins. This report documents severe muscle and subcutaneous reaction with a single dose of oxaliplatin at the site of extravasation in a patient aged 58 years. Conventional therapeutic modalities were employed to reduce the effect of the soft tissue infiltrate. Despite that, significant muscle necrosis and fibrosis occurred. Surgery was deferred secondary to patient choice, and eventual extensive physical therapy restored function to the elbow joint. This case shows that oxaliplatin may not be an appropriate cytotoxic agent to be administered through a peripheral line and consideration must be made for central access when this drug is used. In addition, when extravasation does occur, the current report indicates that non-surgical management can be successful.

Adenocarcinoma↗
PubMed2003

Lower limb dysesthesia--an ominous sign in lumbar fractures.

Attempts at diagnosing dural lacerations secondary to fractures of the lumbar vertebrae on plain radiographs has varied considerably. If undiagnosed these injuries can cause serious complications. We present a clinical sign not previously documented to our knowledge. Plain radiographs in this case failed to show significant canal compromise but excessive hip pain, with the limb held in a characteristic posture, heralded cauda equina injury in a burst lumbar fracture. The limb was held in hip and knee flexion, with resistance to passive extension due to lower limb dysesthesia. This sign helped in determining the investigation and treatment of our patient.

Adult↗
PubMed2002

Lisfranc injuries: patient- and physician-based functional outcomes.

The purpose of this study was to assess functional outcome of patients with a Lisfranc fracture dislocation of the foot by applying validated patient- and physician-based scoring systems and to compare these outcome tools. Of 25 injuries sustained by 24 patients treated in our institution between January 1995 and June 2001, 16 were available for review with a mean follow-up period of 36 (10-74) months. Injuries were classified according to Myerson. Outcome instruments used were: (a) Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), (b) Baltimore Painful Foot score (PFS) and (c) American Orthopedic Foot and Ankle Society (AOFAS) mid-foot scoring scale. Four patients had an excellent outcome on the PFS scale, seven were classified as good, three fair and two poor. There was a statistically significant correlation between the PFS and Role Physical (RP) element of the SF-36.

Adolescent↗
PubMed2002

Quantitative analysis of substance P, neurokinin A and calcitonin gene-related peptide in pulp tissue from painful and healthy human teeth.

AIM: The purpose of this study was to investigate the levels of substance P (SP), neurokinin A (NKA) and calcitonin gene-related peptide (CGRP) in painful and healthy human dental pulps. METHODOLOGY: Forty-six samples of pulp tissue were collected from extracted or endodontically treated painful teeth and 20 from clinically healthy teeth extracted for orthodontic reasons. All pulp samples were boiled in 0.5 m acetic acid for 10 min, centrifuged and the supernatant collected. SP, NKA and CGRP levels were measured using radioimmunoassay. RESULTS: Substance P and CGRP were present in all samples and NKA was detected in 96% of the pulps. CGRP was present in much higher concentrations than SP and NKA in both painful and non-painful teeth. The painful teeth had significantly higher concentrations of SP (P = 0.02), NKA (P < 0.001) and CGRP (P = 0.03) than non-painful teeth. The concentration of CGRP was significantly higher in the pulps of smokers compared with non-smokers (P = 0.02). CONCLUSIONS: Elevated levels of these neuropeptides in pulps from painful teeth indicate that they may play an important role in the process of pulpal inflammation and pain. Further investigation of the association between these neuropeptides and pulpal status may help to improve our understanding of pulpal inflammation and dental pain.

Adolescent↗
PubMed2001

Bilateral wrist dislocation in trisomy 21: a case report.

Ligamentous laxity is common in Trisomy 21 (Down's syndrome). The literature has numerous reports of atlanto-axial instability, patellar instability, carpal instability and other manifestations of joint instability. To date, no report has been published in the English literature describing non-traumatic unilateral or bilateral wrist dislocation either in trisomy 21 or in any other condition.

Adolescent↗
PubMed2000

Extraskeletal Ewing's sarcoma: a case report and review of the literature.

