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Biomedical subjects

J R Johnson

Publications and source records attributed to J R Johnson.

At least 145 records · Page 8Linked to original sources
PubMed1996

Perioperative complications of anterior procedures on the spine.

We reviewed the operative and hospital records of 447 patients in order to determine the rates of perioperative complications associated with an anterior procedure on the thoracic, thoracolumbar, or lumbar spine. The anterior procedures were performed to treat spinal deformity or for débridement or decompression of the spinal canal. The diagnostic groups that we studied included idiopathic scoliosis in adolescents or young adults (100 patients), scoliosis in mature adults (sixty-three patients), kyphosis (sixty-one patients), neuromuscular scoliosis (sixty patients), fracture (forty-seven patients), a revision procedure (thirty-nine patients), congenital scoliosis (thirty-six patients), tumor (nineteen patients), vertebral osteomyelitis or discitis (eight patients), and miscellaneous (fourteen patients). Complications occurred in 140 (31 per cent) of the 447 patients and were classified as major or minor. Forty-seven patients (11 per cent) had at least one major complication and 109 (24 per cent) had at least one minor complication. Two patients died, both from pulmonary complications after the operation. The most common type of major complication was pulmonary; the most common type of minor complication was genito-urinary. The adolescent or young adult patients who had idiopathic scoliosis had the lowest rate of complications, and the patients who had neuromuscular scoliosis had the highest. An age of more than sixty years at the time of the operation was associated with a higher risk of complications. The duration of the procedures involving a thoracic approach was shorter than that of those involving a thoracolumbar or lumbar approach; however, the rate of complications was not significantly different among the three approaches. Vertebrectomies took longer to perform and were associated with a greater estimated blood loss than discectomies; however, there was no significant difference in the rate of complications between the two types of procedures. The patients who had a fracture or a tumor lost more blood than those from the other diagnostic groups. Blood loss increased as the duration of the operation increased for all procedures. Combined anterior and posterior procedures performed during the same anesthesia session were associated with a higher rate of major complications than were procedures that were staged. A logistical regression analysis showed that the variables that increased the risk of a major complication were an estimated blood loss of more than 520 milliliters and an anterior and posterior procedure performed sequentially under the same anesthesia session. This analysis also demonstrated that the diagnosis of idiopathic scoliosis in adolescents or young adults was associated with a reduced risk of major complications. Compared with other major operations, an anterior procedure on the thoracic, thoracolumbar, or lumbar spine performed for the indications mentioned in this study is relatively safe.

Adolescent↗
PubMed1996

Risk factors associated with negative interactions between family caregivers and elderly care-receivers.

This article reports the findings from a study of factors related to negative interactions between elderly care-receivers, recently discharged from a hospital stay, and their family caregivers. Negative interactions are measured as over conflicts between the caregiver and care-receiver, and reported levels of upset with the caregiver. Respondents were forty-one patients aged fifty-six to ninety years. Feeling like a "thing" more than a "person" was significantly associated with higher levels of conflict, and the availability of a confidante was significantly associated with lower levels of conflict. With respect to upset ratings, more psychological distress and feeling like a "thing" were associated with more upset, and adequate social support, as well as the availability of a confidante were associated with lower upset ratings.

Aged↗
PubMed1996

Thoracolumbar burst fractures treated with combined anterior and posterior surgery.

Between 1985 and 1992, 84 burst fractures were surgically managed with anterior decompression, autologous iliac crest strut graft, and posterior instrumentation and fusion. Fifteen were lost to follow-up, leaving 69 patients for detailed review. Of the 22 patients with complete or partial neurologic injury, 12 patients either totally or partially recovered function following surgery. Of these 12 patients, 6 improved 1 Frankel grade; 5 improved 2 Frankel grades, and 1 improved 3 Frankel grades. Follow-up was 12 to 91 months (average 41 months). For all of the fractures in this series, the mean operative correction in sagittal kyphosis was 14 degrees, but this decreased to 7 degrees at final review. No patient had significant scoliosis, and 66 patients achieved solid arthrodesis with 3 pseudoarthroses (4%). Mean operative time for 2-in-1 procedures was 5 hours 42 minutes, with an estimated blood loss of 1,455 mL. Of 62 patients available for follow-up telephone interview, 42 (68%) had minimal or no pain; 11, mild pain; 8, moderate pain; and 1, severe pain. Function in daily activities was assessed as normal or minimally impaired in 43 of 51 patients (84%) with normal neurologic function by physical examination. We conclude that anterior decompression, strut autografting, and posterior instrumented autogenous fusion, either as a combined or staged procedure, is a safe surgical option for thoracolumbar burst fractures.

