Watson-Jones, the book and the Third World.
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Books↗
Biomedical subjects
J N Wilson
Publications and source records attributed to J N Wilson.
Angina and vasospasm at rest in a patient with an anomalous left coronary system.
An anomalous left main coronary artery with passage between the right ventricular infundibulum and aortic root has been incriminated as the causation of sudden death in a small number of individuals, many of whom are quite young. Mechanical features such as angulation and compression are most often incriminated. A 59-year-old man with such a coronary anomaly who had chest pain at rest, ST segment elevation, and ventricular tachycardia, but who had no evidence of effort-related myocardial ischemia, is reported. Improvement in the degree of coronary tone in the anomalous left main coronary with intracoronary nitroglycerin administration was demonstrated. This represents the first report of an individual with an anomalous left main coronary system with ventricular tachycardia/ventricular fibrillation and documented vasospasm in the anomalous artery.
Angina Pectoris↗
Distal femoral replacement by custom-made prostheses. Clinical follow-up and survivorship analysis.
We report the long-term clinical follow-up and survivorship analysis of 40 distal femoral replacements performed between 1964 and 1980 for traumatic, locally aggressive and malignant conditions. Custom-made prostheses with fully-constrained knee joints were used to replace a mean of 42% of the length of the femur. Survivorship analysis showed a cumulative success rate of 80% at eight years, with no subsequent deterioration at 18 years. Clinical assessment revealed 78% excellent or good results. Failure was due to infection in three cases, and in two to fracture of a now-outmoded femoral stem.
Artificial Limbs↗
Endoprosthetic replacement of the proximal humerus.
Endoprosthetic replacement of the proximal humerus has been performed in our unit on 25 occasions between 1950 and 1982. The indication for surgery was destruction of the proximal half of the humerus so extensive that the only alternatives were reconstruction or amputation. Of the patients with tumours two died from metastases, and three from unrelated causes; local recurrence necessitated amputation in two patients. Minor complications were frequent, but there were no deep infections and, after 1964, no prosthesis became loose. Active shoulder movement after operation was considerably limited, but passive movement was good and function of the elbow and hand were preserved.
Adolescent↗
Entrapment of the superficial peroneal nerve. Three case reports.
Entrapment of the superficial peroneal nerve is an unusual cause of pain in the ankle and foot. In such cases decompression of the nerve at the point of exit from the deep fascia will produce a good result. Three cases are described.
Adult↗
American business corollaries to optometric practice.
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Commerce↗
Osteotomy in the treatment of osteoarthritis of the first carpometacarpal joint.
Degenerative changes of the first carpometacarpal joint commonly cause pain, weakness and adduction deformity. Many patients respond to conservative treatment, but in resistant cases an abduction wedge osteotomy of the base of the first metacarpal has been found to relieve symptoms with less complications than other operations. Twenty-one patients with 23 osteotomies have been reviewed, with a follow-up from 2 to 17 years. All have had lasting relief from pain and consider that they have full function, with no stiffness or limited abduction. Osteotomy is indicated mainly for cases where the arthritis is confined to the carpometacarpal joint, but also relieves pain in cases of peritrapezial arthritis.
Adult↗
Ultrasonic assessment of fractures and its use in the diagnosis of the suspected scaphoid fracture.
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Adolescent↗
Influence of genetic hyperlipemia in the Zucker rat upon the lipemic response to graded estradiol exposure.
The present investigation was designed to examine the influence of genetic Type IV hyperlipoproteinemia on the metabolism of lipids in response to estrogen exposure. The influence of 17-Beta-estradiol * was examined in a dose-response study over a range of hormone concentration from 10 to 100 pg/ml in genetic hyperlipidemic Zucker rats. In oophorectomized female rats, replacement levels of plasma estradiol of 40 pg/ml resulted in maximal hypertriglyceridemia of approximately 500 mg/dl representing a 5-fold exaggeration of that observed in control genetically norm-lipemic animals. This hypertriglyceridemia was associated with an increased production of triglyceride (TG) in excess of clearance, with a resulting production: clearance ratio of approximately 1.5. Exposure to maximum blood levels of estradiol, approximately 100 pg/ml, resulted in sub-normal levels of plasma TG (-145 mg/dl) in association with a reduced production: clearance ratio of approximately 0.36. In contrast to the marked hypocholesterolemic response to maximum estrogen exposure seen in normolipemic animals, the genetic Type IV hyperlipemic animal failed to demonstrate reduced plasma cholesterol concentration. This phenomenon was related to a rise in plasma LDL concentration in conjunction with parallel reduction in plasma HDL2 levels.Thus, an abnormal ratio of excessive LDL: HDl emerged in response to estrogen exposure in this model of human Type IV lipemia. This observation suggests that the genetic predisposition of the host may be critical to both the quantitative as well as the qualitative response to estrogen.
Animals↗
Acute blue fingers in women.
