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Biomedical subjects

B J Preston

Publications and source records attributed to B J Preston.

At least 19 recordsLinked to original sources
PubMed1999

CT imaging and three-dimensional reconstructions of shoulders with anterior glenohumeral instability.

Glenohumeral instability is a common occurrence following anterior dislocation of the shoulder joint, particularly in young men. The bony abnormalities encountered in patients with glenohumeral instability can be difficult to detect with conventional radiography, even with special views. The aim of our study was to evaluate the bony abnormalities associated with glenohumeral instability using CT imaging with 3-D reconstruction images. We scanned 11 patients with glenohumeral instability, one with bilateral symptoms; 10 were male, one female, and their ages ranged from 18-66 years. Contiguous 3 mm axial slices of the glenohumeral joint were taken at 2 mm intervals using a Siemens Somatom CT scanner. In the 12 shoulders imaged, we identified four main abnormalities. A humeral-head defect or Hill-Sachs deformity was seen in 83% cases, fractures of the anterior glenoid rim in 50%, periosteal new bone formation secondary to capsular stripping in 42%, and loose bone fragments in 25%. Manipulation of the 3-D images enabled the abnormalities to be well seen in all cases, giving a graphic visualization of the joint, and only two 3-D images were needed to demonstrate all the necessary information. We feel that CT is the imaging modality most likely to show all the bone abnormalities associated with glenohumeral instability. These bony changes may lead to the correct inference of soft tissue abnormalities making more invasive examinations such as arthrography unnecessary.

Adolescent↗
PubMed1999

A low-cost approach to prospective identification of impending high cost outcomes.

OBJECTIVES: The overall objective of this study was to define and evaluate patterns of use of medical services in the care of patients with chronic illness that represent circumstances which, if modified, might lead to reduction in risk of acute-level care. METHODS: This was a retrospective observational study. The study population consisted of Kaiser Permanente enrollees at four sites during January 1993 through June 1995, who were 20 to 64 years of age and had two of three chronic diseases (diabetes, circulatory disorders, obstructive pulmonary disorders). Using logistic regression, the effect of primary care visit patterns and therapeutically risky drug combinations on likelihood of hospital admission in a subsequent 3-month period is adjusted for age, gender, and disease state in the prior 12-month period. RESULTS: Enrollees with visits to three or more different primary care physicians were 46% more likely to be admitted than expected (P < 0.01) according to their age, gender, and disease state, and those with therapeutically risky drug combinations were 34% more likely to be admitted (P < 0.01). CONCLUSIONS: The risk adjustment models evaluated in this study defined care processes associated with increased risk of subsequent acute-level services. Those processes may represent nascent acute disease states or suboptimal organization of care delivery. The results of these models can be used to inform changes in organization and delivery of outpatient care that might improve patient outcomes.

Adult↗
PubMed1998

Magnetic resonance imaging of elephantiasis neuromatosa.

We present the case of a 43-year-old man with neurofibromatosis type 1 who developed elephantiasis neuromatosa of his left leg. The gross limb enlargement was extremely disfiguring, and resulted in such severe disability that he was only able to walk a very short distance using crutches. Previous debulking procedures had resulted in massive blood loss, and prior to attempting further surgical intervention MRI studies were requested. Taking advantage of the excellent tissue characterisation and multiplanar imaging capabilities of MRI, we were able to assess the extent of soft tissue and osseous involvement. The use of recently developed MR angiographic sequences enabled us to non-invasively provide detailed images to assess the relationship of the lesions to the major vessels, as well as the vascular supply and angiographic features of the lesions themselves. This article describes our MRI-based findings, which precluded debulking surgery in this unusual manifestation of neurofibromatosis.

Adult↗
PubMed1998

Intraosseous lipomata of adjacent vertebral bodies.

Osseous lipomata of vertebral bodies are rare. We present a very unusual case where adjacent vertebrae are involved and the plain radiographic and scintigraphic appearances gave cause for some concern. The findings on plain films, scintigraphy, computed tomography and magnetic resonance imaging are discussed.

