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Biomedical subjects

J R Gregg

Publications and source records attributed to J R Gregg.

At least 19 recordsLinked to original sources
PubMed1991

Arthroplasty of the hip and knee in juvenile rheumatoid arthritis.

The primary reason for total hip and total knee replacement in patients with juvenile rheumatoid arthritis is marked functional impairment. Secondary reasons are severe disabling pain and deformity. By the time a patient is ready for arthroplasty, alternatives to surgery have already been considered; synovectomies, soft-tissue releases, and osteotomies have already been performed, or the destructive process is too advanced for any form of therapy to have a considerable effect.

Arthritis, Juvenile↗
PubMed1991

Keeping fit when injured.

Staying physically fit while injured can improve the patient's outlook, both physiologically and psychologically, and help him or her return to regular activities completely, safely, and with decreased risk of re-injury. Although treating and protecting the injured area is of primary concern, it is important to then look beyond the injury, toward keeping the rest of the body as fit as possible. Whether through alternative sports, cross training, or water exercise, the patient can preserve the integrity of the injured joint, keep the noninjured muscles active, and maintain ever-important cardiovascular fitness. The exercise prescription for the injured athlete should emphasize our most vital muscle, the heart.

Athletic Injuries↗
PubMed1988

The use of single photon emission computed tomography (SPECT) in the diagnosis of low-back pain in young patients.

Single photon emission computed tomography (SPECT) is a method of scintigraphy that provides sectional and multi-planar imaging that should improve the sensitivity for diagnosis in remote areas of the spine. To test this hypothesis, the authors reviewed 15 patients with low-back pain and compared the results of the radiographs, planar bone scans (PBS), and SPECT. Four of 15 had normal examinations with all three methods of imaging. The rest had a positive test in at least one of the three methods. Single photon emission computed tomography was positive in eleven, PBS in six, and the radiograph in three of the 11 patients. It appears that the SPECT was the most sensitive method of imaging and greatly enhanced our diagnostic acumen for stress fractures or stress reactions of the spine.

Adolescent↗
PubMed1988

Upper extremity injuries in adolescent tennis players.

The majority of adolescent tennis players will have their playing temporarily interrupted by an injury, with lower extremity problems predominating. Although upper extremity injuries occur less frequently, they tend to be more troublesome. Injuries discussed in this article include "King Kong arm," slipped capital humeral epiphysis, "Osgood-Schlatter disease" of the shoulder, tennis elbow, stress synovitis and elbow flexion contracture, and friction burns and collagen stress fractures of the rotator cuff.

Adolescent↗
PubMed1987

A modified Bristow-Helfet-May procedure for recurrent dislocation and subluxation of the shoulder. Report of two hundred and twelve cases.

A modified Bristow-Helfet-May procedure was performed for recurrent dislocation or subluxation of the glenohumeral joint in 207 patients (212 shoulders), whose average age at the time of surgery was 20.3 years (range, fourteen to forty-seven years). The procedure was modified by directing the coracoid segment and conjoined tendon over the superior border rather than through the substance of the subscapularis tendon and muscle. The indications were either documented recurrent anterior dislocation of the glenohumeral joint or subluxation with instability as demonstrated on examination with the patient under anesthesia. The procedure was evaluated on the basis of the rate of recurrence of dislocation and subluxation, postoperative complications, the patients' subjective evaluation, and the effect of the procedure on the motion of the glenohumeral joint and the strength of the muscles of the shoulder as related to overhead throwing. Eight (3.8 per cent) of the shoulders redislocated and ten (4.7 per cent) had one or more subjective episodes of subluxation after the procedure. Complications included postoperative infection in two patients and problems with the screw that required its removal in ten. One hundred and thirty-one (62 per cent) of the patients responded to a questionnaire regarding their subjective evaluation of the results of surgery. Eleven (8 per cent) were unable to perform daily activities that involved overhead work, and forty-five (34 per cent) stated that they still had some degree of discomfort or pain in the shoulder. One hundred and twenty-six patients (96.2 per cent) stated that they were happy with the results of the surgery and would have the procedure again. Thirty patients had Cybex testing of the muscles of the shoulder. Only three (16 per cent) of the nineteen athletes whose dominant arm had been operated on returned to their pre-injury level of throwing. Data obtained with regard to changes in the range of motion and strength of the glenohumeral joint indicate that this loss of throwing ability was not due solely to a loss of glenohumeral motion. It appeared to be also related to a concomitant loss of strength at the extreme of external rotation of the humerus and the initiation of internal rotation of the humerus.

