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Biomedical subjects

W H Thomas

Publications and source records attributed to W H Thomas.

At least 19 recordsLinked to original sources
PubMed1990

Total shoulder arthroplasty versus hemiarthroplasty. Indications for glenoid resurfacing.

The results of total shoulder arthroplasty and hemiarthroplasty in a similar patient population were compared in an effort to define more clearly the indications for resurfacing the glenoid. The results of 64 Neer hemiarthroplasties in 59 patients were compared with 146 Neer total shoulder arthroplasties in 134 patients in a retrospective review of the period between 1974 and 1986. The average follow-up period was 44 months (range, 24-124 months). Hemiarthroplasty and total shoulder arthroplasty produced similar results in terms of functional improvement. Pain relief, range of motion, and patient satisfaction were better with total shoulder arthroplasty than hemiarthroplasty in the rheumatoid population. Progressive glenoid loosening was found in 12% of total should arthroplasties but no correlation with pain relief or range of motion was noted. Total shoulder arthroplasty is recommended for patients with inflammatory arthropathies, and hemiarthroplasty is recommended for patients with osteoarthritis, avascular necrosis, and four-part fractures with preservation of glenoid congruity and absent synovitis.

Adult↗
PubMed1990

Total knee arthroplasty with the kinematic prosthesis. Results after five to nine years: a follow-up note.

A review of the results of 192 kinematic total knee replacements five to nine years after the operation showed that the results were still satisfactory. At the time of the review, the ages of the patients ranged from twenty-two to eighty-seven years. About half of the patients had rheumatoid arthritis and the other half, osteoarthrosis. About 90 per cent of the results were rated good or excellent, and the average range of flexion was 109 degrees. Radiolucency was present around 40 per cent of the tibial components, 30 per cent of the femoral components, and 60 per cent of the patellar components, but the lines were thin and not progressive. The complications included loosening of the patellar components in five knees, one fracture of the tibial tray with loosening of the patellar component, one fracture of the patellar component, and one dislocation of the patellar component.

Adult↗
PubMed1989

Nonconstrained total shoulder arthroplasty in patients with polyarticular rheumatoid arthritis.

A retrospective review of 114 patients with polyarticular rheumatoid arthritis who had 140 total shoulder arthroplasties revealed that 93% of the patients had excellent pain relief; however, improvement in active forward elevation averaged 34 degrees. Nearly one-half of the patients had significant rotator cuff pathology. Three-fourths of the patients had a press-fit type of humeral component, and 5% of these have had variable amounts of subsidence. None have been sufficiently painful to require a revision. Eighty-two percent of the glenoid components developed radiolucent lines during the follow-up period. One percent of these were definitely loose and 9% were probably loose. To date, none have been revised. Complications occurred in 7% of the shoulders, but no deep or superficial wound infections were noted.

Adult↗
PubMed1989

Non-constrained total shoulder replacement in patients who have rheumatoid arthritis and class-IV function.

The results of twenty-four non-constrained total shoulder replacements that were done in twenty patients who had treatment of rheumatoid arthritis were retrospectively reviewed to determine how those results were affected by the severity of the disease. All of the patients had Class-IV functional capacity, and 92 per cent had Stage-III or IV rheumatoid progression. Nine (38 per cent) of the shoulders had a tear of the rotator cuff. The mean length of clinical follow-up was 4.5 years (range, two to ten years). Preoperatively, all of the patients had disabling pain and limited function. Postoperatively, twenty-two (92 per cent) of the patients had no appreciable pain, and eighteen (75 per cent) had no significant functional limitation (p less than 0.001). Active elevation improved by 88 per cent, and external and internal rotation also improved significantly. Motion, relief of pain, and functional improvement were not significantly greater in the patients who had an intact rotator cuff. Radiolucent lines developed around ten (42 per cent) of the glenoid prostheses, but only two of the prostheses were surrounded by a complete line and were thought to be loose. No revisions were done. We believe that a non-constrained total shoulder replacement affords excellent relief of pain, satisfactorily improves range of motion, and improves function in patients who have severe rheumatoid involvement of the shoulder. However, because motion and function are severely restricted preoperatively, the end-results are not comparable with those that have been reported for patients who have less severe rheumatoid disease.

