Biomedical subjects
Publications and source records attributed to D Shanahan.
Anabolic androgenic steroids are commonly used at high doses by bodybuilders and athletes to enhance physique and improve performance levels. We report a case of spontaneous hepatic rupture with life-threatening haemorrhage associated with a past history of anabolic steroid use.
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Coronal sections of the distal radioulnar joint (DRUJ) were studied in 13 preserved cadaveric wrists specimens before and after 2 mm of shortening of the ulna. The DRUJs were subclassified on the basis of the DRUJ angle and depth of the sigmoid notch. The changes in extent and location of area of contact and radioulnar separation were noted. Although reduction in area of contact occurred in every specimen and DRUJ type, the maximum radioulnar separation and reduction in area of contact occurred in the DRUJ type IB and IIB. This could be a possible factor producing point loading and subsequent occurrence of DRUJ remodelling in the long-term after shortening of the ulna.
We have previously shown that the neurovascular anatomy and length of the long head of biceps femoris (LHBF) is suitable for its possible use in the creation of a dynamic perianal myoplasty to restore faecal continence. If intramuscular arterioarterial anastomoses exist between a muscle's vascular pedicles then the delay procedure, i.e. ligating the vascular pedicles to the transposed section of the muscle, 4-6 wk before transposition, can be used to improve blood flow to the distal part of the transposed muscle. The intramuscular arterial anatomy of 20 biceps femoris muscles was shown by dissection (14) or radiographically (6). The mean entry point of the upper major vascular pedicle to the LHBF was 12 cm (S.D. 3.3) and the mean length of the LHBF was 36.8 cm (S.D. 1.8). Therefore the ratio between upper major vascular pedicle entry point and muscle length in 95% of specimens was 0.33 (0.2). In the present study intramuscular arterioarterial anastomoses were found between the arterial pedicles to the nontransposed and transposed sections of the LHBF and between the long and short heads of this muscle. Using the delay procedure would therefore theoretically allow the intramuscular arterioarterial anastomoses between the arterial pedicle to the nontransposed and transposed sections of the LHBF to open up enhancing blood flow to the distal part of the myoplasty.
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To investigate the validity of five prevalent negative beliefs about residential placement, we followed adolescents from a residential program and a comparison group at 3-month intervals for 4 to 8 years. This residential program in the Midwest uses the Teaching-Family Model in which six to eight adolescents live in a family-style environment. The interviews included five scales reflecting youths' views about important aspects of their lives in placement: (1) Delivery of Helpful Treatment, (2) Satisfaction with Supervising Adults, (3) Isolation from Family, (4) Isolation from Friends, and (5) Sense of Personal Control. Hierarchical linear modeling allowed us to estimate group differences while controlling for developmental trends, demographic factors, and prior differences between groups. The two groups were equivalent on all scales before the study. During the following placement, however, the treatment group's ratings were significantly more positive than the comparison group on four of the five scales and approached significance on the fifth. These findings suggest that negative beliefs about life in residential placement for adolescents may not apply to all programs.
The frequency of an abnormally anterior insertion of scalenus anterior to the scalene tubercle on the superior aspect of the 1st rib was examined as a possible contributory factor to venous compression syndromes and to difficulties in cannulation of the subclavian vein. The insertion of scalenus anterior was exposed bilaterally in 21 adult cadavers and its position determined. The position of the scalene tubercle was also determined in a sample of 50 dried 1st ribs. The results were normalised for height. Three of the cadavers had position values that were above or at the upper point of the 95% confidence limits for the sample, indicating an abnormally anterior insertion. Two dried 1st ribs had values just below the lower 95% confidence limits, implying an abnormally posterior position. In the 3 cadavers with an abnormally anterior position, the subclavian artery and vein followed an abnormally anterior and inferior course with respect to the clavicle, and in 1 the subclavian vein was stenosed bilaterally at the costoclavicular angle. An abnormally anterior insertion of scalenus anterior may be a cause of venous compression syndromes in the root of the neck and give rise to difficulties when undertaking cannulation of the subclavian vein.
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Percutaneous transluminal angioplasty cannot be used for lesions of the superficial femoral artery when the origin of the vessel is occluded. A new technique, retrograde femoral angioplasty, is described in which angioplasty is performed from below via the exposed popliteal artery. In four out of six patients retrograde femoral angioplasty was successfully completed, and three of the four vessels remain patent up to 1 year later. The method provides an alternative to the femoropopliteal bypass graft in some patients.
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Conflicting reports exist for the efficacy of intermittent wound perfusion with bupivacaine in the relief of postoperative pain. A study was devised to assess postoperative pain relief objectively using a Patient Controlled Analgesic Device (PCAD) during continuous wound perfusion with bupivacaine or saline. Thirty consecutive patients undergoing cholecystectomy were randomised to receive continuous postoperative wound perfusion with 0.5% bupivacaine for 24 h followed by normal saline for a further 24 h or vice versa. During the study period, conventional analgesia was provided using a PCAD set to deliver (and record the number of) on-demand bolus doses of intravenous pethidine 0.2 mg/kg at half-hourly intervals as required. Pethidine requirements were higher on the first postoperative day, regardless of which solution was given, but bupivacaine perfusion almost halved mean linear analogue pain scores compared to those recorded with saline. Likewise, the number of bolus doses of pethidine demanded was reduced by an average of 68% compared to those recorded during saline perfusion on day 1 (P = 0.01) and by 82% on day 2 (P = 0.01). When assessed by objective criteria, perfusion of surgical wounds with bupivacaine after cholecystectomy produces better pain relief than wound perfusion with saline.
When patients are admitted with clinically diagnosed acute cholecystitis, no cause will be found for their pain in 9-13% (4.5). Our retrospective study shows that women between 15-35 years are most likely to be in this group. Our prospective study of all patients in the 15-35 year age group admitted with clinical 'acute cholecystitis', showed that in 6 out of 7 patients with 'undiagnosed' pain, the Curtis-Fitz-Hugh syndrome was the cause. We suggest that screening for the Curtis-Fitz-Hugh syndrome is performed in all patients with right upper quadrant pain who have a normal ultrasound scan.
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