Biomedical subjects

Rishi Bhatnagar

Publications and source records attributed to Rishi Bhatnagar.

5 recordsLinked to original sources

PubMed2006

Staged pelvic closure of extreme pubic diastasis in the exstrophy-epispadias complex.

PURPOSE: Staged pelvic closure has been shown to be beneficial in achieving pubic approximation in children with the exstrophy-epispadias complex. We have continued to use this procedure in children with extreme pelvic diastasis and have updated our experience. MATERIALS AND METHODS: We performed closure of the pelvis in 15 patients 12 months to 14 years old presenting with a pubic diastasis of at least 8 cm (range 8 to 16). Of the patients 14 had cloacal exstrophy and 1 had classic exstrophy. Two patients with cloacal exstrophy and the patient with classic exstrophy had prior complete dehiscence at primary closure, and 1 patient with cloacal exstrophy had partial dehiscence. The technique involved bilateral innominate and vertical iliac osteotomy, and placement of a bony fixator with interfragmentary pins. The fixator was gradually closed, and soft tissue and pelvic ring closure occurred 2 to 3 weeks later. In 9 of the 15 patients an interpubic stainless steel plate was used to keep the pubis in apposition at the time of bladder closure. RESULTS: At a mean followup of 5.5 years (range 6 months to 14 years) closure was successful in all 15 patients. One patient (age 12 months) had loosening of the pin between stages, which was salvaged with pin replacement. One patient had ureteral obstruction from hematoma after pin placement without direct pressure from the pins or bone. None of the patients had dehiscence or prolapse. CONCLUSIONS: This technique of staged pelvic closure can be used in the setting of primary or secondary pelvic reconstruction in patients presenting with extreme pelvic diastasis. The gradual reduction in diastasis allows gradual stretching of the soft tissues. It converts a major reconstruction challenge into 2 well tolerated components. However, the procedure is not recommended in children younger than 1 year due to the possibility of the pins loosening during diastasis reduction.

Adolescent↗

PubMed2006

Temporary internal distraction as an aid to correction of severe scoliosis.

BACKGROUND: Halo traction is a well-recognized adjunct for correcting severe complex rigid scoliotic curves, but it is associated with complications and is contraindicated in the presence of fixed cervical instability, kyphosis, or stenosis. In addition, halo traction often requires prolonged hospital stays and is not welcomed by all families. These limitations led to consideration of temporary internal distraction as an alternative. METHODS: We retrospectively reviewed the records of children in whom severe scoliosis had been treated with temporary internal distraction. Our goals were to (1) assess whether the use of temporary internal distraction can aid in the correction of severe scoliosis and (2) identify complications associated with temporary internal distraction and compare them with those associated with halo traction. The mean preoperative curve was 104 degrees . All patients underwent initial posterior release of the rigid portion of the spine (with six also having anterior release) and placement of spinal instrumentation under distraction during spinal cord monitoring. Of the ten patients, four had one distraction procedure (i.e., the initial surgery [or first distraction] followed by definitive fusion and the remaining six had two distraction procedures (i.e., the initial surgery [or first distraction] followed by the second distraction) followed by definitive fusion. After distraction, all patients underwent posterior spinal fusion with definitive dual-rod fixation. The amount of correction was determined by measuring the curve on plain radiographs made preoperatively, after each internal distraction procedure, after definitive fusion, and at the time of final follow-up. RESULTS: Curve correction after use of internal distraction, and before definitive fusion, averaged 53% (from 104 degrees to 49 degrees ) (range, 39% [from 70 degrees to 43 degrees ] to 79% [from 70 degrees to 15 degrees ]). This method facilitated safe, gradual deformity correction in all ten patients. The mean time between the initial procedure and the definitive fusion was 2.4 weeks. The mean final curve correction was 80% (from 104 degrees to 20 degrees ) (range, 73% [from 131 degrees to 35 degrees ] to 91% [from 110 degrees to 10 degrees ]). No neurologic deficits or infections resulted. CONCLUSIONS: Temporary internal distraction is a viable alternative approach to maximizing curve correction in patients undergoing spinal fusion for severe scoliosis. LEVEL OF EVIDENCE: Therapeutic Level IV.

