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Biomedical subjects

R Delamarter

Publications and source records attributed to R Delamarter.

8 recordsLinked to original sources
PubMed1997

Destructive spondyloarthropathy of the cervical spine in patients with chronic renal failure.

STUDY DESIGN: Eleven patients with chronic renal failure and destructive spondyloarthropathy of the cervical spine were evaluated with plain radiographs, flexion-extension views, computed tomography myelogram, or magnetic resonance imaging to determine the results of surgical and nonsurgical treatment. OBJECTIVES: To determine if cervical spine fusion is an effective method of treatment for patients with chronic renal failure and destructive spondyloarthropathy. SUMMARY OF BACKGROUND DATA: Several reports have described the pathogenesis and appearance of this condition, but little has been reported about the orthopedic management of destructive spondyloarthropathy of the cervical spine. METHODS: Three patients had no spinal surgery, three patients had laminectomies alone, three patients had laminectomies with anterior fusions, and two patients had laminectomies with posterior fusions. Radiographs, computed tomography myelograms, and magnetic resonance images were evaluated to determine the results of treatment. Histologic examinations were performed in two patients. RESULTS: Patients with laminectomy alone had no improvement in pain or neurologic function (one died in the immediate postoperative period), one of three patients with anterior fusions had some improvement (one died in the immediate postoperative period), and both of those patients with posterior fusions improved, although both died within a year of surgery from unrelated causes. CONCLUSIONS: Even though the osteopenia present in patients with chronic renal failure tends to allow wire pull-out and makes internal fixation of the spine difficult, successful cervical spinal fusion can relieve pain and improve neurologic deficits in selected patients with chronic renal failure and destructive spondyloarthropathy, allowing them to remain more active for longer periods of time.

Aged↗
PubMed1991

Lumbar nerve root compression and interstitial cystitis--response to decompressive surgery.

An identifiable lumbar nerve root compression appears to cause urological dysfunction consistent with interstitial cystitis. Ten patients (9 females, 1 male) were evaluated for chronic pelvic pain. Cystoscopic and histological appearances were consistent with a diagnosis of interstitial cystitis. Magnetic resonance studies of the lower spine consistently demonstrated a lateral compression of the L5 dorsal nerve root. Decompression of the lateral foramina of L5 resulted in immediate relief of pain in 9 patients, who have been followed up for 6 months without a recurrence. Possible mechanisms involving sympathetic dystrophy of the pelvic plexus are reviewed.

Cystitis↗
PubMed1989

Detection of human T-cell leukemia/lymphoma virus type I in a transfusion recipient with chronic myelopathy.

A white man with a progressive spastic paraparesis that began 15 months after sustaining severe trauma in a motor vehicle accident was positive for antibodies to human T-lymphotropic virus type I (HTLV-I) by enzyme-linked immunosorbent assay. Serum antibody to HTLV-I was confirmed by Western blot and radioimmunoprecipitation assay. We detected specific proviral DNA in peripheral blood lymphocytes by the polymerase chain reaction. Because the incidence of HTLV-I is generally restricted to Southern Japan and Caribbean black populations, the most likely source of HTLV-I infection in this patient was multiple intraoperative blood transfusions. The relatively short interval between transfusion and development of HTLV-I-associated myelopathy is consistent with the more rapid evolution of this clinical syndrome compared with adult T-cell leukemia.

Chronic Disease↗
PubMed1989

Gadolinium-DTPA-enhanced MR imaging of the postoperative lumbar spine: time course and mechanism of enhancement.

