Gas in the soft tissues following a penetrating wound--gangrene or not gangrene?
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Adult↗
Biomedical subjects
R J Newman
Publications and source records attributed to R J Newman.
The effect of hyperthermia (42.5 degrees C) on zymosan-induced synovitis of the knee.
Though heat has been used for many years for the treatment of painful joints such therapy rarely increases the intra-articular temperature significantly. This pilot study investigated the effect of intra-articular hyperthermia induced by microwaves from a combined heating/cooling instrument on zymosan-induced synovitis in the rabbit. There was histological evidence not only of a reduction in the intensity of the inflammatory response but also in its type with the absence of giant cell formation. However, hyperthermia was not totally without effect on the synovium of control joints and further studies are required to investigate the relevance of this effect.
Animals↗
Primary bone tumours of the shoulder: an audit of the Leeds Regional Bone Tumour Registry.
An audit of the prospectively gathered data of the Leeds Regional Bone Tumour Registry found that primary bone tumours of the shoulder constituted 145 of 2039 cases (7%). Seventy-five per cent of these occurred in the proximal humerus, 20% in the scapula and 5% in the outer half of the clavicle. Malignant and benign tumours were of equal overall frequency (73 vs 72) but the malignant lesions tended to occur in an older population (mean ages 43 years and 17 years respectively). Simple bone cyst was the commonest diagnosis in children, chondrosarcoma in the middle age group and osteosarcoma in the over-60s. Presenting symptoms were a poor guide to whether the lesion was malignant or not and the correct preoperative diagnosis was made only in a minority of cases. In 134 cases the diagnosis made by the referring pathologist was confirmed by the Bone Tumour Registry but in 11 cases, the diagnosis was changed by the Tumour Registry and differed with important clinical implications. Bone tumour registries provide a valuable source of cumulative information about uncommon tumours and facilitate accurate diagnosis, teaching and research.
Adolescent↗
Living with health reform. Families in four top-flight managed care plans give their views.
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Consumer Behavior↗
1993 health guide. Top 10 health stories to watch.
A sea change seems likely in the way health care is delivered. In medicine, public health and nutrition, here's what else the year will bring.
Delivery of Health Care↗
Leukergy--a new diagnostic test for bone infection.
This new blood test for infection is based on the phenomenon of leukergy in which white cells agglomerate in the peripheral blood of patients with inflammatory diseases. It was used in 26 patients with proven bone or joint infection and was positive in 25. The leukergy test was more accurate than the ESR, white cell count or blood culture. The percentage of cells agglomerated correlated with the clinical severity of the infection and the test detected reactivation of the septic process better than the other haematological tests. It is a rapid and inexpensive method which is useful in the diagnosis and management of bone and joint infections.
Adult↗
Thyrotropin-releasing hormone action in the preoptic/anterior hypothalamus decreases thermoregulatory set point in ground squirrels.
Earlier work has shown that thyrotropin releasing hormone (TRH) produces dose-dependent decreases in body temperature (Tb) and metabolic rate when microinjected into the dorsal hippocampus (HPC) or preoptic/anterior hypothalamus (PO/AH) of awake ground squirrels. This study employed a behavioral paradigm to investigate the possibility that TRH-induced hypothermia is associated with a decrease in thermoregulatory set point. Six animals were successfully trained to press a bar for radiant heat escape and cool air reinforcement in order to obtain a cooler ambient temperature (Ta). During experimental testing, the animals were microinjected remotely with TRH (10-1000 ng/microliters) or a control solution (sterile saline or TRH-OH) into the PO/AH. The micro-injections were delivered via bilateral injection cannulae inserted through chronic bilateral cannula guides that had been stereotaxically implanted under pentobarbital anesthesia. Cumulative and time-integrated bar presses were obtained on a computer generated display. Tb, measured in the brain via a bead-type thermistor, and chamber Ta were recorded continuously. Following TRH administration, a significant increase in mean bar-press rate was observed during the period in which Tb was falling, when compared to a comparable time period just prior to the microinjection. These findings complement results obtained from four animals that were trained to press a bar for heat reinforcement in a cold (- 10 degrees C) environment. In this alternative behavioral paradigm, microinjection of TRH into the PO/AH or HPC induced a decrease in mean bar-press rate as Tb was falling. The results support the hypothesis that TRH-induced hypothermia in golden-mantled ground squirrels is achieved by lowering thermoregulatory set point.
