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Biomedical subjects

R Sherman

Publications and source records attributed to R Sherman.

At least 19 recordsLinked to original sources
PubMed1995

Results of bone grafting for infected tibial nonunion.

Thirty-two patients with infected tibial nonunions were treated, including 24 men and 8 women whose ages ranged from 21 to 72 years (mean, 40 years). Thirty of 32 patients had bone defects < 3 cm. Using the Cierney-Mader classification of osteomyelitis, 11 of 32 (35%) patients were Stage 4A, and 21 of 32 (65%) patients were Stage 4B. All patients had irrigation, debridement, and stabilization using an external fixation device. Twenty-seven (84%) patients had muscle transfers. The time between initial debridement and muscle transfer ranged from 3 to 24 days (mean, 4 days). Bone grafting was performed between 6 weeks and 8 months (mean, 8 weeks) after soft tissue coverage. Patients received intravenous antibiotics for 2 to 6 weeks (mean, 6 weeks). Twenty patients received anterior grafting, 10 received posterolateral grafting, and 2 received both. Followup times ranged from 12 to 49 months (mean, 28 months). Twenty-nine of the 32 (91%) patients had tibial unions between 3 to 10 months (mean, 5.5 months) after bone grafting. The 3 failed tibias united after posterolateral grafting. Infection was controlled in all 32 patients. Autogenous cancellous bone grafting using infection control principles is an effective means to treat infected tibial nonunions.

Adult↗
PubMed1992

Tinel's sign and Phalen's test in carpal tunnel syndrome.

Tinel's sign and Phalen's test are two provocative tests used in the diagnosis of carpal tunnel syndrome. A review of the literature reveals a wide range of sensitivity for these tests. Analyzing the historical data and comparing these to the Tinel's sign and Phalen's test results of 100 individuals without carpal tunnel syndrome (200 wrists), we conclude that the Tinel's sign is not useful in the evaluation of patients with carpal tunnel syndrome, whereas Phalen's test, which has a greater sensitivity and specificity, can be of use.

Adolescent↗
PubMed1992

Child abuse by scalding.

Physical abuse of children by burning is a serious crime that leaves the youngest of our children with permanent physical and emotional scars. The victims tends to be less than 2 years of age. Burn-abused children usually suffer from a spectrum of physical, psychologic, and nutritional neglect. Burn abuse is costly in terms of pain, suffering and health care. Up to 15% of acutely injured children seen in emergency departments, admitted or not, have been abused. Burns were involved in up to 22% of physical abuse cases. Up to 26% of pediatric burn admissions were the result of abuse. The most common form of burn abuse in children requiring hospitalization is the scald. Physicians who treat children and burn patients should have a knowledge of the literature and clinical factors associated with pediatric burn abuse.

Burns↗
PubMed1992

Review of treatment results for Kienbock's disease.

A review of the literature reveals that Kienbock's disease has been treated in many different ways. Excision of the lunate, with or without replacement arthroplasty, and joint-leveling procedures (radial shortening or ulnar lengthening) are the most popular procedures, but other methods of treatment (nonoperative, wrist denervation, lunate revascularization, intercarpal arthrodesis and proximal-row carpectomy) have also been performed. Based on our current understanding of the etiology, a joint-leveling procedure seems to make the most sense when surgery is indicated. However, other procedures have yielded a high success rate as well.

Carpal Bones↗
PubMed1992

Aging alters ornithine decarboxylase and decreases polyamines in regenerating rat liver but putrescine replacement has no effect.

Aging decreases rat liver regeneration. We (1) compared the expression of ornithine decarboxylase (ODC), a critical enzyme for liver regeneration, and polyamine levels in regenerating liver of 6-week-old and 1-year-old rats and (2) evaluated the effect of exogenous putrescine supplementation on liver regeneration in 1-year-old rats. ODC messenger ribonucleic acid (mRNA) transcript sizes were the same in rats of both ages. ODC mRNA content and enzyme activity were higher in the younger rats; however, magnitudes of increase after partial hepatectomy were greater in the older rats. From peak levels, the rate of decline of the mRNA was slower in the older rats, but enzyme activity declined at the same rate in both ages. ODC apoenzyme content was significantly less in normal liver tissue from 1-year-old rats, but there was little change after partial hepatectomy in rats of either age. No change in ODC transcriptional activity was found. Hepatic putrescine levels were lower in 48 hours regenerating liver tissue from 1-year-old rats. To determine whether supplemental putrescine would increase liver regeneration in 1-year-old rats, putrescine (600 mumol/kg IP every 4 hours) was administered beginning 4 days before or at the time of partial hepatectomy. This raised polyamine levels and decreased ODC activity significantly, but there was no change in regenerating liver weight, total DNA and RNA content, and tritiated thymidine incorporation at 48 hours. These results indicate that ODC expression is different and polyamine levels are lower in 1-year-old rats than in 6-week-old rats. However, putrescine supplementation that is sufficient to decrease ODC activity has no apparent effect on regeneration.

