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Biomedical subjects

R E Booth

Publications and source records attributed to R E Booth.

At least 55 records · Page 3Linked to original sources
PubMed1995

Development of a novel, rapid processing protocol for polymerase chain reaction-based detection of bacterial infections in synovial fluids.

We describe the development of a molecular detection system designed for use with synovial fluid (SF)-based infections. The methodology employs a lysis/extraction procedure that effectively disrupts microorganisms allowing for release of the microbial DNA and its amplification by polymerase chain reaction (PCR). We tested the effectiveness of adding a mixed-bed, ion-exchange resin to the extract to remove PCR inhibitory components present in the SF. After centrifugation to separate the resin, DNA contained in the supernatant is subjected to PCR using oligonucleotide primers designed for broad-spectrum microorganism detection. Amplification products are analyzed by agarose gel electrophoresis and/or DNA hybridization methodology. We report here the detection sensitivity and specificity of the protocol using SF inoculated with Escherichia coli and Staphyloccocus aureus. We have applied this new methodology to clinical SF specimens with results superior to standard laboratory culturing assays.

Bacterial Infections↗
PubMed1995

Postoperative blood salvage in total knee arthroplasty using the Solcotrans autotransfusion system.

One hundred forty-four patients who underwent primary total knee arthroplasty were examined in a prospective controlled study to determine the efficacy and safety of a postoperative wound drainage autotransfusion system (Solcotrans, Smith & Nephew Richards, Memphis, TN). The patients were divided into two groups: control group 1 comprised 88 (61%) patients who either received a Hemovac disposable drainage system (63 patients) or the Solcotrans system and had inadequate drainage for autotransfusion (25 patients). Experimental group 2 comprised 56 (39%) patients who received a Solcotrans drainage system and were autotransfused. The Solcotrans proved itself safe. No sepsis, transfusion reactions, or coagulopathies were associated with autotransfusion, which averaged 524 mL. There were no significant differences between groups 1 and 2 when comparing preoperative and postoperative hemoglobins and hematocrits. The Solcotrans system did not lower homologous blood requirements. Only 1.6% (2 patients) of all patients who autodonated at least 2 units of autologous blood (122 patients) were in need of a homologous blood transfusion in the postoperative period. Thus, although safe, the Solcotrans system was not proven effective in the management of primary total knee arthroplasty patients.

Blood Transfusion, Autologous↗
PubMed1995

Comparison of cemented and cementless total hip arthroplasty in patients with bilateral hip arthroplasties.

A consecutive series of 36 patients underwent primary cemented total hip arthroplasty followed by primary cementless total hip arthroplasty of the contralateral hip. Clinical pain scores between the cementless and cemented hips were not different. Subjectively, patients either had no preference or preferred the cementless side. Comparison of results in the same patient eliminates variability introduced by differences in sex, weight, comorbidities, bone quality, and activity level. Control of these factors permits more meaningful comparison of the type of fixation.

Adult↗
PubMed1995

Gender differences in high-risk sex behaviours among heterosexual drug injectors and crack smokers.

This study was designed to assess gender differences in high-risk sex behaviors related to the transmission of HIV among injection drug users (IDUs) and crack smokers. Using a standard national survey instrument, 593 verified drug users were questioned about their sexual activities and drug use in the 30 day period prior to the interview. High-risk sex behaviors included nonuse of condoms, exchanging sex for drugs or money, sex with an IDU, and sex with more than one partner. Results showed that IDUs who engaged in needle risk practices were more likely report nonuse of condoms than IDUs who practiced safer needle use. African-American ethnicity was a more powerful determinant of exchanging sex than smoking crack cocaine. Sex with more than one partner in the previous 30 day was reported by 11% of married males and 15% of married females. Independently, marital status was found to be a marker for high-risk sex behaviors, in particular, sex with an IDU and nonuse of condoms, behaviors reported more often by married than unmarried respondents. Needle risk, more common among females than males, was associated with sex with an IDU. Approximately one-fourth of the injectors reporting sex with only non-IDUs also reported needle risk, sex with more than one partner, and nonuse of condoms. These findings show the dual threat drug injectors face for HIV infection, through sex and needle risk behaviors, and the pivotal role IDUs play in the heterosexual transmission of HIV to noninjectors.

