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Biomedical subjects

C B Sledge

Publications and source records attributed to C B Sledge.

At least 37 records · Page 2Linked to original sources
PubMed1995

Beta-particle dosimetry in radiation synovectomy.

Beta-particle dosimetry of various radionuclides used in the treatment of rheumatoid arthritis was estimated using Monte Carlo radiation transport simulation coupled with experiments using reactor-produced radionuclides and radiachromic film dosimeters inserted into joint phantoms and the knees of cadavers. Results are presented as absorbed dose factors (cGy-cm2/MBq-s) versus depth in a mathematical model of the rheumatoid joint which includes regions of bone, articular cartilage, joint capsule, and tissue (synovium) found in all synovial joints. The factors can be used to estimate absorbed dose and dose rate distributions in treated joints. In particular, guidance is provided for those interested in (a) a given radionuclide's therapeutic range, (b) the amount of radioactivity to administer on a case-by-case basis, (c) the expected therapeutic dose to synovium, and (d) the radiation dose imparted to other, nontarget components in the joint, including bone and articular cartilage.

Arthritis, Rheumatoid↗
PubMed1995

Dislocation after bipolar hemiarthroplasty of the hip.

Although bipolar hemiarthroplasty of the hip is a frequently performed procedure, little information is available about the frequency of postoperative dislocation and its treatment. For this study, 1,934 hips treated consecutively with primary bipolar hemiarthroplasty were reviewed. A postoperative dislocation developed in 29 patients (1.5%): during the first month after surgery in 24 patients and between 1 month and 5 years after surgery in five patients. Of the 29 dislocations, 25 were successfully reduced with with routine closed methods. Among these 25 hips, 13 (52%) subsequently redislocated, and 7 of these required operative treatment for the recurrent dislocation. Dislocation after primary bipolar hemiarthroplasty is infrequent, can usually be reduced by routine closed methods, but is associated with a high rate of recurrent dislocation.

Adolescent↗
PubMed1995

The validity and reliability of a Total Hip Arthroplasty Outcome Evaluation Questionnaire.

The Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT), the Task Force on Outcome Studies of The American Academy of Orthopaedic Surgeons, and The Hip Society reached a consensus on the nomenclature to be used for the evaluation of the results of total hip arthroplasty. The Task Force of The American Academy of Orthopaedic Surgeons, to assess the results of total hip arthroplasty from the perspective of the patient, subsequently developed a questionnaire that incorporated this nomenclature. The validity and reliability data regarding this questionnaire are reported in this study. Twenty-five patients participated in the reliability test. The non-response rate was five (0.5 per cent) of 941 possible responses. Test-retest reliability was determined by calculating the Spearman correlation coefficients for each question. The coefficients ranged from 0.41 to 1.0 over a mean test-retest interval of sixteen days. Most items had Spearman coefficients that were greater than 0.50, indicating good or excellent reliability. Validity was assessed, for the fifty-four patients who participated, by calculating the Spearman correlation coefficients for the items regarding pain in the affected hip, limitation of usual activities, capacity for walking without support, and the Sickness Impact Profile. The coefficients ranged from 0.11 (pain and limitation of activity) to 0.56 (Sickness Impact Profile and limitation of activity). These coefficients reflected modest associations, as anticipated, indicating that pain, function, and health status are related yet distinct concepts.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1994

A conceptual framework for outcomes research in arthroscopic meniscectomy: results of a nominal group process.

Standard measures for the assessment of arthroscopic knee surgery are needed, as existing instruments do not cover the full range of relevant outcomes. Using a modified nominal group technique, a panel of orthopedic surgeons and methodologists developed a conceptual framework for the assessment of arthroscopic knee procedures. The outcome domains included in the evaluation comprised traditional measures such as range of motion, complications, and other objective parameters, as well as patient-centered variables such as health status and satisfaction. Independent variables that might influence the outcome of surgery included traditional measures such as knee alignment as well as comorbidity and patient expectations. This conceptual framework should allow a more comprehensive, patient-centered assessment of the outcome of arthroscopic meniscectomy.

Arthroscopy↗
PubMed1994

Intra-articular radiation treatment of rheumatoid synovitis of the ankle with dysprosium-165 ferric hydroxide macroaggregates.