STUDY DESIGN: Case report. OBJECTIVES: To report on the diagnosis and current treatment of a rare tumor about the cervical spine. SUMMARY OF BACKGROUND DATA: Extraskeletal Ewing's sarcoma (EES) is rare and has not been previously described about the cervical spine. We present a case of a 24-year-old man with a large mass in the posterior triangle of the neck extending through the vertebral foramens of the cervical vertebrae. This was identified as an extraskeletal Ewing's sarcoma. Traditional treatment paradigms have been associated with a poor prognosis. Since the recommendations of the Intergroup Rhabdomyosarcoma Study II study of multimodal chemotherapy and radiotherapy, this tumor has a significantly better prognosis. METHOD: Surgical debulking of the tumor was necessary to relieve cord compression. Histologic analysis was used to confirm both magnetic resonance imaging and computed tomography diagnosis. A chemoradiation therapy program was commenced in accordance with Intergroup Rhabdomyosarcoma Study II recommendations. RESULTS: Computed tomography and magnetic resonance imaging demonstrated a large lobulated mass extending through the exit foramens of C2/C3 and C3/C4. The mass was entirely extraskeletal and extradural. Histologic examination of the excised mass showed microscopy consistent with extraskeletal Ewing's sarcoma. After surgical debulking and chemoradiation, the patient made a complete recovery. CONCLUSION: A review of the literature confirms that extraskeletal Ewing's sarcoma is a rare tumor and particularly so in the region of the cervical spine. Early diagnosis and surgical debulking combined with current multimodality chemoradiation programs can produce a favorable outcome.

Adult↗
PubMed2000

Fatigue failure of an AO spiral blade.

We report an unusual case of a femoral neck stress fracture leading to the fatigue failure of an AO spiral blade. An unreamed femoral nail with a spiral blade was inserted to treat an unstable subtrochanteric femoral fracture. which lead to fracture union at 5 months. Eight months post-operatively the patient started to complain of left hip pain. Serial radiographs revealed progressive osteoporosis of the proximal femur possibly due to the stress sharing effect of a stiff intramedullary device, which continued to bear a significant amount of the transmitted load. The cause of pain was a stress fracture of the femoral neck and the AO spiral blade, which only became radiologically visible 4 months after the start of the symptoms (1 year after the initial operation). The implant was removed and replaced by a cemented hemiarthroplasty. This case reaffirms the difficulty in diagnosing a stress fracture through a metallic implant. The delay in diagnosis may be shortened if stress fracture were included as an expected complication following an intramedullary nailing.

Aged↗
PubMed2000

Evaluation of the role of pin fixation versus collar and cuff immobilisation in supracondylar fractures of the humerus in children.

Long term results of children with supracondylar humeral fractures treated with manipulation and strapping and manipulation followed by pin fixation were evaluated. Forty patients were regarded as Gartland type II injuries. 33 of these were treated with closed reduction and collar and cuff immobilisation and 7 with closed reduction and percutaneous pinning. Two cases of cubitus varus were reported one from each treatment modality. Forty-four patients were included as Gartland type III injuries. Of these 14 were treated with closed reduction and collar and cuff immobilisation, 25 with closed reduction and percutaneous pinning and five with open reduction and pinning. There were two cases of cubitus varus and one case of cubitus valgus following pin fixation. In addition one case of extension lag and one significant ulnar nerve neurapraxia was recorded following pin fixation. One case of cubitus varus was seen following manipulation and collar and cuff treatment. There was no statistical difference between either treatment modality in terms of predicting a better outcome (p0.05). We conclude that pin fixation has no advantages over simple immobilisation in certain Gartland II and III type injuries. Although pin fixation is beneficial in unstable injuries collar and cuff immobilisation continues to have an important role in the treatment of stable supracondylar fractures.

Algorithms↗
PubMed2000

Computerized infrared thermographic imaging and pulpal blood flow: Part 2. Rewarming of healthy human teeth following a controlled cold stimulus.

