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Biomedical subjects

R B Winter

Publications and source records attributed to R B Winter.

At least 163 records · Page 9Linked to original sources
PubMed1977

Congenital kyphosis.

Congenital kyphosis is an uncommon, but potentially devastating anomaly of the spine. Without treatment, the tendency is for severe, and sometimes catastrophic deformity. It is the most common etiology for spinal cord compression due to spine deformity, excluding tuberculosis. Few patients have nonprogressive benign lesions. Late treatment is difficult and dangerous. Braces and other forms of non-operative treatment do not work. The best treatment is early posterior fusion, before the curve reaches 50 degrees and before age 5 years. For curves over 60 degrees and over age 5, both posterior and anterior fusion are necessary. If cord compression exists, laminectomy is contraindicated. Anterior cord decompression and fusion are required.

Adolescent↗
PubMed1977

Long-term follow-up of Perthes' disease treated nonoperatively.

Forty-six patients with Perthes disease treated nonoperatively were reviewed 10 to 43 years later. The median follow-up was 17 years. The patients were analyzed according to sex, age of onset, quantity of head involvement, type of treatment, duration of treatment, functional end result based on the Harris hip scale, and anatomic end result based on Mose templete evaluation. Most patients were treated with an ischial weight-bearing brace. The anatomic results of this treatment tended to be poor, probably worse than no treatment at all. In general, poor results were correlated with late onset, greater quantity of head involvement, and lateral subluxation of the femoral head. As reported in other series, the anatomic results did not correlate well with the functional results, only two patients having Harris hip scales below 70.

Female↗
PubMed1976

Spine deformity in children: Current concepts of diagnosis and treatment.

Idiopathic scoliosis is a frequently occurring disorder of unknown cause that is the most likely spine deformity to be seen by the pediatrician or family physician. Very mild curves (up to 20 degrees) are periodically observed, under controlled measurement, but not actively treated. Moderate curves (20 to 45 degrees) or progressive curves of less than 20 degrees are treated with braces. Severe curves (more than 45 degrees) are usually treated surgically. The greatest need at the present time is for better early detection and prompt referral to an adequate treatment program.

Adolescent↗
PubMed1976

Congenital kyphoscoliosis with paralysis following hemivertebra excision.

This is a case report of a 13-year-old girl with a severely progressive congenital kyphoscoliosis, treated by halo-femoral traction and a single stage anterior and posterior hemivertebra excision. Forty-eight hours after surgery she developed paralysis of bowel, bladder and all motor function with partial preservation of deep sensation only. She began to have neurologic recovery 2 months later with gradual return of a completely normal neurological status over a period of 12 months. Pseudarthrosis and loss of correction of the original deformity required a second major anterior spine fusion 16 months after the initial procedure. No neurologic problems occurred following the second anterior fusion. A stable correction was ultimately achieved. The mechanism of postoperative paralysis is unknown.

Adolescent↗
PubMed1975

Scoliosis in Marfan's syndrome. Its characteristics and results of treatment in thirty-five patients.

Of sixty-four patients with Marfan's syndrome, thirty-five had scoliosis, which in 44 per cent began in the infantile and juvenile age periods. The curve patterns were double major right thoracic-left lumbar in 48 per cent and single right thoracic in 33 per cent. At the start of treatment the curves were severe (average, 72 degrees) and quite structural (average bending correction, 36 per cent). Seventy-four per cent of the thirty-five patients had back pain. Inadequately treated and untreated curves usually progressed to severe and painful deformity. Milwaukee brace treatment was generally unsuccessful because of the severity and rigidity of the curves or the poor maintenance of correction obtained. Spine fusion combined with Harrington rod instrumentation (fourteen patients) gave an average correction of 41 per cent with an average loss of 7 degrees (average follow-up, 2.3 years). Operative treatment of scoliosis is indicated in most patients with Marfan's syndrome.

Adolescent↗
PubMed1975

Scheuermann's kyphosis. Results of surgical treatment by posterior spine arthrodesis in twenty-two patients.

Twenty-two patients with Scheuermann's kyphosis were treated with correction, Harrington instrumentation (in twenty-one), and posterior spine fusion. This procedure relieved pain and corrected deformity in all patients but loss of correction of 5 degrees or more occurred in sixteen of the twenty-two patients, including all those whose initial kyphosis was greater than 70 degrees. The incidence of complications was so high that this procedure should ordinarily be performed only for disabling pain or spinal cord compression.

Adolescent↗
PubMed1975

Excessive thoracic lordosis and loss of pulmonary function in patients with idiopathic scoliosis.

Idiopathic thoracic lordoscoliosis is more common and more productive of respiratory compromise than is kyphoscoliosis. In some patients with idiopathic scoliosis, thoracic lordosis is the predominant component of the disease. Five such patients, all of whom had idiopathic scoliosis with excessive thoracic lordosis, progressive deformity despite Milwaukee brace treatment, and significant compromise of pulmonary function, are presented. Harrington instrumentation (distraction rod only) and spine fusion improved the deformity and respiratory function. The recommended treatment for this type of idiopathic scoliosis is early recognition and prompt surgical correction. The Milwaukee brace should be avoided. Postoperative management must include early ambulation combined with vigorous breathing exercises.

Child↗
PubMed1974

The location of the repressor binding sites in the lac operon.

The affinity of various mutant lac DNAs for the lac repressor was examined by means of a competition binding assay. The results indicate that there exist at least two binding sites for the lac repressor. The primary binding site is coincidental with the operator, as defined by genetic studies. Mutations of the promoter or the Z gene have little or no effect on the repressor binding properties of this primary binding site, thereby confirming that the operator is distinct from lacP and Z. The secondary binding site(s), which has a 25- to 31-fold lower affinity for the repressor, is located within the operator proximal third of the Z gene.

Binding Sites↗