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Biomedical subjects

R E Hunter

Publications and source records attributed to R E Hunter.

At least 55 records · Page 3Linked to original sources
PubMed1989

Knee mechanics after repair of the anterior cruciate ligament. A cadaver study of ligament augmentation.

An experimental knee-testing system was used to investigate the immediate postoperative mechanical state in knees with nonaugmented and augmented repairs of the anterior cruciate ligament. Ligament, repair tissue, and augmentation forces were measured using buckle transducers, and joint motion was measured using an instrumented spatial linkage during the application of 90 N anteriorly-directed tibial loads to seven fresh knee specimens at 0-90 degrees of flexion. Force and motion data were collected from each knee with an intact and excised anterior cruciate ligament, and after performing (1) a nonaugmented repair and an augmented repair using the Ligament Augmentation Device (3M Company) placed either (2) anatomically through the lateral femoral condyle or (3) in the over-the-top position. The forces in the nonaugmented repair and the repair with the augmentation in the two positions were greater than the forces in the intact anterior cruciate ligament with the knee under the same anterior loads; this difference from normal was not significant with the over-the-top augmentation. With the augmentation anatomically placed, the load sharing did not reduce the force in the repair tissue as compared with the nonaugmented case. The over-the-top augmentation, on the other hand, lowered the repair tissue forces at extension while avoiding high repair tissue forces in flexion. The tibia was consistently in an externally rotated configuration compared with normal in both the unloaded and anterior load states with all three repair procedures.

Biomechanical Phenomena↗
PubMed1989

Use of ultrasonography in the difficult postmenopausal dilation and curettage.

Six patients from our series of 21 cases are presented to illustrate the use of real-time ultrasound to complete the D&C. Thirteen of the 21 had concomitant ultrasound because of stenosis of the cervix or vagina, three because of previous vaginal procedures that distorted the anatomy, and five because of concern regarding perforation.

Aged↗
PubMed1989

Vascularized patella tendon anterior cruciate ligament reconstruction.

Forty-seven patients with a chronic anterior cruciate ligament (ACL) deficiency were treated with patella tendon ACL reconstructions from July 1980 to September 1983. All patients had a minimum two-year follow-up period (range, 24-54 months). Forty-two patients (89%) had meniscal damage in association with the ACL deficiency. This included seven menisci (17%) that had a stable tear and were left in place without suture fixation. Only five patients (11%) had normal menisci at the time of reconstruction. Functional and subjective results were obtained from a questionnaire that included a comprehensive evaluation of patients' symptoms and activities. Objective results were analyzed on the basis of a thorough physical examination, augmented with arthrometer instrumented drawer testing. The detailed questionnaire was returned by 42 patients (89%). Follow-up examinations were obtained for 37 patients (79%), with arthrometer testing of 35 patients (75%). A 100-point rating scale defined objective, subjective, and functional results. Stability testing, using Lachman's test, was judged to be less than or equal to 5 mm of anteroposterior tibiofemoral translation in 51% of the patients examined and less than or equal to 10 mm of translation in 89%. Stability by arthrometer testing was less than or equal to 5 mm side-to-side difference in 83%. No patient lost a menisci after reconstruction. This included six patients with stable tears that were left unsutured. Subjective results were good or better in 60%. Functional results were good or better in 52%, with 41 of 42 patients participating in some form of recreational sports postoperatively. There was a large discrepancy between objective findings and the subjective and functional results (14% poor results compared with 31% and 43%, respectively). Although objective stability could be surgically restored in an ACL-deficient knee, the quality of the knee at the time of reconstruction as well as the postoperative and rehabilitative regimen are implicated in patients with poor subjective and functional results.

Adolescent↗
PubMed1988

Acute anterior cruciate ligament repair.

Sixty-six consecutive patients with acute repair of a complete isolated anterior cruciate ligament (ACL) injury were retrospectively reviewed to evaluate the effectiveness of the authors' surgical technique. All patients noted either a pop, acute swelling, or had acute disability after injury with 58% experiencing all three signs and symptoms. Preoperative testing without anesthesia revealed 95% of patients to have either a positive modified Losee or Lachman test. Postoperative results were obtained by questionnaire in 41 of 42 patients (98%) with a minimum two-year follow-up period. Physical examination was completed in 32 (76%) and arthrometer testing in 30 (71%) patients. Subjective results were good or better in 91%. No patients had buckling or meniscal loss postoperatively. Patellofemoral pain, however, was significant in 15% and severe in 2%. Postoperative functional results were good or better in 78% with all patients participating in sports, 76% in "at risk" sports. A Performance Quotient (P.Q.) was developed to more accurately correlate preinjury and postoperative function. The average P.Q. was 0.87. Objective results were good or better in 100%. Stability was within normal limits by clinical observation in 88%, and by arthrometer testing in 87%. ACL repair is recommended in the young patient who is active in "at risk" sports and who is unwilling to modify activities and willing to undergo a one-year rehabilitation period.

Acute Disease↗
PubMed1988

The Maquet procedure. A retrospective review.

A retrospective review of 20 patients (21 knees) treated by a Maquet tibial tubercle elevation between 1981 and 1985 was conducted with a minimum follow-up period of one year. The mean follow-up period was 29 months. Seventeen patients responded to a questionnaire designed to assess their subjective and functional result, with 12 patients also available for follow-up examination. There were eight complications. The final results from the procedure were not affected by the duration of preoperative symptoms, the number or type of previous surgical procedures, the magnitude of preoperative patellofemoral crepitation, or the degree of chondral surface degeneration. Patients under the age of 35 years and those with a history of patella dislocation were less satisfied with the operation than the other patients, but the difference was not statistically significant. Satisfactory results were observed most frequently in the male patients, those with a Q angle less than 20 degrees, and others in whom no form of internal fixation was used, and those patients with a follow-up period of less than three years. The use of internal fixation was associated with a striking increase in the incidence of complications.

