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Biomedical subjects

J A Finkelstein

Publications and source records attributed to J A Finkelstein.

At least 19 recordsLinked to original sources
PubMed1996

Insertional torque and pull-out strengths of conical and cylindrical pedicle screws in cadaveric bone.

STUDY DESIGN: Insertion torque and pull-out strengths of conical and cylindrical pedicle screws were compared in human cadaveric vertebral bodies. OBJECTIVES: To compare the performance of the conical design with the cylindrical design, and to determine whether insertional torque correlates with pull-out strength. SUMMARY OF BACKGROUND DATA: A tapered pedicle screw design may lessen the likelihood of implant failure. Its effect on thread purchase is not known. Previous studies of cylindrical designs on the relation between insertion torque and pull-out strength have been conducted in bovine and synthetic bone. METHODS: Seventy-eight pedicles were assigned randomly to one of the following pedicle screw: Texas Scottish Rite Hospital (Sofamor-Danek, Memphis, TN), Steffee VSP (Acromed, Cleveland, OH), Diapason (Dimso, Paris, France), AO Schanz (Synthes, Paoli, PA), or Synthes USS (Synthes, Paoli, PA). Pedicle screws were inserted with a torque screwdriver. Each screw was extracted axially from the pedicle at a rate of 1.0 mm/sec until failure using an MTS machine (Bionix 858, Minneapolis, MN). Force data were recorded. RESULTS: The conical design had the highest insertion torque. There were no significant differences in pull-out between any of the screw types. Correlation between insertional torque and pull-out strength was statistically significant only with the Texas Scottish Rite Hospital and Steffee VSP in L4 and AO Schanz in L5. CONCLUSIONS: A conical screw profile increases insertion torque, although insertional torque is not a reliable predictor of pull-out strength in cadaveric bone. Screw profile (with similar dimensions) has little effect on straight axial pull-out strengths in cadaveric bone.

Aged↗
PubMed1996

Open posterior dislocation of the lumbosacral junction. A case report.

STUDY DESIGN: A patient with open posterior dislocation of the lumbosacral junction is reported. OBJECTIVES: Treatment with primary anterior open reduction with internal fixation followed by delayed posterior stabilization and fusion. SUMMARY OF BACKGROUND DATA: This injury has been reported previously on two occasions; however, anterior stabilization was not used. In this case, anterior fixation was necessary because of the posterior soft tissue contamination. METHODS: After an anterior open reduction of L5-S1, stabilization was performed using instrumentation. Posterior wound care was then performed, with delayed posterior fusion and instrumentation of L5-S1 at 2 weeks. RESULTS: At 18 months there was solid fusion of the lumbosacral junction with no evidence of infection. CONCLUSIONS: Satisfactory results were obtained when principles of open fracture management were followed. Primary anterior stabilization allowed appropriate wound care. Definitive posterior stabilization and fusion can be done when soft tissue stability is obtained.

Adult↗
PubMed1996

Oral Ambu-bag insufflation to remove unilateral nasal foreign bodies.

The nose is perhaps the most common site for the insertion of foreign bodies by children. Removal is essential. We report the successful use of the oral Ambu-bag insufflation technique to remove unilateral nasal foreign bodies in three children. Conscious sedation was not required. There were no complications.

Child, Preschool↗
PubMed1996

Lower limb compartment syndrome: course after delayed fasciotomy.

OBJECTIVE: To determine the end result of patients who underwent delayed fasciotomy, i.e., more than 35 hours for an established lower limb compartment syndrome. DESIGN: A retrospective review of patients undergoing delayed treatment for a closed injury of the lower extremity, where fasciotomy should ideally have been performed earlier. MATERIALS AND METHODS: Nine fasciotomies in five patients were identified where there was a delay of more than 35 hours after the injury. The average ischemic time was 56 hours (range 35-96 hours). RESULTS: One patient died of multiorgan failure and septicemia. The remaining four patients required lower limb amputation, because of local infection and septicemia. The one late amputation was performed 6 months after the injury, because the patient was left with a functionless insensate foot. Where recognition of an established compartment syndrome is delayed for more than 8 to 10 hours, we propose that the traditional inevitable fasciotomy be reassessed.

Amputation, Surgical↗
PubMed1996

Sensitivity of new-generation computed tomography in subarachnoid hemorrhage.

