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D J Berry

Publications and source records attributed to D J Berry.

At least 37 records · Page 2Linked to original sources
PubMed2000

Comparison of topiramate concentrations in plasma and serum by fluorescence polarization immunoassay.

Topiramate has been recently licensed as an antiepileptic drug. A fluorescence polarization immunoassay (FPIA), the Innofluor, has been developed to determine topiramate in heparinized plasma. Since therapeutic drug monitoring laboratories may not have control over collection of the samples submitted to them, it is important for analytical methods to be robust and able to cope with any specimen. The effect of different anticoagulants on the topiramate FPIA assay was investigated by collecting blood from 50 patients with epilepsy being maintained on a range of topiramate doses as part of their therapy. After venesection the blood was divided among four tubes: plain, heparinized, EDTA, and fluoride/oxalate. Erythrocytes were separated by centrifugation and supernatant fluid frozen to await duplicate assay by FPIA. Results were compared by means of Altman and Bland difference plots which indicated that there was no significant difference between values obtained with heparinized plasma and the other fluids. It was concluded that the Innofluor assay is robust and gives similar results when blood samples are collected into any of the specified anticoagulants.

Adult↗
PubMed2000

Methsuximide lowers lamotrigine blood levels: A pharmacokinetic antiepileptic drug interaction.

PURPOSE: To determine whether methsuximide (MSM) affects lamotrigine (LTG) blood levels and whether any change is of clinical significance. METHODS: LTG serum levels in 16 patients taking MSM were compared with those before starting or after stopping the MSM. The 16 patients, (11 boys, five girls) were young people (mean age, 15.5 years; range, 9-19 years) with a variety of seizure types and syndromes. In six cases, LTG levels were available both before MSM was started and after it was stopped. RESULTS: The mean LTG serum concentration before starting or after stopping MSM was 13.4 mg/L, and the mean level while taking MSM was 6.3 mg/L. This difference was highly significant (p < 0.0005, paired t test). MSM lowered the LTG serum concentration in every case, with a mean decrease of 53% (range, 36-72%). In some patients this led to a deterioration in seizure control when MSM was added or an improvement in seizure control after MSM was stopped. CONCLUSIONS: Although MSM is a valuable add-on, broad-spectrum drug when used in combination with LTG, adjustment of the LTG dose may be necessary when MSM is started or stopped, to allow for the fact that MSM lowers LTG blood levels.

Adolescent↗
PubMed1999

Epidemiology: hip and knee.

This article reviews the epidemiologic features of periprosthetic fractures around total hip arthroplasty and total knee arthroplasty according to the site of fracture occurrence. The frequency and cause of intraoperative and postoperative periprosthetic fractures vary by anatomic site. For each anatomic site, unique risk factors, some demographic and some technical, appear to be related to risk of fracture. For several anatomic sites, excellent articles that collate large numbers of series are available to the reader to provide aggregate information concerning the epidemiology of these fractures.

Acetabulum↗
PubMed1999

Acetabular fracture associated with cementless acetabular component insertion: a report of 13 cases.

Acetabular fracture during insertion of a cementless acetabular component occurred in 13 patients. The preoperative diagnosis was osteoarthritis in 6 patients, rheumatoid arthritis in 2 patients, avascular necrosis in 3 patients, hip fracture nonunion in 1 patient, and developmental dysplasia of the hip in 1 patient. Several different components were used; however, the acetabulum was underreamed by 1 to 3 mm in all cases. The acetabular fracture was identified in 9 of 13 cases intraoperatively. The fracture was identified on postoperative radiographs for the other 4 cases. Fractures were treated by a variety of means, including the addition of augmentation screws in or around the cup, use of autograft bone at the fracture site, modified postoperative weight-bearing status, and immobilization. In 2 cases, the socket needed to be revised after it progressively migrated and failed. One patient had cup migration, and another had a radiolucent line about the cup but was not symptomatic enough to require revision. In 3 of these 4 cases, the fracture was not identified intraoperatively. Underreaming of the acetabulum and use of an oversized acetabular component has been recommended to improve the initial stability of the acetabular component during total hip arthroplasty. Impaction of an oversized component requires bone to undergo plastic deformation if the cup is to be fully seated. Theoretically, this technique provides improved component stability with enhanced osseous ingrowth into the cup. The 13 cases reported in this study demonstrate that acetabular fracture is a complication that may occur in association with uncemented hip arthroplasty, particularly if oversized components are used. The importance of recognizing acetabular fractures intraoperatively and the need to institute appropriate treatment to ensure a stable acetabular component is emphasized. In patients with osteoporotic bone, line-to-line reaming with use of a cementless acetabular component or insertion of a cemented socket may be considered to avoid this significant complication.

