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Biomedical subjects

R L Lawton

Publications and source records attributed to R L Lawton.

At least 19 recordsLinked to original sources
PubMed2004

Dislocation after long-necked total hip arthroplasty.

Dislocation after total hip arthroplasty is problematic and not completely understood. Skirted long-necked implants have been used to reestablish soft tissue tension with the assumption that their use will reduce dislocation. It is unknown whether the dislocation rates with long-necked implants are different than those with standard neck length devices. The records of 250 consecutive total hip arthroplasties were reviewed, 125 primary and 125 revision, in which long-necked femoral prostheses were used. A matched control sample with standard neck length prostheses was defined. Dislocation rates and radiographic indices of leg length were calculated and compared with the control group. Dislocation rates in the long-necked groups were 10.6% and 18% for primary and revision surgeries, respectively. These rates were significantly higher than the rates seen in standard neck length controls (1.6% and 10%, respectively). There was no difference in leg-length discrepancy between long-necked prostheses and standard neck length matched controls. Long-necked prostheses are associated with higher rates of dislocation after total hip arthroplasty. The higher rates may be attributable to impingement of the neck, inadequate restoration of soft tissue tension, and/or other factors. Although this study cannot claim to have shown a cause and effect relationship between the skirted neck and dislocation, the association between the two variables is clearly shown.

Arthroplasty, Replacement, Hip↗
PubMed1999

The use of heparin in patients in whom a pulmonary embolism is suspected after total hip arthroplasty.

BACKGROUND: The morbidity and mortality associated with pulmonary embolism are well known, as is the benefit of the use of heparin in patients who have a pulmonary embolism. However, the patterns of heparin use as well as its undesirable effects, especially in patients who have recently had a total hip arthroplasty, have been less well studied. Thus, concern arises regarding the use of heparin in patients who have no firm evidence of a pulmonary embolism. The purpose of the current study was to track the use of heparin and associated orthopaedic complications in patients in whom a pulmonary embolism was suspected after a total hip arthroplasty. METHODS: The records of 150 patients in whom a pulmonary embolism had been suspected after a total hip arthroplasty were reviewed retrospectively. The rates of individual complications (such as stroke, infection, and hematoma) and those of groups of complications (such as medical complications, orthopaedic complications, and all complications combined) were recorded and then were stratified according to the treatment (with or without heparin), the presence or absence of pulmonary embolism, and other variables. RESULTS: Thirty-two (47 percent) of sixty-eight patients who were managed with heparin had complications compared with sixteen (20 percent) of eighty-two patients who were not thus managed (p = 0.0006). Specifically, patients who were managed with heparin were more likely to have gastrointestinal bleeding, hematological complications, a loose prosthesis, a hematoma, or an early revision arthroplasty (p<0.05 for all). With the numbers available, the use of heparin was not found to be significantly associated with an increased risk of death, stroke, or infection at the site of the prosthesis. Interestingly, thirty-one (31 percent) of ninety-nine patients who had ventilation-perfusion scans that demonstrated normal findings or findings indicating a low probability of pulmonary embolism were given heparin before the diagnosis of a pulmonary embolism was excluded, and sixteen (52 percent) of these thirty-one had complications. CONCLUSIONS: Given this risk profile, we advise against the use of heparin before the diagnosis of pulmonary embolism is established in patients who have had a total hip arthroplasty. This recommendation is supported by algorithms, in widely read medical texts, pertaining to the use of heparin in patients in whom a pulmonary embolism is suspected.

Adult↗
PubMed1994

Surveillance for smoking-attributable mortality and years of potential life lost, by state--United States, 1990.

PROBLEM/CONDITION: Mortality and years of potential life lost attributable to cigarette smoking. REPORTING PERIOD COVERED: 1990. DESCRIPTION OF SYSTEM: Mortality and years of potential life lost were estimated for each state by using the Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) software. These estimates were based on attributable risk formulas for smoking-related causes of death. Estimates of smoking prevalence were obtained from the Behavioral Risk Factor Surveillance System and the U.S. Bureau of the Census, and mortality data were obtained from CDC. RESULTS: The median estimate for the number of smoking-attributable deaths among states was 5,619 (range: 402 [Alaska] to 42,574 [California]). Within each state, the number of smoking-attributable deaths among males was approximately twice as high as among females. Utah had the lowest mortality rate (218.0 per 100,000 population) and the lowest percentage of all deaths attributable to cigarette smoking (13.4%). Nevada had the highest mortality rate (478.1 per 100,000 population) and the highest percentage of deaths from smoking (24.0%). The number of years of potential life lost ranged from 6,720 (Alaska) to 498,297 (California). INTERPRETATION: The number of deaths attributable to cigarette smoking in 1990 remained high. Efforts are needed to control tobacco use in all states. ACTIONS TAKEN: SAMMEC data are used in many states to assist policymakers in strengthening tobacco control efforts.

