Biomedical subjects

J J Brems

Publications and source records attributed to J J Brems.

40 records · Page 3Linked to original sources

PubMedDate not supplied

Glenoid size, inclination, and version: an anatomic study.

Three hundred forty-four human scapular bones (172 matched pairs) were measured for their glenoid height, width, inclination, and version. The sample consisted of 50 black men, 50 white men, 50 black women, and 22 white women, all of whom were aged 20 to 30 years at the time of death. The mean age of the study group was 25.6 years. No difference in glenoid size was noted between black and white patients. The overall glenoid version for the entire study group was 1.23 degrees of retroversion. The difference in glenoid version between black and white patients was statistically significant. The average glenoid version for black and white patients measured 0.20 degrees and 2.65 degrees of retroversion, respectively (P =.000014). Specifically, the glenoid version for black and white men measured 0.11 degrees and 2.87 degrees of retroversion, respectively (P =.00034). The glenoid version for black and white women measured 0.30 degrees and 2.16 degrees of retroversion, respectively (P =.034). No statistical difference in glenoid version was found between men and women of the same race. No difference was found between measuring the glenoid version based on the transverse axis of the scapula and measuring the glenoid version perpendicular to the glenohumeral joint. No statistical difference was found in the glenoid inclination based on race or sex. The relationships between glenoid size, inclination, and version are important to understand when a surgeon prepares to resurface the glenoid during total shoulder arthroplasty. The knowledge of these values, their variation, and racial differences should help reproduce a more anatomical result.

Adult↗

PubMedDate not supplied

Asymptomatic profound oxyhemoglobin desaturation following interscalene block in a geriatric patient.

BACKGROUND AND OBJECTIVES: Interscalene block can be chosen for complete anesthesia for shoulder surgery. Phrenic nerve block occurs with almost all interscalene blocks, but is well tolerated in most patients. This may not be the case in selected geriatric patients. METHODS: The patient is a 90-year-old female with osteoarthritis of the left shoulder scheduled for total shoulder anthroplasty. Past medical history revealed hypertension, mild mitral valve insufficiency, and a remote episode of congestive heart failure. She underwent interscalene block with 40 mL of 1.4% mepivacaine, 1:200,000 epinephrine freshly added, alkalinized with sodium bicarbonate. RESULTS: The onset of the block was rapid and complete. The patient had minimal intravenous sedation (0.5 mg midazolam) and was resting comfortably with a respiratory rate of 12-14 breaths/min. Approximately 5 minutes after the injection of local anesthetic, the patient was noted to be alert, cyanotic, denying dyspnea, with an oxygen saturation of 75-85%. A chest radiograph revealed elevation of the ipsilateral hemidiaphragm and no pneumothorax or other pathology. Despite supplemental oxygen by face mask, desaturation persisted and general anesthesia was induced. On emergence from anesthesia, the patient had a complete interscalene block. Repeat chest radiograph after resolution of the block revealed return of hemidiaphragm position and no other pathology. The patient was extubated in the recovery room without difficulty. Following extubation the patient demonstrated stable respirations and normal oxyhemoglobin saturation. CONCLUSIONS: Ipsilateral phrenic nerve paralysis caused significant respiratory compromise in an elderly patient without known significant pulmonary disease.

Aged↗

PubMedDate not supplied

Multidirectional instability of the shoulder: pathophysiology, diagnosis, and management.

Multidirectional instability of the shoulder is a complex entity. Relatively few series of patients with this condition have been reported. Affected patients have global (anterior, inferior, and posterior) excessive laxity of the glenohumeral joint capsule and a rotator interval capsule defect. The onset of symptoms is frequently related to atraumatic events. The chief complaint is more often related to pain than to instability per se. Symptoms are mostly experienced within the midrange of glenohumeral motion. Because the contralateral shoulder is often equally lax and asymptomatic, it appears that factors in addition to excessive capsular laxity play a pathophysiologic role. These factors may include subtle losses of strength and/or neuromotor coordination of the rotator cuff and scapular stabilizing muscles, defective proprioceptive responses, and the absence of a limited joint volume. Most patients can be successfully treated nonoperatively with a specific exercise program. If a 6-month trial of nonoperative management fails, the patient is a candidate for surgical reconstruction. The most time-honored procedure is an open inferior capsular shift, which corrects excessive global laxity of the capsule and the rotator interval defect.

Arthroscopy↗

PubMedDate not supplied

Sulfation and glucuronidation of acetaminophen by cultured hepatocytes replicating in vivo metabolism.

A requirement of hepatocytes incorporated into an artificial liver support system will be preservation of in vivo metabolism of the cultured hepatocytes. The metabolic fate of a low (15 mg/kg), medium (125 mg/kg), and high (300 mg/kg) dose of acetaminophen (APAP) was determined in male and female rats. Male rats excreted more APAP as the sulfate conjugate than female rats, which correlated with the twofold greater APAP sulfotransferase activity in the male versus female rats (301 +/- 24 vs. 156 +/- 18 pmol/mg protein/min). Also, as sulfate conjugation became saturated, there was a dose-related shift in APAP metabolism to glucuronide conjugation in both genders. After sacrifice, hepatocytes were cultured with APAP (0, 150, 250, 500, and 1,000 microM). Gender differences in APAP sulfation and glucuronidation persisted in culture for up to 4 days, with sulfation predominating in the male rats, similar to that seen in vivo. With increasing APAP dose, there was a saturation of sulfate conjugation and a shift to glucuronidation as observed in vivo. APAP sulfation and glucuronidation by freshly isolated cultured hepatocytes in vitro can replicate in vivo metabolism.

Acetaminophen↗