Adolescent↗

PubMed2006

Diagnosis and treatment of common fractures in children: femoral shaft fractures and supracondylar humeral fractures.

Femoral shaft fractures and supracondylar elbow fractures are two of the most common major pediatric injuries managed by the general orthopedic surgeon. Therapeutic choices frequently are influenced by many factors, including associated injuries, fracture type, and the child's age, social situation, and economic issues. Nonsurgical management of femoral shaft fractures has been a preferred and cost-effective treatment for most age groups, but recently the use of surgical techniques has gained popularity with the overall goal of rapid mobilization of the child. Supracondylar elbow fractures are diagnostically challenging and can result in severe acute and long-term complications. An understanding of fracture presentation, anatomic detail, and surgical applications will optimize the chances for successful outcomes.

Bone Plates↗

PubMed2006

Adolescent idiopathic scoliosis: modern management guidelines.

Adolescent idiopathic scoliosis (AIS), a structural lateral curvature of the spine of uncertain etiology, is the most common cause of spinal deformity in adolescents. In its most severe form, AIS is characterized by progressive spinal curvature that may lead to a permanent deformity. Thus, the goal of treatment is early detection and prevention of progression. This article provides a review of general spinal anatomy relevant to AIS and its etiology, describes several proposed methods of classifying curves in AIS, delineates the natural history of AIS, and discusses the nonoperative and operative treatment options.

Adolescent↗

PubMed2005

Comparative case study of two biomedical research collaboratories.

BACKGROUND: Working together efficiently and effectively presents a significant challenge in large-scale, complex, interdisciplinary research projects. Collaboratories are a nascent method to help meet this challenge. However, formal collaboratories in biomedical research centers are the exception rather than the rule. OBJECTIVE: The main purpose of this paper is to compare and describe two collaboratories that used off-the-shelf tools and relatively modest resources to support the scientific activity of two biomedical research centers. The two centers were the Great Lakes Regional Center for AIDS Research (HIV/AIDS Center) and the New York University Oral Cancer Research for Adolescent and Adult Health Promotion Center (Oral Cancer Center). METHODS: In each collaboratory, we used semistructured interviews, surveys, and contextual inquiry to assess user needs and define the technology requirements. We evaluated and selected commercial software applications by comparing their feature sets with requirements and then pilot-testing the applications. Local and remote support staff cooperated in the implementation and end user training for the collaborative tools. Collaboratory staff evaluated each implementation by analyzing utilization data, administering user surveys, and functioning as participant observers. RESULTS: The HIV/AIDS Center primarily required real-time interaction for developing projects and attracting new participants to the center; the Oral Cancer Center, on the other hand, mainly needed tools to support distributed and asynchronous work in small research groups. The HIV/AIDS Center's collaboratory included a center-wide website that also served as the launch point for collaboratory applications, such as NetMeeting, Timbuktu Conference, PlaceWare Auditorium, and iVisit. The collaboratory of the Oral Cancer Center used Groove and Genesys Web conferencing. The HIV/AIDS Center was successful in attracting new scientists to HIV/AIDS research, and members used the collaboratory for developing and implementing new research studies. The Oral Cancer Center successfully supported highly distributed and asynchronous research, and the collaboratory facilitated real-time interaction for analyzing data and preparing publications. CONCLUSIONS: The two collaboratory implementations demonstrated the feasibility of supporting biomedical research centers using off-the-shelf commercial tools, but they also identified several barriers to successful collaboration. These barriers included computing platform incompatibilities, network infrastructure complexity, variable availability of local versus remote IT support, low computer and collaborative software literacy, and insufficient maturity of available collaborative software. Factors enabling collaboratory use included collaboration incentives through funding mechanism, a collaborative versus competitive relationship of researchers, leadership by example, and tools well matched to tasks and technical progress. Integrating electronic collaborative tools into routine scientific practice can be successful but requires further research on the technical, social, and behavioral factors influencing the adoption and use of collaboratories.

Acquired Immunodeficiency Syndrome↗