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Biomedical subjects

R Hart

Publications and source records attributed to R Hart.

At least 37 records · Page 2Linked to original sources
PubMed2003

Total knee arthroplasty implanted with and without kinematic navigation.

Between September 2000 and February 2002 we inserted 120 total knee arthroplasties. In 60 patients we used the standard technique, and in 60 patients we used the OrthoPilot navigation system. Postoperatively all patients had standing long radiographs of the lower extremity from the hip joint to the ankle. We considered the ideal value of the anatomic lateral tibiofemoral angle (LTFA) to be 174 degrees. In the standard group the mean value of LTFA was 174.9 degrees and in the navigation group 174.3 degrees. A deviation between 0 degrees and 2 degrees from the ideal value was seen in 42 cases in the standard group and in 53 cases in the navigation group. In the standard group 18 cases had a deviation of more than 2.1 degrees, whereas there were only seven cases in the navigation group with a deviation exceeding 2.1 degrees. There were no complications related to the use of the navigation system. The system affords a possibility to place femoral and tibial components precisely with less axis deviation than with the conventional technique.

Aged↗
PubMed2003

[Case report of extensive metallosis in extra-articular tissues after unicompartmental knee joint replacement].

The authors present a case of extensive metallosis of the knee joint resulting from the secondary abrasive wear of components of a unicompartmental alloplasty. Eight years after medial condyle replacement, an eighty-year-old patient presented with a break of the femoral component. This resulted in a rapid wear of tibial polyethylene and the development of secondary friction between two metal surfaces. The generation of a large number of metal particles produced an increase in the actual metal surface. This extensive articular metallosis affected not only intra-articular but also extraarticular tissues and the subchondral bone. Histological examination confirmed the presence of a large amount of opaque pigment in histiocytes. The condition was treated by total knee arthroplasty with resection of the posterior cruciate ligament (stabilizing plateau). The authors discuss the causes of metallosis development and its various types; they draw attention to the scarcity of literature data on this condition. Metallosis is a combined chemical and toxic reaction which, if the contact surface of a metal implant is large, may cause extensive damage to the surrounding tissue, the bone included.

Aged↗
PubMed2003

[Indications for arthrodesis of the knee joint in modern orthopedics].

INTRODUCTION: Indication for arthrodesis of the knee joint is nowadays most frequently failure of a total endoprosthesis, usually septic. A less frequent indication is purulent gonitis, frequently after corticoid administration, the condition after a complicated intraarticular fracture with subsequent arthritis or oncological disease of the bones in the area of the knee joint. MATERIAL AND METHODS: In the course of 2000 to 2002 at the authors' department 15 arthrodeses were implanted. In three cases the indication for arthrodesis was purulent gonitis, in three cases the condition after an open articular injury associated with infectious complications and in the remaining nine cases failure of an endoprosthesis of the knee, incl. seven caused by infection. The patients were three men and 12 women, mean age 64 years (30-75 years). For stabilization of the arthrodesis 9x external fixation was used, 5x plates and 1x intramedullary osteosynthesis. RESULTS: In all cases consolidation of the arthrodesis was achieved. In one case the external fixation had to be replaced by a system of two fixation devices and in one case correction of the axial position of the extremity was made. The presence of external fixation was perceived negatively in particular by female patients. DISCUSSION: Plate osteosynthesis and the use of external fixation devices are relatively quick, cheap and considerate methods of arthrodesis. External fixation must be used in acute virulent infections while plate osteosynthesis can be indicated in its absence. The characteristic of intramedullary fixation is similar, however special nails used for arthrodesis of the knee are several times more expensive than the previous types of stabilization. The advantage is the possibility to use a massive bone graft to fill the defect.

Adult↗
PubMed2003

[Traumatic spondylolisthesis of the axis].

