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Biomedical subjects

R Emery

Publications and source records attributed to R Emery.

At least 19 recordsLinked to original sources
PubMed2001

A multi-centre study of Osseotite implants supporting mandibular restorations: a 3-year report.

This multi-centre study evaluated the performance of the Osseotite implant in the mandibular arch. Osseotite implants (n = 688) were placed in 172 patients; 43.5% were placed in the anterior mandible and 66.5% in the posterior mandible. Fifteen per cent of the implants were placed in soft bone, 56.9% in normal bone and 28.1% in dense bone. During placement, 49.9% of the implants were identified as having a tight fit, 48.6% a firm fit and 1.5% a loose fit. About one-third of the implants (32.4%) were short (10 mm in length or less). After 36 months, only 5 implants had been lost, for a cumulative survival rate of 99.3%. The 3-year results of this study indicate a high degree of predictability with placement of Osseotite implants in the mandibular arch.

Alveolar Bone Loss↗
PubMed1999

Total elbow replacement in the treatment of rheumatoid disease.

Improvements in total elbow arthroplasty during the last 20 years have resulted in clinical outcomes which now are comparable with the results of hip arthroplasty. The main types of prostheses used are unlinked prostheses or semiconstrained hinged prostheses. The unlinked prostheses require the preservation of bone stock and the ability to reconstruct the collateral ligaments to achieve stability. Semiconstrained, hinged prostheses have inherent stability but humeral loosening was initially a problem. Stress transfer through the humeral stem can be reduced by using a prostheses with anterior flanges (Coonrad-Morrey or GSB3). Survivorship analyses beyond 10 years now are becoming available for these prostheses. There has been no universal agreement as to which outcome measure should be used for total elbow replacements. Future developments will include an evolution of principles as understanding of elbow biomechanics progresses. Operative technique is likely to be modified by the development of alignment aids and jigs.

Arthritis, Rheumatoid↗
PubMed1999

Early experience and validation work with Procedicus VA--the Prosolvia virtual reality shoulder arthroscopy trainer.

Shoulder arthroscopy is a difficult procedure, commonly used for both diagnostic and therapeutic purposes. Until now, the majority of training has been done in theatre, assisting and practising under supervision. Few good simulations exist. Procedicus VA, from Prosolvia Clarus, is a virtual reality simulation of shoulder arthroscopy, with interactive graphics and haptic feedback. The simulator has various modes including anatomy manipulation pathology subacromial decompression. We describe our experience with the simulator, attempting to validate some of the scoring mechanisms, and highlighting some of the pitfalls discovered as the simulator is first trialled by surgeons. This early experience has highlighted both successful aspects of the simulator, and some of the initial pitfalls. Our initial experience confirms the need for close collaboration between virtual programmers and surgical trainers. We are revising the assessment criteria over the coming months.

Arthroscopy↗
PubMed1998

Three-dimensional ultrasonography of choroidal melanoma: localization of radioactive eye plaques.

OBJECTIVE: To evaluate the use of 3-dimensional (3D) ultrasonography for the localization of episcleral eye plaques during the treatment of choroidal melanomas. METHODS: A series of 13 patients with choroidal melanoma were treated with radioactive palladium 103 seeds affixed into gold eye plaques. During surgery, 3D ultrasonography was performed with a commercially available system to evaluate the relative position of radioactive plaques secured beneath their intraocular tumors. This system consists of an automated, rotating, handheld, B-scan ultrasonographic probe operating at 10 MHz, a personal computer, and 3D imaging software. RESULTS: We measured the margins of the plaque extending beyond the tumor and the distance between the radioactive seeds and the tumor apex. We also evaluated the relationship between the plaque edge, the episclera, and the tumor's edges. While the plaques were well centered over the tumor in all cases, the plaque margins around the tumor were found to be variably sized. When comparing measurements taken at the time of plaque insertion with those taken at the time of plaque removal, we noted changes in the apical tumor height and in plaque centration. In the 1 patient with a juxtapapillary tumor, the posterior margin of the plaque was found to be displaced away from the sclera, or "tilted." CONCLUSIONS: Three-dimensional ultrasonography offers a new method for ophthalmic plaque localization. Unique perspectives can be visualized through the use of computer-aided 3D reconstructions that permit the assessment of the relative position of the plaque to the optic nerve and the measurement of the distance between the in vivo radioactive seed and the tumor apex. Our experience suggests that when compared with 2-dimensional ultrasonography, 3D ultrasonography offers new capabilities that can be used to improve plaque placement and radiation dose calculations.

