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Biomedical subjects

F C Wilson

Publications and source records attributed to F C Wilson.

At least 19 recordsLinked to original sources
PubMed2003

Adult survivors of severe cerebral hypoxia--case series survey and comparative analysis.

Over 16 years, Wilson [31] saw and assessed 567 patients, 18 (3.2%) had a primary diagnosis of cerebral hypoxia. The present patient survey includes all referrals for assessment, management/advice and neuropsychological rehabilitation to a part-time clinical neuropsychology service, who were seen by the first author over a five year period (October 1995-2000). Of the total patient sample (n = 168), 13 (7.7%) had incurred hypoxic damage from a variety of causes; [3] carbon monoxide poisoning (smoke inhalation), [3] cardiac arrest, [1] accidental alcohol and drug overdose, [1] near (partial) drowning, [1] near hanging (suffocation), [2] respiratory arrest following prolonged status epilepticus, [1] respiratory arrest following severe pneumonia and [1] following Addisonian crisis. The survey includes a sub-group of patients in vegetative and minimally responsive states on referral. Wilson [31] highlighted that considerable variation in cognitive functioning is likely to be observed depending on (a) nature or cause of the hypoxic insult and (b) the degree of anoxia/hypoxia experienced itself. The results of the present survey when compared with Wilson's earlier work provide a larger total data-set from which to draw conclusions and has implications for practitioners who see such patients and are involved in their multidisciplinary management and rehabilitation.

Adult↗
PubMed2002

Vegetative state and minimally responsive patients--regional survey, long-term case outcomes and service recommendations.

A regional survey of Consultant level Neurology, Neurosurgical and Rehabilitation staff identified a retrospective estimate of patients in vegetative or minimally responsive states from their own clinical caseloads (October 1995--97). 35 patients were identified; the majority of whom were not currently placed in specialist brain injury facilities following acute hospital intervention. In addition, a retrospective review of referrals to this unit (1995--2001) was also undertaken. Of twelve patients referred as being in a vegetative or minimally responsive state, 4 were considered as having been misdiagnosed (emerged) at follow-up; 2 had been presumed to be vegetative for at least one year. All patients remained severely physically disabled (i.e., totally dependent for care) but four were nevertheless able to communicate their preference in quality of life issues, care decisions etc. either by verbal or non-verbal means. Vegetative-minimally responsive patients or those who are very severely and multiply disabled need skilled and frequently prolonged assessment. Appropriate management requires an experienced inter-disciplinary as opposed to multidisciplinary team working style, whose skill repertoire equips them to recognise often-subtle improvements in cognitive function and act to maximise individual patient's quality of life. The current paucity of service provision for this vulnerable group of patients is highlighted.

Activities of Daily Living↗
PubMed2000

Fractures of the ankle: pathogenesis and treatment.

From the foregoing, one may reduce the following principles for the management of ankle injuries: The mechanism of injury and the diagnosis, including ligamentous injury, can be made from initial radiographs. A displaced fracture of only one malleolus must be accompanied by ligamentous injury of either the deltoid or syndesmotic ligaments, or both. When there is only one break in the ring of the ankle mortise, there is no potential for significant displacement; thus, ORIF is rarely necessary. With two breaks in the ring, the potential for displacement exists, even after successful manipulation, which usually makes operative treatment a more attractive option. Closed reduction is done by reversing the direction of the injuring forces, though it is not necessary to do so in precise inverse order to their occurrences. When ORIF is used, all significant malleolar fractures should be rigidly fixed to allow early motion, which, along with delayed weight bearing, is especially beneficial when comminution of the articular surface exists. Syndesmotic fixation is usually unnecessary if the malleolar fractures can be reduced anatomically and securely fixed. The reduction, whatever technique is used, should result in full congruency of the ankle mortise and a level joint line. Trimalleolar fractures, especially when they involve more than 25% of the tibial plafond, are much more likely than bimalleolar fractures to be associated with posttraumatic arthritis.

Ankle Injuries↗
PubMed1999

Knee arthroplasty in hemophilic arthropathy.

