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Biomedical subjects

J D Lowell

Publications and source records attributed to J D Lowell.

13 recordsLinked to original sources
PubMed1984

Intravenous methylmethacrylate after total hip replacement.

In eight patients, radiographs made after total hip replacement revealed methylmethacrylate in the soft tissues of the thigh. In one of them the configuration of the density was that of a vein. In the other seven patients similar but less extensive soft-tissue densities were seen postoperatively. One patient had postoperative hypotension which was thought to be due to a myocardial infarction. In another patient, with a prior history of congestive heart failure, congestive heart failure developed again after total hip replacement. The relationship of these complications to the radiographic observations was not clear.

Aged↗
PubMed1984

Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery, and complications.

This retrospective analysis of 406 patients with proximal femoral fractures was designed to identify both the significant and nonsignificant risk factors that influence patient mortality. The 399 patients treated by open reduction and internal fixation or femoral head prostheses routinely received prophylactic antibiotics and anticoagulants. Of 406 patients followed until death or for at least one year, the overall mortality rate at one year was 14% (58/406). For patients with subcapital fractures the rate was 13% (25/187) and with intertrochanteric fractures 15% (33/219). The expected mortality rate for the normal population of similar age was about 9%. Sex, treatment of subcapital fracture by either internal fixation or arthroplasty, and the level of postoperative ambulation did not influence mortality. The number of preexisting medical conditions and the time of surgery following admission were highly significant factors (p less than or equal to 0.001 for both). The number of postoperative medical complications was also significant. The recommendation is for serious medical conditions to be maximally stabilized for at least 24 hours and pulmonary and physical therapy instituted before scheduling open surgical procedures.

Age Factors↗
PubMed1981

Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis.

Total hip arthroplasty was done in a series of fifty-seven hips with current or prior infection. Active pyrogenic infection existed in eighteen hips at the time of arthroplasty, in five there was probable pyogenic sepsis, and in twenty-seven there was no current pyogenic infection but there was good evidence of prior pyogenic infection. Seven hips had previously been infected with tuberculosis. All but three of the eighteen patients with active infection had a revision of a previous infected arthroplasty. One had had a resection arthroplasty (Girdle-stone) followed six months later by a total hip arthroplasty. The mean length of follow-up was forty-two months. Fourteen of the eighteen reconstructions were successful. The four that were unsuccessful had recurrent infection and included the only two patients with gram-negative organisms. There was no evidence of recurrence of infection in the other three groups (thirty-nine hips).

Adult↗
PubMed1980

Results and complications of femoral neck fractures.

Based on reports in the current literature concerning fractures of the femoral neck, two divergent conclusions are possible. The first is optimistic about the results of treatment by contemporary methods. The second, by contrast, suggests that progress is much less than one might hope for. Over some of the factors that lead to treatment failures, one has little or no control. Over others, one has considerable control. It is in the latter that there are real expectations for improvement.

Bone Nails↗
PubMedDate not supplied

The operating room and the ultraviolet environment.

Clean surgical wounds may be contaminated from three separate sources: endogenously from the patient himself; exogenously from direct contamination by unsterile instruments, drapes, gowns, hands, or gloves; and by bacteria settling from that final common pathway, the air over the operative field. The advent of total joint replacement precipitated a renewed consciousness in the orthopedic community of the disastrous consequences a wound infection can have upon the orthopedic patient. Deep infection around a total joint replacement can convert a procedure with a 95 percent probability of success to a total disaster, leaving the patient worse than prior to operation. Most orthopedists use at least two accepted methods of preventing deep wound infection in the postoperative period: the application of topical antibiotics during surgery, and the intravenous infusion of systemic antibiotics during and after surgery for a brief period. In addition, many orthopedic surgeons are operating in clean air rooms with body exhaust systems; others are operating in an ultraviolet environment. Orthopedic surgery in the ultraviolet environment has been used at the brigham hospitals since 1973. The infection rate has dropped from 3.8 percent to 1.04 percent in a series of 2000 patients. However, inconveniences and hazards have been experienced in the use of ultraviolet radiation in the operating room.

Air Microbiology↗