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Biomedical subjects

R Woo

Publications and source records attributed to R Woo.

At least 19 recordsLinked to original sources
PubMed2001

Spasticity: orthopedic perspective.

The orthopedic management of spasticity is based on the effects of this neurologic condition on the bones and tissues of the growing child. The goal of such intervention is to maximize function, reduce disability, and facilitate mobility. Goal-directed treatment plans are tailored for each patient and may include a combination of modalities such as physical and occupational therapy, casting, orthoses, and surgery. Physical and occupational therapy is emphasized up to 4 to 5 years of age, whereas surgery is best between 5 and 7 years of age. Education and psychosocial development should be emphasized beginning at age 7 years through adulthood, with surgery reserved for more involved cases of contracture or bony dysplasia. In adulthood, treatment should be focused on integration into society and maximizing functional independence. Although there are many undisputed benefits of therapy, no consensus exists regarding the most beneficial modality, the age group that would benefit most, or whether continued treatment is beneficial in adulthood. Whereas the use of serial casting and tone-reducing casts has lessened, lower extremity orthoses have gained widespread acceptance with improvements in design and fabrication and have been demonstrated to help restore normal heel-toe gait. Surgical techniques such as tendon lengthening, transfer, bony osteotomy, and joint fusion are time-honored techniques that continue to be refined with current advances in the use of computerized gait analysis for preoperative planning. Further research in long-term results and outcomes measurement will be necessary to fully assess the impact of current treatment.

Cerebral Palsy↗
PubMed1997

Lifetime victimization history, demographics, and clinical status in female psychiatric emergency room patients.

Studies on the impacts of violence often overlook the moderating role of social or demographic variables and the confounding effects of different victimization experiences on the same individual. In the present study, 93 adult women presenting to an urban psychiatric emergency room were interviewed regarding their lifetime victimization history, and their charts were examined for relevant demographic and psychiatric variables. Self-reported childhood sexual and physical abuse were common in this sample (53% and 42%, respectively). Adult physical assaults outside of a relationship were described by 29% of patients, 37% reported adult sexual assaults or rapes, and 42% stated that they had experienced one or more physical assaults within an adult relationship. Childhood and adult victimization experiences were intercorrelated and were associated with certain sociodemographic variables. Logistic regression analyses indicated that both child abuse and adult assaults were uniquely associated with psychiatric difficulties, even after controlling for relevant background variables. Childhood sexual abuse was the most powerful predictor of later psychiatric symptoms and disorders.

Adult↗
PubMed1996

Femoral version in acute slipped capital femoral epiphysis.

Seven patients with seven acute slipped capital femoral epiphyses (SCFE) had computed tomography (CT) scan determination of femoral version. Version value differences were compared between the involved and uninvolved sides, and each was compared with a standard value for age. Comparison was also made with chronic slipped femoral version values. As compared to the standard of 20 degrees, the acute, involved side femoral version was 9.3 degrees (p = 0.057). Comparisons of involved and uninvolved sides showed no significant difference (p = 0.25). Analysis of differences of bilateral femoral version of patients with acute SCFE with that of patients with chronic SCFE version showed a significant difference (p = 0.009). Version in patients with acute SCFE more closely resembles the normal value than does that of patients with chronic SCFE, further emphasizing the uniqueness of the acute type of SCFE.

Acute Disease↗
PubMed1996

Acetabular version in slipped capital femoral epiphysis: a prospective study.

To determine if acetabular orientation is abnormal in patients with slipped capital femoral epiphysis (SCFE), we measured acetabular version in 60 patients with stable and unstable SCFE by computed tomography (CT) scan. Comparison of the involved sides of the two groups with the standard values for age, with the opposite uninvolved hip, or between stable and unstable hips showed no significant differences.

Acetabulum↗
PubMed1995

The Frank Stinchfield Award. Pulmonary fat embolism in revision hip arthroplasty.

Unilateral cemented hip hemiarthroplasty was done on 16 dogs who subsequently had revision arthroplasty and who were divided into 1 control and 3 experimental groups: The first group had cement extraction using osteotomes; the second, using a high speed burr; the third, an ultrasonic tool. Hemodynamic and transesophageal echocardiographic monitoring were done. Postmortem pulmonary specimens were examined for differences in the quantity of fat emboli. There was a significant increase in emboli with the ultrasonic tool as compared with osteotomes and high speed burr. There was no significant difference in emboli between the osteotomes and high speed burr. Fat emboli syndrome is related to mechanical compression of the femoral canal. The ultrasonic instrument was unique in its tendency to cause large embolic showers, especially during extraction of the distal cement plug. In these young dogs, minimal hemodynamic changes and no cardiac dysrhythmias occurred, which in part may be attributed to their good health. These changes may remain subclinical for patients with good cardiorespiratory reserve, or may become life threatening for those with poor reserve. By outlining the mechanisms of fat embolism in revision total hip arthroplasty, it may be possible to decrease future morbidity, especially in patients who frequently have cardiopulmonary disease.

