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Biomedical subjects

M F Gargan

Publications and source records attributed to M F Gargan.

At least 19 recordsLinked to original sources
PubMed2006

Orthopaedic manifestations and management of spondyloepimetaphyseal dysplasia Strudwick type.

Spondyloepimetaphyseal dysplasia (SEMD) Strudwick type is a rare autosomal dominant condition arising from defects in COL2A1 the genes responsible for the biosynthesis of procollagen type II. The orthopaedic manifestations of patients can be hypoplastic odontoid peg with atlantoaxial instability, severe kyphosis or lordosis of dorsal and lumbar spines, hip subluxation, coxa vara and early severe hip osteoarthritis, and malalignment of lower limbs like genu valgum or club foot. We report a mother and daughter with SEMD Strudwick Type and describe their orthopaedic problems, surgical management and clinical outcome after 30 years and 7 years of follow-up respectively.

Adult↗
PubMed2006

Total hip arthroplasty and hemiarthroplasty in mobile, independent patients with a displaced intracapsular fracture of the femoral neck. A randomized, controlled trial.

BACKGROUND: Hemiarthroplasty and total hip arthroplasty are commonly used to treat displaced intracapsular fractures of the femoral neck, but each has disadvantages and the optimal treatment of these fractures remains controversial. METHODS: In the present prospectively randomized study, eighty-one patients who had been mobile and lived independently before they had sustained a displaced fracture of the femoral neck were randomized to receive either a total hip arthroplasty or a hemiarthroplasty. The mean age of the patients was seventy-five years. Outcome was assessed with use of the Oxford hip score, and final radiographs were assessed. RESULTS: After a mean duration of follow-up of three years, the mean walking distance was 1.17 mi (1.9 km) for the hemiarthroplasty group and 2.23 mi (3.6 km) for the total hip arthroplasty group, and the mean Oxford hip score was 22.3 for the hemiarthroplasty group and 18.8 for the total hip arthroplasty group. Patients in the total hip arthroplasty group walked farther (p=0.039) and had a lower (better) Oxford hip score (p=0.033) than those in the hemiarthroplasty group. Twenty of thirty-two living patients in the hemiarthroplasty group had radiographic evidence of acetabular erosion at the time of the final follow-up. None of the hips in the hemiarthroplasty group dislocated, whereas three hips in the total hip arthroplasty group dislocated. In the hemiarthroplasty group, two hips were revised to total hip arthroplasty and three additional hips had acetabular erosion severe enough to indicate revision. In the total hip arthroplasty group, one hip was revised because of subsidence of the femoral component. CONCLUSIONS: Total hip arthroplasty conferred superior short-term clinical results and fewer complications when compared with hemiarthroplasty in this prospectively randomized study of mobile, independent patients who had sustained a displaced fracture of the femoral neck.

Aged↗
PubMed2005

Factors predicting outcome after whiplash injury in subjects pursuing litigation.

Records of 277 patients presenting for medicolegal reporting following isolated whiplash injury were studied retrospectively. A range of pre-accident, accident and response variables were recorded. Multivariate analysis was used to determine the main factors that predict physical and psychological outcome after whiplash injury. The factors that showed significant association with poor outcome on both physical and psychological outcome scales were pre-injury back pain, high frequency of General Practitioner attendance, evidence of pre-injury depression or anxiety symptoms, front position in the vehicle and pain radiating away from the neck after injury. The strongest associations were with factors that are present before impact. In this selected cohort of patients, there is a physical and a psychological vulnerability that may explain the widely varied response to low violence indirect neck injury.

Accidents, Traffic↗
PubMed2005

The fluctuation in recovery following whiplash injury 7.5-year prospective review.

Forty-two patients with a whiplash injury were assessed at the time of injury, after 3 months, 2 years and a mean of 7.5 years. The range of neck movement, pain, its effect on lifestyle, and psychometric testing were determined in each of the patients. Between 2 and 7.5 years, 5 (12%) described improved symptoms, 12 (29%) complained of continuing pain and 14 (33%) reported increased severity of symptoms since the accident. Neck pain was the commonest complaint in 23 (55%) and low back pain in 18 (43%). Radiation of pain was more common in the severely symptomatic patients. There was no significant difference in either the ages or sex of the patients between the symptomatic and asymptomatic groups. Anxiety and depression correlated well with symptom severity. None of the asymptomatic patients revealed any degree of psychological disturbance compared with 30 (77%) in the symptomatic groups. Symptoms largely stabilised within 3 months but there was significant fluctuation in symptom severity between 3 months and 2 years. This suggests that outcome cannot be accurately assessed during this time. In order to effectively manage those most severely affected by whiplash, patients should be identified within the first 12 weeks following injury if the outcome of their injury is to be modified.

Anxiety↗
PubMed2001

Bilateral hip surgery in severe cerebral palsy a preliminary review.