Adult↗
PubMed1988

His+ reversions caused in Salmonella typhimurium by different types of ionizing radiation.

The yield of his+ reversions in the Ames Salmonella tester strain TA2638 has been determined for 60Co gamma rays, 140 kV X rays, 5.4 keV characteristic X rays, 2.2 MeV protons, 3.1 MeV alpha particles, and 18 MeV/U Fe ions. Inactivation studies were performed with the same radiations. For both mutation and inactivation, the maximum effectiveness per unit absorbed dose was obtained for the characteristic X rays, which have a dose averaged linear energy transfer (LET) of roughly 10 keV/micron. The ratio of the effectiveness of this radiation to gamma rays was 2 for inactivation and about 1.4 for the his+ reversion. For both end points the effectiveness decreases substantially at high LET, i.e., for the alpha particles and the Fe ions. The composition of the bottom and the top agar was the one recommended by Maron and Ames [Mutat. Res. 113, 173-215 (1983)] for application in chemical mutagenicity tests. The experiments with the less penetrating radiations differed from the usual protocol by utilization of a technique of plating the bacteria on the surface of the top agar. As in an earlier study [Roos et al., Radiat. Res. 104, 102-108 (1985)] greatly enhanced yields of mutations, relative to the spontaneous reversion rate, were obtained in these experiments by performing the irradiations 6 h after plating, which differs from the conventional procedure to irradiate the bacteria shortly after plating.

Alpha Particles↗
PubMed1987

Trochanteric advancement for recurrent dislocation after total hip arthroplasty.

Twenty-one patients had trochanteric advancement after experiencing an average of 3.9 dislocations in a mean period of 46 weeks following total hip arthroplasty. Before trochanteric advancement was performed, component malposition and mechanical impingement were excluded as causes of dislocation. Radiographic measurements revealed that the trochanter was advanced an average of 16 +/- 7.7 mm (1 SD). Four patients, all with rheumatoid arthritis, had trochanteric migration greater than 1 cm. Seventeen of the 21 hips had no further dislocations following trochanteric advancement, with mean follow-up period of 2.7 years. Two patients dislocated because of extremes in hip position and had no further dislocations. Two patients dislocated who had trochanteric migration greater than 1 cm. Only one patients with a technically satisfactory trochanteric advancement continued to dislocate repeatedly. In patients without component malposition or obvious sources of impingement, trochanteric advancement is an effective and safe procedure for prevention of recurrent dislocations after total hip arthroplasty.

Adult↗
PubMed1985

Computed tomography of the hindfoot with rheumatoid arthritis.

We are performing direct, coronally oriented computed tomographic (CT) scans of the subtalar joint in patients with rheumatoid arthritis. To date, 16 examinations have been performed in 14 patients, 5 of whom were scheduled to undergo subtalar arthrodesis. Scans were 4-7-mm thick and spanned the length of the subtalar joint. CT scans depicted and localized subtalar abnormalities clearly and precisely. On CT scans, patients showed a characteristic constellation of abnormalities including: soft tissue swelling, cartilage space narrowing, bony erosions, and a pes planovalgus alignment abnormality (consisting of increased heel valgus angulation, and a tendency toward flattening of the sustentaculum tali, and medial and downward slippage of the talar head). The clarity of the CT images facilitated the surgeon's pre- and postoperative evaluation. In particular, it was easy to plan the correction of the valgus deformity, anticipate any special requirements for reinforcing the articular surfaces, and assess the results of surgery. We conclude that coronal CT scans clearly demonstrate abnormalities and help the surgeon evaluate the rheumatoid hindfoot.

Adult↗
PubMed1985

McKeever metallic hemiarthroplasty of the knee in unicompartmental degenerative arthritis. Long-term clinical follow-up and current indications.

