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Biomedical subjects

J E Kuhn

Publications and source records attributed to J E Kuhn.

At least 19 recordsLinked to original sources
PubMed1996

Arthroscopic intra-articular biopsy using a suction trap device.

Biopsy of the synovium and other intra-articular structures is frequently performed arthroscopically. We describe a technique of arthroscopic biopsy using a suction punch device linked in series with a Lukens tube suction trap. This technique allows for the controlled biopsy of intra-articular pathology, collects material in a tube which is convenient for handling, prevents the loss of biopsy material in the joint or portal tracks, and saves time by limiting the number of instrument passages into the joint.

Arthroscopes↗
PubMed1996

Allograft meniscus transplantation.

At this time, meniscal allograft transplantation remains an investigational procedure with very limited indications. To date, no work has shown that the transplanted meniscus is capable of protecting and, preserving the hyaline cartilage of the knee joint. The technical aspects of the procedure have been established and are reproducible. Furthermore, it is apparent that a systemic rejection phenomenon does not seem to occur, and the transplanted meniscus is capable of healing. MR imaging appears to be the best method of assessing postoperative position of the transplanted meniscus in the knee. If the transplanted meniscus cannot be maintained in an anatomic position during weight bearing, it is unlikely to have any functional role. Questions remain with regard to the best way to preserve and sterilize the meniscus and whether the transplanted allograft meniscus is capable of assuming the multifaceted role of the normal meniscus in the knee. As more work is conducted, these questions will be answered, and a better understanding of the efficacy of this novel technique will be achieved.

Biomechanical Phenomena↗
PubMed1995

A nurse's right to refuse a patient care assignment.

Ethics is a set of moral principles or values--a guiding philosophy for behavior. Ethical dilemmas in the health care setting occur daily. Perioperative nurse managers need to consider basic ethical principles when resolving these dilemmas, and they must keep in mind that solutions need to serve the best interests of all people involved in given situations. This article discusses criteria by which a nurse can refuse a patient care assignment and those by which a nurse manager can require that a nurse perform a patient care assignment.

Blood-Borne Pathogens↗
PubMed1995

Divergent single-column fractures of the distal part of the humerus.

We report an unusual intra-articular fracture of the distal part of the humerus that was seen in five patients, including one who had the fracture bilaterally. The fractures were characterized by three features. First, the fractures were initiated in the trochlear groove as a result of a direct impact on the olecranon, which divided the trochlea and then split the two columns of the humerus divergently. Second, the fractures occurred exclusively in adolescents and young adults (average age, fifteen years old; range, thirteen to twenty years old). Third, all of the fractures were seen in patients who had a large fossa or septal aperture between the coronoid and olecranon fossae. Four of the fractures involved the right side and two, the left. There were three fractures of the lateral column and three of the medial column. Because the periosteum, the capsule, and the ligaments remained intact despite intra-articular displacement of the distal part of the humerus, these fractures were also characterized by inherent proximal stability. The fractures were treated with closed reduction and percutaneous internal fixation to reduce the displacement between the two halves of the trochlea. All of the fractures united. Four patients (five elbows) regained full motion by eight months; one patient was lost to follow-up. Current classification systems that describe single-column fractures of the distal part of the humerus should be modified to include this unusual fracture pattern.

Adolescent↗
PubMed1995

Surgical treatment of shoulder injuries in tennis players.

There are a number of disorders that affect the shoulder of the tennis player. The majority of these disorders are approached conservatively at first, and surgery is generally reserved for those with advanced stages of disease, or those who fail conservative treatment. Most surgical procedures for the shoulder are done open; however, arthroscopic techniques are advancing rapidly, and are expected to eventually supersede open surgical procedures. In either case, the postoperative rehabilitation program is an essential part of the surgical treatment of these disorders, and should not be neglected.

Acromioclavicular Joint↗
PubMed1994

Fractures of the acromion process: a proposed classification system.

A review of 27 fractures of the acromion process during a 15-year period revealed five distinct types that were classified into three groups. Stress fractures are rare, do not result from acute trauma, and gain little benefit from nonoperative treatment. Type I fractures are minimally displaced. Type IA fractures are avulsion fractures and heal rapidly. Type IB fractures result from direct trauma to the extremity, and are minimally displaced. Most heal with nonoperative treatment. Type II fractures are displaced laterally, superiorly or anteriorly and do not reduce the subacromial space. Most are pain free with full motion after 6 weeks of nonoperative treatment. Type III fractures reduce the subacromial space. This may occur by an inferiorly displaced acromion fracture, or an acromion fracture associated with an ipsilateral, superiorly displaced glenoid neck fracture. Patients in this group sustained significant trauma to the involved extremity. All type III fractures treated nonoperatively develop significant limited shoulder motion with pain, suggesting that early surgical intervention may be indicated.

