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Biomedical subjects

J Brems

Publications and source records attributed to J Brems.

At least 19 recordsLinked to original sources
PubMed2001

Effect of insertion torque on bone screw pullout strength.

The effect of insertion torque on the holding strength of 4.5-mm ASIF/AO cortical bone screws was studied in vitro. Screw holding strength was determined using an Instron materials testing machine (Bristol, United Kingdom) on 55 lamb femora and 30 human tibiocortical bone sections. Holding strength was defined as tensile stress at pullout with rapid loading to construct failure. Different insertion torques were tested, normalizing to the thickness of cortical bone specimen engaged. These represented low, intermediate, high, and thread-damaging insertion torque. All screws inserted with thread-damaging torque and single cortex engaging screws inserted to high torque tightening moments showed diminished holding strength. This loss of strength amounted to 40%-50% less than screws inserted with less torque.

Biomechanical Phenomena↗
PubMed2000

Returning to the bedside: using the history and physical examination to identify rotator cuff tears.

OBJECTIVES: To determine the value of elements of the bedside history and physical examination in predicting arthrography results in older patients with suspected rotator cuff tear (RCT). DESIGN: Retrospective chart review SETTING: Orthopedic practice limited to disorders of the shoulder PARTICIPANTS: 448 consecutive patients with suspected RCT referred for arthrography over a 4-year period MAIN OUTCOME MEASURE: Presence of partial or complete RCT on arthrogram RESULTS: 301 patients (67.2%) had evidence of complete or partial RCT. Clinical findings in the univariate analysis most closely associated with rotator cuff tear included infra- and supraspinatus atrophy (P < .001), weakness with either elevation (P < .001) or external rotation (P < .001), arc of pain (P = .004), and impingement sign (P = .01). Stepwise logistic regression based on a derivation dataset (n = 191) showed that weakness with external rotation (Adjusted Odds Ratio (AOR) 6.96 (3.09, 13.03)), age > or = 65 (AOR 4.05(2.47, 16.07)), and night pain (AOR 2.61 (1.004, 7.39)) best predicted the presence of RCT. A five-point scoring system developed from this model was applied in the remaining patient sample (n = 216) to test validity. No significant differences in performance were noted using ROC curve comparison. Using likelihood ratios, a clinical score = 4 was superior in predicting RCT to the diagnostic prediction of an expert clinician. This score had specificity equivalent to magnetic resonance imaging or ultrasonography in diagnosis of RCT. CONCLUSIONS: The presence of three simple features in the history and physical examination of the shoulder can identify RCT efficiently. This approach offers a valuable strategy to diagnosis at the bedside without compromising sensitivity or specificity.

Aged↗
PubMed1999

Mastocytosis: diverse presentations and outcomes.

Within the general category of mastocytosis lies an array of clinical presentations with differing prognostic implications. We report 3 cases of systemic mastocytosis distinguished by novel aspects of the disease. Case 1 documents the first successful orthotopic liver transplantation in a patient with mastocytosis; case 2 depicts a potential hereditary component of mastocytosis; and case 3 documents the progression of mastocytosis with hematologic abnormality to mast cell leukemia. Future investigations, such as the early definition of c-kit receptor mutations, may provide additional insight as to the molecular basis for this heterogeneous disease and guidance for prognostic implications and targeted therapies.

Adult↗
PubMed1992

Argon beam coagulator hepatorrhaphy in potential donors.

Advances in medical technology have provided clinicians with the means to successfully treat life-threatening illnesses and injuries. For trauma surgeons, the acuteness and severity of thoracic and abdominal injuries may not allow time for complete, continuous neurologic examination, including computed tomography. The situation may arise in which urgent, major surgical intervention is necessary in a neurologically moribund patient. One such patient is presented herein; the Argon Beam Coagulator is used to repair a severe liver injury in this unstable trauma victim on whom a complete neurologic examination could not be performed. Cerebral death ensued and the repaired liver was successfully transplanted.

Accidents, Traffic↗
PubMed1990

Vancomycin vs tobramycin elution from polymethylmethacrylate: an in vitro study.

We fabricated batches of cement containing 0.5 gm, 1.0 gm, and 2.0 gm vancomycin and one with 1.0 gm tobramycin and shaped them into cylinders. They were immersed into 0.5 L of normal saline and the fluid volume was changed daily. Samples of fluid were obtained on days 1, 2, 3, 5, 7, 14, and 28. All fluid samples had antibiotic assays performed to quantitate the amount of elution for vancomycin or tobramycin. Vancomycin elution from PMMA occurred under our study conditions in similar quantities to that measured for tobramycin controls. Vancomycin-loaded PMMA cement may have a clinical role in the treatment of musculoskeletal sepsis caused by gram-positive bacteria, particularly if organisms resistant to the usual antibiotic agents are identified.