Adolescent↗
PubMed1995

Critical care pathways in thromboembolic disease.

Critical Care Pathways are outlines of each day's expected interventions and treatments for a particular process. They are part of a larger concept of case management, as an extramural, multidisciplinary approach to a patient's problems, with details suitable to their personality and case. This constitutes the overall concept of managed care. Rather than DVT, this presentation focuses on thromboembolism. I think you'll see why I chose to emphasize this complication instead. Modern medicine has been turned upside down; the rules are different, expectations are different. I would suggest to physicians who are resisting the CCP concept that it may be your salvation as much as it is a paperwork torment. It's clearly a way to provide better care for your patients.

Critical Care↗
PubMed1995

Continuous passive motion after total knee arthroplasty. Analysis of cost and benefits.

The authors report the results of a prospective study examining the benefits of daily continuous passive motion combined with physical therapy, compared with physical therapy alone, in 103 consecutive osteoarthritic patients undergoing primary total knee arthroplasty. The first 51 patients received continuous passive motion initiated in the recovery room and the next 52 patients did not receive continuous passive motion. Both groups underwent an identical physical therapy protocol starting on the first postoperative day. At discharge, there was a significant increase in active flexion in the continuous passive motion group. There were no significant differences regarding pain, wound healing, knee swelling, wound drainage, pulmonary embolism, or length of hospital stay between the 2 groups. At 2 years, there were no clinical differences in the motion or knee scores. Knee manipulation was done for < 50 degrees flexion after the tenth postoperative day. There were 5 manipulations in the noncontinuous passive motion group and none in the continuous passive motion group. The entire costs associated with the 5 manipulations was $48,274 or $937 per patient not receiving continuous passive motion. The average daily inpatient rental of the machine was $60 per day. Continuous passive motion is efficacious in increasing short-term flexion and decreasing the need for knee manipulation without increasing costs.

Aged↗
PubMed1994

Acute arterial thrombosis associated with total knee arthroplasty.

PURPOSE: Acute arterial thrombosis associated with total knee arthroplasty (TKA) is a rare but limb-threatening complication. The purpose of this report was to determine the incidence and optimal management of these complications by reviewing our extensive orthopedic experience and the English-language literature. METHODS: Between April 1989 and March 1994 seven (0.17%) patients had development of acute limb-threatening ischemia after 4097 TKAs that were performed at our hospital. Management of these complications included (1) emergency arteriography to define inflow and outflow arteries, (2) use of autologous vein from the contralateral leg when arterial bypasses were necessary (because TKAs are associated with a high incidence of deep vein thrombosis), and (3) early, aggressive revascularization that often required difficult distal bypasses to achieve limb salvage. Management of our cases are compared with treatment of 13 patients described in the literature. RESULTS: Ten patients treated at other hospitals by arterial thrombectomy alone (six cases), sympathectomy alone (two cases), fasciotomy alone (one case) or delayed arterial bypass resulted in seven major amputations and one death. All seven of our patients and three patients treated elsewhere underwent emergency femorodistal bypasses (six tibial, three below-knee popliteal, one pedal). All 10 patients had limb salvage after long-term follow-up (average 18 months; range 1 to 58). CONCLUSION: Thrombectomy alone for acute arterial thrombosis associated with TKA generally is unsuccessful and associated with unacceptably high amputation rates. Dismal results without emergency bypass is due to underlying chronic occlusive atherosclerotic disease found in these patients and intimal plaque disruption that can occur with knee manipulation or tourniquet compression. Acute arterial occlusion after TKA is best managed by emergency arteriography and a femoroinfrageniculate bypass.

Acute Disease↗
PubMed1994

Comparison of interface membranes obtained from failed cemented and cementless hip and knee prostheses.

