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Biomedical subjects

T J Albert

Publications and source records attributed to T J Albert.

At least 55 records · Page 3Linked to original sources
PubMed1997

Relationship of total hip arthroplasty outcomes to other orthopaedic procedures.

The Medical Outcomes Study Short Form-36 was used preoperatively and 2 years postoperatively to compare patients' self reported assessment of health and function between 151 patients who had primary total hip replacement and 49 patients who had total hip revision, 149 patients who had primary total knee replacements, 41 patients who had lumbar laminectomy, and 43 patients who had scoliosis surgery. Primary total hip arthroplasty and lumbar laminectomy posted equivalent followup scores. Primary total hip arthroplasty showed significant improvements in physical function and health perception when compared with revision total hip arthroplasty; all other health parameters were similar. Primary total hip arthroplasty showed significantly better followup scores and greater improvement in scores in four of nine categories of the SF-36 when compared with primary total knee arthroplasty (despite identical scores preoperatively). Despite a higher level of assessed health preoperatively, patients who had scoliosis surgery compared least favorably with patients who had primary total hip arthroplasty at 2 years followup. In terms of patient self assessment of health and function, primary total hip arthroplasty and lumbar laminectomy for radiculopathy gave the best results.

Adult↗
PubMed1996

Surgical anatomy of the vertebral arteries.

STUDY DESIGN: This study compared direct measurements of the distances between the vertebral arteries in the cervical spines of human cadaver specimens with data obtained from axial computed tomography images of these specimens. OBJECTIVE: To determine whether the information obtained from a computed tomography scan can be used reliably to predict the true anatomic location of the vertebral arteries and, in so doing, provide accurate guidelines for the lateral extent of anterior cervical decompressive procedures. SUMMARY OF BACKGROUND DATA: Iatrogenic vertebral artery injury during anterior cervical surgery is uncommon, potentially catastrophic, and avoidable. METHODS: The means and standard deviation of measurements of the location of the cervical segment of the vertebral arteries obtained with high-precision, digital calipers by direct gross anatomic dissection of 16 adult (eight male, eight female) cadaver specimens were recorded. These measurements were compared with computed tomography scan data obtained on the same specimens. RESULTS: The mean distances between the vertebral arteries progressively increased from C3 to C6. Computed tomography scan measurements of the distance between the cervical foramina transversaria were consistently smaller than direct measurements of the gross specimens. At C6, the computed tomography scan data were significantly less than the gross anatomic data. CONCLUSIONS: According to these data, computed tomography scan measurements may be used safely and accurately to plan the lateral extent of anterior cervical decompressive surgical procedures. Although the data obtained from the gross anatomic dissections may serve as guidelines to assist the surgeon, the authors recommend a careful review of the preoperative computed tomography scan on an individual case-by-case basis as the safest method to plan for anterior cervical surgery.

Anatomy, Cross-Sectional↗
PubMed1996

Health outcome assessment before and after lumbar laminectomy for radiculopathy.

STUDY DESIGN: Forty-one patients undergoing lumbar laminectomy for radiculopathy resulting from herniated discs assessed their health status using a generic health outcome instrument (Medical Outcomes Study Short Form 36) before surgery and at an average of 2 years after surgery. OBJECTIVES: To assess whether lumbar laminectomy for herniated nucleus pulposus is a useful intervention when patients evaluate their own perception of health. SUMMARY OF BACKGROUND DATA: The medical Outcomes Study Short Form 36 has been used in multiple studies assessing various medical conditions. It is brief, generic, and reliable. Although surgical treatment for radiculopathy by lumbar laminectomy has been shown to be successful using specific criteria for patient selection and an algorithmic approach, the authors are not aware of any study using a patient-based health outcome assessment to evaluate the results of this type of surgery. METHODS: Forty-one patients (82% completed follow-up evaluation; average follow-up period, 2.08 years) completed Medical Outcomes Study Short Form 36 before and after surgery. Scores from before and after surgery were compared. RESULTS: Statistically significant improvements (P < 0.01) were seen in eight of the nine health scores comparing scores from before and after surgery at follow-up evaluation. These included physical function, social function, role function resulting from physical limitations, role function resulting from emotional limitations, mental health, vitality, pain, and perceived health change. No significant change was seen in the patients' health perception after surgery. CONCLUSIONS: This study shows that the patients' self-reported health outcomes after lumbar laminectomy correlate with the excellent results previously seen using physician-driven outcome measures in an appropriately selected population with radiculopathy. The excellent results shown here did not deteriorate with age (> 40 years compared with < 40 years) or with complications after surgery.