OBJECTIVE: To determine the sensitivity of the initial new-generation CT (NGCT) scan interpretation for detection of acute nontraumatic subarachnoid hemorrhage (SAH) and to decide whether lumbar puncture (LP) should follow a "normal" NGCT scan. METHODS: A retrospective chart review was performed of patients admitted between March 1988 and July 1994 with proven SAH. Exclusion criteria were age < 2 years, diagnosis other than acute SAH, history of head trauma within 24 hours before symptom onset, NGCT scan not done before diagnosis, and records not available. Patients were placed into two groups: symptom duration < 24 hours (group 1) and > 24 hours (group 2) prior to CT scan. The resolution of each NGCT scanner was recorded. An NGCT scanner was defined as a third-generation scanner or more recent. RESULTS: Of 349 SAH patients, 181 met inclusion criteria. The sensitivity of NGCT scans for SAH was 93.1% for the group 1 patients (n = 144) and 83.8% for the group 2 patients (n = 37). The overall sensitivity was 91.2%. All the patients who had SAH not detected by NGCT scans were diagnosed by LP. There was no significant relationship between NGCT scanner resolution and sensitivity for SAH. CONCLUSION: Initial interpretation of NGCT scans to detect SAH does not approach 100% sensitivity. A "normal" NGCT scan does not reliably exclude the need for LP in patients who have symptoms suggestive of SAH.

Adolescent↗
PubMed1996

Varus osteotomy of the distal part of the femur. A survivorship analysis.

Varus osteotomy of the distal part of the femur is often the procedure of choice for the treatment of osteoarthrosis of the lateral compartment associated with genu valgum. We followed twenty-one knees (twenty patients) long term or until failure. At the most recent evaluation (average, 133 months; range, ninety-seven to 240 months), thirteen osteotomies were still successful, seven had failed, and one patient (in whom the knee had remained functional) had died. Of the seven failures, three occurred early (at twelve or twenty-four months) and four occurred late (between seventy-two and ninety-eight months). The probability of survival at ten years was 64 per cent (95 per cent confidence interval, 48 to 80 per cent), as determined with use of the Kaplan-Meier method. We concluded that, with proper selection of patients, this procedure is effective for the treatment of gonarthrosis of the lateral compartment associated with valgus deformity.

Adult↗
PubMed1995

Urine Trinder spot test: a rapid salicylate screen for the emergency department.

STUDY OBJECTIVE: To determine whether the urine Trinder spot test, performed by emergency physicians, is a sensitive bedside screen for salicylates. DESIGN: Prospective, blinded human protocol with subjects serving as their own controls. SETTING: Urban Level I medical center. PARTICIPANTS: Ten male and two female volunteers with negative urine toxicologic screen results before the start of the study. INTERVENTIONS: Each participant ingested 975 mg of nonenteric coated aspirin. Serum and urine samples were collected before ingestion and 2 and 4 hours after ingestion. Three emergency physicians and a toxicology technician independently performed Trinder spot tests. Results were recorded as positive or negative for salicylate on the basis of color change (a purple reading was considered positive). RESULTS: All postingestion urine specimens were detected by all testers with 100% sensitivity. Two false positives occurred in the preingestion samples. Serum quantitative assays confirmed the presence of salicylates in all postingestion specimens. CONCLUSION: This pilot study suggests that emergency physicians can use the Trinder spot test as a sensitive bedside salicylate screen, potentially saving time and quantitative assay expense.

Adult↗
PubMed1995

A Madreporic-surfaced femoral component in a canine total hip arthroplasty model: bone remodelling response at 6 and 24 months.

OBJECTIVE: To evaluate the bone-remodelling response at 6 and 24 months after total hip arthroplasty around a two-thirds Madreporic-surfaced femoral component in a canine model. DESIGN: A research study in dogs. Statistical analysis was by multivariate analysis of variance. SETTING: A musculoskeletal research laboratory in a university teaching hospital. MATERIAL: Ten mature mixed-breed dogs. INTERVENTION: Unilateral implantation of total hip arthroplasty in the right femur with a Madreporic-surfaced prosthesis. Studies were conducted at 6 months in five dogs and at 24 months in five dogs. In each case, the nonoperated femur was the study control. MAIN OUTCOME MEASURES: Fluorescence microscopy analysis on comparable sections at four levels of the femora, percent porosity computed by image analysis, cortical atrophy. RESULTS: Cancellous hypertrophy was most prominent at the junction of the beaded and smooth portions of the femoral stem. At 6 months the cortex demonstrated atrophy predominant in the anteromedial quadrant. Active bone turnover was present within the interstices of the prosthesis at 6 and 24 months. No significant cortical bone loss occurred between 6 and 24 months. Stress transfer to the bone-prosthesis interface and endosteal cortical "cancellization" appear to be linked phenomena.

