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Biomedical subjects

J W Fielding

Publications and source records attributed to J W Fielding.

At least 109 records · Page 6Linked to original sources
PubMed1981

Neurological sequelae of cervical spine trauma.

It is estimated that there will be 5,000 new spinal cord injured patients each year. Prolonged survival has resulted from better understanding of the pathophysiology of cord damage, as well as from the advances in antibiotic and ventilatory therapy. Most well-motivated patients with lesions at or below C5 can attain a level of independence which obviates institutional care. Regional spinal injury centers have done much to increase the survival of and quality of life of cord injured patients. These realities make initial care of patients with acute traumatic lesions of the cervical spine of paramount importance. Neurologic function at both the nerve root and cord levels can be adversely affected by excessive motion of the unstable spine. Early evaluation of X-rays must therefore be carried out in an attempt to determine the stability of the spine.

First Aid↗
PubMed1981

Long saphenous vein stripping under local anaesthesia.

Stripping of the long saphenous vein under femoral nerve block has been preformed on 21 patients (27 limbs). There has been no complication from the nerve block and this form of anaesthesia was found acceptable to all patients in a subsequent questionnaire.

Ambulatory Surgical Procedures↗
PubMed1980

Natural history of "early" gastric cancer: results of a 10-year regional survey.

In "early" gastric cancer the depth of invasion by the primary tumour is confined to the submucosa of the stomach. Out of 13228 cases of gastric cancer notified to the Birmingham Cancer Registry during 1960-9, 90 (0 . 7%) were identifed as early gastric cancer. The crude five-year survival rate of these 90 patients was 57 . 8% (age-adjusted rate 70 . 4%) compared with 3 . 7% (age-adjusted rate 4 . 7%) for all cases and 14 . 6% (age-adjusted rate 17 . 4%) for the cases treated radically. Prognostic factors established for gastric cancer pertained equally to early gastric cancer. Most of the 90 patients had had symptoms related to the gastrointestinal tract, but in contrast to patients with advanced gastric cancer only 19% had lost weight on admission. These findings suggest that early investigation of dyspeptic symptoms would increase the detection of early gastric cancer, the most important prognostic group identified in gastric cancer.

Adenocarcinoma↗
PubMed1980

Intravascular haemolysis and renal impairment after blood transfusion in two patients on long-term 5-fluorouracil and mitomycin-C.

In a multicentre trial of adjuvant chemotherapy in gastric adenocarcinoma, a number of patients developed chronic haemolysis and renal failure following long-term treatment with 5-fluorouracil and mitomycin-C. This was exacerbated by blood transfusion, leading to an acute intravascular haemolytic state accompanied by rapid decline in renal function. One patient investigated extensively was treated with antiplatelet drugs, steroids, and fresh frozen plasma without success. At necropsy this patient and another had renal changes typical of the haemolytic-uraemic syndrome and no evidence of tumour recurrence. Long-term treatment with this drug combination is potentially dangerous, and routine monitoring of renal function is recommended.

Adenocarcinoma↗
PubMed1980

Os Odontoideum.

A review of the cases of thirty-five patients with os odontoideum, the largest series reported to date, supports the concept that trauma is the etiology of the abnormality. Most of the patients had roentgenographic instability of the affected spinal segment, and were treated with spine fusion. Eleven patients had lesions attributable to injuries received before they were four years old, although surgical treatment usually was delayed for one to eight years. Nine patients had documented roentgenographic evidence of a normal odontoid process prior to the development of the os odontoideum. Only one-third of the patients had any signs or symptoms indicative of neural deficits, although most patients had cervical pain. Surgical treatment alleviated the pain and instability.

Adolescent↗
PubMed1980

Treatment of interotrochanteric fractures with the Jewett nail: experience with 1,015 cases.

During the period 1957 to 1976, 1,015 Jewett nails were inserted for intertrochanteric hip fractures. This is one of the largest series of intertrochanteric fractures studied at one institution using one method of treatment. Anatomic reduction was attempted in almost all cases regardless of comminution. Medial or valgus displacement was rarely carried out on purpose. The average delay to surgery was 2.1 days after admission. Most parients were on bed-chair status on the first postoperative day and began toe-touching ambulation 10 to 14 days after surgery. Routine anticoagulation was not employed. The reduction and nail placement were critical factors for fracture healing. Only 3.3% of patients with satisfactory nailings had nail-related complications, such as penetration or cutting out. Eighty-seven per cent of patients with poor nailings had these problems. Ninety-eight and seven-tenths per cent of fractures united, 1.3% went to nonunion, and necrosis was seen in 2 united fractures (0.4%).

