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A J Starr

Publications and source records attributed to A J Starr.

23 records · Page 2Linked to original sources
PubMed1974

Electron microscopic and chemical studies of the vascular changes and edema of lead encephalopathy. A comparative study of the human and experimental disease.

Lead encephalopathy was induced in suckling rats by administering lead to the mother. The brains were studied by light and electron microscopy, and the results were compared with observations in the human disease as well as in cases of cerebral ischemia in children. In their severe forms, both human and experimental lead encephalopathies are characterized by exudative extracellular edema and perivascular PAS-positive globules. The latter consist of osmiophilic non-membrane-limited cytoplasmic inclusions located, in the rat exclusively and in the human predominantly, in perivascular astrocytes. Intervascular strands are also found in both forms of the disease. In the rat these consist of basement membrane surrounding endothelial cytoplasm. Chemically, experimental lead encephalopathy with morphologically demonstrable edema is associated with an increase in brain water, sodium and serum albumin. Relative to the serum concentration, the increase in water is disproportionately greater than the sodium or albumin. There were no demonstrable changes in chloride or potassium.

Adult↗
PubMedDate not supplied

Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures.

OBJECTIVES: The purpose of the present study was to discover any associations between preoperative variables and the occurrence of wound complications in the surgical treatment of calcaneus fractures. DESIGN: Retrospective review. SETTING: A Level 1 trauma center. PATIENTS: One hundred seventy-nine patients, with 190 fractured calcanei, were studied. INTERVENTION: Each patient underwent open reduction and internal fixation for calcaneus fractures with standard techniques. MAIN OUTCOME MEASUREMENTS: The age, sex, preexisting medical conditions, social history, and mechanism of injury of each patient were recorded. Note was made of the status of the soft tissue injury, if any. The time from injury to surgical stabilization was recorded, as was the type of incision used, use of preoperative antibiotics, and type of wound closure. The patients' records were reviewed for wound complications. These complications were classified as those that could be treated nonsurgically and those that required surgical management. RESULTS: Records from July 1992 to July 1998 showed 179 patients who underwent operative stabilization of a calcaneus fracture. Eleven had bilateral fractures, for a total of 190 fractured calcanei. The average age was thirty-five years. Nine patients were diabetics. One hundred eleven of the patients reported current use of cigarettes. Eighteen of the fractures were open. A standard, L-shaped lateral approach to the calcaneus was used in each case. Stabilization was achieved by using standard techniques, with plates and screws. In all cases, a two-layer wound closure was used. Forty-eight patients (25 percent) developed some form of wound complication. Forty (21 percent) of these required surgical treatment. Statistical analysis identified diabetes (p = 0.02; relative risk 3.4), smoking (p = 0.03; relative risk 1.2), and open fractures (p < 0.0001; relative risk 2.8) as risk factors for wound complication. The presence of more than one risk factor increased the relative risk of a wound complication requiring surgery. CONCLUSION: Smoking, diabetes, and open fractures all increase the risk of wound complication after surgical stabilization of calcaneus fractures. Cumulative risk factors increase the likelihood of wound complications. Patients who have the risk factors identified in this study should be counseled as to the possible complications that may arise after surgery. In patients with multiple risk factors, consideration should be given to nonsurgical management.

Adolescent↗
PubMedDate not supplied

Early versus delayed stabilization of pediatric femur fractures: analysis of 387 patients.

OBJECTIVES: To assess the effect of timing of femur fracture stabilization on pulmonary complication rates in pediatric trauma patients. DESIGN: Retrospective review. SETTING: Level I trauma center. PATIENTS: Three hundred eighty-seven previously healthy patients from zero to fifteen years of age with traumatic diaphyseal femur fractures. INTERVENTION: Femur fracture stabilization: early (less than twenty-four hours after injury) in 213 patients and late in 174 patients. MAIN OUTCOME MEASUREMENTS: Age, sex, GCS (Glasgow Coma Score), AIS/ISS (Abbreviated Injury Score/Injury Severity Score), timing of fracture stabilization, duration of mechanical ventilation, intensive care unit stay, and hospital stay were recorded. Pulmonary complications, including pneumonia, respiratory distress syndrome, and pulmonary embolus, were recorded. RESULTS: Thirteen patients developed pulmonary complications. Twelve of these had severe head injuries (GCS < or = 8). One had sustained an upper cervical spine fracture that resulted in quadriplegia. Statistical analysis revealed GCS, GCS < or = 8, ISS, and head and neck AIS to be significant predictors of pulmonary complications. Early stabilization of femur fractures had no apparent effect on the pulmonary complication rate. CONCLUSIONS: Pulmonary complications are rare in pediatric femur fracture patients. Patients with severe head injuries (GCS < or = 8) or cervical spinal cord injuries are at high risk for pulmonary complications. The timing of femur fracture stabilization does not appear to affect the prevalence of pulmonary complications in these patients.

Adolescent↗