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Biomedical subjects

R O Nicol

Publications and source records attributed to R O Nicol.

At least 19 recordsLinked to original sources
PubMed2002

Intramedullary fixation for pediatric unstable forearm fractures.

Forty-nine children with diaphyseal both-bone forearm fractures were treated with either both-bone intramedullary wire fixation (24), single ulnar intramedullary wire fixation (22), or single radial intramedullary wire fixation (3). Six fractures were open and 43 were closed. A limited open approach to one or both bones was necessary for insertion of the intramedullary wire in 10 of 43 closed fractures. All both-bone and single radial intramedullary wire fixations healed with less than 5 degrees angulation. Progressive reangulation of the nonfixed radial fracture after an initial satisfactory reduction was seen in seven of the 22 fractures treated with single ulnar intramedullary wire fixation. In four patients, the reangulation was controlled by a change of cast and molding of the fracture and was between 8 degrees and 12 degrees at union. In two other patients a second operative procedure was required to reduce and internally fix the radius. One fracture healed with a radial angulation of 25 degrees. Three fractures in older patients showed late reangulation after early removal of intramedullary wires at 5 weeks. The results of the current study suggest that the radius and ulna should be stabilized with intramedullary wires and that the wires should be buried to reduce the need for early removal.

Adolescent↗
PubMed2000

Genetics of club foot in Maori and Pacific people.

The role of major gene and multifactorial inheritance in the aetiology of club foot in the New Zealand Polynesian population was studied using 287 New Zealand Maori and Pacific club foot families. The club foot family data were analysed by complex segregation analysis under the mixed model using the computer program POINTER. This analysis shows that the best genetic model for club foot in this population is a single dominant gene with a penetrance of 33% and a predicted gene frequency of 0.9%. These data provide a scientific foundation for molecular studies in the Maori and Polynesian population to identify putative club foot genes.

Alleles↗
PubMed1998

An audit of magnetic resonance imaging in the paediatric orthopaedic setting.

AIMS: To determine when magnetic resonance imaging (MRI) is helpful in the management of a selected group of paediatric orthopaedic patients. METHODS: A retrospective analysis of 131 MRI scans was undertaken with allocation into seven categories based on clinical presentation. RESULTS: MRIs performed for spinal, congenital and intra-articular pathology, as well as for growth plate assessment correlated well with subsequent clinical and/or surgical findings. Three of ten MRIs (30%) incorrectly assessed whether a foreign body was present with a sensitivity of 0.60 and specificity of 0.80. Three of 20 MRIs (15%) could not accurately distinguish between oedema/effusion and frank infection. Here sensitivity was 1.00 and specificity was 0.73. MRIs performed for assessment of tumours were accurate with respect to margins and extent. Assessment of pathology with MRI was never the indication for MRI, thus it was not surprising that in four of 27 soft tissue tumours (sensitivity of 0.88 and specificity of 0.63) MRI did not correlate with subsequent histological findings. CONCLUSIONS: MRI plays an important role in the assessment of a wide range of musculo-skeletal pathology. MRI does not, and could not be expected to, replace the need for incisional biopsy for tumour diagnosis. It must be used with caution where tissues have been previously explored for foreign bodies. Interpretation of MRI in musculoskeletal infection must consider its timing in the evolution of the patient's infection.

Adolescent↗
PubMed1997

Remanipulation of forearm fractures in children.

AIMS: To determine whether operator experience or time of operation affects the outcome of fractures of the forearm in the paediatric age group as measured by the need for remanipulation. METHODS: A retrospective analysis of 1155 children with forearm fractures requiring manipulation was undertaken. RESULTS: The remanipulation rate for these 1155 children was 136 or 11.7%. There was a significant difference in those fractures requiring remanipulation dependent upon the experience of the operator and the time of day the procedure was performed. The lowest rate of remanipulation was obtained by senior registrars operating between the hours of 0800-1700 (6/113 or 5.3%). The highest rate was found to be junior registrars between the hours of 1700-2200 (39/167 or 23.3%). It is especially interesting to note the relatively low rate (31/437 or 7.1%) obtained by junior registrars during the night shift (2200-0800 hours). CONCLUSIONS: The current overall remanipulation rate is acceptable. The low rate between 2200-0800 hours means rescheduling of these patients is unnecessary. The rate for junior registrars between 1700-2200 hours needs to be improved.

Adolescent↗
PubMed1989

Clinical manifestations of the thrombocytopenia and absent radii (TAR) syndrome.

Six patients with the classical features of the TAR syndrome were diagnosed at birth. In one case an older sibling was also affected. The characteristic features of foreshortened forearms and radially deviated hands were noted in all cases at presentation and confirmed radiologically. With one exception skeletal abnormalities of the lower limbs were also present. Varying degrees of thrombocytopenia were present at birth with three of the five patients having platelet counts below 50 x 10(9)/L. Bone marrow examination was performed in two patients and revealed an absence of normal megakaryocytes. Two patients with severe thrombocytopenia had bleeding complications during infancy requiring transfusion support. Severe gastroenteritis occurred in two patients, in one of whom it was attributed to cow's milk intolerance. In all patients the platelet count has risen progressively since birth. Orthopedic surgical procedures have been performed without hemorrhagic complications.

Diseases in Twins↗
PubMed1986

Lytic spondylolysis. Repair by wiring.

A technique for repairing the defect in spondylolysis by wiring is presented together with the results achieved in seven patients; the follow-up ranged from 2 to 12 years. The relative simplicity of the technique is stressed; and the technical problems likely to be encountered, together with the modifications of the basic technique necessary to cope with them, are noted. When conservative methods have been tried without success and the patient has a lesion at one or more levels and is less than 30 years old at presentation, then the technique described will give predictable results with regard to union of the defect and patient function.

