Biomedical subjects

J Gordon McComb

Publications and source records attributed to J Gordon McComb.

22 records · Page 2Linked to original sources

PubMed2003

Lymphangiomatosis of the spine: two cases requiring surgical intervention.

STUDY DESIGN: Two cases of lymphangiomatosis of the spine are presented. OBJECTIVES: To report two cases of lymphangiomatosis of the spine requiring surgical intervention and to review the literature. SUMMARY OF BACKGROUND INFORMATION: Lymphangiomatosis is a rare childhood disease characterized by abnormal lymph tissue at multiple sites. Skeletal and visceral involvement are both common. Prognosis depends on the extent of extraskeletal disease. METHODS: Two cases of lymphangiomatosis causing neural compression and instability at the cervicothoracic junction are presented. Both patients underwent surgical decompression and stabilization. RESULTS: One patient died, whereas the other regained full function and activity. CONCLUSIONS: Surgery is indicated when lymphangiomatosis causes neural compression and instability of the spine. Surgical outcome is strongly influenced by extraskeletal involvement.

Adolescent↗

PubMed2003

Use of elemental iodine for shunt infection prophylaxis.

OBJECTIVE: Elemental iodine (I(2)) can kill a broad spectrum of organisms, including bacteria, fungi, and viruses. Furthermore, it is inexpensive, bacterial resistance is unknown, and allergic reactions are rare. Because of these properties, we wanted to determine the concentration of I(2) that would kill Staphylococcus epidermidis and Staphylococcus aureus without causing injury to the central nervous system, in an attempt to further reduce the rates of shunt infections. METHODS: Bacterial kill studies using S. epidermidis and S. aureus were performed by using Ringer's lactate solution alone or solution containing I(2) at a concentration of 5, 10, 20, 50, 100, or 1000 parts per million (ppm), cefazolin at 1 mg/ml, or bacitracin at 100 units/ml. Twenty-one adult male Wistar rats, in seven groups, underwent a frontoparietal craniectomy. The surfaces of their brains were irrigated for 1 hour with Ringer's lactate solution alone or solution containing I(2) (at the concentrations noted above). After 72 hours of observation, the animals were killed. Their brains were then fixed in formalin, stained with hematoxylin/eosin, and examined. RESULTS: Even with exposure of only 15 seconds to an I(2) solution of 20 ppm, no growth was detected with an inoculum of either bacteria of 100 million. In contrast, the two antibiotics were not nearly as effective as I(2), with kill rates ranging from 19 to 93%. Examination of the rat brains demonstrated no histological changes after subarachnoid exposure to solutions containing 5, 10, 20, or 50 ppm; however, necrosis was observed with concentrations of 100 and 1000 ppm. CONCLUSION: I(2) can be added to irrigation solutions in sufficient concentrations to be bactericidal without causing any central nervous system injury.

Animals↗

PubMed2003

Correction of large (>25 cm(2)) cranial defects with "reinforced" hydroxyapatite cement: technique and complications.

INTRODUCTION: Hydroxyapatite cement is both biocompatible and osteoconductive, and it lacks significant toxic or immunogenic properties, making it an ideal substrate for the repair of cranial defects. However, with its putty-like composition, the repair of large cranial defects can be difficult because significant settling occurs as the cement hardens. We describe a technique in which we use hydroxyapatite cement, reinforced with tantalum mesh and titanium miniplates, for the repair of large (>25 cm(2)) cranial defects. METHODS: After the margins of the cranioplasty are delineated, tantalum mesh is placed under the edges of the defect. Titanium miniplate single-hole bars are used to criss-cross the defect and are then secured to the surrounding bone with screws. The mesh is secured to the bars with 28-gauge stainless steel wire. Hydroxyapatite cement is applied in the defect and contoured appropriately. RESULTS: We performed nine cranioplasties in eight patients ranging in age from 1.5 to 35 years (mean, 12.2 +/- 10.1 yr). The reasons for cranioplasty included cranial defect from prior trauma (n = 4), fibrous dysplasia (n = 2), infected bone flaps (n = 2), and tumor (n = 1). The cranioplasties ranged in size from 40 to 196 cm(2) (mean, 128.3 +/- 56.9 cm(2)). Follow-up ranged from 2 to 33 months (mean, 11.4 +/- 12.8 mo). Two cranioplasty constructs were removed at 1 and 3 months postoperatively owing to infection. CONCLUSION: The use of hydroxyapatite cement with mesh and miniplates provides internal structural support and increased stability of the construct. Although this technique provides an excellent cosmetic result and no evidence to date of bony resorption, the rate of infection is alarmingly high in these large constructs.

Adolescent↗

PubMed2002

Thoracoscopic placement of phrenic nerve electrodes for diaphragmatic pacing in children.

BACKGROUND/PURPOSE: Diaphragmatic pacing can provide chronic ventilatory support for children who suffer from congenital central hypoventilation syndrome (CCHS) or cervical spinal cord injury. The authors report a new thoracoscopic approach for establishing diaphragm pacing. METHODS: Between 1997 and 2000, 9 children ranging in age from 5 to 15 years and suffering from these disorders underwent thoracoscopic placement of bilateral phrenic nerve electrodes. A 3- or 4-trocar technique was used to dissect the phrenic nerve in the midchest and suture a phrenic nerve electrode (Avery Laboratories I-110A, Commack, NY) into place. The electrode was tunneled to a subcutaneous pocket in the upper abdomen and attached to an implanted pacing unit. RESULTS: Bilateral electrodes were placed successfully into all patients. The average procedure time was 3.3 hours (range, 2.5 to 4.6), and average hospital stay was 4.2 days (range, 3 to 5). Four patients experienced postoperative complications (pneumonia, atelectasis, bradycardia, and pneumothorax). Average follow-up has been 30 months (range, 15 to 49). Eight patients have reached their long-term pacing goals. CONCLUSIONS: Phrenic nerve electrodes can be implanted thoracoscopically and allow the successful use of diaphragmatic pacing therapy. Avoidance of thoracotomy with its associated perioperative morbidity and scarring may encourage wider utilization of diaphragmatic pacing in children.

Adolescent↗