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Biomedical subjects

J R Silver

Publications and source records attributed to J R Silver.

At least 19 recordsLinked to original sources
PubMed1992

Paraplegia and traumatic rupture of the aorta: a disease process or surgical complication?

Surgical repair of traumatic rupture of the aorta results in an excellent survival rate especially among the young, although paraplegia continues to be a serious postoperative complication. The authors present nine cases admitted to Stoke Mandeville Hospital, England, including detailed post-mortem findings on one of the cases. Although it was difficult to be certain of the patients' general and neurological status prior to surgery, as it was not well documented in the patients' case notes, it was evident that systemic hypotension and poor distal aortic perfusion were responsible for the disabling complication. A review of the initial medical management of these patients and the surgical techniques employed in repairing such injuries is urgently needed.

Accidents, Traffic↗
PubMed1992

Injuries of the spine sustained during rugby.

A comparison was made between the number of rugby injuries seen between 1956 and 1982 (67) and the number of rugby injuries seen between 1982 and 1987 (20). The standards, the positions, the mechanics of injury and the fitness of the players were analysed. It was concluded that the law changes had resulted in a dramatic fall in the number of players injured, that it was the less fit and less skilled players that were getting injured, and that the laws were adequate but were not being enforced.

Adult↗
PubMed1992

Progressive paralysis after bilateral facet dislocation of the cervical spine.

We report 13 patients with missed bilateral facet dislocation of the lower cervical spine who subsequently developed severe spinal-cord involvement. There were more women and the patients were older than in most groups with spinal injury. The commonest cause was a fall, and paralysis appeared from six to 48 hours after injury in most patients. Ten patients made some recovery after late reduction but three remained totally paralysed. We discuss the pathogenesis of the late cord lesion and the reasons for delay in diagnosis.

Age Factors↗
PubMed1991

Hazards of horse-riding as a popular sport.

The increasing incidence of horse-riding accidents, which are often severe in nature, prompted a pilot study of a questionnaire designed to elucidate the cause of such accidents. It was hoped that, on a larger scale, the information gleaned would highlight possible preventative measures which might improve the safety of an important recreational pursuit enjoyed by young and old from many walks of life. A retrospective study of riders sustaining serious spinal injuries admitted to Stoke Mandeville Hospital was compared with riders sustaining minor but significant injuries as the accidents came to the attention of the authors. The detailed analysis paid particular attention to the setting and to the experience and task of horse and rider. It was found that 70% of the 20 accidents could be thought attributable to the behaviour of the horse at the time, and seven of these were in the spinal injuries group. Rider error was a significant contribution in seven cases, and in two instances the rider was under instruction at the time. There was also inadequate experience of the rider in seven cases, of which five were thought to show inadequate supervision. The limited number of cases studied precludes significant observations, but, as the majority of accidents seemed preventable, a larger study has been initiated in collaboration with the British Horse Society.

Adult↗
PubMed1991

Spinal mediation of thermally induced sweating.

The sweat responses of nine patients with physiologically complete lesions of the spinal cord (six cervical and three thoracic) were recorded by two different techniques while the patients were exposed to elevated environmental temperatures. Oral temperatures, heart rate and respiration were monitored throughout the observational periods. Oral temperature invariably rose during exposure to heat and both heart rate and respiration tended to increase. Sweating was detected on all of the test areas by both the iodine-starch-paper technique and the quinizarin technique, but it was of widely varying intensity in different portions of the body. In the patients with cervical lesions sweating was generally profuse on the head and neck and occurred in progressively decreasing intensity down to the level of the umbilicus. It was invariably present, but only in very low intensity, on the lower extremity. Sweating was frequently present as a result of manipulation of the patient during the initial preparations, but this generally declined or stopped before the heat was turned on. With application of heat, sweating was recruited on previously dry areas or increased in intensity on those areas in which it was previously present. After oral temperature had increased moderately, the heat was turned off and the doors of the chamber opened widely so that the heat stimulus was suddenly removed. Despite a continued rise in oral temperature, sweating stopped or decreased dramatically. These results are interpreted to indicate the direct mediation by the isolated spinal cord of reflex sweating responses to a heat stimulus applied to the skin. The general distribution of sweating was similar to that associated with distension of the urinary bladder, and careful attention was taken to avoid this complication. The distribution of sweating on the patients with lesions in the thoracic cord was quite different, being most obvious and profuse on the lower extremities and lower trunk and completely absent from the upper trunk, head and upper extremities.

Adolescent↗
PubMed1989

Treatment of the clinically negative neck in advanced cancer of the head and neck.

The proper management of the clinically negative neck in primary squamous cell carcinomas of the head and neck remains controversial. Although many clinicians believe that elective neck dissection or neck irradiation are equally effective for controlling subclinical disease, previous studies have not directly addressed this question. The charts of 195 patients with advanced primary squamous carcinoma, yet with clinically negative necks, were reviewed. There were no significant differences in the rates of neck cancer recurrence among the elective neck irradiation, dissection, and combined treatment groups. Elective neck irradiation and neck dissection in patients with clinically negative nodes seemed equivalent in their ability to control neck disease. The decision as to which form of therapy is preferable must therefore be based on other criteria.

Carcinoma, Squamous Cell↗
PubMed1989

Spinal cord injury associated with blunt traumatic rupture of the diaphragm.

