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Biomedical subjects

B D Adams

Publications and source records attributed to B D Adams.

At least 19 recordsLinked to original sources
PubMed2006

Honoring the Admiral: Boerhaave-van Wassenaer's syndrome.

Dr. Herman Boerhaave (1668-1738) first described esophageal rupture and the subsequent mediastinal sepsis based upon his careful clinical and autopsy findings and hundreds of references have since been written about Boerhaave's syndrome. Several fine historical accounts of this brilliant scientist have been published over the years and he has received appropriate credit for his valuable contributions. But what about that unfortunate propositus that Dr. Boerhaave attended to, performed necropsy upon, and subsequently received acclaim with? Medical history pays inadequate regard to the Baron Jan Gerrit van Wassenaer heer van Rosenberg, Prefect of Rhineland and Grand Admiral of the Dutch Fleet. This figure was a nobleman and war hero at the peak of the Dutch Golden Age who played his role in steering the course of European history. Without this nobleman's heroic contemporaneous account, Boerhaave's celebrated impact on medical science would never have been realized. Therefore, we offer an overdue recitation of Admiral van Wassenaer's biography. Based on found precedent we propose that spontaneous rupture of the esophagus be henceforth referred to as the 'Boerhaave-van Wassenaer's syndrome'.

Eponyms↗
PubMed2006

The anion gap does not accurately screen for lactic acidosis in emergency department patients.

INTRODUCTION: Lactic acidosis portends a poor prognosis in trauma, sepsis, and other shock states and is useful for triaging and resuscitating emergency department (ED) patients. The authors sought to determine whether the AG is a reliable screen for lactic acidosis when applied specifically in the ED setting. METHODS: The authors performed a retrospective cohort study over a seven month period. Subjects were all ED patients that had a serum lactate obtained. Sensitivity analyses of the AG for detecting presence of lactic acidosis were calculated for the traditional AG normal value (AG <12) and for the lower AG normal value when using newer ion selective electrode assays (AG <6). RESULTS: Serum lactate levels were ordered in the ED on 440 occasions. 137 samples were excluded by protocol. Using an AG cutoff of 12, the sensitivity for detecting lactic acidosis was 58.2%, specificity was 81.0%, and the negative predictive value was 89.7%. Using the AG cutoff of 6, the sensitivity was 93.2%, the specificity was 17.3%, and the negative predictive value was 91.8%. CONCLUSIONS: The traditional definition of AG >12 was insensitive for the presence of lactic acidosis. Using the revised AG of >6 is more sensitive but non-specific for lactic acidosis. The authors conclude that employing the AG as a screen for LA may be inappropriate in ED patients. Instead, they recommend ordering a serum lactate immediately upon suspicion of a shock state. A prospective study to confirm these findings is needed.

Acidosis, Lactic↗
PubMed2004

Influence of articular geometry on prosthetic wrist stability.

Ellipsoid and toroid-shaped articulations for total wrist prostheses were evaluated using computer modeling and laboratory experiments. An ellipsoidal design was found to accommodate greater width of the concave proximal component, resulting in better capture and prosthetic stability than a toroid shape. An ellipsoid articulation also provides greater contact area through the available arc of motion. An ellipsoidal articulation is a reasonable design for total wrist arthroplasty.

Computer Simulation↗
PubMed2003

Scleroderma renal crisis.

Explore the source record for details and available documents.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2001

Reconstruction of the posttraumatic unstable distal radioulnar joint.

Although not a common problem, the posttraumatic unstable distal radioulnar joint can be difficult to treat. This article focuses on the various methods for reconstruction of the unstable distal radioulnar joint. Attention focuses specifically on anatomic reconstruction of distal radioulnar ligaments. The authors' technique is presented in detail.

Humans↗
PubMed2001

Electrical and ultrasound stimulation for scaphoid fractures.

