Biomedical subjects
Publications and source records attributed to Sanjeev Agarwal.
Pseudohypoparathyroidism (PHP) type 1b is a rare childhood disorder characterized by renal resistance to parathyroid hormone (PTH) resulting in biochemical hypoparathyroidism but with skeletal sensitivity to PTH. We describe a patient with PHP type 1b who we believe is one of the youngest reported patients with bilateral slipped capital femoral epiphyses (SCFE).
Arthrodesis is one of the last options available to obtain a stable, painless knee in a patient with a damaged knee joint that is not amenable to reconstructive measures. Common indications for knee arthrodesis include failed total knee arthroplasty, periarticular tumor, posttraumatic arthritis, and chronic sepsis. The primary contraindications to knee fusion are bilateral involvement or an ipsilateral hip arthrodesis. A variety of techniques has been described, including external fixation, internal fixation by compression plates, intramedullary fixation through the knee with a modular nail, and antegrade nailing through the piriformis fossa. Allograft or autograft may be necessary to restore lost bone stock or to augment fusion. For the carefully selected patient with realistic expectations, knee arthrodesis may relieve pain and obviate the need for additional surgery or extensive postoperative rehabilitation.
We present results of internal stabilization of 16 type B1 periprosthetic femoral fractures following total or hemiarthroplasty of the hip. Seven patients had cemented stems, and the rest had cementless, extensively hydroxyapatite-coated stems. Fourteen were managed by a cable-grip plating system, 1 by Dynamic compression plate, and 1 had insertion of cables only. Minimum follow-up was 1 year. Four patients had a major complication: 2 had deep infection; 1 had nonunion requiring amputation; and 1 had persistent hip pain requiring removal of all metalwork, including the hip prosthesis. The average time to healing in the remaining patients was 16.3 weeks. Harris Hip Scores dropped from an average of 86.8 preoperatively to 73.4 on last follow-up. Periprosthetic fractures are a significant injury, with a high risk of complications.
Evidences of spinal tuberculosis have been found in Egyptian mummies and the disease is one of the oldest diseases afflicting humans. The demography, diagnosis, medical and surgical treatment, as advocated currently, have been reviewed with a brief discussion of the literature. Early diagnosis and comprehensive treatment are needed to control this public health problem.
OBJECTIVE: To assess the safety and effectiveness of long-term use of functional electrical stimulation (FES) for exercise, standing, and walking in individuals with paraplegia, using percutaneous intramuscular wire electrodes. DESIGN: Case study with more than 17 years of follow-up. SETTING: Institutional rehabilitation practice. STUDY PARTICIPANTS: Two long-term (17 years) volunteer participants with paraplegia who were able to stand and walk using FES. INTERVENTION: Chronically indwelling percutaneous intramuscular wire electrodes connected to a portable microprocessor-controlled stimulator were used to exercise muscles while controlling trunk, hips, knees, and ankles and develop activation patterns to produce standing and walking. MAIN OUTCOME MEASURES: Clinical complications, electrode performance and survival probability, and functional performance. RESULTS: The most noted clinical complications included localized inflammation at the electrode site and superficial infection that responded well to topical and oral antibiotic treatment. The change from coil-wire electrodes, with a survival of 35% after 1 year, to double-helix electrodes improved electrode survival to 80% at 1 year and 48% at 5 years. Maintenance of the multichannel percutaneous FES walking system required replacement of an average of 2 electrodes every 6 months. Participants were able to use their system for independent exercise and standing and for walking with standby assistance. CONCLUSION: Although the FES system was devised as a temporary means of achieving functional activation until permanent means could be achieved, it was found to be effective and relatively safe for more than 17 years. Two long-time users of the system had no adverse effects to their skeletal system. The most common problems were daily care of electrodes at exit sites, frequent irritation of the skin around electrodes, and replacement of failed electrodes. The percutaneous system has the potential for short-term rehabilitation in individuals with incomplete paraplegia or stroke.
