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Biomedical subjects

D J Berry

Publications and source records attributed to D J Berry.

At least 55 records · Page 3Linked to original sources
PubMed1998

Cement versus cementless fixation in total knee arthroplasty.

A prospectively studied group of 55 uncemented Press Fit Condylar total knee arthroplasties was compared retrospectively with a matched group of 51 cemented Press Fit Condylar total knee arthroplasties at a mean of 10 years after operation. For the cemented group, the pain and function scores improved from 32 and 45 preoperatively to 95 and 77, respectively. For the uncemented group the scores improved from 33 and 50 preoperatively to 93 and 60, respectively. There were 10 revisions in the uncemented group for femoral or tibial aseptic loosening or osteolysis compared with two revisions in the cemented group. Exclusive of problems related to patellar metal backing, survival to revision for aseptic failure or radiographic loosening was 72% in the uncemented group and 94% in the cemented group at 10 years. A significantly higher revision rate was found in the uncemented compared with cemented total knee arthroplasty of the Press Fit Condylar design.

Arthralgia↗
PubMed1998

Salvage of failed femoral megaprostheses with allograft prosthesis composites.

The records of 11 consecutive adult patients who underwent revision of a failed femoral megaprosthesis (aseptic loosening, nine; periprosthetic fracture, one; and prosthesis fracture, one) to an allograft prosthesis composite were reviewed retrospectively. Complications included radiographic component subsidence in two patients (18%), hip instability in three patients (27%), deep infection in two patients (18%), and allograft fractures in two patients (18%). Five patients (45%) required subsequent reoperations; four patients underwent removal of the allograft prosthesis composite at a mean of 16 months (range, 5-41 months) and one patient (9%) with hip instability underwent revision of the failed megaprosthesis to a constrained acetabulum. Reconstruction of a failed femoral megaprosthesis is a complex problem caused by extensive bone loss and violation of soft tissue attachments. Despite a high complication rate, six patients (55%) remained ambulatory and had mild or no pain at a mean followup exceeding 5.5 years.

Adult↗
PubMed1998

Carbamazepine toxicity with lamotrigine: pharmacokinetic or pharmacodynamic interaction?

PURPOSE: To determine whether the toxicity that occurs in some patients when lamotrigine (LTG) is added to carbamazepine (CBZ) is the result of either a pharmacokinetic or a pharmacodynamic interaction. METHODS: Escalating LTG doses were added to ongoing CBZ treatment in 47 patients. All patients had blood samples collected for drug concentration measurement, including the epoxide metabolite of CBZ, before starting LTG treatment and after stabilising at each dose escalation. Patients also were examined for signs of toxicity. RESULTS: After LTG was introduced, nine patients demonstrated clinical signs of CNS toxicity, mainly diplopia and dizziness. There was no significant (p = 0.05) change in the serum concentrations of either CBZ or its epoxide metabolite when LTG was added either to the group as a whole or to the nine patients who experienced adverse CNS effects. LTG serum concentrations also were below the level at which the common signs of LTG toxicity, such as nausea, vomiting, or unsteadiness, are more likely to occur. In seven of the nine patients who exhibited CNS toxicity, CBZ serum concentrations were >8 mg/L on LTG introduction. CONCLUSIONS: Toxicity is more likely to occur when LTG is added to CBZ if the initial CBZ level is high, typically >8 mg/L. This appears to be the result of a pharmacodynamic interaction. A reduction of CBZ dose usually resolves the toxicity, allowing the LTG dose to be escalated to maximal effect. It is not usually necessary to stop either drug.

Anticonvulsants↗
PubMed1998

The natural history of debonding of the femoral component from the cement and its effect on long-term survival of Charnley total hip replacements.

