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Biomedical subjects

J Mahoney

Publications and source records attributed to J Mahoney.

At least 19 recordsLinked to original sources
PubMed1992

A comparison of a two-wheeled walker and a three-wheeled walker in a geriatric population.

OBJECTIVE: There are few data on the effect of walkers on gait and mobility or on comparisons of different walker types. We compared a commonly used 4-legged, 2-wheeled walker and a newer 3-legged, 3-wheeled walker in measures of gait, mobility, and patient satisfaction. DESIGN: Cross-over controlled trial. SETTING: In the Physical Therapy Department of a Veterans Affairs hospital. PARTICIPANTS: Subjects were 15 male and female frail elderly veterans (mean age, 82 years), both inpatients and outpatients, consecutively enrolled from a sample of 35 patients referred to the Physical Therapy Department for mobility problems. Subjects met the following criteria: age 65 or over, ambulatory, no prior use of a wheeled walker, stable medical condition, and informed consent. INTERVENTION: Subjects were evaluated without either walker and with each of the two walkers on a 15-foot walkway and a 60-foot obstacle course. Subjects were asked which walker they preferred. OUTCOME MEASURE: Outcome measures were stride length on the walkway, time on an obstacle course, and walker preference. RESULTS: Stride length was 1.4 inches (3.6 cm) greater with the 3-wheeled walker than with the 2-wheeled walker (P = 0.016 by Wilcoxon signed-rank test). Time on the obstacle course was 16.0 seconds less with the 3-wheeled walker than the 2-wheeled walker (P = 0.002). The 3-wheeled walker was subjectively preferred. CONCLUSIONS: The 3-wheeled walker appears to have a greater positive impact on gait and mobility than the 2-wheeled walker.

Activities of Daily Living↗
PubMed1991

Wound healing complications in soft tissue sarcoma management: comparison of three treatment protocols.

A prospective, nonrandomized comparison of three treatment protocols was undertaken in 45 patients with soft tissue sarcoma designated preoperatively as being at high risk of wound healing complications. All patients underwent complete resection of the gross tumour mass (5 with positive and 40 with negative microscopic margins). Fourteen patients received postoperative adjuvant irradiation (group I), 16 preoperative irradiation (group II), and 15 preoperative irradiation and vascularized tissue transfer to the surgical bed after resection (group III). Major wound healing complications (defined as complications requiring at least 1 further surgical procedure) were lower in group III patients (chi-square = 5.57, P less than 0.03), as was the mean postoperative hospital stay (P less than 0.02, analysis of variance), and the mean number of secondary surgical procedures. Multivariate analysis showed that the only variable influencing length of stay was the use of tissue transfer. Careful intraoperative assessment of the adequacy of resection is essential prior to performing vascularized tissue transfer to ensure that tumour contamination of the donor site is avoided. Since this study is a nonrandomized clinical trial using sequential distribution of patients to the treatment groups, the data should be considered as preliminary, rather than definitive, evidence of the efficacy of vascularized tissue transfer.

Combined Modality Therapy↗
PubMed1991

Evaluation and treatment of blunt renal trauma.

We examined retrospectively the records of 126 patients with blunt renal trauma to determine the criteria for radiological investigations and the imaging study of choice. Of the 3,993 patients admitted to our regional trauma unit during the last 13 years 126 (3.1%) had blunt renal trauma. Mean patient age was 32 years (range 13 to 87 years) and the male-to-female ratio was 3:1. Mean followup was 7 months (median 4 months). Of the patients 72% had a minor renal injury, 17% had a moderate injury and 11% had a major renal injury. Treatment was conservative in 114 patients, while 9 underwent a genitourinary operation. Results were excellent in 87% of the patients and good in 8%, while 5% failed treatment. All patients who had microscopic hematuria without shock had minor injuries. Excretory urograms (IVPs) were normal in 74% and 39% of the patients when performed for minor and moderate renal injuries, respectively. Computerized tomography (CT) was abnormal in all cases when performed, and was more sensitive and specific than an IVP. Therefore, the majority of patients with blunt renal trauma can be treated conservatively with an excellent result. Furthermore, radiological investigations are not needed in those with microscopic hematuria and no shock. When radiological investigations are indicated a CT scan is the imaging study of choice.