AIM: To investigate the rewarming pattern and rewarming rate of clinically healthy teeth following a controlled cold stimulus using TI techniques. METHODOLOGY: A controlled cold stimulus was developed using an air stream at 20 degrees C. Gingival and incisal sites on 12 healthy maxillary lateral incisors in six patients were imaged under rubber dam following 20 s cooling. Images were captured at 10 s intervals during a 3-min rewarming period and the data used to construct graphs of the rewarming rate. Log transformation of the data was used to produce 'best fit' straight line graphs. Linear regression analysis was used to examine three variables, viz. the side of the mouth (right or left), the site of measurement (gingival or incisal) and the phase of rewarming (early 0-90 s, late 91-180 s). RESULTS: The mean temperature change (delta t degree C) during rewarming was 8.5 degrees C (SD 1.0 degree C) for gingival sites and 7.2 degrees C (SD 1.1 degrees C) for incisal sites. The slope of the 'best fit' straight line data enabled a rewarming index to be calculated for each site on each tooth. Linear regression analysis showed that the phase of rewarming was highly significant but the other variables were not. A one-way ANOVA showed no significant differences between or within groups. CONCLUSIONS: Three min is an appropriate time to record rewarming of teeth cooled for 20 s with an airstream at 20 degrees C. The side or site used to record surface temperatures using this technique is not significant. Rewarming is exponential and log transformation of the data produces a well-fitting straight line graph. The slope of this line provides a rewarming index which should enable comparison of TI and laser Doppler flowmetry in determining pulpal blood flow as a measure of tooth vitality.

Adult↗
PubMed2000

Computerized infrared thermographic imaging and pulpal blood flow: Part 1. A protocol for thermal imaging of human teeth.

AIM: To observe the thermographic appearance of teeth and to develop a suitable protocol for imaging teeth in human subjects using modern thermographic imaging (TI) equipment in a thermologically controlled environment. METHODOLOGY: The emissivity of enamel was investigated using an extracted incisor tooth. A total of 12 unrestored maxillary lateral incisors in six healthy patients were then imaged under rubber dam after a 20-min equilibration period and the thermographic data analysed using a dedicated software package. Recordings were made from standardized gingival and incisal sites on each tooth and the temperature gradient established for each tooth. Subsequently, a sequence of images of both maxillary central incisors in one patient was stored every 30 s during a 20-min equilibration period with and without an air-conditioning unit in operation. RESULTS: For the lateral incisors there was a consistent temperature gradient (mean 1.28 degrees C) from gingival area to incisal area and there were no statistically significant differences between right and left sides for the gingival site (t = 0.34, NS) or the incisal site (t = 0.62, NS). The air-conditioning unit had a rapid and profound cooling effect. With the air-conditioning disabled there was a mean tooth surface temperature increase of 1.1 degrees C from 0 to 5 min of the equilibration period and 0.3 degree C from 15 to 20 min. CONCLUSIONS: There was no significant difference in gingival or incisal temperatures between pairs of contralateral maxillary lateral incisors and a consistent temperature gradient existed from gingival to incisal areas of healthy maxillary lateral incisor teeth. The protocol described is suitable for TI of vital teeth. However, TI measured tooth surface temperature only which was extremely sensitive to air currents. A 15-min acclimatization period under rubber dam was adequate to allow stable tooth surface temperature measurement.

Adolescent↗
PubMed2000

Deep vein thrombosis prophylaxis in hip fractures: a comparison of the arteriovenous impulse system and aspirin.

BACKGROUND: A prospective, randomized controlled trial was used to compare the efficacy of the arteriovenous (AV) impulse system and aspirin in reducing venous thrombosis after fracture to the femoral neck. METHODS: A total of 143 patients underwent hemiarthroplasty, after which 70 patients were treated with the AV pump and a second group of 73 patients were commenced on 325 mg of aspirin. Duplex ultrasound was used to assess both proximal and distal venous thrombi on days 7 to 10. Calf and thigh circumferences were also measured. RESULTS: Thrombi developed in seven of the patients treated with aspirin and in four patients treated with the AV pump. No statistically significant difference could be established (p = 0.109). There was a significant reduction in both calf (p = 0.003) and thigh (p = 0.002) swelling in the group treated with the AV pump. Neither treatment group was a significant predictor of a poorer outcome by using logistical regression analysis (p = 0.258). CONCLUSIONS: Both aspirin and the AV pump are effective in reducing thromboembolic events after hemiarthroplasty of the hip.

