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Biomedical subjects

E A Stringer

Publications and source records attributed to E A Stringer.

At least 19 recordsLinked to original sources
PubMed2001

Pregnancy outcomes after laparoscopic myomectomy with ultrasonic energy and laparoscopic suturing of the endometrial cavity.

STUDY OBJECTIVE: To evaluate pregnancy outcomes in women with laparoscopic removal of myomas that resulted in entry into the endometrial cavity and required laparoscopic repair of the endometrial cavity. DESIGN: Retrospective chart review (Canadian Task Force classification II-2). SETTING; Private obstetrics-gynecology practice and departments of obstetrics and gynecology at two university-affiliated hospitals. PATIENTS: Seven women with symptomatic uterine leiomyomata treated by laparoscopic myomectomy, who achieved pregnancy. INTERVENTION: Laparoscopic dissection of myomas with the ultrasonic scalpel and laparoscopic suturing of the uterus with the Endo Stitch device in three layers. MEASUREMENTS AND MAIN RESULTS: Indications for laparoscopic myomectomies were excessive bleeding and significant growth of uterine myomas. The size of myomas in all patients ranged from 12 to 2 cm. Average operating time was 232.8 minutes and average blood loss was 117.8 ml. The largest number of myomas removed from a single patient was nine. All procedures were performed on an outpatient basis and no complications occurred. All women easily achieved pregnancy and four were delivered at or near term by cesarean section. One delivered vaginally at 28 weeks secondary to uncontrolled premature labor, without uterine dehiscence. Two had elective terminations at 8 weeks. CONCLUSION: Laparoscopic suturing of the endometrial cavity in three layers does not prevent future pregnancies, and pregnancies can progress to term and in some cases be delivered vaginally without dehiscence. (J Am Assoc Gynecol Laparosc 8(1):129-136, 2001)

Adult↗
PubMed2001

Laparoscopic myomectomy after failure of uterine artery embolization.

A patient experienced continuing pain and growth of a broad-based pedunculated myoma 6 months after uterine artery embolization (UAE). A 7-cm myoma was found growing directly from the serosa of the fallopian tube and was removed laparoscopically. To our knowledge, this is the first report of laparoscopic myomectomy performed after failure of UAE. This case identifies one of the predictable limitations of UAE of which gynecologists must be cognizant when recommending the procedure.

Embolization, Therapeutic↗
PubMed1994

Stabilization of thoracic spine fractures resulting in complete paraplegia. A long-term retrospective analysis.

STUDY DESIGN: The impact of surgical stabilization on initial rehabilitation and complications in patients with traumatic thoracic level paraplegia was investigated. One hundred thirteen patient records were retrospectively reviewed. SUMMARY OF BACKGROUND DATA: Forty-six patients had been treated with surgical stabilization and fusion. Nineteen patients had been treated by laminectomy alone. Forty-eight patients had been treated nonoperatively. The most common mechanism of injury was a motor vehicle accident (52.6%). The mean follow-up was 8.4 years. METHODS: All inpatient and outpatient records at Craig Hospital were reviewed for patients who had sustained a thoracic spine fracture (T2-T9) that resulted in complete paraplegia (Frankel A). All patients were followed for a minimum of 5 years. Data were collected regarding initial length of inpatient rehabilitation, as well as early and late complications that affected rehabilitation and function during follow-up. This information was analyzed by treatment group. RESULTS: There was a statistically significant difference in the length of initial rehabilitation days between the surgically stabilized group and the laminectomy-only group. There was a trend toward fewer in-patient rehabilitation days between the surgically stabilized group and the nonoperatively treated group. The surgically treated group had twice as many complications as the nonoperative group. CONCLUSIONS: The surgical stabilization of thoracic (T2-T9) spine fractures with complete paraplegia tends to decrease initial rehabilitation days but is associated with increased overall complications. The treatment of this patient group clearly must be individualized.

Adult↗
PubMed1993

Intramedullary versus extramedullary tibial alignment systems in total knee arthroplasty.