When cerebral palsy involves the entire body pelvic asymmetry indicates that both hips are 'at risk'. We carried out a six-year retrospective clinical, radiological and functional study of 30 children (60 hips) with severe cerebral palsy involving the entire body to evaluate whether bilateral simultaneous combined soft-tissue and bony surgery of the hip could affect the range of movement, achieve hip symmetry as judged by the windsweep index, improve the radiological indices of hip containment, relieve pain, and improve handling and function. The early results at a median follow-up of three years showed improvements in abduction and adduction of the hips in flexion, fixed flexion contracture, radiological containment of the hip using both Reimer's migration percentage and the centre-edge angle of Wiberg, and in relief of pain. Ease of patient handling improved and the satisfaction of the carer with the results was high. There was no difference in outcome between the dystonic and hypertonic groups.

Adolescent↗
PubMed1999

Arthrodesis of the distal tibiofibular joint for a large osteochondroma in an adult.

A case of a large osteochondroma of the distal tibia with distortion of the distal tibiofibular joint is presented. This could not be managed by traditional means, as excision would have resulted in ankle and tibiofibular joint instability. The problem was overcome by performing an arthrodesis. Only enough bone from both the tibia and the fibula was excised to provide a host bed for bone graft. We believe that symptomatic osteochondromata should usually be excised. However, if this would result in damage, then the method described offers an alternative management strategy.

Adult↗
PubMed1996

Headrest position during normal driving: implication to neck injury risk in rear crashes.

The gap and relative height of headrest behind drivers were determined for 1915 vehicles approaching an intersection on a two lane road. Vehicle type and headrest adjustment were also evaluated using film of normal driving taken by the Insurance Institute for Highway Safety. Only 10% of drivers had headrests in the most favorable position to prevent neck extension during a rearend crash. 73% of cars had adjustable headrests, but only a quarter were placed in the up position. 83% of the adjustable headrests could have been raised to better protect the driver. Hyge sled tests were run to determine biomechanical responses for the various conditions observed in normal driving. This included three headrest heights and three gaps behind the head. Neck extension from the Hybrid III dummy was normalized to the response for a high, close headrest, and injury risk was assumed to be proportional to neck extension. The current driving situation has a relative injury risk of 3.4 in rearend crashes, compared to 1.0 for the favorable condition. If all adjustable headrests were placed in the up position, the relative risk would be lowered to 2.4, a 28.3% reduction in whiplash injury risk. Public education and vehicle design should address the importance of proper headrest placement for driving safety.

Accidents, Traffic↗
PubMed1996

Chiropractic treatment of chronic 'whiplash' injuries.

Forty-three per cent of patients will suffer long-term symptoms following 'whiplash' injury, for which no conventional treatment has proven to be effective. A retrospective study was undertaken to determine the effects of chiropractic in a group of 28 patients who had been referred with chronic 'whiplash' syndrome. The severity of patients' symptoms was assessed before and after treatment using the Gargan and Bannister (1990) classification. Twenty-six (93 per cent) patients improved following chiropractic treatment (U = 34, P < 0.001). The encouraging results from this retrospective study merit the instigation of a prospective randomized controlled trial to compare conventional with chiropractic treatment in chronic 'whiplash' injury.

Adult↗
PubMed1996

Soft-tissue injuries of the cervical spine. 15-year follow-up.

Forty patients with a whiplash injury who had been reviewed previously 2 and 10 years after injury were assessed again after a mean of 15.5 years by physical examination, pain and psychometric testing. Twenty-eight (70%) continued to complain of symptoms referable to the original accident. Neck pain was the commonest, but low-back pain was present in half. Women and older patients had a worse outcome. Radiating pain was more common in those with severe symptoms. Evidence of psychological disturbance was seen in 52% of patients with symptoms. Between 10 and 15 years after the accident 18% of the patients had improved whereas 28% had deteriorated.

Adult↗
PubMed1995

How to minimize failures of fixation of unstable intertrochanteric fractures.

Sliding hip screws have improved the treatment of unstable intertrochanteric hip fractures and their success, compared with fixed devices, is in large part due to the sharing of load between the implant and the fracture fragments. In a prospective study of 100 patients with such fractures, five factors concerned with the fracture and its fixation were studied and odds ratios calculated of their relative importance in prediction of failure. The most important factor affecting the load borne by the fracture fragments was the amount of slide available within the device, and that affecting the load carried by the device was the position of the screw in the femoral head. For fractures fixed with a device allowing less than 10 mm of slide, and those with superior screw position, the risk of failure was increased by factors of 3.2 and 5.9, respectively. Anatomical reduction alone, rather than osteotomy, together with sliding hip screw fixation, has been recommended for these fractures in three prospective randomized trials. It is calculated here that to allow sufficient slide when employing this technique, it is essential to use a short barrel device when using dynamic screws of 85 mm or less. This has not been demonstrated before.

Aged↗
PubMed1994

The rate of recovery following whiplash injury.

