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Biomedical subjects

R K Beals

Publications and source records attributed to R K Beals.

At least 37 records · Page 2Linked to original sources
PubMed1991

The treatment of ankle valgus by surface epiphysiodesis.

Progressive ankle valgus in childhood requiring surgical correction is usually because of paralytic disease or conditions that produce a short distal fibula such as multiple exostoses or both. Surface epiphysiodesis of the distal medial tibial physis was used to correct valgus deformity in ten ankles in seven patients. This procedure has been found to be a simple and effective method of treatment. Measurement of the degree of valgus and calculation of the remaining growth of the distal tibial physis are recommended to determine whether this procedure will be effective. It is most often indicated in the presence of moderate valgus in children aged 11 to 14 years.

Adolescent↗
PubMed1989

Role of revascularization to treat chronic nonhealing fractures in ischemic limbs.

The contribution of chronic limb ischemia to long-term nonunion of a lower extremity fracture was suggested in a single published case report from our group 13 years ago. We have since encountered three additional patients with nonunited lower extremity fractures occurring in limbs with arterial ischemia. In each of these four patients limb revascularization was undertaken in an effort to stimulate healing of the fracture. These patients had chronic (mean 6 months) nonunion of tibial (three) or femur (one) fractures associated with severe lower extremity ischemia (ankle/brachial index m = 0.33; range 0.24 to 0.5). All patients had histories of chronic lower extremity ischemia before the fracture (ischemic rest pain, 2; claudication, 2). All patients underwent angiography followed by lower extremity revascularization. Restoration of normal arterial supply to the fracture site was followed by healing of the fracture in all patients. To our knowledge, this represents the first reported series of patients undergoing elective limb revascularization to stimulate healing of the fracture. Widespread appreciation of this relationship by orthopedic surgeons may be of considerable clinical importance.

Aged↗
PubMed1989

Diagnosing dislocation of the hip in infancy.

In evaluating the diagnosis of dislocation of the hip in childhood by orthopedists in Oregon in 1985, we identified 36 dislocations in 32 patients, an incidence of 0.9 per 1,000 live births. In 12 patients, 12 dislocations (33%) were diagnosed after the neonatal period, 5 of which were diagnosed at walking age. Of the 12 children with a late diagnosis, 10 had normal hips when examined in the neonatal period. Neonatal screening will not detect all cases of congenitally dislocated hip. If dislocation of the hip in childhood is to be diagnosed in a timely manner, it is essential that children's hips be examined at the time of routine well-baby evaluations until a normal gait has been established.

Female↗
PubMed1987

Retinal dystrophy in Jeune's syndrome.

Jeune's syndrome is an autosomal-recessive condition characterized by multiple organ abnormalities, the most severe of which affect the skeleton, kidneys, and eyes. Severe respiratory insufficiency frequently results in death in infancy, but several patients have been reported to survive to adulthood. For this reason the prognosis for patients with ocular abnormalities is of interest in counseling families. We report a sibship of two patients who showed evidence for progression by visual field and electroretinogram testing when followed up over 3.7 years. Progressive electroretinographic abnormalities consisted of the following: progressive decrease in responses mediated by dark-adapted rods and both dark- and light-adapted cones in the first patient and progressive increase in b-wave implicit time elicited by 30-Hz flicker stimulation in the second patient.

Abnormalities, Multiple↗
PubMed1986

Position dependence of pulmonary function in a patient with lordoscoliosis.

In this report we describe a young woman with idiopathic thoracic scoliosis associated with marked lordosis. Pulmonary function, tested in the upright standing position, showed a restrictive pattern of impairment. However, when the patient was tested in the forward-flexed position, pulmonary function was dramatically improved. Following surgical partial correction of the thoracic deformity, pulmonary function was largely within normal limits. Our report emphasizes the detrimental effects of thoracic lordosis on pulmonary function. In addition, our patient demonstrated marked position dependence of pulmonary function, a feature not previously described in patients with deformations of the thoracic spine.

