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Biomedical subjects

Peter Grant

Publications and source records attributed to Peter Grant.

10 recordsLinked to original sources
PubMed2006

Radical trachelectomy.

This review examines the emerging place of radical trachelectomy in the management of women with cervical cancer who are seeking fertility preservation.

Adenocarcinoma↗
PubMed2005

Differences in stability and bone remodeling between a customized uncemented hydroxyapatite coated and a standard cemented femoral stem A randomized study with use of radiostereometry and bone densitometry.

The custom made Unique stem is designed to fit closely to the metaphyseal region of the femur in order to obtain maximum mechanical stability and optimal load transfer. Thirty-seven patients (38 hips) with non-inflammatory arthritis were randomized to the uncemented custom made Unique stem or the Elite Plus stem inserted with cement. The patients have been followed clinically as well as with radiostereometry (RSA) and Dual-energy X-ray Absorptiometry (DXA) for 2 years. After 2 years the RSA result showed minimal translation and rotation for the Unique stem while the Elite Plus rotated slightly (mean 1.05 degrees) into retroversion. Compared to previous studies the Elite Plus was as stable as the Charnley prosthesis. The DXA results showed a significantly higher proximal and total (10% for the Unique versus 5% for Elite) bone loss for the Unique stem compared to the Elite Plus. Thus the optimal proximal press-fit of the custom made stem did secure a stable fixation, but did not decrease the proximal bone loss.

Absorptiometry, Photon↗
PubMed2005

Abnormalities of the RB1 pathway in ovarian serous papillary carcinoma as determined by overexpression of the p16(INK4A) protein.

Dysfunction of proteins involved in the G1 to S transition of the cell cycle, such as p16(INK4A) and RB1, is common in many cancer types. A screen of p16 protein expression was performed in benign, borderline, and invasive ovarian tumors, together with endometrial cancers, aligned on a tissue microarray. We observed frequent p16 overexpression in serous papillary carcinomas of ovarian and endometrial origin. An extended cohort of ovarian serous papillary carcinomas was examined to further evaluate the frequency of p16 overexpression. Strong, uniform staining in the majority of cancer cells occurred commonly in invasive serous papillary ovarian cancers, particularly in grade 3 carcinomas. RB1 protein expression abnormalities were rare. Our data indicate that abnormalities in the retinoblastoma pathway, as determined by p16 overexpression, are common in serous papillary carcinomas and are probably an early event.

Adult↗
PubMed2004

Ultralok uncemented femoral prostheses: 12 to 15 year follow-up evaluation.

The results of total hip arthroplasty (THA) in young patients with osteoarthritis have been discouraging. In this prospective study, 78 patients (89 THA) were consecutively included and followed for 12 to 15 years (mean, 12.2 years) after the index surgery with the uncemented Ultralok femoral prosthesis (Zimmer, Wiltshire, UK). Age at surgery was 59.8 years (40 to 76). The follow-up process included an in-office clinical evaluation and a radiographic evaluation. A cumulative survival of 96.6% (with the end point defined as revision of the femoral component because of mechanical or radiographic loosening) was found for the femoral component after13 years, and all unrevised components were radiographically fixed by bony ingrowth. Twenty-three well-fixed stems had to be removed for femoral head damage at the time of the acetabular revision. The results of this comparatively large series show that good fixation has been achieved with a proximal titanium mesh and grit-blasted titanium alloy stem.

Aged↗
PubMed2004

Emergency management of the morbidly obese.

OBJECTIVES: To identify the difficulties encountered with the emergency management of morbidly obese patients and formulate recommendations to streamline care. METHODS: An English language literature search was undertaken using Medline (1966-2003) with key words 'morbid obesity' 'anaesthesia' 'imaging' 'obesity' 'emergency' 'transportation' 'retrieval' 'critical illness' and 'monitoring'. Potential articles were selected for content applicable to emergency medicine based on title and abstract and reviewed in detail. Reference lists were manually searched for further relevant articles. In view of the very limited systematic study in this area, all information deemed by the authors' to be of assistance to the emergency physician was included regardless of evidence level. Additional information was sought from standard critical care textbooks and their bibliographies and through personal communication with local ambulance and retrieval services. The authors' unpublished personal experience in providing emergency care to the morbidly obese was included for aspects of management not documented in medical literature. RESULTS: Obesity levels and associated health problems are rapidly rising in Australia. Few studies were identified dealing with critical illness in the morbidly obese and none specifically addressing ED management. Problems identified included size related logistical issues, and limitations of physical assessment, monitoring and routine investigations. Invasive procedures, intubation and ventilation can be particularly problematic, and modified techniques may be required. Limited data indicates a poorer outcome from critical illness most marked in the case of blunt traumatic injury. CONCLUSION: Very obese patients present a variety of logistical and medical challenges for EDs. A series of recommendations are made based on available data. Further studies in this area would be desirable to more specifically address ED issues.

