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Biomedical subjects

T W Phillips

Publications and source records attributed to T W Phillips.

At least 37 records · Page 2Linked to original sources
PubMed1990

Conservative surgery and definitive radiation therapy for early breast cancer.

Fifty-six patients with clinical Stage I and II breast cancer were treated at Crawford Long Hospital of Emory University with conservative surgery and definitive radiation therapy between the years 1978-1987. All patients had pathologic examination of their lymph nodes except for four patients who had their axillae clinically staged only. All patients received definitive radiation therapy with doses in the range of 45-60 Grays. Boost to the site of the primary was done by electrons, and 10-20 Grays were given. Overall actuarial 5-year survival was 77.8% and disease-free survivals were 69.1% and 64.5% at 5 and 7 years respectively. The actuarial survival for Stage I patients was 77.6% at 5 years with a disease-free survival of 71.1% at 5 years. For Stage II patients, it was 78.7%, with a disease-free survival of 66.3% at 5 years. The most common complication was asymptomatic apical pulmonary fibrosis in 3/50 patients. The overall complication rate was 9%.

Actuarial Analysis↗
PubMed1989

A preconditioned arthritic hip model.

The authors describe a reproducible, inexpensive, large animal model of a preconditioned arthritic hip that can be subjected to various types of surgical reconstructions to assess, compare, and improve their efficacy. In 76 sheep the right hip was denuded of articular cartilage and followed clinically, radiologically and histologically for up to 2 years. In 15 sheep the cartilage was removed and the subchondral bone penetrated, and in 61 the cartilage alone was removed. By 3 months all sheep had developed arthritic changes similar to those seen in humans, with osteophytes, cysts, bone erosions, and periarticular inflammation. The sheep in which the cartilage was removed and the subchondral bone penetrated developed a severe, rapidly destructive arthropathy. These sheep provide a good model for future projects to assess complex methods of surgical reconstruction in cases of deficient bone stock. The sheep in which the cartilage alone was removed developed a moderate, more gradual type of arthritis. These sheep provide a good model for future projects to assess various types of arthroplasties as they might apply to the majority of less destructive arthritic hips, as seen in clinical practice.

Animals↗
PubMed1989

Thompson hemiarthroplasty and acetabular erosion.

The prevalence, severity, and clinical importance of acetabular erosion secondary to hemiarthroplasty of the hip are largely unknown. Of a series of 241 patients (258 hips), sixty-nine patients who were treated with primary cemented Thompson hemiarthroplasty for seventy-two subcapital fractures of the hip were personally interviewed and examined, and radiographs of the hip were made, three to fourteen years after the procedure. The factors that had the highest correlation with the severity of the erosion were the level of physical activity and the duration of follow-up. Erosion through acetabular cartilage into bone developed in thirty-four of the thirty-eight hips in active patients and in none of the thirty-four hips in inactive patients (p less than 0.001). The severity of the erosion increased with time, but only in the hips in active patients, and then it was associated with pain and disability during walking. The patient's age and type of residence (private home or nursing facility) at the time of the fracture were the best predictors of the postoperative level of activity. Patients who were older than seventy years and from nursing homes and those who were older than eighty years and from private homes generally continued to be inactive; in these two groups of patients, the long-term results were good. Of the forty-nine hips in patients who were less than eighty years old and from private homes, thirty-four were in patients who continued to be active.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1989

Destructive arthropathy of the hip following pelvic irradiation: report of four cases.

The replacement of orthovoltage by megavoltage radiotherapy has facilitated selective ablation of cancerous tissue, resulting in less toxicity to bone. However, damage to bone still occurs and may be more common than generally appreciated. In four women, all treated for adenocarcinoma of the reproductive tract, radiotherapy was believed to contribute to acetabular failure and secondary arthritis 2 to 31 years after treatment. In one case the condition was bilateral. Because arthritis of the hip is now common in women, there is a risk that unusual and remote factors may not be recognized or fully appreciated. In these cases prosthetic joint replacement is likely to fail. Special techniques, including bone grafting, peripheral support rings, well-fixed and optimally placed sockets and gradual rehabilitation, are mandatory.

Acetabulum↗
PubMed1988

Design and beam characteristics of the Siemens Stabilipan Orthovoltage Unit for intraoperative radiation therapy.

A 250 KVP Siemens Stabilipan Orthovoltage Therapy machine has been permanently installed in a new operating suite for delivery of intraoperative radiation therapy (IORT). A discussion of the choice of effective energy and half-value layer (HVL), as well as description of the physical aspects of the treatment system including applicator design, radiation data, dosimetry and radiation shielding of the OR suite will be presented.

