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Biomedical subjects

R H Rothman

Publications and source records attributed to R H Rothman.

At least 109 records · Page 6Linked to original sources
PubMed1985

The development of a cervical spine algorithm and its prospective application to industrial patients.

Disorders of the cervical spine are prevalent among industrial employees, but there has been no standardized approach to the treatment and diagnosis of these patients. The purpose of this study is to present a protocol (an algorithm, in this case computerized) designed for cervical spine patients and to evaluate the results of its application to a group of industrial patients with neck problems. The results demonstrated reductions in number of patients seen (by 54%), in number of lost work days (by 65%), and in costs (by 63%). We conclude that good medicine leads to cost savings in treatment of cervical spine injuries and that use of a computerized algorithm is both necessary and practical for consistent care in the compensation setting.

Absenteeism↗
PubMed1985

Intraspinal synovial cyst causing sciatica.

Four patients who had low-back pain and sciatica were diagnosed as having a lumbar intraspinal extradural synovial cyst adjacent to a facet joint between the fourth and fifth lumbar vertebrae. The patients ranged in age from forty-nine to seventy-one years, and the symptoms and signs involved the fourth or fifth lumbar-nerve roots. Roentgenographically, degeneration of the intervertebral discs and facet joints was noted in every patient. Degenerative spondylolisthesis was also a frequent finding. Myelography and computed tomographic scans aided in diagnosis, revealing a soft-tissue lesion, occasionally rimmed with calcification, adjacent to the involved facet joint. The treatment was surgical excision of the cyst, as well as complete laminectomy if there was concomitant spinal stenosis. Follow-up, ranging from eighteen to twenty-five months, revealed complete resolution of the sciatica in all patients.

Aged↗
PubMed1984

Industrial low-back pain. A prospective evaluation of a standardized diagnostic and treatment protocol.

This investigation applied a diagnostic and treatment protocol to two groups of industrial workers: 5,300 employees at Potomac Electric Power Company ( PEPCO ) for two years and 14,000 United States Postal Service workers for one year. An "active" system in which patients were evaluated weekly was implemented at the power company, and a "passive" system in which patients were seen only once was instituted at the U.S. Postal Service. The physicians were unbiased , in that they could not take part in the patients' ongoing care. The results in both groups demonstrated significant and continuous reductions in number of incidents, in days lost from work, in low-back surgery, and in financial costs. The number of low-back pain patients at PEPCO decreased 29% the first year and 44% the second; days lost from work decreased 51% the first year and 89% the second; low-back surgery dropped 88% the first year and 76% the second year. Results for the U.S. Postal Service demonstrated a decrease in the number of low-back pain patients (41%), in days lost from work (60%), and in financial costs (55%). These results, along with our observations about the study, led us to the following conclusions: (1) Good medicine leads to cost savings in treating industrial low-back pain. (2) Use of a standardized medical approach and nomenclature is necessary and practical, for consistent care. (3) A good record keeping system is essential to perform useful medical analyses for identifying scientific problems. (4) Unbiased medical surveillance leads to changes in behavior of both treating physicians and patients. (5) The outcome for most low-back pain patients in industry is not as grim as previously perceived if their medical management is approached in an organized manner.

Absenteeism↗
PubMed1984

Long repair replication patches are produced by the short-patch pathway in a uvrD252 (recL152) mutant of Escherichia coli K-12.

The uvrD252 mutation leads to increased UV sensitivity, diminished dimer excision and host cell reactivation capacity, and an increase in the average patch size after repair replication. A recA56 uvrD252 double mutant was far more resistant to UV than was a recA56 uvrB5 double mutant. Its host cell reactivation capacity was identical to that of uvrD252 single mutant and was far greater than that of the uvrB5 single mutant. The strain showed no Weigle reactivation. From these results, we concluded that the double mutant has no inducible DNA repair (including long-patch excision repair) but retains dimer excision capabilities comparable to the uvrD252 single mutant. It appears, therefore, that the long patches detected in the uvrD mutant were not identical to the recA-dependent patches seen in wild-type cells.

DNA Repair↗
PubMed1984

A study of computer-assisted tomography. II. Comparison of metrizamide myelography and computed tomography in the diagnosis of herniated lumbar disc and spinal stenosis.

