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Biomedical subjects

M D Ries

Publications and source records attributed to M D Ries.

49 records · Page 3Linked to original sources
PubMed1994

Fatal massive adrenal hemorrhage after bilateral total knee arthroplasty.

Adrenal hemorrhage can occur in association with postoperative stress, trauma, myocardial infarction, infection, and chronic medical illness. Other risk factors for the development of spontaneous adrenal hemorrhage include a thromboembolic state and anticoagulation therapy, although it has rarely been observed following orthopedic surgery. The authors report the case of an otherwise healthy 61-year-old woman who died suddenly 9 days after bilateral total knee arthroplasty. The only abnormality found on postmortem examination was massive bilateral adrenal hemorrhage with destruction of nearly all adrenal tissue. Surgeons should be aware of this complication that, if recognized early, can be treated with steroid replacement.

Adrenal Gland Diseases↗
PubMed1994

An in vitro study of proximal femoral allograft strains in revision hip arthroplasty.

Bone allografts are used frequently to replace bone stock subsequent to total hip arthroplasty. Revision of the failed hip replacement results in a complex structure of allograft bone, host bone and a metal femoral component. To evaluate the mechanics of the allograft-implant-host bone structure at the time of surgery, a strain gauge study was undertaken with six fresh/frozen human femora. Under defined loading conditions, cortical strain distributions were measured for five different cases: (1) normal bone, (2) bone with a femoral implant, (3) bone with the femoral component and an osteotomy at the mid-stem level of the implant (i.e. to stimulate the proximal allograft-host junction around the femoral stem), (4) bone with an osteotomy and an implant cemented into the 'allograft' (i.e. the proximal end of the femur), and (5) bone with an osteotomy and the implant cemented into both the proximal 'allograft' and the distal host bone. The results showed that, prior to making the osteotomy, proximal femoral strains were decreased with the insertion of a femoral stem. These strains were further decreased when an osteotomy had been made. This strain distribution did not change when the stem was cemented into the proximal 'allograft' bone, or cemented into the proximal 'allograft' and distal host bone. The decreases in strain for these test cases implied that the discontinuity between the bony segments caused an extended reduction in the tensile or compressive stresses transmitted through the cortices.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Transplantation↗
PubMed1994

Hip arthroplasty in mentally impaired patients.

The outcome of elective hip arthroplasty in 11 mentally impaired patients was compared with a cohort of 244 mentally competent patients. The impaired patients had a diagnosis of cerebral palsy, schizophrenia, or Down's syndrome, and were unable to give their own surgical consent. Major complications requiring additional surgery occurred in 5 of the mentally impaired patients. Three patients sustained fractures of the femur below the stem and were treated with plating, 1 developed a deep infection requiring prosthesis removal, and 1 developed a thoracic decubiti with bone involvement requiring debridement and rotation flap coverage. Three of these patients also developed urinary tract infections. Of the other 6 mentally impaired patients, 3 developed urinary tract infections, and 1 had a deep venous thrombosis. Functional independence was improved after surgery in the mentally impaired patients. However, the average cost of hospitalization, length of stay, and complication rate were significantly higher (p < 0.05) than those of the mentally competent patients.

Activities of Daily Living↗
PubMed1993

Posterior allograft bone-block for recurrent dislocation of the hip after hemiarthroplasty in noncompliant patients with neuromuscular disease.

Two mentally retarded patients with cerebral palsy developed recurrent dislocation of the hip after hemiarthroplasty. Instability had persisted despite release of contracted soft tissues, conversion to a bipolar arthroplasty, and cast immobilization in one patient and repeated closed reductions with abduction splinting and bed rest in the other. Both patients were treated with a posterior femoral head allograft bone-block that resulted in restoration of hip function and control of recurrent dislocations.

Aged↗
PubMed1993

Pulmonary function during and after total hip replacement. Findings in patients who have insertion of a femoral component with and without cement.

Eleven patients who had a femoral component inserted with cement and twenty-three who had a femoral component inserted without cement were studied prospectively for changes in the pulmonary shunt associated with total hip replacement. The levels of oxygen in the arterial blood and the platelet counts were measured preoperatively and each morning for three days after the arthroplasty. Levels of oxygen in the arterial blood were determined intraoperatively, once before and once after the femoral component was inserted. Intraoperative shunt values increased 28 per cent when a femoral component was inserted with cement (p < 0.05), but they did not change when cement was not used. The average postoperative shunt values were higher than the average preoperative shunt values for both groups of patients, but only the values on the second postoperative day after a procedure with cement were significantly higher (p < 0.05). The ability of the patient to tolerate an increase in pulmonary shunt should be assessed when the femoral component is to be cemented during total hip replacement.

Aged↗
PubMed1992

Separation of the polyethylene liner from acetabular cup metal backing. A report of three cases.

