Biomedical subjects
Publications and source records attributed to K A Murray.
Management of arteriovenous malformations confined to the hand is diverse and ranges from conservative measures to amputation. This paper is a retrospective review of 13 patients with arteriovenous malformations of the hand who were managed using an algorithm of treatment which considered the clinical presentation and the anatomical structure of the lesion.
Developmental dysplasia of the hip (DDH) is a spectrum of abnormalities that can range from a very mild disturbance to a very severe process that is incapacitating later in life. This article considers the causative factors and natural history of DDH, as well as anatomic abnormalities, physical examination findings, and both surgical and nonsurgical treatment options. The goal of this article is to place in perspective the use of advanced imaging techniques in the diagnosis and follow-up of patients with DDH. Ultrasound, computed tomography (CT), and magnetic resonance (MR) findings are reviewed with respect to the diagnosis of DDH, treatment complications, and long-term problems that may occur in treated and untreated patients.
Six experiments were undertaken to explore factors affecting young rats' (Rattus norvegicus) frequencies of stealing food from conspecifics when identical food is available in surplus. It was found that (a) rats would walk across a bed of pellets to steal the particular pellet a peer was eating, (b) frequency of stealing within a pair did not decrease over days, (c) rats stole unfamiliar foods more frequently than familiar foods, (d) younger rats stole from older rats more frequently than older rats stole from younger ones, (e) hungry rats stole more frequently than replete rats, and (f) rats that had stolen a pellet of unfamiliar food from an anesthetized conspecific subsequently exhibited an enhanced preference for that food. Results suggest that food stealing is a mode of active seeking of information about what foods to eat.
To standardize the assessment of the hygienic quality of beef carcasses in Northern Ireland (NI) abattoirs, swabbing techniques were evaluated. Six materials, including two commercially produced swabs, were compared for their ability to recover spoilage and pathogenic bacteria and for their ease of use as carcass swabs. A sponge retailed for domestic use was selected on the basis of efficiency of recovery of microorganisms, ease of use, and cost. On sample carcasses, 1,000 cm2 of the brisket was swabbed, since this site is normally readily contaminated. For 9 months, 420 carcasses in seven of the nine European Union-approved abattoirs in NI were sampled while in the chiller (24 to 48 h after kill). Total viable count (TVC), yeasts and molds, and Enterobacteriaceae were enumerated after incubation at 22 (48 h) and 37 degrees C (48 h), and the results were expressed as log CFU/cm2. The mean TVC results at 22 and 37 degrees C were 2.80+/-0.70 and 2.75+/-0.64, respectively. Although 63% of samples had yeasts that grew at 22 degrees C, only 35% were positive at 37 degrees C. The respective mean yeast counts were 1.12+/-0.59 and 0.46+/-0.51. Enterobacteriaceae were present in 15% of samples at 22 degrees C and 21% of samples at 37 degrees C. The mean counts for positive samples were 0.41+/-0.37 and 0.40+/-0.30, respectively. Molds were found in less than 4% of samples. Given that the brisket is normally one of the most heavily contaminated parts of the carcass, these results suggest that good hygienic practices are in operation in NI abattoirs. The results also enabled the abattoirs with the cleanest carcasses to be identified, hence permitting best practices to be found.
In this investigation, surface electromyographic (EMG) recordings were used to make qualitative and quantitative analyses of labial muscle activity during three swallowing tasks, incorporating the use of various drinking implements. EMG was recorded from four quadrants of the perioral region and from the submental muscle complex in 11 normal adult females. Swallowing tasks included liquid extraction from a spoon, a straw, and a cup and posterior bolus propulsion of a 5 ml, thin liquid. Average EMG values obtained during a maximal lip compression task were used to normalize labial muscle responses for each subject thus allowing between-subject comparisons. Variable activity patterns were noted in the perioral muscles once the lips were contacted by a drinking implement. Subjects used a greater percentage of maximal labial muscle activity to remove liquid from an implement than to swallow the liquid. A greater level of EMG was recorded in the lips during straw usage as compared with spoon or cup usage. Significant intrasubject and intersubject variability in labial function occurred during liquid removal using a drinking implement and during the oral swallow in these normal subjects.