One hundred twenty-two patients with surgically confirmed pathology consisting of either herniated lumbar disc, spinal stenosis, or both were included in this investigation. For each of these patients, preoperative metrizamide myelography and computerized tomography were performed. Each myelogram and CT scan was read blindly so that the neuroradiologist interpreting the study had no knowledge of the patient's surgical pathology, clinical examination, nor any knowledge of the interpretation of the other preoperative test. A painstaking attempt was made to describe precisely both the exact nature of the preoperative myelogram and CT scan interpretations. The correlations between the preoperative interpretation of each test and the observed surgical findings then were analyzed statistically. Based upon this analysis, myelography was found to be more accurate than computed tomography in the diagnosis of herniated lumbar disc (83% vs. 72%). In the diagnosis of spinal stenosis, myelography was slightly more accurate than computed tomography (93% vs. 89%). Based upon the results of this study, the authors conclude that metrizamide myelography is more accurate than computed tomography in the diagnosis of both herniated lumbar disc and spinal stenosis and remains the diagnostic study of choice for these conditions. Furthermore, metrizamide myelography gives the added advantage of visualizing the thoracolumbar junction and, thus, affords the opportunity to diagnose occult spinal tumors.

False Negative Reactions↗
PubMed1984

The pharyngovertebral veins: an anatomical rationale for Grisel's syndrome.

UNLABELLED: Non-traumatic subluxation of the atlanto-axial joint following peripharyngeal inflammation (Grisel's syndrome) has been attributed to laxity of the transverse ligament caused by hyperemia, but a satisfactory anatomical rationale for the association of these conditions has been lacking. Injection of the cervical epidural sinuses of a series of human perinatal cadavera showed retrograde filling of a previously undescribed system of veins with frequent lymphovenous anastomoses. This system appears to drain the posterosuperior pharyngeal region. CLINICAL RELEVANCE: Because of their direct connection with the periodontoidal venous plexus and the suboccipital epidural sinuses, the pharyngovertebral veins may provide a hematogenous route for the transport of peripharyngeal septic exudates and neoplastic cells to the upper cervical spinal structures and provide an anatomical explanation for the atlanto-axial hyperemia of Grisel's syndrome.

Adult↗
PubMed1983

The indications for metrizamide myelography. Relationship with complications after myelography.

To test the validity of our impression that in the absence of objective clinical evidence of nerve-root impingement there is a disproportionately high incidence of complications associated with myelography, the results in 248 patients were reviewed retrospectively and those in 110 were studied prospectively. Of all 358 patients, 53 per cent had complications after myelography with injection of metrizamide, of which headache and nausea and vomiting were the most frequent. The incidence of complications in the 112 patients whose objective clinical and myelographic findings were consistent was compared with that in the 180 patients who had only subjective complaints and normal myelographic findings. The incidence of complications was 30 per cent in the former group and 70 per cent in the latter group, an almost twofold difference (p greater than 0.05). The 110 patients in the prospective study were asked to grade the intensity of their headache after myelography. Of the thirty-one patients with positive objective clinical and myelographic findings, ten complained of headache, which was mild in seven (70 per cent) and severe in three. Of the sixty patients with only subjective complaints, thirty-eight complained of headache, which was mild in twelve (32 per cent) and severe in twenty-six.

Adolescent↗
PubMed1983

Clinical usefulness of CT scanning in the diagnosis and treatment of lumbar spine disease.

CT scanning of the lumbar spine is in its infancy. Nevertheless, it has had a remarkable effect on the way we evaluate and treat patients. The principal advantages are the following: (1) If the scan alone in the diagnostic work-up of patients with lumbar disc herniation and correlative neurologic deficit. (2) The CT scan aids in the screening of patients with back and leg pain who did not have a neurologic deficit. It may determine the need for further studies such as myelography. (3) CT has become helpful in the evaluation of patients with lumbar spinal stenosis and may replace myelography when greater experience is garnered. (4) CT is of great value in the evaluation of the lumbar spine previously operated on and may provide diagnostic information unavailable on the myelogram because of dural scar formation, arachnoiditis, and so on. (5) Future comparative studies probably will indicate greater accuracy with CT scanning than with myelography, and consequently, the overall diagnostic acumen in the treatment of patients with lumbar spine disease will be improved.

