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Biomedical subjects

J R Bowen

Publications and source records attributed to J R Bowen.

At least 19 recordsLinked to original sources
PubMed1996

Predictive value of the Griffiths assessment in extremely low birthweight infants.

OBJECTIVE: To assess the relationship between the Griffiths Mental Development Scales at 1 and 3 years and the Stanford-Binet Intelligence Scale (S-B) and Beery Test of Visual-Motor Integration (VMI) at 5 years in extremely low birthweight (ELBW) children. METHODOLOGY: Prospective study of 45 ELBW infants, without severe neurosensory impairment, cared for in a single Level III neonatal intensive care unit. RESULTS: At 5 years, 36 (80%) children were of average intelligence, 8 (18%) had borderline intelligence and one was mentally retarded. The Griffiths general quotient (GQ) at 1 year had a weak correlation with the 5 year IQ (corr. coeff. = 0.47), with only 17% of children with a GQ < -1 s.d. at 1 year receiving an IQ < -1 s.d. at 5 years. In contrast, the Griffiths GQ at 3 years correlated strongly with 5 year IQ (corr. coeff. = 0.78). Among those children with a 3 year GQ < -1 s.d., 67% had a 5 year IQ < -1 s.d. and all had a 5 year 1Q < 89. The 3 year hearing and speech subscale correlated strongly with the 5 year S-B verbal comprehension factor (corr. coeff. = 0.753) and the 3 year combined eye/hand co-ordination/performance quotient had a moderate correlation with the S-B non-verbal reasoning factor (corr. coeff. = 0.597) and with the Beery VMI (corr. coeff. = 0.49). CONCLUSIONS: The 3 year Griffiths GQ is a good predictor of 5 year S-B IQ in ELBW children and can be used to identify children who may benefit from intervention prior to school entry.

Analysis of Variance↗
PubMed1996

Adolescent idiopathic scoliosis: treatment with the Wilmington brace. A comparison of full-time and part-time use.

We reviewed the clinical records and the radiographs of 188 patients who had adolescent idiopathic scoliosis. Our purpose was to determine whether part-time and full-time bracing had been equally effective in preventing progression of the curve. Full-time bracing had been used for ninety-eight patients; part-time bracing, for forty-nine; and electrical stimulation, for forty-one. Eighty-eight patients had had a curve of less than 30 degrees and 100 patients, a curve of 30 to 40 degrees. The treatment was considered a failure if the curve had increased 5 degrees or more. The curve progressed 5 degrees or more in thirteen (36 per cent) of the thirty-six patients who had had full-time bracing for a curve of less than 30 degrees, in thirteen (41 per cent) of the thirty-two who had had part-time bracing for such a curve, and in fourteen (70 per cent) of the twenty who had had electrical stimulation for such a curve. Compared with electrical stimulation, both full-time and part-time bracing prevented progression significantly more effectively (p < 0.02 and p < 0.04, respectively). With the numbers available, the difference in progression between the groups that had had full-time and parttime bracing was not significant (p < 0.18). The curve progressed 5 degrees or more in thirty-six (58 per cent) of the sixty-two patients who had had full-time bracing for a curve of 30 to 40 degrees, in ten of the seventeen who had had part-time bracing for such a curve, and in eighteen (86 per cent) of the twenty-one who had had electrical stimulation for such a curve. The difference in progression between each bracing program and electrical stimulation was significant (p < 0.03 for the full-time program and p < 0.05 for the part-time program). With the numbers available, the difference in progression between full-time and part-time bracing was not significant (p < 1.14).

Adolescent↗
PubMed1996

The Neonatal Neurobiologic Risk Score: does it predict outcome in very premature infants?

OBJECTIVE: To examine the validity of the Neonatal Neurobiologic Risk Score (NBRS) for predicting neurodevelopmental outcome to 3 years in infants born at < 28 weeks gestation. METHOLDOLOGY: The NBRS was retrospectively determined for 56 consecutive infants cared for in our NICU and prospectively followed to 3 years. Neurodevelopmental assessments performed at 3 years were correlated with the NBRS, and the predictive powers of individual items in the NBRS determined. RESULTS: The mean (range) birth weight was 908 (514-1295) g and gestational age was 26 (24-27) weeks. Three-year outcome was abnormal in 12 (21%) infants. A high NBRS at discharge was associated with an increased risk of abnormal 3-year outcome (odds ratio 2.56; 95% C.I. 1.4-4.7, p = 0.002). A modified NBRS using only significantly predictive items (acidosis, hypoxemia, hypotension, intraventricular hemorrhage, infection and hypoglycemia) demonstrated high sensitivity (1.00), specificity (0.98), positive predictive value (0.92) and negative predictive value (1.00) for abnormal 3-year outcome. CONCLUSIONS: This study confirms the validity of the NBRS as a simple and objective means of identifying very premature infants at highest risk of abnormal neurodevelopmental outcome, and of identifying specific events which may contribute to such outcomes.

