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Biomedical subjects

R E McCarthy

Publications and source records attributed to R E McCarthy.

At least 19 recordsLinked to original sources
PubMed2000

Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis.

BACKGROUND: Lymphocytic myocarditis causes left ventricular dysfunction that may be persistent or reversible. There are no clinical criteria that predict which patients will recover ventricular function and which cases will progress to dilated cardiomyopathy. We hypothesized that patients with fulminant myocarditis may have a better long-term prognosis than those with acute (nonfulminant) myocarditis. METHODS: We identified 147 patients considered to have myocarditis according to the findings on endomyocardial biopsy and the Dallas histopathological criteria. Fulminant myocarditis was diagnosed on the basis of clinical features at presentation, including the presence of severe hemodynamic compromise, rapid onset of symptoms, and fever. Patients with acute myocarditis did not have these features. The incidence of the end point of this study, death or heart transplantation, was ascertained by contact with the patient or the patient's family or by a search of the National Death Index. The average period of follow-up was 5.6 years. RESULTS: A total of 15 patients met the criteria for fulminant myocarditis, and 132 met the criteria for acute myocarditis. Among the patients with fulminant myocarditis, 93 percent were alive without having received a heart transplant 11 years after biopsy (95 percent confidence interval, 59 to 99 percent), as compared with only 45 percent of those with acute myocarditis (95 percent confidence interval, 30 to 58 percent; P=0.05 by the log-rank test). Fulminant myocarditis was an independent predictor of survival after adjustments were made for age, histopathological findings, and hemodynamic variables. The rate of transplantation-free survival did not differ significantly between the patients considered to have borderline myocarditis and those considered to have active myocarditis according to the Dallas histopathological criteria. CONCLUSIONS: Fulminant myocarditis is a distinct clinical entity with an excellent long-term prognosis. Aggressive hemodynamic support is warranted for patients with this condition.

Acute Disease↗
PubMed1999

Management of neuromuscular scoliosis.

Neuromuscular scoliosis is classified as a neuropathic or myopathic type. Cerebral palsy is the most common form of neuropathic type, and Duchenne's muscular dystrophy best characterizes the principles and recommended treatment for the myopathic type. Nonoperative measures rarely fully control a progressive scoliosis. Careful preoperative planning and surgery can achieve a well-balanced spine over a level pelvis with a good functional result.

Adolescent↗
PubMed1999

S rod fixation to the sacrum in patients with neuromuscular spinal deformities.

A new form of pelvic fixation has been designed for use in patients with neuromuscular spinal deformities to overcome the problems imposed by the Galveston technique. One end of a Luque rod is prebent into an S shaped configuration and placed over the sacral ala supplying firm fixation across the lumbosacral junction without crossing the sacroiliac joint. It fixes firmly against the sacral ala by distracting against a hook or screw in the lumbar spine. A 12 year retrospective review of 67 patients with severe neuromuscular spinal deformities was accomplished. All surgeries were performed by one surgeon. All patients had good deformity correction with an average followup of 6 years and 2 months. Complications included: recurrence of pelvic obliquity (one patient), skin break-down over hardware (one patient), migration of hardware at sacrum (two patients), and rod breakage (five patients). The S rod is recommended for all patients with neuromuscular spinal deformities who require instrument fixation to the pelvis. Its ease of insertion and decreased operative time allow for a safe and dependable alternative fixation to the sacrum without crossing the sacroiliac joint.

Adolescent↗
PubMed1999

Back pain in childhood and adolescence.

A variety of disorders can account for back pain in the child or adolescent (Outline 1). Some of these can result in significant morbidity if not properly diagnosed and treated. Fortunately, nearly all can be correctly diagnosed by taking a thorough medical history, performing a complete physical examination, and obtaining appropriate imaging and laboratory studies. Although back pain in children and adolescents may result from overuse or minor trauma and will respond to rest and anti-inflammatories, this review should enable the orthopaedist to systematically recognize those back disorders in need of more aggressive medical intervention.

Adolescent↗
PubMed1998

A review of the amyloidoses that infiltrate the heart.

Primary amyloidosis, systemic senile amyloidosis, isolated atrial amyloidosis, and transthyretin isoleucine 122 amyloidosis frequently involve the heart. Amyloid fibrils infiltrate the myocardium, impairing ventricular contraction and relaxation. The clinical manifestations of cardiac infiltration in these disorders are protean, though congestive heart failure and arrhythmias are most common. Treatment of cardiac amyloidosis is directed at the underlying cause and at relief of symptoms. Heart transplantation is not a viable treatment option for patients with primary amyloidosis; its role in the other amyloidoses has not been established. The prognosis of patients with cardiac amyloidosis varies and is largely determined by the underlying disorder responsible for amyloid infiltration.

Aged↗
PubMed1993

The use of total circulatory arrest in the surgery of giant hemangioma and Klippel-Trenaunay syndrome in neonates.

