PubMed Health⌕ Search

Biomedical subjects

M J Blyth

Publications and source records attributed to M J Blyth.

4 recordsLinked to original sources

The changing epidemiology of acute and subacute haematogenous osteomyelitis in children.

We have reviewed the incidence of bacteriologically or radiologically confirmed acute haematogenous osteomyelitis in children under 13 years of age resident in the area of the Greater Glasgow Health Board between 1990 and 1997. In this period there was a fall of 44% in the incidence of both acute and subacute osteomyelitis, mainly involving the acute form (p = 0.005). This mirrors the decline of just over 50% previously reported in the same population between 1970 and 1990. Using multiple regression analysis a decline in incidence of 0.185 cases per 100,000 population per year was calculated for the 28-year period (p < 0.001). Staphylococcus was the most commonly isolated pathogen (70%). Only 20% of patients required surgery and there was a low rate of complications (10%). In general, patients with a subacute presentation followed a benign course and there were no complications or long-term sequelae in this group. Haematogenous osteomyelitis in children in this area is becoming a rare disease with an annual incidence of 2.9 new cases per 100,000 population per year.

Acute Disease↗

Diabetes and trigger finger.

Trigger finger is a stenosing tenovaginitis in which there is a constriction of the annular sheath associated with a nodule in the digital flexor tendon. Clinically this can present as triggering or snapping of the nodule as it passes through the tight constricting tendon sheath. Although many triggering fingers settle spontaneously, and others respond to local anesthetic and steroid injection, others require surgical decompression. The association between diabetes and trigger finger, although not widely known, has been described and forms part of the "diabetic hand syndrome". We studied 100 adult patients in the group that required surgery. Eighteen of the 100 patients were diabetic with six insulin dependent diabetics (IDDM) and 12 non-insulin dependent diabetics (NIDDM). In the current climate of day case surgery this has significant implications both for the management of known diabetics as well as the preoperative detection of those with the condition.

Diabetes Mellitus, Type 1↗

Bier's block: a change of injection site.

Bier's block or intravenous regional anesthesia is a well-proven technique that is useful in the traumatic setting to provide upper limb anesthesia in the manipulation of distal radial fractures. In this situation, the traditional injection site in the dorsum of the hand can present difficulties with subsequent plaster application and with venous access caused by swelling or pain. One hundred patients were randomly allocated into two groups of 50. The first group was injected into the dorsum of the hand and the second into the antecubital fossa, in each case on the injured side. Effectiveness of anesthesia at both the fractures site and the cuff was assessed using a visual analog scale. Results analyzed using Student's t test, showed no difference in anesthesia between the two groups. In addition, there were fewer technical problems associated with venous access and subsequent plaster application in the antecubital fossa group.

Adult↗

Dorsal wedge osteotomy in the treatment of hallux rigidus.

The results of 18 dorsal wedge osteotomies in the treatment of hallux rigidus are presented. Patients were retrospectively interviewed and examined, and an assessment was made in a number of key functional areas. Good or excellent results were obtained in 14 or 18 cases at a mean follow-up time of 4 years with only one patient requiring further surgery. Pain (p = 0.00014), activity levels (p = 0.0019), footwear difficulties (p = 0.0016), and joint range of motion (p = 0.0001) were all significantly improved; tiptoeing was the only activity assessed (p = 0.23) for which the improvement was not significant. These results compare well with other published series. We recommend dorsal wedge osteotomy as a useful alternative in the treatment of hallux rigidus.

Adult↗