Aging↗
PubMed1991

A biomechanical evaluation of a cannulated compressive screw for use in fractures of the scaphoid.

The compressive force generated by a 3.5 mm ASIF cannulated cancellous screw with a 5 mm head was compared with that generated by a standard 3.5 mm ASIF screw (6 mm head), a 2.7 mm ASIF screw (5 mm head), and a Herbert screw. The screws were evaluated in the laboratory with the use of a custom-designed load washer (transducer) to the maximum compressive force generated by each screw until failure, either by thread stripping or by head migration into the specimen. Testing was done on paired cadaver scaphoids. To minimize the variability that occurs with human bone, and because of the cost and difficulty of obtaining human tissue specimens, a study was also done on polyurethane foam simulated bones. The 3.5 cannulated screw generated greater compressive forces than the Herbert screw but less compression than the 2.7 mm and 3.5 mm ASIF cortical screws. The 3.5 mm cannulated screw offers more rigid internal fixation for scaphoid fractures than the Herbert screw and gives the added advantage of placement over a guide wire.

Biomechanical Phenomena↗
PubMed1991

External fixation of extremity flaps and grafts.

Positioning extremities after soft-tissue reconstructive procedures can be difficult, particularly when flaps or skin grafts have been placed for posterior or circumferential defects. We describe a method using the patient's existing external fixator, when present, to aid in the postoperative care and positioning of the patient.

Adult↗
PubMed1991

Aging is associated with reduced liver regeneration and diminished thymidine kinase mRNA content and enzyme activity in the rat.

We studied the effect of aging on rat liver regeneration. We compared the time course of total hepatic mass, DNA and RNA accumulation, and thymidine kinase (TK) messenger RNA (mRNA) content and enzyme activity, after two-thirds partial hepatectomy in 6-week-old (young adult) and 1-year-old rats. Whereas 6-week-old rats had completely regenerated all liver mass, DNA, and RNA by 7 days, the regenerating 1-year-old rat livers at 7 days contained only 60% to 70% of the mass, DNA, and RNA in the normal 1-year-old rat liver. However, rates of tissue regeneration during this time were very similar in both ages. At 28 days the weight and RNA content of the 1-year-old rat livers were 93% of normal, but total DNA was still reduced, at 78% of normal. In the younger rats TK mRNA content and enzyme activity increased substantially after partial hepatectomy and were observed to peak at 24 hours. In the 1-year-old rats TK mRNA was less abundant in normal liver and the peak level observed was lower and delayed until 48 hours. Nonetheless, the incremental increase from baseline to peak was greater in the 1-year-old than in the 6-week-old rats. In contrast to the mRNA, TK activity peaked at 24 hours, but at substantially lower levels than in the 6-week-old rats. Rates of disappearance of TK mRNA and enzyme activity after peak levels were not significantly different by age.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1991

Chronic fatigue syndrome in Minnesota.

Chronic fatigue syndrome (CFS), an illness characterized by debilitating fatigue and a number of associated symptoms, was identified in 135 patients using the case definition provided in 1988. The demographic features of these patients, 97% of whom resided in Minnesota, were similar to those reported elsewhere. About three-fourths of the cases occurred between 1984 and 1989, and in 123 (91.1%), the illness began with what appeared to be an acute infection. Patients had been ill for an average of 4.3 years before enrollment in the study. Fatigue was their most troublesome symptom, although a majority of the patients rated most of the general symptoms and neuropsychological complaints associated with CFS as moderate or severe. Follow-up data obtained on 62 patients one year after initial evaluation revealed that none had completely recovered. However, about 40% reported some improvement in each of the CFS symptoms.

Adult↗
PubMed1991

Spontaneous pneumoperitoneum. A surgical dilemma.

Pneumoperitoneum is usually the result of hollow viscus perforation with associated peritonitis. Nonsurgical spontaneous pneumoperitoneum incidental to intrathoracic, intra-abdominal, gynecologic, iatrogenic, and other miscellaneous causes not associated with perforated viscus have been documented in the literature. Seven cases of spontaneous pneumoperitoneum admitted over 3-year period to Grady Memorial Hospital, Atlanta, Georgia are reported. Six patients with pneumoperitoneum underwent exploratory laparotomy when clinical examination suggested an acute abdomen; no intra-abdominal pathology was documented in any of these patients. A seventh patient, on ventilatory support, was managed conservatively after performing a diagnostic peritoneal lavage that was negative. There were no cases of radiographically misdiagnosed pneumoperitoneum. Pneumoperitoneum, preceded by a reasonable incidental cause in a patient with a adequate abdominal examination, may warrant continued observation thus avoiding an unnecessary laparotomy.

