Arthroscopic surgery in the very young.
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Age Factors↗
Biomedical subjects
J Noble
Publications and source records attributed to J Noble.
Effect of lumbar puncture on flow of cerebrospinal fluid.
The rate at which isotopes descend from the cisterna magna to the lumbar subarachnoid space is highly variable. In monkeys, with and without previous lumbar puncture, transit time was measured. In animals with a previous lumbar puncture, transit times were 10 to 120 minutes; in monkeys without a previous lumbar puncture, transit times were 120 to 180 minutes. In experimental studies of cerebrospinal fluid circulation, the effect of lumbar puncture must be controlled.
Animals↗
Surgical approaches to the dorsum of the wrist: brief report.
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Humans↗
The use of the probe in arthroscopic examination of the knee.
Careful examination of the results of 500 arthroscopic examinations of the knee showed that significant diagnostic information was gained by use of the probe in 52 knees. However, survey results show that in northwest England only 67% of surgeons always perform an arthroscopy prior to meniscectomy and only 41% of surgeons used a probe at every examination. Failure to use the probe at every examination may result in missed pathology.
Arthroscopy↗
Retrospective study of 120 trigger digits treated surgically.
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Adolescent↗
Percutaneous transluminal coronary angioplasty for chronic total coronary arterial occlusion.
Experience is reported with 100 consecutive patients in whom percutaneous transluminal coronary angioplasty (PTCA) was attempted on chronically occluded coronary arteries that had no visible anterograde flow. Ninety-eight patients had angina and all had collateral vessels to the occluded artery on angiography. A movable guidewire/dilatation system was used in all cases. Overall initial PTCA success rate was 56% and was related to duration of occlusion (69% success rate for occlusions of 1 month or less, 50% for 1 to 6 months and 11% after 6 months). Complications were minor; no patient died or required emergency bypass operation. Of the 44 patients in whom PTCA failed, 20 underwent elective bypass surgery for relief of angina and 24 were treated medically. Follow-up at a mean of 8 months (range 1 to 48) was available for 49 of the 56 patients in whom PTCA was successful: 40 had subjective improvement, 6 no change and 3 felt worse. Control angiography was carried out in 40 of the 56 patients with primary success and showed long-term success in 18 and reocclusion or significant stenosis in 22. Of these 22, 11 were successfully treated by a second PTCA, 2 underwent operation and 9 were treated medically. Recanalization of totally occluded coronary arteries with no forward flow has a lower initial success rate (56%) than PTCA for stenoses and the recurrence rate is higher (55%), but effective relief of angina is achieved in successful cases. The risk of serious complications appears to be low.
Adult↗
Percutaneous transluminal coronary angioplasty by high-volume and low-volume operators.
We retrospectively compared the results of percutaneous transluminal coronary angioplasty (PTCA) of three low-volume operators (1.3 PTCAs/month) to those of a relatively high-volume operator (14.9 PTCAs/month) in 396 consecutive procedures (358 patients). PTCA for multiple vessels, total occlusions, or evolving acute myocardial infarction had been excluded. For low-volume operators experienced assistance was considered present when the high-volume operator participated as second operator. The three low-volume operators performed 42, 38, and 24 PTCAs, respectively. Success rates per procedure for these operators were 88%, 84%, and 83%, and the complications rates 5%, 3%, and 13%, respectively. The success rates for assisted vs. nonassisted procedures were 89% vs. 88%, 100% vs. 78%, and 90% vs. 71%, and the complications rates were 6% vs. 4%, and 0% vs. 21%, respectively. The high-volume operator performed 292 PTCAs, with a success rate of 93%, and a complication rate of 5%. The cumulated success rate of the three low-volume operators of 85% was significantly (p less than 0.05) lower than the 93% success rate of the high-volume operator, while the complication rates of 6% and 5%, respectively, were not significantly different. Low-volume operators in an experienced center can perform PTCA safely even without assistance by a high-volume operator. However, their success rate is lower.
Angioplasty, Balloon↗
The effects of intrathecal midazolam on sympathetic nervous system reflexes in man--a pilot study.
Nine patients were given intrathecal injections of midazolam (dose 0.3-2 mg dissolved in 3 ml 5% dextrose). No changes in motor power or general sensation were produced. Resting heart rate and blood pressure were unchanged and normal valsalva manoeuvres were elicited 30 min post-injection. Cardiovascular responses were provoked at a light plane of anaesthesia by intubation of the trachea and manipulation of peritoneum and bowel but not by surgical incision of the skin. Intrathecal administration of midazolam relieved post-operative pain of somatic origin but not of visceral origin. It is concluded that intrathecal midazolam in the dosage used interrupts somatic nociceptive afferent pathways but not abdominal visceral nociceptive afferent pathways.
Adult↗
Rupture of the calcaneal tendon. The early and late management.