Twenty-three total knee arthroplasties in 15 patients with severe hemophilia were performed between February 1974 and September 1988. Thirteen patients had Factor VIII deficiency and two had Factor IX deficiency. The mean followup period was 7.5 years, with a minimum of 4 years for patients who were alive (eight) at the time of this review. Seven patients had died before this report, and all were seropositive for the human immunodeficiency virus. Using the Hospital for Special Surgery knee scoring system, the result was excellent in one knee, good in three, fair in two, and poor in 17. One patient was seropositive for the human immunodeficiency virus at the time of the index procedure, and 12 were seropositive at the most recent followup; the human immunodeficiency status of three patients was unknown. There were two early and two late deep infections, all in patients who were seropositive for the human immunodeficiency virus. The most recent postoperative radiographs for all knees were reviewed using the Knee Society radiographic scoring system. Ten femoral components were well fixed, 11 were possibly loose, and two were probably loose. Eight tibial components were well fixed, 10 possibly loose, three probably loose, and two definitely loose. One knee had been revised for aseptic loosening. There are few published studies of the long term results of total knee arthroplasties in patients with hemophilia. In this series of 23 knees, there was a high rate of loosening and infection. Total knee arthroplasty may be a useful treatment for the relief of pain attributable to end stage hemophilic arthropathy, but there is a high rate of complications, especially in patients who are seropositive for the human immunodeficiency virus.

Adolescent↗
PubMed1997

Fractures of the radius and ulna in adults: an analysis of factors affecting outcome.

Concurrent data were collected by the authors for 104 fractures of the shafts of the radius and ulna in 102 adult patients to determine the relationship of subjective, objective, radiographic and economic outcome parameters to the method of treatment, type of fracture (open or closed), degree of comminution, and the presence of other injuries. Patients treated by open reduction and internal fixation (ORIF) had less pain, lost less forearm rotation, and returned to the same work following injury more frequently than those treated by closed reduction and casting (CR) or pins-in-plaster (PIP). The greatest advantages of ORIF over other treatment methods were improved skeletal alignment and forearm rotation, the factors most often associated with return to the same work following injury. Except for a longer time to union and a higher rate of infection, the outcomes of open and closed fractures were very similar. The presence of other injuries was a strong predictor of a compromised end result, primarily because of more pain, greater loss of forearm rotation, and less frequent return to the same work. The inclusion of patient satisfaction and work status in the assessment of outcomes and the concept of "functional malunion", an outcome-based interpretation of a radiographic finding, should help in counselling patients as to the likely economic and functional impacts of these injuries.

Adolescent↗
PubMed1995

Survivorship analysis of cemented total condylar knee arthroplasty.

From 1977 to 1989, the authors performed and prospectively followed 151 cemented total condylar knee arthroplasties in 113 patients. A metal-backed tibial component was implanted in 133 knees (88%). The mean followup of all knees was 7 years (range, 0.5-16 years); 36 knees were seen in followup for a minimum of 10 years. Survivorship analysis was used to calculate the predicted cumulative rate of success of these knees. Using the criteria for failure as revision performed or recommended, the 10-year survival of these knees was 96.9% (95% confidence interval, 93.8%-100%). Including those knees with radiographic loosening, the 10-year survival was 84.1% (95% confidence interval, 73.4%-96.3%). The cemented total condylar prosthesis remains the standard for success and durability of total knee arthroplasties.

Adult↗
PubMed1994

Angular kyphosis as an indicator of the prevalence of Pott's disease in Transkei.

To understand better the prevalence, distribution and major causes of sagittal spinal deformity in a rural homeland, the authors conducted a study of angular kyphosis in the spines of 2,329 Transkei patients. Thirty-one (1.33%) had angular kyphosis. Lateral chest radiographs were obtained from 22 of these patients. Radiographic kyphotic angles ranged from 28 degrees to 130 degrees (mean: 70.3 +/- 7.6). The vast majority (81%) demonstrated classical clinical and/or radiographic findings of tuberculous aetiology. Less frequent aetiologies included fractures (2), osteoporosis (1), congenital malformation (1) and kyphosis of unknown origin (2). Eleven of the kyphotic patients were seeking care for unrelated problems and were asymptomatic in respect of their kyphoses. As a subset, the asymptomatic individuals demonstrated a similar aetiological distribution, with 73% strongly suggestive of tuberculous aetiology. The prevalence of asymptomatic angular kyphosis in this unselected Transkei patient population was 0.47% +/- 0.14%. In this hospital-based study, angular kyphosis proved a valuable marker for spinal tuberculosis. Because tuberculous spondylitis is more successfully treated when detected early, spinal palpation should be included in the routine physical examination of patients or populations at risk for tuberculosis.

Adolescent↗
PubMed1994

Graduate medical education in the United States.

This paper discusses graduate medical education in the United States under the headings of History, Goals and Incentives, Curricula, Influences, and Essentials. The factors that influence graduate medical education are: evolving knowledge and technology; local, state, and national organizations; class size and composition; changing student specialty preferences; methods of health care delivery; economic constraints; and governmental regulation. Given the desirability for change, those aspects of the graduate medical education experience that must be preserved include control of the educational process by educators, the primacy of education over service, adequate supervision, continuity of care, stable funding, educational breadth, and high standards.