PURPOSE OF THE STUDY: The study presents a group of patients with traumatic spondylolisthesis of the axis. Views on the treatment of different types of spondylolisthesis vary. The aim of this study was to carry out a retrospective evaluation of the group of patients with this traumatic condition. MATERIAL: In the period from 1995 to 2002, 26 patients with traumatic spondylolisthesis of the axis were treated. They accounted for 5% of all patients admitted to our department for cervical spine injuries. Three types of traumatic spondylolisthesis were distinguished according to the Effendi classification. Type I was diagnosed in seven, type II in 18 patients and type III in one patients. METHODS: Type I traumatic spondylolisthesis was, as a rule, treated conservatively. A halo vest was used in four and a Philadelphia collar in three patients. Patients diagnosed with type II spondylolisthesis were treated surgically from the anterior approach (16 patients) or with a halo vest (two patients). The only patient with a type III fracture was operated on from the anterior approach. RESULTS: Osseous healing was achieved in all patients. No pseudoarthrosis developed and no repeat surgery for infection or osteosynthesis failure was needed. No deterioration of neurological findings was recorded. The range of motion in the cervical spine after healing was not affected. DISCUSSION: Views on the classification and therapy of traumatic spondylolisthesis of the axis are diverse. The greatest diversity is associated with making a decision on whether the injury is unstable and requires surgical treatment or not. Further arguments are related to the use of the most suitable approach. Treatment from the anterior approach is prevailing. Type III fractures are rare and must always be treated surgically. CONCLUSIONS: Methods for treatment of traumatic spondylolisthesis of the axis are currently a topic of dispute. The decisive factor for therapy is whether the injury is stable or unstable. When instability is present, anterior C2-3 spondylodesis completed with plate osteosynthesis is the method of choice. Stable injuries are treated by the application of a halo vest or Philadelphia collar.

Adolescent↗
PubMed2003

[Treatment of deep chondral defects of the knee using autologous chondrocytes cultured on a support--results after one year].

PURPOSE OF THE STUDY: The treatment of deep chondral defects is one of the key issues in current orthopedics and traumatology. We developed a new technique that greatly improved the outcome of treatment in young active patients. The method is based on transplantation of in vitro cultured autologous chondrocytes carried on the fibrin glue Tissucol. MATERIAL: In the years 2000 to 2002, 19 patients with deep chondral defects were treated by chondrocyte transplantation with the use of Tissucol. At 1 year, 14 defects (average size, 4.31 cm2; range, 2.0 to 10.0 cm2) in 12 patients were evaluated. The defects were localized on the weight-bearing areas of the femoral condyle, tibial plateau and femoropatellar joint in 10, one and three patients, respectively. METHODS: The Lysholm knee score and IKDC subjective score were used for outcome evaluation. Second-look arthroscopy and repair assessment, on the basis of ICRS, were carried out in four patients. RESULTS: The patients were examined at 5 and 12 months after surgery. The average value of the Lysholm knee score before surgery was 45.6 points and those at 5 and 12 months after surgery were 72.0 points and 81.5 points, respectively. Good or excellent outcomes were achieved in seven patients. The average preoperative IKDC subjective score was 39.0 points and the postoperative values were 60.0 and 71.2 points at 5 and 12 months, respectively. Second-look arthroscopy was performed in four patients at 3 to 5 months after the transplantation. A very good, complete healing of the graft was observed in two patients and partial chondrograft degeneration (30% graft area) was seen in two patients. The graft surfaces were evaluated according to the cartilage repair assessments system (ICSR-cartilage score) and the average value obtained was 8.5 points, i.e., almost a normal graft surface. During the second-look arthroscopy, samples for examination by light and electron microscopy were collected. In the healing defects, they showed the presence of hyaline-like cartilage characterized by typical spherical chondrocytes, extracellular collagenous filaments and formation of typical isogenetic cell groups. In the regions of graft degeneration (fissuration), neovascularization of the issue with the presence of fibroblast-like cells was recorded. DISCUSSION: Excellent and very good outcomes were observed in 58% of our patients. Similar studies reported excellent and good results in 80 to 85% of the patients. On comparison, our group included more serious cases with the high presence of severe concomitant injuries, which influenced the final outcome. However, improvement was achieved in all 12 evaluated patients. CONCLUSIONS: The method described is effective for treating deep chondral knee injuries and can be recommended for use in clinical practice.

