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Biomedical subjects

E J McClain

Publications and source records attributed to E J McClain.

16 recordsLinked to original sources
PubMed1995

The diagnosis of deep vein thrombosis in the multiply injured patient with pelvic ring or acetabular fractures.

Thirty-one patients with unstable displaced pelvic or acetabular fractures were admitted and underwent an open reduction and internal fixation of their fracture. All patients were studied prospectively for the incidence of proximal deep vein thrombosis (DVT) utilizing venous duplex ultrasound. Duplex scans were repeated at 1 week postoperatively in all patients. Additional scans were performed when clinically indicated. A total of 61 scans were completed. DVT developed in three patients (approximately 10%). Two of the three positive scans were noted only on postoperative examination. The third scan was positive on the preoperative phase. Duplex ultrasound was easily applied and well tolerated by the multiply injured patient.

Acetabulum↗
PubMed1993

Total knee arthroplasty in patellectomized patients.

Thirty-two total knee arthroplasties (TKAs) in patellectomized patients were evaluated with recent clinical and radiographic examinations. Eighteen patients had a primary TKA with a mean follow-up period of 49 months, and 14 patients had a revision TKA with a mean follow-up period of 36 months. A control group of 13 TKA patients with intact patellae were randomly generated but matched for age, sex, follow-up data, diagnosis, and prosthesis. Posterior cruciate ligament-retaining types of prostheses were used in the primary knees, while the revision knees underwent arthroplasties with the more constrained, posterior cruciate ligament-substituting prostheses. All knees were evaluated based on the Knee Society's clinical and radiographic scoring system. In addition, 18 patients (9 primary, 9 revision) underwent isokinetic dynamometer testing for quantitation of peak quadriceps and hamstring torque. The knee score, indicative of pain relief, averaged 82.5 in the primary group (16 good/excellent, 1 fair, 1 poor), 86.5 in the revision group (12 good/excellent, 1 fair, 1 poor), and 93.9 in the control group (13/13 excellent). The function score averaged 59.7 in the primary group (6 good/excellent, 6 fair, 6 poor), 60.0 in the revision group (5 good/excellent, 2 fair, 7 poor), and 80.9 in the control group (12 good/excellent, 1 fair). The lower function scores predominantly reflected the patients' difficulty in independently climbing or descending stairs. This was also reflected in their higher flexion to extension peak torque ratios. There was one failure in the primary group requiring a revision and one failure in the revision group requiring a knee fusion. There was no radiographic evidence of impending failure in any of the remaining knees. No clinical or radiographic differences were found between the patients with osteoarthritis or rheumatoid arthritis. Although the knee and function scores were lower in the patellectomized patients, the overall results were generally satisfactory without a high incidence of failures. Satisfactory results were obtained in the primary TKAs using the minimally constrained prostheses when the posterior cruciate ligament was intact. Revision TKAs, in which the posterior cruciate ligament was absent, also demonstrated satisfactory results with the more constrained, posterior cruciate ligament-substituting prostheses.

Aged↗
PubMed1993

A histologic and biochemical comparison of the interface tissues in cementless and cemented hip prostheses.

Thirty-four membranes from 20 cementless and 14 cemented prostheses from 33 patients excised during revision arthroplasty were analyzed for foreign-body reactive processes. As a control, identical analyses were performed using adjacent pseudocapsular tissue taken from 12 patients during revision arthroplasty. Histologically, cementless membranes tended to contain more metal debris, and cemented membranes contained more foreign-body giant cells. Collagenase, gelatinase, prostaglandin E2, and interleukin-1 were measured in conditioned media taken from organ cultures of each interface membrane. Both cementless and cemented membranes released significant levels of gelatinase and collagenase, prostaglandin E2, and interleukin-1 into the conditioned media when compared with control tissues. However, the tissue concentrations were not significantly different between cementless and cemented membranes. Although histologic differences between cementless and cemented interface membranes exist, both share a similar capacity to release bioactive products that can induce bone resorption and cause aseptic loosening of the hip prostheses.

Adult↗
PubMed1986

Carrageenan stimulates reduction of nitroblue tetrazolium by human neutrophils without membrane depolarization, myeloperoxidase secretion, or increased oxygen consumption.

Carrageenan, a sulfated polyanionic polysaccharide, is commonly used to induce inflammation in experimental animals, and this model is used to screen for the effectiveness of antiinflammatory drugs. Carrageenan-induced inflammation has been attributed to a variety of autocoids including histamine, bradykinin, complement, superoxide, and prostaglandins. This study examines the effects of carrageenan on human PMN in a serum-free system. Carrageenan was found to stimulate the reduction of NBT by PMNs without stimulating membrane depolarization, oxygen consumption, H2O2 production, or myeloperoxidase secretion. Carrageenan stimulates a heat-labile, NBT-reducing system which is unassociated with the usual stimulus-response coupling seen with other PMN activators such as PMA, FMLP, and zymosan.

