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Biomedical subjects

T J Spalding

Publications and source records attributed to T J Spalding.

14 recordsLinked to original sources
PubMed2003

A complicated stress fracture of the femoral neck--a case report.

A case is presented of a stress fracture of the femoral neck complicated by complete fracture. Additional complications arose when the repaired fracture went on to non-union due to bending of the DHS screw, requiring revision surgery with a valgus osteotomy. The case is important because this type of stress fracture has previously been considered to be safe from risk of complete fracture. The failure of the operative treatment has implications for young patients treated similarly.

Adolescent↗
PubMed1996

Removal of femoral sherman plates--not a simple operation.

Surgical removal of a Sherman plate from the femur in an adult treated in childhood for Perthes' disease or developmental dysplasia of the hip (DDH) can be time-consuming and difficult. We analyzed the factors that govern the complexity and complications of plate removal. The notes, operative details, and radiographs of 77 operations for removal of a Sherman plate inserted at the first femoral osteotomy for DDH were assessed. The plates had been in place for 1-32 years and were either completely buried in bone or endosteal in 24%, depending on the time elapsed before removal. Approximately one in five screw heads sheared or required excision, the screw shanks subsequently had to be cored from the bone. The operation took > 90 min in more than one quarter of the patients. The procedure is far from benign. Sherman plates should be removed early when possible, and joint replacement should not be planned to coincide with plate removal. The risks of plate removal must be explained to patients.

Adult↗
PubMed1994

Driver reaction times after total knee replacement.

We measured the driver reaction times of 40 patients before total knee replacement (TKR) and 4, 6, 8 and 10 weeks after operation. The ability to perform an emergency stop was assessed as the time taken to achieve a brake pressure of 100 N after a visual stimulus. There were 18 drivers and 11 non-drivers; the latter had longer reaction times. In drivers, the ability to transfer the right foot from accelerator to brake pedal did not recover to preoperative levels for eight weeks after right TKR and was unchanged after left TKR. Patients should be advised that they should not drive for at least eight weeks after right TKR.

Aged↗
PubMed1993

Pseudoaneurysm after arthroscopy of the knee. A case report.

Pseudoaneurysm of the inferior lateral genicular artery occurred in a 25-year-old man after arthroscopy. The arthroscopy was not complicated by postoperative bleeding or hemarthrosis, which has been associated with pseudoaneurysm formation. The diagnosis was confirmed on 99mTc radionuclide scanning and ultrasound, and the anatomy was demonstrated by digital subtraction angiography. Exploration and excision were performed without complication or recurrence. There are several methods for investigating these rare lesions.

Adult↗
PubMed1992

The Royal London Hospital Helicopter Emergency Medical Service: first phase 1990.

A Helicopter Emergency Medical Service (HEMS) has been introduced to improve trauma care in the Southeast of England. The majority of the workload comes from the area bounded by the M25 ring road. In 1989 a Dauphin 365N helicopter equipped for pre-hospital primary rescue and emergency inter-hospital secondary transfer was certified by the Civil Aviation Authority. The helicopter commenced carrying patients with a paramedic and a doctor on board early in 1990. In September 1990 this service was further improved by the opening of a helipad at the Royal London Hospital and a designated HEMS desk at London Ambulance Service central control. Eighty-four patients were transported in primary rescue missions and 107 as emergency transfers in 1990.

Aircraft↗
PubMed1991

Penetrating missile injuries in the Gulf war 1991.

During the recent Gulf war 63 patients with penetrating missile injuries (including 29 Iraqi prisoners of war) underwent operation in a British Army Field Hospital. Their injuries and initial operative management are reported. Fifty-one casualties (81 per cent) suffered an average of nine wounds (range 1-45) due to fragmentation weapons, and 12 casualties sustained bullet wounds. All wounds were explored following the established principles of war surgery. The extremities were involved in 48 patients (76 per cent). Eight compound long bone fractures were managed with external skeletal fixators applied at the time of initial operation. Laparotomy was performed on seven patients, one of whom died. The average duration of operation was 77 min for shrapnel wounds and 85 min for bullet wounds.

Abdominal Injuries↗
PubMed1991

The retrograde tunnel: a method for the fixation of central venous catheters in the military environment.

Central venous catheters (CVCs) are prone to accidental removal during patient transportation. Of the casualties who require transfer between medical facilities, those with CVC in situ require additional vigilance to prevent loss of the CVC, which continues to occur despite various methods of fixation. The fashioning of a subcutaneous tunnel has become an integral part of the placement of central venous catheters. Several methods have been described, but the long-term CVCs in paediatric practice pose special problems, particularly that of the patients continually testing the CVCs fixation. Using a new polyurethane CVC, a retrograde tunnelling technique has been developed which affords immediate and secure fixation. We propose that this CVC, together with the technique of retrograde tunnelling, is the solution to inadvertent central venous line removal during patient transfer.

Adolescent↗
PubMed1989

Fine needle aspiration cytology as part of a three stage diagnostic approach to breast lumps in a District general hospital.

Recent studies from specialist breast centres have suggested that fine needle aspiration cytology in conjunction with mammography and clinical examination can provide a prompt and accurate diagnosis of breast lumps. These three methods of diagnosis have been assessed in the context of a district general hospital by analysing 104 consecutive breast lesions with known histology, of which 75 were benign and 29 malignant. The results are presented in terms of the sensitivity and specificity for each method. Fine needle aspiration cytology had a sensitivity for malignancy of 88% (n = 26) and a specificity of 97% (n = 58). Similarly, sensitivity for mammography was 95% (n = 20) and clinical examination 90% (n = 29). Respective specificities were 96% (n = 45) and 83% (n = 75). In none of the 29 patients with breast cancer were all three modalities negative. It is concluded that without specialist breast clinicians and cytologists, a combination of fine needle aspiration cytology, clinical examination and mammography can still provide a degree of preoperative diagnostic accuracy comparable with specialist centres, allowing prompt counselling with all the subsequent benefits.

Adult↗
PubMed1989

Experiences with ureteroscopy.

Thirty-nine patients underwent 44 ureteroscopic procedures between January 1985 and August 1988 for diagnostic and therapeutic purposes. Twenty six procedures were undertaken on 23 patients for extraction of ureteric calculi and were successful on the initial attempt in 14 (61%). Four stones not removed on the first attempt were however disimpacted and subsequently passed spontaneously, and three more were removed at a second ureteroscopy. The overall success rate therefore was 91%. Only two patients required ureterolithotomy. Ureteroscopic stone extraction is therefore an effective technique with minimal morbidity and allows rapid return of servicemen to high category medical fitness.

Adolescent↗