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Biomedical subjects

W Brien

Publications and source records attributed to W Brien.

7 recordsLinked to original sources
PubMed1995

Total knee replacement. A guideline to reduce postoperative length of stay.

In a retrospective study in an academic, acute-care community hospital, we studied the possible safety and effectiveness of a practice guideline recommending early discharge from the hospital for patients having uncomplicated total knee replacement. Of 206 patients receiving knee replacements, 162 (79%) were classified by the guideline as being at low risk for complications between the 4th and 7th postoperative days. Use of the guideline could have reduced the postoperative length of stay from 7.3 +/- 2.6 days to 4 days for the 112 patients (54%) who became low risk on the 4th postoperative day. Explicit and implicit review of the quality of care determined that 157 patients (96.9%; 95% confidence interval, (92.9%, 99.0%) could have been safely transferred from the acute-care hospital to an appropriate setting when they became classified at low risk between the 4th and 7th postoperative days. Clinical practice guidelines can possibly be used to reduce the postoperative length of acute-care hospital stay for patients having knee replacements. This guideline requires further study in a controlled clinical trial before it can be recommended for use.

Aged↗
PubMed1993

Coverage strategies in total joint replacement.

The strategy for soft-tissue management following total joint arthroplasty begins with prevention. The medical status of the patient is optimized preoperatively. Meticulous surgical technique with liberalized indication for flap closure primarily will reduce soft-tissue failures. Early identification and aggressive team management of complications are critical to decrease long-term morbidity and to obtain a good functional result.

Adult↗
PubMed1992

Interface corrosion of a modular head total hip prosthesis.

Wear and corrosion products released from metallic prosthetic joints can stimulate adverse reactions in the surrounding tissues that may eventually require revision of the prostheses. The authors report here a case of a modular total hip prosthesis removed after 35 months that showed evidence of corrosion and fretting at the Morse taper interface between the titanium alloy femoral stem and the cobalt-chromium ball.

Aged↗
PubMed1992

Titanium wear debris in failed cemented total hip arthroplasty. An analysis of 71 cases.

Seventy-one cemented total hip arthroplasties (THAs) were reviewed following removal of the all-titanium alloy femoral stem. Fifty-one hips were primary arthroplasties that failed due to aseptic loosening, 8 were previous revisions with aseptic loosening, and 12 were removed for infection. The average duration of service for the three groups was 4.5 years, 5.0 years, and 3.7 years, respectively. Femoral bone loss in aseptically loose, primary THA was graded as severe in 51%, moderate in 24%, and mild in 20%. Femoral endosteolysis was present in 94%, while acetabular osteolysis was seen in 6%. Histological evaluation of tissues from failed primary arthroplasties revealed polymethyl methacrylate debris in 75% of cases, polyethylene debris in 80%, metal debris in 75%, and chronic inflammatory cells in all cases. Metallic debris was not seen in the failed revision cases and in only 17% of the infected cases. Examination of retrieved femoral components revealed burnishing of the head in all cases, while 71% of stems with aseptic loosening were abraded from the cement. Metal levels from 12 cases averaged 2,111 mg/g of dry tissue (range, 60-11,823); synovial fluid levels from 8 other cases averaged 106 mg/l (range, 22-340). While it is not certain whether metallic particles are a primary cause of loosening or are generated secondarily, their presence seems to accelerate bone loss and loosening.

Adult↗
PubMed1990

The antiphospholipid syndrome: prevalence among patients with stroke and transient ischemic attacks.

PURPOSE: The prevalence of the antiphospholipid syndrome was determined prospectively in patients presenting with stroke and transient ischemic attacks. An attempt was made to define a subset of stroke patients at risk for this syndrome on the basis of their clinical features. PATIENTS AND METHODS: Fifty-one consecutive patients with stroke and transient ischemic attacks were assessed. Tests used for the laboratory diagnosis of the antiphospholipid syndrome included four phospholipid-dependent coagulation tests for detection of the lupus anticoagulant, and two enzyme-linked immunosorbent assays for antibodies to phospholipid. RESULTS: Three of 51 patients (6%, 95% confidence intervals 0% to 12.0%) had a lupus anticoagulant and the clinical features of the antiphospholipid syndrome. Seven patients had clinical features suggestive of the syndrome but negative laboratory tests. Those patients who were clinically unlikely to have this syndrome also had negative laboratory tests. CONCLUSION: In a series of 51 unselected patients presenting with stroke and transient ischemic attacks, three had the antiphospholipid syndrome. The clinical features of this syndrome are helpful in identifying this group of patients. The role of the lupus anticoagulant in the pathogenesis of stroke remains to be defined.

Adolescent↗
PubMed1986

Auto-immune thrombocytopenia related to interferon therapy.

A patient with renal cell carcinoma developed reversible autoimmune thrombocytopenia while receiving leukocyte interferon (IFN) and subsequently fibroblast IFN. Bone marrow biopsies and elevated platelet-associated IgG were suggestive of immune thrombocytopenia. The patient's history of exposure to IFN and exclusion of other causes are most consistent with drug-induced immune thrombocytopenia. Rechallenge with acetaminophen, the only other drug the patient was receiving concurrently, failed to induce thrombocytopenia. With IFN alpha, acute thrombocytopenia resolved within 48 h, whereas after IFN beta it was 5 wk before platelet counts returned to normal. PaIgG, however, remained elevated for up to 30 wk. Sensitive in vitro tests failed to confirm drug-dependent binding of IgG to the patient's platelets. It is suggested that this patient developed interferon-induced autoimmune thrombocytopenia.

Autoimmune Diseases↗