Animals↗
PubMed1995

Acute posterior fracture dislocations of the shoulder treated with the Neer modification of the McLaughlin procedure.

Posterior dislocation of the shoulder may be associated with an anteromedial impaction fracture rendering the shoulder unstable in internal rotation. The modified McLaughlin procedure as described by Neer involves transplanting the lesser tuberosity with the attached subscapularis tendon into the anteromedial defect. We have used this procedure acutely (from the day of injury to 10 days postinjury) in seven shoulders. All patients were unstable in internal rotation and had an anteromedial impaction fracture occupying 25-40% of the articular surface. This technique provides good stability, enables immediate active range of motion, and allows the patient to rapidly return to activities of daily living.

Aged↗
PubMed1995

Quality of care for preschool children with asthma: the role of social factors and practice setting.

OBJECTIVE: To determine whether patient race or source of payment is associated with differences in the quality of inpatient and outpatient treatment for young children with asthma. DESIGN: Structured medical record review. SETTING: Tertiary care pediatric hospital. PATIENTS: We studied 354 patients aged 1 to 6 years discharged with asthma between October 1, 1989 and September 30, 1990. MEASURES: We developed indicators of the quality of asthma care provided before and during hospitalization and planned after discharge. Outpatient indicators were the use of inhaled beta-agonists and the use of preventive anti-inflammatory medications (inhaled steroids or cromolyn sodium) before admission. In-hospital indicators were the intensity of inhaled beta-agonist therapy in the emergency department and length of stay. Planning for post-hospital care was assessed by the prescription of a nebulizer for home use. We examined associations between these indicators and patient race and source of payment, and explored the influence of primary-care practice type on these associations. RESULTS: After adjustment for potential confounders, we found that Hispanic patients were less likely than white patients to have taken inhaled beta-agonists before admission. Both black and Hispanic patients were less likely than white patients to have taken anti-inflammatory medications. When we adjusted for the patients' primary-care practice type, the effect of patient race did not persist for these indicators of outpatient care. We found no differences by patient race in emergency department care or length of hospital stay. However, black and Hispanic patients were much less likely to be prescribed a nebulizer for home use upon discharge. After adjustment for confounders, there were no differences in the quality of asthma care by source of payment. CONCLUSIONS: We found that young children of racial minorities admitted for an asthma exacerbation were less likely to have received maximally effective preventive therapy. We also identified marked differences in the quality of care planned after hospital discharge for black and Hispanic patients, compared with white patients. Particularly in an era of health reform, attention should focus on barriers to high-quality care for underserved children, who are already at high risk for asthma-related morbidity.

Adrenergic beta-Agonists↗
PubMed1994

The serotonin syndrome associated with paroxetine, an over-the-counter cold remedy, and vascular disease.

There is a new, potentially fatal disorder that is infrequently reported. The apparent rareness may be because of a lack of recognition of the syndrome or its predisposing factors. Fluoxetine (Prozac, Dista Products Co, Division of Eli Lilly Co, Indianapolis, IN), sertraline (Zoloft, Roerig Division, Pfizer Inc, New York, NY), and paroxetine (Paxil, SmithKline Beecham Pharmaceuticals, Philadelphia, PA) belong to a new class of antidepressant medication: the serotonin reuptake-inhibitors (SRIs). The relative safety profile of the SRIs has led to their widespread use. However, a syndrome of excessive serotonergic activity, the "serotonin syndrome" (SS), has recently been recognized. It is characterized by changes in mental status, hypertension, restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, and tremor. A high index of suspicion is required to make the diagnosis in these acutely ill patients. The most common agents implicated in SS are the monoamine oxidase inhibitors in combination with L-tryptophan or fluoxetine. A case of a patient with significant peripheral vascular disease who developed SS while taking paroxetine and an over-the-counter cold medicine is reported. There have been no prior reports of this interaction. Discontinuation of the offending agents, sedation, and supportive care are the mainstays of treatment. The interactions of serotonin with platelets and vascular endothelium are also discussed.

Acetaminophen↗
PubMed1994

Rapid infusion of magnesium sulfate obviates need for intubation in status asthmaticus.