Acetabulum↗
PubMed1999

Functional outcome of excision of heterotopic ossification after total hip arthroplasty.

Fifty-three cases of symptomatic heterotopic ossification were evaluated after total hip arthroplasty for the specific purpose of determining the value of surgical excision without revision or other concurrent procedures. The mean followup was 3.5 years for range of motion and 7.8 years for radiographic evaluation. A statistically significant increase in range of motion was obtained for the group at final followup. The mean increase in flexion arc was 34 degrees, abduction and adduction arc was 22 degrees, and rotation arc was 21 degrees. Of the patients who underwent surgical excision of heterotopic bone solely because of pain, none had complete alleviation of symptoms. It is concluded that surgical excision of heterotopic bone results in significant improvement in functional outcome, but it cannot be expected to predictably alleviate pain. Finally, the ultimate arc of motion was better than that suggested radiographically by the Brooker classification system.

Adult↗
PubMed1999

Total hip arthroplasty in patients with proximal femoral deformity.

Most proximal femoral deformities encountered during hip arthroplasty are secondary to developmental processes, previous osteotomy, or fracture. A classification method is proposed in which deformities are categorized anatomically by level. Anatomic deformity levels include: greater trochanteric deformities, femoral neck deformities, metaphyseal level deformities, and diaphyseal level deformities. Deformities at each level may be angular, rotational or translational, abnormal bone size, or a combination thereof. Treatment is individualized according to patient needs and the anatomy of the deformity. Careful preoperative planning helps predict prosthesis requirements and technical challenges. If cemented implants are used, care must be taken to obtain reasonable alignment and a continuous cement mantle. For uncemented implants, obtaining a good fit is challenging and there is a risk of intraoperative fracture. Access to a wide range of implants helps the surgeon treat unique femoral geometries. Implants fixed in the diaphysis allow some proximal femoral deformities to be bypassed. Modular or custom implants simplify treatment of certain deformities. For patients with severe deformities, femoral osteotomy may be required. Successful osteotomy requires correcting the deformity, maintaining vascular supply of fragments, obtaining fixation of osteotomy fragments (with the implant or adjunctive fixation), and obtaining implant stability. Although most deformities can be treated during hip arthroplasty, occasionally there is a role for two-stage treatment: deformity correction followed later by arthroplasty.

Arthroplasty, Replacement, Hip↗
PubMed1999

Nonunion after periprosthetic femoral fracture associated with total hip arthroplasty.

BACKGROUND: Nonunion after a periprosthetic femoral fracture associated with total hip arthroplasty occurs rarely. There is little information, to our knowledge, regarding the prevalence of this complication, its treatment, and the functional outcomes of treatment. The purpose of this study was to identify the patterns and frequency of nonunions of femoral fractures around total hip prostheses and to evaluate the results and problems associated with treatment of this complication in a consecutive series of patients. METHODS: The study included twenty-three nonunions of periprosthetic femoral fractures in twenty-three patients with an average age of fifty-five years (range, twenty-two to eighty-five years) at the time of the initiation of treatment of the nonunion. Thirteen of the fractures occurred during or after a primary total hip arthroplasty, and ten occurred during or after a revision total hip arthroplasty. According to the classification system of Duncan and Masri, there were six B1 fractures (associated with a well fixed prosthesis), seven B2 fractures (associated with a loose stem), and ten B3 fractures (associated with very poor proximal bone). Ten patients were managed with revision to a long-stem prosthesis. Six patients had revision to a proximal femoral replacement prosthesis. A two-stage technique consisting of removal of the prosthesis and open reduction and internal fixation of the nonunion followed by reimplantation of the prosthesis was used in two patients. Two patients were managed initially with bone-grafting alone, and two patients were managed nonoperatively. One patient who had an infection at the site of the nonunion was managed definitively with resection arthroplasty. RESULTS: The duration of clinical follow-up averaged 8.3 years (range, three months to twenty-three years), and that of radiographic surveillance averaged 7.0 years (range, eight months to seventeen years). Of the thirteen patients in whom an attempt to achieve union was made and for whom radiographs were available, nine eventually had bone-healing. Five of the twenty-three femora became infected and were treated with resection arthroplasty. Of the seventeen patients who had not had a resection arthroplasty for infection and for whom radiographs were available at the time of the most recent follow-up, eleven had a stable and well fixed implant and six had a loose implant as seen radiographically or had had a revision because of aseptic loosening. Seventeen patients had no or mild pain at the time of the most recent follow-up, but ten required two-handed support to walk. The overall complication rate was 52 percent (twelve of twenty-three patients). CONCLUSIONS: Nonunion of a femoral fracture associated with a total hip prosthesis is an infrequent problem. Treatment is difficult, with a high rate of complications and relatively poor functional outcomes. The data from this series must be interpreted with caution, as patients were managed over a period of three decades and many did not have the advantage of modern techniques of revision hip arthroplasty. Prevention of nonunion by optimum treatment of the initial fracture is most important. Treatment of a femoral nonunion about a total hip implant should be implemented on the basis of the status of the fixation of the prosthesis and the quality of the surrounding bone.