Adult↗
PubMed2002

Oral treatments for fungal infections of the skin of the foot.

BACKGROUND: About 15% of the population have fungal infections of the feet (tinea pedis or athlete's foot). Whilst there are many clinical presentations of tinea pedis the most common are between the toes (interdigital) and on the soles, heels and sides of the foot (plantar) which is known as moccasin foot. Once acquired the infection can spread to other sites including the nails, which can be a source of reinfection. Oral therapy is usually used for chronic conditions or when topical treatment has failed. OBJECTIVES: To assess the effects and costs of oral treatments for fungal infections of the skin of the foot (tinea pedis). SEARCH STRATEGY: Randomised controlled trials were identified from MEDLINE, EMBASE and CINAHL from the beginning of these databases to January 2000. We also searched the Cochrane Controlled trials Register (Cochrane Library issue 1, 2000) the Science Citation Index, BIOSIS, CAB-Health, Health star and Economic databases. Bibliographies were searched, podiatry journals hand searched and the pharmaceutical industry and schools of podiatry contacted. SELECTION CRITERIA: Randomised controlled trials including participants who have a clinically diagnosed tinea pedis, confirmed by microscopy and growth of dermatophytes in culture. DATA COLLECTION AND ANALYSIS: Study selection was done by two independent reviewers. Methodological quality assessment and data collection was also assessed by two independent reviewers. MAIN RESULTS: Twelve trials, involving 700 participants, were included. The two trials comparing terbinafine and griseofulvin produced a pooled risk difference of 52% (95% confidence intervals 33% to 71%) in favour of terbinafine's ability to cure infection. No significant difference was detected between terbinafine and itraconazole; fluconazole and either itraconazole and ketoconazole; or between griseofulvin and ketoconazole, although the trials were generally small. Two trials showed that terbinafine and itraconazole were effective compared with placebo. Adverse effects were reported for all drugs, with gastrointestinal effects most commonly reported. REVIEWER'S CONCLUSIONS: The evidence suggests that terbinafine is more effective than griseofulvin and that terbinafine and itraconazole are more effective than no treatment.

Administration, Oral↗
PubMed2002

Semen production in adolescent cancer patients.

BACKGROUND: The influence of an accompanying person (parent, guardian or nurse) on the ability of an adolescent (post-pubescent, <20 years of age) to produce a semen sample for cryopreservation, is undetermined, as is the potential for use of urine samples to retrieve sperm in those adolescents that are unable to produce a semen sample. METHODS: The records from 1991-2000 inclusive were reviewed to derive those adolescent patients who were unable to produce semen for cryopreservation prior to undergoing treatment for a malignant condition. RESULTS: During the study period 238 adolescents attended our unit of whom 205 (86.1%) banked semen ('producers'). The remaining 33 adolescents (13.9%) were initially unable to produce a sample ('non-producers'), four of these provided a urine specimen for analysis (12.1%) and of these one had sufficient sperm for cryopreservation. Of the 'accompanied' patients 29.7% (19/64) were non-producers while in the 'unaccompanied' patients only 8.0% (14/174) were non-producers (chi(2) = 16.58, P < 0.001). The relative risk (RR) of not producing a semen sample for the accompanied group of patients was greater than that for the unaccompanied group (RR = 3.689, 95% confidence interval: 2.0-6.9). One patient returning alone successfully provided a semen sample for storage. CONCLUSION: Units should consider the effect of the presence of an accompanying person when an adolescent is unable to produce a semen sample and should consider requesting urine to retrieve sperm.