Adult↗
PubMed1987

Bilateral hip disarticulation in paraplegics with decubitus ulcers.

A small percentage of paraplegic patients develop chronic decubitus ulcers that are unresponsive to the usual plastic surgical maneuvers. We used anatomic and nonanatomic (filleting) approaches to hip disarticulation in three patients with severe chronic cavernous decubitus ulcers. All patients were rehabilitated to wheelchair ambulation, with subsequent healing of the operative sites. This type of therapy might be considered in paraplegics with less compelling reasons for amputation, because of the associated rehabilitation potential.

Colostomy↗
PubMed1986

Hepatocellular carcinoma presenting as bone pain.

Hepatocellular carcinoma is an uncommon malignancy in the western world, and its presentation as symptomatic skeletal metastasis is rare. The following describes a patient whose initial complaint was arm pain that was subsequently found to be due to metastatic hepatocellular carcinoma. A review of the literature describing skeletal involvement by hepatocellular carcinoma is included.

Arm↗
PubMed1980

Metastases to eyelids: breast.

Edema and erythema of the right eyelid were the first clinical symptoms of widely metastatic carcinoma in a 61-year-old female. At the time of biopsy of the eyelid there were no other clinical manifestations of the disease. The case history points out a rare manifestation and emphasizes the many faces of breast cancer.

Adenocarcinoma↗
PubMed1978

Effect of benzopyranoperidine, a delta-9-THC congener, on pain.

In a double-blind, 5-way crossover designed study, single doses of placebo, 2 doses of codeine sulfate (60 and 120 mg), and 2 doses of benzopyranoperidine (2 and 4 mg) were administered orally to 35 patients who required analgesics for chronic pain due to malignancies. Benzopyranopyridine is an analogue of delta-9-tetrahydrocannabinol and was chosen on the basis of its sedative, hypnotic, and analgesic properties in animals. Pain relief scores indicated a degree of relief of clinical significance with 120 mg of codeine but no consistent difference between placebo and any other active agent. On the basis of the data, bezopyranoperidine (2 or 4 mg) is not as effective as codeine (120 mg or 60 mg) and not more effective than placebo in relieving pain due to cancer; indeed, pain perception appeared to be augmented by both doses.

Adult↗
PubMed1977

Course and treatment results of young patients with carcinoma of the pancreas.

Carcinoma of the pancreas is increasing in incidence and appears to do so, in part, by affecting an increasingly younger population. To define differences or similarities of a young population with those of other reported series, the records of 31 patients less than 46 years of age were summarized and compared. Regardless of age, patients had identical symptoms when first seen, on the average of less than six months' duration. In spite of this short time, the vast majority, 26 of 31 patients, had widespread, unresectable disease at operation. No identifiable difference of epidemiologic significance has been identified. Considerable palliation can be achieved by performing bypass procedures. The three who survived the longest period of time in this group had pancreatoduodenectomies performed for cure.

Adult↗
PubMed1977

Melanoma of skin of the breast: therapeutic considerations based on six cases.

Melanomas of the skin of the breast are uncommon lesions which are amenable to cure with standard mastectomy techniques, even when lymphatic spread has occurred. Of six patients treated at the University of Iowa, two have died of metastatic melanoma, one treated by wide excision and subsequent axillary dissection and the other by radical mastectomy initially. Of the remaining patients, one with positive axillary nodes at the time of mastectomy died 28 years following operation of unrelated causes, one with axillary nodes involved is 5 years without evidence of recurrence, and two who have been followed for less than 2 years, are without evidence of recurrent disease in spite of having had positive nodes at the time of initial treatment. All six patients had had pigmented lesions of the skin of the breast for many years, suggesting that such lesions in this location should be considered premalignant.

Adult↗
PubMed1976

Pancreatic carcinoma as a sequel to therapy of lymphoma.

Development of a carcinoma in the pancreas of a young man who had five years previously undergone intensive radiotherapy and subsequent chemotherapy for treatment of a lymphoma suggests that induction of the second neoplasm occurred as the result of the therapy of the first. While definite proof of causality is lacking, a review of recent literature strongly suggests that the association noted in the patient described is more than serendipitous. Increased usage of high-dose radiotherapy, particularly in conjunction with chemotherapy, may be directly related, and it is imperative that such an association be kept in mind when such patients are seen in follow-up.

Adenocarcinoma↗