Brachytherapy↗
PubMed1998

Evaluating the relative status of health and safety programs for minority academic and research institutions.

The health and safety programs that support academic and research institutions face many challenges because of the wide variety of potential hazards present and the possibility of simultaneous exposures to several agents. This study investigated whether differences in health and safety programs exist between minority and nonminority state-funded academic and research institutions. A cross-sectional mail survey was conducted that included 24 minority and 51 nonminority schools. Questionnaires solicited information on descriptive institutional parameters, health and safety staffing, the hazards present, programs in place to address hazards, and medical surveillance services. The hazard types identified as present on both campus types were found to be very similar. The mean number of health and safety staff serving minority institutions was lower (1.14 versus 3.12), with the difference reliably predicted by the number of institutional employees, not minority status or regulatory environment. Other targeted parameters were found to be similar, with a consistent lack of awareness of specific medical evaluations noted for both groups. Since on average a single person is charged with controlling a diverse set of potential hazards on the minority campuses studied, the need for a comprehensive awareness of a variety of health and safety issues is discussed.

Accident Prevention↗
PubMed1997

Coronary flow in a prosthetic aorto-coronary bypass graft: first report of Possis Perma-Flow graft physiology in a patient.

The coronary physiology of a prosthetic Perma-Flow coronary bypass graft conduit is demonstrated in the first patient at 1-yr follow-up. Coronary blood flow velocity was measured in the body of the graft and into the side-to-side anastomosis to the first diagonal branch. This case report demonstrates the first information on the coronary and prosthetic graft flow in a patient with atherosclerotic coronary disease.

Aged↗
PubMed1996

Radiotherapy for age-related macular degeneration: preliminary results of a potentially new treatment.

PURPOSE: Neovascular macular degeneration is the leading cause of severe blindness in North America today. Limited treatments are available for this disease process. A Phase I/II study was performed to determine the toxicity and efficacy of external beam radiotherapy in patients with age-related subfoveal neovascularization. METHODS AND MATERIALS: Between March 1994 and June 1995, 52 patients with a mean age of 80 (60-92) were enrolled. These patients were either not eligible or were poor candidates for laser photocoagulation, primarily because of the subfoveal location of the neovascularization. Initial visual acuities ranged from 20 out of 32 to finger counting at 3 feet. All patients underwent fluorescein angiographic evaluation and documentation of their neovascular disease prior to irradiation. Patients were treated with a single lateral 4- or 6-MV photon beam, to a dose of 14-15 Gy in eight fractions over 10 days. The field size averaged 5 x 3 cm. RESULTS: No significant acute morbidity was noted. All patients underwent ophthalmic examinations and repeat angiography at 1 and 3 months posttreatment and then at 3-month intervals. With a mean follow-up of 7 months (3-18 months), 41 patients (79%) are within two lines of their pretreatment visual acuity. On angiographic imaging, there was stabilization of subfoveal neovascular membranes in 34 patients (65%). New neovascular membranes have been noted in five patients. CONCLUSIONS: It appears that radiotherapy can affect active subretinal neovascularization, but it is unlikely to prevent new neovascular events produced by this chronic disease. Further investigation is warranted.

Aged↗
PubMed1996

Homochirality as the signature of life: the SETH Cigar.

A characteristic hallmark of life is its homochirality: all biomolecules are usually of one hand, e.g. on Earth life uses only L-amino acids for protein synthesis and not their D mirror images. It is therefore suggested that a search for extra-terrestrial life can be approached as a Search for Extra-Terrestrial Homochirality (SETH). A novel miniaturized space polarimeter, called the SETH Cigar, is described which could he used to detect optical rotation as the homochiral signature of life on other planets. Moving parts are avoided by replacing the normal rotating polarizer by multiple fixed polarizers at different angles as in the eye of the bee. It is believed that homochirality will be found in the subsurface layers on Mars as a relic of extinct life.

