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Biomedical subjects

J L Goldner

Publications and source records attributed to J L Goldner.

At least 55 records · Page 3Linked to original sources
PubMed1983

Diagnosis of patellofemoral malalignment by computed tomography.

Conventional radiographic assessment of the patellofemoral joint (PFJ) is often unsatisfactory for a variety of technical and theoretical reasons. Using a simple device designed to allow easy and reproducible control of knee flexion, we used computed tomography (CT) to evaluate the PFJ in 10 normal volunteers and five patients with a history suggestive of recurrent subluxation or dislocation of the PFJ. At full extension of the knee the patients with a history of malalignment showed an abnormal patellar centralization and tilt compared with those of the normal volunteers. The abnormalities were absent or less pronounced on images obtained at 20 and 45 degrees of knee flexion.

Humans↗
PubMed1983

Postoperative intervertebral disc space infection.

Intervertebral disc space infection is an uncommon, but serious, complication of disc surgery. By a retrospective chart review, we identified 27 patients at our institution who had a postoperative disc space infection; 14 were diagnosed and treated within the last 5 years. The characteristic symptoms were severe spinal pain and limited spinal mobility beginning 7 to 30 days postoperatively. The key physical findings were paravertebral muscle spasm and marked mechanical signs. The key laboratory findings were an elevated erythrocyte sedimentation rate and a mildly elevated white blood cell count. The diagnosis was based on the clinical presentation and early radiographic changes in the vertebral bodies adjacent to the involved disc, especially irregularities of the cortical margins seen best by tomography. Definitive bacteriological diagnosis by Craig needle biopsy was attempted in 14 patients; 7 had positive cultures and all yielded a Staphylococcus species. The usual treatment consisted of the administration of antistaphylococcal antibiotics and immobilization of the spine with a spica cast, a plastic body jacket, or complete bedrest. The final radiographic findings showed bony fusion or bridging in 19 patients, and 25 patients had a pain-free recovery after 1 to 9 months. There was 1 recurrent infection, and 3 patients eventually required an anterior discectomy and fusion. Based on a review of our own cases and those reported in the literature, we stress the importance of spinal tomography in establishing the diagnosis of postoperative disc space infection at a relatively early stage in a patient who is suspected of having this condition on the basis of typical symptoms and signs combined with an elevated sedimentation rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

The effects of intravenous regional guanethidine and reserpine. A controlled study.

We investigated the effects of intravenous regional injection of guanethidine and reserpine in a prospective, randomized, double-blind study of seven volunteers. The sympatholytic activities of these drugs were assessed separately for cholinergic and adrenergic function. Cold challenge was employed to magnify the effect on digital temperatures and alterations in pulse-volume. Only guanethidine significantly increased temperature (p less than 0.025) after cold challenge, this effect lasting for three days. No anticholinergic effect was found. Intravenous regional guanethidine may be useful in the treatment of vasospastic disorders and as prophylaxis for surgically treated patients in whom this complication may be expected to occur.

Adult↗
PubMed1982

Long-term pain control by direct peripheral-nerve stimulation.

In 1970, we began implanting electrodes for prolonged stimulation of injured peripheral nerves to reduce chronic pain. Thirty-eight peripheral nerves in thirty-five patients have been stimulated with electrodes for a period ranging from four to nine years. Nineteen electrode systems were implanted in the upper extremity (eleven on the median nerve, six on the ulnar nerve, one on the median and ulnar nerves, and one on the median and radial nerves), with successful relief of pain in 52..6 per cent of the patients. Sixteen stimulators have been implanted on the sciatic nerve with a success rate for pain relief of 31 per cent. Failures in the lower extremity were found primarily in lesions of the posterior tibial nerve at the ankle. We speculate that the stress of weight-bearing and the anatomical position of the posterior tibial nerve may partially account for this rate of failure. Use of the electrode-implant systems required careful preoperative assessment by an experienced team, meticulous technique, and a mechanical system that tolerates stress. The location and characteristics of the lesion affect the response to electrical stimulation.

