Biomedical subjects

William F Bennett

Publications and source records attributed to William F Bennett.

8 recordsLinked to original sources

PubMed2004

Arthroscopic bicipital sheath repair: two-year follow-up with pulley lesions.

PURPOSE: The purpose of this study was to evaluate arthroscopic repair in patients who had lesions of both the subscapularis insertion/medial head of the coracohumeral ligament and the lateral head of the coracohumeral ligament and supraspinatus tendon (a type 5 biceps subluxation/instability classification), and to determine if primary repair of the torn structures used to reconstruct the bicipital sheath was associated with a high biceps rupture rate. The null hypothesis, that there is no difference between preoperative and postoperative outcomes, was tested. TYPE OF STUDY: Prospective cohort. METHODS: Since 1995, the author has had 18 patients who had lesions that affected both the medial and lateral wall of the bicipital sheath. An adjunct was added if tendonitis was present with fraying, and the biceps tendon was debrided if the fraying consisted of 50% or less the width of the tendon. This was chosen arbitrarily. Greater than 50% fraying of the biceps tendon was treated with repair of the supraspinatus and subscapularis. The biceps tendon was treated with tenotomy or tenodesis in these cases and these patients were not included in this study. This article reports on the repair technique and results having a minimum of 2-year follow-up. RESULTS: There were 12 male patients (age range, 45 to 80 years; average, 62 years) and 6 female patients (age range, 50 to 85 years; average, 66 years). The dominant extremity was involved in 12 of the 16 extremities. Preoperative, ASES Index, Total Constant scores, Subjective Constant scores, Objective Constant scores, visual analog pain scales, and percent function were 31 +/- 19, 53 +/- 13, 12 +/- 8, 41 +/- 8, 7 +/- 3, and 42 +/- 17, respectively. Postoperative scores were 80 +/- 14, 77 +/- 10, 30 +/- 4, 47 +/- 7, 2 +/- 2, and 84 +/- 14, respectively. The null hypothesis was rejected at a level of P = .001, .001, .001, .05, .001, and .001, respectively. CONCLUSIONS: There was 1 biceps disruption in this cohort following repair, for an incidence rate of 6%. There were 2 patients, active tennis players, who had recurrence of biceps inflammation in the follow-up period with no evidence of biceps subluxation. The arthroscopic technique reported is a primary repair used to reconstruct the normal structures of the groove. This may explain why previous recommendations not to reconstruct the groove because of the high biceps disruption rate have been noted previously. This study did not deepen the groove, tubulize the biceps tendon, or close the rotator interval in nonanatomic fashion. This arthroscopic technique is technically feasible and can alleviate the symptoms of biceps tendon inflammation and/or subluxation in the majority of cases in this cohort. LEVEL OF EVIDENCE: Level IV, Case Series.

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PubMed2003

Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/instability.

PURPOSE: The purpose of this study was to evaluate the outcome of patients who underwent arthroscopic repair of anterosuperior rotator cuff tears. The null hypothesis, that there was no difference between preoperative scores and postoperative scores, was tested statistically. TYPE OF STUDY: A cohort study. METHODS: The preoperative and postoperative status of patients with anterosuperior rotator cuff tears was analyzed using the Constant score, American Shoulder and Elbow Society Index (ASES Index), a visual analog pain scale (VAS), a single question of percent function compared with the opposite unaffected extremity, and a single question reflecting satisfaction, "would you undergo the surgery and the postoperative rehabilitation to achieve the result you have today." There were also 2 groups compared: 1 that had a "tac" used for repair of the subscapularis tendon, and the other that used a "tie" technique for subscapularis repair. All supraspinatus tendon tears were complete and were repaired using a soft-tissue fixation device. RESULTS: There was a statistically significant difference for all outcome measures except for the objective Constant score of the tie group, P =.58. Follow-up was 2 to 4 years. There were no differences based on sex or type of fixation device used for repair of the subscapularis tendon. There were no reruptures, clinically. CONCLUSIONS: The arthroscopic repair of anterosuperior rotator cuff tears provides reliable expectation for improvement in function, decreases in pain, decreases in clinical findings of biceps subluxation and inflammation, improvement in shoulder scores, and the improvement of clinical findings of subscapularis insufficiency.