Adolescent↗
PubMed1985

Closed fractures complicated by acute hematogenous osteomyelitis.

Osteomyelitis developed at closed fracture sites in two children. The infection responded to antibiotic therapy, and the fractures healed without chronic infection developing, impairment of bone growth, or loss of function. It is rare for a closed fracture to develop acute hematogenous osteomyelitis, but the diagnosis should be considered in a child with a closed fracture in whom a fever develops or who complains of increasing pain after the fracture has been reduced and immobilized. In children, the condition has an excellent prognosis.

Adolescent↗
PubMed1984

Transient osteopaenia of the hip in children.

The syndrome of transient osteopaenia of the hip is described in children for the first time. Six children 6-12 years of age are presented with follow-up between 1 and 4 years. The presenting symptoms, clinical signs, investigations, and radiologic changes are described, together with the findings at arthrotomy of the affected joints. This syndrome in children closely parallels that described in adults, but, presumably because of growth potential, enlargement of the affected bones occurred in two patients. Management, with emphasis on excluding more sinister pathology and avoiding excessive treatment, is outlined. The fact that the syndrome is characterised by spontaneous resolution is stressed.

Child↗
PubMed1983

Correction of combined tibial torsion and valgus deformity of the foot.

Patients with spina bifida cystica commonly have significant disability from a combination of valgus deformity of the ankle and subtalar joints with lateral tibial torsion and plano-abduction deformity of the foot. These deformities can be corrected by a single procedure which combines a supramalleolar tibial osteotomy with a lateral inlay triple fusion. This procedure was carried out on 20 feet in 15 patients and the results were reviewed after an average of three years (range 18 months to 7 years). In 75 per cent of feet the combination of deformities was fully corrected, ulcers and callosities were eliminated in 95 per cent, the use of calipers minimised in 95 per cent, and in all patients the problem of shoe-wrecking was reduced. Complications included recurrent valgus deformity, delayed union of the tibial osteotomy and failure of midtarsal fusion.

Adolescent↗
PubMed1981

Staging laparotomy in Hodgkin's disease.

A surgeon's experience in staging laparotomy for Hodgkin's disease over an eight-year period is reviewed. The laparotomies concerned were the vast majority of such staging procedures done in this regional centre over this period. A relatively large series of staging operations performed by one surgeon has thus been accumulated and demonstrates the value of experience, and in the light of the allows questioning of the need for some of the steps considered to be basic to staging laparotomy. In the 19 cases reviewed, staging laparotomy altered the method of management in 44%.

Adolescent↗
PubMed1980

Ruptured abdominal aortic aneurysm: a five year review.

This review of patients presenting with ruptured abdominal aortic aneurysm over a five year period shows a high mortality. The natural history of the problem of abdominal aortic aneurysm and the place of elective aneurysmectomy is stressed. Factors affecting the outcome after rupture in the forty-six patients presenting in this five year period are reviewed. Ten patients survived to leave hospital.

Adult↗
PubMed1975

A study of the normal range of blood pressure in the aged New Zealand male.

A study of blood pressure in males 60 years of age and over, its relationship to age, ideal body weight and time of day, was performed by taking a total of 442 recordings on 133 subjects. No relationship between arterial pressure and increasing age was demonstrable. The relationship between arterial pressure and ideal body weight which exists in other sectors of the population also exists in this age group. In this age group, arterial pressure was not found to vary significantly during the day.

Age Factors↗
PubMedDate not supplied

A selective treatment approach to supracondylar fracture of the humerus in children.

The results of a "selective treatment" policy applied to 176 patients presenting with supracondylar fracture of the humerus are analyzed. As initial treatment 148 patients underwent closed reduction and casting, seven closed reduction and pinning, 17 olecranon traction, and four open reduction and pinning. Analysis of patients by fracture type and initial treatment demonstrated a satisfactory outcome in 46 of 75 type III fractures and in 37 of 48 patients with type II fractures treated by closed reduction and casting. Thus a policy of initially pinning all such type III fractures in our unit would mean that 61% of such fractures would be pinned needlessly. Of type II fractures 77% would be needlessly pinned if such a policy was applied to type II fractures. The current trend towards pinning of all type III supracondylar fractures is not supported by the data from this study.

Adolescent↗
PubMedDate not supplied

Synovectomy of the knee in hemophilia.

Synovectomy of the knee in patients with hemophilia presenting in countries with demographic characteristics that make central referral difficult is the subject of this article. Ten patients, six surgeons, and two countries contributed to this study, which demonstrated that approximately 40% of these patients had no further hemarthroses into the affected joint and the remainder had reduced frequency and severity of bleeding. Continuous passive motion has an important place in postoperative management, and manipulation with the patient under anesthesia is of doubtful value. The possible relationship between diminished range of movement and a successful outcome in terms of abolition of hemorrhage is explored. One patient underwent synovectomy of the knee without complication; the other nine suffered significant complications.

Adolescent↗
PubMedDate not supplied

Use of the Cincinnati incision in congenital talipes equinovarus.

A series of 16 patients (24 feet) with idiopathic congenital talipes equinovarus (CTEV) corrected by a Cincinnati incision is presented. Minimum follow-up was 2 years. This series demonstrated that the incision does not adversely affect the outcome, since 75% of these feet had a good or excellent correction. No significant wound problems were encountered. The advantages of the Cincinnati incision, together with the fact that no adverse sequelae resulted from its use, mean that it can be recommended for future use and should be taught to other physicians.

Child, Preschool↗