Biomedical subjects

R P Stanton

Publications and source records attributed to R P Stanton.

28 records · Page 2Linked to original sources

PubMed1989

Scoliosis evaluation and management.

Specific guidelines for the management of scoliosis must be individualized based on a number of factors. It is important to be sure that a patient who appears to have ordinary idiopathic scoliosis does not have some underlying disease process or congenital anomaly, which if undiscovered, may complicate that patient's management. The management of scoliosis has changed in the past few years due to significant advances in blood banking, anesthesia, and spinal instrumentation. Scoliosis fusions are performed regularly throughout the country with a great degree of safety. By combining early detection and modern management techniques, significant untreated curvature of the spine can be eliminated, and functional and cosmetic deformity can be avoided.

Combined Modality Therapy↗

PubMed1987

Prior deposition of autologous blood in elective orthopaedic surgery.

We retrospectively analyzed a program of prior deposit and storage of autologous blood that was used for patients who underwent elective orthopaedic procedures over a period of thirty-six months at the Walter Reed Army Medical Center. Of a total of 211 patients who underwent total joint replacement or spinal fusion during this period and who had sufficient records to be included in the study, a total of 159 patients enrolled in the program. The fifty-two patients who did not enroll in the study, twelve of whom were rejected because of medical problems, served as a control group. Since the preoperative hematocrit values for patients in the group that received autologous blood were similar to those for the control group, multiple preoperative phlebotomies in these patients, who had received supplemental iron, did not seem to have any deleterious effects. One hundred and thirteen (71 per cent) of the 159 patients who were enrolled in the program received only autologous blood. The remaining forty-six patients required homologous blood also, but 64 per cent of their transfusion needs were provided by autologous blood. The only reactions to the transfusions in the study were in four patients who received homologous blood. We think that a program of prior deposit and storage of autologous blood should be an option for patients who are to undergo elective orthopaedic surgery. Such a program is well tolerated by the patients and easily managed by the staff, and it was not difficult to implement at our tertiary referral hospital.

Adolescent↗

PubMed1980

Dissociation of intracellular lysosomal rupture from the cell death caused by silica.

The relationship between intracellular lysosomal rupture and cell death caused by silica was studied in P388d(1) macrophages. After 3 h of exposure to 150 mug silica in medium containing 1.8 mM Ca(2+), 60 percent of the cells were unable to exclude trypan blue. In the absence of extracellular Ca(2+), however, all of the cells remained viable. Phagocytosis of silica particles occurred to the same extent in the presence or absence of Ca(2+). The percentage of P388D(1) cells killed by silica depended on the dose and the concentration of Ca(2+) in the medium. Intracellular lyosomal rupture after exposure to silica was measured by acridine orange fluorescence or histochemical assay of horseradish peroxidase. With either assay, 60 percent of the cells exposed to 150 mug silica for 3 h in the presence of Ca(2+) showed intracellular lysosomal rupture, was not associated with measureable degradation of total DNA, RNA, protein, or phospholipids or accelerated turnover of exogenous horseradish peroxidase. Pretreatment with promethazine (20 mug/ml) protected 80 percent of P388D(1) macrophages against silica toxicity although lysosomal rupture occurred in 60-70 percent of the cells. Intracellular lysosomal rupture was prevented in 80 percent of the cells by pretreatment with indomethacin (5 x 10(-5)M), yet 40-50 percent of the cells died after 3 h of exposure to 150 mug silica in 1.8 mM extracellular Ca(2+). The calcium ionophore A23187 also caused intracellular lysosomal rupture in 90-98 percent of the cells treated for 1 h in either the presence or absence of extracellular Ca(2+). With the addition of 1.8 mM Ca(2+), 80 percent of the cells was killed after 3 h, whereas all of the cells remained viable in the absence of Ca(2+). These experiments suggest that intracellular lysosomal rupture is not causally related to the cell death cause by silica or A23187. Cell death is dependent on extracellular Ca(2+) and may be mediated by an influx of these ions across the plasma membrane permeability barrier damaged directly by exposure to these toxins.

Animals↗

PubMedDate not supplied

Measurement of acetabular index intraobserver and interobserver variation.

Pelvic radiographs of 25 children aged 6 months to 2 years had the acetabular index measured 3 times by each of five pediatric orthopaedists. Interobserver measurements were found to vary +/-3.0 degrees, whereas the intraobserver variation was +/-3.6 degrees. This error reflects only measurement error and does not consider error introduced with different positioning of the pelvis.

Acetabulum↗

PubMedDate not supplied

Slipped capital femoral epiphysis associated with radiation therapy.

