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Biomedical subjects

William C Doukas

Publications and source records attributed to William C Doukas.

14 recordsLinked to original sources
PubMed2006

Diagnosis of superior labral lesions: comparison of noncontrast MRI with indirect MR arthrography in unexercised shoulders.

OBJECTIVE: To prospectively compare the accuracy of noncontrast magnetic resonance imaging (MRI) with indirect MR arthrography (I-MRa) of unexercised shoulders for diagnosis of superior glenoid labral lesions. MATERIALS AND METHODS: Institutional Review Board approval and patient informed consent were obtained for this prospective study. Superior labral findings on shoulder MRI and unexercised I-MRa studies of 104 patients were correlated with findings at arthroscopic shoulder surgery. Two musculoskeletal radiologists independently reviewed the two sets of MR images while blinded to arthroscopic results. For each radiologist, the McNemar test was used to detect statistically significant differences between techniques. RESULTS: The superior labrum was intact in 24 and abnormal in 80 subjects. For detection of superior labral lesions by each radiologist, I-MRa was more sensitive (84-91%) than MRI (66-85%), with statistically significant improvement in sensitivity for one reader (p = 0.003). However, I-MRa was less specific (58-71%) than MRI (75-83%). Overall, accuracy was slightly improved on I-MRa (78-86%) compared with MRI (70-83%), but this difference was not statistically significant for either reader. CONCLUSION: Compared with noncontrast MRI, I-MRa was more sensitive for diagnosis of superior glenoid labral lesions. However, the diagnostic value of I-MRa in shoulders remaining at rest is potentially limited by decreased specificity of the technique.

Adolescent↗
PubMed2006

Process of care for battle casualties at Walter Reed Army Medical Center: Part II. Physical therapy service.

Physical therapists, physical therapy assistants, and physical therapy technicians provide care to soldiers, sailors, Marines, and airmen returning from Operation Enduring Freedom and Operation Iraqi Freedom. We describe the inpatient and outpatient services provided, the problems and solutions encountered, and the lessons learned at the beginning of the war.

Amputation, Surgical↗
PubMed2006

Process of care for battle casualties at the Walter Reed Army Medical Center: Part III. Physical medicine and rehabilitation service.

The Physical Medicine and Rehabilitation Service provides a critical role in the assessment, management, and disposition of the newly injured combatant. This role has been well demonstrated during Operation Enduring Freedom and Operation Iraqi Freedom. Military physiatrists are uniquely suited to support military service members as they maximize their function and either return to duty or transition to civilian life.

Amputees↗
PubMed2006

Process of care for battle casualties at Walter Reed Army Medical Center: Part IV. Occupational therapy service.

Occupational therapy addresses deficits in activities of daily living, upper-extremity motor performance deficits secondary to injury or disease, and occupational or role performance deficits attributable to mental and behavioral health conditions. We describe the inpatient and outpatient services provided, the problems and solutions encountered, and the lessons learned.

Amputation, Surgical↗
PubMed2006

Pectoralis major ruptures.

Although previously considered rare, ruptures of the pectoralis major muscle and tendon have become more common over the past 20 years with increasing participation in competitive sports and weight lifting. These injuries result from maximal eccentric contraction of the muscle with the arm held in an abducted, extended position. Most often, they occur near the tendon insertion. Complete ruptures are more common than partial tears, though many mild strains and partial tears likely go unreported or undiagnosed. Magnetic resonance imaging is the diagnostic study of choice when the diagnosis or extent of the injury is unclear. Partial tears and neglected complete tears with near complete restoration muscle strength after rehabilitation may be treated nonoperatively, with good results. Excellent results can be obtained with early anatomic repair for complete ruptures, though good results have also been reported with delayed repair of complete injuries. Early diagnosis and, when appropriate, anatomic surgical repair are the factors critical to optimizing patient outcomes after pectoralis major rupture.

Athletic Injuries↗
PubMed2004

Evaluation of orthopaedic injuries in Operation Enduring Freedom.

Orthopaedic injuries constitute a majority of the combat casualties in recent U.S. military conflicts. Orthopaedic injuries sustained in Operation Enduring Freedom from December 2001 to January 2003 that were treated in forward-deployed military medial facilities and evacuated to a U.S. army medical center were reviewed. The spectrum of injuries included open fractures, amputations, neurovascular, and soft-tissue injuries. Forty-four patients (85%) received treatment beyond local wound care prior to arrival at a military medical center. Debridement and irrigation was the most commonly performed procedure due to the contaminated nature of these combat injuries. There were no infections among patients with open fractures, and no patients with external fixators had pin tract infections. None of the open fracture patients underwent primary internal fixation or primary wound closure. The average time from injury to wound coverage of the open fracture wounds was 12 days. Two amputations were infected and were treated with revision and delayed wound closure. There were no primary amputations done at our institution due to infection or ischemia. All arterial injuries underwent urgent revascularization in a field hospital. None of the arterial repairs required revision after evacuation to a medical center. Operation Enduring Freedom has been an excellent example of how early and aggressive intervention in a forward-deployed area has a significant effect on rehabilitative and reconstructive efforts at a rear echelon tertiary care center.

