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Biomedical subjects

R M Jay

Publications and source records attributed to R M Jay.

36 records · Page 2Linked to original sources
PubMed1983

The diagnosis of acute, recurrent, deep-vein thrombosis: a diagnostic challenge.

Recurrent venous thrombosis presents a diagnostic challenge. Venography, impedance plethysmography and fibrinogen leg scanning all have potential limitations, and their role in this context has not been evaluated. We performed a prospective cohort study evaluating impedance plethysmography and leg scanning, plus venography, using outcome on long-term follow-up as the end point in 270 patients with clinically suspected recurrent deep-vein thrombosis. Anticoagulant treatment was withheld in the 181 patients negative by noninvasive testing and was given in patients positive by impedance plethysmography if leg scanning was positive or if intraluminal filling defects were detected by venography. The validity of this approach was tested by long-term follow-up. Three of 181 patients (1.7%) negative by noninvasive testing had a recurrence, compared with 18 of 89 (20%) with positive findings (p less than 0.001). Our objective diagnostic approach has high clinical utility; an objective rationale for withholding or giving treatment was established in 95% of patients.

Acute Disease↗
PubMed1983

Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan.

Inherent contradictions in current diagnostic recommendations for pulmonary embolism have created considerable confusion and controversy. To resolve these contradictions, we did a prospective study of ventilation-perfusion scanning, pulmonary angiography, and venography in consecutive patients with clinically suspected pulmonary embolism and abnormal perfusion scans. Ventilation scanning increased the probability of pulmonary embolism in patients with large perfusion defects and ventilation mismatch, but a ventilation-perfusion match was not helpful in ruling out pulmonary embolism. Small perfusion defects with mismatch had neither sufficiently high nor low probability to be of diagnostic value. The observed frequency of proximal vein thrombosis (19% to 51%) and its association with the range of ventilation-perfusion defects have important implications for management of pulmonary embolism. Pulmonary angiography is required in combination with venography in most patients with perfusion abnormalities because the probability of pulmonary embolism is neither sufficiently high nor low to confirm or exclude pulmonary embolism.

Adolescent↗
PubMed1976

Osteomyelitis associated with peripheral vascular disease secondary to diabetes mellitus.

Diabetes mellitus and arteriosclerotic vascular disease have been found to be the predisposing factors of osteomyelitis associated with peripheral vascular disease (10). A diabetic person is more susceptible to osteomyelitis because of the microangiopathy, peripheral neuropathy and decreased resistance to infection. In diabetes mellitus there can be microangiopathy which results from the proliferation of the endothelium of the intima and thickening of the basement membrane. This further contributes to a sluggish blood flow. In the patient with arteriosclerotic vascular disease, the lumens of the arterioles and arterioles are compromised by the atheromatous plaques. The anatomic structure of the blood supply to bone along with the pathologic membrane thickening, allows for slowing of blood. This slowing of blood flow causes micro-thrombi and enhances bacterial growth. In diabetes mellitus it has been shown that there is a decreased immunologic response which, along with the above, contributes to the sheltering and proliferation of bacteria in the small bones of the foot.

Adolescent↗
PubMedDate not supplied

The Dynamic Stabilizing Innersole System (DSIS): the management of hyperpronation in children.

In a study of 50 children, the Dynamic Stabilizing Innersole System (DSIS) was found to decrease the mean resting calcaneal stance position (RCSP) by an average of 6 degrees. A comparison between the neutral calcaneal stance position and the RCSP with the DSIS showed no statistically significant difference between the means for the right or left foot, indicating that the DSIS is capable of returning severe flat foot deformities to their neutral calcaneal stance position. The RCSP with and without the DSIS differed significantly, indicating that the DSIS provides a considerable and statistically significant amount of correction in the RCSP in our study population. Furthermore, the results of linear regression showed that the DSIS appears to be sensitive to the severity of the deformity, preventing overcorrection of less severe flatfoot deformities and providing a long awaited alternative to traditional pediatric corrective flatfoot devices.

Adolescent↗
PubMedDate not supplied

Magnetic resonance arthrography of the ankle.

Magnetic resonance (MR) arthrography is a useful technique in evaluating the articular structures of the ankle. With intra-articular administration of gadolinium-DTPA (Gd-DTPA), visualization and delineation of anatomic structures, that would not be depicted by other traditional imaging techniques, are achieved. It is a technique that proves to be advantageous as it does not require the use of ionizing radiation, nor iodinated contrast material as other conventional diagnostic modalities. MR arthrography also allows multiplanar imaging and provides excellent resolution.

Aged↗
PubMedDate not supplied

Modified crescentic osteotomy in children.

A crescentic osteotomy of the first metatarsal is unstable during the preliminary healing stage. The authors present a modification in the direction of the cut of the osteotomy. This alteration increases stability at the first metatarsal base.

Bone Wires↗
PubMedDate not supplied

Tarsal coalition: etiology, diagnosis, and treatment.

Tarsal coalition has been recognized as a pedal anomaly for hundreds of years. Consistent research through the years has led to new advances in the understanding of this problem. New ideas concerning etiology, incidence, diagnosis, and treatment have necessitated a review of the most recent literature concerning tarsal coalition and its associated disorders. The authors present an update on the current therapies, diagnostic modalities, and corrective procedures involved. This article combines the most current imaging techniques with those traditionally accepted. The authors suggest magnetic resonance imaging (MRI) to replace computerized tomography (CT) scan as the diagnostic imaging technique of choice. An analysis of all the surgical procedures is discussed, and suggestions are made as to the most appropriate approach to this insidious and disabling pathology.

Adolescent↗
PubMedDate not supplied

Surgical treatment of osteoid osteoma in an adolescent.

The literature is complete in its review of osteoid osteoma and benign bone-forming tumors. When present in a child, the clinical and radiographic picture is not that clear and often is missed diagnosed. Routine radiographs may not offer a complete diagnosis in this young patient and additional studies are indicated. Tomograms and computerized tomographic (CT) scans, as well as bone scans, provide more information in determining the presence of absence of a bone lesion in the child. A case is presented of an 8-year-old female with pain for over 10 months, eventually diagnosed as an osteoid osteoma. A surgical procedure was performed to excise the lesion and replace it with a corticocancellous bone graft. The child has been followed for the past 5 years and has remained asymptomatic.

Calcaneus↗
PubMedDate not supplied

Candida osteomyelitis.

Medical care of the hospital patient has become increasingly complicated due to the rising incidence of risk factors for opportunistic infection. With intravenous drug use, HIV infection, and alcoholism complicating an immunocompromised host such as a diabetic, fungal and mycobacterial infections are no longer as rare as in previous reports. The authors present a case of Candida osteomyelitis in a patient with multiple risk factors for opportunistic infection.

Amputation, Surgical↗