Forty patients with forty-four unicompartmental McKeever metallic uncemented hemiarthroplasties were followed for five to thirteen years (average, eight years). Thirty-nine knees had a medial and five, a lateral arthroplasty. The age at surgery ranged from thirty-two to eight-two years (average, sixty-seven years). At the final follow-up, 70 per cent of the knees were rated as good or excellent. Seventy-nine per cent of the knees in patients who were less than sixty-five years old at the time of surgery were in these categories. Six knees (14 per cent) had required revision to either a unicompartmental or a bicompartmental total knee replacement. The average preoperative and postoperative knee flexion did not change, but knees with initially poor motion improved. The average preoperative flexion contracture of 10 degrees improved postoperatively to 5 degrees. Complications were rare and no cases of infection, peroneal palsy, or clinically detectable phlebitis occurred. Obesity did not seem to adversely affect the outcome. This study indicated that the McKeever unicompartmental metallic hemiarthroplasty can provide an attractive alternative in the treatment of unicompartmental degenerative arthritis when proximal tibial osteotomy is contraindicated or has failed or when the patient is too young, heavy, or active to consider total knee replacement.

Adult↗
PubMed1985

Enhanced response of the Salmonella mutagenicity test to ionizing radiations.

Gamma-ray-induced reversions in the Ames Salmonella tester strain TA2638 have been studied for their dependence on a number of experimental parameters. It is shown that exposure to ionizing radiations soon after plating is not the procedure that yields results which correspond to those obtained in the standard utilization of the test with chemical mutagens. The ability to detect mutants is improved by irradiation 6 hr after the beginning of the incubation of the plated bacteria. This procedure has the double advantage of a markedly increased ratio of radiation-induced to spontaneous revertants and of resulting in substantial insensitivity to fluctuations in the number of bacteria initially plated. The reversion-doubling dose so obtained is 1.3 Gy; i.e., it is sufficiently small to disregard inactivation of the bacteria.

Cobalt Radioisotopes↗
PubMed1983

Total knee arthroplasty in juvenile rheumatoid arthritis.

From 1971 to 1981, total knee arthroplasty was performed on forty-eight knees in twenty-eight patients with juvenile rheumatoid arthritis at the Robert Breck Brigham (now Brigham and Women's) Hospital. Seventeen of these patients, with twenty-nine knee-replacement arthroplasties, were followed for from two to eleven years (average, five years) and are the basis for this study. The patients' ages at operation ranged from thirteen to thirty-nine years (average, twenty-three years). Six patients had undergone total hip arthroplasty prior to admission for total knee replacement, and five patients had a total hip replacement performed while they were hospitalized for the knee arthroplasty. Thirteen patients (twenty-one knees) had significant preoperative pain but only three (five knees) had severe discomfort. Four patients were unable to walk, three were household walkers, and ten were limited community walkers. Preoperative deformities of the knees ranged from 20 degrees of varus angulation to 35 degrees of valgus angulation. The average preoperative flexion deformity was 23 degrees and the arc of motion averaged 45 degrees. At follow-up, twenty of the twenty-one knees that had been significantly painful preoperatively were completely relieved of discomfort. The average arc of motion increased by 34 degrees, while in all but one knee the angular deformity had been corrected to zero to 10 degrees of valgus angulation. All but one patient became a limited or full community walker. Complications included one late deep infection and one posterior tibial subluxation. Four knees required subsequent resurfacing of the patella for treatment of pain. We now routinely resurface the patella in all patients with juvenile rheumatoid arthritis who have a total knee replacement. To date no prosthesis has required revision for loosening. Radiolucency of one millimeter or less about the prosthesis was noted at follow-up in eight (30 per cent) of the knees. As custom-made components were required in twelve of the twenty-nine knees, it is obvious that preoperative planning is crucial in the treatment of these patients. Our recent experience has shown that the use of preoperative and postoperative serial casts aids greatly in the correction of severe flexion deformity of the knee. Postoperative manipulation was required for twenty-one of the twenty-nine knees. Skeletal immaturity was not an absolute contraindication to surgery. We think that our results, which showed a marked improvement in both knee function and in quality of life, make the short and long-term risks of knee-implant surgery well worth taking in this patient population.

Adolescent↗
PubMed1979

Clinical study of total ankle replacement with gait analysis. A preliminary report.

