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Biomedical subjects

R Sanders

Publications and source records attributed to R Sanders.

At least 127 records · Page 7Linked to original sources
PubMed1995

Oblique osteotomy for the correction of tibial malunion.

Fifteen patients had an oblique osteotomy of the tibia for the correction of a multiplanar deformity between January 1989 and March 1991; twelve were followed for an average of twenty-five months (range, twelve to forty-two months). Preoperatively, the average deformity in the coronal plane was 14 degrees (range, 30 degrees of valgus to 25 degrees of varus) and the average deformity in the sagittal plane was 13 degrees (range, 40 degrees of recurvatum to 23 degrees of procurvatum [angulation convex anteriorly]). The average leg-length discrepancy was 2.2 centimeters (range, one to six centimeters). No patient had a rotational deformity. After careful preoperative planning, all patients had an oblique osteotomy and placement of a lag screw and a neutralization plate. Somatosensory evoked potentials were monitored during any axial lengthening. A fibular osteotomy and lengthening of the Achilles tendon were performed as needed. Full weight-bearing on the extremity was prohibited until radiographic and clinical examination indicated that union had occurred, which was at an average of 4.5 months (range, three to six months). At the most recent follow-up examination, ten patients had an excellent result. The average correction in the coronal plane was to within 1 degree (range, 0 to 3 degrees) of normal and the average alignment in the sagittal plane was to within 2 degrees (range, 0 to 12 degrees) of normal. An average of 1.3 centimeters (range, 0.5 to 2.5 centimeters) of lengthening was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

The treatment of closed, unstable tibial shaft fractures with unreamed interlocking nails.

Forty-seven closed, unstable tibial shaft fractures were treated with locked intramedullary nailing without reaming at the authors' institution. Fifty-three percent of the fractures were in polytraumatized patients. Followup was possible for 38 (81%) fractures. Thirty-three fractures healed within 6 months (87%). All patients had unlimited ambulation without assistive devices, and the ability to climb stairs in a normal fashion. Range of motion of the knee, ankle, and subtalar joints at final followup was normal, except in those patients who had concomitant joint injuries. There were 2 delayed unions (5%) and 3 nonunions (8%). Three patients had angular deformities. There were no broken nails in this series (0%), but 12 of 80 screws were bent or broken. There was 1 (2.6%) superficial infection, and 1 (2.6%) case of osteomyelitis. Interlocked, intramedullary nailing inserted in an unreamed manner has become the treatment of choice for the closed, unstable tibial shaft fracture in the polytraumatized patient in the authors' institution. A high union rate, coupled with a lack of compartment syndromes or peroneal palsy, makes this procedure an attractive alternative to reamed nailing. This study was not able to prove any superiority over reamed nail insertion in closed, isolated, unstable tibial shaft fractures.

Adolescent↗
PubMed1995

Radiography, sonography, and magnetic resonance imaging for stress incontinence. Contributions, uses, and limitations.

Imaging has increased our ability to understand stress incontinence and prolapse and has advanced our existing concepts of pathophysiology. Once these conceptual contributions have been made, imaging modalities may fade from current use, but the lessons learned will remain. It is the relationship of clinical imaging to conceptual development that is important. Conventional radiographic studies are well understood and can be obtained in most facilities. Sonographic units are currently available in many urologic and gynecologic clinics and offices and can be adapted for stress incontinence studies. The benefits of real-time studies and soft-tissue detail at the urethrovesical junction and office-based convenience make this an attractive new technique. The global pelvic approach offered by MR imaging offers spectacular imaging possibilities, which can help in complex cases and in future concepts in the field. MR imaging is rapidly evolving and may continue to offer new insights as technology permits. In accordance with Hodgkinson's earlier observations, imaging should not be routinely required in all patients undergoing evaluation for stress incontinence, but should certainly be considered in failed operations, complex prolapse, and when clinical diagnosis is in doubt. It is always better to use an imaging technique, no matter how expensive, than to end up with a bad surgical result.

Female↗
PubMed1995

Injuries of the shoulder girdle.

Shoulder girdle injuries occur infrequently, but can lead to high rates of morbidity and mortality if these high energy injuries are underdiagnosed or mistreated. Most injuries can be treated conservatively, but a high index of suspicion and aggressive physical and radiographic evaluations should be used to evaluate patients with polytrauma. This article discusses these injuries, their associated pathoanatomy, and current management.

Acromioclavicular Joint↗
PubMed1995

The management of severe fractures of the lower extremities.

This review is designed to address the problem of severe fractures of the lower extremities that often accompany the patient who is polytraumatized. Although open fractures occupy a predominant place in the subsequent discussion, closed fractures also may be associated with a significant crush component, a vascular lesion, a degloving injury, or a compartment syndrome. It is of paramount importance that the treating physician understand the implications of the potential or actual soft tissue damage to maximize the outcome after these devastating injuries.