Adolescent↗
PubMed1986

Osteochondritis dissecans of the midfoot.

Osteochondritis dissecans of the midfoot is described with discussion focusing on its etiology, classification, and treatment. Two cases are presented in which workup, treatment, and follow-up are described. Difficulty in making the diagnosis is caused by a lack of awareness of this entity and the specific studies needed to identify the lesion.

Adolescent↗
PubMed1986

Knee, ankle, and foot problems in the preadolescent and adolescent athlete.

Children are the nearest thing in the human race to tadpoles in that they have tremendous powers of healing and regeneration. It should be remembered that they are subject to overstress injuries, more so than middle-aged adults. Precautions should be taken and the proper radiographs made when any swelling or tenderness occurs about a joint because of the tendency of children to develop injuries involving the growing centers of bone.

Achilles Tendon↗
PubMed1984

Lipid composition of the tissues of human knee joints. II. Synovial fluid in trauma.

Synovial fluid was aspirated from the knees of 125 patients and lipid profiles were determined. The patients had knee injuries with or without fracture of bone; these lipid profiles were compared with "controls" (synovial fluid obtained at surgery from patients that did not have a knee injury). Floating lipid droplets were observed in some of the synovial fluid from patients with fractures. These lipid droplets could be separated as a well-defined supernatant layer after a few minutes of centrifugation (100 X g). This layer was found to consist mostly of triglycerides. The synovial fluid from patients with fracture and those with only soft-tissue trauma showed increases in total lipids and triglyceride content but had lower phospholipids when compared with nontraumatized knees. Phosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, sphingomyelin, cholesterol, monoglycerides, diglycerides, triglycerides, and free fatty acids were present in all synovial fluids assayed. The large amount of triglycerides in the synovial fluid in many cases may be a good indicator of marrow leakage. Because the soft tissue surrounding the knee is also rich in triglycerides, a low phospholipid level in some cases may be an even better indicator of marrow leakage.

Fatty Acids, Nonesterified↗
PubMed1983

The cervical spine in juvenile rheumatoid arthritis.

Clinical and roentgenographic follow-up examinations of patients with juvenile rheumatoid arthritis (JRA) suggest that neurologic complications are less likely to develop in these patients than in patients with adult rheumatoid arthritis (RA). A review of the charts of 92 patients treated for JRA during the period from 1970 to 1976 revealed that 29 (31%) had clinical evidence of cervical spine involvement. Follow-up examinations in 15 of these 29 patients revealed that all had limited cervical spine motion, 14 had neck pain and stiffness, and two had torticollis. Roentgenographic evidence of atlantoaxial subluxation was present in five patients and ankylosis of the facet joints in four. Two patients with atlantoaxial subluxation had hypereflexia and clonus, but both long tract signs and subluxation spontaneously resolved in one of these patients. None of these patients had basilar invagination or subaxial instability, which can occur in adult RA.

Adolescent↗
PubMed1982

High-dose methotrexate and adriamycin in osteogenic sarcoma: the children's hospital of Philadelphia study.

From 1975 through 1979, 25 patients with osteosarcoma received therapy with vincristine, high-dose methotrexate, citrovorum factor, and Adriamycin. Five patients had metastases prior to receiving chemotherapy, and 11 of the remaining 20 nonmetastatic patients received preoperative or preirradiation chemotherapy. Chemotherapy caused objective tumor regression in 1 of 5 patients with metastases and 1 of 11 with measurable primaries. All five patients with metastatic disease died 7-16 months from diagnosis. Of the 20 nonmetastatic patients, 4 did not have primary amputations: all died. Of 16 patients with primary amputations, 6 are alive relapse-free 24-86 months from diagnosis, and 10 are dead. The actuarial survival of 36% is not statistically different from that of historical control groups or from that of concurrent control groups treated with surgery alone. However, because most adjuvant chemotherapy studies have involved few patients, 36% survival is not statistically different from the 50-70+% survival reported in previous studies. Our data fail to demonstrate that the adjuvant chemotherapy has improved the survival rate of children with osteosarcoma. We support a randomized, controlled comparison of adjuvant chemotherapy and aggressive surgical resection.

