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Biomedical subjects

S M McCarthy

Publications and source records attributed to S M McCarthy.

52 records · Page 3Linked to original sources
PubMed1982

Radiology of postnatal skeletal development. V. Distal humerus.

Thirty-one pairs of distal humeri were obtained from human cadavers ranging in age from full-term neonates to fourteen years. These were studied morphologically and roentgenographically. Specimen roentgenography using air/cartilage interfacing demonstrated both osseous and cartilaginous components of the epiphyses. These roentgenographic aspects of development are discussed and illustrated to provide a basis reference index. The supracondylar region is characterized by a fossa which initially is in both metaphysis and epiphysis, but migrates to the metaphysis completely within the first year. On either side of the fossa are osseous columns, which contrast with the broad metaphyseal bone above the columns. Within the fossa, anteriorly and posteriorly, are fat pads which may be elevated by intraarticular hematoma or reactive joint fluid. The physeal contour initially is transverse and smooth. Lappet formation progressively demarcates the epicondylar physeal regions, with the medial one becoming a functionally, but not histologically separate region. The capitellum is the first region to develop a secondary ossification center. This progressively expands into the trochlear portion of the epiphysis, a factor which predisposes to lateral condyle fracture propagation across the trochlear articular surface. The trochlea characteristically ossifies by multiple foci which fuse over time, often creating an irregular appearance to the developing ossification center. Epicondylar ossification tends to be from solitary foci. The lateral epicondylar center fuses with the capitellar center, whereas the medial epicondyle tends to be functionally separate entity throughout development and does not normally fuse to the trochlear ossification center.

Adolescent↗
PubMed1982

The painful bipartite patella.

Two skeletally immature patients with bipartite patella, a lesion normally classified as a developmental variation, proved to have a symptomatic lesion with a traumatic etiology. In both patients, appropriate treatment resulted in complete subsidence of symptoms; one patient was treated with cast immobilization, while the other eventually required surgical resection. In addition, normal and bipartite patellar specimens from skeletally immature cadavers were histologically and morphologically assessed. These clinical and anatomic studies suggest that in some cases a bipartite patella may be a traumatically induced, chondroosseous disruption of the superolateral pole of the incompletely ossified patella, analogous to Sinding-Larsen-Johansson disease at the inferior patellar pole or Osgood-Schlatter disease in the tibial tuberosity. The possibility of bipartite patella being such a chronic stress fracture in a symptomatic patient should be considered in order to render appropriate treatment.

Adolescent↗
PubMed1977

Embryo mortality and altered uterine luminal proteins in progesterone-treated rabbits.

This study was undertaken to elucidate the location, time, and nature of embryo mortality induced by preovulatory progesteron administration. Progesterone was injected into rabbits on days -2, -1, and 0 (the day of mating) at doses of 0.5, 1.0, and 1.0 mg, respectively. Normal fertilization rates resulted, but embryonic death occurred by day 4. Embryos residing in progesterone-treated does for up to 3 days survived normally when transferred to normal recipients, whereas day 4 embryos from treated does exhibited a reduced ability to implant. Uterine fluid (UF) protein pattern was examined on days 1 to 7 after mating. Total UF protein levels were significantly greater in treated animals on day 4 than in controls. Uteroglobin secretion was significantly advanced in the treated animals by day 3. Examination of the time of the arrival of embryos into the uterus revealed a delay in the progesterone-treated rabbits. This delay, coupled with the earlier secretion of uteroglobin in the treated rabbits, indicated a possible asynchrony of approximately 1 day between embryo arrival in the uterus and certain uterine proteins. To determine whether UF could be etiologically implicated in the progesterone-induced embryonic death, embryonic development in vitro and in vivo was examined after exposure to UF collected at different gestational stages. More normal day 3 morulae placed in UF from day 3 control and day 2 progesterone-treated rabbits developed than similar morulae placed in UF from day 2 controls and day 3 progesterone-treated does. Hence, partial physiologic synchrony was achieved. This was interpreted to mean that "asynchronous" UF can be embryotoxic. Infertility was transient. Ability of the does to produce young at a pregnancy immediately following a progesterone-treated pregnancy was not impaired.

Albumins↗
PubMedDate not supplied

Beyond health care cost containment: creating collaborative arrangements among the stakeholders.

The causes of escalating healthcare costs in the United States and many other industrial countries are well documented. Less evident are the structural factors that underlie the increases and their implications for the future. This paper discusses these structural factors, puts them in the context of the healthcare marketplace, and proposes a way to address them using a collaborative arrangement among all stakeholders in a healthcare system, called value-based partnering. To be successful, the effort must include not only final purchasers (such as employers or Medicare in the USA) but all stakeholders in a healthcare system. Each stakeholder must develop a value equation in terms that are meaningful to the others, and must identify opportunities for value-enhancing partnerships. The paper also identifies some of the impediments to value-based partnering and discusses ways to overcome them, including the need for senior management intervention within some stakeholder groups, and the importance of collaborative discussions among all stakeholders.