Twenty-one ankle replacements in nineteen patients after an average follow-up of 14.7 months were analyzed with respect to their history, physical and roentgenographic findings, and gait analysis. The relief of pain and functional improvement after operation were disappointing compared with the results of prosthetic replacement in other joints and were not related to early complications, age, diagnosis, or the prosthesis used. Muscle weakness about the ankle, especially of the plantar flexors, was a prominent finding and appeared to cause abnormal patterns of gait and of ankle motion. The frequency of progressively increasing radiolucent lines was 88 per cent and of late loosening, 10 per cent. These results suggest a need for more emphasis on postoperative rehabilitation and on the uncertainty of this procedure at its present stage of development.

Activities of Daily Living↗
PubMed1978

Total hip replacement with and without osteotomy of the greater trochanter. Clinical and biomechanical comparisons in the same patients.

Twelve patients with bilateral hip replacement, one side performed with a trochanteric osteotomy and the other without osteotomy, were analyzed by review of the clinical records, the findings on physical examination, preoperative and postoperative Harris hip scores, each patient's evaluation, biomechanical analysis of the preoperative and postoperative roentgenograms of the hips and pelvis, and force-plate gait analysis. All operations yielded good results clinically but the majority of patients preferred the replacement done without osteotomy. Blood loss and trochanteric bursitis were greater problems in patients who had an osteotomy. There were no differences between the two groups in the postoperative Harris scores or in the biomechanical measurements made on the preoperative and postoperative roentgenograms except for the change in the abductor-muscle length. Changes in this parameter correlated well with the patients' symptoms and clinical findings.

Adult↗
PubMed1977

X-ray photoelectron spectrometry of copper-thiouracil complexes.

X-ray photoelectron spectrometry was applied to evaluate the correct oxidation number of copper in complexes with 2-thiouracil, 6-amino-2-thiouracil and 6-methyl-2-thiouracil. Regardless of the mode of preparation exclusively Cu(I) was bound to the different thiouracil compounds, producing one homogeneous signal of the Cu2p3/2 electrons at 932.5 eV. Upon oxidation with H2O2, a typical Cu(II) satellite appeared in the main signal of the Cu2p3/2 level was shifted to higher binding energy values. The reaction of Cu(II) with thioracil yielded identical complexes as above, in which Cu had the formal oxidation state +I. During this reaction portions of the thiouracil were oxidized to 2,2'-dithiobis(4-pyrimidinol) [bis(4-hydroxy-2-pyrimidinyl)disulphide], as seen by the shifted sulphur 2p signals to 163.5 eV. After treating the Cu-thiouracil complexes with H2O2, the simultaneous presence of sulphur species having the oxidation states RStheta (161 eV), RSSR (163.5 eV) and RSOtheta3 (168.5 eV) is indicated by the ESCA signals monitored.

Copper↗
PubMed1977

Conformational changes induced by ionic strength and pH in two bovine myelin basic proteins.

The structures of two biologically different myelin proteins, A1 from the central nervous system and P2 from the peripheral nervous system, were investigated. Both proteins were isolated from nerve tissues. Conformational changes in the homogeneous proteins were examined in aqueous solutions by means of circular dichroism measurements. The secondary structures of both proteins proved to be very stable between pH 2.5 and pH 11.7. Unlike the P2 protein, the A1 protein is stable up to pH 13 without detectable conformational changes. The stereochemistry of the polypeptide chains of both proteins is markedly different in the presence of urea. While the value of theta222 for the A1 protein changes linearly with increasing urea concentration, a sigmoidal curve was obtained for the P2 protein. The observed differences in the dichroic properties of the basic myelin proteins A1 and P2 indicate the possibility of further structure - function correlations.

Animals↗
PubMed1976

Complications of total hip-replacement arthorplasty in patients with rheumatoid arthritis.

During the period 1969 through 1974, 716 total hip-replacement arthorplasties were performed. The results of the surgery in 275 cases of rheumatoid arthritis as regards complications were compared with those in 382 procedures in cases of osteoarthritis. In contrast to the reports of others,the incidence of deep would infection in the two groups was found to be equal. Patients undergoing total hip-replacement arthroplasty as a revision of a previous operation had a substantially increased risk of infection. Patients with rheumatoid arthritis, however, were more subject to certain other complication (intraoperative fracture, difficulties with anesthesia, and malposition of prosthetic components), in addition to the complications that were predictable because of the involvement of multiple joints and the systemic disease process.

Adult↗