Adult↗
PubMed2004

Orthopedic injuries during Operation Enduring Freedom.

Orthopedic injuries comprise a majority of combat injuries seen in recent U.S. military conflicts. Interventions in the forward deployed area have played an important role in improving mortality rates of soldiers as well as outcome at a medical center level. A retrospective review was conducted on orthopedic injuries from Operation Enduring Freedom evaluated at Walter Reed Army Medical Center (WRAMC). Patients were grouped into one of five injury categories (open fracture, amputation, arterial injuries, neurological injuries, and soft tissue injury) with evacuation time (days from time of injury to arrival at WRAMC) and procedures performed before arrival at WRAMC evaluated. The average evacuation time for all orthopedic casualties was 7.9 days. There was an average of 2.6 procedures performed per patient before arrival at WRAMC. There was no difference in evacuation time among the injury groups. Those with only soft tissue injuries underwent fewer procedures than the other injury groups; however, there was no difference among the injury groups in terms of procedures performed. The number of procedures performed did not affect the evacuation time. Fifty-six percent of casualties required operative intervention after arrival at WRAMC. With the unavoidable evacuation time that all casualties must endure regardless of severity of the injury, early operative intervention in forward deployed medical assets, such as the forward surgical team and combat support hospital, remains a necessity for rehabilitative and reconstructive efforts of the soldiers at the medical center level.

Adult↗
PubMed2004

Primary coracoid impingement syndrome.

We measured treatment responses for patients with primary coracoid impingement syndrome to determine whether coracoplasty provided pain relief and improved function. Eleven patients (12 shoulders) were included in the primary group, and secondary cases were excluded. Symptoms included burning pain occurring at the site of the coracoid process aggravated by exercise (push-ups). Magnetic resonance imaging and computed tomography showed a narrow coracohumeral interval. Surgical findings confirmed the diagnosis. Follow-up averaged 2.7 years. After follow-up, coracoplasty responses showed significant relief of pain (P < 0.0001) and improved function (P = 0.006). Treatment responses were good in primary cases, as indicated by pain and function scores.

Adult↗
PubMed2004

Advanced medical care for soldiers injured in Iraq and Afghanistan.

War inevitably advances medical knowledge, particularly in the area of orthopedic surgery. This article presents an overview of the types of injuries emerging from the current conflicts in Iraq and Afghanistan, the majority of which are extremity injuries, and the care soldiers are receiving on the battlefield, while being evacuated, and at Walter Reed Army Medical Center. It highlights the Army's use of new therapeutic approaches such as use of methyl methacrylate antibiotic beads, vacuum-assisted closure devices, and new prosthetic technologies.

Afghanistan↗
PubMedDate not supplied

Evaluation of orthopaedic injuries in Operation Enduring Freedom.

Orthopaedic injuries constitute a majority of the combat casualties in recent U.S. military conflicts. Orthopaedic injuries sustained in Operation Enduring Freedom from December 2001 to January 2003 that were treated in forward-deployed military medical facilities and evacuated to a U.S. army medical center were reviewed. The spectrum of injuries included open fractures, amputations, neurovascular, and soft-tissue injuries. Forty-four patients (85%) received treatment beyond local wound care prior to arrival at a military medical center. Debridement and irrigation was the most commonly performed procedure due to the contaminated nature of these combat injuries. There were no infections among patients with open fractures, and no patients with external fixators had pin tract infections. None of the open fracture patients underwent primary internal fixation or primary wound closure. The average time from injury to wound coverage of the open fracture wounds was 12 days. Two amputations were infected and were treated with revision and delayed wound closure. There were no primary amputations done at our institution due to infection or ischemia. All arterial injuries underwent urgent revascularization in a field hospital. None of the arterial repairs required revision after evacuation to a medical center. Operation Enduring Freedom has been an excellent example of how early and aggressive intervention in a forward-deployed area has a significant effect on rehabilitative and reconstructive efforts at a rear echelon tertiary care center.

Adult↗
PubMedDate not supplied

Effect of drain use in the early postoperative period after arthroscopically assisted anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft.

BACKGROUND: Little data exist on the effect of routine use of postoperative drainage after arthroscopic anterior cruciate ligament reconstruction, although clinical studies of other procedures have not shown benefit to this practice. HYPOTHESIS: Use of a postoperative drain will not result in decreased suprapatellar girth, increased range of motion, and decreased pain compared with nonuse. STUDY DESIGN: Prospective randomized clinical trial. METHODS: Twenty-one patients undergoing arthroscopically assisted bone-patellar tendon-bone anterior cruciate ligament reconstruction were randomly assigned to receive a drain for 24 hours (12 patients) or no drain (9 patients). Data for comparison of groups were collected daily through postoperative day 7. RESULTS: Pain scores on a visual analog scale demonstrated the same improving trend over time for both treatment and control groups; however, the treatment group had significantly higher average pain scores, except on day 7. Differences in suprapatellar girth, flexion, and extension were not found to be statistically significant between groups. CONCLUSION: Use of a drain after arthroscopically assisted anterior cruciate ligament reconstruction provided no benefit in terms of range of motion, effusion, or pain in the early postoperative period.

Adult↗