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Biomedical subjects

S M Lambert

Publications and source records attributed to S M Lambert.

13 recordsLinked to original sources
PubMed2000

Making history: Thomas Francis, Jr, MD, and the 1954 Salk Poliomyelitis Vaccine Field Trial.

This article focuses on the poliomyelitis vaccine field trial directed by Thomas Francis,Jr, MD, of the University of Michigan Vaccine Evaluation Center and sponsored by the National Foundation for Infantile Paralysis (NFIP) or, as it was better known to the public, the March of Dimes. It was a landmark in the widescale testing of a vaccine and the ethical use of human subjects. Millions of American parents readily volunteered their healthy children to participate. A total of 150,000 volunteers, including schoolteachers, physicians, nurses, and health officers all endorsed the study and donated their time and effort to make it successful. Avoiding the use of marginalized groups, the field trial purposefully did not involve institutionalized children; instead, it was based in 15,000 public schools in 44 of the 48 states as clinic sites. A group of 650,000 children received some type of injection, either the vaccine or a placebo, and another 1.18 million served as controls. The field trial depended, most essentially, on both public support and the participation of millions of children who remained enrolled in a study that required a series of 3 injections and a 6-month evaluation period. Enlisting the huge number of participants presented practical examples of the difficulties in experimenting on human subjects. On April 26, 1954, Randy Kerr, a participant or "Polio Pioneer" as the children involved were called, received the first inoculation of the Salk poliomyelitis vaccine. The nationwide study "designed to test the safety and efficacy" of the Salk vaccine had officially begun.

Child↗
PubMed1999

On the timing of soft-tissue reconstruction for open fractures of the lower leg.

The timing of soft-tissue reconstruction for severe open fractures of the lower leg is considered crucial to the later outcome, and yet pertinent publications are few. The purpose of this study was to add some based on evidence arguments for the choice of the most adequate timing in the management of these injuries. Twenty-nine consecutive open fractures of the tibia, including 24 grade 3B and 5 grade 3C fractures, were treated using a protocol of immediate debridement, early definitive skeletal stabilisation and early soft-tissue reconstruction. Fifteen lower legs were reconstructed after a mean delay of 4.4 days (range 1-9 days), while 14 lower legs were reconstructed immediately, i.e. as an emergency procedure on the day of admission. Both groups were comparable for sex, age, type of trauma, associated general injuries, type of fracture, associated arterial lesion, associated tendon rupture, type of soft-tissue reconstruction and duration of follow-up. All patients were reviewed at a mean follow-up of 47 months (range 15-89 months). In the delayed reconstruction group the time to full, unprotected weight-bearing (P = 0.0021), the time to definitive union (P = 0.0049), the number of reoperations (P = 0.0001) and the infection rate (P = 0.0374) were significantly higher. The data suggest that immediate reconstruction is, the general condition of the patient permitting, the timing of choice for soft-tissue coverage.

Adolescent↗
PubMed1996

Allograft reconstruction of segmental defects of the humeral head for the treatment of chronic locked posterior dislocation of the shoulder.

The recognized options for the treatment of chronic locked posterior dislocation of the shoulder are dependent on the size of the anteromedial defect of the humeral head. Transfer of the lesser tuberosity with its attached subscapularis tendon into the defect is recommended for defects that are smaller than approximately 40 per cent of the joint surface. Prosthetic replacement is preferred for larger defects. Four consecutive patients who had a chronic locked posterior dislocation of the glenohumeral joint associated with a defect of the humeral head that was at least 40 per cent of the articular surface were managed with reconstruction of the shape of the humeral head with use of an allogeneic segment of the femoral head. Stability was restored and maintained in each patient at an average of sixty-eight months (range, sixty to seventy-six months) after the procedure. Three patients reported little or no pain and no or slight functional restrictions in the activities of daily living, and they considered the result to be satisfactory. The fourth patient had mild pain and moderate-to-severe dysfunction secondary to avascular necrosis of the remaining portion of the humeral head after a symptom-free period of six years.

Activities of Daily Living↗
PubMed1994

Fractures of the humeral capitellum: Herbert screw fixation.

During the first half of 1991, five patients with displaced fractures of the humeral capitellum were managed by open reduction and fixation of the capitellar fragments with Herbert bone screws. All patients had stable, painfree elbows at follow-up, with no restriction of normal daily activities. There were no evidence of early avascular necrosis of capitellar fragments, even where soft tissue attachments of small fragments had been injured. This method of fixation allows accurate restoration of the articular surface of the humero-radial joint and may therefore contribute to the excellent functional results following this injury in these patients.

Adult↗
PubMed1993

Transfer of multiply-injured patients for neurosurgical opinion: a study of the adequacy of assessment and resuscitation.