A previously undescribed syndrome affecting the fingers of women is presented. The patients experience a sharp pain and then the fingers become blue and numb. The discoloration resolves within 72 hours without the changes normally associated with an ecchymosis. Clinical and haematological examination of six patients failed to show any common factors or associated systemic disease. This syndrome is of no clinical significance to the patient, but it is important for clinicians to be aware of it because the acute phase can cause anxiety, suggesting more serious vascular disease.
Acute Disease↗
Free palmar skin grafts for resurfacing digital defects.
Since 1968, lost skin from the volar aspects of digits has been replaced by full-thickness skin grafts from the thenar area in 40 patients. Durable coverage was obtained in all. No morbidity occurred in the donor site.
Adolescent↗
Endoprosthetic replacement of the proximal femur and acetabulum. A survival analysis.
A series of 81 patients has been reviewed to determine the value of endoprosthetic replacement of the proximal femur and hip in the treatment of bone tumours. Standard statistical methods were used to evaluate the survival of the replacements and the patients. Taking removal of the prosthesis, irrespective of the cause, as the criterion for failure the survival of the replacements was found to be 63 per cent after 10 years. If deaths are regarded as failures, then the survival value falls to 48 per cent. The survival of patients with chondrosarcoma and osteoclastoma treated by endoprosthetic replacement compares favourably with survival after amputation or excision of the tumour.
Adolescent↗
Abductor pollicis longus transfer for replacement of first dorsal interosseous.
One of the tendinous slips of the abductor pollicis longus has been used to replace the first dorsal interosseous. One of the slips which does not insert on the first metacarpal is prolonged by a tendon graft through a subcutaneous tunnel to the insertion of the first dorsal interosseous. This technique has been used in 18 patients who have been followed from 2 to 12 years. All patients had improved stability in pinch, were able to abduct and to flex the index finger independently, and were satisfied with the results. No significant complications were encountered.
Adult↗
Complications of surgical release for carpal tunnel syndrome.
Review of a series of 186 operative cases of carpal tunnel release revealed 34 complications in 22 patients, for an incidence of 12%. Complications were grouped into seven categories: (1) inadequate section of the transverse carpal ligament (associated with both transverse and curved incisions), (2) symptoms related to damage to the palmar cutaneous branch of the median nerve, (3) reflex sympathetic dystrophy, (4) unsightly hypertrophic scar due to inappropriate incision, (5) damage to the superficial palmar arch following blind sectioning of the transverse carpal ligament, (6) bowstringing of the flexor tendons after excision of the transverse carpal ligament, and (7) adherence of the flexor tendons following excision of the mesotenon. Except for four of the complications, two each of bowstringing and reflex sympathetic dystrophy which occurred in our own practice, all of the complications were seen in patients referred for care. Most complications can be prevented by proper operative technique.
Adult↗
Kienböck's disease: the role of silicone replacement arthroplasty.
A review of thirty-eight patients with Kienböck's disease indicated that both delay in diagnosis and prolonged treatment by plaster immobilization led to progressive collapse of the lunate and an unsatisfactory result in most instances. Four clinical and roentgenographic stages were identified, and the results of silicone replacement arthroplasty were correlated with the preoperative stage after an average follow-up of twenty-seven months. The results were satisfactory in fourteen of twenty wrists in which the procedure was performed before collapse of the lunate had occurred. The importance of early diagnosis and early surgical treatment of this disorder was emphasized by the findings in this study.
Adolescent↗
Incidence of metal sensitivity in patients with total joint replacements.
Sensitivity to chromium, cobalt, nickel, molybdenum, vanadium, and titanium was studied by patch tests in 50 patients who had received total joint replacements. Nineteen (38%) were sensitive to one or more of the metals. In 23 patients non-traumatic failure of the prosthesis had occurred, and 15 of these patients were sensitive to metal. Out of 27 patients with no evidence of prosthesis loosening, four were sensitive to nickel and cobalt or nickel only. Dermatological reactions occurred in 13 patients after surgery; in only eight, however, was there evidence of metal sensitivity. These findings indicate that metal-on-metal total joint replacements may sensitise the patient to metals contained in the prosthesis. Although there is a high incidence of prosthesis failure among metal-sensitive patients it remains uncertain whether the loosening causes the sensitisation or vice versa.
Chromium↗
Excision of tumours of humerus and femur, with restoration by internal prostheses.
A personal experience is recounted of operations in cases of tumour involving the humerus or femur with restoration by endoprostheses. Twenty-four patients were treated in this way from 1950 to 1969 inclusive and have been followed up for between four and twenty-four years. The patients selected for treatment have presented chondrosarcoma (ten), so-called benign giant-cell tumour of bone, usually recurrent (nine), angiomatous osteolysis (two), seemingly single thyroid or renal metastasis (two), and ununited pathological fracture after irradiation of a tumour (one). Development of the prostheses from early beginnings is outlined. Some points in surgical management are referred to. The complications and results are recorded.
Adult↗