Biomedical subjects
Publications and source records attributed to B N Stulberg.
In this article, normal and hyperactive states of parathyroid, thyroid, and cortisol production are examined. Their role in bone loss and the rationale for therapeutic intervention are also discussed.
For this study on the incidence and prevention of deep-vein thrombosis, we examined the data on 517 patients with 638 total knee replacements. All of the patients had postoperative venograms and 475 had postoperative perfusion lung scans. We collected data on known risk factors, tourniquet time, knee deformity, postoperative rehabilitation, and methods of prophylaxis, and performed extensive statistical evaluation. Forty-nine patients inadvertently did not receive prophylaxis, and in forty-one (84 per cent) of them ipsilateral deep-vein thrombosis developed. The incidence of ipsilateral thrombosis was 57 per cent in the 468 patients who did receive some form of prophylaxis. Ipsilateral thrombosis in the popliteal veins or thigh was seen in 11 per cent of the patients with unilateral total knee replacement, and contralateral thrombosis was noted in 3 per cent. Bilateral total knee replacement was associated with a 58 per cent incidence of ipsilateral deep-vein thrombosis in the calf and a 14 per cent incidence in the thigh. Pulmonary embolism was diagnosed clinically in nine patients (1.7 per cent), but was suggested on perfusion lung scans in thirty-nine patients (7 per cent). Twelve patients (2.3 per cent) received formal anticoagulant therapy. In no patient was the pulmonary embolism fatal. No specific high-risk population was identified. While no one prophylactic regimen was proved to be more effective than another in our series, we think that prophylactic measures should be part of the management of patients undergoing total knee replacement.
Although this study was performed on a relatively small number of patients undergoing total hip arthroplasty in conjunction with aspirin prophylaxis for postoperative pulmonary embolism, several important points are noted: the use of pre- and postoperative lung perfusion scanning can eliminate a 15% rate of false-positive diagnosis of pulmonary embolism, and pulmonary embolism occurred in approximately 8% of patients undergoing total hip arthroplasty in conjunction with aspirin prophylaxis, without fatality. This occurred despite the inclusion of high-risk patients. "Silent" pulmonary embolization occurred in 4.1% of these patients. Patients who have a history of a thromboembolism, a delayed postoperative course, and two or more risk factors for pulmonary embolism present, are at risk of developing a postoperative pulmonary embolism, despite aspirin therapy, and should be managed more aggressively, i.e., early detection or prophylactic anticoagulation therapy.
Using a biochemical assay of the prostaglandin endoperoxide metabolite malondialdehyde, platelet activity was evaluated in 147 patients who were undergoing orthopaedic surgical procedures. Assays were performed before and after operation and the results were correlated with the type of operation, the sex of the patient, and the use of aspirin as an antiplatelet-aggregation agent. Postoperatively, statistically significant elevations of platelet activity were found in patients who were not taking aspirin, while highly statistically significant suppressions of this activity were found after total hip arthroplasties and other surgical procedures in patients who had received aspirin. Men and women had similar levels of suppression of platelet aggregability with aspirin.
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