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Biomedical subjects

W H Bunch

Publications and source records attributed to W H Bunch.

54 records · Page 3Linked to original sources
PubMedDate not supplied

The Milwaukee brace in paralytic scoliosis.

The Milwaukee brace possesses excellent passive properties in addition to the well known dynamic action, and is of definite value in the bracing of paralytic curves in children in whom a fusion should be de-delayed. This application is a temporary but at the same time a long term expedient to allow spine growth prior to surgery.

Biomechanical Phenomena↗
PubMedDate not supplied

The influence of halothane and nitroprusside on canine spinal cord hemodynamics.

Regional spinal cord blood flow was measured in 12 halothane-anesthetized mongrel dogs by means of 15 +/- 3 u radiolabeled microspheres under (1) control conditions, (2) 60-torr mean arterial blood pressure (MAP) using sodium nitroprusside (NPS), (3) 50-torr MAP using NPS, and (4) after reestablishment of normotension. With the onset of either level of hypotension, there were nonsignificant decreases from control conditions in cardiac output and pulmonary capillary wedge pressure (PCWP). A rise in heart rate was seen at 50 torr MAP. There were no significant changes in spinal cord blood flow (SCBF) under either hypotensive condition in any region of the cord, indicating an intact autoregulatory response. Sensitivity of SCBF to changes in the PaCO2 was shown to be 1.02 ml/min/100 g tissue per torr PaCO2. These data showed that (1) deliberate hypotension with NPS did not change SCBF in the dog; (2) sensitivity to PaCO2 was high under halothane anesthesia; and (3) SCBF was relatively homogeneous throughout the length of the cord.

Analysis of Variance↗
PubMedDate not supplied

Segmental spinal instrumentation for congenital scoliosis. A report of two cases.

Two patients with congenital scoliosis underwent surgical correction with segmental spinal instrumentation and fusion. This technique, coupled with spinal monitoring, provides greater correction of a curve than does cast treatment and eliminates the risk of neurologic injury associated with distraction.

Adolescent↗
PubMedDate not supplied

Progression of unsupported curves in adolescent idiopathic scoliosis.

Stability of three types of double scoliotic curves of 10-40 degrees was analyzed using a biomechanical model: double primary (Type I), primary thoracic with compensatory lumbar (Type II), and primary lumbar with compensatory thoracic (Type III). The load-carrying capacity of each curve was analyzed as a function of magnitude of the curve, its location and flexibility. Curve magnitude was found to be the most influential parameter governing the stability of a scoliotic curve up to 30 degrees. Results suggest that in evaluating curves of comparable magnitudes, Type I and II curves are more likely to progress and, therefore, should be braced at an earlier stage than Type III curves.

Adolescent↗
PubMedDate not supplied

Conversion reactions in pediatric athletes.

We report five children and adolescents who displayed a conversion reaction in response to stresses induced by athletic competition. Failure to make proper diagnosis led to additional physician referral, needless testing, rehabilitation, or orthotic management. Patients are characterized as high achievers who are frequently younger than peers in the sport. Conversation between child and physician identified the source of conflict in four patients. Physical therapy helps resolve symptoms associated with an acute episode and facilitates transition into psychotherapy. Psychotherapy is recommended only for patients with persistent maladaptive behavior.

Adolescent↗
PubMedDate not supplied

The epidemiology of "schooliosis".

Questionnaires submitted to children subsequent to school screening for scoliosis reveal that 13% of respondents recall being referred to a physician. This rate is considerably higher than the 3% referral rate reported by school health officials. The discrepancy points to misperceptions by students and their parents as a likely cause of "schooliosis, " a condition which brings a flood of normal children into the offices of orthopaedists and pediatricians. Correcting possible communications problems, rather than blaming the screening program, should ease the over-referral phenomenon and allow screening to continue at its present efficient levels.

Adolescent↗
PubMedDate not supplied

Psychological factors in failure to wear the Milwaukee brace for treatment of idiopathic scoliosis.

Youngsters who fail to successfully adapt to a Milwaukee Brace displayed measurable psychological differences from those who do adapt satisfactorily to this treatment approach. The study did not encompass all conceivable variables which might affect orthotic wearing, however, use of logical and empirical approach to further delineate important variables seems feasible and desirable. In fact, one can hypothesize a predictive test battery which will detect high risk patients and thus afford the physician the option of alternative treatment modes, or intensified psychological intervention if the orthosis is preferred. The nature of such a psychological test battery, as well as the actions which would constitute effective intervention, will depend on future research. Based on our data, adolescent idiopathic scoliosis patients can be considered high risks for compliance with a Milwaukee Brace program if they display the following psychological characteristics: lower overall intelligence uith relative deficits in general information, reading recognition and reading comprehension skills; greater potential for acting-out/rebellious behavior; relatively lower sense of personal power or "potency", less tension associated with doctors; self reports of very active personal and family life styles.

Achievement↗
PubMedDate not supplied

Factitial synovitis.

This unusual case of trauma depicts a 17-year-old female who had a history of chronic synovitis of her left knee for several months. The patient demonstrated persistent knee effusion despite treatment of several physicians. Failure of the left knee to respond to several surgical procedures, as well as the finding of numerous foreign bodies not present previously, evoked a high index of suspicion leading to the diagnosis of factitial synovitis. The paper further defines the entity, describes the personalities involved and the numerous methods used to inflict trauma. Lastly, the treatment regime is given.

Adolescent↗
PubMedDate not supplied

Decision analysis of treatment choices in the osteochondroses.

Physicians tend to decry the lack of data on which they can make decisions. This is commendable, and all should encourage the pursuit of better data and more precise analysis. But decisions must be made, and each physician must deal with what data are available and evaluate them against all the general uncertainties. Equally important are the values that we place on the outcome of treatment. Much of the disagreement among physicians about treatment protocols involves a difference in values. While this is not necessarily bad, it points to the need to consider explicitly the value we place on a result or the morbidity possibly accompanying that result. In the osteochondroses, consideration of values will protect patients from overzealous treatment. Finally, the formality of a decision process should not necessarily modify a plan of treatment based on fundamentally sound principles, intuition, and anecdotal experience. Regardless of which factors represent the basis for an individual surgeon's selection of a particular approach, evaluation of both desirable and undesirable aspects of each alternative prevents impulsive acceptance of the most recently described, often unproven operation. Salter's aphorism: "The decision is more important than the incision," is particularly applicable in treatment of the osteochondroses.

Adolescent↗
PubMedDate not supplied

The effect of denervation on bony overgrowth after below knee amputation in rats.

Bony overgrowth of amputated limbs of children is an infrequent but difficult problem. This article presents the hypothesis that the bony overgrowth is under nerve control and may represent an abortive form of partial limb regeneration. Tested in young rats, denervation produces a significant reduction in the mass and length of the bony overgrowth and a reduced rate of periosteal cell mitosis.

Amputation, Surgical↗