Adult↗
PubMed1999

Pelvic discontinuity in revision total hip arthroplasty.

BACKGROUND: Pelvic discontinuity is a distinct form of bone loss, occurring in association with total hip arthroplasty, in which the superior aspect of the pelvis is separated from the inferior aspect because of bone loss or a fracture through the acetabulum. The purpose of this study was to describe the population of patients who are at risk for this condition, to identify the characteristic radiographic features associated with it, and to report the results of revision total hip arthroplasty for the treatment of pelvic discontinuity. METHODS: The cases of all twenty-seven patients (thirty-one hips) who were identified as having a pelvic discontinuity at the time of a reoperation for a failed hip arthroplasty at one institution were reviewed retrospectively, and demographic information was collected. The preoperative radiographs and the operative notes were reviewed, and the postoperative results and complications were recorded. RESULTS: Pelvic discontinuity was identified in association with thirty-one (0.9 percent) of 3505 acetabular revisions. The mean age of the patients was sixty-one years (range, thirty-eight to eighty years). Twenty-eight hips were in women, and three were in men. Women (p < 0.001) and patients who had rheumatoid arthritis (p = 0.003) had a significantly increased risk of pelvic discontinuity. The radiographic findings included a visible fracture line through the anterior and posterior columns, medial translation of the inferior aspect of the hemipelvis relative to the superior aspect (seen as a break in Kohler's line), and rotation of the inferior aspect of the hemipelvis relative to the superior aspect (seen as asymmetry of the obturator rings) on a true anteroposterior radiograph. Two patients died within two years after the revision, and two had a resection arthroplasty for the treatment of the pelvic discontinuity; thus, twenty-seven hips were reconstructed and were eligible for follow-up at least two years after the operation. A number of different methods were used for reconstruction, but the results were best in patients who did not have severe segmental acetabular bone loss (type IVa [a satisfactory result in three of three hips]) and poorer in those who had severe segmental or combined segmental and cavitary bone loss (type IVb [a satisfactory result in ten of nineteen hips]) and in those who previously had been treated with irradiation to the pelvis (type IVc [a satisfactory result in three of five hips]). Nine of the twenty-seven hips needed another operation: four, because of aseptic loosening of the acetabular component; four, because of recurrent dislocation; and one, because of deep infection. Excluding three hips that were revised early because of infection or dislocation, a mechanically stable construct (that is, a stable socket and a possibly or definitely healed discontinuity) was obtained in seventeen of twenty-four hips. CONCLUSIONS: Pelvic discontinuity is uncommon, and treatment is associated with a high rate of complications. For hips with type-IVa bone loss and selected hips with type-IVb defects, in which a socket inserted without cement can be satisfactorily supported by native bone, we prefer to use a posterior column plate to stabilize the pelvis and a porous-coated socket inserted without cement. For most hips with type-IVb and type-IVc bone loss, we prefer to use particulate bone graft or a single structural bone graft protected with an antiprotrusion cage.

Acetabulum↗
PubMed1999

Management of osteolysis around total hip arthroplasty.

The indications for treatment of osteolysis are based on osteolysis severity and progression. At present, there is a trend toward selective retention of well-fixed, undamaged components of satisfactory design, but long-term results of limited procedures with component retention for osteolysis are lacking. An algorithm for treatment of osteolysis around THA can be constructed. Such algorithms can help guide treatment, although it is important to note that judgment is still needed about the optimal treatment for each individual case. Regular follow-up of joint arthroplasty patients-especially those who are young and active and those with problematic implant designs--is important to identify osteolysis early and facilitate more limited intervention. There is increased understanding that osteolysis is a progressive process in the great majority of cases, and thus, most surgeons tend to consider intervention earlier than once was the case. Plain radiographs frequently underestimate the severity of osteolysis, particularly in the pelvis and greater trochanter, and metallic implants can obscure bone loss on routine radiographs. Therefore, when operative treatment is undertaken, the surgeon must be prepared for more severe bone loss than is visible on plain radiographs.