Rapid infusion of intravenous magnesium sulfate (MgSO4) was given to two young adults with impending respiratory failure caused by status asthmaticus. The infusion of 2 g of MgSO4 during a 2-minute period was associated with an immediate, dramatic reversal of their severe bronchospasm. This treatment obviated the need for intubation. Continuous beta 2-agonist therapy was performed simultaneously, taking advantage of the MgSO4-induced bronchodilation to deliver the beta 2-agonist to the target tissues. Rapid infusion of intravenous MgSO4 has been documented as safe in standard obstetric literature. Previous reports of MgSO4 therapy for acute asthma have used slow infusion. This is the first report of rapid infusion of MgSO4 for the emergency department management of asthma. In both cases, this therapy obviated the need for endotracheal intubation and mechanical ventilation.

Administration, Inhalation↗
PubMed1994

A study of micromotion and appositional bone growth to a canine madreporic-surfaced femoral component.

A canine total hip arthroplasty model was used to examine micromotion and bone apposition to a proximally two-thirds madreporic-surfaced femoral prosthesis. Micromotion was also measured following initial press-fit implantation into canine cadaveric femora. After initial press-fit fixation and either 6 or 24 months of biologic fixation, micromotion was less than 23 microns in the proximal and midstem regions, a magnitude consistent with bone apposition. Bone apposition was greatest near the junction of the madreporic and smooth surfaces and was not significantly different between 6 and 24 months (51% at 6 months and 47% at 24 months). The quality of the interface tissue appears to be conductive to long-term fixation.

Animals↗
PubMed1994

Hormonal control of growth in the genetically obese Zucker rat. I. Linear growth, plasma insulin-like growth factor-I (IGF-I) and IGF-binding proteins.

The genetically obese Zucker rat is a widely used model of early-onset obesity. Like obese children, these obese rats are hyperinsulinemic and have low GH secretion. However, data on linear growth and insulin-like growth factor-I (IGF-I) levels in this model are scanty and contradictory. In the present study, we investigated linear growth and its hormonal control in Zucker rats (male and female) from 4-20 weeks of age. In the obese animals, compared to their lean littermates, the naso-anal length was normal or slightly greater, whereas the tails and femurs were shorter. The plasma concentration of IGF-I increased between 4-20 weeks of age, and IGF-I levels were normal or slightly higher in the obese animals. The serum level of IGF-binding protein-3 (IGFBP-3) measured by Western ligand blotting was not significantly different in lean vs. obese rats. To assess the IGF-I response to GH, bovine GH was administered (250 micrograms/100 g BW, ip, daily for 3 days) to 16- to 20-week-old female Zucker rats; plasma IGF-I concentrations increased more in the obese (percent increase over baseline, 347 +/- 44% vs. 194 +/- 31%; P < 0.01). These results show that despite low GH secretion, genetically obese Zucker rats have 1) normal linear (nasoanal) growth, 2) normal or increased circulating levels of IGF-I and IGFBP-3, and 3) increased plasma IGF-I responses to exogenous GH. These results suggest that the GH-independent growth in this model could result from direct effects of hyperinsulinism on circulating IGF-I and IGFBP-3 levels and/or indirect effects through increased GH receptor function.

Animals↗
PubMed1993

Potent nonpeptide angiotensin II receptor antagonists. 2. 1-(Carboxybenzyl)imidazole-5-acrylic acids.

The further evolution of the imidazole-5-acrylic acid series of nonpeptide angiotensin II receptor antagonists is detailed (for Part 1, see: J. Med. Chem. 1992, 35, 3858). Modifications of the N-benzyl ring substitution were undertaken in an effort to mimic the Tyr4 residue of angiotensin II. Introduction of a p-carboxylic acid on the N-benzyl ring resulted in the discovery of compounds with nanomolar affinity for the receptor and good oral activity. SAR studies of these potent antagonists revealed that the thienyl ring, the (E)-acrylic acid, and the imidazole ring in addition to the two acid groups were important for high potency. Also, overlay comparisons of the parent diacid with both angiotensin II and a representative biphenylyltetrazole nonpeptide angiotensin II receptor antagonist are presented. The parent diacid analog, SK&F 108566 or (E)-3-[2-butyl-1-(4-carboxybenzyl)-1H-imidazole-5-yl]-2-[(2- thienyl)methyl]propenoic acid, is currently in clinical development for the treatment of hypertension.

Acrylates↗