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Biomedical subjects

J J Callaghan

Publications and source records attributed to J J Callaghan.

At least 145 records · Page 8Linked to original sources
PubMed1989

Femoral head osteonecrosis. Detection by magnetic resonance imaging versus single-photon emission computed tomography.

Magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) examinations were compared for detection of femoral head osteonecrosis. Of 29 hips with clinical and roentgenographic evidence of osteonecrosis (18 histologically confirmed), 15 were Stage II, three transitional, six Stage III, and five Stage IV. MRI identified osteonecrosis in all 29 cases (100% sensitivity), and there were no false-positives (100% specificity). Of 24 osteonecrotic hips with technically adequate examinations, SPECT identified 14 (sensitivity 58%), and there were four false-positives (78% specificity). If Stages III and IV were eliminated, SPECT correctly identified ten of 15 (67% sensitivity).

Adolescent↗
PubMed1989

Operative treatment of acute hip fractures: its effect on serum creatine kinase, lactate dehydrogenase and their isoenzymes.

Serum creatine kinase, lactate dehydrogenase, and their isoenzymes were prospectively studied in 16 patients who underwent operative treatment of acute hip fractures. No perioperative myocardial infarctions occurred; however, two patients died of noncardiac causes. We found that skeletal muscle injury associated with operative treatment of acute hip fractures did not result in significant elevations of serum CK-MB or the LD-1/LD-2 ratio. CK-MB activity exceeding 5% of total CK activity was observed in five patients who did not experience acute perioperative myocardial infarction; however, no patient had an absolute CK-MB value exceeding 50 IU/L. Elevations of serum CK-MB exceeding 50 IU/L and a LD-1/LD-2 ratio exceeding 1.0, therefore, should not be attributed to skeletal muscle injury alone following the operative treatment of acute hip fractures.

Acute Disease↗
PubMed1988

In-111-labeled white blood cell uptake in noninfected closed fracture in humans: prospective study.

Since indium-111 white blood cell (In-111 WBC) scintigraphy is often used to evaluate for osteomyelitis in bone fractures, it is important to know if noninfected fractures have In-111 WBC uptake. Twenty-seven noninfected closed fracture sites in 19 patients were prospectively evaluated with technetium-99m methylene diphosphonate bone scintigraphy and In-111 WBC scintigraphy. In-111 WBC uptake was present in 41% of the 27 sites. In the 11 positive sites, the In-111 WBC uptake was 1+ (definite but minimal) in 55%, 2+ (moderate) in 36%, and 3+ (marked) in 9%. The visual intensity of the radioactive uptake on In-111 WBC scintigrams relative to that on bone scintigrams was less in 82%, equal in 9%, and greater in 9%. The visual size of the area of uptake on In-111 WBC scintigrams and bone scintigrams was smaller in 36%, equal in 55%, and greater in 9%. Factors that may help distinction of In-111 WBC uptake due to fracture alone from infection associated with fracture are discussed.

Adult↗
PubMed1988

Evaluation of benign acetabular lesions with excision through the Ludloff approach.

Six patients with poorly defined chronic hip symptoms (length of time from initial symptoms to definitive diagnoses ranged from four months to three years) were eventually found to have benign lesions in the region of the acetabular fovea. All of these patients had seen multiple physicians including orthopedic surgeons before the definitive diagnosis was made. Four lesions were not visualized on routine roentgenographs. Various imaging modalities were necessary to demonstrate and localize these lesions. Excision through an anteromedial approach (Ludloff) in five cases required minimal dissection, operative time, and blood loss. The approach does not compromise definitive surgery (external or internal hemipelvectomy) in the unlikelihood that the lesion is found to be malignant.

Acetabulum↗
PubMed1988

The accuracy of selective magnetic resonance imaging compared with the findings of arthroscopy of the knee.

