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Biomedical subjects

R L Cruess

Publications and source records attributed to R L Cruess.

82 records · Page 5Linked to original sources
PubMedDate not supplied

Infections in total hips secondary to a primary source elsewhere.

This is a report of 3 cases in which a primary infection in a site other than a total hip led to infection in the hip itself. One hip infection appeared to arise in a tooth abscess, a second in the urinary tract, and one from the respiratory tract. All infections resulted in the necessity of removing the components of the total hip. It is suggested that patients who have had previous total hip replacement should be warned to consult their physician when the possibility of an infection is present, and that antibiotic coverage be given during this period of time. Cultures of infected sites should be made in patients who have had total hip replacements, in order that organisms and their sensitivity may be identified in the event that antibiotic therapy is needed, subsequently.

Aged↗
PubMedDate not supplied

The etiology of steroid-induced avascular necrosis of bone. A laboratory and clinical study.

An attempt was made to reproduce in the experimental animal the clinical condition of steroid induced avascular necrosis of bone. There was a decrease in the ability of subchondral osteocytes to metabolize H3 cytidine and an increased amount of cell death as indicated by the number of empty subchondral lacunae. Oil red O stain for intravascular fat demonstrated large accumulations of fat in subchondral vessels. Much of this fat was deformed and was surrounded by reticulin, leading to the conclusion that it was embolic. A study of human material showed intravascular fat and diminished number of osteocytes in patients on systemic steroids who had died without clinical evidence of avascular necrosis. In addition, intravascular fat was demonstrated in avascular femoral heads and humeral heads both from transplant patients and patients receiving steroids for other reasons. The most tenable explanation for this series of events involves steroid-induced fatty liver with subsequent showeres of fatty emboli, which lodge in the subchondral region owing to the microvascular anatomy. Cell death ensues, and the necrotic bone is partially removed by the normal resorptive mechanism, but steroids retard osteogenesis, lead to microfractures, and eventually sequester the involved area.

Animals↗
PubMedDate not supplied

Experience with steroid-induced avascular necrosis of the shoulder and etiologic considerations regarding osteonecrosis of the hip.

Nineteen of 97 patients with steroid-induced osteonecrosis had a lesion involving the head of the humerus, on one or both sides. The lesion usually began as a subchondral osteolytic area which often progresses to collapse. Articular cartilage separated from subchondral bone, either becoming detached as a free cap or at a later stage reattaching. Present evidence suggests that osteonecrosis of the femoral or humeral head should properly be classified as either traumatic (macrovascular injury) or embolic (microvascular injury) in nature. In 14 patients conservative treatment resulted in satisfactory function with only intermittent symptoms, and including pendulum exercises and avoidance of abduction, particularly against resistance. Five patients required replacement of 6 humeral head replacement arthroplasties with Neer's prosthesis.

Female↗
PubMedDate not supplied

Classification and surgical management of the severe sequelae of septic hips in children.

The treatment of the acute state of septic arthritis of the hip in children has been clearly outlined in the current literature. The treatment of residual anatomic deformity is less well understood; no classification or comprehensive treatment program has been documented. The following classification of the sequelae of septic hips in children is based on the presence or absence of a capital femoral epiphysis and hip stability. This classification defines the case material and outlines the anatomic problem requiring solution. Of ten patients with severe destruction of the femoral head followed for an average period of 11.2 years, there were eight satisfactory and two unsatisfactory results. Both unsatisfactory results were Type III hips with pseudarthrosis of the neck. Both had an average of five surgical procedures, compared with 2.2 procedures for patients with satisfactory results. The complications were leg-length discrepancy, hip instability, and scoliosis.

Adolescent↗