Developmental Disabilities↗
PubMed1995

Scoliosis and fibrous dysplasia of the spine.

STUDY DESIGN: This report is an account of three patients with scoliosis and polyostotic fibrous dysplasia involving the spine. The perioperative course of two patients who underwent posterior spinal arthrodesis is described. OBJECTIVES: The objective of the study was to show that extensive fibrous dysplasia of the spine and scoliosis can be treated by standard methods of posterior spinal arthrodesis with good results. SUMMARY OF BACKGROUND DATA: Scoliosis developed in three patients, and two patients underwent spinal arthrodesis. No report that discusses the results of this type of operation in this patient population exists in the literature. METHODS: Three patients with polyostotic fibrous dysplasia involving the spine and scoliosis were located at our institution. Two of the patients underwent posterior spinal arthodesis in situ; their perioperative courses are described. The course of the nonoperatively treated patient is noted briefly. RESULTS: A stable posterior spinal arthrodesis was achieved in both patients with no major complications. At the time of the last follow-up visit, both patients had radiographic evidence of a solid fusion mass with no signs of pseudarthrosis or graft resorption. Both patients currently are doing well. CONCLUSIONS: Scoliosis and its treatment has been unreported in patients with this condition, and this report demonstrates that satisfactory results can be obtained with attention to detail.

Adult↗
PubMed1995

Risk factors for sensorineural hearing loss in extremely premature infants.

OBJECTIVE: To identify potentially preventable risk factors for sensorineural hearing loss (SNHL) in extremely premature infants. METHODOLOGY: A case control study of survivors with gestational age (GA) < 28 weeks or birthweight (BW) < 1000 g using data collected prospectively in our Neonatal Intensive Care Unit database. Each subject with bilateral SNHL > 40 dB was matched according to GA, BW and sex with two controls who had neither sensorineural nor conductive hearing loss. RESULTS: Infants with SNHL had increased mean (+/- s.d.) days ventilated (53 +/- 21 vs 37 +/- 23 days, P = 0.006) and in oxygen (107 +/- 44 vs 69 +/- 28 days, P = 0.02) compared with controls. The risk for SNHL was increased for infants who spent > 90 days in oxygen (OR 4.0 [95% CI 1.1-15.6]), had maximum FiO2 > 0.90 (5.6 [1.2-26.9]), minimum plasma Na < 125 mmol/L (5.6 [1.1-27.8] or maximum pH > 7.60 (5.6 [1.1-89.0]). Neither maximum serum bilirubin nor exposure to ototoxic drugs was associated with SNHL. CONCLUSIONS: Avoidance of severe hyponatraemia and extreme alkalosis, as well as use of surfactant to minimize the severity of hyaline membrane disease, may result in a decreased incidence of SNHL in extremely premature infants.

Alkalosis↗
PubMed1995

An evaluation of various methods of treatment for Legg-Calvé-Perthes disease.

An analysis of 5 methods of treatment for Legg-Calvé-Perthes disease was done on 124 patients with 141 affected hips. Before treatment, all groups were statistically similar concerning initial Mose measurement, age at onset of the disease, gender, and Catterall class. Treatments included the Scottish Rite orthosis (41 hips), nonweight bearing and exercises (41 hips), Petrie cast (29 hips), femoral varus osteotomy (15 hips), or Salter osteotomy (15 hips). Hips treated by the Scottish Rite orthosis had a significantly worse Mose measurement across time interaction (repeated measures analysis of variance, post hoc analyses, p < 0.05). For the other 4 treatment methods, there was no statistically different change. At followup, the Mose measurements for hips treated with the Scottish Rite orthosis were significantly worse than those for hips treated by nonweight bearing and exercises, Petrie cast, varus osteotomy, or Salter osteotomy (repeated measures analysis of variance, post hoc analyses, p < 0.05). There was, however, no significant difference in the distribution of hips according to the Stulberg et al classification at the last followup.

Analysis of Variance↗
PubMed1994

Is it necessary to decorticate segmentally instrumented spines to achieve fusion?

