Ethical conflicts in long-term care of the aged.
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Aged↗
Biomedical subjects
R C Hamdy
Publications and source records attributed to R C Hamdy.
A special clinic for the over-65s in a GP surgery.
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Aged↗
Subacute hematogenous osteomyelitis: are biopsy and surgery always indicated?
Forty-four consecutive cases of subacute osteomyelitis admitted at our institution over a 12-year period were retrospectively reviewed to assess the effectiveness of conservative versus surgical treatment of this condition and to determine the indications for open biopsy and surgical debridement. Twenty-four cases were treated with antibiotics only, and 20 had surgical debridement followed by antibiotics. Except for one case that received inadequate antibiotic therapy, all patients responded well to this treatment, whether conservative or surgical. At an average follow-up of 18 months, there were no recurrences. Our results also showed that with a careful radiologic assessment of these cases, most lesions showed characteristic benign radiologic features. We can therefore conclude that conservative management of cases of subacute osteomyelitis is as effective as surgical treatment. We believe that conservative treatment with antibiotics should be the first line of management in most of these cases and that open biopsy or surgical debridement or both should be reserved for cases that do not respond to antibiotics or show aggressive radiologic features.
Adolescent↗
Use of bone scan in management of patients with peripheral gangrene due to fulminant meningococcemia.
Technetium bone scintigraphy was performed in four patients with fulminant meningococcemia and extensive peripheral gangrene. The bone scans showed variable levels of absent uptake in all extremities of the four patients who subsequently required quadrimembral amputations. In 13 limbs, the level of amputation was determined primarily by the bone scan findings, and operation was successful in 84% of those limbs. These findings suggest that bone scanning is a useful adjunct in differentiating viable from nonviable tissues in patients with extensive peripheral gangrene secondary to fulminant meningococcemia and thus helps determine the appropriate level of amputation in such patients.
Amputation, Surgical↗
Long-term effects of strokes on bone mass.
The purpose of the study was to determine the long-term effects of muscle weakness secondary to strokes on the bone mineral content of the hemiparetic limb. Patients who had experienced single recent strokes were studied. The bone mineral content of each limb was measured by Dual Energy X-ray Absorptiometry using the region of interest analysis program. Muscle strength of each muscle group was ranked using the Oxford scale, and the mean was calculated for each limb. Bone and muscle parameters were measured within seven days after the stroke and repeated thereafter at monthly intervals for up to 6 mo. A repeated measures analysis of variance, Newman-Keuls pair-wise comparisons, and orthogonal contrasts were done for each parameter. Significance levels were set at P < 0.05. Sixteen patients were included in this study. Demineralization was more pronounced in the upper than lower limbs. Demineralization of bones on the paralyzed side started during the first month after the stroke and gradually progressed. By the fourth month, the bone mineral content decreased by a mean of 9.3% (P = 0.01) and 3.7% (P = 0.01) in the upper and lower limbs, respectively, for the 11 patients followed for 4 mo. In the patients we followed for more than 4 mo, there was no further significant mineral loss. No change in bone mineral content was observed in the healthy nonparetic limbs. In conclusion, after a stroke, bone demineralization occurs in the paralyzed side and reaches its maximum within 3 to 4 mo. Arms are affected more than legs.
Absorptiometry, Photon↗
Correlation between ultrasound imaging and mechanical and physical properties of lengthened bone: an experimental study in a canine model.
The right tibias of 16 adult mongrel dogs were lengthened 2.5 cm using a uniplanar lengthening device (Orthofix). After the animals were killed in groups of 4 at 3, 6, 9, and 12 weeks postlengthening, ultrasound imaging and mechanical and physical testing was performed. There was a direct relationship between the percentage of intact cortices on ultrasound imaging and the mechanical and physical properties of lengthened bone. However, once 80-90% of all the cortices regained their continuity, the strength of the lengthened bone was only 50-60% that of the control. Ultrasound imaging, therefore, may be useful in predicting the mechanical and physical properties of lengthened bone in the early phases of limb lengthening. Once all the cortices become continuous, however, another method for assessment of the mechanical properties of lengthened bone should be used.
Animals↗