One hundred twenty consecutive total knee arthroplasties were performed to compare the accuracy of intramedullary versus extramedullary tibial resection guides. An intramedullary guide (group 1) was used in 60 cases and an extramedullary guide (group 2) was used in another 60 cases. In group 2, the distal portion of the extramedullary guide was shifted 3 mm medial to the midpoint of the ankle in order to position it over the center of the talus. Postoperative tibial component alignment angles were similar in both groups (group 1, 0.43 degrees varus; group 2, 0.36 degrees valgus). However, 88% of tibial components in group 2 were aligned within 2 degrees of the 90 degrees goal versus only 72% of tibial components in group 1. Satisfactory alignment can be obtained with either intramedullary or extramedullary resection guides, although a wider range of error was encountered with intramedullary guide use. Distal positioning of the extramedullary guide over the center of the talus rather than the midpoint of the ankle is important to avoid varus tibial resection. Extramedullary guides avoid the potential complications of intramedullary guide use, including fat embolization and hypoxia, intraoperative fracture, loss of polymethyl methacrylate pressurization, and inability of intramedullary rod passage due to deformity, retained hardware, or pathologic bone disease.

Aged↗
PubMed1992

Swanson silicone arthroplasty of the wrist in rheumatoid arthritis: a long-term follow-up.

Twenty-three Swanson silicone rubber implants in patients with stage III or stage IV rheumatoid arthritis were reviewed at an average of 72 months after surgery. Minimum follow-up in patients with unrevised implants was 44 months. Results were rated good or excellent in 48%, fair in 4%, and poor in 48%. Pain was the primary indication for surgery. Patient satisfaction and pain relief were achieved in 63%. Implant fracture occurred in 52%. Revision rate was 30%, including one recommended revision. Radiographic changes consistent with particulate synovitis were seen in 30%. Prosthesis settling and bony resorption were seen in more than 75% of the patients. Survivorship analysis demonstrated 42% survival at 77 months. Progressive clinical and radiologic deterioration was seen. Swanson silicone rubber implant is recommended only in the very low demand patient with stage III or stage IV rheumatoid arthritis and in those with insufficient bone stock to allow total wrist arthroplasty with a metal-on-plastic design.

Arthritis, Rheumatoid↗
PubMed1992

The Clayton total hip arthroplasty. A ten-year follow-up study.

Early success has been reported using a long-stem cemented femoral component in total hip arthroplasty (THA). The same patient group reported by the authors' institution at five years were reviewed again at ten years postarthroplasty. Certain trends can now be defined, including gradual deterioration in the Harris hip score, tendency toward failure of acetabular fixation (8.4% loosening rate requiring revision), and increased calcar resorption. Overall, the cemented femoral component has performed admirably, with a 97% success rate at ten-years' post-THA (3.1% revision rate). In this study, success was defined as arthroplasties that did not require revision. Ninety percent of observed patients were rated as good or excellent using the Harris hip score. The Clayton femoral component provides excellent durability by virtue of design.

Aged↗
PubMed1992

Posterior cruciate condylar total knee arthroplasty. Average 11-year follow-up evaluation.

Forty-two total knee arthroplasties (TKAs) of the posterior cruciate condylar design performed from 1975 until 1978 were reviewed. Follow-up evaluations averaged 11 years. There were 21 knees each of osteoarthrosis and rheumatoid arthritis. The average postoperative knee score was 85.4 points. Thirty-nine knees (92.8%) were rated good or excellent, one (2.4%) was judged fair, and two (4.8%) were considered failures. Postoperative flexion averaged 104 degrees. Analysis of osteoarthritic versus rheumatoid arthritic subgroups demonstrated no significant differences in motion, alignment, or knee score. Roentgenographic review demonstrated no cases of femoral or tibial loosening, but one case of patellar component dislodgement was observed. Nonprogressive radiolucent lines were observed in 75% of the cases. Good results can be expected if satisfactory lower-extremity alignment is attained. Posterior cruciate ligament retention has provided a slightly improved postoperative range of motion. Residual problems appear to be centered about the patellofemoral joint.