Adolescent↗
PubMed2002

Semen quality and cryopreservation in adolescent cancer patients.

BACKGROUND: Adult cancer patients are routinely offered pre-treatment sperm cryopreservation. However, only recently has the welfare of adolescent cancer sufferers gained momentum, including their infertility, and unsurprisingly relatively little is known about their semen quality and feasibility of cryopreservation. METHODS AND RESULTS: A total of 238 adolescent cancer patients referred to our centre between 1991 and 2000, from post-pubertal age up to 19 years 11.9 months, were included. Their semen was processed after appropriate counselling. Semen cryopreservation was possible in 205 of the initial 238 patients referred (86.1%). The pathology of the cancer cases included Hodgkin's lymphoma, non-Hodgkin's lymphoma, osteosarcoma, Ewing's sarcoma, acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML), testicular, leukaemia, and others. The mean sperm counts were broadly uniform across the disease and age groups, except for the AML group. There was no cancer group analysed in which sperm could not be stored. Semen volume was broadly uniform across the disease groups, except the ALL and Ewing's sarcoma groups, which showed relatively lower and higher mean semen volumes respectively. Older adolescent patients appeared to have a higher mean semen volume. CONCLUSIONS: Semen cryopreservation was possible in most adolescent cancer cases regardless of age or diagnosis. In all cases the quality of the semen was potentially useful for assisted conception procedures. An offer to freeze sperm in all patients aged >12 years should be made. Adequate support and counselling of both the boys and their parents is essential.

Adolescent↗
PubMed2001

Phase I trial of concurrent tirapazamine, cisplatin, and radiotherapy in patients with advanced head and neck cancer.

PURPOSE: To determine the maximum-tolerated dose of tirapazamine when combined with cisplatin and radiation in patients with T3/4 and/or N2/3 squamous cell carcinoma of the head and neck. PATIENTS AND METHODS: The starting schedule was conventionally fractionated radiotherapy (70 Gy in 7 weeks) with concomitant cisplatin 75 mg/m2 and tirapazamine 290 mg/m2 (before cisplatin) in weeks 1, 4, and 7 and tirapazamine alone 160 mg/m2 three times a week in weeks 2, 3, 5, and 6. Positron emission tomography scans for tumor hypoxia (18F misonidazole) were performed before and during radiotherapy. RESULTS: We treated 16 patients with predominantly oropharyngeal primary tumors, including 10 patients with T4 or N3 disease. Febrile neutropenia occurred toward the end of radiotherapy in three out of six patients treated on the initial dose level. Two of these patients also developed grade 4 acute radiation reactions. Another 10 patients were treated with the same doses, but the week 5 and week 6 tirapazamine doses were omitted. This resulted in less neutropenia and only one dose-limiting toxicity (DLT) (febrile neutropenia), and eight out of 10 patients completed treatment without any dose omissions. In these 10 patients, the acute radiation toxicities were not obviously enhanced compared with chemoradiotherapy regimens using concurrent platinum and fluorouracil. 18F misonidazole scans detected hypoxia in 14 of 15 patients at baseline, with only one patient having detectable hypoxia at the end of treatment. With a median follow-up of 2.7 years, the 3-year failure-free survival rate was 69% (SE, 12%), the 3-year local progression-free rate was 88% (SE, 8%), and the 3-year overall survival rate was 69% (SE, 12%). CONCLUSION: DLT was due unexpectedly to febrile neutropenia, which could be overcome by omitting tirapazamine in weeks 5 and 6. The combination of tirapazamine, cisplatin, and radiotherapy resulted in remarkably good and durable clinical responses in patients with very advanced head and neck cancers. It warrants further investigation.

Adult↗
PubMed2001

Diagnostic and therapeutic advantages of hysteroscopic surgery in management of intrauterine lesions in postmenopausal women.