Adult↗
PubMed1986

Pathologic fracture of the humerus.

Review of patients with pathologic fracture of the humerus disclosed that closed treatment resulted in a high incidence of pain, disability, and failure to heal. The most common cause of pathologic fracture of the humerus is breast cancer. A review of records of 103 patients with persistent disease after initial treatment for breast cancer revealed that 19 had humeral metastases (18.5%); of those with humeral metastases, two patients (10%) had pathologic fractures. Prophylactic internal fixation of humeral metastases is not routinely recommended, but operative treatment for pathologic fracture of the humerus is generally superior to nonoperative methods of fracture management.

Aged↗
PubMed1986

Fractures of the tibial plafond.

The cases of one hundred and forty-two patients with 145 fractures of the ankle joint that involved the tibial plafond were reviewed. The fractures were classified into five types according to the severity of the injury. The methods of treatment were divided into two groups: open reduction and rigid internal fixation by the AO technique, and other methods. The most important variables that affected the final clinical result were the type of fracture, the method of treatment, and the quality of the reduction (p less than or equal to 0.05). The best results were obtained by rigid open reduction and internal fixation, with which 65 per cent of the more severe type-III, IV, and V fractures obtained a good or excellent result.

Adolescent↗
PubMed1985

Congenital contractural arachnodactyly. Report of four additional families and review of literature.

We report here four families with congenital contractural arachnodactyly (CCA) in which a wide range of phenotypic expression is observed. In one family with a large number of affected individuals the condition is mildly expressed. These individuals usually have crumpled ears, camptodactyly with ulnar deviation of the fingers, adducted thumbs, limited elbow and/or knee extension, and hypoplasia of the calf muscles. Arachnodactyly is not a constant feature. No spinal deformities are present and only the proband has clubfoot deformities. With time, affecteds have experienced spontaneous improvement of their contractures and their condition in adulthood has not interfered with a normal lifestyle. Within this family there is little phenotypic variation between affected individuals. Those affected within each of the other families have had varying degrees of severity of the condition. A review of 29 other kindreds described in the literature with congenital contractural arachnodactyly shows that in this condition the most common features are abnormally formed ears, camptodactyly, arachnodactyly, adducted thumbs, limited movement of the elbows and knees, and underdevelopment of the calf muscles. Spontaneous improvement of the contractures with age is reported in 94% of cases. Kyphosis, scoliosis or kyphoscoliosis occurred in 50% and these defects were present in those who where more severely affected with CCA. No ocular problems have been reported in this syndrome, but congenital heart defects have occurred in 14.7%. Marfan syndrome is the most important condition to differentiate from congenital contractural arachnodactyly since these two conditions are similar phenotypically. However, in the former there are frequently serious ocular and cardiovascular problems which lead to significant morbidity and/or early death.

Adolescent↗
PubMed1984

Compensation and recovery from injury.

Workers' compensation laws influence recovery from injury. They affect the "cause" of disease, access to care, diagnostic evaluation, treatment, response to treatment and residual disability. Paradoxically, financial compensation may discourage return to work, the appeal process may increase disability, an open claim may inhibit return to work and recovering patients may be unable to return to work. Physicians may help improve the prospects of returning patients to work by providing care that is medical, caring and independent. It is essential that the treatment of back pain be based on the known natural history and on the understanding that the management of acute pain differs from that of chronic pain. Increased awareness of the factors controlling return to work should motivate legislative bodies, labor and industry to alter those features of the compensation system that interfere with the return to work of injured workers.

Accidents, Occupational↗
PubMed1983

Fractured femur in infancy: the role of child abuse.

