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Biomedical subjects

M J Bell

Publications and source records attributed to M J Bell.

At least 73 records · Page 4Linked to original sources
PubMed1991

Ischiopagus tetrapus twins: urological aspects of separation and 10-year followup.

Conjoined twins occur once in 50,000 births. Only 6% of conjoined twins are of the ischiopagus type in which the twins are joined symmetrically at the pelvis and fusion begins at the level of the common umbilicus. The longitudinal axis extends in a straight line in opposite directions and the genitourinary and gastrointestinal tracts are shared. Tetrapus is a subtype in which all 4 lower extremities are present and oriented at right angles to the axis of the common trunk. Two sets of female ischiopagus tetrapus twins were born in 1977 and successfully separated at the St. Louis Children's Hospital in the following year. We describe the genitourinary and associated anomalies, surgical separation and long-term urological followup of these 2 sets of ischiopagus tetrapus twins.

Abnormalities, Multiple↗
PubMed1991

An investigation into the etiology of irritable hip.

A prospective review has been made of 111 children who presented with acute hip pain to determine it's etiology and assess the need for multiple investigations at presentation. There was no clinical hematological, serological or bacteriological evidence to identify positively patients with an irritable hip, neither was there good correlation with a history of infection. An effusion was diagnosed by ultrasound in 71% but there were no factors, either clinically or by investigation, to differentiate between patients with or without an effusion. We conclude that multiple investigations to find a source of infection in patients with irritable hip are not warranted as they are rarely positive, seldom affect management and are of no help in investigating the etiology of irritable hip.

Adolescent↗
PubMed1991

Comparison of four articular indices for use in clinical trials in rheumatoid arthritis: patient, order and observer variation.

Using a Latin square design, 4 patients were examined by 4 rheumatologists. Joints were scored for tenderness and inflammation. The Ritchie, the index of the American Rheumatism Association (ARA), the Hart modified Ritchie and a simplified Lansbury index were calculated from the raw data. The results suggest that an articular index consisting of a simple count of tender joints (Hart modified Ritchie) or a simple count of tender or swollen joints (ARA index) are the most reproducible with multiple observers. We suggest that these indices would be most appropriate for multicenter clinical trials.

Arthritis, Rheumatoid↗
PubMed1991

Results of leg lengthening using Wagner's technique.

Nineteen leg lengthenings by Wagner's technique were reviewed. Average patient age was 13 years (range, 8-18 years). The gain averaged 3.9 cm (range, 1.1-10 cm). Complications were prolonged treatment period (9 cases), metal-work failure (6), loss of gain (5), malunion (6), fracture (5), deep infection (2), and joint problem (6). The osteogenesis in the elongation gaps affected the results. No callus formation by 40 days after osteotomy and no bridging callus by the end of elongation period were warning signs of poor osteogenesis. All tibial lengthenings and femoral lengthenings of more than 5 cm or 13% of the original length were at risk of poor osteogenesis. Proper stabilization and bone grafting were the most effective measures for poor osteogenesis. Currently, Wagner's technique is not the treatment of choice because new techniques with fewer complications are available. However, Wagner's technique is useful in the cases to which the new procedures are not applicable.

Adolescent↗
PubMed1990

Measurement of functional status, quality of life, and utility in rheumatoid arthritis.

In 40 years of development in the area of quality of life, the goal of applicability to the individual patient has not been accomplished. During the 1980s, we strived to improve the applicability of these instruments by refining disease-specific measures and developing patient-specific measures so that the sensitivity of these tools to clinically important change could be increased and comparative indices across conditions could be established. Finding the balance between brevity, reliability, and comprehensiveness will improve practicality. The reliability of serial measurements using the various instruments in individual patients and in small groups of patients needs to be established. In the absence of a gold standard, validity will continue to be derived from testing new measures against accepted clinical measures. The ideal tool for use in clinical practice has not yet been developed. At this time, the clinician may choose among the many reliable and valid questionnaires assessing functional status, health status, and utility, according to his or her purpose. The information gathered from these instruments may help identify patients' problems, set treatment priorities, direct interventions, monitor the longitudinal course of disease, and assist in program evaluation and policy planning.

Activities of Daily Living↗
PubMed1990

Ultrasound examination of the irritable hip.

We made a prospective study of 111 children with acute hip pain to assess whether ultrasound can replace traditional radiography. An effusion was diagnosed in 71% by ultrasound but in only 15% by radiography. This effusion persisted for a mean of nine days; symptoms lasted for five days. Two patients found to have Perthes' disease had longer-lasting effusion and symptoms. Patients without an effusion had no obvious cause for their pain, so the pressure of an effusion from a transient synovitis does not account for all patients with irritable hips. Patients with an effusion persisting for over 24 days (the mean + 2 s.d. of our series) had more symptoms, a significantly larger effusion and greater limitation of movement. They may be more at risk for avascular necrosis. We found that radiographic examination influenced the immediate management of only two patients, those with Perthes' disease. We therefore propose a protocol of management for irritable hip, using ultrasonography at the first presentation of certain categories of patients. This would reduce the number of early radiographs by 75%.

