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Biomedical subjects

J K Webb

Publications and source records attributed to J K Webb.

At least 91 records · Page 5Linked to original sources
PubMed1988

Hump changes on forward flexion of the lumbar spine in patients with idiopathic scoliosis. A study using ISIS and the Scoliometer in two standard positions.

A detailed study of the effects of forward flexion in the spine on back shape is reported. ISIS and the Scoliometer were used to record angle of trunk inclinations (ATIs) in 13 patients with idiopathic scoliosis. Two standard positions were used: standing erect (for ISIS) and sitting forward bending (for the Scoliometer). In the lumbar region, a positional change in ATI between standing erect and sitting forward is revealed; it is related to the type and side of mainly compensatory spinal curves. It does not correlate with Cobb angle but it does correlate with each of spinous process rotation (Bunnell) and pedicular rotation (Perdriolle). In the thoracic region, the change from a standing-erect to a sitting-forward-bending position, in contrast, shows a statistically significant reduction of the hump on the convexity of the spinal curve. The findings have relevance to screening tests for scoliosis.

Child↗
PubMed1988

Surgery for malignant extradural tumours of the spine.

We have reviewed 41 patients with malignant extradural tumours of the spine treated by anterior decompression for cord compression, or uncontrolled back pain or both. An anterior operation alone was performed in 37 cases, four had combined or staged anterior and posterior decompression. An anterior operation on its own achieved major neurological recovery in 18 of the 33 cases with neurological loss (56%); only four remained unchanged. Eleven had minor improvement but not enough to allow them to walk or to regain bladder function. No patient with complete paraplegia gained a useful neurological recovery. Back pain was improved in 30 of the 41 patients (73%), sound internal fixation being important in this respect. There were four early deaths and another 23 died from disseminated disease after a mean survival of 4.1 months. Fourteen patients are still alive with a mean survival of 14 months.

Adult↗
PubMed1988

Plate fixation of open fractures of the tibia.

The results of immediate plate fixation of 97 open fractures of the tibial shaft in 95 patients are reported. Significant joint stiffness occurred in 11.4% and angular malunion of greater than 5 degrees in any plane was seen in 3.1%. The infection rate was 10.3%. However, even in those cases which develop delayed union or other complications, plate fixation of open fractures can produce excellent recovery of limb function.

Adolescent↗
PubMed1988

Child to child: an approach to the health education of primary school-age children.

Child to Child is an approach to health education of the primary school-age child. In developing countries, infants and young children spend much of their lives in the care of an older brother or sister. Morley, a paediatrician, saw the potential of teaching these older children to provide better care for their siblings. Working with colleagues in education, Child to Child was launched in 1978, the International Year of the Child. Teaching material was prepared covering developmental needs, nutrition, common illnesses and aspects of the environment; a book was published describing an activity-oriented teaching method. This material was distributed to developing countries world-wide, with encouragement to use the material and ideas freely, adapting, translating, or innovating as found useful. Child to Child is now in use in 60 or more countries, and in at least 15 languages. It is being used by agencies like the World Bank, UNICEF, UNESCO, and OXFAM as a way of reinforcing community education in the search for 'Health for All by 2000'. A world-wide review of Child to Child is in hand. Information from this will help to provide firm guidelines on implementation in the different contexts where its value has already been established.

Child↗
PubMed1988

Variation in vertebral levels of the vertebra prominens and sacral dimples in subjects with scoliosis.

The vertebra prominens is found most frequently at C7 in both sexes (78.7% of 47 females, 58.8% of 17 males). It is frequently at T1 in females (3 of 47: 6.4%) though not uncommonly so in males (6 of 17: 35%). The first spinous process felt at the lower end of the nuchal furrow is an unreliable guide to the vertebra prominens in the female (being at C6 in 59.6% of female subjects and coinciding with the vertebra prominens in only 46.8%). The sacral dimples have a wide distribution in vertebral level and are unreliable as surface vertebral landmarks. The generally accepted vertebral level of sacral dimples being at S2 is disputed, being present at this level in only 5 of 68 subjects (7.4%). There is a significant sex difference in the location of sacral dimples, being higher relative to vertebrae in females than in males, P less than 0.05. This finding is related particularly to the greater pelvic height of adolescent girls compared with boys.