Ankle Injuries↗
PubMed1995

Operative treatment of intra-articular fractures of the calcaneus.

Displaced intra-articular fractures of the calcaneus remain a diagnostic and therapeutic dilemma. The classification of these fractures has been frustrated in the past by limitations of radiographic technique. Because of our need to consistently analyze our results, a CT scan classification was developed, based on the number and location of articular fracture fragments. The authors have treated displaced intra-articular calcaneal fractures according to an operative protocol using a modified lateral approach, a new plate and lag screws, all without the use of bone graft. This article will discuss in depth the treatment options available as well as the controversies that surround them.

Arthritis↗
PubMed1995

Clinical spectrum of adrenal myelolipoma: analysis of 8 tumors in 7 patients.

Adrenal myelolipoma is a rare, benign, and biochemically nonfunctioning tumor. Most patients with adrenal myelolipoma are asymptomatic and the condition is discovered incidentally at autopsy. Review of the literature reveals 70 patients with surgically documented adrenal myelolipoma. We report 7 additional patients with 8 adrenal myelolipomas, of whom 5 underwent surgical removal because of tumor size, unusual imaging features or symptomatology. Of our patients 4 had symptomatic lesions requiring surgical removal, while 1 had an adrenal myelolipoma that was discovered intraoperatively. Of the remaining 2 patients 1 had a small (3 cm.) lesion discovered incidentally on excretory urography and 1 had bilateral adrenal myelolipoma discovered incidentally on computerized tomography.

Adrenal Gland Neoplasms↗
PubMed1994

Vertical shear fractures of the medial malleolus: a biomechanical study of five internal fixation techniques.

Fifty embalmed human tibias were osteotomized to create a simulated vertical shear (supination-adduction) fracture of the medial malleolus and were stabilized using one of five internal fixation techniques. In offset axial testing, which simulated supination-adduction loading, the fixation strength of tibias stabilized with either cortical or cancellous lag screws placed perpendicular to the osteotomy was over five times greater than the strength of those treated with an antiglide plate and nearly two and a half times greater than those treated with cancellous lag screws placed oblique to the osteotomy. The tibias stabilized with cancellous lag screws placed perpendicular to the osteotomy exhibited twice the fixation strength of the tibias stabilized with an antiglide plate and distal lag screw. The tibias stabilized with an antiglide plate and distal lag screw and perpendicularly placed cortical or cancellous lag screws demonstrated three times greater resistance to displacement to the applied supination-adduction load than those stabilized with an antiglide plate alone. In offset transverse testing, to simulate loading in external rotation, the mean failure load of the tibias stabilized with cancellous lag screws placed perpendicular to the osteotomy was over two and a half times greater than those stabilized with an antiglide plate and distal lag screw. No significant differences were observed in the resistance to displacement for these tests. These results support the use of lag screws placed perpendicular to the fracture surface for stabilization of vertical shear fractures of the medial malleolus and indicate that the use of an antiglide plate, with or without a distal lag screw, does not offer any advantage over lag screw fixation.

Biomechanical Phenomena↗
PubMed1994

[Application of confocal laser microscopy in studying the effect of epidermal growth factor on the seminiferous epithelium].

Effects of epidermal growth factor (EGF) on pH transients in aggregates of Sertoli cells and germinal cells have been investigated with confocal microscopy using a fluorescent pH sensitive indicator. In some Sertoli cells EGF caused a rapid rise in the pH whereas other Sertoli cells did not respond to EGF. Some Sertoli cells showed a delayed response which coincidated with a similar pH change in neighbouring germinal cells. Since isolated germinal cells never showed a pH response after exposure to EGF, we have concluded that some Sertoli cells may communicate with germinal cells via gap junctions.

Animals↗
PubMed1994

The treatment of open tibial shaft fractures using an interlocked intramedullary nail without reaming.

Between January 1989 and September 1991, 117 consecutive open tibial shaft fractures were treated at our institution. Of these, 64 (55%) met the inclusion criteria and were prospectively treated according to protocol using unreamed interlocking intramedullary nails as definitive fixation. Wounds were classified according to the method of Gustilo et al., and included 10 type I, 16 type II, and 38 type III (17 type IIIA, 21 type IIIB) wounds. Contraindications to intramedullary nailing included (a) fractures involving the proximal or distal one fifth of the tibia, (b) patients with open physes, and (c) an associated vascular injury (type IIIC). Proximal locking was routinely performed, whereas distal locking was used as needed for axial and/or rotational stability. Soft-tissue coverage was obtained after adequate debridement within 7 days: 26 of 64 fractures (41%) required a soft-tissue procedure (17 split-thickness skin grafts, eight free-tissue transfers, one rotational muscle flap). Patients were encouraged to bear full weight in a short leg cast or Sarmiento brace as soon as other injuries or pain permitted. Average follow-up time was 24.8 months (range 12-44) and was possible in 46 fractures (71.875%; nine of 10 type I, 12 of 16 type II, 10 of 17 type IIIA, and 15 of 21 type IIIB). Mean time to healing was as follows: type I, 4.8 months; type II, 4.7 months; type IIIA, 8.28 months; and type IIIB, 9.30 months. Twenty fractures exhibited a delay in healing (> 6 months). This included two of 12 type II (16%), six of 10 type IIIA (60%), and 12 of 15 type IIIB fractures (80%).(ABSTRACT TRUNCATED AT 250 WORDS)