Carrageenan↗
PubMed1986

Periprosthetic femoral fractures following total knee arthroplasty.

Supracondylar and distal femoral fractures involving total knee arthroplasties present a relatively new and challenging problem. The alignment of the total knee components prior to and subsequent to the fracture, as well as the patients' range of motion, symptoms, and level of function following their treatment, were investigated in 14 cases. Ten of the patients had nonoperative treatment. Four had had an operative procedure. Osteoporosis, notching of the femur, and revision arthroplasty were identified as predisposing factors with femoral fractures. The results of treatment depended primarily on reduction of varus deformity and/or posterior displacement of the femoral component. Nonoperative treatment was most successful in this regard.

Aged↗
PubMed1983

A mechanism for inhibition of luminol-dependent neutrophil chemiluminescence by polyanions.

Heparin has been reported to have antiinflammatory properties in both experimental animal and human disease states. Previous investigators assumed that the antiinflammatory properties of heparin were related to its anticoagulant effect. In this study we confirm the ability of heparin to inhibit luminol-dependent chemiluminescence by neutrophils stimulated with serum-activated zymosan. This inhibition is due to a combination of the diminished release of myeloperoxidase and the scavenging of the luminol oxidant generated by the myeloperoxidase-H2O2-chloride system. Although the polyanions heparin and dextran sulfate were effective in inhibiting luminol-dependent myeloperoxidase-H2O2-chloride chemiluminescence, the uncharged polysaccharide dextran T500 was without effect. None of the polysaccharides inhibited oxygen consumption by stimulated neutrophils. Additionally, heparin was able to reduce the myeloperoxidase release from zymosan-stimulated neutrophils by nearly 50%. Recent studies have shown that some antiinflammatory drugs scavenge peroxidase-generated oxidants of luminol. Such a property may explain the previously observed antiinflammatory effects of heparin and other polyanions.

Cytochrome c Group↗
PubMed1976

The acute carpal tunnel syndrome: nine case reports.

Nine cases of acute carpal tunnel syndrome are reported. Etiologies include: bleeding secondary to chronic lymphatic leukemia; Colles' fracture of the wrist (2 cases); Epiphyseal fracture (Salter II) of the distal radius; Bleeding secondary to giant cell tumor of the tendon sheath; Unstable distal radio-ulnar joint; Displaced intra-articular fracture of the distal radius; Rheumatoid synovitis and vasculitis; Trans-scaphoid, perilunar fracture dislocation of the wrist. Early recognition of median nerve compression in the carpal tunnel is vital. The signs of median nerve compression should be looked for in all cases of wrist trauma. In our opinion, immediate surgical decompression is frequently indicated.

Acute Disease↗
PubMed1975

Prophylactic anticoagulation in total hip replacement.

In the prevention of thromboembolic complications following elective total hip operations, warfarin is a safe and effective agent which causes minimal bleeding complications, if the drug is first administered on the first postoperative day and thereafter continued in various dosages to maintain a prothrombin time between one and one and one-half and two times that of the control. Dextran also is effective in preventing thromboembolic complications but causes more bleeding problems, especially when administered intraoperatively.

Aged↗
PubMedDate not supplied

A comparison of the posterolateral and anterolateral approaches to total hip arthroplasty.

A comparative statistical analysis was performed weighing the relative merits of two surgical approaches for total hip arthroplasty--the Watson-Jones anterolateral approach and the gluteus maximus splitting posterolateral approach. Intraoperative and clinical records were evaluated for 175 patients undergoing total hip arthroplasty between 1975 and 1979--100 by a posterolateral approach and 75 by an anterolateral approach. Minimum follow-up period was two years. Mean operative times for the posterolateral and anterolateral approaches were 62 minutes and 140 minutes, respectively. The posterolateral group had a mean blood loss of 433 ml, with 35% requiring an average transfusion of 2.5 units. The anterolateral group had a mean blood loss of 767 ml, with 78% requiring an average transfusion of 2.5 units. The average lengths of hospitalization for posterolateral and anterolateral groups were 13 and 15 days, respectively. The time to independent cane ambulation was significantly less in the posterolateral group. The rate of post-operative complications was similar in each group. However, in the posterolateral group there were four dislocations, three loosened femoral components, one deep-wound infection, and one pulmonary embolus, while the anterolateral group suffered one dislocation, no prosthesis loosening, no deep-wound infections, and three pulmonary emboli. Although the posterolateral approach was associated with a lower perioperative morbidity than the anterolateral approach, the latter exhibited fewer dislocations and loosened acetabular components.

Adolescent↗