Animals↗
Case report 745: Synovial lipoma arborescens.
A case is presented of lipoma arborescens of the knee with an atypical, sudden onset. Arthrography and ultrasound confirmed a synovially based lesion in the suprapatellar pouch. CT enabled a preoperative diagnosis of lipoma arborescens to be made, which was confirmed by surgical excision of a fronded fatty mass. Histological studies showed hyperplastic villi with mature adipose cells in the subsynovial layer. Resection of the synovium is considered curative, with only one case of recurrence after synovectomy having been reported [4].
Diagnostic Imaging↗
Permanent tetraplegia in an infant following improper use of a car seat restraint.
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Accidents, Traffic↗
The perioperative care of orthopaedic and trauma patients in a high-dependency unit: a 2-year prospective audit.
There is an increasing trend towards the establishment of high-dependency units in large hospitals since it is thought that they conveniently 'fill the gap' between the intensive care unit and the routine wards. This paper prospectively reviews the results of management of 205 orthopaedic and trauma patients who passed through such a unit over a 2-year period. The unit was shown to provide effective and safe care for a group of particularly high-risk patients for whom care on a routine ward at times would be insufficient and for whom care on an intensive care unit is unnecessarily expensive and occasionally unavailable. The high-dependency unit as described in this paper represents an efficient use of resources for this group of patients.
Adolescent↗
US Medicaid drug formularies: do they work?
Does the use of a restricted drug formulary achieve cost savings within state Medicaid programmes? Restricted formularies are often justified by putting forth the attributes of a perfectly operating and implicitly costless policy. Analysis suggests, however, that the operation of 'actual' restricted formularies produce realised effects that are substantially at odds with the desired effects. Although the implementation of a restricted formulary can reduce a state's drug expenditures, service substitution causes expenditures to increase elsewhere in the system. Furthermore, direct savings in the drug budget are completely offset by these spillover effects.
Cost Savings↗
Measuring the relationship between income and NHEs (national health expenditures).
This article uses recently published time series data for the Organization for Economic Cooperation and Development countries to estimate income elasticities for health care expenditures. Several different models and alternative specifications are examined to determine the sensitivity and robustness of the estimated relationships. Income is the dominant-determinant of health care spending and longrun income elasticity for health care is significantly greater than unity. This implies that health care is a luxury good, and expenditures will tend to rise with the level of national income. There is little evidence that the degree of public finance reduces the level of health care expenditures.
Data Collection↗
Fracture of the sternum in motor vehicle accidents and its association with mediastinal injury.
Sternal fractures occurred in 78 out of 2097 consecutive victims of road traffic accidents who required to attend hospital; an incidence of 3.7 per cent. They were most common in restrained, front seat vehicle occupants involved in frontal collisions, and their frequency increased with age. There was a positive association with visceral chest injury but the latter was not thought to be the cause of death in any individual. Follow-up of survivors 2-4 years later revealed potential cardiac sequelae in 6 per cent.
Accidents, Traffic↗
Natural history of impacted subcapital femoral fractures and its relevance to treatment options.
A study of 123 patients with impacted, subcapital femoral fractures was undertaken to determine the natural history of this injury. It was found that the angle of the fracture, the degree of valgus and the degree of retroversion were without significant effect on the incidence of subsequent disimpaction. Age was important, with a 20 per cent incidence of disimpaction in patients over the age of 68 years. In patients younger than this the incidence was only 2 per cent. These results indicate that conservative treatment may be appropriate for some younger patients, but the advantages of this approach must be compared with the medical, social and economic benefits of early mobilization that the relatively simple operative procedure permits.
Age Factors↗
Primary tumors of the axial skeleton. Experience of the Leeds Regional Bone Tumor Registry.
Primary tumors of the axial skeleton are rare and a survey of the Leeds Regional Bone Tumor Registry found them to constitute only 55 of the 1950 cases (2.8%). Chordoma was the most frequent tumor in the cervical and sacral regions as well as the most common diagnosis overall and osteosarcoma ranked second. Pain was the most frequent presenting symptom but over half the patients developed some neurological abnormality. In spite of treatment survival was poor in patients with malignant lesions or neurological involvement. The establishment of Bone Tumor Registries is the only way that sufficient data on large numbers of these rare tumours can be amassed to provide a valuable and otherwise unavailable source of information for research, education and service.
Adolescent↗