Two hundred and ninety-seven consecutive Charnley total hip replacements that had been followed for at least twenty years or until revision or death were analyzed to determine the effect of early debonding of the smooth-surfaced femoral component on its subsequent survival. Radiographically evident debonding was not found to have a significant effect, with the numbers available, on the long-term survival of the femoral component when the maximum thickness of the radiolucent line between the superolateral border of the prosthesis and the cement had been less than 2.0 millimeters during the first one to five years after the operation. The radiographic finding of debonding also was not found to be associated with pain in the hip. These data show that most components with early debonding functioned well during a long period of follow-up and suggest that debonding of a smooth femoral component of a Charnley total hip replacement should not be considered to be analogous to loosening. In contrast, when the maximum thickness of the radiolucent line between the superolateral border of the prosthesis and the cement was 2.0 millimeters or more, an early appearance of debonding was associated with a significantly poorer (p < 0.0001) probability of survival of the Charnley femoral component without revision because of aseptic loosening. Thus, pronounced early subsidence of the component within the cement mantle had a strong negative impact on the long-term performance of the implant. The results of the present study should not be extrapolated to prostheses with substantially different design characteristics, as it appears that different types of femoral components behave differently when debonding occurs.

Adult↗
PubMed1998

Total hip arthroplasty after operative treatment of an acetabular fracture.

Sixty-six primary total hip arthroplasties were performed to treat post-traumatic osteoarthrosis that had developed following an acetabular fracture and subsequent open reduction and internal fixation. The mean age of the patients at the time of the total hip arthroplasty was fifty-two years (range, nineteen to eighty years). The arthroplasty was performed with cement in forty-four hips and without cement in twenty hips; in the remaining two hips, the acetabular component was inserted without cement and the femoral component was inserted with cement (a so-called hybrid procedure). Scarring from a previous procedure, retained hardware, heterotopic bone, and residual osseous deformity and deficiency made the procedure more complex than routine total hip arthroplasty in most patients. However, only one of the sixty-six procedures was associated with an operative complication. Three patients were lost to follow-up. The remaining sixty-three patients were followed for a mean of 9.6 years (range, two to twenty years). The mean duration of follow-up was 14.9 years for the acetabular components inserted with cement, 11.6 years for the femoral components inserted with cement, 4.6 years for the femoral components inserted without cement, and 3.9 years for the acetabular components inserted without cement. The mean Harris hip score improved from 49 points preoperatively to 93 points at the latest follow-up evaluation for the forty-six patients who did not have a revision procedure after the index arthroplasty. Seventeen patients had a revision; sixteen revisions were performed because of aseptic loosening of one or both components (nine acetabular and eleven femoral components). Mechanical failure (radiographic loosening or revision due to aseptic loosening) occurred in twenty-five hips. As determined with use of the Kaplan-Meier method, the ten-year survival rate, with revision due to aseptic loosening as the end point, was 78 per cent (95 per cent confidence interval, 66 to 92 per cent) for the prosthesis as a whole (that is, no revision of either component), 87 per cent (95 per cent confidence interval, 76 to 99 per cent) for the acetabular component, and 84 per cent (95 per cent confidence interval, 72 to 97 per cent) for the femoral component. An age of less than fifty years (p = 0.02), a weight of eighty kilograms or more (p = 0.047), and large residual combined segmental and cavitary deficiencies in the acetabular bone (p < 0.0001) were significant risk factors for revision because of aseptic loosening. At the ten-year follow-up, none of the twenty-two acetabular components that had been inserted without cement had been revised or demonstrated radiographic loosening. The ten-year rate of failure due to aseptic loosening was higher than that in many reported series of total hip arthroplasties performed for other indications; this was probably partly because of the young mean age of the patients, the high number of patients who had Charnley class-A involvement, and the predominantly male cohort.

Acetabulum↗
PubMed1998

Total hip arthroplasty for the treatment of an acute fracture of the femoral neck: long-term results.

