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Biomedical subjects

M R Brinker

Publications and source records attributed to M R Brinker.

At least 55 records · Page 3Linked to original sources
PubMed1990

A comparison of three varieties of noncemented porous-coated hip replacement.

We reviewed 134 primary noncemented porous-coated total hip replacements in 125 patients: 64 were DePuy AML prostheses, 20 were Howmedica PCA and 50 were Implant Technology LSF. The prostheses had been in situ for an average of 36 months, 40 months and 24 months respectively. The average pre-operative Harris hip scores were 38.2 for AML, 33.2 for PCA, and 41.0 for the LSF prostheses. The average postoperative scores were 80.7 for AML, 83.8 for the PCA, and 91.5 for LSF. Thigh or groin pain associated with the prosthesis was present in 30% of AML, 30% PCA and 8% of the LSF cases. The clinical and radiographic review showed better early results with the LSF prostheses than the others; this seemed to be related to the implant design, which provided improved initial stability and more physiological transfer of load.

Adult↗
PubMed1990

Four-year average follow up of cemented PCA total knees: clinical and roentgenographic analysis.

Twenty patients with 25 consecutive primary-cemented Howmedica PCA total knee prostheses were clinically and roentgenographically reviewed. Twenty implants were placed in 16 women and five in four men. The average patient age at surgery was 68.0 years (range, 53 to 82), and average follow up was 51 months. Total knee replacement indication was degenerative joint disease in 21 knees and rheumatoid arthritis in four. Excellent or good results were seen in 22 of 25 knees (88%) at the early follow up examination and 18 of 25 knees (72%) at the most recent follow up examination.

Aged↗
PubMed1990

Pharmacological regulation of the circulation of bone.

A study was undertaken to investigate the reactivity of the circulation of bone and to pharmacologically characterize the receptor populations that may be present in this poorly described vascular bed. The nutrient artery of the tibia in skeletally mature mongrel dogs was cannulated, under direct vision, through a posterolateral operative approach. An extracorporeal circuit was established so that the nutrient artery of the tibia could be perfused in vivo under conditions of constant blood flow. Diverse vasoactive substances were injected into the perfusion circuit in small volumes as a bolus close to the nutrient artery of the tibia. A range of doses of nitroglycerin, acetylcholine, isoproterenol, methoxamine, U46619 (a thromboxane A2 mimic), dibutyryl cyclic AMP, 8-bromo-cyclic GMP, and endothelin-1 were injected in a randomized sequence for each experiment. The antagonists that were used were atropine (a non-selective muscarinic receptor antagonist), ICI 118551 (a selective beta 2-adrenoceptor antagonist), ONO 3708 (a prostaglandin H2/thromboxane A2 receptor antagonist), and prazosin (an alpha 1-adrenoceptor antagonist). The results of changes in bone-perfusion pressure under conditions of constant blood flow indicated that the vascular bed of bone actively responds to various vasoconstrictor mechanisms, whereas vasodilator mechanisms appear to be considerably less active. Intra-arterial injections of nitroglycerin, acetylcholine, and 8-bromo-cyclic GMP resulted in dose-related decreases in bone-perfusion pressure that were weak relative to concomitant changes in systemic arterial pressure. Intra-arterial administration of methoxamine, U46619, and endothelin-1 resulted in a potent dose-related increase in bone-perfusion pressure. The results of intra-arterial injections of isoproterenol and dibutyryl cyclic AMP were surprising; both substances caused a substantial rise in bone-perfusion pressure. The responses to acetylcholine, methoxamine, and U46619 were blocked in a competitive manner after administration of atropine, prazosin, and ONO 3708, respectively.

Acetylcholine↗
PubMed1990

A survey of running injuries in 1505 competitive and recreational runners.

A 33 item multiple choice questionnaire was circulated; completed questionnaires from 1505 runners (1130 male and 375 female) were obtained. Questions focused upon training, injuries sustained, and medical care. Biomechanical imbalances such as leg length inequality appear to be a major contributing factor to running injuries. Correction of an underlying biomechanical defect may be important in the treatment of many running injuries. Female runners were found to be more susceptible than males to stress fractures at higher mileages. The cause of this increased incidence may be attributable to lower bone mineral density levels as a result of hormonal factors. Factors such as running surface, age and stretching techniques do not appear to play a significant part in the pathogenesis of running injuries.

Adult↗
PubMed1990

Clinical and roentgenographic evaluation of bipolar prostheses with noncemented anatomic medullary locking femoral stems.