Biomechanical Phenomena↗
PubMed1989

Effect of bradykinin on feline gallbladder water transport and prostanoid formation.

Continuing evaluation of the pathophysiology of gallbladder disease has demonstrated significant relationships between gallbladder mucosal fluid transport, gallbladder inflammation, and prostanoid formation. Inflamed gallbladder mucosa secretes, rather than absorbs, fluid, a process associated with prostaglandin formation. Bradykinin has been previously implicated in the pathogenesis of cholecystitis and, in the intestine, bradykinin stimulates mucosal fluid secretion by a prostaglandin-mediated mechanism. Bradykinin was infused into the gallbladder lumen and administered intraarterially into the hepatic artery of perfused cat gallbladders. Both methods of bradykinin administration reversed the mucosal absorption present during control experiments as measured by concentration changes in a nonabsorbable marker. Perfusate and gallbladder tissue prostaglandin E concentrations were significantly increased by bradykinin when compared to control values. Concentrations of 6-keto PGF1 alpha in perfusate solutions and in gallbladder tissue were significantly increased, suggesting bradykinin increased prostacyclin formation. Bradykinin administration significantly increased inflammation, as evaluated by a histologic scoring system. Indomethacin was administered intravenously along with luminal perfusion of the gallbladder with bradykinin. Indomethacin significantly decreased gallbladder fluid secretion and prostanoid formation, but not histologic inflammation, when compared to values produced by bradykinin alone. An increase in systemic vascular and bile kinin concentrations produces gallbladder mucosal water secretion, a process which may be mediated by prostanoids. Histologic inflammation produced by bradykinin was not prevented by indomethacin.

6-Ketoprostaglandin F1 alpha↗
PubMed1987

Operations upon the biliary tract during transplantation of the liver.

Operation upon the biliary tract is a discipline within transplantation of the liver. There exists a background of basic science information concerning anatomy and physiology, an historical evolution of surgical techniques, a divergence of contemporary opinion regarding preferred approaches and a body of well described complications. The complication rate, once more than one-half with substantial contribution to mortality rates, now ranges from approximately 15 to 25 per cent. Current practice in most institutions is to use choledochocholedochostomy with T-tube stent when a recipient duct is present and Roux-en-Y choledochojejunostomy with internal stent when a suitable recipient duct is absent. Hepatic arterial thrombosis is an important cause of complications of the biliary tract. The overlap of symptoms and signs of rejection with those of biliary sepsis and other complications of the biliary tract underscores the need for algorithmic use of diagnostic modalities in the post-transplant period.

Biliary Tract Surgical Procedures↗
PubMed1986

A five-year experience with the bovine heterograft for vascular access.

We retrospectively analyzed 385 bovine heterografts inserted in 331 patients receiving dialysis to determine patency and complication rates. Eighty-two grafts were inserted in diabetics, 303 in nondiabetics; 129 were primary grafts, 256 secondary. There were 251 "distal" grafts using the distal radial artery and 134 "proximal" grafts using the distal brachial artery (127 grafts) or the superficial femoral artery (seven grafts). During this five-year interval, 209 complications were identified with the most prevalent being thrombosis (160), aneurysms (18), and puncture site (18) or wound (eight) infections. An aggressive surgical approach to these complications prolonged graft patency, as evidenced by only 82 irreversible graft failures. The overall patency rate at one through four years was 79%, 69%, 63%, and 51% respectively. One- and two-year patency for diabetics (81%, 74%) vs nondiabetics (78%, 70%), primary (85%, 77%) vs secondary grafts (73%, 64%), and proximal (80%, 66%) vs distal grafts (75%, 64%) were not significantly different. Long-term patency was unaffected by diabetes, previous access procedures, or graft location.

Aneurysm↗
PubMed1984

The effect of 16, 16-dimethyl prostaglandin E2 on experimental bile reflux pancreatitis in the opossum.

Pharmacological attempts to alter the course of experimental pancreatitis in the opossum were made using synthetic 16, 16-dimethyl prostaglandin E2 (16, 16-dm PGE2). Anatomically, the opossum has an elongated ampulla resulting in a supraduodenal pancreatic duct-common bile duct junction allowing for bile reflux pancreatitis to be produced by ligating the distal common bile duct. Preliminary evaluation demonstrated that at 72 hours common bile duct ligation distal to the pancreatic duct orifice produced pancreatitis comparable in severity to that produced by a Pfeffer loop. When the oppossum distal common bile duct was ligated, serum amylase concentrations progressively increased from control values of 182 +/- 43 to 742 +/- 62 Somogyi units/dl at 5 hours. Administration of 0.2 microgram-kg-1-min-1 16, 16-dm PGE2 significantly decreased the hyperamylasemia associated with bile reflux pancreatitis and, in addition, decreased the pancreatic gland weights when compared to control values. Subsequent evaluation of the administration of 75 micrograms-kg-1 16, 16-dm PGE2 every 12 hours for 72 hours to opossums with distal common bile duct ligation demonstrated no significant differences in serum amylase concentrations when compared to control values. Histologic evaluation of the pancreas glands at 72 hours demonstrated increased glandular integrity when the pancreas glands from the opossums receiving 16,16-dm PGE2 were compared to the glands subjected to distal common bile duct ligation alone. This report identifies several favorable characteristics in the course of experimental pancreatitis associated with the administration of a synthesis PGE analog at the onset of the inflammatory process.(ABSTRACT TRUNCATED AT 250 WORDS)