Case-Control Studies↗
PubMed1996

Prenatal detection of fetal anomalies in pregnancies complicated by insulin-dependent diabetes mellitus.

OBJECTIVES: We evaluated the clinical utility of a comprehensive program of prenatal diagnostic testing for congenital anomalies in pregnancies complicated by insulin-dependent diabetes mellitus. STUDY DESIGN: Data were retrospectively analyzed from 289 diabetic women and their newborns from August 1987 to July 1993. Our protocol included initial hemoglobin A1 and maternal serum alpha-fetoprotein determinations and comprehensive fetal ultrasonography inclusive of a standard four-chamber view of the heart and detailed multiimage fetal echocardiography. RESULTS: Anomalies were identified in 29 of 289 (10%) fetuses and neonates: 12 cardiac only, 14 noncardiac, and 3 combined. In 21 of the 29 (72%) neonates the anomalies were detected prenatally. Twelve of 15 (80%) cardiac and 10 of 17 (59%) noncardiac lesions were identified prenatally. Cardiac lesions, especially of the cardiac septum and great vessels, accounted for 50% of all fetal defects. Malformations of the neuroaxis, skeleton, and genitourinary system were also detected. There were six neonatal deaths and four therapeutic pregnancy terminations associated with congenital anomalies. Although the hemoglobin A1 level was statistically significantly increased in 22 mothers of anomalous fetuses (p = 0.017), the actual difference between affected and nonaffected pregnancies was not clinically meaningful and much overlap occurred. Although 96% of women with a normal hemoglobin A1 level were delivered of normal infants, only 14% of those with an elevated value had a malformed fetus. Similarly, although 89% of gravid women with a normal maternal serum alpha-fetoprotein level were delivered of nonaffected fetuses, only 7.3% of patients with an elevated value had a malformed fetus. For the detection of cardiac defects, the sensitivity of the four-chamber view compared with detailed multiimage fetal echocardiography was 33% and 92%, respectively. CONCLUSIONS: This study demonstrates the utility of a comprehensive program to detect fetal anomalies in pregnancies complicated by diabetes mellitus.

Congenital Abnormalities↗
PubMed1995

Health outcome assessment before and after adult deformity surgery. A prospective study.

STUDY DESIGN: Fifty-five patients undergoing surgery for adult spinal deformity assessed their health status using a generic health outcome instrument before surgery and at an average of 2 years after surgery. OBJECTIVE: To assess whether adult spinal deformity surgery is a useful intervention when patients evaluate their own perception of health. The Medical Outcomes Survey Short Form-36, a validated generic health outcome assessment form, was used to measure patient's health status. SUMMARY OF BACKGROUND DATA: Surgery for adult scoliosis is technically demanding. No study that we are aware of uses a generic health outcome instrument in a prospective manner to compare patients' perception of their health after adult scoliosis surgery. The Medical Outcomes Survey Short Form-36 has been validated in multiple studies assessing other medical conditions and was found to be reliable, comprehensive, brief, and generic. METHODS: Sixty-eight adult patients undergoing surgery for adult spinal deformity were prospectively enrolled. Fifty-five patients were available to complete the Medical Outcomes Surgery Short Form-36 after surgery. The scores of the health profile were compared before and after surgery. The results of patients younger than 40 years were compared with those of patients older than 40 years. The results of patients younger than 40 years were compared with those of patients older than 40 years. The results of patients fused to more caudal end vertebral levels ((L4, L5)5) were compared with those who were fused to more cranial end vertebral levels. The results of patients without complications after surgery were compared with those of patients with complications after surgery. RESULTS: Average follow-up period was 22.5 months (minimum 12 months) in 82% of 68 patients. Statistically significant improvements were seen in postoperative scores for physical function, social function, bodily pain, and perceived health change. We found no significant differences in self-reported health function parameters related to age ( > 40 vs. < 40), end vertebral level of fusion, or presence of complications after surgery. CONCLUSIONS: Applying a generic health outcome instrument to adult spinal deformity surgery shows that adult scoliosis surgery significantly improves patient self-reported health assessment and function. Beneficial results do not appear to deteriorate with age or more caudal end vertebral levels of fusion. Future studies combining disease-specific outcomes analysis and generic health surveys to assess end results of adult spinal deformity surgery will be useful.

