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Biomedical subjects

P A Templeton

Publications and source records attributed to P A Templeton.

At least 19 recordsLinked to original sources
PubMed2005

Management of unstable cervical spine injuries in southern Iraq during OP TELIC.

INTRODUCTION: Cervical spine fractures and dislocations are uncommon injuries that can have serious neurological consequences. These injuries require adequate stabilisation to prevent further spinal cord injury during transfer between hospitals. Evacuation often requires a combination of road ambulance, helicopter and fixed wing aircraft from military hospitals. This paper outlines the neck injuries sustained during Op Telic and discusses the need for Halo vests to be available at Role 3. METHODOLOGY: The MND(SE) Hospital databases were used to identify all casualties admitted with either a "Cervical" or "Neck" injury. The databases covered the period from 24 March 2003 until 15 April 2004. The diagnoses were categorised into minor and serious cervical spine injuries. We defined a serious cervical spine injury as either a fracture or dislocation. We looked at the discharge letters of all casualties evacuated to a Role 4 hospital to confirm whether the casualties had serious cervical spine injuries. RESULTS: Forty seven casualties were admitted and all were British except three, two Iraqi civilians and one US soldier. Thirty three casualties were returned to their unit for duty, or discharged at the airhead on return to the UK. Fourteen casualties required hospital treatment. There were five serious cervical spine injuries over the study period which included one Hangman's fracture of C2, one flexion compression injury of C5, one flexion compression injury of C7, one unifacetal dislocation and one bifacetal dislocation. CONCLUSIONS: Five casualties were treated at MND(SE) Hospital for serious injuries to the cervical spine. Two patients were transferred without Halo stabilisation after failing to obtain halos in Iraq. One casualty was kept until a Halo was flown out from the UK. RECOMMENDATIONS: All unstable cervical spine fractures should be stabilised with a Halo Vest prior to transfer from Role 3. Halo Rings and Vests should be available at Role 3 facilities.

Adult↗
PubMed2004

"Failure" of forearm intramedullary elastic nails.

Elastic nails are an established modality for treating forearm fractures in children. These nails are usually removed 6-9 months after surgery as refracture may occur in 10% of cases if the nails removed earlier. We report a case of refracture of the forearm bones with elastic nails in situ, 5 months after the original fractures. The fracture was angulated approximately 80 degrees with the apex pointing anteriorly. Closed reduction was difficult and resulted in breakage of the ulnar nail. The authors describe the details and outline the management of this unreported complication.

Adolescent↗
PubMed2003

Use of perioperative mupirocin to prevent methicillin-resistant Staphylococcus aureus (MRSA) orthopaedic surgical site infections.

We have examined whether topical perioperative prophylaxis can reduce the incidence of methicillin-resistant Staphylococcus aureus (MRSA) surgical site infections (SSIs). Using a controlled before and after approach on patients from four orthopaedic wards, undergoing orthopaedic surgery involving insertion of metal prostheses and/or fixation, received perioperative prophylaxis with nasal mupirocin for five days, and a shower or bath with 2% (v/v) triclosan before surgery (PPNMT). After introduction of PPNMT there was a marked decrease in incidence of MRSA SSIs (per 1000 operations) from 23 in the six months beforehand (period A) to 3.3 (P<0.001) and 4 (P<0.001) in subsequent consecutive six-month periods (B and C, respectively). Of 11 MRSA SSI cases that occurred during periods B and C, only one had actually received PPNMT, and 10 occurred after acute, as opposed to elective, surgery (P<0.001). Point prevalence nasal MRSA carriage decreased from 38% before PPNMT to 23% immediately after, and 20%, 7%, 10% and 8% (P<0.001) at six-monthly intervals post-intervention. Conversely, the prevalence of nasal MRSA carriage in a control elderly medicine ward did not change significantly. Vancomycin usage, in terms of defined daily doses, declined by 23%. Low-level mupirocin resistance was found in 2.3% of S. aureus isolates from orthopaedic patients before PPNMT, and in 3.9%, 6.1%, 10% and 0% in subsequent six month periods. No S. aureus isolates with high-level mupirocin resistance were found. PPNMT can reduce the incidence of MRSA SSls after orthopaedic surgery, probably by reducing nasal MRSA carriage in the endemic setting, without selecting for mupirocin resistance.

Anti-Bacterial Agents↗
PubMed2000

Complications of tibial shaft soccer fractures.