Adolescent↗
PubMed1991

Demonstration of increased bone metabolism in melorheostosis by multiphase bone scanning.

The multiphase bone scan features of melorheostosis are presented. Early increased tracer delivery demonstrated by blood pool imaging supports the concept of ongoing accelerated bony metabolism as a cause of tracer uptake within the osteosclerotic lesions of melorheostosis. There is excellent correlation between the scintigraphic and radiographic distribution of these lesions.

Adult↗
PubMed1991

Fractures following limb-salvage surgery and adjuvant irradiation for soft-tissue sarcoma.

In a prospective study, consecutive patients were treated for soft-tissue sarcoma (STS) by wide resection and adjuvant irradiation. Twelve patients had resection of bone to achieve a tumor free margin; five of these patients were left with lower extremity open segmental cortical defects in the high-dose radiation field. Four of the five patients with cortical defects suffered a fracture through the defect more than six months after surgery. Only one of 71 patients not treated with bony resection suffered a late fracture. Patients requiring bony cortex resection for STS of the lower extremity should be considered at risk for late fracture if adjuvant irradiation is prescribed.

Adult↗
PubMed1990

Concurrent Poland's syndrome and gynecomastia: a case report.

Gynecomastia (enlargement of the male breast) is a common occurrence during puberty and usually resolves. Poland's syndrome or hypoplasia of the chest wall is a rare congenital anomaly associated with hypoplasia of the ipsilateral extremity. Simultaneous presentation of gynecomastia and Poland's syndrome in a 26-year-old man increased the extent of asymmetry and the perception of each deformity. Surgical reduction of the enlarged breast greatly reduced the asymmetry, giving a satisfactory result.

Adult↗
PubMed1989

Non-neurogenic soft tissue tumours of the axilla: prospective review of 16 cases.

Sixteen consecutive patients entered in a prospective study of non-neurogenic soft tissue tumours had lesions in the axilla. Delayed diagnosis and inappropriate biopsy prior to referral to a surgical oncologist were frequent findings. Sarcoma and fibromatosis were diagnosed in 14 cases, and the approaches used for these two diseases were fundamentally different. The functional outcome with limb salvage surgery in these patients is presented.

Adolescent↗
PubMed1989

Salvage of the infected groin vascular graft with muscle flaps.

Debridement and reconstruction of the infected groin wound, including those involving prosthetic graft material, have been performed in eight patients. Healing of the groin wound with functional preservation of the graft has been possible. Our patients have been followed up for at least six months. The procedure described here is a useful addition to the surgical armamentarium for battling this difficult problem.

Aged↗
PubMed1989

Nonoperative management of complications of percutaneous renal nephrostomy.

Between 1984 and 1986 at the Wellesley Hospital in Toronto, 210 percutaneous renal nephrostomies were performed for drainage and 140 were done to provide access for nephrolithotomy. Less than 2% of the patients experienced complications requiring intervention and less than 0.5% required an open surgical approach for the management of procedure-related problems. Complications that were managed conservatively included splenic puncture, false aneurysm, laceration of the renal artery, arteriovenous fistula, hemorrhage requiring transfusion, pneumothorax-empyema, urinoma, septic shock and the hemolysis-hyponatremia-renal shutdown syndrome.

Adult↗
PubMed1989

Effect of capsulectomy on the hemodynamics and viability of random-pattern skin flaps raised on expanded skin in the pig.

Skin flaps constructed on expanded skin usually include the underlying capsular tissue. It has been hypothesized that capsulectomy may jeopardize the viability of the expanded skin flap. The experiments reported herein were designed to test this hypothesis. Specifically, we studied the hemodynamics and viability of random-pattern skin flaps (8 X 20 cm) raised on delayed bipedicle flaps (group A) and on expanded skin pockets with capsulectomy at the time of flap elevation (group B) or with intact underlying capsular tissue (group C). Each group was randomly assigned to each flank in 16 pigs. Skin pockets were expanded by inflation of subcutaneous silicone tissue expanders with sterile saline (299 +/- 7 ml; X +/- SEM) over a period of 3 weeks. At the end of this period, the bipedicle flaps were constructed. Eight days later, random-pattern skin flaps were raised on bipedicle flaps and skin pockets. The length and area of skin flap viability, judged by the fluorescein dye test performed 1 day postoperatively, were not significantly different (p greater than 0.05) among groups A, B, and C (n = 31 to 32). There also were no significant differences (p greater than 0.05) in total skin capillary blood flow measured 1 day postoperatively (A = 2.6 +/- 0.4, B = 2.4 +/- 0.4, and C = 2.7 +/- 0.6 ml/min per flap; n = 15 to 16) and in skin viability assessed 7 days postoperatively (A = 74 +/- 2, B = 75 +/- 2, and C = 76 +/- 2 percent; n = 16) among delayed skin flaps and skin flaps raised on expanded skin pockets with or without capsulectomy. The results of this flap viability study were confirmed in 5 minipigs in a separate experiment. We conclude that capsulectomy did not have a detrimental effect on the hemodynamics and viability of random-pattern skin flaps raised on expanded skin. Furthermore, we hypothesize that skin flaps raised on expanded skin are similar to delayed skin flaps in that the skin blood flow is optimally augmented; therefore, the capsular tissue does not add significant blood supply to the overlying skin.

