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Biomedical subjects

J P O'Brien

Publications and source records attributed to J P O'Brien.

At least 163 records · Page 9Linked to original sources
PubMed1979

Fissuring of the posterior annulus fibrosus in the lumbar spine.

Severe back-ache in young adults may present a difficult clinical problem when the absence of neurological signs results in delayed diagnosis. Fourteen patients, with discographic evidence of posterior annular fissuring are reported. The discrepancy between painful disability and negative radiographic examination including radiculography is stressed. Discography has proved to be the investigation of choice in these patients. This will demonstrate the morphology of the lesion and reproduce the symptomatology in the majority of cases. The clinical implications are discussed.

Adolescent↗
PubMed1978

A concept of diffuse actinic arteritis. The role of actinic damage to elastin in 'age change' and arteritis of the temporal artery and in polymyalgia rheumatica.

Actinic damage (actinic elastosis) affecting the internal elastic lamina appears to be the prime cause of 'age change' and arteritis of the temporal artery. Resorption and removal of altered elastin (elastolysis) is an integral part of the pathology of actinic damage. Actinic irradiation is probably responsible for the destruction and disappearance of a vast number of arterioles in elastotic skin. The intimate connection between temporal arteritis and polymyalgia rheumatica prompts the belief that the vascular and other internal malign components of the temporal arteritis/polymyalgia rheumatica syndrome might likewise be due, albeit indirectly, to the same actinic cause. Actinic elastotic damage at the body surface could have this effect by provoking a state of systemic elastolysis. Although ultraviolet (uv) light is often regarded as the sole cause of actinic elastosis, penetrating infrared (heat) irradiation may deserve a large or even a dominant share of the blame.

Adult↗
PubMed1977

Increase in suicide attempts by drug ingestion. The Boston experience, 1964-1974.

At the Massachusetts General Hospital between 1964 and 1974, there was an estimated 118% increase in emergency ward admissions for drug overdose suicide attempts and an estimated 257% increase in such attempts by individuals in the 20- to 29-year age range. Approximately 67% of overdoses seen in 1972 and 1974 occurred in individuals under age 30. An increase in drug overdose suicide attempts by males was noted. By 1972, males were making approximately as many attempts as females. Based on extrapolations from the Massachusetts General Hospital drug overdose data, and not including an estimate of non-hospital-treated suicide attempts, an estimated annual (1972) suicide attempt rate of 337/100,000 (0.38%) was obtained for Boston. The estimated suicide attempt-completed suicide ratio for the Boston area was 39:1. These estimates should be interpreted as giving an approximate order of magnitude and not as specifying precise rates.

Adolescent↗
PubMed1977

Chylothorax: a complication of Dwyer's anterior instrumentation.

The authors report the development of an extensive right chylothorax several days after Dwyer's anterior instrumentation in a 6-year-old girl with a severe progressing infantile scoliosis. Instrumentation extended from T11 to L4 with removal of the tenth rib and with splitting of the diaphragm. The postoperative course was initially without any problems. However, respiratory distress on the tenth day after surgery was accompanied by mediastinal shift and the symptoms were relieved with aspiration of 600 ml of chyle from the right pleural cavity. The literature on this complication of chylothorax is reviewed; it has been observed in cardiothoracic surgery. The management of the case is reported in detail and methods of detection and treatment are discussed.

Child↗
PubMed1977

A study of low-dose amitriptyline overdoses.

Although a 1-week supply of tricyclic antidepressants is generally considered safe, the author shows that this amount can be severely toxic. Six of 12 instances of low-dose (500-1000 mg) amitriptyline overdoses were life threatening. The author suggests that prescription guidelines for tricyclic antidepressants be tightened and that physicians prescribe less than a 1-week supply to potentially suicidal patients.

Adolescent↗
PubMed1977

Ultimate bony fusion of lower limb joints following severe trauma.

Three patients presented with limb deformity some years after being run over and sustaining degloving injuries of their lower limbs. Spontaneous joint fusions were observed in each patient; The causes of these could be: i) Extensive intra-articular fracture, ii) Prolonged immobilisation due to the scar tethering the joint, or most likely, iii) A chronic low grade infection following compound joint injury with degloving.

Adolescent↗
PubMed1977

Kyphosis secondary to infectious disease.

Infections of the spine usually involve the vertebral body and therefore by definition produce a kyphosis. Non-tuberculous infection usually staphylococcal and in the lumbar spine, is often diagnosed late and can involve the cord. Open exploration and stabilization with graft should therefore be considered. The destruction is usually less extensive and therefore the kyphosis less severe than in late neglected tuberculous infections. Tuberculous spinal infection accounts for 59% of all orthopedic tuberculosis. It invariably involves vertebral bodies and is progressive. Destruction of the bodies is by infection and avascular necrosis, kyphosis is inevitable and cord compression a common threat. While L-1 is the most commonly affected body T-10 is statistically the most commonly associated with cord compression. The treatment of spinal tuberculosis should be aimed at correcting 5 basic defects associated with the disease and the deformity: mechanical instability; chronic smoldering infection; spinal cord and nerve root compression; disturbance of spinal growth; depressed lung function. The cornerstone to effective treatment for spinal tuberculosis is drug therapy and the anterior fusion operation. For the established tuberculous kyphosis, which is always a fixed deformity, multiple staged operations and gradual correction used the Halo-pelvic apparatus is the best treatment available at present.