STUDY OBJECTIVE: To determine the value of hysteroscopic surgery in the management of intrauterine lesions in postmenopausal women. DESIGN: Descriptive study (Canadian Task Force classification II-2). SETTING: Tertiary care university hospital. Patients. Fifty postmenopausal women, most with vaginal bleeding, all with intrauterine lesions (leiomyomas, polyps, adhesions) on hysteroscopy or ultrasound. INTERVENTION: Hysteroscopic operations consisting of myomectomy, polypectomy, and adhesiolysis. MEASUREMENTS AND MAIN RESULTS: Forty-seven procedures were completed successfully by hysteroscopy; partial myomectomies were performed in three women for large or deeply embedded leiomyomas. The only complication was one case of fluid overload. Median operating time was 20.0 minutes (range 5.0-60.0 min) and median postoperative hospital stay was zero days (range 0-2 days). Eight patients (16%) subsequently underwent hysterectomy, mostly for uterine malignancy or premalignancy. In two cases, the operative specimen included malignant elements that were not evident on preoperative endometrial biopsy. During mean follow-up of 33.1 months (range 6-72 mo), 95.2% of women without hysterectomy were free of symptoms. CONCLUSION: Hysteroscopic surgery is an effective and safe option for postmenopausal women with intrauterine lesions. It allows the correct diagnosis to be made, reduces the need for major and unnecessary surgery, and is therapeutic in most patients. (J Am Assoc Gynecol Laparosc 8(1):87-91, 2001)

Female↗
PubMed2001

A systematic review of oral treatments for fungal infections of the skin of the feet.

OBJECTIVE: To synthesize the evidence for the effectiveness and cost-effectiveness of oral treatments for fungal infections of the skin of the feet. DESIGN: Systematic review. INTERVENTIONS: Oral treatments for fungal infections. METHODS: Ten electronic databases, four journals and the bibliographies of all review papers identified were searched. The authors also wrote to international pharmaceutical companies and all podiatry schools in the UK. The studies selected were randomized trials of clinically diagnosed fungal skin infections of the foot that confirmed cure by culture and microscopy. Two reviewers independently selected trials and abstracted data using a structured tool including 12 recognized quality criteria. RESULTS: Of 26 trials identified, 12 met the inclusion criteria and evaluated five different treatments. Single placebo-controlled trials showed that terbinafine and itraconazole were both effective. Two trials showed that terbinafine cures 50% more patients than griseofulvin. Four trials compared terbinafine with itraconazole, one showed that terbinafine given for 2 weeks had a better cure rate than 2 weeks of itraconazole, but the other three showed that it was no better than 4 weeks of itraconazole. CONCLUSIONS: There is significant evidence that terbinafine is more effective than griseofulvin, though more costly. There is weak evidence that terbinafine may be more cost-effective than itraconazole. Firm recommendations about the choice between terbinafine and the azoles need further research.

Administration, Oral↗
PubMed2001

A prospective controlled study of the effect of intramural uterine fibroids on the outcome of assisted conception.

BACKGROUND: Although uterine fibroids occur in 30% of women and are associated with a degree of subfertility, the effect of intramural fibroids on the outcome of IVF or ICSI treatment has not been prospectively studied. METHODS: Data were prospectively collected on 434 women undergoing IVF/ICSI in the assisted conception unit of an inner London teaching hospital. Patients were assessed for the presence of fibroids by transvaginal ultrasound and hysterosonography or hysteroscopy where appropriate. RESULTS: During the study period, 112 women with (study), and 322 women without (controls), intramural fibroids were treated. Patients were similar regarding the cause and duration of their infertility, number of previous treatments, and basal serum FSH concentration. Women in the study group were on average 2 years older (36.4 versus 34.6 years; P < 0.01). There was no significant difference in the duration of ovarian stimulation or gonadotrophin requirement, number of follicles developed, oocytes collected, embryos available for transfer or replaced. When analysing only women with intramural fibroids of < or =5 cm in size (n = 106) pregnancy, implantation and ongoing pregnancy rates were significantly reduced: 23.3, 11.9 and 15.1 respectively compared with 34.1, 20.2 and 28.3% in the control group (P = 0.016, P = 0.018 and P = 0.003). The mean size of the largest fibroids was 2.3 cm (90% range 2.1-2.5 cm). Logistic regression analysis demonstrated that the presence of intramural fibroids was one of the significant variables affecting the chance of an ongoing pregnancy, even after controlling for the number of embryos available for replacement and increasing age, particularly age > or =40 years, odds ratio 0.46 (CI 0.24-0.88; P = 0.019). CONCLUSION: This study demonstrated that an intramural fibroid halves the chances of an ongoing pregnancy following assisted conception.

