Biomedical subjects
Publications and source records attributed to B A Shaw.
Atlas anomalies in terms of clefts and aplasia are rare. They can sometimes simulate fractures and need further evaluation. Imaging in terms of CT and MR can help resolve diagnostic confusion and also outline associated neurological involvement. A rare anomaly of anterior and posterior atlas arch, previously unclassified, is presented.
OBJECTIVES: The purpose of this study is twofold: (a) to see whether the association between age and perceived control is the same for Blacks as well as Whites; and (b) to see if education, health, income, social support, cognitive function, and religion account for the relationship between age and control in the same way for Blacks and Whites. METHODS: Data for this study come from the first wave of the Americans' Changing Lives panel study. Complete data are available for 357 Black and 2,792 White individuals. Respondents were asked questions about their feelings of control, health status, income, social support, cognitive function, religious participation, and demographic information. RESULTS: The findings suggest that age has an inverse and nonlinear association with feelings of control. Moreover, this relationship is similar for Blacks and Whites. The data further reveal that, across all age groups, Blacks report a lower sense of control than Whites. Less education, less income, greater cognitive impairments, and more religiosity are associated with a lower sense of control. These factors, along with health and social support, account for 69% of the association between age and control, with no differences according to race. DISCUSSION: These results show that lower levels of control are associated with older age in both Blacks and Whites, and that racial disparities in feelings of control persist across all age groups. This suggests that Blacks may be at a particular disadvantage in the face of the increasing challenges of aging.
Familial transmission of congenital muscular torticollis (CMT) has been reported in the literature, and postaxial polydactyly has been frequently reported in familial cases, but, to our knowledge, familial CMT with postaxial polydactyly has not been described. In this article, we report a rare case of CMT with postaxial polydactyly in 3 generations of a family and suggest an autosomal-dominant pattern of inheritance in these cases.
The purpose of this study is to examine the impact of 2 different measures of personal control on mortality in late life. The 1st reflects control over the 3 roles that are most important to elderly study participants. The 2nd is a global measure that assesses control over life as a whole. Data provided by a nationwide survey of older adults (N = 884) indicate that feelings of control over the single most important role significantly reduce the odds of dying. In contrast, control over the 2nd and 3rd most important roles are not related to mortality, nor are feelings of control over life as a whole. The theoretical implications of these findings are discussed.
OBJECTIVE: The purpose of this study was twofold: (1) to see if providing emotional support to others bolsters the self-esteem of older adults over time; and (2) to assess whether the salubrious effects of helping others are more likely to be enjoyed by high socioeconomic status (SES) elders. METHODS: Interviews were conducted with a nationally representative sample of older adults at three points in time: 1992-1993, 1996-1997, 1998-1999. Complete data are available for 511 elderly people. During each round of interviews, respondents were asked how often they provided emotional support to their social network members. Information on the self-esteem of older support providers was also gathered at each point in time. RESULTS: Initially, the findings revealed that helping others tends to bolster the self-esteem of all study participants regardless of their SES standing. However, these benefits began to taper off for lower SES elders during the course of the study. By the third wave of interviews, the salutary effects of helping others were evident only among older adults in upper SES levels. DISCUSSION: The results highlight the dynamic nature of the helping process and underscore the importance of taking SES into account when studying the effects of assisting others in late life.
A 9-month-old child sustained a displaced odontoid fracture in a motor vehicle accident. She was treated with closed reduction and a Minerva cast for 6 weeks, followed by a collar for an additional 2 weeks. At 5-year follow-up, she had made a complete recovery with solid union, no deformity, and no instability.
The purpose of this prospective, randomized, double-blind, placebo-controlled clinical study was to determine whether the administration of intravenous ketorolac, coadministered with morphine patient-controlled analgesia (PCA), demonstrates an opioid-sparing effect, provides improved analgesia, and reduces the incidence of opioid-induced side effects in children after orthopedic surgery. The findings of enhanced analgesia with decreased opioid use suggest that coadministration of ketorolac with morphine PCA is beneficial for the treatment of pain in children after orthopedic surgery.
Portable C-arm fluoroscopy is often used in the operating room. We describe a sterile technique that enables the physician to position the C-arm without requiring the use of a sterile drape.
