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Biomedical subjects

R E McCarthy

Publications and source records attributed to R E McCarthy.

At least 19 recordsLinked to original sources
PubMed1990

Air embolism in spinal surgery.

We present two cases of fatal venous air embolism that occurred in previously healthy adolescents during posterior spine fusion and instrumentation for scoliosis. Previously recorded cases in the literature have been rare and only briefly discussed. Air embolism has been a complication noted in the anesthesia and neurosurgical literature, occurring primarily in total hip patients and those patients undergoing neurosurgical procedures in a sitting position. An examination of the pathophysiology of air embolism in posterior spinal procedures would indicate the use of properly placed central lines and end-expiratory CO2 monitoring as the primary modes of detection and treatment considering the potentially fatal risk factors for spinal patients.

Adolescent↗
PubMed1989

High-resolution hip ultrasound in the limping child.

Hip ultrasound was performed on 44 children (114 exams) presenting with a painful hip or a limp thought to be due to hip disease. Effusions were found in 20 patients (21 hips). Hip ultrasound in combination with aspiration of the joint was found to be useful in diagnosis of osteomyelitis and septic joints, transient synovitis, trauma, and traumatic synovitis. We had no false positives or false negatives for hip effusions by ultrasound. In previous reports, absolute measurements have been relied upon for determination of hip effusions. We present a characteristic appearance of a capsule with and without abnormal joints fluid. The results of these 44 patients are summarized.

Arthritis, Infectious↗
PubMed1989

Pseudomonas osteochondritis complicating puncture wounds of the foot in children: a 10-year evaluation.

From 1978 to 1988, microbiologically proven Pseudomonas osteochondritis and septic arthritis following nail puncture wound to the foot was diagnosed in 77 children aged 18 mo-19 y (77 and 17 cases, respectively). The syndromes were found in children with a history of wearing tennis shoes (70 cases), other shoes (5), and no shoes (2). All cases had surgical debridement of the infected cartilage or bone and drainage of infected joints. Pseudomonas aeruginosa was isolated in 38 cases and in conjunction with Staphylococcus aureus in 18. Anti-Pseudomonas antibiotics were initiated in all cases before surgical exploration; the average duration of treatment was 7.5 +/- 1.2 d postoperatively. Patient follow-up was 5.2 +/- 3.4 y (median, 4.8 y; range, 3 mo-10 y). Two relapses occurred; both patients had a previously undetected septic arthritis. These data suggest that with aggressive surgical management, Pseudomonas osteochondritis and septic arthritis can be treated effectively with postoperative antibiotics for 7 d.

Adolescent↗
PubMed1989

Luque fixation to the sacral ala using the Dunn-McCarthy modification.

The Galveston-Luque technique of fixation to the pelvis requires solid bone and a strong pelvis. Because the majority of neuromuscular patients who require fixation to the pelvis have a weak and thin illum, an alternative to the Galveston technique was sought. A technique of rod contouring was developed that takes advantage of the reliable, stout bone of the sacral ala for fixation. Twenty-four patients have been instrumented with Luque rods and fused to the sacrum over the past 4 years using the technique. There have been no complications in this short follow-up.

Follow-Up Studies↗
PubMed1988

Altered gentamicin disposition in a child with a cavernous hemangioma.

Physiologic third spacing can cause an increase in the volume of distribution of certain drugs, such as aminoglycosides, which results in a decrease in the serum concentration. The case reported here, that of a child with a large cavernous hemangioma, demonstrated this phenomenon. To obtain adequate serum and tissue concentrations, alteration of antimicrobial dosing may be needed in similar cases.

Amputation, Surgical↗
PubMed1988

Role of starch as a substrate for Bacteroides vulgatus growing in the human colon.

Bacteroides vulgatus is the numerically predominant Bacteroides species in the human colonic microflora. Unlike other colonic Bacteroides species, B. vulgatus is not a versatile utilizer of polysaccharides. The only types of polysaccharide that support rapid growth and high growth yields by all strains are the starches amylose and amylopectin. Amylase and alpha-glucosidase activities are among the highest found in a bacterial fraction obtained from human feces. This observation raised the question of whether B. vulgatus was the source of the fecal enzymes. Both alpha-glucosidase and amylase were produced at 20- to 40-fold-higher levels when B. vulgatus was grown on maltose, amylose, or amylopectin than when B. vulgatus was grown on glucose or other monosaccharides. Both enzymes had the same pI (4.6 to 5.0) and undenatured molecular weight (150,000). The pIs and molecular weights of the B. vulgatus amylase and alpha-glucosidase were the same as those of the fecal enzymes. To determine whether the B. vulgatus alpha-glucosidase was identical to the fecal alpha-glucosidase, we partially purified the B. vulgatus enzyme and raised an antiserum against it. Using this antiserum, we showed that all strains of B. vulgatus produced the same enzyme. The antiserum did not detect the B. vulgatus alpha-glucosidase in the bacterial fraction from human feces, even when a partially purified preparation of the fecal enzyme was used. Thus the alpha-glucosidase activity in the bacterial fraction from human feces is not the B. vulgatus enzyme.