Aged↗
PubMed1980

Osteoid osteoma of the thoracic spine: report of a case.

Osteoid osteoma occurring in the thoracic spine, manifest as purely referred pain, is extremely uncommon. In the case of a 24-year-old man, the treatment for painful osteoid osteoma of the spine was excision. Since excision of a thoracic spinal osteoid osteoma compromised stability, a posterior fusion was performed at the time of excision, and the results were excellent.

Adult↗
PubMed1980

The telescoping Pugh nail in the surgical management of the displaced intracapsular fracture of the femoral neck.

In 187 intracapsular fractures of the femoral neck at St. Luke's Hospital from 1930 to 1971, the rates of nonunion and avascular necrosis have decreased with improved treatment methods. Since 1963, the Pugh nail has been used in displaced fractures. Two hundred and fifty six patients have been reviewed at an average of 2 1/2 year following injury, 90% (230) united and 17% (40) developed avascular necrosis. Twenty four of the 40 patients with necroses were asymptomatic and were considered to have satisfactory results. Therefore, 84% of the 256 patients had good or excellent results. The dangers and complications inherent in prosthetic replacement when used in potentially active patients as opposed to the paucity of these complications observed after use of the Pugh nail make nailing the preferred method of treatment.

Age Factors↗
PubMed1979

Tibial tubercle transfer: a long-range follow-up study.

The prime indications for tibial tubercle transfer are 2 or more complete patellar dislocations with trivial trauma or recurrent subluxation with or without pain causing "giving way." A high "Q" angle, flat lateral condyle, aplastic patella or positive apprehension test may be associated but are not always prime indications in surgery. Methods of fixation are of individual preference in this series and a single screw sufficed. An arthrotomy is not always necessary but is suggested if indicated. If the proximal tibial epiphysis is open, corrective measures are suggested that do not involve the extension of the proximal tibial epiphysis into the tibial tubercle. The tubercle should be advanced to compensate for patella alta and lined up with the femoral shaft. Transplantation of the tubercle medially 3/4'' and distally 1/2'' was generally satisfactory in a series of 377 operations with an average follow up of 3 1/2 years.

Adolescent↗
PubMed1978

The effect of small bowel bypass on diabetes mellitus.

The effect of jejunoileostomy on fasting blood sugar, glucose tolerance, hypoglycaemic therapy and weight reduction has been studied in 13 massively obese diabetic patients. The average weight reduction was 36.7 per cent of the preoperative body weight. As a result, 12 patients resumed normal fasting blood sugars and 8 showed normal glucose tolerance tests. A significant improvement in the glucose tolerance tests of the remaining 5 patients was seen. None of the patients required long term hypoglycaemic therapy after the small bowel bypass.

Adult↗
PubMed1978

Traumatic spondylolisthesis of the axis.

The lesions of C2 seen in hyperextension injuries of the cervical spine following motor vehicle accidents, diving accidents, and headlong falls resemble the cervical lesion found in judicial hangings. Although the mechanism of injury in these cervical fractures is different, the distinction is significant. The fracture seen in motor vehicular accidents today usually seems to be one of hyperextension and axial compression rather than hyperextension and distraction. This distinction is responsible for the low incidence of neurologic involvement seen in the fracture caused by motor vehicle accidents. The incidence of face and scalp injuries associated with axis pedicle fractures appears significant. Union of this fracture can generally be expected, and it rarely produces late sequelae. Management of this fracture is generally preferable on an ambulatory basis utilizing a cervicothoracic brace or a halo and caudal support in more unstable fractures. A period of 12 weeks of immobilization is recommended for satisfactory union of this fracture. Occasionally the treatment of this fracture may require traction or operative intervention. If operative intervention is required, an anterior route employing interbody fusion is suggested.

Accidents, Traffic↗