Activities of Daily Living↗
PubMed1995

Can tetraplex recombination models explain observations in induced mitotic gene conversion?

Induced mitotic gene conversion studies on the CYC1 gene of yeast have shown that the actual base pair changes, the types of changes (base substitution, deletion or addition) and the distances between mutations all affect gene conversion yields. In crosses between mutations less than four bases apart, gene conversion rates are as low as back mutation rates. The same mutants crossed to alleles more than five bases away may recombine 50-fold more. In crosses between mutations five or more base pairs apart, recombination rates varying by up to ten-fold are observed when comparing mutations at the same codon sites. The actual mutations in crosses affect recombination rates at these distances. The data rules out models in which mutants are repaired independently. Models with large gaps at the initiation site are ruled out if the mutants are within the gap. Recombination models are favoured in which both mutations can interact at a distance to affect the probability of recombination; such interactions may reflect the geometry of the recombinational junctions. The specific interactions proposed are that the actual mutations, and residual mismatches arising on excision resynthesis, affect both the further migration of the recombinational junction, and the probability that excision-repair will detect and correct residual mismatches. Junction models in which interactions are expected include those composed of base tetraplexes. The data is interpreted in terms of these models. Meiotic recombination data is consistent with these models.

Cytochrome c Group↗
PubMed1995

An evaluation of motor-evoked potentials for detection of neurologic injury with correction of an experimental scoliosis.

STUDY DESIGN: Controlled correction of scoliosis in a rat model was used to assess the accuracy of intraoperative motor-evoked potential monitoring. OBJECTIVES: The purpose of this study was to develop a model in which motor-evoked potential changes could be compared with neurologic function after surgery, such that a threshold for responding to motor-evoked potential changes may be established. SUMMARY OF BACKGROUND DATA: Intraoperative motor-evoked potential monitoring has become technically feasible. Clinical application now depends on the development of useful interpretation parameters and correlation with neurologic sequelae. METHODS: Experimental scoliosis was produced in 30 rat pups. After growth, the rats underwent correction of their scoliosis by distraction. Changes in tcMMEP onset latency and amplitude were measured. Distraction was applied either until a 10% delay in tcMMEP onset latency (Group 1), until tcMMEP responses were ablated (Group 2), or for 10 minutes after the loss of transcranial magnetic stimulation response (Group 3). RESULTS: In Group 1 (n = 10), all animals had tcMMEP with normal onset latency and normal neurologic examinations 24 hours after surgery. In Group 2 (n = 10), tcMMEP were normal in four rats, markedly delayed in three rats, and absent in three rats 24 hours after surgery. neurologic examination was normal in the four rats with normal tcMMEP. Moderate deficit was noted in two of the three rats with prolonged onset latency 24 hours after surgery; the third was intact. Moderate neurologic injury was noted in two of three rats with absent tcMMEP 24 hours after surgery; the third rat was paralyzed. In Group 3 (n = 10), vertebral dislocation was noted on lateral radiographs in eight of 10 animals. Twenty-four hours after surgery, tcMMEP remained absent, and paralysis was noted in the eight rats with dislocation. The two rats without dislocation had delayed tcMMEP but some return of neurologic function. CONCLUSIONS: Comparison of the three groups shows a significant correlation between tcMMEP and endpoint neurologic outcome. None of the rats in Group 1 had a neurologic deficit after surgery as opposed to five of 10 rats in Group 2 and 10 of 10 rats in Group 3 with significant neurologic injury. These findings suggest that a 10% delay in onset latency would be an appropriate threshold for responsing to changes in tcMMEP.

Analysis of Variance↗
PubMed1995

A prospective analysis of intraoperative electromyographic monitoring of pedicle screw placement with computed tomographic scan confirmation.