Two neonates required deep hypothermia and circulatory arrest to provide a central control of blood loss for the resection of giant cavernous hemangiomas. Both infants were placed on cardiopulmonary bypass, cooled to 16 degrees, and exsanguinated before resection of these peripheral lesions. The surgery was done as a lifesaving measure in both instances because both infants were suffering from high-output cardiac failure. In both cases, the small total blood volumes were critical in excision of these hypervascular tumors. Use of the techniques described allowed for the surgery to be performed in a bloodless field over a short period (one hour), thus preventing massive blood loss. Both patients are living with no neurologic or developmental deficits more than five years after the operation.

Amputation, Surgical↗
PubMed1990

Air embolism in spinal surgery.

We present two cases of fatal venous air embolism that occurred in previously healthy adolescents during posterior spine fusion and instrumentation for scoliosis. Previously recorded cases in the literature have been rare and only briefly discussed. Air embolism has been a complication noted in the anesthesia and neurosurgical literature, occurring primarily in total hip patients and those patients undergoing neurosurgical procedures in a sitting position. An examination of the pathophysiology of air embolism in posterior spinal procedures would indicate the use of properly placed central lines and end-expiratory CO2 monitoring as the primary modes of detection and treatment considering the potentially fatal risk factors for spinal patients.

Adolescent↗
PubMed1989

High-resolution hip ultrasound in the limping child.

Hip ultrasound was performed on 44 children (114 exams) presenting with a painful hip or a limp thought to be due to hip disease. Effusions were found in 20 patients (21 hips). Hip ultrasound in combination with aspiration of the joint was found to be useful in diagnosis of osteomyelitis and septic joints, transient synovitis, trauma, and traumatic synovitis. We had no false positives or false negatives for hip effusions by ultrasound. In previous reports, absolute measurements have been relied upon for determination of hip effusions. We present a characteristic appearance of a capsule with and without abnormal joints fluid. The results of these 44 patients are summarized.

Arthritis, Infectious↗
PubMed1989

Pseudomonas osteochondritis complicating puncture wounds of the foot in children: a 10-year evaluation.

From 1978 to 1988, microbiologically proven Pseudomonas osteochondritis and septic arthritis following nail puncture wound to the foot was diagnosed in 77 children aged 18 mo-19 y (77 and 17 cases, respectively). The syndromes were found in children with a history of wearing tennis shoes (70 cases), other shoes (5), and no shoes (2). All cases had surgical debridement of the infected cartilage or bone and drainage of infected joints. Pseudomonas aeruginosa was isolated in 38 cases and in conjunction with Staphylococcus aureus in 18. Anti-Pseudomonas antibiotics were initiated in all cases before surgical exploration; the average duration of treatment was 7.5 +/- 1.2 d postoperatively. Patient follow-up was 5.2 +/- 3.4 y (median, 4.8 y; range, 3 mo-10 y). Two relapses occurred; both patients had a previously undetected septic arthritis. These data suggest that with aggressive surgical management, Pseudomonas osteochondritis and septic arthritis can be treated effectively with postoperative antibiotics for 7 d.

Adolescent↗
PubMed1989

Luque fixation to the sacral ala using the Dunn-McCarthy modification.

The Galveston-Luque technique of fixation to the pelvis requires solid bone and a strong pelvis. Because the majority of neuromuscular patients who require fixation to the pelvis have a weak and thin illum, an alternative to the Galveston technique was sought. A technique of rod contouring was developed that takes advantage of the reliable, stout bone of the sacral ala for fixation. Twenty-four patients have been instrumented with Luque rods and fused to the sacrum over the past 4 years using the technique. There have been no complications in this short follow-up.

Follow-Up Studies↗
PubMed1988

Altered gentamicin disposition in a child with a cavernous hemangioma.

Physiologic third spacing can cause an increase in the volume of distribution of certain drugs, such as aminoglycosides, which results in a decrease in the serum concentration. The case reported here, that of a child with a large cavernous hemangioma, demonstrated this phenomenon. To obtain adequate serum and tissue concentrations, alteration of antimicrobial dosing may be needed in similar cases.

Amputation, Surgical↗
PubMed1988

Role of starch as a substrate for Bacteroides vulgatus growing in the human colon.