To define the time course and mechanism of enhancement of epidural fibrosis after gadolinium-DTPA (Gd-DTPA) injection, we undertook a three-part study in humans and dogs with epidural scar after spine surgery. First, the dynamic in vivo contrast-enhancing properties of epidural scar were assessed by using sequential fast (18-sec) spin-echo sequences after contrast injection. Epidural scar in dogs rapidly enhanced; peak enhancement (101%) was 6 min after injection, with a slower decline toward baseline to 45% after 44 min. Epidural fibrosis in patients followed a similar pattern, with a maximum enhancement of 73% after 5 min. Paraspinal muscle had a lower peak enhancement in both patients (36%) and dogs (22%). Second, vascular injection in two dogs with India ink demonstrated multiple small vessels throughout the epidural scar. Third, light and electron microscopy was performed on epidural scar obtained at reoperation in both patients and dogs. Light microscopy showed multiple small capillaries scattered throughout a background of collagen. Electron microscopy demonstrated a wide variation in the junctions between endothelial cells ranging from "tight" to "loose." Regions of endothelial discontinuity were also visualized. This study suggests that Gd-DTPA diffuses rapidly into the extravascular space in epidural scar, with a slower, net movement toward the intravascular compartment as the agent is renally filtered. The contrast agent transgresses the endothelium through "leaky" intercellular junctions and areas of endothelial discontinuity.

Animals↗
PubMed1989

Late neurological complications of Harrington-rod instrumentation.

From our patients who had idiopathic scoliosis, we identified a subset of eighteen in whom Harrington rods were used for fixation down to the fifth lumbar vertebra. In five of these patients, low-back pain, sciatica, and other neurological problems developed at two to thirty-two months after arthrodesis. These complications were caused by migration of the caudad hook into the spinal canal. The migration was probably caused by a combination of lumbosacral lordosis and mobility of the fifth lumbar vertebra (the most caudad mobile segment) on the segment below, resulting in weakening of the lamina of the fifth lumbar vertebra. After removal of the hardware, all patients had improvement of the lumbosacral and radicular pain as well as resolution of the neurological abnormalities.

Adult↗
PubMed1989

The cast brace and tibial plateau fractures.

Three hundred six tibial plateau fractures treated at the authors' institutions and in private practice were analyzed in relation to the use of a cast brace or fracture brace. One hundred forty-one of these patients had had a cast brace or fracture brace as part of their treatment program, either as the primary fracture treatment or after open reduction or traction. The aims of this study were (1) to determine if cast bracing could maintain alignment, fracture position, and range of motion and (2) to compare its results with those of other major long-term studies of similar fractures. There were 85 lateral, 24 medial, and 32 bicondylar fractures. Cast bracing was used for one to 17 weeks, with a mean of eight weeks. Ninety-nine of the 141 patients were followed for at least one year. Eighty-two of the patients maintained alignment with less than 5 degrees of deformity, and fracture position was maintained in 85% of cases, with only 15% having 4-8 mm of loss of position. Medial plateau and subcondylar fractures had an increased incidence of fracture position loss. Ninety-seven percent of patients had greater than 90 degrees of flexion, and 90% had full extension, i.e., less than 5 degrees of contracture. Pain was minimal or absent after heavy exercise in 90% of patients using cast bracing. Arthritic changes on roentgenographic analysis were absent or mild in 93.5% and moderate or severe in 6.5% of patients. Complications, including phlebitis, pulmonary emboli, wound infection, hardware slippage, and skin slough, occurred in nine patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Treatment of acute femoral neck fractures with total hip arthroplasty.

Between 1973 and 1983, 27 patients with acute femoral neck fractures were treated at the UCLA Medical Center with total hip arthroplasty. These cases were selected on the basis of age, high activity level, and degenerative changes in the acetabular cartilage. The average age was 72 years. There were 19 women and eight men. The average follow-up period was 3.8 years with a range of one to ten years. Methods used included analysis of clinical data, roentgenograms, final pain ratings, walking ratings, and activity levels using the UCLA rating system. Pain relief and overall functional results were better than that of most series of acute femoral neck fractures treated with hemiarthroplasty and similar to that of total hip arthroplasty series. The complication rate was slightly less than both authors' elective total hip series, and considerably less than most hemiarthroplasty series. Complications included a superficial wound infection, a urinary tract infection, and a perforated colon diverticulum. Four patients died within one year from causes unrelated to the hip arthroplasty. There were no deep infections, dislocations, or reoperations. Total hip arthroplasty in selective cases of acute femoral neck fractures can give more consistent pain relief and better functional results than hemiarthroplasty, without an increase in complications.

Acute Disease↗