Acromion↗
PubMed1991

Airway compromise as a result of retropharyngeal hematoma following cervical spine injury.

Mechanical airway obstruction secondary to prevertebral hematoma following cervical spine injury is a life-threatening emergency. We present eight cases of mechanical airway obstruction from prevertebral hematomas in patients with cervical spine injury. They are combined with 13 previously reported cases to produce a study population of 21 patients. Although it is a rare complication of cervical spine injury, swelling significant enough to cause airway obstruction should be anticipated in all patients, regardless of age, severity of trauma, or lack of symptoms. To date, this phenomenon has not been reported in injuries below C6. Additionally, because symptoms may take hours to develop, initial cervical radiographs may not show evidence of retropharyngeal swelling and impending airway obstruction.

Adult↗
PubMed1991

Primary hyperparathyroidism and monoclonal gammopathy.

Coexistent primary hyperparathyroidism and monoclonal gammopathy, although rare, has been reported previously by a number of investigators. We report four patients with such an occurrence who were seen between 1976 and 1988. Another patient with primary hyperparathyroidism also had multiple myeloma and was in remission for 12 years. These patients represent approximately 1% of the 386 patients with primary hyperparathyroidism seen during the same 12-year period. Although several mechanisms have been proposed to explain this concurrence, we believe it is the result of a chance occurrence. A review of the literature, an estimate of the chance occurrence of coincidental monoclonal gammopathy, benign or malignant, in patients with primary hyperparathyroidism, and some practical implications of this interesting coexistence are presented.

Aged↗
PubMed1986

Ibuprofen improves survival and neurologic outcome after resuscitation from cardiac arrest.

Post-ischemic inflammatory changes in the central nervous system (CNS) following cardiac arrest and resuscitation are potentially responsible for ultimate survival and much of the neurologic damage, producing greater morbidity and mortality in successfully resuscitated patients. This study was undertaken to assess the non-steroidal anti-inflammatory agent, ibuprofen, in a controlled and monitored experimental model of canine cardiac arrest and resuscitation. With the investigator blinded as to the intervention, eight of 21 dogs were randomly assigned to receive ibuprofen as an i.v. bolus (10 mg/kg) and a 6-h i.v. infusion (5 mg/kg per h). The other 13 dogs received an equivalent volume of 0.9% NaCl to serve as controls. No statistically significant differences between the two groups were detected in any pre-arrest variables. All 21 dogs were successfully resuscitated. At 24 h, dogs receiving ibuprofen exhibited 100% survival, while control dogs exhibited only 54% survival (P = 0.03). The majority of deaths for the control group occurred within the first 6 h. Neurologic deficit scores were assigned at 1, 2, 6 and 24 h after resuscitation. A general trend occurred such that dogs treated with ibuprofen improved over time, while the control dogs remained severely impaired. A significant difference in neurologic deficit score was detected at 6 h (P = 0.01). At 24 h the ibuprofen group exhibited minimal neurologic deficit (5.9 +/- 3.2), and the control group exhibited significantly more severe neurologic impairment (52.2 +/- 13.0, P = 0.01). These results suggest that ibuprofen may be helpful in the pharmacologic management of cardiac arrest as a means of increasing survival and decreasing neurologic impairment.

Animals↗
PubMedDate not supplied

Validation of the lift-off test and analysis of subscapularis activity during maximal internal rotation.

We used electromyographic analysis to determine the muscle activity of the shoulder muscles during the lift-off test and during resisted internal rotation. The activity in the upper and lower subscapularis muscle during a lift-off test from the region of the midlumbar spine was approximately 70% of maximal voluntary contraction. This level was significantly higher than for all the other muscles tested (P < 0.05). The lift-off test with the hand placed in the region of the midlumbar spine resulted in one-third more electromyographic activity in the subscapularis muscle than when the test was modified and performed with the hand at the buttocks region. A resisted lift-off test resulted in higher activities in all the muscles, but only a small increase in the pectoralis major muscle. The pectoralis major muscle was significantly more active during resisted internal rotation with the arm in front of the body. Comparison of activity in the upper subscapularis with that in the lower subscapularis muscle showed no significant differences during any of the tests. This study documents the importance of the subscapularis muscle during the lift-off test and suggests that other potential internal rotators of the humerus have a limited role in maintaining internal rotation when the arm is placed behind the back.

Adult↗