Biomedical subjects

W J Gogan

Publications and source records attributed to W J Gogan.

11 recordsLinked to original sources

PubMed1995

Magnetic resonance imaging findings 10 years after treatment for lumbar disc herniation.

STUDY DESIGN: Fifty-six patients with lumbar disc herniation who had participated in a double-blind study comparing chymopapain with saline were invited to undergo a magnetic resonance imaging assessment of the lumbosacral spine more than 10 years later. OBJECTIVE: The aim of this study was to assess the long-term morphologic changes after treatment of disc herniation by chemonucleolysis and laminectomy and to compare these findings with the natural history of the disorder. SUMMARY OF BACKGROUND DATA: There is little information on the effects of different treatment methods for lumbar disc herniation on the long-term morphologic changes in the disc. METHODS: Of the original 56 patients, 39 were entered into the study: 12 had been treated by saline injection alone, 14 by chemonucleolysis alone, and 13 had subsequently required laminectomy for a failed intradiscal injection. Each sequence of magnetic resonance images was examined by a radiologist who was unaware of the treatment given. The signal strength was assessed on T2-weighted images in the sagittal plane and disc morphology on T1- and T2-weighted sagittal and T1-weighted axial images. RESULTS: The signal of the treated disc was absent in all cases in each group. Thirty-seven percent of patients were found to have a persistent herniated disc and the incidence was similar in all three treatment groups. The presence or absence of herniation at 10 years had no significant bearing on a successful outcome. CONCLUSION: The findings of this study indicate that long-term improvement of a patient's symptoms after treatment of disc herniation may occur with or without resolution of the hernia. This and the similar morphologic findings in the different groups is consistent with the 10-year clinical results after the treatment of disc herniation reported by Weber.

Adult↗

PubMed1992

Chymopapain. A 10-year, double-blind study.

Sixty patients with sciatica from lumbar intervertebral disc herniation were entered into a double-blind study. Following a randomized schedule, 30 patients were treated with intradiscal chymopapain and 30 patients with intradiscal normal saline. At 10 years, with the patients still unaware of the treatment given, 80% of the chymopapain patients regarded the injection to be successful, compared with 34% for the saline group (P = 0.0006). Laminectomy was required in 20% of the chymopapain patients, compared with 47% of the saline patients (P = 0.028). Seventy-seven percent of the chymopapain group was assessed by a blinded independent observer to be at least moderately improved, compared with 38% for the saline group (P = 0.004). The results of this double-blind study at 10 years demonstrate a sustained therapeutic effect of chymopapain in the treatment of patients with sciatica from lumbar intervertebral disc prolapse.

Adult↗

PubMed1992

A modified muscle-splitting approach to the lumbosacral spine.

A modification of a previously reported extraperitoneal approach to the lumbosacral spine is described. The external oblique muscle is split in line with its fibers. The anterior and posterior layers of the rectus sheath are divided vertically medial to the semilunaris without splitting the internal oblique and underlying transversalis abdominus muscles. This allows an extensile retroperitoneal approach suitable for exposure of both the mid-lumbar and lumbosacral spine. There have been no complications of this approach with its use in over 50 patients undergoing anterior lumbar interbody fusion.

Abdominal Muscles↗

PubMed1991

Pseudomonal osteomyelitis of the medial sesamoid bone.

Because osteomyelitis may complicate puncture wounds about the first metatarsophalangeal joint, we believe sesamoid roentgenograms are mandatory. These views may show subtle demineralization, which cannot be seen on standard films. Treatment must include excision of the sesamoid and culture-directed antibiotics.

Adult↗

PubMed1991

Total hip replacement after failed hemiarthroplasty or mould arthroplasty. Comparison of results with those of primary replacements.

We compared the radiographic results of secondary total hip replacements, 99 following failed uncemented hemiarthroplasties and 21 following failed mould arthroplasties, with those of 825 primary cemented total hip replacements. The probability of occurrence of a number of radiological changes over time was calculated using survival analysis. The mean follow-up was 7.6 years (range one month to 20 years). The performance of the secondary total hip replacements varied with the preceding implant and was different for acetabular and femoral components. The incidence of radiological loosening was higher for femoral components implanted after failed hemiarthroplasties and for acetabular components after failed mould arthroplasties. However, the incidence of continuous radiolucent lines was lower for the acetabular components of converted hemiarthroplasties than for the primary replacements.

Arthroplasty↗

PubMed1990

Cup containment and orientation in cemented total hip arthroplasties.