Fifty-six DePuy anatomic medullary locking femoral bipolar prostheses were reviewed clinically and roentgenographically in 50 patients at an average follow-up period of 30 months (range, 24-71 months). Forty-four of the implantations were in 40 male and 12 were in ten female patients. Forty-five devices were placed in primary operations, while 11 were used in revisions. The overall average age was 53.5 years. The average Harris hip scores for the primary bipolars were 29.8 preoperative and 77.3 postoperative, while the revision bipolars had Harris hip scores of 35.9 preoperative and 75.1 postoperative. Nearly one-half (47%) of all primary and 54% of the revision patients experienced pain to some degree on ambulation. Roentgenographically, all femoral components appeared to be well fixed biologically. Roentgenographic changes occurred with time in both primary and revision prostheses. On roentgenographic zonal analysis of primary prostheses, radiolucencies greater than 1 mm were present most frequently in the most proximal lateral zone and at the distal tip of the prosthesis. Although the use of noncemented bipolar prostheses generally shows acceptable clinical results, noncemented fixed acetabular components with noncemented femoral components produce a more satisfactory clinical result.

Adult↗
PubMed1990

Postoperative somnolence in patients after carotid endarterectomy.

Eighty-one patients undergoing carotid endarterectomy were divided into two groups based on the degree of stenosis of the carotid artery. Group I, 37 patients, was defined as having severe carotid stenosis (greater than 70%). Group II, 44 patients, was defined as having mild (less than 40%) or moderate (40% to 70%) carotid artery stenosis. Both groups were evaluated for neurologic and psychologic changes in the postoperative period. Prospective analysis demonstrated no significant differences between groups I and II in the areas of cardiac disease, history of preoperative stroke, preoperative and postoperative hypertension, diabetes, or postoperative computed tomography changes. Group II had a significantly higher percentage of carotid artery ulceration (p less than 0.01). Postoperative analysis revealed 34 group I patients had 6 to 8 weeks of lethargy versus two group II patients (p less than 0.01). Eleven group I patients had headaches for the first week postoperatively versus three patients in group II (p less than 0.05). Four group I patients had paranoid ideation, and another four patients had clinical depression, but not one patient in group II (p less than 0.01) had these psychiatric disturbances. These data suggest that significant, reversible neurologic and psychologic changes can occur because of reperfusion after relief of severe stenosis of the carotid artery.

Aged↗
PubMed1990

Clinical and roentgenographic evaluation of noncemented porous-coated anatomic medullary locking (AML) and porous-coated anatomic (PCA) total hip arthroplasties.

Eighty-four primary noncemented porous-coated total hip arthroplasties (THAs) in 78 patients were reviewed clinically and roentgenographically at an average follow-up period of 37 months. The average patient age was 51.9 years. Sixty-four Anatomic Medullary Locking (AML) devices were placed in 58 patients, and 20 Porous-Coated Anatomic (PCA) devices were placed in 20 patients. The AML devices had been in situ an average of 36 months (range, 24-49 months), and the PCA devices had been in situ an average of 40 months (range, 29-51 months). The average patient ages were 52.7 and 49.2 years for AML and PCA patients, respectively. The AML devices included three that were fully coated, 59 that were five-eighths coated, and two that were one-third coated. The average preoperative Harris hip score was 38.2 for the AML devices and 33.2 for the PCA devices. The average postoperative Harris hip score was 80.7 for the AML devices and 83.8 for the PCA devices. Pain related to the implant was present in 30% of the AML devices and 30% of the PCA devices. Roentgenographically, no component demonstrated complete radiolucency, and all components demonstrated roentgenographic evidence of bone ingrowth. Roentgenographic changes with time noted for both the AML and PCA devices included: neck roundoff, neck osteolysis, neck corticocancellization, endosteal bone bridging, and distal hypertrophy. On roentgenographic zonal analysis, radiolucency greater than 1 mm was observed most frequently in the most proximal lateral zone and distal tip of the femoral component. The current series of cases, although clinically acceptable, does not support the current widespread enthusiasm for primary noncemented AML and PCA total hip systems. Cemented THA appears to produce superior clinical results, particularly when contemporary cementing techniques are employed.

Adult↗
PubMed1989

The effects of calcium on bone mineral density in postmenopausal women with colles fractures.

The increased incidence of fracture in postmenopausal women may be attributable, in part, to osteoporosis. Prediposing factors other than age include genetic constitution, physical activity, alcohol and caffeine abuse, and dietary calcium deficiency. A group of 15 postmenopausal women between the ages of 43 and 85 years were analyzed for bone mineral density within 4 weeks of an acute fracture of the distal radius. Dual photon absorptiometry scanning was performed on the first through fourth lumbar vertebrae. Results indicate that bone mineral densities below the fracture threshold (0.965 g/cm2) were seen in 9 of 15 (60%) patients. Each woman was given 1500 mg/day calcium supplementation for 1 year. At 1 year, each woman was contacted for a follow-up bone mineral density analysis. While no significant increase in bone mineral density was seen, calcium supplementation appeared to inhibit further bone loss. The results of this study support previous work which has indicated that supplemental calcium may be beneficial in combatting age-related bone loss.