The standard treatment for delayed union or nonunion of the scaphoid is operative management. Electrical stimulation has been employed in these clinical situations in patients unable or unwilling to undergo surgical intervention. Recent interest has also focused on the use of low-intensity ultrasound as an adjunct to healing in distal radius and tibial fractures. Results with the use of ultrasound for scaphoid fractures is encouraging. A review of the mechanisms of action, clinical results, and possible indications is presented for these two nonoperative modalities.

Casts, Surgical↗
PubMed1998

Amlodipine overdose causes prolonged calcium channel blocker toxicity.

Amlodipine is a relatively new agent that has the longest half-life of all calcium channel blockers. This report describes a severe overdose that resulted in prolonged and severe hemodynamic compromise for up to 10 days, but responded to aggressive therapy with calcium, glucagon, and other vasoactive medicines.

Aged↗
PubMed1998

The role of antibiotics in the management of elective and post-traumatic hand surgery.

The use of prophylactic antibiotics in elective and emergency hand surgery is an unsettled issue. Although their benefit in general surgical cases and certain orthopedic cases is well established, the lower infection rates in elective and emergency hand surgery have made attempts to prove the efficacy of prophylaxis more difficult. Valid arguments can be made for the use of antibiotics in human and animal bites. Prophylactic antibiotic use is efficacious in the following scenarios: (1) soft-tissue reconstructive procedures with large flaps, (2) total elbow or wrist implant arthroplasty, (3) procedures of long duration, and (4) complex open hand trauma with wound contamination and extensive soft-tissue and bony injury. Antibiotic prophylaxis does not appear warranted in clean, elective procedures lasting fewer than 2 hours. The duration of antibiotic use should be as short as possible to minimize complications and the development of bacterial resistance. The selection of a particular antibiotic regimen remains the surgeon's choice, but many inexpensive and relatively safe antibiotic agents are available. Although uncommon, potentially serious hazards exist with the use of antibiotics. Definitive guidelines on the use of antibiotics in hand surgery are not available; hand surgeons should apply basic principles of prophylaxis and be aware of the existing controversies.

Anti-Bacterial Agents↗
PubMed1997

Bioabsorbable pin fixation of intercarpal joints: an evaluation of fixation stiffness.

OBJECTIVE: Bioabsorbable pins made of poly-p-dioxanone (Johnson and Johnson Orthopaedics, Raynham, Massachusetts) were compared to steel pins in the fixation of the scapholunate and lunotriquetral intercarpal joints of the wrist. DESIGN: An in vitro experiment was performed using fresh-frozen cadaver wrists. BACKGROUND: In the surgical treatment of wrist ligament injuries, temporary intercarpal joint fixation is required. Although steel pins are currently used, there are several clinical problems associated with their use. These complications could potentially be reduced by using bioabsorbable fixation. METHODS: The carpal bones were mounted between sets of plates which were then attached to a materials testing machine. Two parallel pins were used for joint fixation; steel pin fixation was tested first in each joint. Seven scapholunate joints and seven lunotriquetral joints were each tested in three different modes: translation in two orthogonal directions, and rotation. RESULTS: Bioabsorbable pin fixation provided an average of 46% of the stiffness of steel pin fixation. CONCLUSIONS: Although bioabsorbable pin fixation was statistically less stiff than steel pin fixation, relatively high loads were required to induce significant intercarpal joint translation and rotation. RELEVANCE: The strength retention profile of poly-p-dioxanone pins and the quality of fixation demonstrated in this study indicate that these bioabsorbable pins could provide satisfactory fixation of the scapholunate and lunotriquetral joints in the treatment of partial injuries of the intercarpal ligaments.

Journal Article↗
PubMed1997

Staged extensor tendon reconstruction in the finger.