We reviewed the radiographs of 864 Charnley and STH (Zimmer) cemented total hip arthroplasties with a mean follow-up of seven years (maximum 16 years). Survivorship analysis was used to assess the correlation between radiographic performance and the bony containment or the coronal orientation of the acetabular cup. The cup orientation and containment were interrelated; all vertically oriented cups were completely contained, whereas 25% of more horizontal cups were only partially contained. Completely contained cups had significantly lower incidences of complete cement-bone radiolucency (p = 0.02) and of wear (p = 0.09). Vertically oriented cups had a lower incidence of continuous radiolucency than neutrally oriented cups, but this was not statistically significant (p = 0.25). Our results confirm the importance of complete bony containment, and also indicate that it is better to accept vertical orientation and obtain full bony coverage than to have a more horizontal orientation with partial containment.

Alloys↗

PubMed1990

Total hip arthroplasty with cement. A long-term radiographic analysis in patients who are older than fifty and younger than fifty years.

The long-term performance of a total of 712 Charnley and STH prostheses was evaluated as a function of the patient's age (older than fifty years or younger than fifty years) and of the underlying disease (osteoarthrosis, rheumatoid arthritis, or avascular necrosis). In patients who were older than fifty years, there were lower incidences of continuous cement-bone radiolucency about the acetabular component (p = 0.04), wear of the polyethylene acetabular cup (p = 0.03), and resorption of the calcar (p = 0.03). However, larger percentages of younger patients had rheumatoid arthritis or avascular necrosis. In the cohort of patients who had osteoarthrosis, the performance of the prosthesis did not differ significantly between older and younger patients; therefore we attributed the differences that were observed to the disease--that is, to rheumatoid arthritis or avascular necrosis.

Age Factors↗

PubMed1990

Pseudoaneurysm of the radial artery as a cause of a late compartment syndrome. A case report.

Pseudoaneurysm has been reported in the literature as a cause of compartment syndrome. The onset of the subsequent compartment syndrome is usually early. Often, while the compartment syndrome is diagnosed and treated, the pseudoaneurysm is missed. A second operative procedure is then necessary. A 40-year-old woman illustrates an unusual case of a late compartment syndrome, following the development of a radial artery pseudoaneurysm three weeks after a penetrating injury. It is important to investigate the vascular tree in compartment syndromes after a penetrating injury, no matter how late the patient is seen.

Adult↗

PubMed1989

Dynamic axial fixation for immobilization of cross-leg flaps in chronic osteomyelitis.

Free flaps are usually the first choice for soft tissue coverage in the distal leg. There continue to be, however, some clinical situations in which a cross-leg flap is the best choice. Use of the cross-leg flap has previously been limited by the difficulty of immobilizing both legs during the early healing stage (2 to 3 weeks). The traditional plaster immobilization or multibar external fixator system is time consuming to apply, difficult to adjust, cumbersome for nursing care, and uncomfortable for the patient. We have used the Orthofix external fixator to immobilize a cross-leg flap in 3 patients with refractory distal tibial osteomyelitis. The Orthofix dynamic axial fixator (DAF) is a single frame external fixator which, when used in a cross-leg fashion, is quick and easy to apply. It provides the necessary strength for immobilization and overhead suspension. It has few parts and is therefore lighter and less awkward both for the patient and nursing personnel and is easy to adjust on the ward or in the clinic. The DAF has two modes: locked (static) and released (dynamic). The locked mode can be easily adjusted to alter tension on the healing flap. As the flap matures the dynamic mode allows the frame to slide, decreasing muscle spasms and increasing flap movement. The DAF also provides better soft tissue access for flap observation and nursing care. Few transfixation pins are needed, decreasing the chance of pin tract infection. When a cross-leg flap is required, use of the DAF for immobilization circumvents many of the previous problems with both-leg immobilization.

Accidents, Traffic↗

PubMed1989

Treatment of high-pressure water gun injection injury of the foot with adjunctive hyperbaric oxygen: a case report.

High-pressure injection injuries are reported often in the hand and occasionally in the foot. Injection with water and air causes minimal tissue damage but nevertheless requires irrigation, minimal debridement, administration of antibiotics, and concern for development of compartment syndrome. The outcome for patients injected with water and air should be excellent. Adjunctive hyperbaric oxygen causes immediate resolution of subcutaneous emphysema, edema, and pain for more rapid rehabilitation.

Adult↗

PubMed1988

Subcapital fracture of the hip following an intertrochanteric fracture. A case report and literature review.

A 42-year-old alcoholic man who had a normal femoral head histologically incurred a subcapital fracture four months after surgical treatment of an intertrochanteric fracture of the same hip. Subcapital fracture of the hip following intertrochanteric fracture is an unusual occurrence, with possibly as few as 11 cases documented in the literature. Affected persons are usually elderly females with severe osteoporosis. Though unusual, the fracture is obvious and not difficult to treat.

Adult↗