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Biomedical subjects

D L Douglas

Publications and source records attributed to D L Douglas.

7 recordsLinked to original sources
PubMed1991

Fatal pulmonary fat embolism during total hip replacement due to high-pressure cementing techniques in an osteoporotic femur.

High-pressure cementing techniques, involving the use of a cement gun and cement restrictor, placed within the femoral medullary cavity, are commonly used to secure the femoral component of hip arthroplasties. Such techniques have been shown to be important in maintaining the integrity of the bone-cement interface and also the integrity of the cement itself. This case report illustrates that such techniques are not without complications.

Cementation↗
PubMed1991

Risk of deep infection with intramedullary nailing following the use of external fixators.

A retrospective review was carried out to assess the incidence of deep infection occurring when intramedullary nailing was performed following the use of an external fixator. Three groups of patients were identified: group 1 in which the external fixator was used in initial fracture management (ten cases, nine patients), group 2 in which the external fixator was used in the management of established non-union (seven cases, seven patients), and group 3 in which the external fixator was used in limb lengthening procedures (eight cases, eight patients). All the 25 cases reviewed had clinical evidence of pin track infection before removal of the external fixator. After removal of the fixator it is our normal policy to wait for the pin sites to become dry before performing intramedullary nailing. In only one case, where there was a history of preceding recrudescent osteomyelitis, was there evidence of deep infection being reactivated following intramedullary nailing. We therefore conclude that pin track infection does not seem to be a contraindication to the subsequent use of an intramedullary nail, providing that underlying active osteomyelitis is not present. A delay of 7 to 14 days after removal of the fixator is recommended. Some problems experienced during nailing are highlighted, and solutions proposed.

Adolescent↗
PubMed1990

Improvement in the deformity of the face in Paget's disease treated with diphosphonates.

We studied nine patients with Paget's disease affecting the skull or facial bones, who were subsequently treated with either dichloromethylene diphosphonate (clodronate) or ethylene-1-hydroxy-1,1-diphosphonate (etidronate). Long-term treatment induced a clinical and biochemical improvement in eight, and this was associated with a reduction in maxillary or skull volume as assessed by quantitative stereophotogrammetry. The one patient whose disease was resistant to treatment with diphosphonate, showed no change in maxillary shape. These studies suggest that the long-term control of disease activity attained with diphosphonates, results in the improvement of skeletal deformity.

Aged↗
PubMed1990

Bicondylar St. Georg sledge knee arthroplasty.

Fifty-three bicondylar St. Georg sledge knee arthroplasties in 44 patients were reviewed. These patients had a mean follow-up period of 5.9 years (range, three to ten years). Function was assessed using the d'Aubigné scale coupled with measurement of range of motion (ROM) and stability. Pain relief was substantial (75%), and functional ability improved commensurately. ROM improved from a preoperative average of 83 to a postoperative 123. Three (5.7%) arthroplasties failed and were subsequently revised, while three (6.8%) of the knees examined at review have static radiolucent lines at the tibial bone-cement interface. The remaining 44 knees examined (93.2%) showed no signs of impending failure and have sustained their functional result. The polyethylene tibial components are not metal backed, and it is of interest that bone-cement interface failure has been unusual. This operation is a somewhat exacting procedure, but with the correct choice of patient and technique, a predictable result can be expected.

Adult↗
PubMed1975

Evaluation of diagnostic ultrasound in gynecology.

The experience with 300 consecutive gynecologic patients undergoing diagnostic ultrasound has been evaluated. Follow-up was obtained by recording the clinical course and/or the operative findings. The ultrasound studies were diagnostic in 21 per cent, confirmatory in 74 per cent, and misleading in 5 per cent of the patients. Certain conditions lend themselves to diagnosis with ultrasound: hydatidiform mole, intrauterine pregnancy, dermoid cyst, ascites, simple ovarian cyst, and lost intrauterine contraceptive devices (IUCD's). The studies in patients with chronic pelvic inflammatory disease or adhesions were occasionally misleading. Diagnostic ultrasound was particularly helpful in the obese patient, in whom adequate pelvic examination was difficult.

Adnexal Diseases↗
PubMedDate not supplied

Spontaneous fractures in a patient treated with low doses of etidronic acid (disodium etidronate).

The recommended regimen of etidronic acid (disodium etidronate) for the treatment of Paget's disease of bone is 5mg/kg/day for a period of less than six months. There have, however, been reports of impaired mineralisation of bone and concern that the risk of fracture is increased with this dosage. We report a patient with Paget's disease in whom fractures occurred through pagetic and non-pagetic bone which appeared to be causally related to treatment with lose doses of etidronic acid. The osteomalacia resolved when etidronic acid was discontinued.

Aged↗