We reviewed the long-term results of 126 consecutive total hip arthroplasties performed with cement in eighteen men and 108 women who had an acute fracture of the femoral neck. The patients had a mean age of seventy-five years (range, thirty-nine to eighty-nine years) at the time of the operation and were followed for a minimum of 10.1 years (or until the patient died or had a revision operation) and a maximum of 20.4 years. The median duration of follow-up was 8.8 years for all patients and 15.7 years for the twenty-two patients who were alive at the end of the study period. Six hips (5 per cent) were revised because of aseptic loosening. Survivorship analysis revealed that the probability of survival of the prosthesis without revision (with 95 per cent confidence intervals) was 95 per cent (91 to 99 per cent) at five years, 94 per cent (88 to 98 per cent) at ten years, 89 per cent (79 to 97 per cent) at fifteen years, and 84 per cent (66 to 97 per cent) at twenty years. Of the 118 patients who were alive at the one-year postoperative examination, 117 (99 per cent) had no pain or mild pain and eighty-one (69 per cent) had regained or had an improvement in the preoperative level of function. At the latest follow-up examination, eighty-seven (86 per cent) of the 102 patients who were available still had no pain or only mild pain. Twenty-six patients (21 per cent) had had perioperative medical complications, and twenty-one patients (17 per cent) had had operative complications, including thirteen patients (10 per cent) who had had a dislocation of the hip. Total hip arthroplasty performed in elderly patients for the treatment of an acute fracture of the femoral neck was associated with a higher rate of complications than usually is reported for hemiarthroplasty in such patients. However, the total hip arthroplasty provided good clinical results and was associated with long-term survival of the prosthesis.

Adult↗
PubMed1997

Recruitment of individually (all-or-none) responding cells, rather than amplitude enhancement, is the single-cell mechanism subserving the dose-responsive activation of intracellular calcium second messenger signaling by the human luteinizing-hormone receptor.

We have investigated at the single-cell level how the human LH receptor mediates a dose-responsive increase in intracellular free calcium-ion concentrations ([Ca2+]i). In human embryonic kidney cells (293 cells) stably transfected with the full-length human LH receptor cDNA. Intact dimeric LH, but not LH beta- or alpha-subunits, evoked specific [Ca2+]i signals. High-resolution fluorescence (fura-2) video-microscopy demonstrated cell-to-cell variability in [Ca2+]i signaling responses in individual cells, viz., an all-or-none spike (9%), spike-and-plateau (25%), or plateau (52%) types of temporal signal. Oscillatory [Ca2+]i responses were observed in 12-14% of LH-stimulated cells unrelated to LH concentration. The LH dose-response originated by higher concentrations of LH recruiting more individually responding cells (rather than altering [Ca2+]i signal amplitude), and eliciting a [Ca2+]i rise more rapidly, i.e., at reduced latency. Cobalt did not abolish the LH-stimulated [Ca2+]i spike-and-plateau response, but decreased the percentage of cells with a plateau pattern. Quench experiments demonstrated influx of Mn2+ following the [Ca2+]i spike, thus directly documenting divalent cation inflow during the plateau phase. Adenylyl-cyclase activation with forskolin or treatment with a cAMP analog failed to elicit the biphasic [Ca2+]i response, and pertussis toxin (PTX) did not alter LH-stimulated [Ca2+]i signaling. However, overnight preincubation with LH reduced the percentage of [Ca2+]i-responding cells following re-exposure to LH to 5.7% (vs 72% in control), suggesting LH-induced desensitization of the LH-receptor directed [Ca2+]i signal. In summary, the present studies of human LH receptor signal transduction at the single-cell level show that increasing concentrations of LH achieve a dose-dependent intracellular Ca2+ signaling response by recruiting an increasing number of [Ca2+]i-responding cells, while concomitantly decreasing the temporal latency of the biphasic [Ca2+]i signal without altering the amplitude of its spike phase. Prolonged exposure to LH appears to desensitize the LH receptor-driven [Ca2+]i signal.

Adenylate Cyclase Toxin↗
PubMed1997

Abductor avulsion after primary total hip arthroplasty. Results of repair.

