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Biomedical subjects

T M O'Brien

Publications and source records attributed to T M O'Brien.

29 records · Page 2Linked to original sources

Osteoid osteoma: excision with scintimetric guidance.

The definite diagnosis of osteoid osteoma relies on the demonstration of the nidus, best shown by CT, which also provides precise preoperative localization of the nidus. While bone-block excision to remove the nidus is feasible in the long bones, there may be unacceptable sequelae in the vertebral column and small bones of the hands. By precisely localizing the nidus, radionuclide scintimetry permits excellent therapeutic results, with minimal morbidity.

Adolescent↗

A new guard for Kirschner wires.

Means of providing adequate protective cover for Kirschner wires protruding through the skin were investigated. A new guard was developed which satisfactorily abolishes the difficulties associated with other forms of cover.

Fracture Fixation, Internal↗

The innervation of hyperplastic epidermis in the mouse: a light microscopic study.

The innervation of the skin of hairless mice has been studied following induction of epidermal hyperplasia by physical and chemical methods. Physical stimuli comprised ultraviolet irradiation, heat, wounding, and friction. Effective chemicals included benzene, carbon tetrachloride, chloroform, creosote, formaldehyde, hexadecane, hydrobromic acid, sodium lauryl sulfate, and turpentine. Epidermal hyperplasia, however produced, was associated with growth of sensory nerve fibers into the outer part of the epidermis. Following a single 10-min exposure to an ultraviolet sunalmp at 40 cm, the nerves extended into the epidermis within 24 hr and disappeared during the second week as the epidermis reverted to its normal thickness. Repeated irradiation (until tumors appeared) was accompanied by persistent hyperplasia and neural invasion. Of 32 papillomas examined, intraepithelial nerves were found in 28. The presence and location of nerves in the tumor epithelium were related to the incorporation of tactile hair disc epithelium. The hyperplastic regenerative epithelium at the margins of skin ulcers were also invaded by nerves which sometimes followed the migrating epithelium across the ulcer floor. Since the regenerative epithelium was not directly treated, it was concluded that the proliferation of nervous tissue in response to skin injury was the result of the hyperplasia per se, regardless of the method used to produce it.

Acids↗

Pelvic remodeling after Salter osteotomy.

Salter innominate osteotomy is a widely used operative procedure to redirect the acetabulum in cases of acetabular dysplasia. The effectiveness of this redirection is indicated by the change in the appearance of the obturator foramen after the procedure. This is usually accompanied by an increase in the center edge (CE) angle with an effective decrease in the forces transmitted across the hip joint. In a prospective study of 20 Salter innominate osteotomies performed on two different age groups, one mature and one immature, we studied the change in the deformity of the obturator foramen with time after this procedure. In the immature pelvis, the asymmetric appearance of the obturator foramen remodeled gradually during the 6 months after the procedure. However, in the mature patient, no such remodeling potential was demonstrable during the study period. This finding has clinical implications regarding the advice for performing Salter innominate osteotomies in mature and immature patients.

Acetabulum↗

Orthopaedic complications following cardiac transplantation.

Cardiac transplantation has become the treatment of choice for end stage heart disease. In 1990 2,000 transplants were performed worldwide. Orthopaedic Surgeons will be asked with increasing frequency to evaluate and treat bone and soft tissue problems with these patients. Orthopaedic service at the Mater Hospital has been involved in the follow-up treatment of orthopaedic complications in 46 transplant patients over a six year period. Thirty eight were male and eight were female. The ages were between 12 years and 65 years (mean 44.3). Nine (20%) of these patients developed thirteen orthopaedic complications: A vascular Necrosis of the hip (AVN) (4), Soft tissue infections (3), Osteoporosis (2), Stress Fractures (2), Osteomyelitis (1) and Ostomalacia (1). The mode of presentation, investigation and management of orthopaedic problems particular to these patients is described. Most patients who develop bony complications have had increased doses of steroids for episodes of rejection. This study highlights the special features of this patient population that require modification of the treatment approach such as the need to avoid the drug Erythromycin and the increased risk of AVN of the hip in patients who require high dose steroids.

Adolescent↗

Split tibialis posterior tendon transfer in the treatment of spastic equinovarus foot.

Sixteen patients with cerebral palsy causing equinovarus deformity were treated surgically. All of these patients underwent preoperative gait analysis by using a CODA-3 motion analyzer. The equinus deformity was assessed by using sagittal kinematics, and in particular, the range of movement of the ankle during stance phase and the maximal dorsiflexion during swing. The varus deformity was assessed by the degree of varus of the foot at prepositioning. The degree of varus was obtained by measuring the angle generated between the plane of progression and a line joining a marker on the heel to a marker on the fifth metatarsal in the transverse plane. All patients underwent split tibialis posterior tendon transfer and, in 13, this was combined with tendo calcaneus lengthening. Clinical assessment and gait analysis repeated 1 year postoperatively confirmed good outcome after split tibialis posterior tendon transfer in combination with gastrocnemius lengthening. This was confirmed by using sagittal kinematic analysis and quantitative assessment of the degree of varus of the foot at the time of prepositioning.

Ankle Joint↗