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Biomedical subjects

A J Starr

Publications and source records attributed to A J Starr.

At least 19 recordsLinked to original sources
PubMed2005

The use of a virtual three-dimensional model to evaluate the intraosseous space available for percutaneous screw fixation of acetabular fractures.

We created virtual three-dimensional reconstruction models from computed tomography scans obtained from patients with acetabular fractures. Virtual cylindrical implants were placed intraosseously in the anterior column, the posterior column and across the dome of the acetabulum. The maximum diameter which was entirely contained within the bone was determined for each position of the screw. In the same model, the cross-sectional diameters of the columns were measured and compared to the maximum diameter of the corresponding virtual implant. We found that the mean maximum diameter of virtual implant accommodated by the anterior columns was 6.4 mm and that the smallest diameter of the columns was larger than the maximum diameter of the equivalent virtual implant. This study suggests that the size of the screw used for percutaneous fixation of acetabular fractures should not be based solely on the measurement of cross-sectional diameter and that virtual three-dimensional reconstructions might be useful in pre-operative planning.

Acetabulum↗
PubMed2001

Preliminary results and complications following limited open reduction and percutaneous screw fixation of displaced fractures of the acetabulum.

Twenty-four patients underwent attempted closed or limited open reduction of displaced acetabular fractures. If reduction was successful, the fractures were stabilized with percutaneous screws. Group 1 was composed of elderly patients with complex fractures and radiographic findings that were felt to be predictive of post-traumatic arthritis. In these patients, percutaneous screw fixation was used to improve fracture anatomy, allow mobilization and total hip replacement later, if necessary. In group 1, anatomical reduction was not felt to be a necessity. Group 2 was composed of young patients with simple fracture types. For group 2, anatomical reduction was the goal. In 23/24 patients, closed or limited open reduction was successful. In group 1, maximum displacement averaged 10 mm preoperatively, 3 mm postoperatively. In group 2, maximum displacement averaged 7 mm preoperatively, 1 mm postoperatively. One elderly patient was lost to follow-up and one died, leaving 21 patients with an average follow-up of 12 months. All the fractures healed. One patient had a transient femoral nerve palsy, and two elderly patients had minor losses of reduction due to unprotected ambulation after surgery. Five of the elderly patients have gone on to total hip arthroplasty. The average Harris Hip scores in groups 1 and 2 were 85 and 96, respectively.

Acetabulum↗
PubMed1999

The "swashbuckler": a modified anterior approach for fractures of the distal femur.

A modified anterior approach to the distal femur is presented. The approach allows surgical exposure of the entire articular surface of the distal femur. The quadriceps muscle bellies are spared during the approach. The skin incision used will not interfere with subsequent total knee arthroplasty, if posttraumatic arthritis develops and arthroplasty is necessary.

Femoral Fractures↗
PubMed1998

Treatment of femur fracture with associated head injury.

OBJECTIVES: The aim of this study was to determine (a) whether delay in femur fracture stabilization beyond twenty-four hours in patients with head injury increased the risk of pulmonary complications and (b) whether immediate (up to twenty-four hours) femur fracture stabilization increased the risk of central nervous system (CNS) complications. DESIGN: Retrospective analysis. MATERIALS AND METHODS: Thirty-two patients with femur fracture and head injury were identified. Fourteen underwent immediate stabilization of their fractures, and eighteen underwent delayed (four-teen patients) or no (four patients) stabilization of their fractures. RESULTS: In the immediate stabilization group, five patients had severe head injuries [Glasgow Coma Score (GCS) < or = 8] and nine had mild head injuries (GCS > 8). In the mild head injury group, no patient had a pulmonary complication and one had a CNS complication. In the severely head-injured group, one patient had a pulmonary complication and no patient had a CNS complication. In the delayed stabilization group, six patients had mild head injuries (GCS > 8) and twelve had severe head injuries (GCS < or = 8). In the mildly head injured group, one patient had a pulmonary complication, two patients had CNS complications, and one patient died. In the severely head injured group, nine patients had pulmonary complications, three patients had CNS complications, and one patient died. Logistic regression identified delay in femur stabilization as the strongest predictor of pulmonary complication (p = 0.0042), followed by severity of chest Abbreviated Injury Score (AIS; p = 0.0057) and head AIS (p = 0.0133). Delaying fracture stabilization made pulmonary complications forty-five times more likely. Each point increase in the chest AIS and head/neck AIS increased the risk of pulmonary complication by 300 percent and 500 percent, respectively. A statistically significant predictor of CNS complications could not be identified by using logistic regression. CONCLUSION: Delay in stabilization of femur fracture in head-injured patients appears to increase the risk of pulmonary complications. However, due to selection bias in this patient sample, this question cannot be definitively answered. Early fracture stabilization did not increase the prevalence of CNS complications.

