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Biomedical subjects

R A Colyer

Publications and source records attributed to R A Colyer.

16 recordsLinked to original sources
PubMed1994

Surgical treatment of the infected hip implant. Two-stage reimplantation with a one-month interval.

Successful treatment of the infected hip prosthesis demands careful planning for infection control and reimplantation. Inadequate surgical debridement dooms well-executed revision surgery to infection failure. Reimplantation is difficult after resection arthroplasty, and this difficulty is increased with longer intervals between resection and reimplantation. Older patients will rehabilitate better if the interval is shorter. The reported protocol successfully compromises between one-stage exchanges and reported two-stage exchanges.

Aged↗
PubMed1991

Case report 689. Metastatic atrial myxoma to the pubis.

We have presented a 23-year follow-up of a patient with left atrial myxoma with continuing slowly growing, skeletal metastases. The relatively indolent nature of the metastatic disease and the lack of mitotic figures suggest that the metastatic lesions may be treated locally. The patient underwent therapeutic tumor embolization and local resection of the pelvic lesion, with good results as she continues to do well with close follow-up.

Bone Neoplasms↗
PubMed1986

Surgical stabilization of pathological neoplastic fractures.

The most important factor to consider in deciding between treatment options in the management of metastatic bone disease is the level of the patient's dysfunction and pain. Severe dysfunction or pain demands a treatment that predictably leads to a quick resumption of the painless activities of daily living. A treatment that predictably will restore function in months may seem reasonable in patients with a normal remaining life span, but is untenable if those months represent a high percentage of remaining life span, as they do in metastatic disease afflicted patients. The treating physician needs also to understand the basis for the patient's dysfunction. A destroyed joint will not return to painless function even if the metastasis responsible is totally eliminated. A bone that has lost its structural integrity, even though not grossly fractured, will not support weight bearing for months even if the metastasis is eliminated. Control of the metastatic tumor does not always equate with return to function. Treatment options in the management of metastatic bone disease are not mutually exclusive. In many patients treatment options are combined. Surgical stabilization may best return the patient's function while he is being treated postoperatively with radiotherapy or chemotherapy for good neoplasm control. Neoplasm control should not be such an overriding concern that function is not addressed. Function can almost always be returned to the patient, but neoplasm "cure" is rarely achieved in this group of patients. It is a reasonable goal to avoid allowing bone metastasis to progress to pathological fracture. Routine periodic examinations and bone scans should commonly alert the treating physician to the presence of metastatic bone disease well before fracture occurs. Pathological fracture narrows the range of treatment options, mitigates against full functional restoration, demands a rehabilitation hiatus, and acutely frightens the patient who does not have time to participate fully in treatment decisions. An impending pathological fracture can be treated with surgery, radiotherapy, chemotherapy, or hormonal manipulation. The options are basically operative or nonoperative. Lesions that predictably will fracture short term, involve joints, or will cause catastrophic consequences if fracture occurs should be strongly considered for surgical stabilization. Other factors to consider are the location of the metastasis, the primary tumor, and the expected response to nonoperative therapy. The patient becomes a surgical candidate for the above reasons and not because of any estimated life span.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1985

An aggressive treatment approach for adult osteomyelitis.

Osteomyelitis in the adult patient has been associated with failure of eradication, late recurrence, nonunion, and prolonged hospitalization. A staged aggressive approach has been used for the past seven years to treat 53 patients with adult osteomyelitis. This approach includes: evaluation of bone necrosis and identification of the etiologic organisms by deep bone culture; radical surgical debridement of devascularized tissue; intensive systemic antibiotics; and early bone and soft tissue reconstruction. All patients have been followed at least 1 year (mean, 33 months). Lower extremity bones predominated in the series (24 tibias, 13 femurs); and 19 patients had bony instability. Thirty-seven patients had initial successful eradication of their infections with 26 of these returning to full activity status. The remaining 16 patients developed recurrent infection; however, 11 patients totally responded to further aggressive treatment. Of the five failures in the total series, three patients required amputation and two patients have persistent infection. Fifteen of the 19 patients with bony instability healed with initial treatment, and the remaining four patients healed with subsequent treatment. Six patients had primary muscle flap soft tissue reconstruction, and an additional two patients had reconstruction as a secondary procedure. In all these patients with tibial instability, bony union was accelerated compared to those patients with tibial instability not receiving muscle flaps (4 months vs 12 months). The muscle coverage provided by either pedicled flaps or transferred by microvascular anastomoses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

Flexor pollicis longus tenodesis in tetraplegia at the sixth cervical level. A prospective evaluation of functional gain.