Adult↗
PubMed1994

Interleukin-1 beta regulates the inducible cyclooxygenase in amnion-derived WISH cells.

The purpose of this study was to determine the mechanism of enhanced prostaglandin synthesis in amnion-derived WISH cell cultures when stimulated by interleukin-1 beta (IL-1 beta). Confluent monolayer cultures of WISH cells were incubated with human recombinant IL-1 beta (0.001-10 ng/ml) for 0-24 hours, while control cells received medium alone. PGE2 production was measured by specific radioimmunoassay. IL-1 beta enhanced the production of PGE2 in a dose- and time-dependent manner with enhanced production detectable by 2 h following exposure. Immunoblot analysis using isoform-specific antibodies showed that the inducible cyclooxygenase enzyme, i.e., COX-2, was expressed by 2 h in IL-1 treated cells, while the constitutive COX-1 remained unaltered in its expression. Northern blot analysis demonstrated that COX-2 mRNA expression was not detected in untreated cells, but became evident after a 30-min exposure to IL-1 beta (10 ng/ml). COX-1 mRNA was detected under basal conditions and did not increase significantly following IL-1 beta treatment. The close parallel between the kinetics of COX-2 mRNA and protein expression and PGE2 accumulation in the medium, as well as the constitutive, unregulated nature of the COX-1 isoform, indicates that cytokine-driven PGE2 formation in WISH cells may be mediated by de novo expression of the novel COX-2 enzyme.

Amnion↗
PubMed1993

Early versus late replacement of autotransfused blood in elective spinal surgery. A prospective randomized study.

The use of autologous blood is a well established and extremely popular technique to decrease the necessity for homologous transfusions and the attendant risks of hepatitis, HIV, and HTLV--I/II infections. The most beneficial timing for autologous reinfusion of predonated blood remains unknown. The present study was undertaken to determine the optimal timing of autologous blood reinfusion in elective spinal surgery. Fifty-seven patients were prospectively individually randomly allocated into early versus delayed reinfusion groups prior to undergoing elective spinal surgery by a single surgeon. Three surgical subgroups were entered into the study: anterior/posterior (A/P) spinal fusion patients, posterior thoracolumbar scoliosis fusion patients (PSF), and degenerative posterior lumbar fusion patients (LF). Randomization was successful in that three was no significant difference in male to female ratio, age, preoperative hemoglobin, or number of units predonated between the early and delayed reinfusion groups. Likewise, there was no significant difference in the details of the operative procedure when compared as a group for the early versus delayed reinfusion groups. A significant increase in the postoperative day #1, 2 and 3 hemoglobin was seen in the early reinfusion group, while there was no significant difference seen in the postoperative day #7 hemoglobin between the early versus delayed reinfusion group. There was no effect of surgical grouping on these significant comparisons. Earlier patient mobilization was also seen in the early reinfusion groups for the A/P and PSF groups. There was no difference in patients' subjective evaluation of satisfaction and discomfort between the early or delayed reinfusion groups as determined by blinded interview on days 1, 3, 5, and 7 postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

MRI evaluation of fusion mass incorporation after anterior cervical bony fusions: preliminary findings.