Embryo Implantation↗
PubMed2001

Selectivity and sensitivity of intramuscular and transcutaneous electromyography electrodes.

We evaluated the differences in selectivity and sensitivity of intramuscular fine-wire electrodes and transcutaneous electrodes in detecting dynamic electromyography (EMG) signals from extensor digitorum (EDC) and extensor carpi radialis (ECR) muscles during isolated EDC and ECR contractions in two able-bodied subjects. Intramuscular fine-wire electrodes differentiated EDC and ECR EMG activities better than transcutaneous electrodes, and intramuscular fine-wire electrodes recorded higher amplitude signals than transcutaneous electrodes. Data suggest that intramuscular fine-wire electrodes are more selective and sensitive than transcutaneous electrodes in detecting EMG signals from adjacent forearm muscles.

Electric Stimulation↗
PubMed2001

Screening for HIV, hepatitis B and C infection in a population seeking assisted reproduction in an inner London hospital.

The Human Fertilisation and Embryology Authority requires all sperm donors to be screened for human immunodeficiency virus (HIV), hepatitis B and C and their semen quarantined for six months. No guidelines exist for screening prior to in vitro fertilisation or intracytoplasmic sperm injection. We prospectively analysed the prevalence of these viruses in our patients. Screening detected one case of HIV (0.13%), four of hepatitis C (0.5%) and 14 new cases of hepatitis B (1.7%). The prevalence of hepatitis B and HIV in our antenatal population at this time was 1.4% and 0.8%, respectively. Knowledge allows measures to be taken to reduce the risk of transmission to partner, fetus, new born baby, or by cross-contamination during embryo cryostorage and enables couples to make an informed decision regarding proceeding with treatment. Detection of infection in one partner should no longer preclude fertility treatment.

Female↗
PubMed2001

Cohort studies of health effects among people exposed to estuarine waters: North Carolina, Virginia, and Maryland.

A variety of human symptoms have been associated with exposure to the dinoflagellate Pfiesteria and have been grouped together into a syndrome termed "possible estuary-associated syndrome." Prospective cohort studies of health effects associated with exposure to estuarine waters that may contain Pfiesteria spp. and related organisms are in progress in North Carolina, Virginia, and Maryland. The three studies recruited cohorts of 118-238 subjects who work or engaged in recreation in estuary waters. Baseline health and neuropsychological evaluations are conducted, and study subjects are followed prospectively for 2-5 years with periodic assessments of health and performance on a battery of neuropsychological tests. Health symptoms and estuary water exposure are recorded by telephone interviews or diaries every 1-2 weeks. Water quality information, including measurements of Pfiesteria spp., is collected in the areas where the subjects are working. Because it is not possible to measure individual exposure to Pfiesteria or a toxin produced by this organism, these studies examine surrogate exposure measures (e.g., time spent in estuary waters, in a fish kill area, or in waters where Pfiesteria DNA was detected by molecular amplification). Preliminary analyses of the first 2 years (1998-2000) of data indicate that none of the three ongoing cohorts have detected adverse health effects. However, there have not been any reported fish kills associated with Pfiesteria since the studies began, so it is possible that none of the study subjects have been exposed to toxin-producing Pfiesteria spp.

Animals↗