Animals↗
PubMed1992

Laterality and modality-specific effects of chronic pain.

Previous investigations indicated that thresholds to nonpainful tactile stimuli were elevated in chronic-pain patients when compared with pain-free individuals (Seltzer & Seltzer, 1986; Seltzer et al., 1988). The present study attempted to determine whether thresholds to tactual and visual stimuli also were elevated by chronic pain. Furthermore, lateralization of the pain effect on tactile thresholds was assessed by obtaining thresholds from both left and right arms. A decrease in tactile sensitivity to nonpainful stimuli in chronic-pain patients was confirmed, but laterality of the effect was not demonstrated. Visual thresholds were not significantly affected by chronic pain. The data in the present study, taken together with other data, support the proposition that pain does not affect right hemispheric processes more than left hemispheric processes.

Arousal↗
PubMed1989

Epidural spinal cord stimulation in the management of reflex sympathetic dystrophy.

Eighteen subjects with intractable pain due to reflex sympathetic dystrophy (RSD) underwent treatment by epidural spinal cord stimulation (SCS). All the patients had previously undergone multiple sympathetic blocks and/or surgical sympathectomy with either no results or only temporary therapeutic effects. Four subjects did not experience any beneficial effects during a 1-week trial and the electrode was removed, and 14 patients had the system internalized surgically. In 4 cases two separate systems (electrode + pulse generator) were implanted, in order to cover distant areas of the body involved by the disease (neck, shoulders, upper extremities, trunk and lower extremities). Follow-up varies from 4 to 14 months. In the implanted group, pain relief was absent in 3 patients, minimal in 1, moderate in 5 and good in 6. Pain relief was strictly limited to the body parts covered by the parasthesiae induced by SCS. In 3 patients, SCS produced visible changes in the swelling of the painful extremities. None of the patients was made neurologically worse. In 7 patients there were technical problems related to electrode breakage or migration, change in the pattern of paresthesiae and poor connection due to body fluid infiltration. All the problems were corrected surgically under local anesthesia. SCS has some value in the management of refractory RSD pain in selected cases. Because of the limited series and follow-up, its value in the comprehensive management of RSD requires further investigation.

Adolescent↗
PubMed1987

The lack of response to suggestion under controlled surgical anesthesia.

Thirty-two ASA I or II women undergoing abdominal hysterectomy were randomly allocated to four groups to determine what type, if any, of recorded intraoperative message they would receive. Groups I and II heard a neutral recording with no verbal content. Group III heard an experimental recording with a positive suggestion for a rapid recovery. Group IV had a self-prepared message. The tapes were played during general anesthesia when anesthetic depth was judged to be stable and adequate by vital signs, end-tidal anesthetic concentration and EEG compressed spectral array. No patient reported any recall of intraoperative messages when interviewed on the day after surgery. Chart review showed no difference in days of hospitalization, dose of analgesics required, time to beginning oral intake, or the amount of wound drainage (P greater than 0.05). We conclude that no awareness can be observed directly by recall or indirectly by response to suggestion given under stable and adequate general anesthesia.

Adult↗
PubMed1987

Monodeiodination of triiodothyronine and reverse triiodothyronine during low and high calorie diets.

The impact of varying caloric intake on peripheral monodeiodination and plasma disposal of T3, rT3, and the three diiodothyronines (T2) was studied in five normal subjects while they were consuming a low calorie diet (1200 Cal/day) and again while receiving a high calorie diet (3600 Cal/day). Toward the end of each diet period 240 nmol 3,3'-T2 (126 micrograms) and 80 nmol 3',5'-T2 (42 micrograms) were infused for 7 h, and a bolus injection of 137 nmol 3,5-T2 (72 micrograms) was followed by a 12-h infusion of 69 nmol 3,5-T2 (36 micrograms) and 111 nmol rT3 (72 micrograms) on another day. [125I]T3 (30 muCi) was injected on the third day. The T2 and rT3 concentrations were measured by RIA during the 2 days of infusion, and the serum disappearance of [125I]T3 was studied by immunoprecipitation and trichloroacetic acid precipitation of the labeled T3. Four to 5% of the plasma disposal of T3 was accounted for by 3'-monodeiodination, and 36-39% by 5-monodeiodination. Increasing caloric intake resulted in a higher overall plasma disposal rate of T3, but no change in the percentage of T3 metabolized by monodeiodination pathways. In contrast, 5'-monodeiodination accounted for 21% of the total plasma disposal of rT3 during the low calorie diet and 45% during the high calorie intake. This increase in 5'-monodeiodination of rT3 was at the expense of alternative pathways of disposal. A marked increase in the plasma clearance rate of 3,5-T2 was also found during the high calorie diet, indicating that the level of caloric intake affects pathways of metabolism other than outer ring monodeiodination. These studies emphasize the important role played by diet in the regulation of peripheral thyroid hormone metabolism through modulating outer ring monodeiodination, and that overnutrition changes other pathways of iodothyronine metabolism as well.