STUDY DESIGN: In a prospective study of 90 patients undergoing lumbar pedicle screw instrumentation, 512 screws were tested intraoperatively using electrical stimulation. The accuracy of this technique was verified after surgery by computed tomography. OBJECTIVES: Computed tomographic scans taken after surgery were used to evaluate the efficacy of intraoperative screw stimulation and electromyographic monitoring of pedicle screw placement. SUMMARY OF BACKGROUND DATA: Previous cadaveric and clinical studies showed the risk of pedicle screw malposition and the inadequate reliability of intraoperative radiographs to identify misplaced screws. METHODS: Screws (total, 512) in 90 patients were stimulated intraoperatively, and stimulation threshold was recorded. Computed tomographic scans were taken after surgery to document pedicle screw position. Electromyographic thresholds and computed tomographic data were evaluated independently and compared to assess the accuracy of the electromyographic screw stimulation technique. RESULTS: Intraoperative screw stimulation was extremely accurate in confirming the adequacy of screw position. A stimulation threshold greater than 15 mA provided a 98% confidence that the screw was within the pedicle. In eight of 90 patients (9%), electromyographic monitoring detected a screw malposition that was not identified on lateral radiograph. CONCLUSIONS: Screw stimulation monitoring is a valuable and efficacious adjunct to lumbar pedicle screw instrumentation. A stimulation threshold greater than 15 mA reliably indicates adequate screw position. A stimulation threshold between 10 and 15 mA was generally associated with adequate screw position, although exploration of the pedicle is recommended. A stimulation threshold less than 10 mA was associated with a significant cortical perforation in most instances.

Bone Screws↗
PubMed1995

Fraternal sisters with adult polycystic kidney disease and adenoma of the ampulla of Vater.

The cases of two fraternal sisters with symptomatic biliary obstruction due to adenomas of the ampulla of Vater are reported. Both sisters had autosomal dominant adult polycystic kidney disease. There are no previous reports of a familial occurrence of ampullary adenomas in the absence of familial adenomatous polyposis, nor has an association between autosomal dominant polycystic kidney disease and ampullary adenoma been described. The coexistence of both disorders in these sisters raises the possibility of a genetic link between autosomal dominant polycystic kidney disease and ampullary adenoma.

Adenoma↗
PubMed1995

Evaluation of the seal of various amalgam products used as root-end fillings.

Different formulations of amalgam have physical properties that may make them behave differently in the often-contaminated root end environment. Five different brands of amalgam were evaluated for microleakage of root-end fillings placed in extracted human teeth. These included a zinc-free spherical amalgam, a zinc-free admixture amalgam, two zinc-containing admixture amalgams, and a zinc-containing lathe-cut amalgam. The amalgams were placed either into dry root-end preparations or into preparations contaminated with human blood. The fluid filtration method was used to measure microleakage at 1, 2, 4, 8, 12, and 24 wk after placement. Analysis of variance revealed significant differences in the rates of microleakage at every measurement period. Scheffé's test showed that the zinc-free spherical amalgam had significantly greater leakage than all the other products evaluated. There were no significant differences between any of the other products. Blood contamination did not adversely affect the seal of any amalgam.

Analysis of Variance↗
PubMed1995

Controlled release of a contraceptive steroid from biodegradable and injectable gel formulations: in vitro evaluation.

PURPOSE: The purpose of this study was to investigate the effects of formulation factors including varying wax concentration, drug loading and drug particle size, on drug release characteristics from both pure oil and gel formulations prepared with a combination of derivatized vegetable oil (Labrafil 1944 CS) and glyceryl palmitostearate (Precirol ATO 5), using levonorgestrel as a model drug. METHODS: The effects of varying drug loadings, different drug particle sizes, and wax (Precirol) concentrations on in-vitro drug release rates were evaluated, and the mechanisms of drug release from the gels were determined. RESULTS: Zero-order drug release rates from the 10% Precirol gel formulations containing 0.25, 0.50 and 2.00% w/v drug loadings were lower than those observed for oil formulations containing identical drug loadings. Higher zero-order release rates were observed from formulations containing smaller drug particles suspended in both oil and gel formulations. The mechanism of drug release from gels containing less than 0.25% w/w drug was diffusion-controlled. Increasing the wax concentrations in the gels from 5% w/w to 20% w/w significantly decreased the diffusivity of the drug through the gel formulations and markedly increased the force required to inject the gels from two different sizes of needles. CONCLUSIONS: This study shows how modification of the physicochemical properties of the gel formulations by changing the drug particle size, wax concentration and drug loading, affects drug release characteristics from the system.