Adult↗
PubMed1989

Sacrococcygeal teratoma in children: case report and review.

Four patients with sacrococcygeal teratomas are reported. Two of the four infants were correctly diagnosed in utero by ultrasound examination. Roentgenograms of the tumors disclosed diffuse calcifications in three of the four patients. The tumors were composed primarily of benign tissues, with some immature tissues in three of the patients. The immature tissue was central nervous tissue in two patients and a mixture of nervous tissue and mucus-type epithelium in the third. In all patients, the tumors were excised early, with resection of the coccyx to reduce the possibility of recurrence and malignant change. Chemotherapy and radiotherapy were not chosen for the patient with malignant tissue because no evidence of metastases was found.

Female↗
PubMed1988

Below-knee physiologic cryoanesthesia in the critically ill patient.

Controversy has surrounded the role of local hypothermia as a preoperative treatment in amputations of the lower extremity. A study was undertaken to determine the effectiveness of amputation under cryoanesthesia in decreasing postoperative morbidity and mortality in below-knee (BK) amputations. Of 154 BK amputations, only 91 with unreconstructable vascular disease, gangrene, or both, were included in this study. Group I consisted of 48 patients (mean age 63.9 years) who had undergone a routine BK amputation; group II consisted of 43 patients (mean age 65.7 years) who were acutely ill and too unstable to undergo a major surgical procedure. Group II patients were treated by amputation while under cryoanesthesia before any definitive operative intervention. The patients in group II were significantly (p less than 0.05) more ill preoperatively than those in group I. Group II patients had a higher prevalence of previous myocardial infarction, previous stroke, diabetes mellitus, osteomyelitis, and wet gangrene. Seventy percent of the patients in group II had three or more risk factors vs. 46% in group I. Early postoperative mortality rates did not differ significantly between groups (group I, 8%; group II, 9%); the average length of hospital stay for group I patients was 24.2 days compared with 17.7 days in group II. Group II patients sustained slightly more postoperative complications. Amputation under cryoanesthesia appears to be of value in reducing postoperative morbidity and mortality and length of hospital stay in the acutely ill patient with unreconstructable vascular disease, gangrene, or both.

Aged↗
PubMed1986

CT scan helps delineate cervical osteoid osteoma and atypical nidus.

Computerized tomography proves to be particularly helpful in anatomically delineating an osteoid osteoma of the spine in an inaccessible area and in also identifying an atypical nidus. A case is presented of an 8-year-old boy with a one-year history of pain in the right shoulder and neck. Computerized tomography accurately delineated in anatomic detail the lesion along with an atypical nidus adjacent to the spinal canal, thus assuring total excision of both lesions. The patient regained normal neck and shoulder motion with no recurrence of pain.

Cervical Vertebrae↗
PubMedDate not supplied

Self-assessment of general health status in patients with five common shoulder conditions.

The SF-36 Health Survey is a patient self-administered general health status evaluation designed to measure the impact of disease on an individual's perception of his or her health. Five hundred forty-four patients with five common shoulder conditions (anterior glenohumeral instability (149 patients), complete reparable rotator cuff tear (111 patients), adhesive capsulitis (100 patients), glenohumeral osteoarthritis (67 patients), and impingement (117 patients)) completed the SF-36 Health Survey before undergoing treatment. When compared with U.S. general population norms, the patients with each of these shoulder conditions had statistically significant decreases in their health for Physical Functioning, Role-Physical, Bodily Pain, Social Functioning, Role-Emotional, and the Physical Component Summary as measured by the SF-36 Health Survey. Comparison with published data demonstrated that these shoulder conditions rank in severity (in terms of affecting a patient's perception of his or her general health) with five major medical conditions (hypertension, congestive heart failure, acute myocardial infarction, diabetes mellitus, and clinical depression). The data presented in this study should serve as a baseline to document the impact of shoulder musculoskeletal conditions and possibly to allow comparison among various methods of operative and nonoperative treatment.

Adolescent↗
PubMedDate not supplied

Pseudo-dislocation of the sternoclavicular joint.

Fractures of the medial third of the clavicle are the rarest of all clavicle fractures. We present two cases of medial clavicle fracture nonunions that were initially thought to be chronic anterior sternoclavicular dislocations and describe the entity of pseudo-dislocation of the sternoclavicular joint. Computed tomography should be performed on all patients with suspected or established injuries of the sternoclavicular region to ensure differentiation between fracture and dislocation.