We have reviewed 106 patients after treatment for spontaneous rupture of the calcaneal tendon, and assessed the clinical results including the power of plantarflexion. In patients treated within 48 hours of injury the result was very similar in conservatively and in operatively treated patients. The incidence of major complications was higher after operation (17%) than in those treated conservatively (4%). Patients who were treated more than one week after injury, however, had an inferior result with respect to power of plantarflexion after conservative management. It is therefore recommended that calcaneal tendon rupture is treated conservatively with a plaster in full equinus when it is diagnosed within 48 hours of injury, and by operation when diagnosis has been delayed for more than one week.
Achilles Tendon↗
[Chronic total coronary occlusion dis-obstruction by balloon angioplasty].
Ninety-three consecutive patients with chronic total coronary occlusion underwent an attempted mechanical des-obliteration by percutaneous coronary angioplasty with a balloon catheter. The global results were 55 p. 100 initial successes (residual stenosis less than 50 p. 100). The good prognostic factors were: 1) left coronary artery, especially left circumflex artery occlusion p less than 0.50, and 2) the proximity to the date of occlusion as assessed from the clinical history or by the occurrence of occlusion between the time of diagnostic coronary angiography and angioplasty. In cases of recent occlusion dating less than one month, the success rate was high: 69 p. 100. On the other hand, there were no successes in occlusions of over 6 months standing. The presence of myocardial infarction did not influence the results. There were few complications (7 p. 100) and these did not include any deaths or cases requiring emergency surgery. Exercise stress tests were carried out after the procedure and were negative in 28 out of 32 patients (88 p. 100). Forty-three patients successfully revascularised were followed up for 1 to 48 months (average 9 months) after angioplasty. Thirty-one patients were asymptomatic. Of the 12 symptomatic patients, 7 underwent exercise stress tests (6 positive) and all had control angiography which showed restenosis in 10 cases with 5 occlusions. Percutaneous coronary angioplasty of recent total coronary occlusions gives good initial results without major complications, and the medium term clinical results are satisfactory.
Adult↗
A geriatric neuropsychiatric inpatient unit.
Geriatric neuropsychiatry units have been developed in hospitals in various parts of the United States to provide an intensive diagnostic and treatment program for geriatric patients who have behavioral problems or the early signs of dementia. The Geriatric Neuropsychiatry Unit at the Boston City Hospital is described as a model unit. The process of patient selection and admissions criteria are outlined. Diagnostic interventions and the full evaluative process are then presented, followed by a summary of the therapeutic interventions. These interventions include pharmacologic, psychotherapeutic, behavioral, and milieu therapies. The communications process essential for effective multidisciplinary team function is also reviewed. Discharge planning procedures are presented, along with a summary of patient outcomes.
Aged↗
Immediate mobilization of fractures of the neck of the fifth metacarpal.
Although fractures of the neck of the fifth metacarpal are common injuries, their management remains controversial. In this study we present the results of early mobilization after these fractures in 101 patients. We conclude that if rotational alignment of the finger is maintained, these fractures can be treated by immediate use with good functional and cosmetic results.
Adolescent↗
Complications of the Attenborough knee replacement.
Of a consecutive series of 144 Attenborough knee replacements, 107 were re-examined between two and six years after operation and revealed a high incidence of complications. Wound problems were common and led to deep infection in four knees. When a patellar implant was used fracture of the patella followed in 17.5% of knees, but when the patella was not resurfaced 16% of knees developed patellofemoral pain of sufficient severity to require a further operation. In 10% of knees, definite loosening of one or both of the major components occurred.
Adult↗
The function, pathology, and surgery of the meniscus.
The menisci are vital for normal function of the knee joint and appear to protect the articular surfaces. Meniscal tears are very common, although often they may be asymptomatic. The diagnosis of tears on clinical grounds alone is unreliable, but the advent of arthrography and arthroscopy has made assessment much more accurate. Care should be taken in the ascription of symptoms to minor tears so discovered. The traditional view that meniscal tears cause osteoarthritis is hard to substantiate, and torn menisci may coexist with articular cartilage in excellent condition, whereas grossly degenerate joints may contain amazingly normal menisci. Total meniscectomy is followed by abnormal stress transfer across the joint, and ultimately degenerative changes frequently occur. Partial meniscectomy will relieve mechanical symptoms while preserving a rim capable of some function. Arthroscopic meniscectomy gives excellent results rapidly and is very efficient for both the patient and the surgeon.
Animals↗
Revision arthroplasty of the knee: two problem knees.
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Aged↗
The significance of peak expiratory flow rate in assessing prognosis of elderly patients undergoing operations on the hip.
Peak expiratory flow rate (PEFR) was measured using a Wright peak flow meter in 190 patients with fracture of the proximal part of the femur, and in 110 patients who underwent elective total hip replacement. PEFR was significantly lower in the fracture group than in the elective group when similar age ranges were compared. In the fracture group, PEFR of less than 100 was associated with a 69.6 per cent mortality rate, whereas no deaths occurred where the PEFR was greater than 300. It is suggested that the patients' PEFR is a good indicator of their prospects and it can be easily measured on admission.
Age Factors↗
Salvage of the destroyed wrist.
Two cases of complex limb threatening destruction of the wrist region and their reconstruction are described. The role of external fixation and composite vascular grafts in controlling infection and achieving bony union is outlined.
Hand Injuries↗