Biodegradation, Environmental↗
PubMed1995

Controlled release of contraceptive steroids from biodegradable and injectable gel formulations: in vivo evaluation.

PURPOSE: The purpose of this study was to investigate in vivo biocompatibility, biodegradability and biological effects of contraceptive steroids, such as levonorgestrel and ethinyl estradiol, released from gels prepared with a combination of derivatized vegetable oil (Labrafil 1944 CS) and glyceryl ester of fatty acids (Precirol ATO 5). METHODS: Biocompatibility, biodegradability, and in vivo effects of levonorgestrel and ethinyl estradiol were studied by histologic evaluation of rat tissue, visual estimate of changes in gel size, and assessment of drug effects on reproductive cyclicity of female rats, respectively, following subcutaneous injection of gel formulations. RESULTS: Histological evaluation of the tissue samples following an injection of the gel revealed an inflammatory reaction for about 7 days, after which the tissues did not show any inflammatory response. Complete degradation of the gels containing 10% wax was observed between 5 and 6 weeks. Normal rat estrous cycles were completely blocked by the contraceptive steroids released from the gels. Gel formulations containing 0.25% w/w levonorgestrel were more effective in blocking the estrous cycle of female rats compared to the oil formulations containing an identical drug loading. The duration of the biological effect induced by levonorgestrel appears to be dose-related. The gel formulation containing 2.00% ethinyl estradiol was superior to oil formulation containing an identical drug loading in terms of controlling drug release and toxicity. CONCLUSIONS: These observations suggest that Labrafil-Precirol gels are biocompatible and biodegradable. Moreover, controlled release of steroids is possible in vivo for a prolonged period of time.

Animals↗
PubMed1995

Nonlethal adherence to human neutrophils mediated by Dr antigen-specific adhesins of Escherichia coli.

Uropathogenic Escherichia coli strains express a variety of adhesins, including members of the Dr adhesin family such as the Dr hemagglutinin, AFAI, and AFAIII. Certain E. coli adhesins (e.g., type 1 and S fimbriae) are known to mediate adherence to human polymorphonuclear leukocytes (PMNs). The receptor on erythrocytes for Dr family adhesins, decay accelerating factor, is also present on PMNs. To determine whether Dr family adhesins mediate adherence to PMNs and to characterize the specificity and consequences of such adherence, we studied agglutination of PMNs and adherence to PMNs by recombinant E. coli strains expressing various mannose-resistant or mannose-sensitive adhesins, in the presence or absence of inhibitors of adherence. Dr family adhesins, like type 1 fimbriae, mediated concentration-dependent adherence to PMNs. Adherence to PMNs was mannose sensitive for type 1 fimbriae but mannose resistant for Dr family adhesins. Chloramphenicol inhibited PMN adherence for the Dr hemagglutinin with the same potency as that with which it inhibited hemagglutination, but it was inactive against PMN adherence and hemagglutination mediated by other members of the Dr adhesin family. In contrast to PMN adherence mediated by type 1 fimbriae, adherence mediated by the Dr hemagglutinin did not lead to significantly increased bacterial killing. These data suggest that Dr family adhesins mediate a novel pattern of adherence to PMNs, probably by recognizing decay accelerating factor, with minimal consequent bacterial killing.

Agglutination↗
PubMed1995

Direct antimicrobial susceptibility testing for acute urinary tract infections in women.