Adolescent↗
PubMed1987

Complications of external fixation of open fractures of the tibia.

Forty-two cases of open fractures of the tibia treated by external fixation are presented. Forty-three per cent of patients developed sepsis around one or more pins. Pin track sepsis occurred in 78 per cent of cases involving transfixion pins through muscle and bone but in only 17 per cent of cases using transcutaneous half-pins. Malalignment of more than 5 degrees in any plane was seen in 38 per cent of cases, almost half of which increased in plaster after removal of the fixator.

Adolescent↗
PubMed1987

Adolescent idiopathic thoracic scoliosis. A prospective trial with and without bracing during postoperative care.

Fifty patients with adolescent idiopathic scoliosis treated by posterior fusion and Harrington instrumentation augmented by a Cotrel bar or by sublaminal Luque wires were studied in a prospective trial to ascertain the need for postoperative bracing. Twenty-five patients wore a plaster brace postoperatively for six months, while 25 were managed without a brace. The mean loss of correction from the first standing postoperative radiograph to one obtained two years later was 7 degrees in the braced group, and 6.3 degrees in the unbraced group, the difference not being statistically significant. We conclude that postoperative bracing is unnecessary after augmented Harrington instrumentation.

Adolescent↗
PubMed1987

A surgical approach to the upper thoracic spine.

We describe a surgical approach to the upper thoracic spine which allows an adequate exposure of the vertebral bodies from T1 to T3. The approach causes little functional disturbance and is especially useful in older patients with spinal tumours causing spinal cord compression.

Aged↗
PubMed1987

The penetration of antibiotics into the normal intervertebral disc.

The role of antibiotics in the treatment of disc-space infection is controversial. This study assessed the tissue penetration of flucloxacillin and cephradine into the normal intervertebral disc after intravenous administration of a bolus dose of antibiotic. Twenty-five discs were removed from 12 adolescent patients having anterior spinal surgery to correct scoliosis; antibiotic had been administered between 30 minutes and four hours before operation. Despite high blood levels, no antibiotic could be detected by bioassay or by high-pressure liquid chromatography (h.p.l.c.) in any of the specimens from the nucleus pulposus or the annulus fibrosus.

Absorption↗
PubMed1985

Stature and its components in adolescent idiopathic scoliosis. Cephalo-caudal disproportion in the trunk of girls.

Stature and its components were examined in 143 girls aged 11 to 15 years with adolescent idiopathic scoliosis. Correction was made for loss of height due to the lateral spinal curvature, and the findings were compared with those from 202 healthy girls of similar age. Using three components of stature (suprapelvic, pelvic and subischial heights) we were able to show that the relatively greater stature of girls with adolescent idiopathic scoliosis was due to changes in the pelvis and lower limbs but not significantly in the spine. Suprapelvic height was reduced relative to subischial height; this probably represents the growth pattern of predominantly ectomorphic individuals, reflecting the physique of many of these girls. Pelvic height was disproportionately increased, and this is considered to be a true rather than an apparent difference. Cephalocaudal disproportion involving two segments suggests a common mechanism of causation which is unlikely to be secondary to the scoliosis. These physical features may in some way be associated with a predisposition to progression of the scoliosis.

Adolescent↗
PubMed1985

Stature and its components in healthy children, sexual dimorphism and age related changes.

This paper reports a cross sectional study of three components of stature (suprapelvic height, pelvic height and subischial height) for a sample of 585 healthy children aged 8-15 years. Data are also given for stature, sitting height and bi-iliac width. Sexual dimorphism is revealed in both suprapelvic height and pelvic height. In girls, the increase in pelvic height is detected before the increase in bi-iliac width and before the appearance of secondary sexual characteristics. The data provide the first 'standards' for each of suprapelvic height and pelvic height for clinical use.

Adolescent↗
PubMed1984

A comparison of surgery and chemonucleolysis in the treatment of sciatica. A prospective randomized trial.