Adult↗
PubMed1990

Capitello-Condylar total elbow arthroplasty for rheumatoid arthritis.

Twenty-one total elbow arthroplasties using the Capitello-Condylar design of Ewald were performed at the Denver Orthopedic Clinic from 1977 to 1986. Indications for operation included intractable pain unrelieved by medical therapy as well as late state III or IV rheumatoid arthritis. The average total elbow score at 48 months after operation was 89.5 points, including excellent pain and function ratings. Modest gains in motion occurred with lesser gains in patients with juvenile rheumatoid arthritis than those of the adult variety. Forty percent of the elbows suffered some type of complication although most are successfully manageable. There was one clinical failure due to deep infection in a renal deficient patient.

Adult↗
PubMed1984

Ribosomal subunit antiassociation activity in rabbit reticulocyte lysates. Evidence for a low molecular weight ribosomal subunit antiassociation protein factor (Mr = 25,000).

A ribosomal subunit antiassociation activity has been purified from both the postribosomal supernatant and ribosomal salt-wash protein fractions of rabbit reticulocyte lysates. A majority (greater than 90%) of the activity is associated with a low molecular weight protein of Mr of approximately 25,000. A small but significant level of antiassociation activity (less than 10%) was found to be associated with higher molecular weight protein fractions. The purified 25,000-dalton antiassociation factor interacts with 60 S ribosomal subunits to prevent them from reassociating with 40 S ribosomal subunits. The factor does not seem to interact directly with 40 S subunits nor does it dissociate 80 S monosomes. The properties of this factor are thus similar to the eukaryotic initiation factor 6 isolated from both wheat germ and calf liver extracts.

Animals↗
PubMed1984

The posterior cruciate condylar total knee prosthesis. A five-year follow-up study.

Remarkable results were demonstrated for the nonlinked, semiconstrained total condylar knee prosthesis in the first long-term follow-up study. The posterior cruciate condylar prosthesis, a variation of the basic design, leaves the posterior cruciate ligament intact. Ninety-four consecutive knees were observed for a minimum postoperative follow-up period of five years. Apart from this design modification and a slightly different program of postoperative care, the methods and techniques used were identical to those used with the total condylar knee prosthesis. By the same method of assessment (The Hospital for Special Surgery Knee Rating Scale), 54 of the ninety-four knees (57.4%) were rated excellent; 37 (39.4%), good; two (2.1%), fair; and one (1.0%), poor. The average preoperative score was 48 points, and the average postoperative score was 81 points (85-100 points = excellent). The posterior cruciate condylar total knee prosthesis represents an excellent prosthetic design for a wide variety of knee deformities and maintains the posterior cruciate ligament for supplementary posterior support.

Adult↗
PubMed1983

The effect of hypotensive anesthesia on cephalosporin concentrations in serum, soft tissue, and bone.

The objective of this study was to determine the efficacy of a hypotensive anesthetic in enhancing tissue perfusion while simultaneously controlling surgical blood loss. One hundred ten patients undergoing 126 total hip arthroplasties were administered either cephalothin or cefamandole on a double-blind basis. Hypotensive anesthesia was administered to 64 patients; 46 received a normotensive anesthetic. Degree of tissue perfusion was measured by the concentration of cephalosporin found in samplings of serum, soft tissue, and bone. These samples, obtained during the course of total joint arthroplasty, indicate that the hypotensive anesthetic sodium nitroprusside did not significantly alter the concentrations of cefamandole or cephalothin from those found in the normotensive group.

Anesthesia↗
PubMed1983

Correlation of prosthetic femoral head size and/or design with longevity of total hip arthroplasty.

Sixty-seven Mueller and 84 Charnley total hip arthroplasties were followed up for a minimum of seven years; pain, radiographic radiolucency, and prosthetic component loosening were evaluated. The patients who had Mueller total hip prostheses had significantly more pain at five (p less than 0.021) and seven years (p less than 0.001). No statistical differences were found between the two prosthetic groups in regard to incomplete or complete radiolucency or loosening of the femoral component, or incomplete or complete nonprogressive radiolucency of the acetabular component. The Mueller acetabular cup was loose in 15%, as compared with 4% for the Charnley group (p less than 0.032). A survival analysis at five and seven years revealed that the success rate for Charnley total hip arthroplasties was 94% and 86%, respectively, as compared with 87% and 70%, respectively, for Mueller total hip arthroplasties (p less than 0.003). This difference possibly is due to the large Mueller femoral head; if so, resurfaced hips would also experience earlier acetabular loosening.