The incidence of spinal cord injury associated with blunt traumatic rupture of the diaphragm is extremely low and rarely mentioned in the numerous reports about rupture of the diaphragm. It is thought that more such cases can be found among the fatalities of aircraft accidents and presumably among the fatalities of road traffic accidents as the forces causing such injuries make it unlikely for the casualty to survive. The authors present six cases encountered at Stoke Mandeville Hospital, England, and at Sheba Medical Centre, Israel. Although the mortality of such cases, if the patient survives the original impact, is usually due to associated injuries, early diagnosis is essential as late complications increase the incidence of delayed mortality.

Adolescent↗
PubMed1988

Injuries of the spine sustained during rugby.

In 1984 JR Silver reported on 63 patients who had sustained serious injuries of their cervical spine as a result of games of rugby between the years 1952 and 1982. In this paper his results have been brought up to date. A further 19 players who were treated personally are reported, sustaining their injuries between 1983 and 1987. The mechanism of injury was still blows to the head or the head being driven into the ground. Seven injuries occurred in the scrums all were front row forwards. One was injured when the players charged, two players were inexperienced and the other cases all followed a collapse of the scrum after which the second rows continued to push. Five players were injured while tackling, six players were injured in a ruck and maul situation--in each case they were pushed to the ground while stooping to pick up the ball, other players piled on top of them (one player broke from the scrum and he endeavoured to retrieve a low ball and then fell striking his head). Further research was carried out by circularising all the spinal units in the United Kingdom to obtain the overall figures. It has been found that there has been a reduction in the number of injuries from ten in 1983 to five in 1986/7, presumably from a change in the laws. In order to determine whether a further change in the laws was necessary or whether the existing laws were adequate, research was carried out by video recording several games of rugby and analysing the games later in slow motion and determining how injuries occurred. Most of the injuries in these small number of games occurred in the ruck and maul situation. It was concluded that the majority of such injuries were not due to bad luck but were caused by irresponsible actions. The laws were still being broken and not being enforced. The existing laws were adequate since there has been a reduction in the number of injuries overall, particularly at first class and schoolboy levels, but were not enforced at junior levels-they were the main source of injury.

Athletic Injuries↗
PubMed1987

Hysterical paraplegia.

Between 1944 and 1984 20 patients were admitted to a spinal injuries centre with a diagnosis of traumatic paraplegia. They subsequently walked out and the diagnosis was revised to hysterical paraplegia. A further 23 patients with incomplete traumatic injuries, who also walked from the centre, have been compared with them as controls. The features that enabled a diagnosis of hysterical paraplegia to be arrived at were: They were predominantly paraplegic, There was a high incidence of previous psychiatric illness and employment in the Health Service or allied professions, Many were actively seeking compensation. The physical findings were a disproportionate motor paralysis, non anatomical sensory loss, the presence of downgoing plantar responses, normal tone and reflexes. They made a rapid total recovery. In contrast, the control traumatic cases showed an incomplete recovery and a persistent residual neurological deficit. Investigations apart from plain radiographs of the spinal column were not warranted, and the diagnosis should be possible on clinical grounds alone.

Female↗
PubMed1987

An electromyographic study of the abdominal muscles during postural and respiratory manoeuvres.

A method was developed for making EMG recordings from the four individual muscles of the anterior abdominal wall. It was then demonstrated that these muscles have different and distinguishable actions on trunk movement, but act together in breathing. The level of ventilation at which the abdominal muscles become active in expiration was shown to be posture dependent.

Abdominal Muscles↗
PubMed1986

Injuries of the spine sustained during gymnastic activities.

Between 1954 and 1984, 38 patients were seen as a result of gymnastic activities. Thirty three were men, five were women, and their ages ranged from 12 to 54, the mean age being 20. Thirty one had spinal injuries (28 in the cervical region, three in the thoracolumbar region), two no definite injury, and for five the information was incomplete. The accidents occurred largely because gymnasts landed on their heads, the force being transmitted to the cervical spine. Most took place in gymnasiums and were caused by a failure of supervision.

Accidental Falls↗
PubMed1986

Trampolining injuries of the spine.

Between 1963 and 1978 16 patients were seen as a result of trampolining accidents; 15 had spinal injuries in the lower cervical region, resulting in severe paralysis. Their ages ranged from 10 to 43; 13 were male and the mean age was 21. There were six schoolboys. The factors causing the injuries were analysed. In almost all cases injury was due to failure of supervision and it was not recognized initially that the trampoline is an extremely dangerous piece of equipment that can project people up to 9 m (30 ft) in the air. The accidents occurred as a result of people landing on their heads. The recommendations to make this sport safer are discussed.

Accident Prevention↗
PubMed1986

An electromyographic study of the abdominal muscles of tetraplegic patients.

Bipolar fine wire electrodes were used to make electromyographic (EMG) recordings of the abdominal muscles of 8 stable complete tetraplegic patients. Synchronous recordings were made of ventilation, and in 5 subjects an oesophageal electrode was used to record diaphragm EMG. In all 8 subjects we demonstrated phasic inspiratory EMG activity which we have shown to be localised to the abdominal muscles. We believe that this activity was triggered by stretching of the abdominal wall on inspiration. Its effect will be to decrease abdominal wall compliance allowing the diaphragm to generate greater intra-abdominal pressure as it descends, thus promoting inflation of the lower rib cage.

Abdominal Muscles↗