The results of reoperation and repair of abductor musculature avulsion that occurred as a complication of a primary total hip arthroplasty performed through an anterolateral approach were reviewed in nine patients 2 to 13.5 years (mean, 4.8) after repair. Limp was markedly decreased in five of nine patients, and need for ambulatory aids also was reduced in five of the nine. Improvement continued for 1 to 3 years after the repair. Objectively, three of the four patients (75%) without significant preoperative pain had a good or excellent result, whereas only one of five patients (20%) with significant preoperative pain had a good or excellent result. In all three cases where hip instability was a presenting symptom, it was successfully treated. Four patients felt they were much better, three felt somewhat better, and two felt they gained no improvement by repair. This information suggests that the best indications for repair are symptoms of marked abductor weakness or hip instability; significant preoperative pain is less likely to be decreased.

Aged↗
PubMed1997

Maintaining a hip registry for 25 years. Mayo Clinic experience.

A computerized database was established for all total joint replacements done at the authors' institution. To date the registry contains information on more than 56,000 arthroplasties of which more than 30,000 involve the hip. The registry was designed to determine the effectiveness of total hip arthroplasty as a function of implant design, surgical technique, and patient selection. Furthermore, by maintaining and updating the patient record, data regarding success or anticipated failure could be communicated to the patient. Finally, this resource would provide reliable information that could be communicated to the orthopedic community. Patients are routinely evaluated at 1, 2, and 5 years postoperatively and at 5-year intervals thereafter by examination or letter or telephone questionnaire. Followup of patients at each interval is approximately 95%. Patients are more likely to respond by questionnaire (rather than be seen in person) if they are older, if a longer time has elapsed since surgery, or if they live a long distance from the clinic. Data are collected by five full time employees including computer and statistical support specifically assigned to the project. The annual joint registry budget is in excess of $400,000. Unfortunately, the future of this endeavor is challenged by the needs to: (1) show cost effectiveness of the activity; (2) update and validate outcomes instruments used as input into the database; and (3) maintain satisfactory followup rates in a medical economic environment that often discourages patient return visits or local assessment.

Adult↗
PubMed1997

Acute pseudo-obstruction of the colon as a postoperative complication of hip arthroplasty.

Acute pseudo-obstruction of the colon (Ogilvie syndrome) results in massive colonic dilatation that may lead to a life-threatening perforation. This complication is known to occur after arthroplasty of the hip, yet the prevalence of the complication and its effects on the outcome of the procedure are unknown. We reviewed the records of thirty patients (mean age, 74.3 years; range, fifty-six to ninety years) in whom acute colonic pseudo-obstruction developed after hip arthroplasty between 1984 and 1993. During this ten-year period, 10,468 hip arthroplasties were performed at our institution; therefore, the prevalence of acute colonic pseudo-obstruction was 0.29 per cent. The most common presenting symptom was abdominal distention, which occurred a mean of 3.5 days (range, one to eleven days) postoperatively and was noted in twenty-seven of thirty patients. Nausea (fourteen patients), vomiting (eight patients), and abdominal pain (two patients) were observed less frequently. Twenty-one associated medical complications, including pulmonary embolism (four patients), upper gastrointestinal bleeding (three patients), and deep infection (not evident intraoperatively) at the site of the arthroplasty (two patients), developed in fifteen patients. Eighteen of the twenty-one complications occurred after the onset of colonic pseudo-obstruction. The associated medical problems resulted in four deaths (13 per cent). Recognition by the orthopaedic surgeon of the presenting features of acute colonic pseudo-obstruction is important in order to facilitate prompt initiation of treatment, which may hasten recovery and reduce the morbidity and the mortality associated with this complication.

Abdomen↗
PubMed1995

Anterior iliopsoas impingement after total hip arthroplasty.