Aged↗
PubMedDate not supplied

Lipohemarthrosis of the knee: MR imaging.

Two patients with sports-related knee injuries underwent magnetic resonance (MR) imaging, which demonstrated intracapsular fractures and effusions with a signal pattern characteristic of lipohemarthrosis. Four distinct signal bands were identified: superior band representing floating fat, a central band containing serum, an inferior band of dependent red blood cells, and a thin band representing chemical shift artifact at the interface of serum and floating fat.

Adipose Tissue↗
PubMedDate not supplied

MR imaging of the normal ligaments and tendons of the ankle.

The 10 major ligaments and nine major tendons of the ankle were evaluated in 17 ankle MR studies to determine the incidence of visualization of each structure in each of the three orthogonal planes. High-resolution technique was used, with 3 mm slice thickness and an in-plane resolution of 0.6 mm. Of the 19 ligaments and tendons evaluated, 18 demonstrated more than 70% frequency of visualization in at least one imaging plane. However, seven ligaments and three tendons demonstrated 0% visualization in at least one of the three orthogonal planes. Seven ligaments showed more than 70% visualization in only one plane (three coronal, two axial, two sagittal). Only the Achilles tendon and anterior tibial tendon demonstrated 100% visualization in all three planes. We conclude that all three orthogonal planes are essential to achieve optimal visualization of all of the major ligaments and tendons of the ankle. For specific evaluation of selected ligaments or tendons, only one or two planes may be required.

Achilles Tendon↗
PubMedDate not supplied

Comparison of MRI with postcontrast CT for the evaluation of acute abdominal trauma.

We compared the ability of MRI and CT to detect and characterize abdominal visceral injury. Seven patients with contrast-enhanced abdominal CT interpreted as showing definite (five patients) or possible (two) solid organ injury following blunt abdominal trauma were referred for abdominal MRI with a mean interval of 3 days between modalities. T1-weighted and T2-weighted spin echo sequences were obtained in all patients. Gradient-recalled echo (GRE) sequences (22-25/12-13/60 degrees flip angle) were obtained in five cases. Both CT and MR allowed detection of complex splenic lacerations in two patients and complex hepatic injuries in three other patients. A sixth patient had subtle periportal hypodensity noted on CT which was not detected prospectively on MRI. One patient had a right adrenal hematoma detected on MRI but not on CT. Relative lesion conspicuity and extent were judged equal on CT and T2-weighted imaging. The T1-weighted and GRE imaging were judged inferior to CT. We conclude that MRI offers no significant advantage over CT for the routine evaluation of acute abdominal trauma.

Abdominal Injuries↗
PubMedDate not supplied

MR evaluation of clinically suspected adnexal masses.

OBJECTIVE: Our goal was to determine the sensitivity, specificity, predictive value, and accuracy of pelvic MRI in the prospective evaluation of women with a clinically suspected pelvic mass. MATERIALS AND METHODS: One-hundred three patients with clinically suspected pelvic masses were prospectively evaluated by pelvic MRI. Masses were analyzed for size, location, morphological characteristics, and signal behavior. Masses were classified as benign, malignant, or indeterminate and in every case an attempt was made to generate a specific diagnosis according to previously reported characteristic MR appearances. Surgical follow-up was obtained within 3 months of MRI examination for all patients, excepting 11 patients with typically appearing leiomyomas. RESULTS: One hundred twenty pelvic masses were confirmed. Magnetic resonance was 100% sensitive and 99% specific in prospectively diagnosing dermoids, 96% sensitive and 100% specific in diagnosing subserosal leiomyomas, and 92% sensitive and 91% specific in diagnosing endometriomas. CONCLUSION: When physical examination or ultrasound examination is inconclusive, pelvic MRI can aid in the evaluation of women with a suspected pelvic mass. By identifying these common benign gynecologic conditions, unnecessary surgery can be avoided.

Adnexal Diseases↗
PubMedDate not supplied

Value-based partnering in healthcare: a framework for analysis.

Value-based partnering is designed to move the healthcare system beyond cost-based competition. It recognizes that the healthcare "product" is not a commodity and that much of the value in the system comes from relationships between and among four stakeholders: consumers, providers, health plans, and employers. Given the difficulty of measuring such benefits as quality of care, improved health status, and increased employee productivity, stakeholders within the system traditionally have focused on easily measurable financial considerations such as premium rates. This focus has led to a system that defines relationships in purely financial terms. In contrast, the value-based partnering model presented in this article recognizes the range of factors that stakeholders consider in their relationships with each other. This approach has the potential to change the nature of competition and presents opportunities for those organizations that can effectively partner with other stakeholders and demonstrate value, rather than just lower cost. Moreover, by recognizing the interdependencies among stakeholder groups, the approach creates a strategic reason for employers, health plans, providers, and consumers to exchange information and create long-term alliances.

Consumer Behavior↗