Fifty consecutive patients with soft-tissue neck injuries following rear end collisions were studied prospectively to assess their rate of recovery. Patients were seen within 5 days of the accident, after 3 months, 1 year and 2 years, and their symptoms were classified into one of four groups (A, asymptomatic; B, nuisance; C, intrusive; D, disabling). Fourteen of 15 patients (93%) who were asymptomatic after 3 months remained symptom-free after 2 years. Of 35 patients with symptoms after 3 months, 30 (86%) remained symptomatic after 2 years. After 1 year, 26 (52%) stated that they had recovered completely, but after 2 years this had fallen to 19 (38%). Nine of the 15 patients who had improved between 3 months and 1 year deteriorated to their previous status, or worse, between 1 and 2 years. In asymptomatic cases, a prognosis that is 93% accurate after 2 years can be given after 3 months, and 86% of patients who are symptomatic after 3 months will remain so after 2 years. However, the severity of their symptoms will change during this period and will be at the same degree of severity in less than 50%.

Adolescent↗
PubMed1994

How effective are osteotomies for unstable intertrochanteric fractures?

Osteotomy has been used in the treatment of unstable intertrochanteric hip fractures in an attempt to increase the stability of the fracture fragments. We have assessed this stability in a randomised prospective trial on 100 consecutive patients, all having fixation by an AO dynamic hip screw, comparing anatomical reduction with two types of osteotomy. The groups were similar in terms of age, gender, mental test score, and fracture configuration. There were more failures of fixation in the osteotomy groups, and the operations took longer. We found no clear benefit from osteotomy and therefore recommend anatomical reduction and fixation by a sliding hip screw in most cases. Rarely, a fracture configuration which does not allow load-sharing between the fracture fragments and the device may benefit from an osteotomy or the use of an alternative implant.

Aged↗
PubMed1993

Whiplash injury and surgically treated cervical disc disease.

The incidence of a previous whiplash injury in 215 unselected patients who underwent an anterior cervical discectomy and fusion between 1988 and 1991 was found to be twice that of a control population of 800 general orthopaedic outpatients (P < 0.05). The mean age at which the whiplash injury occurred in the surgical group was 37 years and in the control group 36 years. The mean age at operation of those patients with a previous whiplash injury (45 +/- 12 years) was significantly less than those patients without a previous whiplash injury (55 +/- 14 years, P < 0.001). This study provides further evidence that whiplash injury causes structural changes predisposing to premature degenerative disc disease.

Adult↗
PubMed1991

Prognostic factors in soft tissue injuries of the cervical spine.

A series of 35 patients presenting with soft tissue injuries of the cervical spine were reviewed clinically and radiographically after an average of 10.8 years. Symptoms persisted in 86 per cent and were intrusive or worse in 23 per cent. On presentation, paraesthesia, thoracolumbar back pain and multiple symptoms were predictive of continuing symptoms and their severity. Degenerative changes of the cervical spine were present in 68 per cent of the patients, of whom 87 per cent were symptomatic. Of those with normal radiographs, 80 per cent were symptom-free. Degenerative changes occurred significantly more frequently in patients who had sustained soft tissue injuries than in a control population.

Adult↗
PubMed1990

Long-term prognosis of soft-tissue injuries of the neck.

We reviewed 43 patients who had sustained soft-tissue injuries of the neck after a mean 10.8 years. Of these, only 12% had recovered completely. Residual symptoms were intrusive in 28% and severe in 12%. Pain in the neck and lower back was the commonest complaint and older patients had a worse prognosis. After two years, symptoms did not alter with further passage of time.

Adult↗
PubMed1983

Ketamine and the guinea-pig ileum: possible opiate agonist and antagonist actions and effects of peptidase inhibition.

The effects of ketamine and its interaction with naloxone were studied on the transmurally stimulated guinea-pig ileum preparation. Ketamine (at concentrations between 10(-4) and 10(-3) M) depressed the contractions of the ileum, showing a very steep log concentration-effect curve. Naloxone partially reversed the depressant effect of ketamine at slightly higher concentrations (between 10 nM and 1 microM) than those normally required to reverse opiate depression in this tissue. Naloxone did not affect pentobarbitone-induced depression, suggesting that ketamine has specific actions on opiate transmission. Phentolamine and propranolol did not affect the ketamine-induced depression, whereas acetylcholinesterase inhibition did not alter the action of naloxone on this depression. Ketamine showed some reversal effect on the depressant action of morphine and caused contractions of the morphine-tolerant ileum, suggesting that it may have opiate antagonist activity. Inhibition of peptidase enzymes by a mixture of dipeptides potentiated the depression after high-frequency stimulation of the ileum, but did not affect the action of ketamine. The results suggest that ketamine may interact with opiate mechanisms in the ileum to produce part of its depressant action and may also have some opiate antagonist activity.

Acetylcholine↗