Biomedical subjects
Publications and source records attributed to R Greenfield.
A multidiscipline procedure has been described that provided prosthodontic restoration of esthetics and function for a patient with amelogenesis imperfecta.
Between July 1987 and December 1990 in Washington, DC, 116 patients sustained 146 fractures and seven dislocations due to an assault with a baseball bat. The ulna was the most common site of trauma (61 fractures), followed by the hand (27 injuries) and the radius (14 injuries). Forty-two of the 146 fractures were significantly displaced and required open reduction and internal fixation to restore satisfactory alignment. Twenty-nine of the 146 fractures were open fractures. Treatment protocol for open fractures consisted of irrigation and debridement, antibiotic therapy, and bone stabilization with either internal or external fixation, or casting. Recognition of the severity of the soft tissue and bone damage is important in the management of musculoskeletal trauma secondary to the baseball bat.
The effect on hypertension of hydrochlorothiazide 100 mg daily plus timolol 20-60 mg daily versus hydrochlorothiazide plus placebo and of hydrochlorothiazide plus timolol plus hydralazine 40-200 mg daily versus hydrochlorothiazide plus placebo plus hydralazine was evaluated in a double-blind, randomized, crossover study in 38 patients with hypertension. Hydrochlorothiazide plus timolol was more effective than hydrochlorothiazide plus placebo in lowering both supine and standing systolic and diastolic blood pressures. Hydrochlorothiazide plus timolol plus hydralazine was a very effective regimen in lowering both supine and standing systolic and diastolic blood pressure. The patients tolerated this regimen well with greater hypotensive activity and a lower incidence of side effects than on hydrochlorothiazide plus placebo plus hydralazine.
We performed double innominate osteotomy in twenty-five patients with acetabular insufficiency resulting from congenital dislocation of the hip and other lesions. Following iliac (Salter) osteotomy, the second osteotomy was carried out medial to the obturator foramen in the interval between the symphysis pubis and the pubic tubercle. In children more than six years old, adolescents, and adults, addition of the pubic osteotomy increased the amount of acetabular rotation and coverage of the femoral head that could be achieved. An additional benefit was that the femoral head could be shifted medially, decreasing the length of the femoral lever arm. The improvement in center-edge angle in the twenty-five patients averaged 27 degrees, and the acetabular index decreased an average of 19.5 degrees. The center of the head shifted medially an average of 1.5 centimeters. Hip stability was achieved in twenty-three of the patients.
The distribution and severity of osteoarthritis were investigated in 56 knees by history and physical examination, assessment of knee function, radiography with and without weight-bearing, double-contrast arthrography, and 99mTc-polyphosphate bone imaging. Compartmental involvement (medial, lateral, patellofemoral) was graded independently by 2 or 3 observers for each modality and was correlated with that observed during arthroscopy or direct surgical inspection. The more involved compartments were graded abnormal by all methods. In the less involved compartments, the gamma camera image was most sensitive to pathology, followed by arthrography. The choice of surgical technique and the prognosis depend upon accurate preoperative knowledge of the extent of disease.