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Biomedical subjects

R B Welch

Publications and source records attributed to R B Welch.

At least 37 records · Page 2Linked to original sources

Alternating prism exposure causes dual adaptation and generalization to a novel displacement.

In two experiments, we examined the hypothesis that repeatedly adapting and readapting to two mutually conflicting sensory environments fosters the development of a separate adaptation to each situation (dual adaptation) as well as an increased ability to adapt to a novel displacement (adaptive generalization). In the preliminary study, subjects alternated between adapting their visuomotor coordination to 30-diopter prismatic displacement and readapting to normal vision. Dual adaptation was observed by the end of 10 alternation cycles. However, an unconfounded test of adaptive generalization was prevented by an unexpected prism-adaptive shift in preexposure baselines for the dual-adapted subjects. In the primary experiment, the subjects adapted and readapted to opposite 15-diopter displacements for a total of 12 cycles. Both dual adaptation and adaptive generalization to a 30-diopter displacement were obtained. These findings may be understood in terms of serial reversal learning and "learning to learn."

Adaptation, Psychological↗

The patellofemoral joint after total knee arthroplasty without patellar resurfacing.

One hundred total knee replacements with a total condylar prosthesis and without patellar resurfacing were followed for a minimum of two years. Eighty-four per cent of the knees were affected by osteoarthrosis. Graded according to the knee-rating system of the Hospital for Special Surgery, there were eighteen excellent, fifty-three good, eighteen fair, and eleven poor results. At the most recent follow-up, twenty-nine knees (29 per cent), nine of which were affected by rheumatoid arthritis, were still painful in the patellofemoral area. The height and weight of the patient definitely influenced the amount of patellofemoral pain postoperatively. Small patients who had osteoarthrosis were exceptionally free of pain, regardless of sex, age, or level of activity. It seems that the best approach to patellofemoral replacement includes resurfacing of the patella in all patients who have rheumatoid arthritis and in patients who have osteoarthrosis if they have preoperative patellofemoral pain, are more than 160 centimeters tall, weigh more than sixty kilograms, and have advanced changes in the patella at the time of the operation.

Aged↗

Bietti's crystalline dystrophy. A clinicopathologic correlative study.

We report the clinical and electrophysiologic findings in three patients with Bietti's crystalline corneal-retinal dystrophy. The initial evaluation in one patient demonstrated diffuse disease involving retinal pigment epithelium and choriocapillaris with severe widespread disturbance of retinal function. The patient's disease progressed greatly from the age of 36 to 47 years. Two brothers had regional involvement of the posterior pole with disturbances of retinal function attributable to localized disease, and there was only mild progression in these patients. A corneal biopsy specimen from the more severely affected patient and biopsy specimens from a patient whose case had been previously reported demonstrated crystals resembling cholesterol or cholesterol ester and complex lipid inclusions in corneal and conjunctival fibroblasts. Similar inclusions were present in circulating lymphocytes, suggesting that Bietti's crystalline corneal-retinal dystrophy may be due to a systemic abnormality of lipid metabolism.

Adult↗

Interphotoreceptor retinoid-binding protein levels in subretinal fluid from rhegmatogenous retinal detachment and retinopathy of prematurity.

Interphotoreceptor retinoid-binding protein (IRBP) has been detected qualitatively in subretinal fluid associated with rhegmatogenous retinal detachments. We have used a quantitative enzyme-linked immunosorbent assay to determine the IRBP concentrations in 24 fluid specimens collected at retinal reattachment surgery from 22 patients, and from 17 patients who underwent surgery for retinopathy of prematurity with traction detachment. We observed a wide range of concentrations (1 to 176 micrograms of IRBP per milligram of protein). Higher concentrations were found only in fluid from the more recent rhegmatogenous detachments. The lowest concentrations were detected among fluids drained from under rhegmatogenous detachments ranging from five days' to one year's duration. The IRBP concentration in subretinal fluid showed no correlation with visual outcome and may be influenced by IRBP turnover in the vitreous cavity. Most strikingly, none of the 17 samples from patients with retinopathy of prematurity contained detectable amounts of IRBP.

Adult↗

Charnley low-friction arthroplasty. A fifteen- to seventeen-year follow-up study.