Adult↗
PubMed1990

Urinary hydroxyproline in infants with and without fractures/rickets.

Molar ratios of peptide-bound and free hydroxyproline:creatinine (OHPr:Cr) in urine were measured at 3, 6, 9, and 12 months of age in two groups of very-low-birthweight (VLBW less than or equal to 1500 g) infants. Group A (15 infants) had radiographically confirmed fractures and (or) rickets (F/R); Group B (17 infants) did not. The urinary peptide-bound OHPr:Cr ratio varied widely within groups and was greatest at three months in both groups: A = 0.81 +/- 0.45 and B = 0.55 +/- 0.32 (mean +/- SD). The ratio decreased with increasing postnatal age for each group but was not statistically different between groups throughout the study. The urinary free OHPr:Cr ratio also was greatest at age three months (A = 0.32 +/- 0.15 and B = 0.53 +/- 0.46), rapidly decreasing afterwards, and was not statistically different between groups throughout the study. We conclude that, in VLBW infants, bone turnover as indicated by the urinary peptide-bound OHPr:Cr ratio is highest during early infancy; however, the wide range of values for this ratio suggests that its use alone is not sufficient for detection of F/R in VLBW infants. The rapid decrease in free OHPr:Cr ratio is presumably related to the maturation of renal tubular function.

Body Height↗
PubMed1989

Serum vitamin D metabolites in very low birth weight infants with and without rickets and fractures.

Seventy-one very low birth weight (less than or equal to 1500 gm) infants were studied to determine the sequential changes in serum vitamin D metabolite concentrations between infants with and without radiographically documented rickets, fractures, or both (R/F). Usual intake of vitamin D included 20 IU/kg/day from parenteral nutrition or 400 IU/day supplementation with enteral feeding. Radiographs of both forearms and serum samples were obtained at 3, 6, 9, and 12 months. Twenty-two infants had R/F. At 3 months, significantly lower mean (+/- SEM) serum phosphorus levels (4.5 +/- 0.4 vs 6.1 +/- 0.2 mg/dl), higher 1,25-dihydroxyvitamin D (1,25-[OH]2D) concentrations (96 +/- 5 vs 77 +/- 4 pg/ml), and higher free 1,25-(OH)2D index (1,25-[OH]2D:vitamin D binding protein ratio; 5.2 +/- 0.3 x 10(5) vs 4.0 +/- 0.2 x 10(5] were found in the R/F group. These values returned to normal and were similar between groups on subsequent measurements. Serum calcium, magnesium, and 25-hydroxyvitamin D (25-OHD) concentrations were normal and similar between groups. In both groups, serum vitamin D binding concentrations increased initially but remained stable and normal beyond 6 months. We conclude that in very low birth weight infants with R/F, the vitamin D status (as indicated by serum 25-OHD concentrations) is normal, and that lowered serum phosphorus levels, higher serum 1,25-(OH)2D levels, and a higher free 1,25-(OH)2D index support the thesis that mineral deficiency (especially of phosphorus) may be important in the pathogenesis of R/F in small preterm infants.

Calcifediol↗
PubMed1989

The role of CT scan in evaluation for laparotomy in patients with stab wounds of the abdomen.

Not every patient with a penetrating stab wound of the abdomen requires laparotomy. This report evaluates use of computerized tomographic (CT) scan in assessment of stable asymptomatic patients, with penetrating abdominal stab wounds, as an indicator of the necessity of abdominal exploration. In a prospective study, 50 patients with abdominal stab wounds were treated successfully with observation only, after admission abdominal CT scan interpretation was negative for pathology in 45 patients. In the remaining five it was of such minor nature that conservative management was justified (Series I). Twenty-eight stable asymptomatic patients with penetrating stab wounds of the abdomen comparable to the ones in Series I had CT scan on admission, and then underwent exploratory laparotomy independent of their CT scan findings (Series II). Of these 28 patients, 22 had correct CT scan findings verified by laparotomy, three were false positive for intra-abdominal injury resulting in negative explorations, and three patients had such nonspecific findings as fluid or air in the abdomen incompatible with precise organ injury identification. Our study shows that CT scan in patients with abdominal stab wounds identifies solid organ injury with great specificity and sensitivity, evaluates the retroperitoneum well, and detects peritoneal penetration by demonstrating intraperitoneal fluid or air. CT scan was unreliable in detection of bowel injury and does not demonstrate diaphragmatic injuries.

Abdominal Injuries↗