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Biomedical subjects

M Pitt

Publications and source records attributed to M Pitt.

36 records · Page 2Linked to original sources
PubMed1991

Ankle mortise stability in Weber C fractures: indications for syndesmotic fixation.

A Weber type C ankle fracture was sequentially reproduced in 12 cadaver lower extremities and an external rotation torque was applied at each interval. The fractures were then repaired in staged fashion and the rotational stability of the mortise evaluated. Maximum external rotation of the talus within the mortise averaged 7.7 degrees in the intact ankle and increased by 311% to 31.8 degrees after creation of a Weber C injury. Rigid fixation of the fibular fracture restored 32% of the rotational stability, whereas isolated fixation of the medial malleolus reconstituted 57%. Fibular fixation combined with a syndesmotic screw restored 51% of original stability, and the addition of medial malleolar fixation improved stability to 101%. Bimalleolar fixation without a syndesmotic screw yielded 73% of the original rotational stability. The results of this study suggest that when rigid medial and lateral osteosynthesis can be achieved, syndesmotic fixation may not be necessary.

Ankle Injuries↗
PubMed1986

Bone reinforcement lines in chronic adult osteopenia: a hypothesis.

Although linear bands of increased radiodensity have been described in the tubular bones of children, similar but less often reported structures are frequent in the osteopenic skeleton of middle-aged and elderly patients. In this study, the radiology, pathology, and histology of osseous bands in the mature skeleton were analyzed in 20 cadavers, 29 macerated ancient and modern bone specimens, and 100 recent radiographs. These radiodense areas represent complete or incomplete, horizontally or obliquely oriented bars composed of compact lamellar bone. Although their precise pathogenesis is not clear, they are associated with long-standing (vs. acute) osteopenia. In some instances, bone bars appear to be formed during skeletal growth, remain hidden in the adult because of adjacent trabeculae, and are unmasked by osseous resorption. In other instances, bone bars appear to be formed initially in the mature skeleton as a response to chronic mechanical stress and, as such, are not identical with growth recovery lines observed in children. They are more accurately considered bone reinforcement lines.

Adult↗
PubMed1985

Computed tomography and automated image analysis of prehistoric femora.

Non-invasive characterization of limb bone cross-sectional geometry would be useful for biomechanical analyses of skeletal collections. Computed tomography (CT) is potentially the method of choice. Additionally, CT images are suitable for automated analysis. CT is here shown to be both accurate and precise in the analysis of cross-sectional geometry of prehistoric femora. Beam hardening artifacts can be reduced by using a water bath. As the availability of CT for research increases, both bone density and geometry could be determined simultaneously with this method.

Autoanalysis↗
PubMed1985

Vitamin D metabolites in adolescents and young adults with cystic fibrosis: effects of sun and season.

To assess mineral metabolism in patients with cystic fibrosis and to study the effects of season and sunlight exposure on generation of vitamin D metabolites, we quantified serum levels of calcidiol and calcitriol, other measures of bone metabolism, and radiographic bone mass in 20 adolescents and young adults with CF and 20 age-matched normal volunteers. Levels of calcidiol were lower in patients with CF than in controls and lower in Massachusetts than in Arizona in both study groups. Controls in Arizona had higher (P less than 0.05) levels of calcitriol than in Massachusetts throughout the year. All control subjects in both states had higher levels of calcitriol than did patients with CF. Patients in Massachusetts had significantly lower levels of calcitriol in winter than in summer. Summer levels of calcitriol in CF were significantly higher in Massachusetts than in Arizona; during winter, lower levels were found in Massachusetts than in Arizona. Mean bone density in patients with CF was 88% and 89% of normal American standards in Massachusetts and Arizona, respectively. These data indicate a seasonal, sunlight-related influence on levels of vitamin D metabolites in patients with CF receiving approximately 1000 IU vitamin D per day. Older patients with CF with progressively diminishing sunlight exposure may be at increased risk for development of osteopenia. The detected radiographic abnormalities of bone mineralization may also be related to malabsorptive deficiencies of calcium and phosphorus.

25-Hydroxyvitamin D 2↗
PubMed1983

Osteopenic bone disease.