Swallowing and respiration are well-coordinated and interdependent functions. When one of these processes is impaired, the ramifications may be negative for the other. This article describes the mechanics of normal swallowing, the disorders of swallowing, the effects of tracheotomy and mechanical ventilation on swallowing, and the procedures used to assess and treat swallowing. Combining a basic understanding of these concepts with practical management can increase safe and efficient oral intake in patients with artificial airways.
OBJECTIVE: To evaluate the influence of stereotactic core needle biopsy (SCNB) as an alternative to wire localization biopsy (WLB) on the evaluation and workup of nonpalpable mammographic lesions. DESIGN: A 4-year retrospective clinical review. SETTING: University hospital and clinics. PATIENTS: All patients evaluated for nonpalpable mammographic lesions after screening, diagnostic mammography, or both during the 4-year period of the study were included. OUTCOME PARAMETERS: Changes in the number and types of mammograms and diagnostic biopsies and the histologic findings using each technique (SCNB vs WLB), including total number of cancers diagnosed. RESULTS: The number of screening mammograms and WLBs performed remained constant compared with a marked increase in the number of diagnostic mammograms and SCNBs. The rates of positive findings for each biopsy technique were consistent while the total number of cancers diagnosed increased dramatically. The percentage of biopsy specimens with positive results (ductal carcinoma in situ and invasive cancers) for SCNB was 13.3% compared with 26.2% for WLB specimens. There has also been an increase in the number of cancers found, from 22 in the first year to 54 in the fourth year. In the first year, 45% of these cancers were diagnosed by SCNB; in the fourth year, 83% of the cancers were diagnosed by SCNB. CONCLUSION: Stereotactic core needle biopsy has replaced WLB as the standard for the diagnostic biopsy of suspicious, nonpalpable mammographic lesions. Since adopting this technique, more patients have been examined and their conditions diagnosed as breast cancer in an efficient, cost-effective manner.
In summary, we believe that the CR system adds significantly to our department. The film quality is superb, and the learning curve for radiologists to adapt to the added noise from anatomic structures on chest radiographs is short. The inherent film latitude and flexibility add a new dimension to interpretation and film management. System costs are significantly greater than for traditional film-screen systems. Recurring operational costs are yet to be determined but certainly will be greater with the shorter expected life span of the imaging plates. Film cost savings cannot be a justifiable reason for using a CR system. Film cost savings must await the ultimate conversion to soft imaging through networks and workstations. Technical issues are significant and require structured and specific courses of study and workshops for users before implementation of the CR system. As CR owners, we were frustrated by the lack of published protocols and guides for the CR user. Most of our experiences were learned in practice, and we believed published guides would be useful for both existing users and future buyers. Careful attention to accuracy, histogram selection, positioning, collimation, and patient data input is critical to the success of CR. The persistent lack of a CR information system interface has led to occasional labeling errors and requires added vigilance on the part of both the technologist and the radiologist. Other important user problems we experienced with CR included the RVS. When images are reprinted from the RVS, they can be printed on 10 x 14 inch (26 x 36 cm) film only. Images that were acquired on the larger cassettes are printed on this smaller film, minified by one third from the original size. Minified images are unacceptable to our orthopedic colleagues. Networking problems have still not been resolved, and this resolution remains an important goal. The manipulation and transfer of images without loss of data were major reasons for our switch to electronic imaging and have still not been achieved. Unique image artifacts were encountered, as were new parameters to judge the quality of an image. The final issue is radiation dose. To assign dose reduction as an attribute of CR would be misleading. We have found that in many instances the reverse is true. Many examinations have required more radiation exposure than traditional film-screen techniques. At the least, to harvest the benefits of CR one must significantly alter technical exposure factors and understand how the system operates. The problems we encountered were not minor. Our technologists and radiologists and the Fuji personnel have put in many hours to implement and optimize our system. The image quality is superb, and we continue to work on the important networking and archival goals.
