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Biomedical subjects

R J Emery

Publications and source records attributed to R J Emery.

52 records · Page 3Linked to original sources
PubMed1991

Bipolar hemiarthroplasty for subcapital fracture of the femoral neck. A prospective randomised trial of cemented Thompson and uncemented Moore stems.

We performed a randomised prospective trial to compare the results of 27 cemented and 26 uncemented bipolar hemiarthroplasties in active patients with displaced subcapital fractures of the femoral neck. After a mean follow-up of 17 months, significantly more of the uncemented group were experiencing pain in the hip and using more walking aids than the patients in the cemented group. The incidence of postoperative complications, the early mortality rate and the operating time and blood loss were not significantly different. Using otherwise identical prostheses the early results were much better with a cemented Thompson stem than with an uncemented Austin Moore stem.

Aged↗
PubMed1991

Glenohumeral joint instability in normal adolescents. Incidence and significance.

One hundred and fifty asymptomatic shoulders in 75 schoolchildren were studied. The shoulders were tested for instability and a hyperextensometer was used to assess joint laxity. Signs of instability were found in 57% of the shoulders in boys and 48% in girls; the commonest sign was a positive posterior drawer test which was found in 63 shoulders. A positive sulcus sign was found in 17 shoulders and 17 subjects had signs of multidirectional instability. General joint laxity was not a feature of subjects whose shoulders had positive instability signs.

Adolescent↗
PubMed1991

The shoulder girdle in ankylosing spondylitis.

We report the clinical findings in the shoulders of fifty-two patients who had ankylosing spondylitis. The three major patterns that were found included limitation of scapulothoracic motion (forty-one patients), acute inflammatory arthropathy of the sternoclavicular or acromioclavicular joint (six patients), and severe restriction of glenohumeral motion (five patients). Although radiographic abnormalities were common, they correlated with the clinical findings in only minor respects.

Acromioclavicular Joint↗
PubMed1990

Selective depression of metabolic activities in cortical osteoblasts at the site of femoral neck fractures.

The aim of this investigation was to determine whether some metabolic defect might be related to the propensity of osteoporotic femoral necks to fracture acutely. To this end, the activities of two dehydrogenases of the glycolytic Embden-Meyerhof pathway, two of the pentose phosphate pathway, two mitochondrial enzymes, and alkaline phosphatase were measured in the cortical and in the trabecular osteoblasts. Comparison was made with such activities in iliac crest biopsies from patients with these fractures and from the equivalent femoral and iliac crest samples from patients with osteoarthritis of the hip, in biopsies from the iliac crests from seven patients with no bony abnormality, and in specimens from the fracture site of six traumatic fractures. The results showed a highly significant decrease in the activities of the two enzymes of the pentose phosphate pathway (p less than 0.001) in the cortical, but not in the trabecular, osteoblasts in the osteoporotic fractures. This could not be attributed to the trauma of acute fracture since it was not found in traumatic fractures. Other experimental evidence has indicated that a relationship may occur between depressed activity of these enzymes and a retardation of bone formation.

Aged↗
PubMed1990

Prophylactic pinning in slipped upper femoral epiphysis. Prevention of complications.

We report the complications of prophylactic pinning of slipped upper femoral epiphysis with Crawford Adams pins in 95 cases. Complications of pin placement were seen in 13.7%. Although seven hips had penetration of the joint, there were no cases of chondrolysis or avascular necrosis. Excavation of the lateral femoral cortex was required at pin removal in 12.5% of cases. Analysis of the growth around pins allowed recommendations to be made regarding pin protrusion. The use of improved fixation devices may reduce the need for multiple pins.

Adolescent↗
PubMed1989

Hook-pin fixation of subcapital fractures of the femur: an atraumatic procedure?

Eighty-seven patients with subcapital fractures of the femur treated by hook-pin fixation were reviewed clinically and radiologically with an average follow-up time of 29 months. There were 58 undisplaced and 29 displaced fractures. Seven per cent of the undisplaced and 31 per cent of the displaced fractures developed avascular necrosis (AVN) and failure of fixation was seen in 3.5 per cent and 10 per cent respectively. Overall, 23 per cent of patients developed healing complications of which just over one-half had revision arthroplasty. The AVN rate in the undisplaced group was relatively low, though there was no clear advantage over simple screw fixation. In contrast, the incidence of AVN in displaced fractures was higher than with other methods. Fixation failure was related to surgical error in most instances.

Adult↗
PubMed1989

Comparative metabolic enzymatic activity in trabecular as against cortical osteoblasts.

On the basis of studies with bone-seeking isotopes, it is generally believed that the metabolic activity of osteoblasts of the trabecular bone is greater than that of the osteoblasts of the cortex. This implies that the oxidative activity, which provides the energy for biosyntheses, will also be greater in the former than in the latter. In the present study, direct measurement of the activities of representative enzymes of the major oxidative pathways, as well as of alkaline phosphatase, showed that the reverse pertained. However, owing to the greater cellularity of trabecular bone, the activity per unit mass of bone may be higher in the trabecular bone.

3-Hydroxyacyl CoA Dehydrogenases↗
PubMed1988

Capsular distension and intracapsular pressure in subcapital fractures of the femur.