Acetabulum↗
PubMed1982

Hemin-independent control of globin synthesis in Friend erythroleukemia cells induced to differentiate.

A hemin-independent translational inhibitor that prevents synthesis of rabbit globin when uninduced Friend leukemia (FL) cell and rabbit reticulocyte lysates are mixed [Cimadevilla, J. M. & Hardesty, B. (1975) Biochem. Biophys. Res. Commun. 63, 931-937] cannot be detected in FL cells induced to differentiate. Mixing of lysates of FL cells induced with hexamethylene bisacetamide or aminonucleoside of puromycin and rabbit reticulocytes does not cause inhibition of rabbit globin synthesis. Induction also results in the cells acquiring sensitivity to the inhibitor from uninduced FL cells. A reduction in total protein synthesis is observed when uninduced and induced FL cell lysates are mixed. Inhibition does not result from competition by an excess of uninduced FL cell mRNA species for the translational machinery because uninduced FL cell lysates retain their inhibitory activity after treatment with micrococcal nuclease. Rabbit globin mRNA recovered from rabbit reticulocyte lysates that have been incubated with lysates of uninduced FL cells can still be translated effectively, indicating that inhibition does not result from modification of other species of mRNA by uninduced FL cell lysates. A switch to hemin-dependent translational control does not follow induction of differentiation. The rate of amino acid incorporation in induced FL cell lysates--like that in uninduced FL cell lysates--is unaffected by omission of exogenous hemin from the system. Its presence is not required to prevent activation of heme-regulated inhibitor. From these data, it is clear that the control of protein synthesis in FL cells--whether or not they are induced--is different from that regulated by hemin in normal erythroid cells.

Acetamides↗
PubMed1981

Radiolucency surrounding the posterior cruciate condylar total knee prosthetic components.

A total of 73 knees with posterior cruciate condylar knee replacements and postoperative follow-ups of two years or more were examined roentgenographically at six months, one year, and two years for evidence of surrounding radiolucency. Those subjects with evidence of lucent lines surrounding either the tibial, femoral, or patellar components at the two-year postoperative point were compared to subjects revealing no radiolucency on the basis of The Hospital for Special Surgery Knee Rating Scale. Twenty-five subjects were noted to have femoral component radiolucency, 16 showed tibial component radiolucency, and two had evidence of patellar radiolucency. All instances of radiolucency were incomplete and less than 1 mm in width. There was no significant difference in the total code or pain code between the radiolucent and nonradiolucent groups. The subject's preoperative diagnosis did not rest upon the appearance of lucent lines. At the two-year postoperative interval, radiolucency of this extent does not appear to be a sign of imminent loosening.

Arthritis↗
PubMed1981

Functional significance of nonunion of the greater trochanter.

The effects of a trochanteric nonunion on four commonly measured criteria (pain, range of motion, walking, and a functional evaluation) used in evaluating the sucess of total hip arthroplasty were demontrated by statistical comparison of 557 hips with trochanteric union to 78 nonunions. Analyses performed at six months, one year, two years, and three years postoperation revealed no significant differences in the level of pain experienced by subjects with united fragments and those with trochanteric nonunion. However, nonunion subjects having had previous operations were found to have higher than usual levels of pain. Of the remaining criteria tested, only the walking evaluation showed significant differences between subjects with a united fragment and those with trochanteric nonunion. Patients with a united fragment demonstrated an improved ability to walk, significant at the p less than or equal to 0.05 level, at six months, one year, two years, and three years postoperatively. The size of the trochanteric gap (less than or equal to 1 cm) was not found to influence these results.

Evaluation Studies as Topic↗