Aged↗
PubMedDate not supplied

Tibial shaft fractures with an associated infrapopliteal arterial injury: a survey of vascular surgeons opinions on the need for vascular repair.

OBJECTIVE: To determine current practice for tibial arterial revascularization in trauma patients with tibial shaft fractures associated with infrapopliteal arterial injuries. DESIGN: Nationwide survey of board-certified vascular surgeons, proportionally stratified by geographic region. METHODS: We surveyed a random sample (probability sample stratified by geographic region) of 200 members of the 729 active members of the Society for Clinical Vascular Surgery. We designed a twenty-one-item questionnaire to elicit opinions on the need for vascular repair for a variety of clinical scenarios. RESULTS: Completed questionnaires were returned by fifty-one vascular surgeons. For the eight isolated and combined infra-popliteal arterial injuries we studied, agreement between vascular surgeons as to the need for arterial repair was better for scenarios with clinical evidence of limb ischemia than for those without clinical evidence of limb ischemia. For injuries with clinical evidence of limb ischemia, excellent agreement (90 percent or more of respondents agreeing) was seen for five of the eight injuries, good agreement (80 to 89 percent of respondents agreeing) was seen for two injuries, and poor agreement (less than 70 percent of respondents agreeing) was seen for one injury. For injuries without clinical evidence of limb ischemia, excellent agreement was seen for one injury, good agreement was seen for two injuries, fair agreement (70 to 79 percent of respondents agreeing) was seen for three injuries, and poor agreement was seen for two injuries. CONCLUSIONS: A review of the literature and results of our study suggest that no standardized protocol exists in the current practice of revascularization of infrapopliteal arterial injuries with concomitant tibial shaft fractures; disagreement among vascular surgeons was particularly common for cases where a vessel was known to be injured but there was no clinical evidence of limb ischemia. Our study highlights the need for randomized prospective studies so that standardized protocols can be developed for these serious injuries. Because of the relatively small numbers of this type of injury and the wide variety of injury patterns seen, a study such as this would best be designed as a multi-center study.

Adult↗
PubMedDate not supplied

Vibratory hypersensitivity in idiopathic scoliosis.

This study determined whether a significant difference in response to vibratory stimuli was consistently present in a large group of children with idiopathic scoliosis as compared with age-matched controls. Fifty-eight unselected adolescent females with documented progressive idiopathic scoliosis were studied along with age-matched controls. Threshold to detection of a vibratory stimulus was measured in both the right and left upper and lower extremities. Results indicated that highly significant differences existed between scoliotic children and controls at all sites tested (p less than 0.01), with scoliotic children being more sensitive than controls. The results support the presence of a central aberration in posterior column function that may be a primary etiology of idiopathic scoliosis.

Adolescent↗
PubMedDate not supplied

Overgrowth management in Klippel-Trenaunay-Weber and Proteus syndromes.

Twenty-eight patients with limb overgrowth and the diagnosis of Klippel-Trenaunay-Weber or Proteus syndromes were evaluated retrospectively. These disorders are part of the phakomatosis spectrum of syndromes. The orthopedic problems consisted of asymmetric limb overgrowth, localized gigantism, angular deformities, scoliosis, vascular malformations, and skin anomalies. Systemic abnormalities are common and deserve full evaluation before treatment. Surgical treatment consisted of epiphysiodesis, osteotomies, debulking procedures, and amputation. Mixed results were obtained with surgery, and conservative or supportive treatment should be the primary mode of orthopedic care.

Adolescent↗
PubMedDate not supplied

Surgical correction of medial subluxation of the patella.

We evaluated the results of a surgical procedure to correct medial subluxation of the patella in 63 patients (65 knees), most of whom had undergone a lateral retinacular release. We performed a direct repair or a reconstruction of the lateral patellotibial ligament using locally available tissue such as strips of iliotibial band or patellar tendon. Followup averaged 53.7 months (range, 24 to 99). Outcome was based on the examiner's inability to clinically reproduce the patient's painful medial subluxation and on the patient's general impression of his or her improved functional status. Forty-four patients (68%) reported improvement in their functional levels and 49 (75%) reported that they were subjectively improved by the procedure. Overall, 50 patients (80%) had a rating of good or excellent. Six knees required a second surgical reconstruction because of failure to improve or because of a reinjury. Analysis of overall clinical outcome revealed no significant relationships based on the patient's age at the time of the initial procedure, sex, or length of followup (P > 0.10). Reconstitution of the lateral patellotibial ligament effectively corrected medial subluxation of the patella and long-term results of this salvage procedure were satisfactory.

Adolescent↗