Amylases↗
PubMed1988

Importance of mucopolysaccharides as substrates for Bacteroides thetaiotaomicron growing in intestinal tracts of exgermfree mice.

We used two approaches to determine whether the mucopolysaccharide chondroitin sulfate is an important source of carbon and energy for Bacteroides thetaiotaomicron in the intestinal tracts of germfree mice. First, we tested the ability of three mutants that grew poorly or not at all on chondroitin sulfate to colonize the intestinal tract of a germfree mouse and to compete with wild-type B. thetaiotaomicron in this model system. One mutant (CG10) was rapidly outcompeted by the wild type. However, since this mutant was unable to grow on chondroitin sulfate because it could not grow on N-acetyl-galactosamine, one of its monosaccharide components, this mutant might also be unable to utilize glycoprotein mucins. Two mutants (46-1 and 46-4) were isolated that grew poorly on chondroitin sulfate but normally on both component sugars. One of them was outcompeted by the wild type, but the percent wild type increased more slowly than with CG10. In one experiment, the percent wild type never reached 100%. The other (46-4) was not outcompeted by the wild type. These results indicate that, although chondroitin sulfate may be a carbon source in the animal, it is not of major importance. Our second approach was to determine by immunoblot analysis whether a 28-kilodalton outer membrane protein that is produced by B. thetaiotaomicron only when it is grown on chondroitin sulfate or hyaluronic acid was being produced at induced level by B. thetaiotaomicron growing in the ceca of exgermfree mice. There was no evidence for induction of this protein in vivo. Thus, the immunoblot results are consistent with results of the mutant competition experiments.

Animals↗
PubMed1988

A locking collar for Luque rods.

The migration of hardware has been a problem in the Luque system of segmental spinal instrumentation. To prevent this migration, a device was designed to slip on the 3/16th inch or 1/4 inch Luque rod. This prevents movement between the wire-rod interface, stopping both distal and proximal rotation of the rod. This article reports 21 patients with neuromuscular scoliosis on whom this technique was used. There was no migration of hardware and only one wire breakage in an area separate from the locking collar. These results are a marked improvement from patients of previous reports who did not receive the new device. Laboratory testing on the locking collar determined the best location on the "L" rod to be in the middle third of the rod. Rod migration has essentially been eliminated with this technique.

Adolescent↗
PubMed1988

Avascular necrosis of the femoral head in children.

Two types of AVN occur in childhood. The first is the idiopathic type best characterized by Legg-Calvé-Perthes' disease associated with repeated infarctions that slow the healing process. The second is the traumatic type caused by a direct insult to the blood supply of the developing femoral head. Both can result in profound growth disturbances of the proximal femur and early degenerative changes. They may have little effect on hip function or appearance. The variables affecting these outcomes are the age of the child, the degree of femoral head involvement, the presence of at-risk signs, the ability of the acetabulum to contain the healing head, and whether or not the growth plate closes as a result of the AVN. Bone scans and magnetic resonance imaging offer some potential for improved accuracy in diagnosis and prediction. The recommendation treatment for AVN in children is to treat the synovitis whenever it occurs or recurs. Abduction bracing should be used for the first six months in most young children with idiopathic AVN of the Legg-Calvé-Perthes' type. Protected weightbearing with crutches should suffice for the early phases of traumatic AVN. Within six months, one should be able to determine the classification and whether to continue the treatment being used or to change to another form of treatment. Petrie casts are used rarely but can be very useful in certain patients. Prolonged crutch use may help to prevent collapse while relieving symptoms in the older child.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1988

Proximal femoral resection to allow adults who have severe cerebral palsy to sit.

Resection of the proximal end of the femur and interpositional arthroplasty was done in thirty-four patients (fifty-six hips) to allow the patients to sit comfortably and to make perineal care painless. All of the patients were severely handicapped because of cerebral palsy, were unable to walk, and were residents of one of two state institutions. After a minimum follow-up of two years, the result had not deteriorated in thirty-three of the thirty-four patients.

Adolescent↗
PubMed1988

Simultaneous bilateral avulsion fracture of the tibial tuberosity. A case report.

Bilateral avulsion fracture of the tibial tuberosity is a rare injury. A 14-year-old male gymnast sustained simultaneous tibial tuberosity displaced fractures while attempting a forward flip. The recommended treatment was open reduction and internal fixation. Functional results were excellent one year after surgical treatment.

Adolescent↗
PubMed1987

Prevention of the complications of scoliosis by early detection.

The focus of medicine has increasingly turned toward prevention rather than treatment of disease. In the absence of the ability to prevent the occurrence of scoliosis, the focus of attention should be on early identification in order to prevent complications brought on by the disease. Scoliosis detection through screening of school children is a technique that has been popularized over the last three decades. The screening technique can be performed by trained personnel. Though the initial result of these screenings was over-diagnosis, the program has been shown to be cost-effective when the screeners are well-trained and appropriate referrals are made to minimize the lack of specificity. The use of the scoliometer to make a quantitative determination of the degree of truncal rotation has reduced the number of inappropriate referrals. The complications of scoliosis itself include pulmonary compromise, pain, and deformity; these are best prevented by early detection and early treatment. When scoliosis is treated late and larger curves are present, more involved and complication-ridden procedures are required. School children screening programs promote a better understanding and heightened awareness of this disease and acceptance of the treatment methods by the public.