The results of selective magnetic resonance imaging of the knee were compared with those of arthroscopy in a prospective series of fifty patients. A specifically designed protocol for imaging, producing T1 sagittal images interleaved at four millimeters while the patient's foot was in 20 degrees of external rotation, was utilized. This technique, called selective magnetic resonance imaging, yielded excellent visualization of the posterior cruciate ligament, medial meniscus, and lateral meniscus in all patients. However, in only 76 per cent of the patients was the anterior cruciate ligament well visualized. Compared with arthroscopy, the sensitivity, specificity, and accuracy of selective magnetic resonance imaging were, respectively, 95.8, 100, and 98 per cent for tears of the medial meniscus; 66.7, 95.1, and 90 per cent for tears of the lateral meniscus; undefined, 100, and 100 per cent for tears of the posterior cruciate ligament; and 100, 96.9, and 97.3 per cent for tears of the anterior cruciate ligament, when that ligament was well visualized. Our selective sequence can be performed in fifteen minutes at a cost that is comparable with that of arthrography. It is totally non-invasive and requires no exposure to ionizing radiation. Selective magnetic resonance imaging can be a safe and valuable adjunct to the clinical evaluation of the knee and an aid to efficient preoperative planning.

Adolescent↗
PubMed1988

The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series.

Fifty uncemented porous-coated total hip prostheses were implanted in forty-seven patients whose mean age was fifty-eight years. Clinical hip-rating scores, as described by Harris, were determined and anteroposterior and frog-leg lateral radiographs were made preoperatively, shortly postoperatively, and at three months, six months, one year, and two years postoperatively. The mean hip-rating score was 92 points (range, (range, 74 to 100 points) at one year and 92 points (range, 69 to 100 points) at two years. The thigh was slightly painful in nine patients (18 per cent) at one year and in eight (16 per cent) at two years. Fourteen hips (28 per cent) (in thirteen patients) caused a moderate or severe limp two years postoperatively; however, this complication appears to have been related more to the direct lateral approach that was used than to the prosthesis. Six (13 per cent) of the patients walked with a cane at one year and five (11 per cent) still required a cane at two years. Serial radiographic evaluations revealed that, between the first and second postoperative years, a progressive radiodense femoral line developed in twenty hips (41 per cent); a progressive acetabular line, in four hips (8 per cent); and progressive femoral sclerosis, in twelve hips (24 per cent). There was progressive loosening of beads from twelve (24 per cent) of the femoral components and from nine (18 per cent) of the acetabular components. The position of one acetabular and one femoral component changed. Two femoral shafts fractured, one intraoperatively and one fourteen months postoperatively. We concluded that the clinical results were encouraging in these patients at the end of two years. We are concerned, however, about the progressive radiodense lines, sclerosis, and loosening of beads as well as the slight, but persistent, pain in the thigh in eight patients.

Acetabulum↗
PubMed1988

Fracture of the femoral component. Analysis of failure and long-term follow-up of revision.

Although fracture of the femoral component is an uncommon mode of mechanical failure, when it does occur, symptoms may be dramatic. In addition, it presents the surgeon with one of the more challenging problems in revision total hip arthroplasty surgery. This study reviews the problem of femoral stem fracture and evaluates the stem failures and long-term follow-up of the revision for femoral component fractures performed at The Hospital for Special Surgery.

Aged↗
PubMed1987

Diagnosis of infection by preoperative scintigraphy with indium-labeled white blood cells.

Scintigraphy with indium-labeled white blood cells has been reported to be sensitive and specific in the diagnosis of low-grade sepsis of the musculoskeletal system. We reviewed the records of fifty patients who had suspected osteomyelitis or suspected infection about a total joint prosthesis and who underwent scintigraphy with technetium-99m methylene diphosphonate and scintigraphy with indium-111 oxine-labeled white blood cells before an open surgical procedure. Any patient who received preoperative antibiotics was not included in the study. For all of the patients, gram-stain examination of smears, evaluation of a culture of material from the operative site, and histological examination were done. The patients were divided into two groups. Group I was composed of twenty-four patients, each of whom had a prosthesis in place and complained of pain. Group II was composed of twenty-six patients for whom a diagnosis of chronic osteomyelitis had to be considered. With the indium scans alone, there was only one false-negative result (in Group II), but there were eighteen false-positive results (eight patients in Group II and ten patients in Group I). Although scintigraphy with indium-labeled white blood cells is quite sensitive, it is not specific in detecting chronic osteomyelitis; a negative scan should be considered highly suggestive that osteomyelitis is not present. Specificity can be increased by interpreting the indium scan in conjunction with the technetium scan.

Adult↗
PubMed1987

Prior deposition of autologous blood in elective orthopaedic surgery.