Pain after total hip arthroplasty (THA) can be caused by a multitude of conditions, including infection, aseptic loosening, heterotopic ossification, and referred pain. It is also recognized that soft tissue inflammation about the hip, such as trochanteric bursitis, can lead to hip pain after THA. Two cases of persistent iliopsoas tendinitis following THA are reported, which are believed to be caused by psoas tendon impingement against a malpositioned, uncemented, metal-backed acetabular component. The authors are unaware of previous reports of this problem, and suggest that the problem be considered in the differential diagnosis of groin pain following THA.

Aged↗
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

Analysis of desmethylmethsuximide using high-performance liquid chromatography.

Analysis of desmethylmethsuximide by high-performance liquid chromatography (HPLC) is described. After adding an internal standard (IS), 200 microliters of plasma was buffered to pH 4.5 and extracted with dichloroethane. The organic solvent was then evaporated to dryness and the residue reconstituted in 100 microliters of mobile phase prior to injecting a 20 microliters aliquot onto a Hypersil 5 MOS column, which was eluted with acetonitrile/acetate buffer (pH 5.5) 36:64 vol/vol. Constituents were separated in approximately 8 min. Using this method, down to 1.0 mg/L of desmethylmethsuximide in plasma can be accurately determined. The method is suitable for therapeutic monitoring of desmethylmethsuximide in patient samples.

Anticonvulsants↗
PubMed1995

Acetabular anti-protrusio rings and cages in revision total hip arthroplasty.

Uncemented hemispherical porous-coated acetabular components work well for the great majority of acetabular component revisions. Unfortunately, when bone loss is so severe that little contact between a porous-coated socket and native bone can be achieved, high rates of failure of uncemented porous-coated sockets have been reported. When circumstances are encountered in which porous-coated hemispherical sockets are unlikely to succeed, acetabular reinforcement devices have advantages over cemented polyethylene sockets alone. The ability of antiprotrusio rings and cages, now used to augment socket fixation to the pelvis, facilitate extensive pelvic bone grafting, and prevent early socket migration, have led to renewed interest in these devices as useful tools in the orthopedic surgeon's armamentarium to manage some of the most challenging acetabular reconstruction problems. This article discusses the rationale for selected use of acetabular reinforcement devices, the reported results of using acetabular reinforcement rings and cages in revision total hip arthroplasty, and the circumstances in which these devices may be considered for acetabular reconstruction at the present time.

Acetabulum↗
PubMed1995

Survivorship of uncemented proximally porous-coated femoral components.

Three hundred seventy-five consecutive total hip arthroplasty revisions done using proximally porous-coated femoral components of 6 designs were reviewed a mean of 4.7 years after surgery. Fifty-nine hips have been rerevised for aseptic femoral loosening, and 4 for osteolysis. Moderate or severe pain was present in 23% of surviving hips, and radiographic evidence of femoral loosening was present in 38% of surviving hips at the most recent followup. At 8 years, survivorship free of revision for aseptic femoral failure (for loosening or osteolysis) was 58% (95% confidence intervals, 44.3%, 69.6%); survivorship free of aseptic femoral loosening (revision for aseptic loosening or radiographic loosening) was 20% (95% confidence intervals, 12%, 27%); and survivorship free of symptomatic femoral loosening (revision for aseptic loosening or radiographic femoral loosening with moderate or severe pain) was 45% (95% confidence intervals, 32.3%, 56%). More severe preoperative bone loss correlated with poorer survivorship free of aseptic loosening and subsidence of > or = 5 mm. Differences among the prosthetic-type groups with respect to patient's age, gender, and bone loss severity precluded direct comparison of performance for each prosthetic type; however, all the prostheses had a significant rate of rerevision and aseptic loosening. Stable long-term fixation with the proximally porous-coated femoral components used in this series was not achieved on a predictable and reproducible basis. The damaged, weakened bone often present in the proximal femur during revision probably does not provide an optimal environment for sturdy initial or long-term biologic fixation of these devices that rely on the proximal femoral bone for fixation.

Adult↗