Fifty-two patients with unilateral sciatica caused by intervertebral disc herniation were selected on strict clinical and radiological criteria. All patients had failed to respond to conservative measures. Patients in this trial group randomly were allocated surgery or Chymopapain. During the same period, a further 71 patients, who were put forward for the trial, and did not fulfill the trial criteria, were offered Chymopapain as an alternative to surgery. Both groups were assessed at one month, three months, and one year--progress being recorded by clinical examination and visual analogs. The failure rate in the two Chymopapain groups were comparable, with 52% and 47%, but were significantly higher than the surgical group (11%). Surgery in the failed Chymopapain group frequently was delayed and unrewarding. Failures can be predicted at one month posttreatment, and early surgery may be indicated to prevent chronic scarring.

Adolescent↗
PubMed1984

Clinical evaluation of spinal cord monitoring in scoliosis surgery.

The somatosensory evoked potential (SEP) is a technique that can be used to monitor sensory conduction within the spinal cord throughout the course of spinal surgery. The authors describe the technique, stimulation, and recording parameters, which most critically affect the success and reliability of monitoring trials. In addition, we show that in all 40 patients tested fully, the SEP results were in complete agreement with the clinical findings at the time of the wake-up test. In this series, there was no instance of a "false-positive" SEP result, or of the SEP failing to detect neural damage. Temporary, neurologic deficit occurred on two occasions, which are described in detail. These show that the SEP is rapid, enables neurologic complications to be detected at an early stage of surgery, and can identify lateralized problems. It is concluded that the technique may provide a clinically valuable method for continuous and prolonged monitoring of spinal cord function.

Adolescent↗
PubMed1983

A study of function after tibial cast bracing.

103 patients with fresh unilateral fractures of the tibial shaft were reviewed clinically and radiologically to assess the results of treatment by functional bracing. At review, 84 had returned to their previous employment and all but 22 could run. All had full knee movements, 85 per cent had a normal range or a mild loss of subtalar movement, and only 11 patients had greater than 25 per cent reduction of measured ankle movement. The average shortening measured radiologically was 0.5 cm. Angulation greater than 10 degrees was present in 1 patient. Factors leading to delayed union include comminution, severe displacement, open injuries and not bearing weight. The importance of early weight bearing is discussed.

Braces↗
PubMed1983

A study revealing a tall pelvis in subjects with low back pain.

Modern anthropometric techniques were used to investigate two groups of subjects, one with various syndromes associated with pain in the lower back and the other a control group. Analysis confirmed previous reports that people prone to pain in the back have a greater standing height than people who are not. To investigate this further two new components of height, namely pelvic height and suprapelvic height, were calculated in addition to the established calculation of subischial height. Consecutive components, namely suprapelvic height, pelvic height and subischial height, together constituted the standing height of a subject. The main finding of this investigation was that the relatively large standing height of the subject prone to back pain was due only to the pelvic component.

Adult↗
PubMed1983

Standardised trunk asymmetry scores. A study of back contour in healthy school children.

This paper reports a new method for expressing numerically asymmetry of the contour of the back in a forward-bending position. Information is given at three spinal levels (T8, T12 and L3) for 636 schoolchildren aged 8 to 15 years. Rib-hump and lumbar-hump scores were standardised to create trunk asymmetry scores (TASs) making comparison possible between children of different age, size and sex. Two groups of children were defined: those with clinically straight spines (585 children); and those with clinical evidence of lateral spinal curves (51 children). In the children with clinically straight spines the main findings were: about 1:4 had objectively detectable rib and lumbar humps; female-to-male ratios were 1.2:1 for the thoracic region and 1.4:1 for the lumbar region; right humps were about 10 times more common than left; TASs in the boys and girls at each spinal level had normal distributions about means to the right of zero (where zero represents perfect symmetry); at T8 and T12, a wider scatter of TASs in girls than in boys; at L3, larger TASs in girls than in boys; a relation between shortening of one lower limb and a contralateral hump on the back; and no relation to age (except at L3), stature (corrected for age) or handedness. The findings are discussed in relation to possible causes of back contour asymmetry, early diagnosis of scoliosis by screening, sexual dimorphism and significance for the pathogenesis of idiopathic scoliosis. Ten children with clinically straight spines and larger TASs, and 42 out of 51 children with clinical evidence of lateral spinal curves in the forward-bending position attended for radiographic examination. Twelve children had "scoliosis curves" of 11 degrees or more as defined by the Scoliosis Research Society. The results are reported in relation to TASs, spinal curve angle (Cobb) and vertebral rotation.

Adolescent↗