In three young patients with cementless Porous Coated Anatomic (PCA) total hip prostheses implanted two to four years previously, the polyethylene liner separated from metal backing. These cups were of the original PCA design, manufactured and packaged as single assembled components, rather than the more recent two-piece components packaged with interchangeable liners separate from the metal backing. Each case of separation was associated with the failure of the thin outer polyethylene rim and central polyethylene peg on the back of the liner that secures it to the metal backing. Cup liners should be securely attached to the metal backing. The possibility of polyethylene failure is considerable when cementless metal-backed acetabular cups are used in active young patients.

Acetabulum↗
PubMed1992

Bipolar hip arthroplasty for recurrent dislocation after total hip arthroplasty. A report of three cases.

Recurrent dislocation after total hip arthroplasty is often a difficult complication to manage. Bipolar prostheses may be useful in these cases because motion can occur at two bearing surfaces and thus permit the greater range of motion necessary to dislodge the head from the acetabulum. The bipolar head is also larger than a conventional total hip femoral component, so a greater volume must be displaced from the acetabulum for dislocation to occur. Three patients with recurrent dislocation of a total hip prosthesis were successfully treated by conversion to bipolar devices after failure of multiple surgical procedures and treatment even with braces.

Adult↗
PubMed1991

Functional hallux rigidus in the rheumatoid foot.

Hallux rigidus results from arthritic involvement of the first metatarsophalangeal joint. The authors have observed loss of motion at this joint in patients with rheumatoid arthritis in the absence of hallux valgus or joint destruction. A hyperextension deformity of the interphalangeal joint has also been observed, with a painful callus beneath it. The first metatarsophalangeal joint appears normal on roentgenograms, and passive motion of the joint is normal when it is examined clinically. The loss of first metatarsophalangeal motion is functional, and stems from muscle spasm of the great toe intrinsic muscles in an effort to relieve pressure on the lesser metatarsal heads. The interphalangeal hyperextension may develop secondary to "functional hallux rigidus."

Adult↗
PubMed1990

Epineural ganglion of the ulnar nerve at the elbow.

Ganglion cysts of peripheral nerves in the upper extremity are rare. Cysts located in the substance of the nerve and extraneural ganglia that cause symptomatic nerve compression have been reported. Intraneural ganglia may be difficult to separate from the neural elements without resultant nerve injury. This case involved a ganglion cyst confined to the epineurium of the ulnar nerve at the elbow. Because of the peripheral location, it was removed without damage to the underlying nerve.

Cysts↗
PubMed1990

Scoliosis in trisomy 18.

Patients with trisomy 18 typically present with multiple congenital anomalies and most die within the first year. However, long-term survivors are not uncommon. Seventeen patients with trisomy 18 were evaluated to study the development of scoliosis associated with this disorder. There were 13 females and 4 males with ages ranging from birth to 22 years. Twelve patients died by age 2. None developed scoliosis or had vertebral anomalies. The five patients who survived beyond age 2 developed scoliosis. Curve progression was demonstrated in the patients who returned for follow-up. Bracing was not well tolerated in two patients with curves of 48 degrees and 58 degrees. Both had poor motor control and sitting ability. One patient with a 30 degree curve was successfully managed by bracing. Another patient with a severe scoliosis was successfully fused with anterior and posterior instrumentation. Patients with trisomy 18 should be carefully evaluated for scoliosis. Scoliosis in the older child, surviving beyond age 2, may be progressive and difficult to manage.

Abnormalities, Multiple↗
PubMed1990

Medial external fixation with lateral plate internal fixation in metaphyseal tibia fractures. A report of eight cases associated with severe soft-tissue injury.

Eight patients with unstable fractures involving the articular surface and metaphyseal-diaphyseal bone of the proximal or distal tibia associated with severe soft-tissue injury or compounding wound were treated with irrigation, debridement, tetanus inoculation, antibiotic prophylaxis, and combined internal fixation with one-half frame external skeletal fixation for neutralization. All patients were followed to complete healing and functional restoration of the extremity. All fractures healed, but one superficial and one deep infection occurred. All patients achieved at least 110 degrees of knee motion. This method should be considered in unstable metaphyseal and articular tibia fractures not adequately stabilized with a lateral plate in which use of an additional medial plate is required for stability, but contraindicated because of the status of the soft tissues or extensive comminution of the bone.

Accidents, Traffic↗
PubMedDate not supplied

Arthrokatadysis in trisomy 18.

Protrusio acetabuli may be characterized by an inward displacement of the femoral head into the pelvis. A 20-year-old patient with trisomy 18, who is also notable for her longevity, developed bilateral protrusio over a course of 2 years. We believe that trisomy 18 should be considered a cause of protrusio.

Acetabulum↗