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PubMed2003

Arthroscopic repair of isolated subscapularis tears: A prospective cohort with 2- to 4-year follow-up.

PURPOSE: The goal of this study was to evaluate the outcomes of the arthroscopic repair of isolated subscapularis tears. Additionally, this study explores details of the clinical diagnosis, magnetic resonance arthrography findings, and surgical repair techniques. TYPE OF STUDY: A prospective cohort. METHODS: The preoperative and postoperative status of patients with isolated subscapularis tears were analyzed using the Constant Score, American Shoulder and Elbow Society Index (ASES Index), a visual analog pain scale (VAS), a single question of percent function compared with the opposite unaffected extremity, and a single question reflecting satisfaction: "Would you undergo the surgery and the postoperative rehabilitation to achieve the result you have today." RESULTS: There was a statistically significant difference for all outcome measures from preoperative to postoperative follow-up at 2 to 4 years, except for the objective Constant Score. There were no differences based on gender. Preoperative magnetic resonance arthrography aids in the confirmation of the subscapularis tear. CONCLUSIONS: The arthroscopic repair of the isolated subscapularis tear provides for reliable expectations of improvement in function, particularly the use of the arm behind the back, decreases in pain, decreases in biceps subluxation or instability, and the return of active normal internal rotation. Subjectively, magnetic resonance arthrography is better than magnetic resonance imaging for visualizing the subscapularis tear.

Adult↗

PubMed2003

Arthroscopic repair of full-thickness supraspinatus tears (small-to-medium): A prospective study with 2- to 4-year follow-up.

PURPOSE: The objective of this study is to report on the complete arthroscopic repair of full-thickness tears of the supraspinatus. TYPE OF STUDY: Prospective cohort study. METHODS: Between 1995 and 1999, 139 full arthroscopic rotator cuff repairs were performed; 37 were repairs of full-thickness supraspinatus tears. Between 1997 and 1999, there were 24 patients who had a complete arthroscopic repair of supraspinatus tears. The preoperative and postoperative status of these patients was analyzed using the Constant score, American Shoulder and Elbow Society Index (ASES Index), a Visual Analog Pain Scale (VAS), a single question of percent function compared with the opposite unaffected extremity, and a single question reflecting satisfaction, "Would you undergo the surgery and the postoperative rehabilitation to achieve the result you have today?" There were 37 patients who had preoperative to postoperative VAS, percent function, postoperative acromiohumeral interval, and clinical rerupture incidences evaluated. The null hypothesis was tested and there was no difference between the preoperative to postoperative outcomes. Two groups were evaluated, those who had concomitant decompression and those who did not. RESULTS: The null hypothesis was not supported. The 4 scoring systems used for evaluation showed statistically significant improvement from preoperative to postoperative. There were no differences in outcome based upon sex or age as a variable. All patients would have surgery again to achieve their postoperative state. CONCLUSIONS: The arthroscopic repair of supraspinatus tears is effective for improving the functional status of the shoulder.

Acromion↗

PubMed2003

Arthroscopic repair of massive rotator cuff tears: a prospective cohort with 2- to 4-year follow-up.

PURPOSE: The goal of this study is to report on the complete arthroscopic repair of massive rotator cuff tears. TYPE OF STUDY: Prospective cohort study. METHODS: Between 1997 and 1999, 37 patients underwent complete arthroscopic repair of massive rotator cuff tears. The preoperative and postoperative outcomes of these 37 patients were analyzed using the constant score, American Shoulder and Elbow Society (ASES) index, visual analog pain scale (VAS), a single question of percent function compared with the opposite unaffected extremity, and a single question reflecting satisfaction (Would you undergo the surgery and the postoperative rehabilitation to achieve the result you have today?). The null hypothesis that was tested was that there was no difference between the preoperative and postoperative outcomes. The 37 patients were divided, by cohort design, into 2 groups; massive anterosuperior (AS; subscapularis, supraspinatus, and infraspinatus with or without the teres minor) and massive posterosuperior (PS; supraspinatus and infraspinatus, with or without the teres minor) tears. Additionally, the null hypothesis that there was no difference between outcomes for massive AS and massive PS subgroups was tested. RESULTS: There was no statistically significant difference between either subset of massive rotator cuff tears with respect to preoperative and postoperative outcomes. The null hypothesis was supported for between groups. All but 2 patients said that they would undergo surgery again to achieve the postoperative state. CONCLUSIONS: The arthroscopic repair of massive rotator cuff tears is effective for decreasing pain and improving the functional status of the shoulder for most patients. Complete coverage was achieved in 78% of the patients at the time of surgery. A subset of patients who did not have complete coverage or coverage at a second setting showed similar outcomes as those with full coverage. The patient satisfaction rate was 95%.