Aged↗
PubMed1999

Patients' concerns prior to undergoing total hip and total knee arthroplasty.

OBJECTIVE: To document and examine the concerns patients have prior to undergoing primary total hip or total knee arthroplasty in a tertiary care center or an orthopedic private practice group. PATIENTS AND METHODS: In this prospective survey, 136 patients from a tertiary care center and 130 from an orthopedic private practice group completed a questionnaire covering 54 items regarding their concerns prior to undergoing primary total hip or total knee arthroplasty. Patients responded on a visual analog scale, and concern was ranked by mean responses (1, not concerned at all; 2, somewhat concerned; 3, very concerned; or 4, extremely concerned). RESULTS: Responses to only 6 items averaged scores higher than 1.9: pain immediately after the surgery (2.07), length of recovery (2.07), ability to walk as much as you wish (2.03), ability to return to recreational activities (1.97), ability to go up and down stairs (1.94), and risk of getting acquired immunodeficiency syndrome from a transfusion (1.92). Older patients (> or = 65 years) were less concerned than younger patients (< 65 years) in 34 of the 54 questions asked. Women were more concerned than men in 19 of the 54 questions asked. CONCLUSION: These data provide information that will be helpful in preoperative patient discussions and in development of educational materials for patients undergoing total hip or total knee arthroplasty.

Adult↗
PubMed1999

Clinical consultations using store-and-forward telemedicine technology.

OBJECTIVE: To investigate the potential role of a store-and-forward (SAF) telemedicine system in specialty consultations initiated by primary care physicians. MATERIALS AND METHODS: In this pilot telemedicine study, patients needing consultations in cardiology, dermatology, endocrinology, and orthopedics had both standard face-to-face (FTF) consultations and SAF consultations. RESULTS: Fifteen patients had both FTF and SAF consultations, 4 had echocardiograms transmitted for an SAF consultation only, and 1 had an SAF consultation but no FTF appointment. Of 19 diagnoses made, all were essentially the same in both types of consultations; 14 of 15 FTF consultations and 15 of 19 SAF consultations resulted in additional treatment recommendations. CONCLUSIONS: While it was possible to develop a desktop system for SAF consultations, the equipment was not adequately integrated. Without total digital input, including electronic patient medical records, packaging of information is laborious and impractical. Seamlessly adapting to existing clinical practice is vital. Issues such as increasing work for the physicians or office staff, gathering adequate patient information, and designing a referral process were more difficult than we had anticipated. Patient acceptance was high, but the clinical pilot had very small numbers.

Female↗
PubMed1999

Early experience and results with the periacetabular osteotomy. The Mayo Clinic experience.

The purpose of the present study was to review the early results of periacetabular osteotomy in the initial group of patients undergoing this procedure at the authors' institution. The first 21 hips in 19 patients with greater than 2 years followup, which represents the learning curve with this operation, were reviewed retrospectively. There were 14 females and five males with an average age of 21 years (range, 17-43 years). Intertrochanteric osteotomy was performed simultaneously on four patients with coxa valga and inadequate correction with periacetabular osteotomy alone. At an average of 38 months of followup (range, 24-52 months), the Mayo hip scores improved from an average of 46 points (range, 34-58 points) to an average of 68 points (range, 42-80 points). Hip range of motion declined slightly in all three arcs of motion. The lateral center edge angle of Wiberg improved from an average of 2 degrees to an average of 24 degrees. The loading zone angle (Tönnis) improved from an average of 24 degrees to an average of 11 degrees. The anterior center edge angle of Lequesne improved from an average of -6 degrees to an average of 38 degrees. Complications included two peroneal palsies, both of which resolved completely; three ischial fractures that healed uneventfully; three asymptomatic pubic nonunions; and asymptomatic heterotopic ossification in five patients. One patient underwent subsequent total hip arthroplasty for progressive arthritis and pain. Another patient required intertrochanteric osteotomy at a later date. The early results in this initial group of patients treated with periacetabular osteotomy show reliable radiographic correction of deformity and improved function with an acceptable complication rate. Patients should be counseled carefully about possible loss of motion postoperatively. Additional study is necessary to assess the long term results of this procedure.