A total of 21 consecutive referrals with multiple injuries (Injury Severity Score (ISS) 17-66), admitted into the Regional Neurosurgical Unit (RNSU) over a 1-year period from August 1989, was analysed to evaluate the risks associated with transfer of such patients from district general hospitals within the North West Thames Region. Injury assessment was deficient in nine cases. Four developed hypovolaemic shock during transfer, and in five resuscitation was inadequate. Four had minor head injuries and two had no head injury; of these cases, one died. There were four fatalities: the mean ISS in this group was 42, and in all cases deficiencies in resuscitation and assessment before transfer were identified. There were seven major missed injuries. All patients had musculoskeletal injuries and 16 required orthopaedic intervention within 6 h. Interhospital transfer of this group of patients carries significant risks, may be unnecessary, and may delay other surgical priorities.

Craniocerebral Trauma↗
PubMed1984

Modification of guanine nucleotide-regulatory components in brain membranes. I. Changes in guanosine 5'-triphosphate regulation of opiate receptor-binding sites.

Guanine nucleotides regulate binding of opiate agonists to membrane receptors by increasing agonist dissociation rates. The current study demonstrates that the ability of guanosine 5'-triphosphate (GTP) and its nonhydrolyzable analogue guanylyl-5'-imidodiphosphate (Gpp(NH)p) to inhibit opiate agonist binding to rat brain membranes can be altered by two methods: by preincubating with EDTA, and by preincubating at pH 4.5. EDTA pretreatment increased the potency of Gpp(NH)p in inhibiting [3H]morphine binding by 4-fold, with little apparent change in the maximum effect of Gpp(NH)p or on levels of binding itself. The effect of EDTA pretreatment was blocked by prior incubation of membranes with excess calcium or manganese but could not be reversed by any divalent cation if the EDTA incubation was longer than 10 min. EDTA pretreatment increased the effects of GTP on dissociation rates of agonists. Pretreatment of membranes at pH 4.5 increased the ability of guanine nucleotides to regulate agonist binding by increasing the maximum effect of Gpp(NH)p from 50% to 80% inhibition of [3H]morphine binding with minor increase in potency of Gpp(NH)p. The actions of EDTA and low pH pretreatments were additive when both were conducted on the same membranes. These results suggest that modification of brain membranes can alter the interaction of receptors with guanine nucleotide-regulatory components which may lead to changes in post-receptor membrane events.

Animals↗
PubMed1983

Selective alterations in guanine nucleotide regulation of opiate receptor binding and coupling with adenylate cyclase.

Pretreatment of rat brain membranes at pH 4.5 increased GTP and Gpp(NH)p regulation of [3H]-D-ala2-met5-enkephalinamide (D-ala-enk) binding with no change in absolute binding itself. Pretreatment at pH 4.5 did not alter basal adenylate cyclase activity but did cause a loss (50-90%) in NaF- and Gpp(NH)p-stimulated activity, indicating a functional loss of GTP-coupling proteins. The addition of cis-vaccenic acid partially restored NaF- and Gpp(NH)p-stimulated cyclase after low pH pretreatment but, in the same membranes, did not reverse the increase in GTP regulation of agonist binding. These results suggest that GTP regulation of binding and stimulation of adenylate cyclase occur by fundamentally different mechanisms.

Adenylyl Cyclases↗
PubMedDate not supplied

Decortication and plate osteosynthesis for nonunion of the clavicle.

Between 1968 and 1995, 37 patients with ununited fractures of the clavicle were treated by decortication and plate osteosynthesis. Thirty-two (86%) were failures of union of fractures of the middle third. Thirty-four (92%) patients had post-traumatic nonunion or delayed union. Sixteen (43%) patients had undergone primary operative treatment. Autogenous cancellous bone graft was used in 24 (65%) patients with atrophic nonunion. Nine tricortical, iliac crest, intercalary grafts were used for segmental bone loss equal to or greater than 15 mm. At the end of treatment, union had been achieved in 35 (95%) cases. At a mean follow-up of 8.6 years (range 13 months to 17 years), 32 (86%) patients had no symptoms and had a full range of motion of the shoulder. Decortication with plate osteosynthesis is a reliable, durable technique for the management of symptomatic, ununited fractures of the clavicle.

Adolescent↗
PubMedDate not supplied

The deltoid extension lag sign for diagnosis and grading of axillary nerve palsy.

The deltoid extension lag sign has been developed to avoid the pitfalls confounding the diagnosis of an axillary nerve lesion. The physician elevates the arm into a position of near full extension. The patient is asked to attempt active maintenance of this position. If the deltoid is weak, the arm will drop. In five patients with traumatic axillary nerve palsy after anterior dislocation of the shoulder, the deltoid extension lag sign was used to evaluate the functional status of the deltoid muscle. The magnitude of the angular drop, or lag, of the arm was a precise indicator of the functional status and recovery of the deltoid. The sign proved to be objective and reproducible, allowing confident assessment of deltoid function and when repeated over time allowed precise follow-up of deltoid recovery.

Adolescent↗