Adult↗
PubMed1982

Pyogenic arthritis: emphasis on the need for surgical drainage of the infected joint.

A ten-year retrospective review of patients with acute hematogenous pyogenic arthritis at the Duke University Medical Center yielded 14 affected joints in the pediatric group and 32 in adults. Follow-up ranged from six months to eight years. Analysis of factors possibly affecting end results included the joint involved, organism, duration of infection, antibiotics used, age of the patient, and mode of drainage--whether surgical or by needle aspiration. Surgical drainage in the pediatric group yielded uniformly excellent results. In adults, needle aspiration correlated with increased mortality and morbidity. In contrast to other series in the medical literature we found the indications for needle aspiration to be highly restrictive, and we recommend surgical drainage and appropriate antibiotics as the treatment of choice for most patients with pyogenic arthritis.

Adult↗
PubMed1981

Wick catheter in evaluating and treating compartment syndromes.

We prospectively analyzed 45 patients with suspected compartment syndromes involving 55 extremities to determine the role of the wick catheter in their management. The wick catheter technic allows the continuous monitoring of interstitial pressure and provides an objective assessment of compartment pressure. Indications for catheter use, technics for catheter preparation and insertion, and guidelines for the timing of fasciotomy are presented. Clinical evaluation of every extremity injury must be tempered by suspicion and vigilance to detect compartment syndromes early enough to prevent ischemic contracture. Providing reliable and accurate pressure determinations without significant morbidity, the wick allows continuous monitoring of interstitial compartmental pressure and objective indications for fasciotomy.

Adolescent↗
PubMed1981

Hallux valgus and hallux flexus associated with cerebral palsy: analysis and treatment.

Hallux valgus and hallux flexus associated with cerebral palsy foot deformity may be due to equinovalgus and/or metatarsus primus adductus or combinations of these. Occasionally the condition occurs in equinovarus feet. Hallux flexus or "dorsal bunion" is usually due to a weak extensor hallucis longus, overpull of the anterior tibial muscle on the first metatarsal and spasticity or contracture of the flexor hallucis longus or brevis. A weak peroneus longus muscle has not caused this deformity. The condition is usually predictable in the growing child if all factors related to gait, collagen stability and foot alignment are observed. Treatment includes soft-tissue and bone realignment. Release of the adductor hallucis, lateral collateral ligaments of the metatarsophalangeal joint, plication of the medial capsule and of the abductor hallucis and centralization of the extensor hallucis longus will realign the first ray. The flexor hallucis longus is transferred to athe extensor hallucis longus proximal to the metatarsophalangeal joint and the anterior tibial tendon is transferred to the second metatarsal. An osteotomy at the base of the first metatarsal and at the base of the proximal phalanx will realign the skeleton. Twenty-six great toes in 16 patients have been observed for two to 20 years. The correction has been maintained without arthrodesis of the metatarsophalangeal joint except where chondromalacia occurred. Once the pattern of deformity is evident, progression is unrelenting and treatment is indicated in order to prevent chondromalacia of the articular cartilage.

Adult↗
PubMed1979

Wound infections in patients undergoing total hip arthroplasty. Ultraviolet light for the control of airborne bacteria.

Ultraviolet (UV) irradiation (1,537 A) during total hip arthroplasty will effectively reduce risk of airborne bacterial contamination of the operative field. An air sampling study at the operative site compared 28 total hip arthroplasties with UV lights on and 19 operations with UV lights off. The use of UV irradiation significantly reduced the average number of airborne bacteria over the operative site, although the results indicate that the number of airborne bacteria collected at the operative site in each conventional operating room without UV irradiation was quite low. Data confirmed the fact that airborne bacteria are a reflection of operating room personnel and their activities. With UV light, the rate of infection from possible airborne sources was 0.15% for 1,322 total hip patients. Thus, emphasis is now placed on those causes of infection that are not airborne.

Adult↗