One hundred Charnley low-friction arthroplasties have been reviewed at 15 to 17 years. Thirty-five of the patients have died. A revision rate of 16 per cent has been recorded. Only two cases demonstrated cavitation and cortical destruction of the femur, and these cases were revised successfully. One of the major causes for revision was fracture of the femoral component. With modern alloys, this should not be a long-term problem. Our data would suggest that the cemented arthroplasty can be used with confidence in patients 65 and older. It is our hope that modern cement technology and component design will increase the longevity of the cemented arthroplasty.

Adult↗

Acetabular preparation in cementless revision total hip arthroplasty.

The rationale for and experience with the use of a hemispherical, cementless, microporous socket (Harris-Galante prosthesis) are presented as an approach to acetabular revision arthroplasty. Advantages are noted in preservation of existing bone, ease of rigid fixation, and bone grafting with either lyophylized particle allograft or autograft. The early results of a series of 75 sockets show no loss of fixation, mild to major resorption of non-contained bone graft, and favorable roentgenographic appearance of contained bone graft. In bone-grafted regions, a high percentage of lucencies at the graft-porous interface implies a lack of bone ingrowth. The authors were unable to characterize any roentgenographic behavioral differences between allograft or autograft. The approach is successful in severely deficient acetabulae, especially of the Type III combined cavitary and segmental medial wall deficiency.

Acetabulum↗

Transfer of perceptual-motor training and the space adaptation syndrome.

Perceptual cue conflict may be the basis for the symptoms which are experienced by space travelers in microgravity conditions. Recovery has been suggested to take place after perceptual modification or reinterpretation. To elucidate this process, 10 subjects who repeatedly experienced a visual/vestibular conflict (Purkinje) over trials and days, were then tested in a similar but not identical perceptual situation (pseudo-Coriolis) to determine whether any savings in perceptual adaptation had occurred as compared to an unpracticed control group (N = 10). The practiced subjects experienced lessening dizziness and ataxia within and over sessions. Their response to the new perceptual situation was markedly less than the control group (p less than 0.001). Assessment of "adaptability," in addition to the provocative vestibular tests now in use, may improve prediction of susceptibility to the space adaptation syndrome. An adaptability trait may exist in humans which, properly measured, could be used to predict who would adapt more readily to visual/vestibular conflict and perhaps to environmental stressors in general.

Adaptation, Physiological↗

Complications of acute symptomatic posterior vitreous detachment.

During a ten-year period, 172 eyes of 155 patients developed acute symptomatic posterior vitreous detachments. The study included only patients examined within three months of the onset of symptoms. The patients ranged in age from 22 to 82 years, with an average age of 60 years. Of the 172 eyes, 118 (69%) developed no retinal or vitreous complications. Retinal tears occurred in 14 eyes (8%) and vitreous or retinal hemorrhages occurred in 36 eyes (21%). Seventeen patients (11%) who had acute symptomatic posterior vitreous detachment in one eye later developed acute symptomatic posterior vitreous detachment in the fellow eye. The second posterior vitreous detachment developed within two years of the first one in 15 eyes (88%). In 13 patients (76%), the second eye responded in the same manner to the posterior vitreous detachment as had the first, that is, ten pairs of eyes had no further complications, two pairs had retinal or vitreous hemorrhages, and one pair had retinal breaks.

Acute Disease↗

The avulsed retinal vessel syndrome and its variants.

The course of 18 patients (19 eyes) with the avulsed retinal vessel syndrome and its variants was followed up for an average of 54 months. This syndrome consists of recurrent vitreous hemorrhages from an avulsed retinal vessel caused by retinal tear formation. Even after the retinal tears are closed by various techniques, vitreous hemorrhages may recur until the retinal vessel ruptures. The visual prognosis is generally good.

Aged↗

Removal of scleral buckling elements. Causes and complications.

Fifty-three patients underwent removal of their scleral buckling elements in our operating rooms during a 25-year period. Of these, 18 patients suffered a retinal redetachment and two went on to phthisis. "Life-table" (survival) analysis showed that the risk of redetachment was 23% within the first 30 days after buckling element removal and 33% within 90 days. The cumulative risk of redetachment during a four-year period gradually increased to 47%. Factors that had a statistically significant association with redetachment included the degree of vitreous traction at the time of the original retinal detachment and the extent of the original detachment. Age, race, sex, preoperative condition, type of buckling element, and cause of buckling element removal did not have a statistically significant association with redetachment.

Adolescent↗