Biochemical and histologic analyses were performed on interface membranes obtained at revision of aseptically loosened hip implants (n = 36) and knee implants (n = 16). Clinical failure occurred sooner in patients with uncemented total hip implants (Group 1) than in patients with cemented implants (Group 2) (p < 0.02). There was no difference in time to revision between the patients with uncemented implants (Group 3) and patients with cemented total knee implants (Group 4). Histologically, more small (< 5 mu) polyethylene particles were found within macrophages and fibroblasts in membranes from Groups 1 and 2. Polyethylene particles from failed total knees (> 10-100 mu) were larger than those from failed total hips. Large polyethylene fragments and foreign-body giant cells were more common in failed knees than failed total hip membranes. Biochemically, proteinase and cytokine activity in the tissue culture supernatant from all groups was higher than in the control tissue (p < 0.01). The activities of stromelysin, prostaglandin E2, interleukin-1 alpha, interleukin-1 beta, and tumor necrosis factor-alpha were higher in Groups 1 and 2 than in Groups 3 and 4 (p < 0.05). These findings support the hypothesis that interface membranes enveloping femoral (hip) and tibial (knee) components of failed total joint implants may promote bone resorption and aseptic loosening. The reason for slower failure of knee implants as compared with hip prostheses may be the lower level of biochemical activity and macrophage density that correlates closely with larger polyethylene particles.

Aged↗
PubMed1994

A biochemical, histologic, and immunohistologic analysis of membranes obtained from failed cemented and cementless total knee arthroplasty.

Biochemical, histologic, and immunohistochemical analyses were performed on 34 interface membranes obtained from 33 patients during revision total knee arthroplasty. The membranes had surrounded components of cementless (n = 11) and cemented (n = 23) knee prostheses that were aseptically loose. None of these implant failures was caused by catastrophic polyethylene erosion leading to metal-to-metal contact. The histologic findings were similar in the membranes from cemented and cementless knee components: small polyethylene debris within macrophages and large birefringent polyethylene debris within foreign-body giant cells. Metallic debris was seen in membranes from both groups, but cemented membranes had more polymethylmethacrylate particles and more hyalinization. Intracytoplasmic asteroid bodies were observed in several foreign-body giant cells in both types of membranes. No significant differences were found between the two groups in levels of collagenase, prostaglandin E2 (PGE2), interleukin-1 (IL-1), interleukin-6 (IL-6), or tumor necrosis factor-alpha (TNF-alpha), nor in the population of inflammatory cells stained with IL-1, IL-6, and TNF-alpha antibodies. Membranes that had surrounded components with radiographic evidence of diffuse or localized periprosthetic bone loss released significantly more collagenase, IL-1, IL-6, and TNF than did membranes from components without bone loss. These two groups, however, did not have significantly different PGE2 levels. These findings suggest that polyethylene and metal debris may play a role in macrophage activation and the release of mediators of bone resorption in the membranes surrounding failed cemented and cementless total knee implants.

Aged↗
PubMed1994

The patellar "clunk" syndrome after posterior stabilized total knee arthroplasty.

In 20 patients with patellar "clunks" after posterior stabilized total knee arthroplasty, the average time to presentation was 10.7 months postarthroplasty. All patients demonstrated an audible and often painful "clunk" during extension. Fourteen procedures (11 arthroscopic debridements and three patellar component revisions) were performed in 12 patients. At reoperation, a suprapatellar fibrous nodule was seen to wedge into the intercondylar notch during flexion and dislodge during extension, generating the symptoms. The disorder resolved after nodule excision. Although four recurrences arose after arthroscopic debridements, none developed after arthrotomy and patellar button revision. Femoral component design, postsurgical inflammation, and altered extensor mechanics are potential etiologic agents of this complication.

Aged↗
PubMed1994

Predictors of unsafe needle practices: injection drug users in Denver.

To identify factors associated with unsafe needle hygiene, we studied 378 injection drug users (IDUs) in Denver, Colorado. The sample was drawn from neighborhoods with large concentrations of injectors and crack smokers. Respondents were questioned about their needle hygiene practices during the 30-day period prior to the interview. Unsafe needle hygiene, defined as injecting with previously used, nondisinfected needles, was reported by more than a third of those interviewed. Unsafe needle practices were associated with a number of factors, including heroin injection, perceived chance of getting AIDS, and lack of exposure to AIDS interventions in the community. The high percentage reporting unsafe needle practices within a 30-day interval points to the grave risk AIDS continues to pose for drug users. We conclude that the apparent success of exposure to AIDS intervention efforts in changing needle practices shows promise for prevention programs targeting drug injectors.

Adult↗