We reviewed 32 children with 41 radiation-therapy associated slipped capital femoral epiphyses (RTASCFE). Ten were from the authors' institutions and 22 from the literature. Gender distribution was equal. The age at diagnosis of the malignancy was 4.3 +/- 3.1 years; the amount of radiation was 4,240 +/- 1,445 rads. Children with RTASCFE presented younger (10.4 +/- 3.2 years) than a routine SCFE. The average symptom duration was 5 +/- 6 months. Children with RTASCFE are usually thin (median weight, 10th percentile) in contrast to children with typical SCFE, who are usually obese (<95th percentile). The majority (82%) of the slips were mild, compared to routine SCFEs (approximately 50%); 28% were bilateral. There was a positive linear relationship between the age at presentation of the SCFE and the age at diagnosis of the malignancy; there was a negative linear relationship between the age at presentation of the SCFE and the amount of radiation therapy.

Adolescent↗

PubMedDate not supplied

Surgical fusion in childhood spondylolisthesis.

Twenty cases of surgical fusion for spondylolisthesis were reviewed at the Scottish Rite Hospital (Atlanta, GA, U.S.A.) to determine whether a procedure other than a simple posterolateral fusion is necessary for most patients. The patients were treated postoperatively with pantaloon spica cast immobilization. The fusion rate was high (90%), and patient satisfaction was high. One patient developed neurologic loss postoperatively. Two patients' slips progressed greater than 10% before solid fusion occurred. Thus, bilateral posterolateral fusion, followed by pantaloon spica cast immobilization, is effective for patients with symptomatic spondylolisthesis or asymptomatic children with grade 3 or greater slips. Reduction was not performed in this series.

Adolescent↗

PubMedDate not supplied

Surgical treatment of adolescent hallux valgus.

Surgical for adolescent hallux valgus (HV) was performed on 32 feet. Five feet (16%) required revision surgery, and technical errors accounted for recurrence in all five. Satisfaction was obtained in 70% of patients. According to a new bunion rating score, 59% of patients had good to excellent results. In a subgroup of patients treated with metatarsal osteotomy for metatarsus primus varus, the Mitchell osteotomy provided an excellent rating in 95% of patients. Surgery for adolescent HV provides satisfying results in most patients. The one factor most highly correlated with both decreased risk of recurrence of angular deformity and patient satisfaction was a reduction of the intermetatarsal (IM) angle.

Adolescent↗

PubMedDate not supplied

Computed tomography for early evaluation of developmental dysplasia of the hip.

Computed tomography (CT) provides an axial image of the dysplastic hip. We reviewed 130 CT scans performed after closed reduction for developmental dysplasia of the hip (DDH) in 42 patients (52 hips). We evaluated methods of measuring CT scans and found no described measurement that was predictive of development of avascular necrosis (AVN) or persistent acetabular dysplasia. The CT scan provides an excellent image of the infant hip when the child is in a spica cast and is useful to confirm an adequate reduction. No patient in this series lost reduction after 2 weeks.

Casts, Surgical↗

PubMedDate not supplied

Orthopaedic manifestations in de Barsy syndrome.

de Barsy syndrome is a rare, genetically transmitted condition characterized by severe cutis laxa, joint hypermobility, growth retardation, mental retardation, and characteristic facies. Affected individuals have many orthopaedic manifestations, including developmental dysplasia of the hip, scoliosis, multiple joint dislocations and subluxations, and congenital vertical talus. The management of the orthopaedic manifestations of this syndrome is presented in two typical cases.

Bone Diseases↗

PubMedDate not supplied

Growth arrest resulting from unicameral bone cyst.

Growth arrest complicating unicameral bone cyst of the proximal humerus is reported in five patients. These patients represented 10% of 51 consecutive patients treated by the senior author at our hospital from 1988 through 1995. The youngest patient at first clinical presentation was aged 6 years, and the oldest was 14 years 9 months. The follow-up ranged from 35 to 69 months (average, 57.2). The youngest patient at final follow-up was 9 years 1 month, and the oldest was 20 years 5 months. Pathologic fracture was the common clinical presentation in all patients. Growth arrest was diagnosed by limb-length discrepancies, as well as radiographic evidence of premature closure of the physis and deformity of the upper humerus. Treatment was either aspiration of the cyst and local injection of corticosteroids or curettage and bone grafting. Growth arrest was documented, both clinically and radiographically, before the surgery in the two cases treated by curettage and grafting. The origin of growth arrest resulting from unicameral bone cyst remains uncertain. Direct iatrogenic damage to the physis was not a likely cause of growth arrest in this series. Growth arrest as a complication of unicameral bone cyst of the proximal humerus is more common than is generally appreciated (10%).

Adolescent↗