Curriculum↗
PubMed1994

Plantar flexion injuries of the ankle. An experimental study.

A biomechanical study was designed to test the hypothesis that isolated plantar flexion of the ankle can produce avulsion fractures of the medial and lateral malleoli without fracture of the posterior articular surface of the tibia. Cadaver specimens were subjected to a standard plantar flexion force in the Burstein torsion testing machine. They showed the following typical patterns of injury in 26 of 32 ankles: (1) avulsion of the anterior ankle capsule; (2) a short oblique distal fibular fracture or fibular avulsion of the anterior talofibular ligament; and (3) an oblique medial malleolar fracture or a tear of the deep fibers of the deltoid ligament. Of particular interest was the direction and location of the medial malleolar fracture. This pattern, previously identified with supination-external rotation injuries, was also produced by isolated plantar flexion, which may be attributed to the anatomical attachments of the deltoid ligament on the medial malleolus, as well as the position of the foot and direction of the injuring force.

Adult↗
PubMed1993

Credentialing in medicine.

This article describes the history and process of credentialing: accreditation of programs and certification of individual practitioners. Under accreditation, general (institutional) and discipline-specific requirements, both for residencies and fellowships, are considered, along with possible outcomes and the appeals mechanism for an unfavorable review. Under certification, the relationship between individual specialty boards and the American Board of Medical Specialties is defined, followed by a consideration of the principles underlying subspecialty certification and recertification. It is concluded that enforced standards of learning are one of the pillars of accountability upon which a profession must rest; that if medicine abdicates its responsibility to impose credible standards on itself, its place will be taken by very interested, but less knowledgeable, others; and that we must, therefore, rededicate ourselves to the requirement of reasonable standards as a professional obligation and use the best means possible to meet that responsibility.

Accreditation↗
PubMed1992

Fluoride concentrations in human and rat bone.

The most recent report on fluoride concentrations ([F]) in human bone was published over a decade ago. Such data are of interest in the context of changing patterns in systemic fluoride exposure. In the study reported here, bone samples were collected from 24 human subjects who underwent orthopedic surgery. Medical histories and the best possible life-time systemic fluoride exposure information were obtained from each subject. Bone samples were assayed for fluoride concentration using the acid diffusion, ion selective electrode method. For ash from whole bone, the lowest value was 378 ppm in a 16-year-old subject, and the highest value was 3,708 ppm in a 79-year-old person. Fluoride concentrations in bone were significantly correlated with age (r = .62). The regression line intercept at birth was 442 ppm, and the slope was 22 ppm per year. When measured separately, trabecular bone ash fluoride concentrations were significantly higher than the corresponding cortical bone values. Trabecular and cortical bone samples from rats' drinking water containing 75 ppm F were assayed for F. The mean trabecular bone fluoride concentration was significantly higher than the mean cortical bone concentration. There was close agreement between F assay results using a modification of the acid diffusion method and the method originally reported by Singer and Armstrong. The human bone ash [F] values reported in this study are similar to those reported from other North American subjects over the last three decades. These findings are of interest in the context of evidence indicating increased systemic fluoride exposure in the United States population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Topical antibiotic irrigation in the prophylaxis of operative wound infections in orthopedic surgery.

1. Although the orthopedic literature on the clinical use of topical antibiotics is sparse, the effectiveness of topical antibiotics has been shown well enough in vitro and in the surgical literature to justify strong consideration of their use in orthopedic procedures. 2. Saline irrigation should not be relied upon to reduce bacterial contamination completely, although it does remove debris, foreign material, and clot, which often contain bacteria, from the surgical wound. 3. Topical antibiotic agents used for irrigation should have a broad spectrum of antimicrobial activity. Triple antibiotic solution (neomycin, polymyxin, and bacitracin) provides the most complete coverage against the organisms most likely to cause infections in both clean and contaminated orthopedic surgical cases. These agents should be allowed to remain in the wound for at least 1 minute before their removal. 4. Further studies of topical antibiotic irrigation in orthopedic surgery are needed to demonstrate the most effective antibiotic(s) and technique of administration. 5. There is evidence to suggest that the more often an irrigant is used, the more effective it is in preventing infection. 6. The use of bacitracin as an irrigant should probably be avoided in patients previously exposed to that agent. 7. Antibiotic-containing solutions should be utilized with pulsatile lavage systems. Saline alone may drive previously administered antibiotics from bone, leaving insufficient local antibiotic levels.

Administration, Topical↗