We retrospectively analyzed a program of prior deposit and storage of autologous blood that was used for patients who underwent elective orthopaedic procedures over a period of thirty-six months at the Walter Reed Army Medical Center. Of a total of 211 patients who underwent total joint replacement or spinal fusion during this period and who had sufficient records to be included in the study, a total of 159 patients enrolled in the program. The fifty-two patients who did not enroll in the study, twelve of whom were rejected because of medical problems, served as a control group. Since the preoperative hematocrit values for patients in the group that received autologous blood were similar to those for the control group, multiple preoperative phlebotomies in these patients, who had received supplemental iron, did not seem to have any deleterious effects. One hundred and thirteen (71 per cent) of the 159 patients who were enrolled in the program received only autologous blood. The remaining forty-six patients required homologous blood also, but 64 per cent of their transfusion needs were provided by autologous blood. The only reactions to the transfusions in the study were in four patients who received homologous blood. We think that a program of prior deposit and storage of autologous blood should be an option for patients who are to undergo elective orthopaedic surgery. Such a program is well tolerated by the patients and easily managed by the staff, and it was not difficult to implement at our tertiary referral hospital.

Adolescent↗
PubMed1986

Reimplantation in infection. Elution of gentamicin from cement and beads.

A prospective study was performed to evaluate the arthroplasty fluid, serum, and urine antibiotic levels in 38 patients implanted with gentamicin-impregnated cement and in 18 patients with gentamicin-impregnated beads. Radioimmune assays were performed on arthroplasty fluid, serum, and urine samples at various times after surgery. On day 1, high arthroplasty fluid levels of gentamicin were eluted from bead-implanted patients (mean, 36.9 micrograms/ml; range, 19.6-69.5) and cement-implanted patients (mean, 14.9 micrograms/ml; range, 2.7-38.9) with very low serum and urine levels. The arthroplasty levels of gentamicin obtained in bead-implanted patients on day 1 were 17 times higher, and in cement-implanted patients, seven times higher, than those obtained with intravenous administration of gentamicin. The serum and urine levels were approximately ten to 20 times less in patients with gentamicin-impregnated cement or beads compared to those levels obtained after intravenous administration. These very low systemic levels should preclude nephrotoxic and ototoxic effects. No toxic effects were observed in these patients. Bioactivity of gentamicin in the specimens was confirmed. Staphylococci were exquisitely sensitive, while Streptococci were moderately resistant to gentamicin. Both gentamicin-impregnated beads and cement appear safe and provide substantial local in vivo antibacterial activity.

Bone Cements↗
PubMed1986

14-year follow-up study of a patient with massive calcar resorption. A case report.

The authors present an in-depth clinical, radiographic, and pathologic analysis of a 62-year-old man with massive bone reabsorption around the proximal femur in a total hip arthroplasty (THA). The THA was revised 13 years after implantation. Thirty millimeters of calcar resorption was noted radiographically. Evidence of stem bending was present on examination of the femoral implant, and marked wear of the acetabular cup was noted. The pathologic evaluation of removed calcar bone and cement revealed a histiocytic mass invading the bone. Intracellular and extracellular polymethylene debris was noted within the invasive mass. Evidence of fragmented methylmethacrylate cement was also present. The bone-cement interface in the excised calcar region contained segments that showed active bone remodelling around the cement without an interposed membrane. It is possible that this case of calcar resorption began with histiocytic activation and recruitment by polyethylene wear debris followed by active bone lysis. The process may be perpetuated by the fragmentation of cement, as motion occurred at the calcar bone-cement interface, and may represent an extreme example of a process occurring in cases of calcar resorption in general.

Bone Cements↗
PubMed1985

Long-term results of revision total hip replacement. A follow-up report.

The results of 110 revision total hip replacements performed for aseptic failure, with an average follow-up of 3.4 years, were reported in 1982. We were able to continue to follow ninety-nine of these patients for an average of 8.1 years (range, five to 12.5 years). With this longer follow-up, we found that twenty-nine (29 per cent) of these revised arthroplasties have since failed. Most of the failures after 1982 occurred in the hips that were known to have a progressive radiolucency at the time of the first evaluation. We concluded that there is an increased failure rate with longer follow-up of revision total hip replacement, and that progressive radiolucency at an interface indicates a poor prognosis for the arthroplasty.

Activities of Daily Living↗