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Biomedical subjects

R Jarvis

Publications and source records attributed to R Jarvis.

10 recordsLinked to original sources

Injuries to the ulnar carpometacarpal region: are they being underdiagnosed?

Thirteen cases with radiographic evidence of injury to the ulnar side of the hand are reviewed. These injuries included intraarticular fractures and/or dislocations of the fourth and fifth carpometacarpal joints and associated bones collectively discussed here as the ulnar carpometacarpal region. In nine the extent of the injury was not appreciated on first presentation. Injuries to this region are often difficult to assess clinically and radiographically even in experienced hands. In our experience computerized tomography (CT) scans in the longitudinal and longitudinal oblique axis best display the ulnar carpometacarpal joint surfaces and their relationship to each other. We recommend CT of the ulnar carpometacarpal region where clinical evidence of an injury to this region is not in keeping with the plain radiographic findings, and when planning surgery on a complex injury in this region.

Adolescent

Join the club: a modest proposal to increase availability of donor organs.

The shortage of suitable donor organs is the most significant single limiting factor in transplant programmes. More lives could be saved or immeasurably improved if more organs were available. I look at two traditional solutions to the shortfall, and suggest that they are ineffective and/or offensive, and consider the features common to any answer to the problem. I then suggest a third solution: that admission to future transplant lists be conditional on registration as a potential organ donor, outlining its benefits, and defending it against one possible objection.

Coercion

Painful, mixed density mass of the right maxilla.

An additional case of rare, benign osteoblastoma occurring in the right maxilla of a 27-year-old female is reported. The differential diagnosis is discussed and the important distinction between osteoblastoma and low-grade osteosarcoma is stressed.

Adult

Prosthetic programme after above-knee amputation in children with sarcomata.

A programme for early mobilisation using a temporary prosthesis was evaluated in 17 children who had had an amputation above the knee for sarcomata. The temporary prosthesis had a performed adjustable polypropylene quadrilateral socket which was able to accommodate changes in the size of the stump during the first few months after amputation. The adjustable sockets were assembled onto wooden knee-shank-foot units or onto modular components covered with foam. The wooden units were better for routine use as more adjustment was possible between the socket and the knee and because they were more durable in active children. Prosthetic fitting usually took one hour and was carried out 10 days after the amputation to coincide with the start of the chemotherapy programme. The prosthesis was cosmetically acceptable, easy to use and provided a simple and economical way of rehabilitating the amputees and restoring their morale. After two to three months a new prosthesis with a laminated socket suspended by a waistband was supplied. The skin tolerated the closer fit of this socket and the small fluctuations in the size of the stump that occurred with each course of chemotherapy were easily accommodated by varying the thickness of the stump sock. A self-suspending laminated socket was provided after completion of the chemotherapy. The permanent sockets were assembled onto wooden components but the girls usually preferred the modular system covered with foam. The chemotherapy and rehabilitation programmes were successfully co-ordinated so that the children spent as little time as possible away from their normal activities.

Adolescent