Osteoporosis, osteomalacia, and hyperparathyroidism are the common causes of skeletal osteopenia. Radiograms of the skeleton are a basic part of the clinical evaluation of these osteopenic processes. Accurate interpretation of these radiograms is difficult; the presence and degree of osteopenia is often a subjective estimate. This article discusses radiographic features of the common deossifying disorders, including objective criteria that may be useful in routine clinical practice.

Adult↗
PubMed1982

Spinal cord injury, spinal fracture, and spinal stenosis in ankylosing spondylitis.

The authors report a retrospective review of 105 patients with ankylosing spondylitis (AS) diagnosed over a 6-year period in Tucson, Arizona. In the series, there were 13 patients with spinal fractures and eight with severe spinal cord injury. Two patients with central cord contusion had no demonstrable cervical spine fracture. Injury was often trivial and dislocation at fractures sites was minimal, demonstrating the extreme fragility of these patients. Spinal stenosis, which has not previously been associated with AS, was documented in three cases. Pseudarthrosis, a destructive vertebral lesion that does not require surgical decompression or fusion, was found in four patients; this entity is believed to originate as a pathological or traumatic fracture. Atlanto-axial subluxation and basilar invagination associated with spinal ankylosis occurred in one patient. The study emphasizes the value of computerized tomography scanning of the spine for diagnosis, and halo-vest application as a nonoperative treatment for cervical immobilization. Early diagnosis and appropriate therapy to decompress, reduce, and immobilize unstable spinal lesions may result in reduction of the 29% mortality rate and 45% permanent neurological morbidity rate observed after spinal fracture in this series of AS patients. Because of the high operative complication rate observed, nonsurgical immobilization is the recommended treatment unless spinal dislocation or bone fragment displacement has occurred at the fracture site.

Adult↗
PubMed1980

Hyperaldosteronism, hyperparathyroidism, medullary sponge kidneys, and hypertension.

Hyperparathyroidism and hyperaldosteronism coexisted in association with medullary sponge kidneys in a 27-year-old woman with severe hypertension. A modest fall in systolic and diastolic pressure followed removal of a parathyroid adenoma. Blood pressure was controlled with spironolactone therapy and restored to normal after removal of an aldosterone-secreting adrenal tumor. Elevated levels of aldosterone may have been responsible for the severe hypertension, while hypercalcemia may have had a synergistic effect on the arteriolar response to circulating vasoactive peptides.

Adenoma↗
PubMed1978

Psoriatic spondylitis. Association with advanced nongranulomatous upper lobe pulmonary fibrosis.

We describe the case of a patient with psoriasis, peripheral and axial arthropathy, and upper lobe fibrosis. This association of findings has not, to the best of our knowledge, been described in the past. Pulmonary fibrosis is not found to be more common in people with psoriasis than would be expected in a control Veterans Administration population and, while this association may be coincidental, pulmonary fibrosis in psoriatic spondylitis should be searched for in other patients.

Adult↗
PubMed1977

Coccidioides immitis osteomyelitis of the mandible in an infant.

Coccidioidomycotic osteomyelitis developed at the angle of the right side of the mandible in a 5-month-old Papago infant. The disease was successfully treated with a combination of amphotericin B, surgery, and transfer factor with complete immunological, microbiological, and radiological cure. At 4 years of age, the only residual effect is prominence of the right hemimandible with asymmetry of the jaw.

Amphotericin B↗
PubMedDate not supplied

Coronary artery surgery for ischemic heart failure: risks, benefits, and the importance of assessment of myocardial viability.

Heart failure and left ventricular dysfunction are common and are most often caused by myocardial ischemia/infarction secondary to occlusive coronary artery disease. Although recent refinements in medical therapy have resulted in improved survival, morbidity and mortality remain high in patients with advanced heart failure. Heart transplantation remains an option for selected patients, and implantable left ventricular assist devices may soon provide another treatment strategy for such patients. However, patients with established postischemic heart failure, significant myocardial viability, and coronary artery anatomy amenable to surgical revascularization can derive significant functional and survival benefit after coronary artery surgery, albeit with an increased perioperative risk. We discuss the role of coronary artery surgery in ischemic heart failure and review the evidence for such an approach.

Algorithms↗