Acute Disease↗
PubMed1976

Halo-pelvic distraction apparatus. An analysis of one hundred and fifty consecutive patients.

One hundred and fifty consecutive patients on whom the halo-pelvic apparatus was used were analyzed. Sixty-six per cent had tuberculous kyphosis or paralytic scoliosis. The apparatus was of great value in holding and correcting spines with tuberculous kyphosis and the results were gratifying, even though the average correction of the kyphos was only 20 per cent. In paralytic scoliosis a 46 per cent correction was obtained, but presently Dwyer and Harrington instrumentation are used for the majority of such cases. The halo-pelvic apparatus was effective in holding and correcting severe congenital curves and kyphoscoliosis secondary to neurofibromatosis, especially when there were signs of cord compression. The complication rate was high early in the series, but has been lowered by strict patient selection and close adherence to specific guidelines in the application of the apparatus. The apparatus should be reserved for severe deformities when other means of correction or stabilization are inadequate.

Adolescent↗
PubMed1976

Batchelor's extra-articular subtalar arthrodesis. A report on sixty-four procedures in patients with poliomyelitic deformities.

Sixty-four feet of fifty-four patients treated with Batchelor's extra-articular subtalar arthrodesis for poliomyelitic deformities were reviewed after a minimum follow-up of four years. Early in the series the results were poor because of inexperience with the technique and poor selection of patients. The incidence of non-union, which appeared to be high in this series compared with other series in which the Grice technique was used, was attributed mainly to the more advanced age of our patients at the time of arthrodesis (average age, 9.9 years). A common factor in the cause of non-union was tightness of the heel cord. Redistribution of muscles to balance power in the foot did not appear to be necessary to achieve good results in feet with equinovalgus deformity, and conversely, energetic redistribution of muscle power in these feet did not result in late varus deformity.

Adolescent↗
PubMed1976

Triple tenodesis of the knee. A soft-tissue operation for the correction of paralytic genu recurvatum.

There are two types of genu recurvatum: one with bone deformity, which responds well to osteotomy, and one with posterior soft-tissue laxity with secondary bone changes. To date, no reliable treatment short of arthrodesis has been effective for the second type. An operation for this type of genu recurvatum (post-poliomyelitic) is described: a soft-tissue reconstruction of the lax tissues posterior to the knee joint done in three layers. The operation was done on sixteen knees in fourteen patients, with an average follow-up of four years and three months. The average recurvatum before surgery was 42 degrees and at the time of follow-up it was 6 degrees. Preliminary surgery is often required and precise surgical technique and prolonged bracing after surgery also are needed. All but one patient was made brace-free provided the limb operated on was not flail.

Adolescent↗
PubMed1975

Actinic granuloma. An annular connective tissue disorder affecting sun- and heat-damaged (elastotic) skin.

Ring-shaped inflammatory lesions sometimes develop in the abnormal "elastotic" connective tissues of skin damaged by sun and heat. The lesions, which commence as papules and nodules, enlarge very slowly and may persist for years. Microscopical sections show that there is an infiltrate composed mainly of foreign-body giant cells, the cells being engaged in digesting and absorbing the abnormal elastotic fibers. The disorder, which occurs on several continents, should probably be regarded as a phenomenon of repair within damaged connective tissue. The name actinic granuloma indicates its external or environmental origin and distinguishes it from other granulomas with which it is constantly being confused. Actinic granuloma and granuloma annulare appear to be related. In granuloma annulare, a productive and resorptive process also occurs, but its nature remains obscure. Actinic granuloma may be misdiagnosed as "atypical necrobiosis lipoidica" or as a sarcoidosis. The subject of actinic damage to blood vessels deserves study.

Atrophy↗
PubMed1975

Discography in paralytic scoliosis.

Observations are made on the progressive alterations of the intervertebral disc in paralytic scoliosis, demonstrated by discography.

Adolescent↗
PubMed1975

Avascular necrosis of the proximal end of the dens. A complication of halo-pelvic distraction.

Roentgenographic evidence of avascular necrosis of the upper part of the dens was observed in thirteen of ninety-four patients treated for tuberculous kyphosis or non-tuberculous scoliosis using halo-pelvic distraction. Four patients had some residual loss of motion. A significant relationship was demonstrated between avascular necrosis and the amount of distraction visible on roentgenograms.

Adolescent↗
PubMed1975

Paralytic pelvic obliquity. Its prognosis and management and the development of a technique for full correction of the deformity.

Thirty-nine patients with post-poliomyelitic scoliosis and pelvic obliquity were treated and followed for up to four years. The dominant pathological mechanism causing the pelvic obliquity was trunk-muscle imbalance. The natural history of untreated pelvic obliquity is progression, leading ultimately to dislocation of the hip. The functional abilities of the patient are then severely restricted. Our aim in treatment was to obtain the maximum possible correction of pelvic tilt and so to prevent subluxation of the femoral head. Total correction was obtained in fifteen patients; no loss of correction was seen in twenty-four patients. The best results were achieved by preliminary traction, Dwyer instrumentation distally to the fifth lumbar vertebra, and extensive posterior fusion extendind distally to the sacrum.

Female↗