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RATIONALE AND OBJECTIVES: We determined whether a limited number of high-resolution computed tomography (HRCT) scans will effectively screen for interstitial lung disease (ILD) in a population of individuals exposed to asbestos. METHODS: We retrospectively reviewed the computed tomography studies of 49 patients exposed to asbestos. HRCT in the supine and prone positions had been performed at specifically preselected levels. Two teams of thoracic radiologists evaluated, on separate occasions: (1) all images, (2) prone images only, and (3) a single prone image through the lung bases for the presence of diffuse ILD. RESULTS: A relatively high level of accuracy was obtained with a single prone scan. However, improvement to 95% or better was found when additional prone images were used. CONCLUSION: A screening study for ILD, in this case patients exposed to asbestos, may be performed by preselected prone HRCT images only. The ease and decreased time of performing the procedure make screening relatively large patient groups for ILD more feasible.
Proximal interphalangeal joint injuries can severely affect hand function. Early, active motion is important in ensuring a good range of motion and a functional outcome. Active traction splinting is a dynamic splinting system that can be performed with either open or closed reduction of phalangeal joint fractures, especially at the proximal interphalangeal level. This system allows for continued traction on the involved joint and thereby aids in providing a dynamic force that will unload the joint throughout its arc of motion and noticeably decrease pain. Early, active therapy and the continual in-line traction enables the patient to achieve an almost full range of motion early in the course of rehabilitation. This combination contributes significantly to improve patient understanding and compliance. The benefits of the active traction system are reduction of fragments, marked decrease in pain, and early range of motion with improved patient compliance. Early, active motion facilitates improved joint nutrition, contouring, and healing. Active traction splinting for proximal interphalangeal joint injuries is a relatively simple and effective method for treating these complex injuries.
This study was conducted to determine how testing of nerve repair using nerve isolation techniques compares with standard testing. Nerve isolation consisted of double-gloving, leaving the study finger free, and administering local anesthetic blocks to all other sensory contributions in the exposed digit. Ten patients with 13 single digital nerve repairs of equally severe injuries were studied at a mean of 41 months postoperatively. Standardized tests yielded an excellent result in 77% for static two-point discrimination (S2pd), 85% for moving two-point discrimination (M2pd), and 46.2% for Semmes-Weinstein monofilaments (SWMF). The same studies combined with nerve isolation yielded an excellent result in only 43% for S2pd, 43% for M2pd, and 0% for SWMF. These results indicate a statistically significant difference and the importance of crossover innervation from intact nerves in the long-term result of digital nerve repair. Nerve isolation study techniques are an important adjunct in assessing the outcome of nerve repair and are the only method of evaluating the true end result of nerve regeneration following neurorrhaphy.
OBJECTIVE: We examined the accuracy and cost-effectiveness of large-core needle breast biopsy in a selected group of patients with mammographically detected lesions. MATERIALS AND METHODS: We selectively used large-core needle biopsy to sample breast lesions that were intermediate (neither clearly benign nor clearly malignant) and wire localization biopsy to sample breast lesions that were strongly suggestive of cancer. We compared 2 years' experience using this protocol with the preceding 2 years at the University of Utah Health Sciences Center during which we did only a few large-core needle biopsies on a nonselective basis. RESULTS: Our biopsy rate increased from one biopsy per 36 mammographic screening examinations to one per 26 (p = .001) when the protocol was used. The cost of biopsy per cancer detected decreased from $11,555 to $8356. The specificity of large-core needle biopsy was 98%; the sensitivity based on limited follow-up was 100%. CONCLUSION: Large-core needle biopsy is an accurate and cost-effective method for sampling breast lesions when used in a selective fashion.