Contraindications↗
PubMed1994

The value of skull radiography in ophthalmology.

Skull radiographs and special views are still requested in ophthalmology despite the increasing availability of other radiological investigations such as CT, MR imaging and ultrasound. In order to assess the value of skull radiography in ophthalmology we retrospectively studied the use of skull radiographs and CT images in our department. In only one instance was patient management based purely on skull radiograph findings. Over 50% of CT examinations had been preceded by skull films which made no contribution towards management. In some cases the skull films had been misleading by not showing significant pathology and had consequently created considerable delay before diagnosis was reached. It is therefore unjustifiable to use skull films as a method of screening for orbital or intracranial disease and there is little indication for skull radiography in ophthalmology, except in detection of intraocular foreign bodies, facial and orbital fractures and simple sinusitis.

Brain Neoplasms↗
PubMed1994

The treatment of open and/or unstable tibial fractures with an unreamed double-locked tibial nail.

A multicenter, prospective study was conducted to assess the efficacy of an unreamed, double-locked tibial nail for the acute management of open and/or unstable tibial fractures. Seventy-seven acute unstable and/or open tibial fractures in 74 patients were treated from December 1986 to February 1989. Forty fractures were closed and 37 were open; 25% occurred in polytraumatized patients and 39% of the patients had additional fractures. All closed tibial fractures healed at an average of 14.2 weeks; 94.6% of the open tibial fractures healed at an average of 20.1 weeks. There were no infections in the closed tibial fracture group. There were 4 infections among the 37 patients (11%) in the open tibial fracture group, 2 superficial and 2 deep. There were 7 problems intraoperatively (8.4%) with fin deployment: 2 fins bent during nail insertion, 4 fins penetrated the cortex, while 1 set of fins only partially deployed. Difficulty was encountered with proximal screw insertion in one third of the cases. Considering the high energy of these injuries, the treatment of open and/or unstable tibial fractures with an unreamed, double-locked tibial nail can offer the surgeon a high rate of union (97%) with minimal complications. The low infection rate found in this series indicates that this nail may be of particular benefit in the treatment of closed and select open tibial fractures.

Adolescent↗
PubMed1993

The Misti Gold bio-oncotic gel filled breast prosthesis: an acceptable alternative to silicone?

Concern about the use of silicone gel as a filler for breast prostheses has stimulated interest in other materials. We have evaluated the Misti Gold prosthesis which contains a "bio-oncotic" gel of low molecular weight Polyvinylpyrrolidone (PLASDONE 24AUK). Our experience of its use in breast augmentation is that the aesthetic results obtained with retromammary placement are inferior to those obtained from a silicone gel filled prosthesis. Nonetheless there are theoretical advantages for its use which will need to be considered in the light of recent regulatory decisions.

Female↗
PubMed1993

Early diagnosis of staphylococcal toxaemia in burned children.

The features of toxic shock syndrome in burned children have been described in a review of seven patients (J. D. Frame et al., Burns 1985; 11, 234). These include a 'prodromal' 24-48 h period with diarrhoea, vomiting, general malaise, pyrexia, tachycardia and tachypnoea. The white cell count and haemoglobin concentration fall prior to the 'shock' phase, which occurs 3-4 days postburn. Once 'shock' has occurred the mortality of the condition is approximately 50 per cent; in the absence of 'shock' it is much reduced. We have undertaken a retrospective review of six burned children who were admitted in a 2-year period to the Mount Vernon NHS Trust Burns Unit with a clinical diagnosis of toxic shock syndrome. The evidence from our patients suggests that reliable early diagnostic signs are a rapidly developing severe pyrexia of 39.5 degrees C or above, and a simultaneously increasing tachycardia and tachypnoea to high levels. There is a sudden profound fall in the white cell count and haemoglobin concentration over a period of hours between 1 and 3 days from injury. Specific treatment should be instituted before the onset of 'shock'. The name staphylococcal toxaemia might promote earlier diagnosis and treatment of this condition and so reduce its mortality.

Bacterial Toxins↗