While Modic has described certain MRI changes in bone grafts in patients after anterior cervical discectomy and fusion (ACF), no study has evaluated specific MRI signal changes in the fusion mass prospectively and longitudinally. The goal of the present study was to prospectively evaluate MRI changes in ACF grafts in a longitudinal fashion. Twenty-seven MRIs were included in the evaluation of seven postoperative patients. MRIs were obtained in a 1.5 tesla GE imager immediately postoperatively, and at 1, 3, and 6 months in most patients. All patients received at least three sequential MRIs. Two patients had greater than one level fused. T1 and T2 images were evaluated in all patients at each available interval. GRASS images were not found to be helpful secondary to a prohibitive amount of noise. For single level fusion masses, T1 images showed a very intense homogeneous graft signal in the immediate postoperative period which decreased slightly at 1 month. At 3 months the signal intensity of the graft was similar to the 1 month image, but was slightly less homogeneous. At 6 months, the T1 signal had greatly decreased in much of the graft. Immediate postoperative specimens showed heterogeneously high signal on T2 images which increased at 1 month in the whole graft, and then seemed to increase at the endplates while decreasing in the graft at 3 months. At 6 months the graft was becoming difficult to delineate on T2 images in many specimens. The two and three level fusions had a more heterogeneous image progression without clear evidence of solid fusion at 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Cervical Vertebrae↗
PubMed1993

The results of chemonucleolysis as a function of three dimensional volumetric analysis of disc herniation.

Spinal canal and dural sac morphometry as demonstrated by CT scan analysis in patients undergoing chemonucleolysis for the treatment of herniated lumbar discs was analyzed in an attempt to develop a method of predicting positive or negative follow-up clinical results. The morphometry of the canal and dural sac at the intervertebral disc level was defined by reviewing normal levels of CT scans. Levels with herniated discs were then analyzed for comparison of treatment results between successful and unsuccessful procedures. The concept of spinal reserve capacity was evaluated. Significant differences between canal morphometric parameters of patients with treatment success or failure were then identified. The concept of spinal reserve capacity may be applicable in spinal stenosis, but we were unable to delineate any predictive value in the evaluation of patients with herniated lumbar discs undergoing chemonucleolysis.

Adult↗
PubMed1993

Upper lumbar disc herniations.

This study reviews the presentation, diagnosis, and outcomes of upper lumbar disc herniations (L1-2, L2-3, L3-4). One hundred forty-one patients operated upon at three centers between 1980 and 1990 were analyzed (102 men, 39 women; 3 L1-2, 21 L2-3, 117 L3-4; average age 51.6 years; 10.4% of all lumbar discectomies performed). Preoperative signs and symptoms were highly variable. Sensory, motor, and reflex testing was variable and potentially misleading in suggesting a level of herniation. In analyzing radiographic studies (noncontrast CT, myelography, MRI) individually and using other radiographic studies and operative findings as a standard for comparison, a high false-negative rate was found for all studies when considered individually, especially at the higher L2-3 level. Intraoperative radiographs were employed with increasing frequency as the level of herniation ascended. Six operative complications (4.3%) were identified, all of which were treated and were resolving at the time of discharge. Follow-up obtained at an average of 2.2 years in 87% of patients by chart review showed no reoperations or late complications. Noncompensation patients had a significantly higher percentage of good/excellent results (86%) than those with compensation or legal claims pending (45% good/excellent results). Based upon these data, we recommend myelogram with postmyelogram CT and/or MRI in the workup of these patients and intraoperative radiographs in all cases when decompressing an upper lumbar disc herniation. Patients with compensation/legal claims should be approached cautiously, because their subjective results are significantly worse than those of noncompensation patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Concomitant noncontiguous thoracolumbar and sacral fractures.

