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Biomedical subjects

D T Reilly

Publications and source records attributed to D T Reilly.

At least 19 recordsLinked to original sources
PubMed1991

The use of bone allografts in two-stage reconstruction after failure of hip replacements due to infection.

Bone allografts were used to reconstruct deficient acetabular and femoral bone in eighteen patients during two-stage revision of a hip arthroplasty that had failed due to infection. At a mean of 4.2 years after reimplantation, only two patients had had recurrence of the infection. Four patients needed another revision arthroplasty for reasons other than infection. These results suggest that allografts of bone are useful for the reconstruction of osseous deficiencies in carefully selected patients who have a hip arthroplasty after infection. The results do not support the concern that allografts that are used under these circumstances necessarily lead to a high rate of recurrence of infection. However, the long-term results of the use of allografts in hip arthroplasty after infection remain unknown.

Acetabulum↗
PubMed1990

Prospective comparative study of cefotetan with piperacillin for prophylaxis against infection in elective colorectal surgery.

This study compared one dose of cefotetan with three doses of piperacillin as prophylaxis against wound infection in 153 patients undergoing elective colorectal surgery. The patients were randomized into two groups: the first received 2 g cefotetan intravenously with induction of anaesthesia (n = 75), and the second received three doses of 2 g piperacillin (n = 78). Wound infection was defined as the presence of an abscess or discharging pus from the wound. In the cefotetan group there were 14 (19%) wound infections and 13 (17%) in the piperacillin group. There were three septic deaths, one in the cefotetan group and two in the piperacillin group. Both groups were comparable with regard to age, sex, nature of pathology and pre- and perioperative risk factors. No significant haematological or biochemical abnormalities were detected. The only adverse reaction was one patient who had an allergic reaction (rash) to piperacillin. These data suggest that single-dose cefotetan is as effective as triple-dose piperacillin in prophylaxis against infection in elective colorectal surgery.

Cefotetan↗
PubMed1989

Vascular graft infection: the role of indium scanning.

Infection of a prosthetic graft is one of the most feared complications of vascular surgery. The difficulties of accurate, objective diagnosis are well recognised. We have used III Indium labelled white blood cell scans (InWBC) in two groups: 9 control patients who underwent uncomplicated aortic aneurysm surgery, and 23 patients with suspected graft sepsis. In the control group there was one positive scan in a patient with an inflammatory aneurysm. In the suspected sepsis group, 11 patients subsequently has proven graft sepsis. Nine were correctly predicted by Indium scanning. Ten of 12 patients who did not have proven graft sepsis had negative scans. There was a total of 5 inflammatory aneurysms in the control and suspected sepsis groups, of whom two had positive scans. False positive scans were not present in the early postoperative period i patients without inflammatory aneurysms. In our experience Indium labelled WBC scanning for suspected graft sepsis has a accuracy of 83% a negative predictive value of 83% and a positive predictive value of 82%. These results suggest that Indium white cell labelling techniques which do not involve substantial cross-labelling of platelets are the best objective methods of establishing the presence or absence of graft sepsis.

Aorta↗
PubMed1989

Prophylactic methods against thromboembolism.

Deep vein thrombosis and pulmonary embolism are significant hazards of surgery, especially in orthopedic procedures. However, the true incidence of these complications is unknown. Many surgeons are now using prophylactic methods to prevent the postoperative occurrence of thromboembolic disease. Pneumatic compression devices are recommended in some instances, especially in cases where increased bleeding could be devastating. Several pharmacologic agents are also used, alone or in combination with pneumatic devices. These include subcutaneous heparin, warfarin, dextran, and aspirin. Each agent has advantages and disadvantages. The US National Institutes of Health (NIH) and numerous ongoing clinical trials are attempting to establish recommendations and guidelines for the use of prophylaxis against postoperative deep vein thrombosis and pulmonary embolism.

Anesthesia, Epidural↗
PubMed1988

Percutaneous transluminal angioplasty for the ischaemic lower limb: the early Dunedin experience.

A consecutive series of 60 percutaneous transluminal angioplasties has been performed in 53 patients with severe peripheral ischaemia over a 4 year period. There were 78 lesions dilated with an initial technical success rate of 78%. Forty-eight lesions were dilated for severe claudication and 30 for rest pain or necrosis. There was a mean followup of 24 months (range 9-56) for the immediately successful angioplasties. When these were analysed according to symptomatic relief, 59% of claudicants with iliac lesions were still improved at 2 years, compared with 86% of those with femoropopliteal lesions. Amongst patients treated for rest pain or necrosis there was a 100% success rate at 2 years for iliac lesions, compared with 49% for femoropopliteal lesions. The overall success of this procedure in this high risk group is reflected by the fact that at 2 years 85% of claudicants and 72% of those with rest pain and necrosis have avoided any further procedure. This encouraging early experience confirms the place of interventional radiology in the management of peripheral vascular disease.

Adult↗
PubMed1988

Dynamic loading of normal joints.

The biomechanics of joints are discussed with regard to the relative motion of the bones controlled by a combination of muscle forces, condylar shape, and ligamentous constraints. The author describes the joint reaction forces that are a result of muscle forces, and provides a detailed description of joint loads to the hip and knee.

Body Weight↗
PubMed1988

Strategies for improving fixation of femoral components in total hip arthroplasty.

As strategies are considered for improving fixation of femoral components in total hip arthroplasty (THA), one is challenged to exceed the standard set by contemporary cement procedures. However, despite the improved ten- to 15-year clinical results anticipated with current cementing techniques, the limited fatigue strength of polymethylmethacrylate warrants continued investigation of alternative systems, particularly for younger patients and in revision arthroplasty. Design considerations for femoral stems for cementless THA include (1) initial mechanical stability afforded by the stem shape, (2) strength and stiffness of the stem, and (3) surface features relating to biocompatibility and attachment to bone. In one approach a fit-and-fill algorithm has been implemented to design stems that maximize contact between prosthesis and cortex in priority areas to achieve stability. Titanium is recommended for the fabrication of such stems because of its corrosion resistance, its biocompatibility, and its modulus, which is lower than that of cobalt-chromium alloy. Long-term fixation of these implants will be dependent upon the maintenance of normal strain patterns in the host bone. Achievement of this goal will require additional strategies that combine optimal fit and optimal material properties of the prosthesis.

Biocompatible Materials↗
PubMed1987

A controlled trial of pentoxifylline (Trental 400) in intermittent claudication: clinical, haemostatic and rheological effects.

A formulation of pentoxifylline (Trental 400) has been claimed to increase claudication distance by improving red cell deformability and decreasing blood viscosity and platelet aggregation. In order to test this claim 30 stable claudicants recruited from one population took part in a double-blind randomised trial of placebo versus pentoxifylline. Both placebo and pentoxifylline treated patients improved subjectively and increased their claudication distance over the study period. Analysis of the blood results showed that the only apparent change was a tendency towards increased red cell filtration in the group treated with pentoxifylline; but no significant difference was found between claudicants and normal controls in the degree of red cell filterability nor did red cell filterability correlate with claudication distance. Pentoxifylline did not affect claudication distance or have any useful effect on blood flow properties, calling into question both its efficacy and suggested mode of action.

Adult↗