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Biomedical subjects

J R Eckersley

Publications and source records attributed to J R Eckersley.

11 recordsLinked to original sources
PubMed2001

Surgery for cerebral palsy part 3: classification and operative procedures for thumb deformity.

Spastic thumb deformity is the result of imbalance between intrinsic and extrinsic forces acting across unstable joints. This paper presents a classification of spastic thumb deformity based on the accurate assessment of the deforming forces, outlines methods for their correction and reviews the results of our surgery. Thumb reconstruction procedures were performed in 32 patients with 33 spastic thumb deformities. All patients were assessed pre- and postoperatively using the same functional assessment system which was performed by the same team. The thumb was maintained out of the palm in 29 patients and lateral pinch was established in 26 patients.

Activities of Daily Living↗
PubMed1996

The surgical treatment of brachial plexus injuries.

BACKGROUND: Brachial plexus injuries cause a devastating loss of function in the arm. The aim of this study was to review the results of surgical treatment of patients with brachial plexus injuries. METHODS: Forty-seven patients were reviewed. Five patients did not undergo surgery. Forty-two patients had exploration and 38 had primary surgery with neurolysis, nerve graft or neurotization or a combination. Four patients had other reconstructive surgery primarily. Secondary reconstructive surgery consisted of joint fusions and tendon transfers to enhance or replace the primary surgery. RESULTS: Nerve grafting achieved 62% Medical Research Council (MRC) grade M3 or better. Intercostal neurotization (ICN) of the musculocutaneous nerve (MCN) for elbow flexion achieved M3 or better in 69% of patients. CONCLUSIONS: Primary nerve reconstruction, combined with joint fusions and tendon transfers, provides a worthwhile return of function to many patients. We advise early exploration (i.e. within 2 weeks when possible) for patients with complete C5-T1 lesions or C5,6,7 lesions in conjunction with high energy injuries. In order to obtain optimal results patients with brachial plexus injuries should be referred to appropriate units as early as possible.

Adolescent↗
PubMed1990

Glove punctures in an orthopaedic trauma unit.

A series of 421 operations in an orthopaedic trauma unit have been studied for glove punctures; 37.5 per cent of operations had a puncture demonstrated in the surgeon's gloves. The procedures at a high risk of glove punctures were hip operations (57 per cent) and internal fixation (54 per cent). The use of double gloving reduced the contamination of the surgeon's hand in these operation groups to 17 per cent (P less than 0.05). The potential risk of the surgeon being infected by his patients has become increasingly important with the increase in the number of people infected with HIV. The trauma surgeon is at a high risk due to frequent spillage of body fluids in trauma and the difficulty in identifying patients who may be at risk. Reducing the risk to the surgeon is difficult but awareness of the areas of potential contamination such as glove puncture may help.

Cross Infection↗
PubMed1986

Laparoscopy as an adjunct to decision making in the 'acute abdomen'.

When patients are admitted to hospital with acute abdominal pain, clinicians, irrespective of a specific diagnosis, intuitively select three diagnostic classes: operation definitely required (Group A); operation definitely not required (Group B); need for operation uncertain (Group C). The last is followed either by a precautionary laparotomy or a variable period of observation/investigation. We have studied prospectively the influence of laparoscopy on the distribution between these classes and particularly on outcome in group C. One hundred and twenty-five consecutive patients with abdominal pain severe enough for emergency admission have been classified by one of two admitting surgeons (SHO/registrar), who also expressed in group C a view on how they would proceed--operation or observation. Group C were then laparoscoped. The procedure confirmed a provisional view that laparotomy was needed in 11 of 15 patients. In the 'observation' sub-group the provisional decision was confirmed in 14 of 16 and early discharge followed in most. Six inappropriate decisions were thus avoided. Seven management decisions in group A and 4 in group B proved incorrect (11/94: 12 per cent). The majority were potentially recognizable by laparoscopy. Though relatively high rates of successful decision making are achieved with conventional clinical techniques, they can be further improved by laparoscopy. This procedure is particularly applicable in the management of patients with acute abdominal pain without a definite diagnosis, or when appendicitis is regarded as an established diagnosis.

Abdomen, Acute↗
PubMedDate not supplied

Prospective scenarios: a method of evaluating new decision tools.

Prospective randomized controlled trials are rarely suitable for the evaluation of new decision making techniques. An approach is described in which a cohort of patients is taken down the usual study pathway to the point at which the new technique would be used. Conventional decision rules are then applied and the results recorded. The new technique is then deployed and the cohort reclassified. The logical and statistical justification for this approach is outlined. More rapid (although possibly less pure) analysis of the effect of the new technique is achieved.

Clinical Trials as Topic↗
PubMedDate not supplied

Unrecognised arterial injury of the forearm: a secondary bleed presenting as acute compartment syndrome.

This case describes an arterial injury that remained unrecognised for 3 days, when a sudden secondary bleed caused acute compartment syndrome of the forearm. We have been unable to find another case of compartment syndrome presenting in this manner. The importance of thorough wound exploration is highlighted and the diagnosis and treatment of the syndrome discussed.

Adolescent↗