It has been shown that raised intracapsular pressure causes avascular necrosis of the femoral head in experimental animals, but the relevance of this to clinical fractures of the femoral neck is controversial. We have studied 19 patients with intracapsular fractures of the femoral neck by pressure measurement and by ultrasonography to demonstrate capsular distension. The intra-articular pressure in Garden Grade I and II fractures averaged 66.4 mmHg with a maximum of 145 mmHg. In 10 Garden Grade III and IV fractures the average pressure was 28 mmHg with a maximum of 65 mmHg. Most of the recorded intracapsular pressures were high enough to have caused possible vascular embarrassment, and it is suggested that early decompression of the haemarthrosis should be considered.

Aged↗
PubMed1985

Early discharge despite postoperative pyrexia after inguinal herniorrhaphy in unselected patients.

Although shown to be suitable for selected patients with subsequent community medical and social support early discharge from hospital after inguinal hernia repair is apparently not well established. The application of such a policy may also be inhibited by postoperative pyrexia even though the cause of this is not evident. We report a series of 103 unselected patients presenting consecutively to an inner London hospital for hernia repair in whom early discharge was proposed in 95 per cent and achieved in 79 per cent irrespective of clinically unaccountable postoperative pyrexia and without special community health provision. This discharge policy placed no additional burden on the community health services and did not affect adversely patients' welfare, satisfaction or time off work.

Adolescent↗
PubMedDate not supplied

Pioneers of shoulder replacement: Themistocles Gluck and Jules Emile Péan.

Dr. Jules Emile Péan is widely credited with having performed the first total shoulder replacement March 11, 1893, at the Hôpital International in Paris. However, in his original report Péan refers to the work of Themistocles Gluck as being the inspiration for his shoulder prosthesis, a fact understated if not completely overlooked during the last hundred years. This article therefore attempts to reappraise the relative contributions of these two pioneering surgeons to shoulder arthroplasty.

France↗
PubMedDate not supplied

A standard method of shoulder strength measurement for the Constant score with a spring balance.

The strength component of the Constant score has been criticized for its lack of a precisely defined measurement method. A series of experiments was performed to compare three different methods in normal and pathologic shoulders with the use of a standard test position. These were (1) the Isobex isometric dynamometer, (2) Constant's unsecured spring balance, and (3) a new modification in which the spring balance is fixed at one end and the reading is taken after 5 seconds of maximum effort. The results suggest that this simple modification with a low-cost spring balance can give similar values to those from the Isobex. The need for precision of terms and a definition of the method is discussed, and recommendations for the standardization of the many variables in making this measurement are made.

Adult↗
PubMedDate not supplied

A comparison of methods for determining lead content in drinking water: a portable anodic stripping voltammetry instrument method versus the standard EPA 239.2 method.

Lead levels in drinking water were measured by the standard U.S. Environmental Protection Agency (EPA)-approved atomic absorption spectroscopy-graphite furnace Method 239.2 and compared with determinations made with a newly available portable anodic stripping voltammetry (PASV) instrument. A standard curve was prepared at 2, 5, 10, 15, 20, 25, and 30 microg/L of lead. PASV instrument readings were lower than standard EPA method values, with a mean difference and standard error (SE) of the mean between the two of 1.538+/-0.588 microg/L (n = 7, p = 0.040, significant at the 95% confidence interval [CI]). First-flush drinking water samples collected from 144 water fountains/coolers were preserved with nitric acid. Total lead content was tested twice for 29 EPA method samples and 54 PASV instrument samples to determine the variation within each method; results were not significant at the 95% CI. Total lead content was determined for 144 samples by both methods. PASV instrument readings were lower than standard EPA method values (mean difference and SE of the mean 0.630+/-0.206 microg/L; n = 144, p = 0.0027, significant at the 95% CI). Mean and standard deviation of the 144 samples for the EPA method and the PASV instrument were 6.5+/-11.8 microg/L and 5.9+/-11.6 microg/L, respectively. Means were below the action level for lead of 15 ppb (microg/L), but some values were above the action level (18 [13%] using the EPA method; 20 [14%] using the PASV instrument). Retesting by EPA method showed two false positive PASV values. Results indicate that in some field situations the PASV instrument may prove useful due to its relatively low price, small size, ease of use, and quick readings.

Electrochemistry↗
PubMedDate not supplied

The c/b ratio in the radiological monitoring of the hip joint in congenital dislocation of the hip.

We report a method of monitoring hip joint development for congenital dislocation of the hip in children. The c/b ratio was measured on serial radiographs of 41 hips in 38 patients. The measurement was compared to c/b ratio obtained from normal hips. It was used to detect concentric reduction or its loss by migration of the femoral head during growth. The age at diagnosis ranged from 8 months to 10 years 6 months. The normal c/b ratio was found to change little with age. Deviation of the c/b ratio from normal in congenital dislocation of the hip resulted in a poor outcome and identified cases requiring further surgical intervention. This measurement of c/b ratio is simple and accurate, using easily determined points. The graphic display promotes critical analysis of situation and allows selection of cases at risk for treatment.

Child↗