UNLABELLED: BACKGROUND Scapula fractures are rare and are presumed to indicate severe underlying trauma. We studied injury patterns and overall outcome in patients with multiple injuries with scapula fractures. METHODS: We carried out a retrospective review of patients with multiple injuries (Injury Severity Score [ISS] > or = 16) with chest and musculoskeletal injuries admitted to our institution between 1993 and 1999 to investigate whether the presence of a scapula fracture is a marker of increased morbidity and mortality. RESULTS: There were 1,164 patients admitted with multiple trauma. Seventy-nine (6.8%) of the 1,164 sustained a scapula fracture, forming the study group. The remainder of the patients (n = 1,085) formed the control group of the study. Both groups of patients were similar with regard to age and Glasgow Coma Scale score (age, 42 +/- 17.8 [+/- SD] vs. 40 +/- 22; GCS score, 11.2 +/- 5.1 vs. 11 +/- 5 in the study and control groups, respectively). The overall ISS was significantly higher in those with scapula fractures (27.12 +/- 15.13 vs. 22.8 +/- 14.4, p = 0.01). Patients with scapula fractures also had more severe chest injuries (Abbreviated Injury Scale score of 3.46 +/- 1.1 vs. 3.1 +/- 1.0, respectively), but not significantly so. However, the incidence of rib fractures was significantly higher in the patients with scapula fractures (p < 0.05). The incidence and severity of head and abdominal injuries were similar in the two groups. The severity of extremity injuries in patients with scapula fractures was significantly lower (2.4 +/- 0.6 vs. 2.7 +/- 0.7, p = 0.001). The rate of admission, the length of intensive care unit stay, and the overall length of hospital stay were similar in the two groups. The overall mortality rate was 11.4% in patients with scapula fractures and 20% in those without scapula fractures (p = 0.1). CONCLUSION: Patients with scapula fractures have more severe underlying chest injuries and overall ISS. However, this did not correlate with a higher rate of intensive therapy unit admission, length of hospital stay, or mortality.
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This study describes the clinical, radiographic, and histopathologic features, and discusses the management options of 11 cases of benign giant-cell tumors of the patella seen over 20 years. Fine needle aspiration cytology was a useful preoperative diagnostic tool. Ptellectomy and reconstruction of the extensor apparatus is the favored treatment option with curettage and bone grafting restricted to selected localized lesions.
BACKGROUND: Solitary bone involvement without lymphadenopathy is a rare manifestation of Rosai-Dorfman disease, or sinus histiocytosis with massive lymphadenopathy (SHML). Only 11 cases have been reported in the literature to date, all diagnosed on histology. CASE: A 7-year-old girl had a radiolucent, lytic lesion in the shaft of the tibia clinically simulating Ewing's sarcoma. Fine needle aspiration cytology (FNAC) showed a microscopic picture typical--of SHML. There was no lymphadenopathy. CONCLUSION: Rosai-Dorfman disease sometimes involves bone without lymphadenopathy and can be diagnosed confidently on FNAC. To the best of our knowledge, this is the 12th case report of solitary bone involvement.
This study was completed to understand the usage patterns, system performance, degree of satisfaction, complications, and health benefits as perceived by recipients of a surgically implanted neuroprosthesis for exercise, standing, and transfers in individuals with low-cervical or thoracic spinal cord injury (SCI). A standardized telephone survey was administered to 11 recipients of the Case Western Reserve University/Veterans Affairs (CWRU/VA) implanted standing neuroprosthesis with more than 12 months of experience with the functional electrical stimulation (FES) system. Nine implant recipients were using the neuroprosthesis regularly for standing and/or exercising at the time of the survey. All 11 implant recipients noted improved health and a reduced incidence of pressure sores, leg spasms, and urinary tract infections (UTIs). No incidents of deep-vein thrombosis, infection, cellulitis, or electrical burns because of the neuroprosthesis were noted. System recipients uniformly felt that the neuroprosthesis resulted in better overall health and general well-being. Subjects were moderately to very satisfied with the performance of the neuroprosthesis and unanimously expressed a willingness to repeat the surgery and rehabilitation to obtain the same clinical outcome. All implant recipients reported the system to be safe, reliable, and easy to use. The implanted standing neuroprosthesis appears to be a clinically acceptable and effective means of providing the ability to exercise, stand, and transfer to selected individuals with paraplegia or low tetraplegia.