Biomedical subjects

J C Winters

Publications and source records attributed to J C Winters.

29 records · Page 2Linked to original sources

PubMed1997

Physical examination of the cervical spine and shoulder girdle in patients with shoulder complaints.

OBJECTIVE: To look for differences in mobility in randomly selected patients without shoulder complaints depending on age, gender and left- or right-handedness; to investigate in the patient group whether specific differences exist, depending on the diagnosis made or the afflicted side; and to detect differences between the findings on the mobility examination of the cervical and cervicothoracic spine in patients with shoulder complaints compared with the healthy population. DESIGN: Comparative study. METHOD: The physical examination findings after inclusion and after 26 wk of 101 shoulder patients were compared with those of 75 randomly selected patients without shoulder complaints and adjusted for age and gender. RESULTS: In the population of patients without shoulder complaints, the mobility in the cervical and upper thoracic spine was found to decrease with aging. Significant differences were found between the healthy and the afflicted population at the time of inclusion as well as after 26 wk, even though the majority of patients felt cured at that time. With all types of shoulder complaints, functional disorders in the shoulder girdle were found in which, at the time of inclusion, the emphasis was on pain and, after 26 wk, on restricted motion. Thus, functional disorders in the cervical spine, the higher thoracic spine and the adjoining ribs are not extrinsic causes of shoulder complaints, but an integral part of the intrinsic causes of shoulder complaints. CONCLUSION: Further study is needed to determine if this finding explains the high recurrence rate of shoulder complaints. It may be advisable to include the treatment of functional disorders of the shoulder girdle in treatment of patients with shoulder complaints.

Aging↗

PubMed1996

Percutaneous antegrade collagen injection therapy for urinary incontinence following radical prostatectomy.

OBJECTIVES: To determine the potential utility of glutaraldehyde cross-linked collagen (GAX-collagen) administered in an antegrade fashion into the submucosa of the bladder neck in patients who present with postprostatectomy urinary incontinence. METHODS: Twenty-four men aged 59 to 76 years (mean 69.0) with stress type urinary incontinence after radical prostatectomy were evaluated in this study. All patients had previously received retrograde collagen (mean number of treatments 4.33; amount of collagen was 25.72 mL) and had failed to develop further improvement by this approach alone. These patients subsequently received antegrade collagen via a suprapubic approach. An average of 7.1 mL of GAX-collagen was used for the procedure. RESULTS: Minimal follow-up was 12 months (range 12 to 15). Patients were considered cured if they were dry and wore no pads or were socially continent with less than one pad per day. Eighteen of 24 patients (75%) were dry at the 6-month follow-up. With longer follow-up at 12 months, however, only 9 of 24 patients (37.5%) were totally dry. All patients experienced symptomatic improvement as manifested by lower pad usage. CONCLUSIONS: With proper patient selection, antegrade administration of GAX-collagen in patients who have failed standard retrograde collagen injection may salvage many patients from eventual failure of the conservative treatment approach. As newer injectables become available, the overall results may improve.

Aged↗

PubMed1996

The Le Bag orthotopic urinary diversion.

PURPOSE: We reviewed our experience with Le Bag orthotopic urinary diversion in 38 cases. MATERIALS AND METHODS: Between April 1990 and January 1995, 38 men underwent radical cystectomy and Le Bag urinary diversion for treatment of bladder cancer. Approximately 20 cm. each of detubularized ileum and cecum were used to construct the pouch. A total of 22 pouches was fashioned with absorbable staples. In 21 cases freely refluxing Bricker ureterointestinal anastomoses were used. RESULTS: There was no significant difference in major complication rates in the hand sewn versus stapled anastomosis groups, and there were no complications specifically related to the use of staples. There were 3 episodes of febrile urinary tract infection: 2 in the Bricker group and 1 in the tunneled anastomosis group. There was no significant difference between the 2 groups with respect to ureteral obstruction. The daytime continence rate was 91%, and 80% of the patients are completely dry or have only mild incontinence at night. Most patients had mild hyperchloremic metabolic acidosis postoperatively as evidenced by a decrease in median serum bicarbonate level (28 versus 24 mmol./l.). This difference appears to be related to pouch length (r = 0.58, p = 0.0002). CONCLUSIONS: We conclude that the Le Bag technique is a technically feasible form of urinary diversion with functional results similar to other forms of orthotopic diversion. Use of absorbable staples simplifies pouch construction without increasing complications. This form of urinary diversion is associated with hyperchloremic metabolic acidosis, which is related to pouch length.