Bacteroides vulgatus is the numerically predominant Bacteroides species in the human colonic microflora. Unlike other colonic Bacteroides species, B. vulgatus is not a versatile utilizer of polysaccharides. The only types of polysaccharide that support rapid growth and high growth yields by all strains are the starches amylose and amylopectin. Amylase and alpha-glucosidase activities are among the highest found in a bacterial fraction obtained from human feces. This observation raised the question of whether B. vulgatus was the source of the fecal enzymes. Both alpha-glucosidase and amylase were produced at 20- to 40-fold-higher levels when B. vulgatus was grown on maltose, amylose, or amylopectin than when B. vulgatus was grown on glucose or other monosaccharides. Both enzymes had the same pI (4.6 to 5.0) and undenatured molecular weight (150,000). The pIs and molecular weights of the B. vulgatus amylase and alpha-glucosidase were the same as those of the fecal enzymes. To determine whether the B. vulgatus alpha-glucosidase was identical to the fecal alpha-glucosidase, we partially purified the B. vulgatus enzyme and raised an antiserum against it. Using this antiserum, we showed that all strains of B. vulgatus produced the same enzyme. The antiserum did not detect the B. vulgatus alpha-glucosidase in the bacterial fraction from human feces, even when a partially purified preparation of the fecal enzyme was used. Thus the alpha-glucosidase activity in the bacterial fraction from human feces is not the B. vulgatus enzyme.

Amylases↗
PubMed1988

Importance of mucopolysaccharides as substrates for Bacteroides thetaiotaomicron growing in intestinal tracts of exgermfree mice.

We used two approaches to determine whether the mucopolysaccharide chondroitin sulfate is an important source of carbon and energy for Bacteroides thetaiotaomicron in the intestinal tracts of germfree mice. First, we tested the ability of three mutants that grew poorly or not at all on chondroitin sulfate to colonize the intestinal tract of a germfree mouse and to compete with wild-type B. thetaiotaomicron in this model system. One mutant (CG10) was rapidly outcompeted by the wild type. However, since this mutant was unable to grow on chondroitin sulfate because it could not grow on N-acetyl-galactosamine, one of its monosaccharide components, this mutant might also be unable to utilize glycoprotein mucins. Two mutants (46-1 and 46-4) were isolated that grew poorly on chondroitin sulfate but normally on both component sugars. One of them was outcompeted by the wild type, but the percent wild type increased more slowly than with CG10. In one experiment, the percent wild type never reached 100%. The other (46-4) was not outcompeted by the wild type. These results indicate that, although chondroitin sulfate may be a carbon source in the animal, it is not of major importance. Our second approach was to determine by immunoblot analysis whether a 28-kilodalton outer membrane protein that is produced by B. thetaiotaomicron only when it is grown on chondroitin sulfate or hyaluronic acid was being produced at induced level by B. thetaiotaomicron growing in the ceca of exgermfree mice. There was no evidence for induction of this protein in vivo. Thus, the immunoblot results are consistent with results of the mutant competition experiments.

Animals↗
PubMed1988

A locking collar for Luque rods.

The migration of hardware has been a problem in the Luque system of segmental spinal instrumentation. To prevent this migration, a device was designed to slip on the 3/16th inch or 1/4 inch Luque rod. This prevents movement between the wire-rod interface, stopping both distal and proximal rotation of the rod. This article reports 21 patients with neuromuscular scoliosis on whom this technique was used. There was no migration of hardware and only one wire breakage in an area separate from the locking collar. These results are a marked improvement from patients of previous reports who did not receive the new device. Laboratory testing on the locking collar determined the best location on the "L" rod to be in the middle third of the rod. Rod migration has essentially been eliminated with this technique.

Adolescent↗
PubMed1988

Avascular necrosis of the femoral head in children.

Two types of AVN occur in childhood. The first is the idiopathic type best characterized by Legg-Calvé-Perthes' disease associated with repeated infarctions that slow the healing process. The second is the traumatic type caused by a direct insult to the blood supply of the developing femoral head. Both can result in profound growth disturbances of the proximal femur and early degenerative changes. They may have little effect on hip function or appearance. The variables affecting these outcomes are the age of the child, the degree of femoral head involvement, the presence of at-risk signs, the ability of the acetabulum to contain the healing head, and whether or not the growth plate closes as a result of the AVN. Bone scans and magnetic resonance imaging offer some potential for improved accuracy in diagnosis and prediction. The recommendation treatment for AVN in children is to treat the synovitis whenever it occurs or recurs. Abduction bracing should be used for the first six months in most young children with idiopathic AVN of the Legg-Calvé-Perthes' type. Protected weightbearing with crutches should suffice for the early phases of traumatic AVN. Within six months, one should be able to determine the classification and whether to continue the treatment being used or to change to another form of treatment. Petrie casts are used rarely but can be very useful in certain patients. Prolonged crutch use may help to prevent collapse while relieving symptoms in the older child.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1988

Proximal femoral resection to allow adults who have severe cerebral palsy to sit.

Resection of the proximal end of the femur and interpositional arthroplasty was done in thirty-four patients (fifty-six hips) to allow the patients to sit comfortably and to make perineal care painless. All of the patients were severely handicapped because of cerebral palsy, were unable to walk, and were residents of one of two state institutions. After a minimum follow-up of two years, the result had not deteriorated in thirty-three of the thirty-four patients.

Adolescent↗