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PubMed2002

The graveyard shift: experience with a night float system.

The aim of this study is to describe the effects of a new night float system on the circadian rhythm and clinical judgment of our residents. In addition, the study looks at the residents' opinions of how to optimize the night float system in the future. All 20 of the radiology residents at our institution completed a questionnaire about the night float system after completing their night float coverage. The results of the questionnaire were then compiled and tabulated. It took our residents an average of 2.0 days to become acclimated to the night float and an average of 2.3 days to return to a normal daily routine after completing the night float. No residents perceived impairment in their clinical judgment while on the night float. However, 9 of the 20 residents (45%) stated that their clinical judgment was improved on the night float compared to that of a 24-hour call. Eighteen of 20 residents (90%) preferred the night float system to a 24-hour call system. On average, our residents believe that the optimal number of hours for a night float shift is 10.5 hours and the optimal numbers of days to do the night float consecutively is 6.8 days. In conclusion, a night float system can be a preferable means of evening coverage as it has a minimal effect on the circadian rhythm by allowing residents to become acclimated to working the night shift over the course of several days. The night float system also demonstrates no appreciable adverse effects on clinical judgment and may allow better clinical judgment than a 24-hour call system.

Journal Article↗

PubMed2002

Ureterolithiasis: classical and atypical findings on unenhanced helical computed tomography.

Evaluation of patients with acute flank pain using helical computed tomography (CT) is a well-accepted, rapid, and safe procedure in the emergency setting. Various primary and secondary signs are described in the literature for evaluation of these patients. Our purpose is to demonstrate both the classical findings associated with ureteral calculi on unenhanced helical CT and atypical findings and potential pitfalls. We also provide readers with a systematic approach to interpreting unenhanced helical CT scans performed for acute flank pain.

Journal Article↗

PubMed2002

Using contrast-enhanced MR cholangiography with IV mangafodipir trisodium (Teslascan) to evaluate bile duct leaks after cholecystectomy: a prospective study of 11 patients.

OBJECTIVE: The purpose of our study was to determine whether contrast-enhanced MR cholangiography using IV mangafodipir trisodium can accurately detect the presence and location of bile duct leaks in patients who have undergone cholecystectomy. SUBJECTS AND METHODS: Our study group included 11 patients with suspected bile duct leaks after cholecystectomy. Axial single-shot fast spin-echo and gradient-echo images were acquired in all patients before and 1-2 hr after IV administration of mangafodipir trisodium. The contrast-enhanced MR cholangiograms were evaluated for image quality, degree of ductal or small bowel opacification, and the presence and location of bile duct leaks, strictures, and stones. MR cholangiograms were correlated with conventional contrast-enhanced cholangiograms obtained in all patients, including endoscopic retrograde cholangiography (n = 10) and percutaneous transhepatic cholangiography (n = 1). RESULTS: Excretion of mangafodipir trisodium was noted in the intrahepatic and extrahepatic bile ducts in all patients from 1 to 2 hr after IV administration. Bile ducts and fluid collections that contained excreted mangafodipir trisodium showed increased signal intensity on gradient-echo sequences and decreased signal intensity on single-shot fast spin-echo sequences. Conventional contrast-enhanced cholangiography showed the presence of bile duct leaks in six patients and the absence of bile duct leaks in five patients, with false-negative findings in one patient and false-positive findings in one patient for bile duct leak (sensitivity, 86%; specificity, 83%). CONCLUSION: Contrast-enhanced MR cholangiography with IV mangafodipir trisodium can successfully detect the presence and location of bile duct leaks in patients suspected of having such leaks after undergoing cholecystectomy. More research is necessary before acceptance of this examination as routine in the workup of these patients.

Adult↗