Anastomosis, Surgical↗

PubMed1996

A shoulder pain score: a comprehensive questionnaire for assessing pain in patients with shoulder complaints.

This study describes the validation and application of a comprehensive questionnaire (the shoulder pain score) in assessing pain experienced by patients with shoulder complaints. The shoulder pain score comprised six pain symptom questions selected from the literature, together with a 101-Numerical Rating Scale (NRS-101). The score was tested in a follow-up study of 101 patients with shoulder complaints. The coefficient for the internal consistency of the shoulder pain score was 0.82. A factor analysis disclosed two factors: one containing the NRS-101 with the "active" items of the shoulder pain score and another containing the "passive" items. The shoulder pain score gave a reliable impression of the pain experienced and proved to be a useful instrument for following the course of the disorder over time and giving an indication when a patient feels cured.

Adult↗

PubMed1996

The influence of the mobility in the cervicothoracic spine and the upper ribs (shoulder girdle) on the mobility of the scapulohumeral joint.

OBJECTIVE: To examine the influence of the cervicothoracic spine and upper ribs (shoulder girdle) on glenohumeral mobility and the development of shoulder complaints. DATA COLLECTION AND SYNTHESIS: Literature was collected by a search in Medline and Embase for English, German and Dutch publications, by further checking references in the articles found and by perusal of already collected literature regarding shoulder research. Articles referring directly or indirectly to a mutually influencing anatomical connection between the cervicothoracic spine, upper ribs (shoulder girdle) and scapulohumeral joint were selected during a consensus meeting of all reviewers. RESULTS: Eight relevant articles, differing strongly in supposition and objective, were found and subsequently classified and presented according to the anatomical relations indicated in the articles. Indications were found that suggested anatomical relations between the mobility in the shoulder girdle and the scapulohumeral joint, between the mobility in the spinal column and the first rib (shoulder girdle) and between the spinal column and the scapulohumeral joint. No relevant indications regarding the development of shoulder complaints were found. CONCLUSIONS: Although no direct evidence was found, a comparison of the results of this study with theories postulated by other researchers on this subject suggests that a certain relation does exist.

Cervical Vertebrae↗

PubMed1996

Collagen injection therapy in the treatment of urinary incontinence.

Patients with intrinsic sphincteric deficiency (ISD) require a procedure to create urethral compression or coaptation by employing a sling procedure, the artificial urinary sphincter, or intraurethral injections. Collagen, marketed under the trade name Contingen, is the most commonly used injectable in the United States currently. When a patient exhibits poor urethral function, lack of detrusor instability, and good anatomic support, she/he is considered an ideal candidate for intraurethral injections. Methods of injection are described for male and female patients. The only adverse effects of collagen injections have been transient and treatable, including urinary retention in up to 8% and urinary infection in 4%. The treatment response in female patients using collagen is similar to surgical procedures to correct ISD; newer approaches and techniques for needle localization appear promising in improving the results of implantation in male patients postprostatectomy.

Biocompatible Materials↗

PubMed1995

Ungated Medstone outpatient lithotripsy.