Astronomy↗
PubMed1994

[Infected total knee prosthesis. Guidance for therapeutic choice].

PURPOSE OF THE STUDY: The aim of the study is to assess the functional results and septic evolution in the treatment of infected total knee arthroplasties. MATERIAL AND METHODS: 22 patients were reviewed; 8 were initially treated in our institution and 14 transferred from other hospitals. Articular debridement alone leaving the prosthesis in situ was initiated in 3 of our 8 patients as well as in 6 of the transferred cases. In both groups, this procedure appeared to be a failure. Prosthetic-reimplantation procedure was elected in 10 patients either as a one-stage (5 cases) or a two-stage surgery (5 cases). This has been successfully rated in 7 cases. Femoro-tibial arthrodesis was performed in 15 patients, three of them being a failure of the prosthetic reimplantation. Follow-up ranges from 16 months to 9 years with well documented records. RESULTS: As stated earlier, articular debridement alone has not proven to be a helpful procedure since it did not eradicate the septic complication in any case. Prosthetic reimplantation has been a successful treatment in 7 of the 10 attempted cases. The one-stage procedure is providing the best functional result. Recurrent infection occurred in 3 cases: there were patients with poor host defense (diabetes, arteritis, old age, ...) with resistant bacteria complicating a hinge-knee prosthesis. Femoro-tibial arthrodesis was achieved in 10 of the 15 patients and necessitated all together 23 surgical operations. The highest union rate was observed in cases where sterile conditions were achieved, fixation being performed with an intramedullary nail. Failure of arthrodesis confines the patients in such an uncomfortable situation that 2 of them has asked for an amputation. DISCUSSION AND CONCLUSION: Early surgical debridement may occasionally salve a prosthesis when it is performed shortly after the onset of infection, in an unloosened unconstrained prosthesis infected by a low-virulence organism. In our study, no patient but one met those criteria. For those cases nevertheless, our procedure of choice is now the one-stage reimplantation who seems to be more effective for eradicating the infection and gives rise to a better clinical result. The two-stage reimplantation is the current procedure for handling an infected knee prosthesis. Some patients are still excluded from this procedure because of their poor health condition, bone loss, inadequate viability of skin and extensor mechanism or an uncontrolled sepsis. For such a case, arthrodesis remains the most reliable method of management, especially when it can be stabilized with an intramedullary fixation, which implies to perform a two-stage arthrodesis.

Adult↗
PubMed1994

[Supple intervertebral stabilization according to Graf. Evaluation of its use and technical approach].

The authors report their clinical experience with Graf's supple intervertebral stabilization system. The results are discussed with respect to the biomechanical and clinical definitions of vertebral instability and the natural evolution of degenerative disease of the lumbar spine. The result are favorable for the cases with clinical instability, but are not as good for the degenerative cases or after discectomy. In spite of the short-term clinical benefits for the cases with pathological articular hypermobility, the authors are cautious regarding the use of this technique. They emphasize the unknown long-term clinical and biomechanical evolution and the difficulties encountered for secondary arthrodesis caused by the volume of the pedicular screws.

Adult↗
PubMed1994

[Revision of arthrodesis of the knee using total prosthesis. Case report].

The authors report the case of a 62-year-old patient whose desire to recover mobility of the knee, arthrodesed 22 years ago, led them to perform a total arthroplasty. The result was satisfactory. The contraindications and implications of such procedures are discussed with reference to 13 other cases reported in the literature.

Arthrodesis↗
PubMed1992

Release of bacterial aerosols during infectious waste compaction: an initial hazard evaluation for healthcare workers.

