Biomedical subjects
Publications and source records attributed to C S Roberts.
A 72-year-old woman had rupture of a coronary artery during angioplasty in the setting of abciximab therapy. Prolonged reinflation of the balloon failed to produce closure of the perforated site. Emergency coronary ligation and bypass after abciximab administration was associated with excessive postoperative bleeding.
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Our study assessed the accuracy of shoulder ultrasonography in detecting complete and partial rotator cuff tears. We performed a prospective study in 24 patients scheduled for shoulder arthroscopy for impingement, partial-thickness or full-thickness (complete) rotator cuff tears, adhesive capsulitis, or arthritis. Before surgery, all patients underwent diagnostic shoulder ultrasonography followed by a shoulder arthroscopy with examination of the rotator cuff. The arthroscopic findings of rotator cuff integrity were compared with the diagnoses made from ultrasonography. The ultrasonographer was not blinded to the history and examination findings, and the surgeon was not blinded to the results of the ultrasonography. Ultrasound had sensitivity and specificity rates of 80% and 100%, respectively (positive and negative predictive rates of 100% and 88%), in the diagnosis of full-thickness rotator cuff tears and sensitivity and specificity rates of 71% and 100%, respectively (positive and negative predictive values of 100% and 88%), for partial-thickness tears. Although the potential for bias exists in this study, the results suggest that diagnostic ultrasound is effective in the diagnosis of rotator cuff tears.
To treat atherosclerosis systemically in the surgical patient, proper drug therapy and risk factor modification are necessary. A secondary prevention program for coronary bypass patients was established at the University of North Carolina School of Medicine for that purpose. Modifiable risk factors, such as hypercholesterolemia and hypertension, are identified preoperatively, and therapy is initiated postoperatively, with follow-up in the Risk Reduction Clinic at 3 and 6 months. Treatment is designed to achieve defined goals in secondary prevention.
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An analysis of 183 patients in sinus rhythm who underwent coronary artery bypass grafting was conducted to determine the association of multiple preoperative factors, including an elevated left ventricular end-diastolic pressure, with early postoperative atrial fibrillation. An association with advanced age, a history of atrial fibrillation, and preoperative digoxin use was found, but not with an elevated left ventricular end-diastolic pressure, irrespective of left ventricular systolic function.
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Isolated innominate arterial rupture from blunt trauma is rare. We present the case of a pregnant woman with an isolated injury to the innominate artery distal to an anomalous origin of the left common carotid artery. A safe operative technique is described.
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This study shows the ability of 3 standard endoscopic instruments to access the length of the intramedullary canal through a technique that we have termed "medulloscopy." Cadaveric studies were performed to determine the dimensions of the proximal tibia and the relative abilities of a knee arthroscope, a hip arthroscope, and a flexible rhinolaryngoscope to visualize the length of the intramedullary canal of the tibia. The 3 endoscopes were able to access the length of the intramedullary canal in the following proportions: 19.1% +/- 1.0% for the knee arthroscope, 29.1% +/- 3.8% for the hip arthroscope, and 84.1% +/- 1.8% for the flexible scope (P <.05). The proximal aspect of the intramedullary canal of the tibia can be visualized with standard knee and hip arthroscopic equipment. A flexible rhinolaryngoscope was required to access the distal tibia. Further studies are needed to determine the specific indications for intramedullary arthroscopy.
BACKGROUND: Coronary artery bypass grafting (CABG) and carotid endarterectomy (CE) are palliative operations for patients with severe atherosclerosis of the coronary or carotid arteries. Secondary preventive measures after these operations have received little attention. METHODS: We conducted a retrospective observational study to determine the frequency of lipid-lowering drug therapy before and after CABG or CE done in 1997. RESULTS: Of the 204 patients who had CABG, 56 (27%) were receiving lipid-lowering drug therapy before admission, and 71 (37%) of 192 were discharged receiving it. Of the 59 patients who had CE, only 12 (20%) were taking a lipid-lowering drug before admission, and 8 (14%) upon discharge. Of those 59 patients, 23 (39%) had coronary artery disease. CONCLUSION: Secondary prevention after coronary or carotid operations for atherosclerosis has been underemphasized at our institution, prompting the establishment of a postoperative risk reduction program.
Spontaneous hemopneumothorax is uncommon, especially among women. We report a case of spontaneous hemopneumothorax in a 19-year-old woman and review seven other cases of spontaneous hemopneumothorax in women that have been reported in the English language.