Adult↗
PubMed1987

Pain control for the urologist.

Pain states can be divided into three categories: acute, chronic not resulting from malignancy, and chronic malignant pain. A Pain Clinic can provide in-depth evaluation and treatment of difficult pain problems. A variety of oral and parenteral medications, ranging from nonsteroidal analgesics to narcotics, are available to control pain. Local anesthetics can be used for local infiltration, and peripheral and central nerve blocks can also be used as indications warrant.

Acupuncture Therapy↗
PubMed1985

Effect of increased physical activity on voluntary intake in lean women.

To determine the effect of exercise-related factors on food intake, five nonobese women (mean +/- SEM of the percent of desirable body weight, 97 +/- 5) were hospitalized as part of a metabolic experiment. Excess amounts of a mixed food diet were provided on platters to the subjects. They served themselves from these and ate freely. Intake was estimated covertly by weighing the platters before and after serving. Expenditure was monitored with daily activity diaries and indirect calorimetry determinations of all the activities recorded. After a five-day evaluation phase, each subject underwent three 19-day treatment periods in which physical activity was modified. Total daily expenditure was increased to 114 +/- 4% of the sedentary treatment for a mild exercise period and 129 +/- 3% for a moderate period. Corresponding voluntary intakes during exercise were 117 +/- 5% and 122 +/- 6% of sedentary treatment. Although moderate exercise (mean 772 +/- 40 kcal/d) was greater than mild (378 +/- 63 kcal/d), the increased intake levels of the two were comparable. However, the resulting energy balances of 10 +/- 71 kcal/d for sedentary, 64 +/- 43 kcal/d for mild and -116 +/- 92 kcal/d for moderate treatments were not different. Therefore, in a paradigm which permits maintenance of a voluntary balanced energy state during an inactive period, compensatory intake responses to exercise occur. Unlike obese women who do not match their intakes to energy expended as physical activity, nonobese women demonstrate hyperphagic responses.

Adult↗
PubMed1985

Nitroglycerin-controlled circulation in orthognathic surgery.

Significant blood loss is a potential complication of maxillary osteotomies and maxillary and mandibular osteotomies. Controlling circulation by lowering blood pressure is a technique that has been used successfully to avoid this problem. Of the various agents available, nitroglycerin was chosen because of its known beneficial cardiovascular effects and its lack of toxicity as compared with sodium nitroprusside. Nine patients undergoing either maxillary or maxillary/mandibular osteotomies were anesthetized with halothane, N2O, O2, and supplemental doses of a muscle relaxant and narcotic. Nitroglycerin was used to lower mean arterial pressure during periods of potential increased blood loss. Estimated blood loss was 439 +/- 1.19 ml. The hemoglobin and hematocrit fell slightly from 13.8 +/- 1.74 g/dl and 41.2 +/- 5.11% to 12.04 +/- 1.8 g/dl and 35.6 +/- 4.9%. Attenuation of the pulmonary hypoxic vasoconstriction reflex was also seen, as was evidenced by a decrease in PaO2 after nitroglycerin administration. It was concluded that nitroglycerin is a safe and efficacious agent for controlled circulation during maxillary osteotomy surgery.

Adolescent↗
PubMed1985

Effect of exercise on food intake in human subjects.

We review human studies of the effect of physical activity on food intake. Most are flawed by inaccurate measurement of energy expenditure and/or energy intake, by lack of controls, or by short study periods. While lean persons seem to regulate and maintain weight well, studies in obese subjects are inconclusive. At realistic exercise intensities, the effect on weight is generally small. There is little evidence of inhibition of food intake. In our metabolic ward studies, treadmill exercise neither enhanced nor inhibited food intake in obese individuals. Since intake remained fixed, a negative energy balance was observed with exercise. When more savory food was provided, intake again remained fixed as exercise was increased, but subjects ate more throughout and maintained positive energy balance. Thus, energy output does not regulate energy intake closely in the obese. Food-related cues seem more important than exercise-generated signals. The beneficial effect of exercise on body weight is limited to the extra calories expended. Further careful studies are essential to differentiate effects of kinds and intensities of exercise.

Body Weight↗