A retrospective study of AO type 42 tibial diaphyseal fractures that presented to a teaching hospital over a 54 month period was made to identify the proportion sustained whilst playing soccer, determine their characteristics and report treatment and outcome. Sport accounts for 73/329 (22.1%) of these fractures and soccer 58/73 (79. 5%) of these. All patients were male with mean age of 24.3 years (range 8-48). Fifty-four fractures were closed and 93.1% (54/58) were situated in the middle third or at the junction of the middle and distal thirds of the diaphysis. Fifty-six (96.6%) had simple or wedge patterns and 45 (77.6%) were right sided. Forty-four (76.2%) were treated non-operatively in plaster, 12 (20.3%) by intramedullary nails and two (3.4%) with external fixators. Two patients were lost to follow-up and the remaining 56 fractures united at a mean of 6.5 months. There were 21 complications in 19/56 (33.9%) patients which included 8/56 (14.3%) delayed/non-unions requiring surgery. There was a significantly higher complication rate for operated fractures (p<0.005) but no significant link to AO fracture type. Thus we cannot assume that treatment of these common fractures is without risk, especially if they are treated operatively.

Adolescent↗
PubMed2000

CT fluoroscopy for thoracic interventional procedures.

In the past several years, CT fluoroscopy has proved a valuable new technique in guiding the performance of intrathoracic procedures. Several approaches to using CT fluoroscopy are discussed. We have found an interrupted, real-time technique optimal to facilitate biopsy of percutaneous lung nodules, particularly small lesions. The technique is also valuable in assisting thoracic drainage procedures. This article also discusses the use of CT fluoroscopy to guide transbronchial needle aspiration, which is another potentially important application.

Biopsy, Needle↗
PubMed1999

Lung cancer: value of various imaging modalities.

Bronchogenic carcinoma is the leading cause of cancer death, and the overall prognosis remains poor. Imaging plays a critical role in the initial staging and follow-up of the disease. Bronchogenic carcinoma is typically detected first on chest radiography but computed tomography (CT) scan is the most important imaging technique, providing both staging information and assessment of recurrence. Magnetic resonance imaging (MRI) is most useful as a problem-solving tool. The increasing role of positron emission tomography (PET) scan in the evaluation is reviewed, and imaging guidelines of two national organizations are presented.

Journal Article↗
PubMed1998

Castleman disease of the thorax: radiologic features with clinical and histopathologic correlation.

PURPOSE: To correlate the radiologic manifestations of thoracic Castleman disease with the clinical and histopathologic features. MATERIALS AND METHODS: The clinical, surgical, and histopathologic records; chest radiographs; and computed tomographic (CT) and magnetic resonance (MR) images in 30 pathologically proved cases of thoracic Castleman disease were reviewed. RESULTS: Patients with localized Castleman disease (n = 24) typically had the hyaline-vascular type (n = 23), were asymptomatic (n = 14), and had solitary, well-circumscribed mediastinal masses (n = 24). All lesions at contrast material-enhanced CT (n = 13) enhanced. All lesions at MR imaging (n = 5) were heterogeneous and had increased signal intensity on T1- and T2-weighted images. Three patterns were observed on CT or MR images in 20 patients: a solitary, noninvasive mass (n = 10); a dominant infiltrative mass with associated lymphadenopathy (n = 8); or matted lymphadenopathy without a dominant mass (n = 2). Patients with disseminated Castleman disease (n = 6) typically had the plasma cell type (n = 4), were symptomatic at presentation (n = 5), and had bilateral mediastinal masses on chest radiographs (n = 4). At CT, all lesions manifested with diffuse mediastinal lymphadenopathy. All lesions at contrast-enhanced CT (n = 5) enhanced. CONCLUSION: Localized Castleman disease manifests as either a solitary, well-circumscribed mediastinal mass or an infiltrative mass with associated lymphadenopathy on CT or MR images. Disseminated Castleman disease manifests with diffuse mediastinal lymphadenopathy.

Adolescent↗
PubMed1998

Evaluation of biopsy needles and prototypic needle guide devices for percutaneous biopsy with CT fluoroscopic guidance in simulated organ tissue.

The authors evaluated accuracy and success rates for placement of fine-aspiration, core, and coaxial biopsy needles in pork meat with three needle guide devices and computed tomographic fluoroscopic guidance. Accuracy and reliability with a metallic sponge-forceps needle holder was equal to or greater than those with other devices, and it was preferred by operators due to its lighter weight and single-handed manipulation. All needle holders functioned poorly with thin-walled needles.

Animals↗
PubMed1998

Real-time CT fluoroscopy: usefulness in thoracic drainage.