Seventeen patients were identified with concomitant thoracolumbar and sacral fractures representing 26% of sacral fractures and 7.7% of pelvic fractures. The thirteen men and four women exhibited a bimodal age distribution. There were thirteen vertical compression thoracolumbar fractures, three transverse process fractures, and one traumatic herniated nucleus pulposus. There were seven Zone I, seven Zone II, and three Zone III sacral fractures using the Denis classification. Five of the sacral fractures were missed on initial presentation. Four of the patients had neurogenic bowel or bladder symptoms. Seven of the thoracolumbar fractures and three of the sacral fractures were treated operatively. Results were generally good or excellent unless significant neurologic injury was present at initial presentation. The authors recommend aggressive computed tomographic evaluation of the sacrum in any suspicious pelvic trauma or when the neurologic lesion does not match the more proximal bony lesion. They hypothesize that decompression of both sacral and thoracolumbar lesions may be necessary if either lesion could be responsible for neurogenic bowel or bladder symptoms.

Adolescent↗
PubMed1993

Metatarsal shaft fracture after first metatarsophalangeal joint fusion: a complication of Steinmann pin fixation.

First metatarsophalangeal joint fusion is a successful procedure for the treatment of rheumatoid forefoot problems, severe osteoarthritis of that joint, and failed first ray surgeries. We have identified three patients with fracture of the first metatarsal after fusion with Steinmann pins. Penetration of the plantar and/or plantar medial cortex of these pins should be avoided. If penetration occurs, we recommend casting after pin removal.

Adult↗
PubMed1991

Patient-controlled analgesia in a postoperative total joint arthroplasty population.

The present study prospectively evaluated patient-controlled analgesia (PCA) in 94 postoperative primary total joint patients. Total knee arthroplasty patients had significantly higher pain scores than those undergoing total hip arthroplasty. Trochanteric osteotomy patients used less morphine (mean, 37.6 mg) than those undergoing a muscle-splitting (Hardinge) approach. Eighty-eight percent of patients would use PCA again. The authors recommend PCA as a potentially superior form of postoperative pain control in joint arthroplasty patients, but recommend antiemetic usage, generous additional intravenous administration of bolus doses on the floor, trials of higher set doses, and earlier administration of PCA in the recovery room.

Aged↗
PubMed1991

Rotation affects apparent radiographic positioning of femoral components in total hip arthroplasty.

The authors have noted a change in the varus/valgus positioning of femoral components on anteroposterior (AP) radiographs that is dependent on limb rotation after total hip arthroplasty (THA). This effect, called pseudoposition, was demonstrated in six cadaver femurs implanted with an uncemented prosthesis that is noncanal-filling in the AP dimension. The distal tip of the prosthesis was positioned posteriorly in all specimens due to the bow of the femur. External rotation causes pseudovalgus positioning, and internal rotation causes pseudovarus positioning. Awareness of this phenomenon is important in the longitudinal analysis of femoral components after THA and emphasizes the need for standardized radiographic technique.

Femur↗
PubMed1991

Gastrointestinal complications in spinal cord injury.

Fifty-nine patients were identified with 70 gastrointestinal tract complications from a review of 950 spinal cord injury patients admitted during a 10-year period (prevalence 6.2%). When compared to a random spinal-cord-injured noncomplication control group (N = 31 patients), there was no difference in the percentage of low-dose steroids (dexamethasone 40 mg/day) given or in the percentage of patients receiving ulcer prophylaxis. All but two patients in the complication group received ulcer prophylaxis. Although an increase in the percentage of cervical and complete lesions was seen in the bleeding complications group, this increase was not statistically significant. The low complication rate (6.2%) seen in this study probably reflects the global use of ulcer prophylaxis and heightened awareness at a regional spinal cord injury center.

Female↗
PubMed1990

Initial stability of a collarless wedge-shaped prosthesis in the femoral canal.

A collarless wedge-shaped implant was inserted with cementless technique in seven fresh-frozen adult femora. Micromotion of the implant in the proximal femur was evaluated by applying an axial load of 3,000 N or a rotational force of 12 Nm. Six femurs were prepared using a cemented implant, and their stability was similarly determined for comparative purposes. In all tests, the amount of plastic deformation after load relief was quantitated. The cementless prosthesis had excellent initial stability with axial and rotational loading; also the micromotion was similar to that of the cemented implant. Deformation under these experimental conditions was predominantly elastic. The stability demonstrated with this cementless prosthesis satisfies the conditions necessary for bone ingrowth in vivo.

Adult↗