Adolescent↗
PubMed1987

Pharmacokinetics of 111In-labeled OC-125 antibody in cancer patients compared with the 19-9 antibody.

We recently reported on the pharmacokinetics in 14 cancer patients of the 19-9 antibody radiolabeled with 111In. We have now repeated this investigation in 18 cancer patients using the OC-125 antibody, in part to compare the in vivo behavior of two murine monoclonal antibodies of the same subclass administered as the F(ab')2 fragments, by the same route and at the same dose. As in the earlier investigation, 1 mg of fragments was infused i.v., and organ quantitation was obtained for up to 72 h along with frequent blood and urine samples for chromatographic evaluation. Analysis of urine showed that activity clearance by this route amounted to 0.29%/h and consisted of labeled DTPA only in early samples and metabolic products thereafter. Analysis of serum samples often showed the presence of a high-molecular-weight species appearing within 24 h. This species is probably due to antibody binding to circulating antigen, although the percentage of circulating activity present as this species did not correlate well with circulating antigen levels. As before, organ accumulation was greatest in the liver, although levels were significantly reduced (12% compared to 20% of administered dose at 24 h, P less than 0.01). Plasma clearance was also significantly different: whereas the label in the case of the OC-125 antibody showed one-compartment clearance kinetics and remained in the plasma compartment, in the 19-9 case the label diffused to a second, unidentified compartment.

Antibodies, Monoclonal↗
PubMed1987

Steroid hormone receptors in carcinoma of the cervix.

To correlate the presence of specific steroid receptors with certain characteristics of cervical carcinoma, cytosol estrogen receptors (ERc) were measured in 70 cases of cervical carcinoma, and progesterone receptors (PRc) were measured in 56 of these cases; ERc and PRc were also measured in 17 normal cervices. Measurements were made using a dextran-coated charcoal technique involving a seven-point Scatchard plot analysis. In carcinoma of the cervix significant numbers of ERc (greater than 3 fmol/mg protein) were found in 41% of the cases, and of PRc (greater than 3 fmol/mg protein) in 30%; only 28% of the 56 cases contained both ERc and PRc. In the normal cervices, 59% contained significant levels of ERc and 41% significant levels of PRc. No correlation was found between ERc and PRc and menopausal status of the patient, stage, cell type, or histologic grade of the tumor. A weak (P = 0.063) correlation between the presence of PRc and length of survival was also found, but there was no correlation between ERc and survival. Unlike the situation for breast cancer, measurement of ERc and PRc appears to add little of value to the clinical management of cervical carcinoma.

Adenocarcinoma↗
PubMed1987

Use of indium-111-labeled OC-125 monoclonal antibody in the detection of ovarian cancer.

This is a preliminary study to evaluate the utility of using the monoclonal antibody (CO-125) labeled with indium-111 to image recurrences of ovarian cancer. This technique has been investigated in 23 patients with ovarian cancer and the results have been compared with blood OC-125 levels, CT scans, and findings at second-look surgery. Following infusion of 1 mg of F(ab')2 fragments (1-2 mCi 111In), quantitative SPECT and planar imaging was obtained daily for 72 hr along with analysis of serum. The nuclear medicine scans of the tumor site recurrences were technically excellent. When compared to second-look laparotomy, there were 2 true negatives, 2 false positives, 14 true positives, and 2 false negatives by nuclear imaging. CT scans correlated less well with surgery, but serum OC-125 levels correlate more closely with nuclear scans and second-look surgery. Those with multiple small metastatic implants showed a pattern of diffuse uptake which increased with time, whereas those with nodal or larger recurrences showed a more focal uptake. The combination of favorable biodistribution and positive images, especially in patients with normal antigen levels and negative CT scans, suggests a role for OC-125 monoclonal antibody imaging in their clinical management. However, further investigation is needed to determine whether nuclear scans can replace second-look surgery. If it can show that enough 111In-labeled antibody accumulates in the tumor site to justify radioimmunotherapy, then 90Y (a pure beta emitter) could be exchanged for 111In. This is potentially a method of radioimmunotherapy for recurrent ovarian carcinoma.

Adult↗
PubMed1983

Initial clinical trials of the subrenal capsule assay as a predictor of tumor response to chemotherapy.

Retrospective and prospective clinical trials were performed to determine the usefulness of the 6-day subrenal capsule (SRC) assay for the prediction of response to chemotherapy. Evaluable assays were obtained in 86% of 1000 consecutive specimens obtained from a variety of solid malignancies. Analysis of chemotherapeutic sensitivity in this assay gave reproducible and consistent results. The overall predictive accuracy of the assay in 62 retrospective clinical trials in 55 patients was 85%. Of 37 evaluable patients with chemotherapy refractory cancers treated in a prospective trial with single agent chemotherapy as determined by the assay, 14 (38%) responded. Greater degrees of tumor regression in the assay were associated with a higher probability of clinical response. The SRC assay shows potential value as a rapid predictive test for chemotherapeutic selection on an individual patient basis. However, additional prospective clinical trials are necessary to document its ultimate utility.

Animals↗