Adult↗
PubMed1997

Bilateral fracture dislocation of the sacroiliac joint.

We present a rare case of a 27-year-old man sustaining a bilateral fracture dislocation of the sacroiliac joints without disruption of the anterior pelvis, following a fall from a height. Reconstructed images in the coronal plane and three-dimensional CT images were invaluable in the diagnosis and assessment of this injury.

Accidental Falls↗
PubMed1995

Case report: lipoma arborescens of the sub-deltoid bursa.

Lipoma arborescens is a rare synovial disorder which principally affects the knee joint. We describe an unusual case of lipoma arborescens arising within the sub-deltoid bursa in association with a rotator cuff tear. Pre-operative diagnosis was made by magnetic resonance imaging.

Aged↗
PubMed1993

Cystic change in the head of the fibula in osteoarthritis.

We report eight patients with prominent cystic changes in the head of the fibula. Seven of these had osteoarthritis of the adjacent knee, and five had evidence of local deposition of calcium pyrophosphate dihydrate crystals. A radiographic survey of 470 knees in 254 patients with osteoarthritis suggested that such cysts are rare, but should be considered in the differential diagnosis of such changes before expensive or invasive investigations are performed.

Aged↗
PubMed1992

Outcomes of California's Medicaid cost-containment policies, 1981-84.

In 1982, California enacted a package of tough Medicaid cost-containment measures. This article examines its effects on program expenditures through 1984 by enrollment group and service category. Total expenditures fell by 19 percent (or $656.5 million) after inflation. Expenditures per enrollee declined for almost every group, with enrollees on cash assistance taking the greatest reductions. Ambulatory, physician, and pharmacy spending declined the most followed by long-term and hospital care. The effects of these policies are of particular importance in the early 1990s as States face even greater fiscal challenges and seek lessons from past attempts at controlling program costs.

California↗
PubMed1990

The impact of the M1 air crash on the radiological services at the Queen's Medical Centre, Nottingham.

Following the M1 air crash on 8 January 1989, 39 casualties were taken to the Queen's Medical Centre, Nottingham. A team of 31 radiographers and four radiologists used all five X-ray rooms adjacent to the Accident and Emergency Department. Patients with head and spinal injuries were further assessed in the CT suite by four radiographers and a neuroradiologist. The volume of work in the first few hours and in the subsequent days is described. All radiological examinations have been reviewed and the injuries, including those missed at initial assessment, are discussed. The role of the radiologists was to issue immediate reports, manage examinations so as to minimize any delay and assess the need for further specialized investigation. Important problems were identified, specifically: the call-out system; patient deterioration and lack of resuscitation equipment; patient flow; documentation; radiology equipment; and missed injuries. These problems are discussed and recommendations are made for X-ray Departments in dealing with disasters.

Accidents, Aviation↗
PubMed1989

Acquired coronal cleft vertebra.

Five patients with acquired coronal clefts in lower lumbar vertebral bodies are presented. The appearances on plain radiographs, skeletal scintigraphy, discography, computed tomography and magnetic resonance imaging (MRI) are described. The aetiological factors are discussed with particular emphasis on the role of the intervertebral disc and the discovertebral junction in the pathomechanics of vertebral body injury. Magnetic resonance imaging was helpful in the radiological assessment and provided information from which an explanation of the clefts could be proposed.

Adult↗
PubMed1986

Assessment of the relative impact of magnetic resonance imaging on the evaluation of rheumatoid disease of the cervical spine.

A study was made of 15 patients with rheumatoid involvement of the neck in whom neurologic symptoms were of sufficient severity that operative intervention was being planned. Magnetic resonance imaging (MRI) was performed in all patients and compared with conventional radiography, conventional tomography, myelography and computed tomography (CT) assisted myelography. MRI clearly demonstrated any deformity or compression of the cord and was able to show the effects of flexion and extension of the neck. It is concluded that MRI could replace myelography for defining cord compression. If details of atlanto-axial alignment and bony outline of the spinal canal are required then CT will provide the appropriate images.

Arthritis, Rheumatoid↗