Acetabulum↗
PubMed1999

Cemented all polyethylene tibial components in patients age 75 years and older.

Between 1976 and 1980, 81 knees in 59 patients 75 years of age or older, underwent primary total knee arthroplasty with a cemented, condylar femoral component and a cemented, moderately conforming, all polyethylene tibial component. All patients were followed up until death, revision surgery, or for a minimum of 10 years. Mean clinical followup was 8.1 years for the entire group and 14.6 years for those patients still alive. At final followup one patient (one knee) required revision surgery (for medial instability), and one patient (one knee) had marked pain but no radiographic evidence of loosening. No patients required revision surgery for aseptic loosening and no patients had symptomatic aseptic loosening at last followup. The mean Knee Society knee and function scores were 78 and 64 points, respectively at last followup. The mean postoperative range of motion was 101 degrees. The Kaplan-Meier survival of the index total knee arthroplasty at 14 years was 100% with symptomatic aseptic loosening as the end point; and 98% with revision for any cause as the end point. Cemented all polyethylene tibial components with a moderately conforming tibiofemoral articulation implanted in patients older than 75 years of age showed a high rate of survivorship without the need for revision surgery and without symptomatic loosening.

Age Factors↗
PubMed1998

The role of CD8+ CD40L+ T cells in the formation of germinal centers in rheumatoid synovitis.

In rheumatoid synovitis, lymphocytes can be arranged in follicular structures resembling secondary lymphoid follicles. To understand the organizing principles of this ectopic lymphoid tissue, the cellular components contributing to synovial follicles were examined. In 9 of 24 synovial tissue biopsies, lymphoid aggregates were found consisting of CD4+ T cells and CD20+ B cells. In four of the nine patients, the follicular centers were occupied by CD23+ CD21+ cellular networks representing follicular dendritic cells involved in germinal center reactions. In five patients, CD23+ cells were absent from the centers of the aggregates, suggesting that fully developed germinal centers are generated in only a subset of patients. To identify factors involved in the regulation of the synovial microarchitecture, cell populations contributing to the follicles were quantified by digital image analysis of immunostained tissue and by flow cytometry of tissue-derived lymphocytes. Proportions of CD4+, CD20+, and CD68+ cell subsets were surprisingly invariant, irrespective of the presence or absence of CD23+ follicular dendritic cells. Instead, tissue biopsies with CD23+ germinal center-like regions could be distinguished from those with CD23- T cell-B cell aggregates by a fourfold increase in the frequency of tissue-infiltrating CD8+ T cells, a fraction of which expressed CD40 ligand (CD40L). The data suggest a previously unsuspected role of CD8+ lymphocytes in modulating germinal center formation and raise the possibility that CD8+ CD40L+ T cells are involved in aggravating pathologic immune responses in rheumatoid synovitis.

Adolescent↗
PubMed1998

Histologic and biochemical differences between osteolytic and nonosteolytic membranes around femoral components of an uncemented total hip arthroplasty.

The unique design characteristics of an uncemented femoral component were used to study differences in the periprosthetic membranes in the presence and absence of osteolysis. A component (Omniflex, Osteonics, Allendale, NJ) that has a large midportion of the stem that does not contact bone was studied. A membrane forms, even in the absence of bone resorption, in Gruen zones 3 and 5 of this component. Analysis of this membrane showed noninflammatory fibrous tissue, no or minimal particulate debris, and few macrophages. In contrast, analysis of membranes from osteolytic regions around the same prosthesis demonstrated typical inflammatory characteristics. Collagenase, gelatinase, and stromelysin expression was high in osteolytic membranes but was low in tissues from noninflammatory regions without osteolysis. The data suggest a sequence of events in periprosthetic membrane formation. A noninflammatory membrane initially forms between the bone and the prosthesis. This membrane is transformed into an inflammatory membrane by the influx of particulate debris. Matrix metalloproteinases are selectively expressed in regions of osteolysis, implicating these enzymes in periprosthetic bone loss and suggesting a possible level for pharmaceutical intervention to prevent or treat osteolysis. Formation of the noninflammatory membrane around the distal part of the prosthesis of this or similar designs in the absence of bone resorption implies that these tissue samples could serve as useful negative control tissues to identify factors present in osteolytic periprosthetic membranes.

Adult↗