Aged↗
PubMed2000

Massive subperiosteal hemorrhage and femoral shaft osteonecrosis: a complication of tissue plasminogen activator therapy for purpura fulminans.

We present the case of a child who developed a massive subperiosteal hemorrhage and subsequent osteonecrosis of her right femur after treatment with tissue plasminogen activator for post-varicella streptococcal purpura fulminans. Radiographs showed posteromedial translation of the capital femoral epiphysis on the necrotic shaft, and the hip was immobilized. The femur slowly remodeled and has continued to grow. The child is independently ambulatory with a 2.1-cm leg length discrepancy, a varus deformity of the hip, and a valgus distal femur.

Bone Remodeling↗
PubMed2000

An investigation into the role of oxygen free radical scavengers in preventing polymethylmethacrylate-induced necrosis in an osteoblast cell culture.

This study examined the effect of polymethylmethacrylate (PMMA) on osteocytic necrosis and the role of free radical scavengers in minimizing this damage. Bovine osteoblast cells with a characteristic phenotype were seeded at a density of 4x10(4) cells/cm2 and cultured in a DMEM supplemented with 10% fetal calf serum. A transwell insert with 2 cc of PMMA was suspended above the culture, and a time log response curve was established following elusion of free radicals around the osteoblast media. Chemiluminescence was used to determine quantitative free radical release. Using a Student's two-tailed t test there was a significant difference in the amount of hydroxyl radical released at 1-6 hours compared with controls (P=.028). Using histologic markers, there was a significant correlation between the use of PMMA and osteoblast cell necrosis. Transwell plates were coated with varying concentrations of mannitol, a known hydroxyl radical scavenger. A log dose response curve was established. There was a clear statistical association between a 10% mannitol solution and a reduction in the free radical release from PMMA (P=.03). Similarly, using Trypan blue histologic staining, there was a significant reduction in PMMA-induced cell necrosis when 10% mannitol was used as a scavenger (P=.01). A Rockwell superficial hardness test was used to determine whether mannitol had any effect on the surface hardness of the polymer. No statistical difference could be found between those treated with mannitol and controls at a depth of up to 1 mm. These results demonstrate hydroxyl radical is released from the polymerization reaction of PMMA. These radicals cause cell death in an osteoblast culture medium. This has been addressed using a 10% mannitol solution, which reduced cell necrosis.

Cells, Cultured↗
PubMed1999

Predictors of outcome in cauda equina syndrome.

This retrospective review examined the cause, level of pathology, onset of symptoms, time taken to treatment, and outcome of 19 patients with cauda equina syndrome (CES). The minimum time to follow up was 22 months. Logistical regression analysis was used to determine how these factors influenced the eventual outcome. Out of 19 patients, 14 had satisfactory recovery at 2 years post-decompression; 5 patients were left with some residual dysfunction. The mean time to decompression in the group with a satisfactory outcome was 14 h (range 6-24 h) whilst that of the group with the poor outcome was 30 h (range 20-72 h). There was a clear correlation between delayed decompression and a poor outcome (P = 0.023). Saddle hypoaesthesia was evident in all patients. In addition complete perineal anaesthesia was evident in 7/19 patients, 5 of whom developed a poor outcome. Bladder dysfunction was observed in 19/19 patients, with 12/19 regarded as having significant impairment. Of the five patients identified as having a poor overall outcome, all five presented with a significant sphincter disturbance and 4/5 were left with residual sphincter dysfunction. There was a clear correlation between the presence of complete perineal anaesthesia and significant sphincter dysfunction as both univariate and multivariate predictors of a poor overall outcome. The association between a slower onset of CES and a more favourable outcome did not reach statistical significance (P = 0.052). No correlation could be found between initial motor function loss, bilateral sciatica, level or cause of injury as predictors of a poor outcome (P>0.05). CES can be diagnosed early by judicious physical examination, with particular attention to perineal sensation and a history of urinary dysfunction. The most important factors identified in this series as predictors of a favourable outcome in CES were early diagnosis and early decompression.

Adult↗