Adolescent↗
PubMed1998

Percutaneous fixation of the columns of the acetabulum: a new technique.

A technique for percutaneous placement of cannulated screws in the acetabulum is presented. Surgical technique is described, and fluoroscopic imaging techniques used to guide screw placement are also illustrated. The technique was used to limit soft tissue dissection in three patients. Results and examples are presented.

Acetabulum↗
PubMed1996

Treatment of femur fracture with associated vascular injury.

OBJECTIVE: The aim of this study was to determine (1) if internal fixation was associated with a high amputation rate in patients with femur fracture and vascular injury; and (2) if patients who underwent internal fixation before vascular repair had a higher amputation rate. DESIGN: This is a retrospective analysis. MATERIALS AND METHODS: Twenty-six patients requiring femoral stabilization with injury to the superficial femoral artery, popliteal artery, or common femoral vein were studied. The Injury Severity Score and the Mangled Extremity Severity Score were calculated for each. Nineteen patients underwent internal fixation. Ten patients had internal fixation before vascular repair. RESULTS: Sixteen of 19 patients treated with internal fixation had limb salvage. Nine of 10 patients who had internal fixation before vascular repair had limb salvage. Poor outcomes (gangrene, amputation, or death) were associated with a Mangled Extremity Severity Score > or = 6 (p = 0.005). CONCLUSIONS: In these patients, poor outcome is associated with severe leg injury, (with a Mangled Extremity Severity Score of > or = 6). Internal fixation can be safely used, and skeletal stabilization can be safely performed before vascular repair. If ischemic time is prolonged, vascular shunts should be used until skeletal stabilization is completed.

Adolescent↗
PubMed1990

Stress, coping, and quality of life in adult kidney transplant recipients.

The purpose of this study was to identify specific stressors and coping strategies identified by adult kidney transplant recipients in the first 6 months after transplantation. Quality of life was used as the outcome measure. Subscales were rationally constructed based on literature review and logic for both the stress and coping scales. Health-related items were identified as most stressful including uncertainty about whether the transplant will be a success and concern about risk of infections and/or viruses. Work-related items were least stressful. Strongly endorsed coping strategies included items on the Distancing/detachment and Self-control/accepting responsibility subscales. Quality of life scores were significantly higher after the transplant than before. Total stress was the important predictor of quality of life before transplant. Both total stress and total coping were important predictors of quality of life after transplant. The expanded transplant nursing role provides an opportunity to identify stressors and suggest appropriate coping strategies early in the transplant experience.

Adaptation, Psychological↗
PubMed1989

Ab urbe condita.

Explore the source record for details and available documents.

Delivery of Health Care↗
PubMed1982

Comparison of lyophilized and frozen microtiter systems for routine MIC testing in the clinical laboratory.

Frozen microtiter plates (Micro-Media Systems, Inc.) and lyophilized microtiter plates (Sensititre--Seward Laboratory/Gibco Diagnostics) were used to perform simultaneous MIC determinations. Specimens were obtained from blood, urine and other clinical isolates. The authors found that there was good correspondence of results with the frozen microtiter MIC plates and the lyophilized microtiter MIC plates. After careful evaluation, the authors conclude that the lyophilized product is as stable and as reproducible as the frozen product. The lyophilized product is more easily and conveniently stored, has a longer shelf life and is more flexible.

Anti-Bacterial Agents↗
PubMed1979

Squamous papilloma of the esophagus.

We have described two cases of squamous papilloma of the esophagus, one of which is an unusual case of probable malignant transformation of a benign squamous papilloma to a low-grade verrucous carcinoma.

Adult↗