Compaction has been suggested as an interim processing method for infectious waste. Compaction greatly reduces the volume of waste at the site of generation and produces a more stable package for handling, shipment, and treatment. Preliminary studies have also indicated that when partially compacted waste is burned in an incinerator, the performance of the incineration unit is enhanced. Compaction is not currently used in institutions because the process may lead to the release of infectious aerosols, which could pose a significant hazard to healthcare workers. To determine if bacterial releases can be adequately controlled by a compaction device specially designed and constructed for the task, a prototype infectious waste compactor was challenged by compressing waste containing known quantities of indicator bacteria. Samples were collected to monitor bacterial releases and surface contamination. The data collected from this initial evaluation document that indicator bacteria were released from the unit. Modifications to the design and operation of a compactor of this type are proposed as suggestions that may improve system performance with regard to the health and safety of workers. A critical review of the experimental procedure used in this study is also included for the benefit of any future studies.

Aerosols↗
PubMed1992

Characterization of low-level radioactive waste generated by a large university/hospital complex.

Descriptions of the physical characteristics and radioactive contents of waste generated by a large university/hospital complex were recorded in a computerized data base for 1 y. The data were summarized to create a waste stream profile so that major waste sources could be identified and minimization efforts quantified. The resultant profile provides a comprehensive description of the low-level radioactive waste produced by a large biomedical research and patient care facility, and projects the methods that will be used to process and ultimately dispose of the material.

Hospitals↗
PubMed1989

Epiphyseal distraction monitored by strain gauges. Results in seven children.

Ten epiphyses in seven children underwent fixed-rate distraction of 0.25 mm twice daily in an attempt to achieve percutaneous leg lengthening by chondrodiatasis. The forces generated across the growth plate were recorded by means of strain gauges incorporated into the distractors. All epiphyses fractured before 33 days of lengthening. An average gain of 6.75 cm was achieved. Epiphyseal distraction at the lower femur produced many complications, but at the upper tibial epiphysis planned lengthening was achieved, with excellent bone production and few complications.

Adolescent↗
PubMed1986

Dr. Copeland on cardiac transplantation. Interview by Monica Kalker.

The following interview is an exchange between Jack Copeland, M.D., Robert Emery, M.D., and Anne Nicholson, R.N., members of the heart transplant team at the University of Arizona Medical Center in Tucson, Arizona. Dr. Copeland currently is the chief cardiac surgeon as well as professor and chief of Cardiovascular and Thoracic Surgery. Dr. Emery is an associate professor in the division of cardiothoracic surgery. Ms. Nicholson is a cardiac transplant coordinator for the Center. The University of Arizona's Heart Transplant program has proven itself in terms of actuarial survival, innovative approaches to recipients, surgical techniques, and with the maintenance of relatively short hospital stays and low costs to the patient.

Arizona↗
PubMed1983

Management of malignant obstructive jaundice at The Middlesex Hospital.

A total of 180 patients with malignant obstructive jaundice have been treated by 5 different methods: surgical resection; surgical by-pass; percutaneous prosthesis; endoscopic prosthesis; and endoscopic sphincterotomy (for papillary tumours). The spectrum of patients is unusual, because many elderly and ill patients were referred for nonoperative management. Operative by-pass, percutaneous and endoscopic prostheses gave similar overall results, with a mean survival of about 6 months. Patients with tumours of the papilla of Vater treated by endoscopy or surgery fared well; 11 of 18 were alive at follow-up. Median survival after resection of other tumours was 17 months. These results underline the need for randomized clinical trials, which are now in progress.

Adult↗
PubMed1982

Effects of marital discord on the school behavior of children of schizophrenic, affectively disordered, and normal parents.

An association between children's school behavior and two family variables, marital discord and parental psychopathology, has been consistently reported in the literature. However, the joint effects of each of these two familial factors has not been closely examined. The present report provides a further examination of the interrelationships among these three variables with particular emphasis on the effects of marital discord on children's school behavior in families with behaviorally disturbed parents. Marital discord was found to account for much of the association between having a parent with bipolar disorder or unipolar depression and problematic school behavior, but the same variable did not explain the relationship between having a schizophrenic parent and problems in school. The implications of these findings for interventions with the children of disturbed parents and for high-risk research are discussed.

Adolescent↗