Adolescent↗
PubMed1986

Acquired bone dysplasia secondary to catheter-related complications in the neonate.

Four neonates presented with leg-length discrepancy in the first and second year of life, secondary to physeal growth arrest. All four had stormy postnatal periods, requiring indwelling arterial and/or hyperalimentation catheters. One had documented osteomyelitis. In the last three cases, the growth disturbance may have been secondary to aseptic emboli to the bones from the indwelling catheters. In two cases, there was evidence of other nonseptic embolic phenomena.

Bone Diseases, Developmental↗
PubMed1986

Evidence that polygalacturonic acid may not be a major source of carbon and energy for some colonic Bacteroides species.

Five Bacteroides species that are found in the human colon can utilize polygalacturonic acid (PGA) when they are grown in laboratory media: Bacteroides thetaiotaomicron, Bacteroides vulgatus, Bacteroides ovatus, Bacteroides fragilis subsp. a, and Bacteroides sp. strain 3452A (an unnamed DNA-DNA homology group). PGA-degrading enzymes from B. thetaiotaomicron have been isolated and characterized previously. To determine whether a PGA lyase activity in human feces could be attributed to any of these species, we first determined the properties of PGA lyases from the other four Bacteroides species. PGA lyases from all the Bacteroides species were soluble, cell associated, and inducible by PGA. All had similar pH optima (8.4 to 8.8) and similar molecular weights (50,000). All activities were enhanced by calcium. The PGA lyases from the five species differed with respect to isoelectric point: B. thetaiotaomicron (pI 7.5), B. vulgatus (pI 7.7), B. ovatus (pI 5.8, 7.2), B. fragilis subsp. a (pI 6.1), and Bacteroides sp. strain 3452A (pI 7.7). The PGA lyase activity in human feces resembled those of the Bacteroides PGA lyases in that it had a pH optimum of 8.4 to 8.8 and was enhanced by calcium. However, it differed from the Bacteroides PGA lyases both with respect to isoelectric point (pI 4.2 to 4.4) and molecular weight (100,000). On the basis of these findings, it appears that the PGA lyase activity in human feces is not produced by any of the Bacteroides species surveyed in this survey. Moreover, there was no detectable PGA lyase activity in feces that had the same properties as the Bacteroides enzymes.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteroides↗
PubMed1986

Allograft bone in spinal fusion for paralytic scoliosis.

To determine the efficacy of allograft bone in spinal surgery, a retrospective study was carried out on thirty-two patients who had had spinal fusion with banked bone from the femoral head between 1977 and 1983. The diagnoses were paralytic and neuromuscular scoliosis. At final follow-up (average, 3.7 years), the infection rate was 9.3 per cent. There were no pseudarthroses, and all patients had well marginated trabecular markings by eighteen months. The rates of complications and of fusion were comparable with or better than those obtained using autogenous bone graft.

Adolescent↗
PubMed1986

Bilateral fracture of the pedicle of the second cervical vertebra in the young child.

We report the cases of five children, six to eighteen months old, who had bilateral fracture of the pedicles of the second cervical vertebra. The children were treated with gentle cervical traction in mild extension or were maintained in near-anatomical reduction in a Minerva jacket or halo cast. The fractures united in four patients. One patient underwent fusion to stabilize the spine.

Braces↗
PubMed1985

Timentin therapy for bone, joint, and deep soft tissue infections in children.

Timentin, a combination of clavulanic acid (0.1 g) and ticarcillin (3.0 g), has proved effective in vitro against bacterial pathogens that produce beta-lactamases. The usual etiologic bacteria of osteochondritis of the foot (Pseudomonas species) and osteomyelitis/septic arthritis (Staphylococcus aureus) are commonly resistant to penicillins. To date, we have used Timentin to treat 30 children with bone, joint, and deep soft tissue infections. Timentin was administered intravenously at an average dosage of 207 mg/kg per day for mild to moderate infection and 310 mg/kg per day for bone and joint infections with systemic signs (sepsis). The lower dose was used in 24 patients and the other six patients, who had signs of sepsis, received the higher dose. All patients received Timentin intravenously over 30 minutes every four to six hours for a minimum of five days (mean 6.6 +/- 2.6 days, range five to 14 days). The mean time to defervescence and/or reduction in clinical symptoms was 1.6 +/- 1.3 days (range zero to four days). Osteochondritis due to P. aeruginosa was diagnosed in six patients, and septic bursitis, osteomyelitis, or septic arthritis due to S. aureus (13 patients) or Staphylococcus species and group A streptococci (four patients) was diagnosed in 17 patients. All isolates were susceptible to Timentin in vitro by disk-diffusion analysis. All patients showed a response to therapy with Timentin, with or without surgical intervention. All patients had clinical and microbiologic cures; no adverse reactions or side effects were observed. There have been no clinical or microbiologic relapses to date. Timentin may prove to be useful in specific bone and joint infections in children.

Arthritis, Infectious↗