Adolescent↗
PubMed1990

Extending intramedullary rods in congenital pseudarthrosis of the tibia.

Five patients with Boyd type II congenital pseudarthrosis of the tibia underwent excision of the pseudarthrosis and double onlay bone grafting. Stability was maintained by extending intramedullary rods. Clinical union was achieved in all cases at a mean of 8.6 months (range six to 11). The rods extended by 15.7% (range 2% to 31.4%) as growth occurred. One rod was removed because of infection and a vascularised free fibular graft was subsequently performed. The extending rods provided stability while union occurred and did not require revision as the legs grew. The rods can be removed easily and have not jeopardized further surgical options.

Bone Transplantation↗
PubMed1989

Carpal malalignment in Colles' fractures.

Thirty-two unilateral Colles' fractures were reviewed after one year to assess the evidence for carpal malalignment. Various radiographic parameters on the injured and uninjured wrists were correlated with a functional score. There was significant correlation with respect to the angles measuring carpal alignment on the late films and the functional score which was not present on either the initial or post-manipulation films. The carpus aligns in a dorsal instability pattern. Radial angulation or shortening was not found to be as significant in either the early or late films. This suggests that dorsal instability as the cause of morbidity after Colles' fracture is far commoner than originally thought.

Aged↗
PubMed1989

Gamekeepers thumb: a prospective study of functional bracing.

Patients with acute thumb metacarpophalangeal joint injuries were assessed by stress radiography, arthrography, and clinical examination. Arthrograms served to assess tissue injury by the extent and location of dye leaks including the differentiation of displaced (Stener lesion) from undisplaced tears of the ulnar collateral ligament. Patients were treated for a minimum of 6 weeks by use of a removable custom-fit splint and daily range of motion exercises, and followed at a minimum of 1 year. In the 32 patients available for follow-up, mean relative instability improved from 17 degrees (after injury) to 2.3 degrees (follow-up) (p = 0.0001). Functional and subjective outcomes were good or satisfactory in more than 90% of patients; outcomes for all patients with Stener lesions were satisfactory, although joint stabilization was less than in the whole group. The three failures involved persistent symptoms, that defied subsequent surgery. These cases could not be predicted from the initial clinical tests. The treatment regimen was an economical, noninvasive, and effective method for a range of acute thumb metacarpophalangeal joint injuries.

Adolescent↗
PubMed1989

The role of expanding intramedullary rods in osteogenesis imperfecta.

We report the results of using 83 expanding intramedullary rods in 24 children with osteogenesis imperfecta after a mean follow-up of five years three months. In all, 62% of the rods have expanded after one primary operation. Thirty-four additional operations were necessary; 11 for the correction of rotation or angulation deformities and 23 for revision of the rod or T-piece. All these revisions were successful. Complications were more frequent in children who required very small rods. Problems with Bailey-Dubow rods led to the development of the Sheffield rod system; 17 bones treated with these rods are included in the series. Before surgery only eight of the 24 children were able to walk but at review 20 children were walking, 15 without walking aids. Elongating intramedullary rods should be available to all children with osteogenesis imperfecta as they improve walking capability, reduce the number of fractures, prevent deformity and allow integration of the child into society.

Adolescent↗
PubMed1988

The management of dropfoot using the Lambrinudi arthrodesis.

The results of 12 Lambrinudi arthrodeses in 10 patients with spinal dysraphism were compared with 11 operations performed in patients with only motor nerve deficits performed over the same 10 year period. The early failure and complications were more common in these patients and the tendency to recurrence of dropfoot occurred earlier. Despite this, the operation was effective in the management of these patients, especially for the improvement of co-existent sores or the fitting of shoewear.

Adolescent↗
PubMed1987

Irreducible congenital dislocation of the knee. Aetiology and management.

We report nine cases of irreducible congenital dislocation of the knee which were treated by early operation with good results. All were resistant to conservative measures and operation was performed at an average age of nine months. The essential abnormality was a short quadriceps muscle together with subluxation of the hamstring muscles to lie anterior to the axis of knee flexion. The quadriceps tendon was lengthened by VY-plasty and in six cases additional length was gained by proximal mobilisation of the muscle. After operation all the patients were able to walk.

Female↗
PubMed1985

Peritonitis in the newborn--current concepts.

The author provides well-detailed discussion of peritonitis in the newborn and draws the following conclusions. Prognosis for neonates with gastrointestinal perforation has considerably improved and will continue to improve. Sepsis remains the primary cause of death, with necrotizing enterocolitis the most common cause of perforation. The characteristic gastrointestinal microflora and innate immunologic deficiency of this population, particularly in the critically ill preterm neonate, require further delineation.

Anti-Bacterial Agents↗