Analysis of 80 femoral fracture episodes in children under 4 years of age revealed that 8.5% were due to violent trauma, 12.5% were "pathologic" fractures, 30% were related to child abuse, and 49% resulted from normal trauma to normal children. Child abuse as a cause of femoral fracture is more common in children under 1 year of age, first-born children, those with preexisting brain damage, and those with bilateral fractures. The fracture configuration was not usually pathognomonic of abuse, although fractures at the subtrochanteric level and chip fracture of the distal metaphysis were more common in abused children. This study suggests that if there is a reasonable history of cause of fracture, appropriate timing in seeking medical care, and no evidence of additional trauma, further evaluation will not be likely to provide evidence of abuse. If any of these criteria is lacking, a skeletal survey and further evaluation are indicated.

Child↗
PubMed1982

Chemoprophylaxis in cardiac and orthopedic surgery: comparison of cephalothin and cephapirin.

In a retrospective sequential study we determined the rate of infection occurring despite cephalothin or cephapirin chemoprophylaxis in orthopedic and cardiac surgery done from 1973 to 1977. The incidence of infection after prosthetic hip placement or open reduction of hip fracture was 3.4% and 1.0% in patients receiving cephalothin or cephapirin, respectively. The infection rate after prosthetic heart valve implantation was 3.5% in those receiving cephalothin and 1.6% in those receiving cephapirin. There was no significant difference in infection rate, duration of fever greater than or equal to 38.0 C, or length of postoperative hospitalization. The efficacy of selected antistaphylococcal antibiotics in preventing colonization of human fibrin clots by staphylococci was studied. Although cephapirin was effective at lower concentration, the activity of cephalothin and cephapirin was comparable. Cephalothin and cephapirin have equivalent chemoprophylactic activity by clinical and microbiological criteria, permitting cost to be used as a basis for choosing between these antibiotics.

Cardiac Surgical Procedures↗
PubMed1982

Hemihypertrophy and hemihypotrophy.

Analysis of 30 patients with skeletal asymmetry indicates that hemihypertrophy and hemihypotrophy are separate and distinct clinical syndromes. Hemihypotrophy is often associated with scoliosis, mental retardation, and chromosomal mosaicism and occasionally associated with the Silver syndrome. It is not associated with childhood neoplasia. Limb-length inequality is usually mild. Hemihypertrophy is more common than hemihypotrophy and is sometimes associated with primitive neoplasms of the liver, adrenals and kidneys, as well as with benign organ growth aberrations. It is not normally associated with fixed scoliosis nor with mental retardation. Limb-length discrepancy usually requires surgical management. Family counseling and periodic assessment for neoplasia are indicated during childhood.

Abnormalities, Multiple↗
PubMed1981

The marfan skull.

The classic clinical features of Marfan syndrome include ectopic lens, valvular heart disease and dissecting aneurysm, and long, narrow extremeties associated with tall stature. When the classic features are incomplete, diagnosis is uncertain. This study presents some radiographic measurements of the skull in patients with the Marfan syndrome, in an attempt to aid diagnosis by quantitating the features defining the syndrome. Compared with the normal skull, the Marfan skull was found to be longer, taller, thicker, and to have have increased frontal sinus area. The most consistent and therefore diagnostic abnormality ws increased height.

Adolescent↗
PubMed1980

Ultrasound as a diagnostic aid in the evaluation of popliteal swelling.

Ultrasound (US), because of its ability to distinguish cystic from solid tissue, is an ideal tool for diagnosing masses in the popliteal fossa. Five cases are presented. Two cases show the typical ultrasound images in the most common popliteal mass, a cyst. A third case significantly points out the necessity of further investigations if the US findings are atypical of a simple cyst and the patient is symptomatic. A fourth case demonstrates that the US image can distinguish an aneurysm of the popliteal artery from a cyst. A fifth case demonstrates that a solid tumor in the popliteal fossa, in contrast to that of a cyst, has a characteristic US image. Ultrasound is a simple, quick, noninvasive outpatient procedure available to almost every physician. In most instances, US appears to be the diagnostic procedure of choice following conventional radiography in the evaluation of swelling in the popliteal fossa.

Adult↗