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Biomedical subjects

M J Broom

Publications and source records attributed to M J Broom.

15 recordsLinked to original sources
PubMed1994

Sciatic tension signs and lumbar disc herniation.

STUDY DESIGN: Sciatic stretch maneuvers designed to elicit signs of nerve root compressions secondary to lumbar disc herniation were evaluated in a prospective manner to correlate intraoperative evaluation of surgical pathology regarding level and anatomic location and proximity of the herniated disc to the nerve root. OBJECTIVES: To study the correlation between specific diagnostic maneuvers of sciatic stretch and anatomic location or level of lumbar disc pathology. SUMMARY OF BACKGROUND DATA: Maneuvers of sciatic tension, such as the straight leg lift, the well leg lift, Lasègue's sign, and the bowstring sign, have been used since the 1880s as a diagnostic maneuver to separate sciatica from hip pain. METHODS: Fifty consecutive candidates with clinical and radiographic evidence of disc herniation were examined. Initial physical examination included evaluation of sciatic tension signs using the straight leg lift, cross leg lift, Lasègue's sign, and the bowstring sign. The presence of lumbar disc herniation was confirmed radiographically. Intraoperatively, the 50 patients were assessed for anatomic location of disc herniation and the presence of disc protrusion or extrusion. RESULTS: The straight leg lift was the most sensitive preoperative physical diagnostic sign for correlating intraoperative pathology of lumbar disc herniation. CONCLUSIONS: Physical diagnostic maneuvers for evaluating sciatic tension in patients with documented lumbar disc herniation have a high correlation with surgical pathology. These diagnostic signs of sciatic stretch can be reliable guides that lead to more aggressive modes of evaluation. No correlation was found between specific sciatic stretch maneuvers regarding location of disc herniation relative to the nerve root.

Adult↗
PubMed1993

Foraminal and extraforaminal lumbar disk herniations.

Thirteen patients with foraminal or extraforaminal lumbar disk herniation were treated during a 32-month period. Myelography and magnetic resonance imaging proved to be ineffective in identifying the lesion in most patients. High-resolution computed tomography demonstrated the lesions in all patients, and the findings were subsequently confirmed at surgery. Surgical treatment consisting of disk fragment removal and nerve root decompression was effective in relieving radicular pain.

Adult↗
PubMed1991

The histomorphologic sequence of dural repair. Observations in the canine model.

This study was undertaken to investigate the histopathologic events of the dural reparative process. Uniform 2-mm dural defects were created in adult beagles, repaired, and then examined in a 6-week period. Primary fibroblastic bridging of the durotomy was not seen until Postoperative Day 6, and it was not until Postoperative Day 10 that ablation of this defect was uniformly seen. Cerebrospinal fluid egress through the dural defects was prevented in the vast majority of cases by the formation of an internal patch composed of proliferative elements of pia and arachnoid mater.

Animals↗
PubMed1990

Quantification of leakage pressures after durotomy repairs in the canine.

This study was undertaken to investigate the relative strengths of dural repair using standard suture techniques, suture supplemented with tissue adhesive, and tissue adhesive alone. Uniform 2 mm dural defects were created in adult beagles, repaired, and then subjected to pressurization testing. Defects repaired with suture alone initially leaked within the range of physiologic pressurization, while those supplemented with tissue adhesive or repaired with tissue adhesive alone failed at higher pressurization levels. Histologic sections obtained from the dura treated with fibrin adhesive sealant demonstrated minimal inflammatory response not significantly different than those sections examined at sites repaired by suture alone. A new substance, fibrin adhesive sealant, appears to be useful in effecting dural repair due to its ability to withstand pressures greater than those obtained with suture alone.

Animals↗
PubMed1990

Adult scoliosis. Current concepts.

Back pain and increasing deformity of the spine can develop in adults with idiopathic scoliosis. It is known that scoliosis can continue to progress after skeletal maturity and cause problems in adults. Conservative treatment is effective in most cases, but occasionally surgery is necessary. Recent advances in spinal instrumentation have resulted in improved results and fewer complications.

Adult↗
PubMed1989

Update-1988. Current status of internal fixation of thoracolumbar fractures.

Rigid internal fixation has become the preferred method of treatment for unstable thoracolumbar fractures in most American spine centers. In most cases, posterior instrumentation alone is adequate, but occasionally an anterior procedure is necessary. A number of internal fixation devices are now available to the orthopaedic surgeon. Controversy exists regarding the number of levels that need to instrumented and the optimal form of internal fixation.

Adult↗
PubMed1989

Spinal fusion augmented by luque-rod segmental instrumentation for neuromuscular scoliosis.

Seventy-four patients who had deformity of the spine secondary to a neuromuscular disorder were treated using posterior fusion with Luque-rod segmental instrumentation. The mean curve was 73 degrees preoperatively and 38 degrees postoperatively. The mean loss of correction was 4 degrees at an average duration of follow-up of forty-two months (range, 2.0 to 7.3 years). Complications included one death, three deep wound infections, two pressure sores, six sets of broken rods, and one instance of distal rotation and migration of the rod. There were no major perioperative neurological complications. Failure of instrumentation occurred more frequently with 3/16-inch (4.8-millimeter) diameter than with 1/4-inch (6.4-millimeter) diameter stainless-steel rods. There was a tendency for cephalad progression of deformity when the fusion ended cephalad at or below the fourth thoracic vertebra. We concluded that Luque-rod segmental instrumentation with posterior spinal fusion is an effective treatment for patients who have neuromuscular scoliosis.

Adolescent↗
PubMed1988

Complications of fractures of the cervical spine in ankylosing spondylitis.

Five patients with ankylosing spondylitis who suffered severe neurologic complications after fracture of the cervical spine are presented. All developed delayed neurologic complications, ranging from 2 to 35 days after the initial injury (mean, 15.8 days). The diagnosis was delayed in four, and in three this delay contributed to morbidity. All fractures occurred in the lower cervical spine (C5 to C7). In three patients, the fracture was the result of minor trauma. A high index of suspicion, an appreciation of the extreme instability of these fractures, and prompt rigid immobilization with a halo vest or case in the alignment of preexisting kyphosis are all important factors in preventing neurologic complications.

Adult↗
PubMed1988

Emphysematous septic arthritis due to Klebsiella pneumoniae.

A 60-year-old woman with rheumatoid arthritis developed acute emphysematous septic arthritis of the knee due to Klebsiella pneumoniae. She was brought to the hospital in septic shock with disseminated intravascular coagulation and had striking physical signs and roentgenograms showing distention of the knee with gas. She also had an infection of the hand with subcutaneous gas. After surgical drainage and institution of antibiotic therapy, she remained critically ill for several days but gradually improved. Two months later, she was ambulating independently. Emphysematous septic arthritis is rare. Four cases have previously been reported, but none were caused by Klebsiella.

Arthritis, Infectious↗
PubMed1986

The plica syndrome: a new perspective.

The symptomatic medial patellar plica is a definite but uncommon pathologic entity. Even after complete excision of an inflamed, thickened plica, mild symptoms may persist despite considerable improvement. The plica syndrome may, in some cases, be part of a broader problem, possibly involving aberrant patellofemoral mechanics. Continued critical analysis of the disorder and the treatment results is necessary to clarify the syndrome further, but excision of a thickened, inflamed plica appears to be very helpful in most patients.

Adolescent↗