Actuarial Analysis↗
PubMed1982

Reflex sympathetic dystrophy in children.

Six patients with reflex sympathetic dystrophy were investigated during the period between 1973 and 1978. Children do not develop the severe, disabling pain nor the patchy osteoporosis (Sudeck's atrophy) which are considered essential features of reflex sympathetic dystrophy in adults. In contrast to the adult variety, reflex sympathetic dystrophy in children is a self-limiting condition which usually responds well to mild analgesics and physical therapy. Frequently it may be necessary to administer the physical therapy in an intensive, inpatient program, both to break the pain-disability cycle and to remove the patient from a stressful family environment that may have initiated or prolonged the syndrome. The use of steroids (dexamethasone) had no appreciable effect on the clinical course in these children.

Adolescent↗
PubMed1980

How to prescribe for hunters and marksmen.

Hunters and marksmen have some unusual seeing problems and they differ depending upon the type of gun--shotgun, rifle or pistol. A number of suggestions are made concerning prescribing for these individuals, especially presbyopes. Sighting techniques are discussed, including possible solutions to the difficulty created by crossed dominance.

Dominance, Cerebral↗
PubMed1979

Serratus anterior paralysis in the young athlete.

Ten cases of isolated, complete paralysis of the serratus anterior muscle were diagnosed in young athletes during a three-year period. One patient had recurrent partial paralysis of the serratus anterior muscle, the first such case reported. From studies on cadavera and clinical observations, we concluded that paralysis of the serratus anterior muscle results from a traction injury to the long thoracic nerve of Bell. Since full recovery usually occurs in an average of nine months, surgical methods of treatment should be reserved for patients in whom function fails to return after a two-year period. Non-strenuous use of the involved extremity with avoidance of the precipitating activity, followed by exercises designed to maintain the range of motion of the shoulder and to increase the strength of associated muscles, is advocated for treatment of acute or repetitive injuries to the long thoracic nerve of Bell.

Adult↗
PubMed1979

Lipid composition of the tissues of human knee joints. I. Observations in normal joints (articular cartilage, meniscus, ligaments, synovial fluid, synovium, intra-articular fat pad and bone marrow).

The composition and lipid profiles of the following tissues of the human knee joint were determined: articular cartilage, meniscus, ligaments, synovial fluid, synovium, intra-articular fat pad and bone marrow. The tissues were obtained from fresh cadavers and from surgical specimens. The lipid profiles of articular cartilage, meniscus and ligaments were similar to reported analyses of other tissues that are also rich in collagen. The lipid profiles for the remaining tissues were more like the profiles found in the fat depots and fatty tissues of the human body. Both the phospholipid and fatty acid patterns of these tissues were similar within statistical deviation. These results suggest that the per cent compositions of fatty acids and the phospholipid family profile ratios have limited range variability in the "normal" tissues of the human knee. On the other hand, the per cent neutral lipid compositions and their individual profiles showed great variations among the different tissue tissues of the knee.

Adipose Tissue↗
PubMed1978

Neutral fat globules in traumatized knees.

Synovial fluid was analyzed for neutral fat globules using a modified Gurd test in 146 patients with various knee disorders. The presence of liquid neutral fat without an intra-articular fracture is an ominous sign of a significant soft tissue injury. Mechanically damaged knees contain neutral fat globules that are not found in normal or osteoarthritic knees. While liquid neutral fat may suggest a surgically amendable ligamentous and/or meniscal injury, 10% of the injured knees containing fat had an intra-articular fracture.

Humans↗