BACKGROUND: Although coronary artery bypass grafting (CABG) has been analyzed intensely for 30 years, little information is available on the characteristics and outcome of CABG patients operated upon by resident trainees or first-year attending surgeons in a public teaching hospital. METHODS: The first 100 CABG patients operated upon by a supervised resident were compared with the first 100 CABG patients under the care of the same person as an attending surgeon at the same institution. In the first group, the resident was directly supervised by one of three different staff surgeons. In the second group, the same person, as an attending, performed 60 operations and directly supervised one of two trainees in 40. RESULTS: Comparing the resident group versus the attending group, mean age (62 versus 61 years), percentage of females (37 and 37), tobacco use (74 versus 77), obesity (43 versus 55), insulin-dependent diabetes mellitus (20 versus 17), ejection fraction < or =0.5 (29 versus 35), and previous myocardial infarction (56 versus 54) were similar. Three or more coronary anastomoses were performed in 83 patients in the first group and in 74 in the second group. Early mortality (in-hospital and/or < or =30 days) occurred in 2 patients in the resident group and 3 in the attending group; each patient had a low ejection fraction and severe narrowing of all three major epicardial coronary arteries. Morbidity in the two groups was similar. CONCLUSION: If properly supervised by experienced staff surgeons, a resident trainee can achieve satisfactory results in CABG in a heterogeneous group of patients. Furthermore, the transition to attending surgeon can be achieved with a good outcome for the patients.
The purpose of this study was to evaluate the accuracy of sonography in measuring the dimensions of the cadaveric patellar tendon to determine whether sonography might have future applications in the preoperative assessment of autograft tissues before anterior cruciate ligament (ACL) reconstruction. Eleven lower-extremity human cadaveric limbs, with an average donor age of 75 years (range, 67 to 87 years), underwent patellar sonography with a 7.5-MHz transducer. Patellar tendon thickness, width, and length were measured sonographically. After skin removal, the patellar tendon dimensions were measured manually. Sonographic and manual measurements were compared statistically. Sonographic and manual measurements showed good agreement for thickness. There was poor agreement for width and length. Because of its limited accuracy, sonography cannot be recommended for the measurement of the patellar tendon before ACL reconstruction.
Without an intact anterior cruciate ligament (ACL) to resist anterior tibial translation, it is commonly believed that ACL-deficient patients employ alterations in walking. Although there is no consensus in the literature about the specific kinematic and kinetic adaptations in these patients with ACL tears, the gait adaptation of quadriceps avoidance is perhaps the one most popularized. The purpose of our study was to determine whether quadriceps avoidance is common in patients with ACL-deficiency. We used a video-based motion analysis system and surface electromyography (EMG) to study 18 patients with ACL-deficiency. All patients demonstrated an internal knee extension moment during early mid-stance (similar to normal subjects). Quadriceps EMG activity was noted throughout most of stance. No patients demonstrated an internal knee flexion moment, a decreased internal knee extension moment or a decreased duration of quadriceps EMG activity during stance. The findings of this study would suggest that quadriceps avoidance as a gait adaptation in ACL-deficient patients may be less common than previously reported.
OBJECTIVE: To compare the relative risks of neurovascular injury from perforation during distal interlocking and the biomechanical stability of two approaches to distal interlocking of tibial nails. DESIGN: In vitro anatomical and biomechanical study. SETTING: All mechanical testing was performed in a servohydraulic test frame with a customized motion transducer. INTERVENTION: Tibial nails were interlocked distally with a medial-to-lateral (ML) or a lateral-to-medial (LM) approach. MAIN OUTCOME MEASURE: The distances from the nearest end of each distal locking screw to four neurovascular structures were measured manually with calipers, and two-dimensional motion under simulated stance load across the fracture site was recorded. RESULTS: There were greater distances from the posterior tibial neurovascular bundle and the superficial peroneal nerve with distal targeting from the LM direction compared with targeting from the ML direction. Biomechanically, the ML nail configuration demonstrated slightly greater resistance to bending than the LM configuration. CONCLUSIONS: Distal tibial interlocking from the LM direction appears to be safer than interlocking from the ML direction with regard to relative distances from the neurovascular structures. This small anatomical advantage must be considered in light of slightly greater resistance to bending of the ML interlocking configuration compared with the LM interlocking configuration.
Cholangiocarcinoma is a rare tumor of the bile duct system known to frequently metastasize to the axial skeleton, lungs, adrenal glands, brain, and lymphatic system. Spread to the long bones has not previously been reported in the literature partly because of the short life expectancies of patients with this disease. We discuss a case of a pathologic humerus fracture due to metastatic cholangiocarcinoma.