Despite its theoretical advantages, direct antimicrobial susceptibility testing (DST) of urine specimens remains controversial largely because of concerns regarding its accuracy, particularly with mixed cultures. To evaluate the performance of DST in the setting of acute urinary tract infection (UTI), we performed DST using 25 traditional and contemporary antimicrobial agents on urine specimens from 162 women with suspected acute uncomplicated UTI, and compared these results with the results of standardized disk diffusion susceptibility tests done on the same specimens. Direct tests were interpretable for 129 specimens, i.e., 80% of all specimens and 85% of the 152 specimens that met the culture criteria for UTI. Of the 2,983 individual comparisons between the direct and standard tests, 0.8% represented very major errors, 0.6% represented major errors, 3.1% represented minor errors, and 95.5% were in agreement. Errors were more common in association with older antimicrobial agents and agents with a high prevalence of antimicrobial resistance, non-Escherichia coli strains, low urine bacterial concentrations, sparse or mixed growth in the direct test, and the presence of multiple significant organisms in urine. The urine leukocyte concentration was > or = 15/mm3 in all subjects and did not differentiate between specimens that gave an interpretable direct test and those that did not. Calculation of the sensitivity of DST in identifying antimicrobial resistance supplemented conventional error rate analysis. We conclude that when used selectively and interpreted carefully, DST of urine specimens offers an efficient, rapid, and accurate method for antimicrobial susceptibility determination for acute UTI, particularly when the urine bacterial concentration is > 10(5) CFU/ml.

Acute Disease↗
PubMed1995

Transcranial magnetic motor-evoked potentials in scoliosis surgery.

Spinal cord monitoring using SSEPs is an accepted adjunct in the surgical correction of spinal deformities, but does not directly assess motor function. Motor-evoked potentials have been introduced in an effort to meet this important need. In this series of 18 patients, the feasibility of intraoperative monitoring using transcranial magnetic motor-evoked potentials is documented. The potential value of this neurophysiologic monitoring technique, as well as the pitfalls in interpretation, are reviewed.

Adolescent↗
PubMed1995

Relative biological effectiveness of tritium for induction of myeloid leukemia in CBA/H mice.

To help resolve uncertainties as to the most appropriate weighting factor for tritium beta rays, a large experiment was carried out to measure the relative biological effectiveness (RBE) of tritiated water compared to X rays for the induction of myeloid leukemia in male mice of the CBA/H strain. The study was designed to estimate the lifetime incidence of myeloid leukemia in seven groups of about 750 mice each; radiation exposures were approximately 0, 1, 2 and 3 Gy both for tritiated water and for X rays. The lifetime incidence of leukemia in these mice increased from 0.13% in the control group to 6-8% in groups exposed to higher radiation doses. The results were fitted to various equations relating leukemia incidence to radiation dose, using both the raw data and data corrected for cumulative mouse-days at risk. The calculated RBE values for tritium beta rays compared to X rays ranged from 1.0 +/- 0.5 to 1.3 +/- 0.3. A best estimate of the RBE for this experiment was about 1.2 +/- 0.3. A wR value of 1 would thus appear to be more appropriate than a wR of 2 for tritium beta rays.

Animals↗
PubMed1995

Successful xenotransplantation of human lung cancer correlates with the metastatic phenotype.

BACKGROUND: Occult micrometastases could explain deaths from stage I non-small cell lung cancer (NSCLC) after complete resections. If patients who have occult metastases could be identified, systemic therapy might be beneficial. METHODS: Non-small cell lung cancers from 81 patients in stages I, II, and III were transplanted to nude beige mice. Mean follow-up was 22.5 months (2 to 61 months). RESULTS: Twenty-one xenotransplants successfully took, and seven metastasized in the nude mice. Neither the predominant cell type nor the incidence of lymph node metastases correlated with the results of xenotransplantation. Of the 21 patients whose NSCLCs took in xenotransplantation, 13 (61.9%) have had development of metastases, and 9 (42.9%) have died of the cancer. Among the 57 patients whose NSCLCs did not take, 14 (24.6%) have had development of metastases, and 9 (15.8%) have died of their cancer. The higher incidence of metastases in association with xenotransplant take is significant (p = 0.0032). CONCLUSIONS: Patients whose NSCLCs take in xenotransplantation are at high risk for metastases. The xenotransplantation model is a step toward facilitating precise cellular biologic definition of the metastatic propensity of human NSCLC:

Animals↗