The purpose of this study was to measure the relationship between severity of injury and sensibility outcome. This was done by a retrospective study of 37 digital nerve repairs in 26 patients, with a mean follow-up of 35 months. All patients underwent complete hand examination and standard nerve testing, including static and moving two-point discrimination, Semmes-Weinstein monofilaments (SWMF), object recognition, and the pick-up test. A hand injury severity scoring system based on wound characteristics, mechanism of injury, and number of structures involved was then developed. Severity grading led to three classes, and each study group was well matched. Subjectively, all patients considered their outcome as either good or excellent. Objective results are reviewed individually for each test, with the overall combined result of static and moving two-point discrimination being excellent (Highet S4) in 81% for class I, 41% for class II, and 31% for class III, all different at a statistically significant level. We concluded that the severity of injury in the hand can be graded and does have a relationship to the functional end result of digital nerve repair.
A rare case of isolated complex dorsal dislocation of the MP joint of the ring finger is described. Differences in the pathological findings between dislocations of the ring finger and other digits are discussed.
BACKGROUND: Associated injuries and central nervous system (CNS) trauma are historically associated with poor outcome in patients with pulmonary contusions, but the value of specific factors reflecting shock, fluid resuscitation requirement and pulmonary parenchymal injury in predicting mortality in this population is not well established. METHODS: The medical records of 100 consecutive patients with pulmonary contusion, admitted over a 5-year period, were retrospectively reviewed. Survivors and nonsurvivors were compared in terms of age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), PaO2/FiO2 (oxygenation ratio), the severity and adequacy of shock resuscitation reflected in plasma lactate, resuscitation volume and transfusion requirements, using one-way ANOVA. To determine the contribution of individual, interdependent variables to mortality, the data were then analyzed using multivariable analysis. RESULTS: ISS and transfusion requirement were significantly higher, and GCS and PaO2/FiO2 at 24 and 48 hours after admission were significantly lower in nonsurvivors than in survivors. After multiple regression analysis, the factors most strongly associated with mortality included patient age, oxygenation ratio at 24 hours after admission, and resuscitation volume. CONCLUSIONS: Outcome in patients with pulmonary contusion is dependent upon a number of variables including the severity of pulmonary parenchymal injury as reflected in PaO2/FiO2 ratio.
The lymphoproliferative disorders represent a spectrum of lymphoid abnormalities that can involve the chest. Plasma cell granuloma, pseudolymphoma, posttransplantation lymphoproliferative disorders, lymphoid interstitial pneumonia, and lymphomatoid granulomatosis involve the pulmonary parenchyma, whereas Castleman's disease, infectious mononucleosis, and angioimmunoblastic lymphadenopathy with dysproteinemia involve intrathoracic lymph nodes. Recent immunohistochemical techniques give us a better understanding of the lymphoproliferative disorders. Clinical and radiologic features often allow differentiation of the lymphoproliferative disorders from the more common aggressive lymphomas.
Cremation as a method of body disposition has increased over the last two decades. Mishandling of the remains is bringing the analysis of cremains to the attention of forensic anthropologists. The destruction of skeletal components by heat, and mechanical reduction, make the analysis of cremains difficult. Three years after receiving cremains believed to be that of their mother, a family received a second set of cremains that were also purported to be those of their mother. Questioning whether which, if either, set of remains were the decedent, the family initiated an anthropological analysis of both sets of remains. The investigation focused on both osseous and nonosseous characteristics of each set. Total weight of the material and differences in both the osseous and nonosseous characteristics indicate that the cremains represent two individuals. These differences include the degree of color change due to heat, the amount of bone fragments vs. ash, and the lead and calcium content remaining in the fragments from each set. Differences in the nonosseous components of each set are related to coffin hardware, and medical and dental artifacts.