Animals↗
PubMed1988

Altered hepatic calcium homeostasis in guinea pigs with halothane-induced hepatotoxicity.

Exposure of guinea pigs to 1% halothane in air for 4 hr resulted in extensive centrizonal hepatic necrosis in 70% of animals examined 2 to 3 days later. In contrast, confluent hepatic necrotic lesions were not present in animals studied 24 hr after halothane exposure; only microvascular fatty change of hepatocytes with occasional necrotic cells was observed at that time (in 84% of animals). This delayed onset of lesion development afforded the opportunity to study microsomal membrane composition and indices of Ca++ homeostasis before and after the onset of halothane-induced hepatic necrosis. Hepatic microsomal cytochrome P-450 levels were unaltered 24 hr after halothane exposure, but fell to approximately 50% of control values at 72 hr. This indicates that such changes were most likely the result of hepatocellular necrosis. Microsomal lipid composition, including the relative proportions of individual phospholipids, was unaltered during halothane-induced hepatotoxicity. In contrast, microsomal Ca++ sequestration, as assessed by 45Ca uptake, was reduced 24 hr after halothane exposure compared with controls (2.76 +/- 1.32 nmol/mg of protein per min, vs. 6.63 +/- 2.88 nmol/mg of protein per min, P less than .001). This early change in microsomal Ca++ uptake was associated with a 10-fold increase in total hepatic Ca++ content at 24 hr. Subsequent changes in hepatic Ca++ content were proportionate to the severity of liver necrosis. The observation that abnormalities of hepatic Ca++ homeostasis antedate the presence of liver cell necrosis is consistent with a role for altered Ca++ fluxes in the mechanism of halothane-induced liver injury.

Alanine Transaminase↗
PubMed1987

Toe transfer to the vessels of the reversed forearm flap.

A 23-year-old man had a severe degloving injury of his hand, amputation of multiple fingers, and devascularization of the thumb. Primary care consisted of successful revascularization of the thumb and skin grafting of the hand. Secondary soft tissue reconstruction of the hand was done with a reverse forearm flap. This was followed by second-toe transfer to the hand, with the recipient vessels, the radial artery, and the venae comitantes of the reverse forearm flap.

Adult↗
PubMed1987

Posterior wall disruption of the left ventricle after mitral valve replacement: management of bleeding and cardiac enlargement.

Two patients who underwent mitral valve replacement sustained posterior left ventricular disruption postoperatively and survived. Management consisted of repair from outside the heart without removal of the mitral prosthesis. This was achieved with a running Prolene suture in the atrioventricular junction in one patient and pledgeted sutures in the other who had transverse midventricular disruption. Biologic glue was crucial in controlling hemorrhage after the repair in both cases. The patient with transverse midventricular disruption required placement bilaterally of pectoralis muscle flaps to close the sternal wound because of swelling and dilatation of the heart.

Aged↗
PubMed1979

Advanced digoxin toxicity in renal failure: treatment with charcoal hemoperfusion.

Glycoside toxicity, a common and potentially fatal complication among patients taking digoxin, is treated basically by managing cardiac arrythmias until the patient can excrete enough drug to decrease the intoxication. Patients with renal failure, however, are particularly difficult to manage. We describe a case of advanced digoxin toxicity in an elderly man with severe renal failure, treated with a charcoal hemoperfusion device.

Aged↗