Biomedical subjects

Anthony J Wilson

Publications and source records attributed to Anthony J Wilson.

5 recordsLinked to original sources

PubMed2004

Modularisation - flexible or restrictive professional education.

In response to the Dearing Report [Higher education in the learning society. Report of the National Committee of Inquiry into Higher Education. HMSO, London, 1997] modularising courses has been a major activity in schools of nursing and midwifery. This should make it easier for students to transfer between courses, university to university with credit for academic achievement. In respect of mental health nursing students the effect upon opportunities for personal and professional development is considered. The paper questions whether a modular framework of learning experiences meaningfully prepares students for their future as mental health nurses. The continued use of an adapted [A. Beattie, in: P. Allan, M. Jolley (Eds.), The Curriculum in Nurse Education, Croom Helm, London, 1997] fourfold curriculum model in working with students is contrasted with the process of modularisation. Challenges that have arisen for mental health nursing lecturers to continue with this are discussed.

Curriculum↗

PubMed2002

Can we rely on mediastinal widening on chest radiography to identify subjects with aortic injury?

Widening of the mediastinum on chest radiography is widely promoted as a useful criterion for detecting aortic injury. We sought to determine the reliability, sensitivity, and specificity of this sign. The initial chest radiographs from 30 subjects with aortic injury and 47 controls were independently reviewed by six radiologists, who were blinded to diagnosis. The radiologists were asked to decide whether the mediastinum was normal or not normal, as well as whether the mediastinum was widened. Agreement, sensitivity, and specificity were assessed. Agreement for overall assessment of the mediastinum was substantial (kappa = 0.64). Individual radiologists had sensitivity varying from 0.77 to 0.97 and specificity varying from 0.62 to 0.89. For "widening" of the mediastinum, agreement was moderate (kappa = 0.49). "Widening" was less sensitive than the radiologists' overall impression (P = 0.01), varying from 0.50 to 0.83, but no difference was detected in specificity (P = 0.36), varying from 0.81 to 0.94. Mediastinal width has unacceptable sensitivity for predicting aortic injury, with substantial inter-reader variability. Medical education has ingrained the widely promoted concept of mediastinum widening, which may be misleading.

Journal Article↗

PubMed2002

Radiologic and clinical spectrum of occipital condyle fractures: retrospective review of 107 consecutive fractures in 95 patients.

OBJECTIVE: We proposed to characterize the radiologic spectrum of occipital condyle fractures in a large series of patients and to correlate fracture pathology with neurosurgical treatment and patient outcome. MATERIALS AND METHODS: We conducted a retrospective review of the findings on conventional radiography, CT, and MR imaging in 95 patients with 107 occipital condyle fractures. We described fracture patterns according to two previously published classification systems. Clinical findings, neurosurgical management, and patient outcome were obtained from the medical records. RESULTS: Inferomedial avulsions (Anderson and Montesano type III) were the most common type of occipital condyle fracture, constituting 80 (75%) of 107 overall fractures. Unilateral occipital condyle fractures were found in 73 (77%) of 95 patients, and 58 patients were treated nonoperatively; occipitocervical fusion was required in nine patients for complex C1-C2 injuries, and six patients died. Bilateral occipital condyle fractures or occipitoatlantoaxial joint injuries were seen in 22 (23%) of 95 patients. Occipitocervical fusion or halo traction for the craniocervical junction was required in 12 patients, all of whom had CT evidence of bilateral occipitoatlantoaxial joint disruption and six of whom showed normal craniocervical relationships on conventional radiographs. Six patients with nondisplaced fractures were treated nonoperatively, and four patients died. Thirty (32%) of 95 patients showed continued disability, whereas 55 (57.5%) of 95 patients had good outcomes at 1 month. Associated cervical spine injuries were present in 29 (31%) of 95 patients. CONCLUSION: Given their associated traumatic brain and cervical spine injuries, occipital condyle fractures are markers of high-energy traumas. That conventional radiographs alone may miss up to half of the patients with acute craniocervical instability has not been well established. Avulsion fracture type and fracture displacement are associated with both injury mechanism and the need for surgical stabilization. In this series, most unilateral occipital condyle fractures were treated nonoperatively, whereas bilateral occipitoatlantoaxial joint injuries with findings of instability usually required surgical stabilization.

Adolescent↗

PubMed2002

Validation of chest X-ray comparisons for unknown decedent identification.

Comparing skeletal structures between antemortem and postmortem chest radiographs is widely used by forensic specialists from many disciplines to positively identify unknown decedents. However, validity assessments of this method have been fairly limited. This study had three objectives: 1) to quantify the reliability of ante- and postmortem chest radiograph comparison for decedent identification; 2) to identify useful radiologic features supporting decedent identification; and 3) to recognize sources of error in decedent identification related to use of comparative radiographs. A forensic pathologist, a forensic anthropologist, and two radiologists participated in the study. Our results showed that chest radiograph comparisons proved reliable, if basic decedent information was provided, and antemortem and postmortem radiographs were adequately positioned and exposed. A "morphological approach" using normal anatomical structures for comparison may provide the most efficient method for accurate identification.

Adult↗

PubMedDate not supplied

From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation.

Chondrosarcoma is a malignant tumor that produces cartilage matrix, and lesions that arise de novo are called primary. Primary chondrosarcoma is the third most common primary malignant tumor of bone, constituting 20%-27% of all primary malignant osseous neoplasms. There are numerous types of primary chondrosarcomas, including conventional intramedullary, clear cell, juxtacortical, myxoid, mesenchymal, extraskeletal, and dedifferentiated. The conventional intramedullary chondrosarcoma is the most frequent type, and it most commonly involves the long bones or pelvis in up to 65% of cases. Although the pathologic appearance varies with specific lesion type, chondrosarcomas grow with lobular type architecture, and these hyaline cartilage nodules demonstrate high water content and peripheral enchondral ossification. Imaging features directly reflect this pathologic appearance, and the various subtypes often show distinctive features. Radiographic findings often suggest the diagnosis of chondrosarcoma because of identification of typical "ring-and-arc" chondroid matrix mineralization (representing the enchondral ossification) and aggressive features of deep endosteal scalloping and soft-tissue extension. These latter features are usually best assessed, as is lesion staging, with computed tomography (CT) or magnetic resonance (MR) imaging. CT is optimal to detect the matrix mineralization, particularly when it is subtle or when the lesion is located in anatomically complex areas. Both CT and MR imaging depict the high water content of these lesions as low attenuation and very high signal intensity with T2-weighting, respectively. Understanding and recognizing the spectrum of appearances of the various types of primary chondrosarcoma allow improved patient assessment and are vital for optimal clinical management including diagnosis, biopsy, staging, treatment, and prognosis.

Academies and Institutes↗