Ungated lithotripsy has raised the specter of possible cardiac arrhythmias. We reviewed ungated outpatient lithotripsy performed on 82 patients to evaluate the incidence of arrhythmias encountered and time saved. All patients were chosen in a random nonselected, prospective fashion. All treatments were performed on a mobile Medstone 1050 STS lithotriptor. The incidence of arrhythmias was 21%. All but 2 arryhthmias were benign and all reversed with gating. No arrhythmias occurred during treatment of right ureteral stones. In the left ureter only 1 patient had benign premature ventricular contractions during treatment. Arrhythmias occurred at 20 to 24 kv. in 20% of patients with right renal stones and 31% with left renal stones. All arrhythmias resolved with gating. No arrhythmias were encountered at an energy level of less than 20 kv. There was no evidence of electrocardiographic changes up to 1 hour after treatment. Pharmacological manipulation to maintain a heart rate of 100 may allow a treatment time of approximately 24 minutes. With ungating the rate may reach 120, allowing for a treatment time of approximately 20 minutes. In this series average ungated lithotripsy time was 36 minutes. In comparison, the average treatment time in 20 patients undergoing gated lithotripsy was 38.7 minutes. It is not clear from this study whether persistent ungated lithotripsy would have precipitated any life threatening arrhythmias since our practice has been to terminate the procedure and re-gate the shocks at the first sign of any persistent change in cardiac rhythm. Our data indicate that ungated lithotripsy with the Medstone device is safe when simple monitoring rules are followed.

Ambulatory Care↗

PubMed1995

Presurgical orthopedics in the surgical management of unilateral cleft lip and palate.

Forty years after its introduction by McNeil and Burston, presurgical orthopedics remains a controversial subject. Although the more extravagant claims for the technique have been dismissed, assessment of its proper place in cleft rehabilitation has been hampered by the poor design of early studies. Furthermore, although the principles of presurgical orthopedics are derived from the venerable tradition of reducing cleft width to facilitate reconstructive surgery, almost all research has focused on matters of dental alignment, cross bites, and maxillary arch form. Not one research paper has ever been published investigating the possible benefits to cleft surgery resulting from presurgical orthopedic treatment. Although it is now generally accepted that presurgical orthopedics does not give significant orthodontic benefits, there are still numerous opinions indicating that presurgical orthopedics does facilitate primary reconstructive surgery for cleft lip and palate. Furthermore, presurgical alignment of the maxillary skeletal base is considered essential to some of the new techniques of primary rhinoplasty.

Cleft Lip↗

PubMed1995

Periurethral injection of collagen in the treatment of intrinsic sphincteric deficiency in the female patient.

In properly selected patients, the periurethral injection of collagen is a safe and effective form of management for females with intrinsic sphincteric dysfunction. Performed under local anesthesia, this procedure allows for the treatment of patients who may not be suitable candidates for anesthesia and formal surgery. In female patients, excellent treatment results are obtained, which appear durable for greater than 2 years; these results are obtained usually within three treatment sessions. Periurethral collagen injection has been shown to elicit only a minimal inflammatory reaction and there have been no adverse immunogenic effects, foreign-body reaction, or migration of the injected material. Adverse events associated with the periurethral injection of collagen are rare. Collagen has proven to be a highly efficacious substance for use in periurethral injections for the treatment of intrinsic sphincteric dysfunction.

Collagen↗

PubMed1993

Hereditary gingival fibromatosis with a recessive mode of inheritance. Case reports.

Hereditary gingival fibromatosis is characterized by varying degrees of attached gingival hyperplasia and may in rare cases present as a feature of a generalized syndrome. It is usually inherited as an autosomal dominant condition though recessive forms are described. The dental and genetic features of an affected brother and sister with a probably unique autosomal recessive hereditary fibromatosis syndrome are presented.

Adolescent↗

PubMed1992

Invasive bladder cancer following 125iodine implants.

We present 2 cases of invasive transitional cell carcinoma of the bladder following implantation of 125iodine seeds for the treatment of localized adenocarcinoma of the prostate. These tumors, which occurred approximately 6 years after radiotherapy, were located in the trigone and prostatic urethra within the previous radiation treatment field. The development of high grade transitional cell carcinoma in these patients may be due to the tumorigenic effects of 125iodine radiation.

Adenocarcinoma↗