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Entrapment of tendons in pediatric forearm fractures has been reported rarely and often is diagnosed months to years after the initial injury. Tendon entrapments are reported to occur more frequently distally than proximally. Two pediatric cases of proximal entrapment of the flexor digitorum profundus in an ulnar shaft fracture are reported here. Early diagnosis permitted surgical release and early restoration of full function. These cases emphasize the difficulty in diagnosing this rare condition in a young child and the need for careful digital range of motion examination under ideal circumstances, with pain and apprehension eliminated.
We report a case of spontaneous resolution of a congenital osteochondroma in a child with metachondromatosis. We could find no reports of congenital or neonatal osteochondromas. Furthermore, reports of spontaneous resolution of osteochondromas are rare. We conclude that some of these radiologically benign lesions may be observed in very young patients.
Coccidioidomycosis is a fungal infection endemic to the southwestern United States. Musculoskeletal involvement is rare, and there are few reports with clear recommendations regarding treatment. The purpose of this study was to review a series of 25 patients with musculoskeletal coccidioidomycosis and to assess their outcomes with respect to presentation and treatment. There were 36 lesions among the 25 patients, 8 located in the spine, with the remainder distributed throughout the body. Seventeen patients had a delay in diagnosis of more than 1 month. Eight patients had an elevated white blood cell count, and 10 had an elevated sedimentation rate. Only 7 of the patients had an overt pneumonia before the musculoskeletal presentation. Twenty-four patients underwent formal irrigation and debridement and 22 patients had at least 1 course of Amphotericin B. The average followup after the initiation of treatment was 3.5 years, ranging from 2 to 10 years. Seven patients had recurrent lesions that required further surgical intervention, 4 of whom had a delay in diagnosis of more than 1 month. There were 3 deaths. All surviving patients were free of disease at final followup.
Cannulated screw guide wires may be inadvertently removed while using the cannulated drill or tap. We describe a simple technique for securing the guide wire during drilling and tapping.
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An uncommon fracture of the proximal tibial epiphysis is described in two cases. A flexion-type Salter II fracture of the proximal tibia resulting from a partially closed physis can be reduced easily and appears to have no long-lasting effects. Radiographic review of the adolescent knees showed that physeal closure of the proximal tibial epiphysis proceeds from posterior to anterior, thereby making this particular fracture more likely during this phase of development.
One hundred forty-three displaced (type III) supracondylar fractures of the humerus in children were treated over a 5.5-year period with 17 (11.9%) having signs of vascular impairment at the time of presentation. Rapid reduction and Kirschner wire stabilization without arteriogram was performed in each case. In three cases in which satisfactory blood supply to the hand was not present after reduction, circulation was restored after exploration of the brachial artery revealed two intimal tears and one arterial entrapment. The remaining 14 patients were normal at follow-up with no late vascular compromise. Based on these findings, we feel prereduction arteriography is not indicated in this injury.
Despite intensive study of acute septic arthritis in infancy and childhood, poor outcomes continue to occur. Failures are often due to delayed diagnosis and inadequate therapy, but can be due to factors beyond physicians' control such as associated osteomyelitis and occurrence during infancy. Recent advances in the understanding and management of septic arthritis include: (1) demonstration of beneficial effects of continuous passive motion in rabbits; (2) identification of inflammatory mediators of cartilage destruction and their respective sources; (3) recognition of changing patterns of pathologic organisms; (4) evolution of new antibiotics and standards for oral and home intravenous therapy; (5) development of arthroscopic debridement of septic knees; and (6) further refinement of indications for aspiration-irrigation versus open surgical drainage of septic joints. Permanent sequelae from septic arthritis can only be prevented by early diagnosis and aggressive treatment.
Infection with the Isabel strain of Leishmania has been followed in several inbred strains of mice over an extended period. The mouse strains segregate into three major types with respect to susceptibility to infection: BALB/c, BALB.B and SWR/J are susceptible; DBA/1J is intermediate; and C57BL/6, C57BL/10, DBA/2J and B10.D2 are resistant. Infections with other leishmanial strains have been well-characterized in the BALB/c mice. Therefore, BALB/c mice were selected for extended studies. Progression of the disease was assessed by the following parameters: (1) numbers of parasites isolated from various tissues including footpad lesions, spleens, and lymph nodes and (2) the presence of metastatic lesions. This model should prove valuable in the study of the early immunological events in leishmaniasis.