Humans↗
PubMed1983

Effects of thermal therapy on rehabilitation after total knee arthroplasty. A prospective randomized study.

The role of local heat or cold therapy used in conjunction with exercise in the rehabilitation of total knee arthroplasty patients was investigated. Thirty-six osteoarthritic patients were analyzed. Parameters evaluated were range of motion, swelling about the knee, and pain. All patients received the total condylar knee prosthesis and began range of motion rehabilitation fourteen days after operation. Results showed that temperature alteration does not augment passive range of motion after total knee arthroplasty. It was also shown that cold application decreases swelling as compared with heat. Additionally, the application of cold partially alleviates the discomfort of the rehabilitation process in certain patients.

Aged↗
PubMed1982

The detection and prevention of pulmonary embolism in total hip replacement. A study comparing aspirin and low-dose warfarin.

Because of the controversy surrounding prophylaxis for thromboembolism after total hip surgery, we undertook a prospective study comparing the results of the administration of aspirin with that of low doses of warfarin in 194 patients (200 hips) undergoing total hip replacement. The incidences of both clinically apparent and silent (asymptomatic) pulmonary emboli were determined using the objective criteria of preoperative and postoperative levels of arterial blood gases, chest roentgenograms, electrocardiograms, and perfusion lung scans. With this surveillance plan, the accuracy of diagnosis of clinically symptomatic pulmonary emboli was improved and the detection of otherwise silent pulmonary emboli became possible. The group of patients who received low doses of warfarin showed a 6 per cent total incidence of pulmonary emboli compared with a 19 per cent incidence in the group receiving aspirin (p less than 0.05). There was, however, no significant difference when the incidences of only the clinically suspected emboli were compared, the rates for the two groups being 5 and 8 per cent, respectively (p greater than 0.05). There was also no significant difference between men and women with regard to the prophylactic efficacy of aspirin in preventing pulmonary embolism.

Aspirin↗
PubMed1981

Multiple thoracic spine fractures complicating ankylosing hyperostosis of the spine.

Ankylosing hyperostosis of the spine is a distinct clinical entity that merits diagnosis and recognition of its structural limitations. The case of multiple thoracic spine fractures presented here emphasizes the potentially increased susceptibility of involved spines to trauma and also suggests the need to caution diagnosed patients from placing their spines at undue risk.

Bone Diseases↗
PubMed1981

Arterial vascularization of the cauda equina.

UNLABELLED: Vascular injection of eleven perinates revealed that each lumbosacral spinal-nerve root received its intrinsic blood supply from both distal and proximal radicular arteries through which the blood flowed toward a mutual anastomosis in the proximal one-third of the root. Segmental arteries supplied the distal vessels while their proximal equivalents received blood from their respective anterior or dorsolateral spinal arteries, which derived their flow from the large, irregularly located medullary arteries. CLINICAL RELEVANCE: The region of relative hypovascularity formed below the conus by the combined areas of anastomoses in the cauda equina may provide an anatomical rationale for the suspected neuroischemic manifestations concurrent with degenerative changes in the lumbar spine.

Angiography↗
PubMed1981

Treatment of dural tears associated with spinal surgery.

We reviewed the cases of five consecutive patients with tears of the spinal dura with postoperative leaks of cerebrospinal fluid. Problems in cluded the persistence of cerebrospinal-fluid fistulas in four patients and a late symptomatic pseudomeningocele in one, all requiring reoperation and meticulous closure of the dura. Dural tears should be repaired at the time of the original operation either directly or utilizing a fascial graft or a tissue-plug technique. When the leak is first noted in the postoperative period, reoperation for repair of the dura is recommended.

Adult↗
PubMed1980

Dimer excision in Escherichia coli in the presence of caffeine.

The observation that polA1 and recL152 mutations result in both slow pyrimidine dimer excision and large repair patch size leads to the hypothesis that patch size is directly related to the rate of excision. In this study caffeine, a known inhibitor of excision repair, was used to examine the extent of correlation between excision rate and patch size by measuring patch size in the presence of several concentrations of caffeine. Both the rate of excision and the resistance to ultraviolet radiation were reduced with increasing concentrations of caffeine after irradiation. Caffeine also inhibited the rate at which incisions were made and prolonged the time required to rejoin the discontinuities. Patch size, however, was unaffected by caffeine treatment.

Caffeine↗