Staged extensor tendon reconstruction using a silicone implant followed by tendon grafting was done to restore proximal interphalangeal (PIP) joint extension in 6 fingers with severe injuries to the dorsal skin and extensor mechanism. Abrasions to the joint capsule and cortical surfaces were also present. To avoid finger stiffness, the reconstruction was delayed and range of motion exercises were initiated early. The skin injury was managed by split-thickness skin grafting or allowed to heal by secondary intention to avoid prolonged immobilization. During surgery, the peritendinous fascia of the extensor tendon is used to guide insertion of the implant, and it serves as a premade tunnel that appears to aid the gliding and stability of the implant and subsequent tendon graft. Active extension of the PIP joint was restored in all fingers; there was an average extension lag of 15 degrees. PIP joint flexion averaged 95 degrees. On the basis of this experience, the author believes the technique to be a reliable treatment alternative for severely injured fingers with extensor mechanism loss.

Adult↗
PubMed1996

Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility.

The Frykman, Melone, Mayo, and AO classification systems for distal radius fractures were evaluated for interobserver reliability and intraobserver reproducibility in a clinical setting using initial plain radiographs. Two attending orthopedic hand surgeons and two attending radiologists classified 55 sets of distal radius fractures. kappa-statistics were used to establish a relative level of agreement between observers for the two readings and between separate readings by the same observer. Interobserver agreement was rated as moderate for the Mayo classification and fair for the Frykman, Melone, and AO classifications. Intraobserver agreement was substantial for only one of four observers for each of the Frykman, Melone, and Mayo, while the remaining three observers achieved only fair to moderate reproducibility. Intraobserver agreement for the AO classification was fair for all four of the observers. Neither interobserver or intraobserver agreement was affected by combining similar subclasses in the Melone classification or by reducing the number of categories in the AO system from 27 to 9. However, further reducing the AO system to its three main types brought agreement to the "substantial" level. No difference was found in interobserver agreement between the first and second readings or in interobserver or intraobserver agreement between orthopedic hand surgeons and radiologists. Understanding the limitations of fracture classifications based solely on plain radiographs can help avoid undue reliance on them. Given the low degree of interobserver and intraobserver agreement for each of the distal radius fracture classifications in this study, their use as the sole means for determining the direction of treatment or for the direct comparison of results among different studies is not warranted.

Adult↗
PubMed1996

Triangular fibrocartilage injury: a laboratory model.

A potential injury mechanism for triangular fibrocartilage tears and ulnar styloid fractures was investigated in cadaver specimens. The distal radioulnar joint was distracted to failure, thus applying a tensile force to the triangular fibrocartilage. During distraction, strains in the triangular fibrocartilage and the anatomic site of disruption were recorded with an image analysis system. Complete avulsion of the triangular fibrocartilage from the ulnar head occurred in 7 of 10 specimens. No ulnar styloid fractures occurred. Although strains were high in the radial portion of the disk (28%), no tears occurred in the substance of the disk or at its attachment to the radius. These findings suggest that distal radioulnar joint distraction can cause avulsion of the triangular fibrocartilage. However, ulnar styloid fractures and tears within the disk are more likely caused by injury mechanisms that include shear or compressive forces. Since complete avulsions of the triangular fibrocartilage occurred without a fracture, the absence of a fracture does not rule out a destabilizing injury to the distal radioulnar joint.

Adult↗
PubMed1995

Analysis of finger extensor mechanism strains.

Strains in the extensor mechanism of the finger were measured in a cadaver model using Hall-effect transducers. Several components of the mechanism were evaluated at different joint positions, with different intrinsic and extrinsic tendon loading conditions, and after creating a boutonnière deformity. Landsmeer's theory that predictable and obligatory interactions occur within the extensor mechanism during finger movement is strongly supported by our results. The concept of the Bunnell intrinsic-tightness test was confirmed. Results were consistent with clinical observations and current theories on the pathomechanics of claw and boutonnière deformities. Based on our experimental findings, we conclude that strain analysis is an effective method of evaluation of the extensor mechanism with potential for in vivo surgical applications.

Cadaver↗
PubMed1995

Hand and wrist.

Some basic principles of orthopedic management of common conditions of the hand and wrist have been presented. These basic principles and an awareness of the potential complications should aid radiologists in evaluation of postoperative films. The interested reader is referred to Green's Operative Hand Surgery and Chapman's Operative Orthopaedics for more detailed information.

Carpal Bones↗