Eight patients with tetraplegia at the sixth cervical level had ten flexor pollicis longus tenodeses performed to create a key grip. Two of the patients also had tendon transfers to create active finger flexion; these failed. The remaining six patients were objectively evaluated by the hand-function test of Jebsen et al. to measure gains in hand function. All patients improved postoperatively, the average improvement being 31 per cent. Although these patients did not add many new hand activities to their repertoire, they showed increased speed and ease of pre-existing hand functions. Three patients did gain the ability to self-catheterize, enabling two of them to live totally independent life-styles. Fixation of the thumb interphalangeal joint with Kirschner wires did not provide sufficient long-term stability, and initial arthrodesis of this joint is recommended in conjunction with the flexor pollicis longus tenodesis.

Activities of Daily Living↗
PubMed1980

Marked suppression by salicylate of the augmented proteoglycan synthesis in osteoarthritic cartilage.

In osteoarthritis a net increase in proteoglycan synthesis has been noted until the disease is far advanced and presumably reflects an attempt by the chondrocyte to repair the defect in the cartilage matrix. Because salicylates are the agents most commonly employed in treatment of osteoarthritis and because we recently showed that 10(-3) M sodium salicylate (i.e., approximately 20 mg%) suppresses proteoglycan synthesis in normal canine knee cartilage in vitro, we have studied the effects of this compound on osteoarthritis knee cartilage from dogs whose anterior cruciate ligament had been transected 9 weeks previously. The data indicated that the augmented synthesis of glycosaminoglycans in the degenerating cartilage was suppressed to a much greater degree by 10(-3) M sodium salicylate than the lower level of glycosaminoglycan synthesis in control cartilage from the contralateral knee of the same animal. Uptake of 14C-acetylsalicylic acid was increased about 35% in osteoarthritic cartilage, suggesting that the drug permeated it more readily than normal cartilage. The salicylate-induced suppression of proteoglycan synthesis in the osteoarthritic cartilage was not accompanied by reversal of the defect in proteoglycan aggregation or by improvement in the (presumed) defect in proteoglycan-collagen interaction in the matrix, as reflected by the abnormally high proportion of 35S-proteoglycans present in the culture medium.

Animals↗
PubMed1980

Metastasizing atrial myxoma.

Tumors that were identical in morphology to a previously excised atrial myxoma were found in the choroid plexus and the scapula of a 46-year-old woman 8 and 10.5 years, respectively, after cardiac surgery. Ultrastructurally the scapular lesion resembled previously reported atrial myxomas. This case demonstrates that atrial myxoma is a true neoplasm capable of metastatic spread despite its slow growth and innocuous histologic appearance.

Bone Neoplasms↗
PubMed1979

Osteogenic sarcoma in siblings.

A brother and sister with osteogenic sarcoma are reported. A review of the literature reveals thirty additional cases of osteogenic sarcoma in familial aggregation, sixteen of sibling relationship. Genetic and environmental etiologic factors of osteogenic sarcoma are discussed.

Adolescent↗
PubMed1979

Skeletal changes during prolonged external irradiation: alterations in marrow, growth plate and osteoclast populations.

This report describes hematologic and skeletal changes in young mice subjected to continuous external whole body irradiation (45 rads/day) for 4 days to 12 weeks. Irradiation caused a rapid depletion of hematopoietic stem cells, marrow aplasia and pancytopenia, all of which persisted during the period of irradiation but resolved afterward. In spite of suppressed cellular proliferation and disarray of cartilage cell columns in metaphyseal plates, linear bone growth appeared to continue at physiologic rates. Histologic and morphometric studies provided no evidence of impaired osteoblast function, but the presence of thickended trabeculae beneath the growth plate and of cartilagenous islands within cortical shafts of long bones indicated that bone remodeling was deficient. Direct osteoclast counts demonstrated that marrow aplasia was followed by a progressive decline that could not be reversed by parathormone injections or infusions with mature macrophages and lymphocytes but that resolved once the bone marrow recovered following cessation of irradiation. Therefore, the altered bone remodeling probably resulted from radiation injury to osteoclast precursors in the hematopoietic compartment.

Animals↗
PubMedDate not supplied

Magnetic resonance imaging of extremity masses.

Twenty-seven adults with extremity masses were examined by magnetic resonance imaging (MRI). In 26/27 cases, computed tomography (CT) scans were available for comparison. Imaging with multiple pulse sequences is necessary to optimize diagnosis by MRI. Advantages of MRI include direct sagittal and coronal imaging, demonstration of vessels without contrast and superior soft tissue contrast. CT better demonstrates cortical destruction and small calcifications, which may be important in some cases. For noncalcified masses without bone involvement, MRI is equivalent or superior to CT. In those cases with calcification or bone involvement, MRI plays a role complementary to CT.

Adolescent↗