Intra-articular radiation treatment using dysprosium-165 ferric hydroxide macroaggregate has been performed on eight patients with refractory synovitis of the ankle. Seventy-five percent (six patients) responded well to the treatment, and there were no complications from the injection. Although ankle synovectomy is not often indicated, those patients with rheumatoid synovitis without significant joint destruction respond favorably to radiation treatment.

Adult↗
PubMed1993

Enhancement of joint fluid with intravenously administered gadopentetate dimeglumine: technique, rationale, and implications.

This study reports findings on joint fluid enhancement after intravenous administration of gadopentetate dimeglumine. Ten subjects were studied: two asymptomatic volunteers and eight patients with suspected meniscal tears. The subjects underwent imaging at 1.5 T before, immediately after, and 42-60 minutes after intravenous administration of gadopentetate dimeglumine. The rate of fluid enhancement was assessed in three subjects, and the effects of exercise were studied. All subjects exhibited enhancement of joint fluid. Mean fluid enhancement for patients was 137% on initial and 262% on delayed images obtained after exercise. Exercise increased the rate and degree of fluid enhancement and distributed contrast material uniformly throughout the joint. The arthrographic effect of the fluid enhancement increased the number of perceived cartilage defects. This study documents enhancement of joint fluid in healthy subjects and in those with effusions. The arthrographic effect may provide a more convenient alternative to intraarticular injection of gadopentetate dimeglumine for MR arthrography.

Contrast Media↗
PubMed1993

Capitellocondylar total elbow replacement in rheumatoid arthritis. Long-term results.

We evaluated the long-term results of 202 capitellocondylar total elbow replacements that had been performed, from July 1974 through June 1987, in 172 patients. The duration of follow-up averaged sixty-nine months (range, twenty-four to 178 months). At the most recent follow-up examination, use of a 100-point rating score demonstrated an improvement from an average preoperative score of 26 points (range, 2 to 50 points) to an average postoperative score of 91 points (range, 45 to 100 points). The most improvement occurred in the categories of relief of pain, functional status, and range of motion in all planes except extension. The improvements in these categories and in the roentgenographic appearance that were seen in the early postoperative period did not deteriorate with time. The average preoperative arc of motion at the elbow ranged from -37 degrees of extension to 118 degrees of flexion. The average postoperative arc of motion at the elbow ranged from -30 degrees of extension to 135 degrees of flexion. Supination improved from 45 degrees preoperatively to 64 degrees postoperatively; pronation improved from 56 degrees preoperatively to 72 degrees postoperatively. The roentgenograms showed a radiolucent line adjacent to eight humeral and nineteen ulnar components; most of the lines were incomplete and one millimeter wide or less. Revision of the prosthesis was necessary in three elbows (1.5 per cent) because of loosening without infection, and in three additional elbows because of dislocation of the prosthesis. Complications included deep infection in three elbows (1.5 per cent); problems related to the wound in fifteen (7 per cent); permanent, partial sensory ulnar-nerve palsy in five (2.5 per cent); permanent, partial motor ulnar-nerve palsy in one (0.5 per cent); and dislocation in seven (3.5 per cent).

Adult↗
PubMed1993

Long-term complications after total knee arthroplasty with or without resurfacing of the patella.

The long-term complications related to the patella were retrospectively evaluated for 891 knees (684 patients) that had had a total arthroplasty, with or without resurfacing of the patella, with use of an unconstrained, condylar, posterior-cruciate-preserving prosthesis. The study population comprised two groups of patients who were similar in size, age, sex distribution, and diagnosis. One group (396 knees [303 patients]) had had a total knee arthroplasty with patellar resurfacing and the other group (495 knees [381 patients]) had had the same procedure without resurfacing. The average duration of follow-up was six and one-half years (range, two to fifteen years). The decision to resurface the patella was based on subjective inspection of the articular surface and on assessment of patellar tracking at the time of the operation. Resurfacing was performed if there was loss of cartilage, exposed bone, gross surface irregularities, or tracking abnormalities. Complications occurred an average of three years (range, immediately postoperatively to nine years) after the operation in the group that had had resurfacing and an average of four years (range, immediately post-operatively to ten years) postoperatively in the group that had not had resurfacing. In the group that had had resurfacing, there was loosening of the patellar component in five knees, patellar subluxation in four knees, fracture of the patella in three knees, rupture of the patellar tendon in three knees, and chronic peripatellar pain in one knee. In the group that had not had resurfacing, the complications included patellar subluxation in five knees, rupture of the patellar tendon in two knees, and chronic peripatellar pain in fifty-one knees.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Total hip arthroplasty in beta-thalassemia. Case report and review of the literature.