16,16-Dimethylprostaglandin E2↗
PubMedDate not supplied

Basket removal of intraatrial catheter after liver transplantation: technical note.

A fragment of an intravenous catheter, lodged in the right atrium of a patient after a recent liver transplant, was removed percutaneously. Extra care is needed in such patients if the transfemoral approach is used. Reasons for the additional precautions are discussed and a case history is provided.

Cardiac Catheterization↗
PubMedDate not supplied

Intraarticular morphine and bupivacaine reduces postoperative pain after rotator cuff repair.

BACKGROUND AND OBJECTIVES: To determine whether intraarticular injection of morphine, fentanyl, or sufentanil added to bupivacaine provided pain control after open rotator cuff repair. METHODS: These data were collected as a prospective, randomized, blinded observer study. All patients received a standard interscalene anesthetic with 1.4% mepivacaine with 1:200,000 epinephrine. At the conclusion of surgery, they received an intraarticular injection after the shoulder capsule was closed. Patients were randomized into 4 groups. All received 20 mL of 0.25% bupivacaine: group 1, plain; group 2, with 1 mg of morphine added; group 3, with 50 microg of fentanyl added; and group 4, with 10 microg of sufentanil added. Pain scores in the postanesthesia care unit were evaluated at 0, 30, 60, 90, 120, and 240 minutes and at 4-hour intervals postoperatively using a visual analogue scale. Breakthrough pain was managed with morphine, via patient controlled analgesia pump. RESULTS: Thirty-nine patients were entered into the study. Pain scores at 2 hours and beyond were lowest in group 2. Total morphine utilization was significantly lower for the first 24 hours in group 2. CONCLUSIONS: Intraarticular injection of the shoulder with 0.25% bupivacaine and 1 mg morphine at the conclusion of surgery provided pain control and diminished morphine used in the first 24 hours after open rotator cuff repair. Fentanyl and sufentanil did not improve the analgesia over that achieved with bupivacaine alone.

Analgesics, Opioid↗
PubMedDate not supplied

Liver transplantation: who to refer and when.

Liver transplantation is a surgical procedure offered to individuals with irreversible, near fatal liver disease. The timing of both transplantation listing and surgical engraftment are critical factors in the success of this endeavour. To accomplish each and maintain surgical survival rates without prematurely transplanting individuals to achieve excellent outcome statistics is an art that requires knowledge about the procedure and the natural history of the specific liver disease in question. Herein are the views of the transplant team at Loyola University of Chicago as to how this can be accomplished within the framework of the American experience, and the rules and regulations governing donor organ procurement and allocation in the United States.

Costs and Cost Analysis↗
PubMedDate not supplied

Alkalinization of mepivacaine improves the quality of motor block associated with interscalene brachial plexus anesthesia for shoulder surgery.

BACKGROUND AND OBJECTIVES: Interscalene block has produced appropriate anesthesia for shoulder surgery. Success is partly determined by the quality of motor block achieved. This study was designed to evaluate the influence of alkalinization of mepivacaine on the quality of motor block achieved with interscalene brachial plexus anesthesia. METHODS: The study design included a prospective, randomized trial of 2 groups of 20 patients each undergoing shoulder surgery by one surgeon with interscalene block. Both groups received interscalene block with 40 mL 1.4% mepivacaine, 1/200,000 epinephrine, using a 25-gauge, blunt-bevel needle and elicitation of paresthesia in the arm. One group had 1 mL sodium bicarbonate (1 mEq/mL) per 10 mL mepivacaine added and the other had an equal volume of saline. Average pH was determined for each solution in a nonclinical setting. Motor block was graded by a blinded observer after a standard 3-minute injection at 1 and 10 minutes after injection on a 0-5 standard neurologic scale. The surgeon, blinded to group selection, graded the quality of motor block as excellent, good, fair, or poor at preparation, incision, and 15 minutes postincision. RESULTS: Both groups were similar demographically. All blocks provided successful surgical anesthesia. Motor block quality was evaluated as better at all times in the study group (alkalinization) by both the blinded observer and the surgeon. CONCLUSIONS: Alkalinization of mepivacaine improves the quality of motor block after interscalene brachial plexus block for shoulder surgery.

Brachial Plexus↗