OBJECTIVE: The purpose of our study was to review the application of real-time CT fluoroscopy in the drainage of localized pleural and mediastinal collections. SUBJECTS AND METHODS: Between July 1996 and August 1997, 20 patients with 10 loculated pleural effusions, two mediastinal fluid collections, and 12 focal pneumothoraces were treated using CT fluoroscopy. The patient population was 25-77 years old and included 14 men and six women. Methods of drainage included using a modified Seldinger technique with a guidewire and serial dilators in 10 patients and a single-stick trocar technique in the remaining 14. Total room time, procedure time, and CT fluoroscopy time were recorded. RESULTS: All 24 collections were successfully evacuated using either real-time or interrupted real-time CT fluoroscopy. The real-time capability of CT fluoroscopy proved particularly useful for rapid placement of drainage tubes in patients who were unable to cooperate with breathing instructions and in patients who had a narrow window of access. Average total room time was 65 min. Average procedure time was 32 min, and average CT fluoroscopy time was 143 sec. CONCLUSION: CT fluoroscopy permits rapid drainage of intrathoracic collections. CT fluoroscopy is a particularly useful treatment for patients who are unable to perform breath-holding or in whom access to the drainage site is difficult.

Drainage↗
PubMed1997

An audit of trauma documentation.

Research into aspects of the care of the injured depends on accurate and complete documentation. Inadequate records make audit almost impossible and are unacceptable medico-legally. An audit was made of the standard of trauma documentation in the Yorkshire region before the introduction of trauma charts in 1992. After it was established that a problem did exist, an audit was made of the standard of documentation before and after introduction of trauma charts in one city teaching hospital. Case notes were inspected for completeness of documentation of respiratory, circulatory and neurological status. Results from 1988-1989 showed that only 39.4 per cent of notes recorded the four parameters under investigation. In 1992-1994 the standard had improved. Without trauma charts documentation increased to 90 per cent, but with trauma charts in primary referrals the result improved to 97 per cent. Only 56 per cent of notes were complete for tertiary referrals when a trauma chart was not used. The standard of documentation in major injuries improved with the use of trauma charts. It is recommended that trauma charts are used routinely for all primary and tertiary referrals of injured patients. Tertiary referral patients should be reassessed fully after hospital transfer and a new trauma chart completed.

Blood Pressure↗
PubMed1997

Mediastinal mature teratoma: imaging features.

OBJECTIVE: The purpose of this study was to characterize the cross-sectional imaging features of mediastinal mature teratomas. MATERIALS AND METHODS: Sixty-six cases of mediastinal mature teratoma were retrospectively reviewed, noting clinical, radiologic, surgical, and pathologic findings. The patient population consisted of 38 females and 28 males who were 1 week to 67 years old (mean age, 23 years 10 months). RESULTS: Forty-six patients presented with symptoms, predominantly chest pain, dyspnea, and cough. Twenty patients were asymptomatic. Fifty-four tumors were found in the anterior mediastinum, two in the posterior mediastinum, one in the middle mediastinum, and nine in multiple compartments. CT studies (n = 66) showed masses of heterogeneous attenuation with varying combinations of soft tissue, fluid, fat, and calcium. Soft-tissue attenuation was observed in 66 tumors (100%), fluid in 58 tumors (88%), fat in 50 tumors (76%), and calcification in 35 tumors (53%). The most frequent combination of attenuations was soft tissue, fluid, fat, and calcium, which was noted in 26 masses (39%). The combination of soft tissue, fluid, and fat was seen in 16 tumors (24%); and the combination of soft tissue and fluid was seen in 10 tumors (15%). Fat-fluid levels were seen in seven masses (11%). CONCLUSION: Mediastinal mature teratoma typically manifests on CT as a heterogeneous anterior mediastinal mass containing soft-tissue, fluid, fat, or calcium attenuation, or any combination of the four. Fluid-containing cystic areas, fat, and calcification occur frequently. Cystic lesions without fat or calcium were seen in 15% of tumors. Fat-fluid levels, considered highly specific for the diagnosis of mediastinal mature teratoma, are uncommon. CT is the imaging technique of choice in the evaluation of these lesions.

Adolescent↗
PubMed1996

Infantile haemangiopericytoma of the hand.

Infantile haemangiopericytomas (IHP) are rare subcutaneous tumours arising from pericytes. Clinically they are difficult to diagnose and pathologically they appear to be locally invasive, but they have a better prognosis than adult haemangiopericytomas. We report a case of IHP affecting the hand of a 7-week-old child that required urgent treatment.

Hand↗