A 60-year-old man with beta-thalassemia intermedia and degenerative joint disease was successfully treated by total hip arthroplasty. The operation was complicated by severe bleeding associated with marked bone marrow hyperplasia. Despite autologous cell salvage, massive homologous transfusion was required. Special orthopaedic and perioperative complications stem from beta-thalassemia syndromes. Management may be complicated by anemia, medullary hyperplasia, organ dysfunction associated with iron overload, and susceptibility to infection. The orthopaedic manifestations of beta-thalassemia may be mitigated by chronic transfusions.

Blood Transfusion↗
PubMed1992

Synovium-like tissue from loose joint replacement prosthesis: comparison of human material with a canine model.

The formation of synovium-like tissue is a biological response to a loose joint replacement prosthesis. Histological examination of this tissue has shown a synovial lining with a predominance of fibroblasts and macrophages, some multinucleated giant cells, and dispersed particles from the implant. Previous studies have reported elevated interleukin 1 (IL-1), prostaglandin E2 (PGE2), and collagenase in this tissue. We developed a canine model for the loose cemented femoral stem. Tissue harvested from the canine model was compared with human tissue retrieved at revision arthroplasty. Histology showed synovium, similar to that observed around loose human prostheses, adjacent to the canine cement sheath. Cells were isolated from this tissue and incubated in culture medium with or without naproxen for 3 days. Aliquots of the conditioned media were tested in the thymocyte proliferation assay to determine IL-1-like activity. IL-1 beta levels in human cell-conditioned media were analyzed by enzyme-linked immunosorbent assay, and PGE2 levels were measured by radioimmunoassay (RIA) using a PGE2 RIA kit (New England Nuclear). Human tissue contained levels of IL-1 beta in the range of 150 to 7,040 pg/mL and PGE2 levels of 82 to 952 ng/mL. The canine specimens contained IL-1-like activity and significant amounts of PGE2 (76 to 1,720 ng/mL). Naproxen decreased PGE2 levels in vitro. This animal model provides the means to investigate the in vivo and in vitro activity of the synovial cells around loose total joint prostheses.

Adult↗
PubMed1992

Evaluation of the hip with pigmented villonodular synovitis. A case report.

Pigmented villonodular synovitis (PVNS) is an uncommon disorder of the synovium that rarely involves the hip joint. The natural history of an untreated case of PVNS is presented herein. A young adult with a painful hip and destructive changes on plain roentgenograms requires further diagnostic evaluation. The relative value of current imaging techniques is discussed in this report. Plain roentgenograms alone often suggest the correct diagnosis of PVNS of the hip, but traditional criteria have proven to be inaccurate. Computed tomography (CT) is helpful in demonstrating the location and degree of bone loss throughout the pelvis and assists in determining the need for bone graft or prosthetic modification in preoperative planning. Experience with magnetic resonance imaging (MRI) in this disorder is limited, but no clear advantage over CT has been demonstrated thus far. Three-dimensional reconstruction has provided no useful information not already found on plain CT or MRI. For diagnostic accuracy and effective preoperative planning, evaluation should include a complete blood count, sedimentation rate, CT scan, and MRI.

Adult↗
PubMed1991

Chondrocyte mediated cartilage degradation: regulation by prostaglandin E2, cyclic AMP and interferon alpha.

Local responses to cytokines and their induced products play a critical role in outcome in the arthritic joint. Using a bovine nasal cartilage culture model, chondrocyte mediated breakdown was stimulated by lipopolysaccharides or tumor necrosis factor. Cartilage breakdown was inhibited in a dose dependent manner by prostaglandin E2, cyclic AMP enhancement and interferon alpha. The possible regulatory roles played by these agents in cytokine activated cartilage breakdown suggest potential therapeutic strategies in human arthritis.

Animals↗
PubMed1991

Total hip arthroplasty in ankylosing spondylitis.

Total hip arthroplasty was performed on 29 hips in 19 patients diagnosed with ankylosing spondylitis over a 13-year period. The results were analyzed retrospectively with an average follow-up period of more than four years. Complete pain relief was achieved in 97%, and significant gains were made in ambulatory capacity. The limited gains in total range of motion (average improvement 75 degrees) were felt to be primarily due to the high incidence of Brooker Class III and IV myositis ossificans (23%) and long-standing soft tissue contractures.

Adult↗