Biomedical subjects

D A Boston

Publications and source records attributed to D A Boston.

5 recordsLinked to original sources

PubMed1985

The significance of peak expiratory flow rate in assessing prognosis of elderly patients undergoing operations on the hip.

Peak expiratory flow rate (PEFR) was measured using a Wright peak flow meter in 190 patients with fracture of the proximal part of the femur, and in 110 patients who underwent elective total hip replacement. PEFR was significantly lower in the fracture group than in the elective group when similar age ranges were compared. In the fracture group, PEFR of less than 100 was associated with a 69.6 per cent mortality rate, whereas no deaths occurred where the PEFR was greater than 300. It is suggested that the patients' PEFR is a good indicator of their prospects and it can be easily measured on admission.

Age Factors↗

PubMed1985

Acetabular cup failure after total hip replacement.

Fracture of the polyethylene acetabular cup is a rare late complication of total hip replacement. Five cases are reported. In each one this followed a fall, and involved a Müller arthroplasty which had previously been symptomless. It is postulated that ridges or other irregularities of bone, produced by keying holes, could lead to areas of thin cement and potential weakness of support for the cup.

Accidents↗

PubMed1985

Lateral mass fusion. A prospective study of a consecutive series with long-term follow-up.

A prospective study of a consecutive series of lateral mass fusion operations was undertaken between 1972 and 1982 in 144 patients, of whom 129 were available for review. The main indications for operation were persistent back pain associated with spondylolisthesis, localized degenerative disease of the lumbar spine and previous laminectomy and disc excision. The minimum follow-up was 2 years. Although 83% of patients were improved overall, the results in spondylolisthesis and degenerative disease without previous surgery were much better than in those who had previously had disc excision. A pseudarthrosis was found in 13% of patients and was significantly more likely (P less than 0.05) when fusion at more than one level was attempted. There were no serious long-term complications.

Adolescent↗

PubMed1982

Bilateral fractures of the femoral neck.

This study has analysed 500 patients admitted with fractures of the femoral neck. Fifty-three (10.6 per cent) had previously fractured the opposite hip. Thirty-eight per cent had fractured the second side within 1 year of the original fracture, and 74 per cent had initially sustained an intracapsular lesion. Eighty-three per cent sustained a similar type of fracture on both sides. The 3-month mortality following a second fracture was 30 per cent compared with 13 per cent following a first fracture. Thus, following a single fracture there is a significant risk of a second fracture, with an associated high mortality rate. This problem will only be solved if effective, prophylactic measures can be found to prevent bone mineral loss.

Adult↗

PubMedDate not supplied

Effects of nonparticipation in trauma center system on emergency department utilization.

The University of Illinois Hospital (UIH) serves an inner-city urban population in one of the highest crime rate districts in Chicago. On May 20, 1986, the city's Level I Trauma ordinance took effect with the University of Illinois Hospital declining to participate. To measure the impact of the ordinance on a nonparticipating hospital, we undertook a retrospective analysis of our trauma patient utilization statistics. Consecutive monthly patient census data of 71 months was compiled with emphasis on patient presenting complaints and related subspecialty evaluation. We observed significant decreases of patients presenting with head injuries, fractures, and animal bites as well as with major trauma, minor trauma, and general surgery hospital admission. The final disposition of the patients arriving by ambulance was consistent with the observed decrease in major traumatic conditions and in minor traumatic conditions. However, the mean number of patient presentations per day (ppd) admitted to regular medical or surgical beds decreased from 2.70 ppd to 2.30 ppd while the mean number of ppd sent home increased from 2.64 ppd to 3.49 ppd. These data suggest that loss of trauma center status designation has a profound effect on utilization of emergency departments not participating in the trauma system. Nonparticipation appears to be associated with a significant decrease in utilization rates for major and minor trauma patients and a significant increase in the number of patients discharged who had arrived by the Chicago Fire Department Paramedic System (CFD). This effect on the emergency department extends to utilization of inpatient services.

Chicago↗