STUDY DESIGN: The effects of spinal instrumentation and decortication on spinal arthrodesis rates--when performed independently and when used together--were studied in an experimental animal model. MATERIALS AND METHODS: Fifty-two immature New Zealand white rabbits underwent six different spinal procedures. The animals were killed six weeks postoperatively and their spines were evaluated by gross examination, radiography, manual stress testing, and histologic means. RESULTS: The addition of rigid instrumentation to autologous iliac grafting significantly improved fusion rates in animals that were not decorticated. However, when decortication was done, a statistically significant improvement could not be documented. The addition of decortication to autologous iliac grafting significantly improved fusion rates in noninstrumented spines, but in instrumented spines, a statistically significant improvement could not be demonstrated.

Animals↗
PubMed1994

Vitamin A status in preterm neonates with and without chronic lung disease.

It has been proposed that there is an association between vitamin A (VA) deficiency and the development of chronic lung disease (CLD) in preterm infants. This study was designed to measure the VA status in preterm infants and to compare the results in the group of babies who developed CLD with the group who did not. Vitamin A status was assessed by measuring plasma VA, retinol binding protein (RBP) and the plasma VA:RBP molar ratio in 25 infants of less than 31 weeks gestation during the first 28 days of life. Eleven babies developed CLD and 14 did not. There was no significant difference in plasma VA levels between the CLD and non CLD groups during the first 28 days. The majority of infants had adequate VA status, with a subgroup being deficient.

Chronic Disease↗
PubMed1994

Evaluation of physeal behavior in response to epiphyseodesis with the use of serial magnetic resonance imaging.

The stages in the closure of the growth plate after percutaneous epiphyseodesis were studied in fourteen patients (eight girls and six boys) with coronal T1-weighted spin-echo images and coronal field-echo images of the knee. A total of thirty-three magnetic-resonance imaging studies of the knee were made the first week, the fourth month, the eighth month, or one year after the epiphyseodesis. A mature bridge of bone was seen at the operative sites approximately eight months after the operation. In the central undisturbed area between the operative sites, there was a progressive decrease in the width of the physeal cartilage that remained visible eight months after the operation. Growth recovery lines were not seen postoperatively in any patient, and the physis closed in all of the patients. The physis of the adjacent untreated bone served as a control bone and showed neither a change in width nor any growth recovery lines. Magnetic resonance-imaging studies provide excellent visualization of the anatomical changes that lead to closure of the physis after an epiphyseodesis, and we believe that these studies provide a method of assessment of the physis after an injury.

Child↗
PubMed1993

Persistent bony lesions in congenital syphilis. A report of three cases.

We report three cases of congenital syphilis with bony lesions which were unusual because they were unilateral and asymmetrical. They did not heal with conventional penicillin treatment and they resulted in angular deformities, shortening of the limb and pseudarthrosis following pathological fractures.

Bone Diseases↗
PubMed1993

Serum cefazolin levels during spinal fusion: effect of blood loss and duration of surgery.

Perioperative cefazolin prophylaxis is commonly employed in posterior spinal fusion (PSF) procedures, which are often lengthy and involve significant blood loss. In this study, serum levels of prophylactically administered cefazolin were measured serially during spinal fusion procedures, and the possible relationship of antibiotic concentrations to blood loss and fluid therapy were examined. Serum antibiotic levels, measured at 30-min intervals, declined with a half-life of 90 min, similar to the previously reported experience with normal adult volunteers. There was no relationship between serum half-life and blood loss or fluid replacement. An explanation for these findings is offered, along with recommendations for dosing.

Adolescent↗
PubMed1993

Extremely low birthweight infants at 3 years: a developmental profile.

This study documents the neurodevelopmental outcome at 3 years of 52 of 55 extremely low birthweight (ELBW) survivors (survival rate 49%) born in a tertiary maternity centre from July 1985 through December 1988, and examines more closely the developmental profile of the neurologically normal survivors. At 3 years, 6 (12%) children had severe neurodevelopmental impairment (severe cerebral palsy, blindness, deafness or a General Quotient (GQ) < 70 on the Griffiths Scales), 11 (21%) had mild to moderate impairment and 35 (67%) had no neurosensory impairment and normal development (GQ > or = 85). Significant risk factors for severe impairment were stage 3 or 4 retinopathy of prematurity (odds ratio [OR] 21.5), treatment with postnatal steroids (OR 21), grade III or IV intraventricular haemorrhage (OR 11) and supplemental oxygen at 'term' (OR 6.4). The developmental profile of the 35 neurologically normal children revealed a significant weakness in eye and hand coordination skills and a relative strength in hearing and speech skills. Early recognition of this developmental profile may allow implementation of more appropriate preschool programmes for ELBW children.

Blindness↗