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Biomedical subjects

R H Browne

Publications and source records attributed to R H Browne.

28 records · Page 2Linked to original sources
PubMedDate not supplied

Prospective study of spinal muscular atrophy before age 6 years. DCN/SMA Group.

Spinal muscular atrophy (SMA) is a common neuromuscular disorder of childhood, associated with a high mortality rate during the first 2 years of life. Most practitioners expect patients with SMA to follow a progressive course with loss of muscle strength and function over 2-10 years. Counselling sessions with parents frequently emphasize the high mortality rate and risk for respiratory failure. The progressive nature of SMA has been attributed to the loss of motor neurons. Fifty-eight children, ages 6 years and younger, were examined between January, 1987, and April, 1992, as part of a large, multicenter collaborative study of SMA. Muscle function was evaluated at regular intervals using a standardized protocol that was demonstrated to be reliable. We determined a prevalence of 56% for tongue fasciculations, a prevalence of 22% for facial weakness, and persistent deep tendon reflexes in one patient. Improved motor function and acquired milestones during the study were documented. This work should contribute toward a better understanding of the natural history of SMA.

Child↗
PubMedDate not supplied

Reducing sample sizes when comparing experimental and control groups.

In comparing rates for two groups (one control and the other experimental), one may use an historical control to reduce the sample size needed for a test of significance to one-fourth that required if the control is not historical. If there is some doubt as to whether one's control is comparable to the historical control, a test showing the equality of the historical and experimental controls can lead to a halving of the sample required for significance testing. This same argument also applies to the comparison of two means.

Research Design↗
PubMedDate not supplied

Polymicrobial sepsis: an analysis of 184 cases using log linear models.

Polymicrobial sepsis is a common and frequently fatal clinical condition that has received relatively little attention in published reports. Retrospectively, we reviewed the case records of 184 patients with polymicrobial sepsis seen at three Dallas hospitals between 1972 and 1977. Analysis of clinical data using log linear models enabled us to identify significant positive correlations (p < 0.05) between mortality resulting from polymicrobial sepsis and underlying disease category, failure to manifest fever, a pulmonary portal of entry, hypotension, and hospital-associated sepsis. No significant correlation with outcome could be demonstrated for age, hospital service, species of infecting microorganisms, number of microorganisms isolated from blood, WBC count, or antimicrobial therapy. In spite of indirect evidence for synergistic relationships between microorganisms responsible for polymicrobial sepsis in man, we could not resolve whether antimicrobial regimens that are effective against all of the microorganisms participating in polymicrobial infections are required to insure a favorable outcome.

Adolescent↗
PubMedDate not supplied

Chronic musculoskeletal pain in childhood.

We studied 73 children with chronic or recurrent musculoskeletal pain of > or = 6 weeks' duration. Thirty-six children had no identifiable organic etiology for their pain, with a minimum follow-up of 2 years for ongoing symptoms. Thirty-seven children had an organic etiology for their pain. Use of an Inappropriate Symptom Checklist was helpful in distinguishing between children with chronic pain who were found to have an organic disease and those without an identifiable organic disease. Seventy-seven percent of children with no inappropriate symptoms had an organic diagnosis ultimately made. Conversely, 79% of children with two or more inappropriate symptoms ultimately had no organic diagnosis to explain their pain. Behavioral self-report measures testing could not differentiate between children with chronic pain with or without organic disease. Intervention by a psychologist skilled in pain management was helpful.

Adolescent↗
PubMedDate not supplied

Back pain during orthotic treatment of idiopathic scoliosis.

The incidence and etiology of back pain during orthotic management of idiopathic scoliosis was determined for 303 patients treated from 1980 through 1990 for a minimum of 1 year. All patients denied back pain before orthotic prescription. Thirty-four (11%) patients reported back pain after institution of brace treatment. A family history of scoliosis (p = 0.014) and vigorous sports activities (p < 0.001) were correlated with pain. Seventeen of 34 patients with pain showed >10 degrees of curve progression during bracing, whereas 67 of 269 patients without pain progressed (p = 0.002). Four patients with pain and 11 without were eventually found to have an underlying pathology (spondylolysis/listhesis). No other underlying pathologies were found. Night pain or a left thoracic curve pattern were not correlated with a serious underlying etiology. Back pain occurring after institution of brace treatment for idiopathic scoliosis is often associated with curve progression and is poorly correlated with a serious underlying pathology.

Back Pain↗
PubMedDate not supplied

The lateral pillar classification of Legg-Calvé-Perthes disease.

To determine the predictive value of a new classification system for Legg-Perthes, 93 hips in 86 patients with radiographic follow-up to maturity were reviewed. All patients were treated by bracing at the Texas Scottish Rite Hospital from 1970 to 1980. Hips were classified during the fragmentation stage of disease into three groups based on radiolucency in the lateral pillar of the femoral head. Final radiographs were reviewed at skeletal maturity, and the outcome was determined according to the Stulberg classification. Group A had a uniformly good outcome (100% Stulberg I and II results); Group B had a good outcome in patients who were less than 9 years at onset (92% Stulberg I and II, 8% Stulberg III results), but a less favorable outcome in patients who were greater than 9 years at onset (30% Stulberg II, 50% Stulberg III, and 20% Stulberg IV results). In Group C, the majority of femoral heads became aspherical in both age groups (29% Stulberg II, 52% Stulberg III, and 19% Stulberg IV results). The group C hips also had a longer duration of fragmentation and reossification stages. Members of the Legg-Perthes study group agreed 78% of the time when applying the classification to unknown radiographs. The classification group was a stronger determinant than age of onset in predicting final outcome. This classification system is easy to apply during the active stage of the disease and has a high correlation in predicting the amount of flattening of the femoral head at skeletal maturity.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

Treatment of femoral fractures in children by pediatric orthopedists: results of a 1998 survey.

SUMMARY: This study aimed to determine treatment preference of various femoral fracture patterns in children by pediatric orthopedists and whether it is practice dependent. In September 1998, members of the Pediatric Orthopedic Society of North America were surveyed to determine their current preferences in treating each of four middle one-third femoral fracture patterns in four age groups. Forty-four percent (286/656) of those surveyed responded. For each fracture pattern, operative treatment was increasingly preferred over nonoperative as patient age increased, and the preferred treatments within the operative and nonoperative categories changed significantly as patient age increased. Fourteen specific cases of femoral head avascular necrosis were noted after rigid reamed and unreamed rodding. There is a statistically significant trend by pediatric orthopedists to treat older children's femur fractures operatively and younger children's nonoperatively. The consensus treatment is age dependent. The numerous cases of avascular necrosis after rigid rodding are a concern.

Adolescent↗