Catheterization↗
PubMed2004

Total hip arthroplasty with the Lord prosthesis. A long-term follow-up study.

BACKGROUND: The Lord prosthesis has been used rather extensively for total hip arthroplasty. In 1981, we began a prospective study for the purpose of determining the long-term results associated with the use of this prosthesis. In the present report, we describe the results for the living patients after a mean duration of follow-up of 17.5 years (range, fifteen to twenty years). METHODS: One hundred and two patients (116 hips) with a mean age of sixty-two years at the time of the index arthroplasty were included in the study. Eighty-nine hips were in women, and twenty-seven were in men. The Lord femoral prosthesis (with a 32-mm head) and the Lord threaded cup were used in all patients. The protocol included radiographic analysis, recording of complications, and a clinical evaluation. The patients were evaluated at one to four years, five to nine years, and fifteen to twenty years. RESULTS: One patient (one hip) refused to participate and forty-two patients (forty-five hips) died with the femoral component in place, leaving fifty-nine patients (seventy hips) available for clinical assessment. One femoral component was revised because of mechanical loosening, and one was revised because of a stem fracture. One stem appeared to be loose radiographically. Kaplan-Meier survivorship analysis with revision of the femoral component because of mechanical loosening, stem fracture, or radiographic loosening as the end point revealed a cumulative survival rate of 98% (95% confidence interval, 95.3% to 100.7%) (with twenty-eight hips at risk) at 17.5 years. Seventeen acetabular components were revised because of mechanical loosening, and sixteen were considered to be radiographically loose. Kaplan-Meier survivorship analysis with revision of the acetabular component because of mechanical or radiographic loosening as the end point revealed a cumulative survival rate of 65% (95% confidence interval, 53% to 72%) (with twenty-two hips at risk) at 17.5 years. CONCLUSIONS: We believe that the survival rate of the Lord femoral component after 17.5 years of follow-up was excellent. However, there was a substantial rate of proximal femoral bone loss. The results associated with the threaded cup were rather poor, and many patients had a loose implant but few symptoms. We recommend that patients with these implants be followed closely so that revision can be performed before substantial destruction of the acetabulum has occurred. LEVEL OF EVIDENCE: Therapeutic study, Level II-1 (prospective cohort study). See Instructions to Authors for a complete description of levels of evidence.

Adult↗
PubMedDate not supplied

Raised plasma fibrinogen concentration in patients with abdominal aortic aneurysm.

A feature associated with abdominal aortic aneurysms (AAA) is the presence of intraluminal thrombi (ILT). Elevated plasma fibrinogen concentrations predict a greater risk of thrombosis. Therefore, the authors assessed the relationship between fibrinogen levels, AAA size, and ILT. An age- and sex-matched case-control study was conducted. Demographic data and plasma samples were obtained from 110 patients with AAA and 110 controls. All subjects had an abdominal ultrasound scan to determine the size of the aneurysm and the percentage of the ILT occupying the lumen. Plasma fibrinogen concentrations were measured by the Clauss method. Fibrinogen concentrations were significantly higher in patients with AAA than in controls (median: 2.89 vs 2.53 g/L; p<0.01). Patients with AAA who were current smokers had a larger median AAA size (4.50 vs 4.30 cm; p<0.04) and greater percentage of the ILT (40% vs 30%) than those who did not smoke. Fibrinogen was positively correlated with AAA size (r =0.323; p<0.01) and the percentage of ILT occupying the lumen (r =0.358; p<0.05). Fibrinogen levels were higher in the AAA group. The authors also demonstrated positive correlations between the AAA size, ILT, and fibrinogen concentration. Smoking was associated with larger aneurysms and ILT. Fibrinogen may be a useful marker to monitor the progression of AAA.

Aged↗