Humans↗
PubMed1988

Cementless hip replacement for arthritis. Problems with a smooth surface Moore stem.

We have analysed the clinical results of a cementless hip replacement using a Moore stem with a smooth surface, and correlated these results with the radiological changes. Forty-two consecutive arthroplasties in 41 patients were studied prospectively and reviewed at a minimum of two and up to six years; 63% had a good clinical result, 18.5% a fair result, and 18.5% a poor result. Thigh pain on weight-bearing was the main problem and was due to loosening of the stem. We caution against the use of this implant in arthritic patients, in whom a good result can be obtained more predictably with cement fixation.

Aged↗
PubMed1988

Kaposi's sarcoma.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Risks and benefits of elective hip replacement in the octogenarian.

We reviewed the records for 100 consecutive cases of elective hip replacement in 91 patients in their 80s (average age 82.8 years), all of whom lived in their own homes before surgery. In 92 cases the patients returned home, 59 within 3 weeks. The average duration of hospital stay was 20.1 days. In eight cases there were major complications, including three cases of myocardial infarction (one of them fatal) and two cases of pulmonary embolism (one of them fatal). In 15 cases there were moderate complications, including deep venous thrombosis (in 5) and urinary tract complications necessitating transurethral prostatectomy (in 2). In 44 cases there were minor complications, including the need for urinary catheterization (in 27) and brief periods of postoperative confusion (in 14). In 33 cases there were no complications; in 31 of these cases the patients returned directly home within 3 weeks. The preoperative risk rating of the American Society of Anesthesiologists (ASA) correlated well with the complication rates: the rates of major complications in cases with a rating of ASA class I, II or III were 0%, 6% and 15% respectively. In 49 of 52 cases in which the procedure had been performed more than 2 years previously, the patients were happy they had had the operation.

Aged↗
PubMed1987

Selection of an animal model for resurfacing hip arthroplasty.

This study was done to determine whether sheep provide a better model of resurfacing hip arthroplasty than dogs. Eighteen sheep were subjected to unilateral resurfacing arthroplasty. Fifty-eight percent developed femoral loosening by 10 months. This reflects the clinical situation in humans: loosening has been the leading cause of failure. By contrast, reports of experiments with dogs describe very low loosening rates. Sheep provide a more stringent test of hip arthroplasty than dogs. The critical difference appears to be activity level. Sheep allowed free activity on a farm more closely simulate the situation of active patients than do dogs housed in small enclosures in conventional research facilities. New techniques of prosthetic hip arthroplasty that lend themselves to animal models should be studied in sheep before being studied in humans.

Animals↗
PubMed1987

The Bateman bipolar femoral head replacement. A fluoroscopic study of movement over a four-year period.

The purpose of this study was to establish if the Bateman prosthesis functions as a bipolar device moving primarily at the inner metal-on-polyethylene bearing as originally proposed, or as a unipolar hemiarthroplasty moving at the outer metal-on-cartilage surface as has recently been suggested. One hundred hips were examined at one year follow-up; 78 were examined again at two to four years. The replacement was performed for arthritis in 76 hips and for femoral neck fracture in 24. Movement was assessed both with and without weight-bearing. In 80% of the arthritis group the prosthesis functioned as a bipolar hip replacement with movement occurring primarily at the inner metal-on-polyethylene surface. By contrast, in 75% of the fracture group the prosthesis functioned largely as a unipolar device with movement occurring primarily at the outer metal-on-cartilage surface. In all cases examined serially the movement pattern was the same at two to four years as it has been at one year. Clearly, the action of the prosthesis depends on the condition of the acetabular cartilage.

Biomechanical Phenomena↗
PubMed1986

Delayed epidural hemorrhage in hypotensive multiple trauma patients.

Despite the availability of high resolution computed tomography, severely head-injured patients often present diagnostic dilemmas. An initially negative computed tomographic scan in the presence of severe multiple trauma does not predict an uncomplicated course. Early repeat scanning should be considered. We present three cases of delayed epidural hemorrhage in multiple trauma patients who initially were hypotensive secondary to hypovolemia. Possible etiologies for the hemorrhage as well as a list of indications for repeat scanning in the posttraumatic period are discussed.

Adolescent↗
PubMed1986

Sulphur colloid bone scan assessment of femoral head vascularity following subcapital fracture of the hip.

The study was done to determine femoral head vascularity in the immediate postfracture stage as assessed by 99m Tc-sulphur colloid bone scanning and tetracycline uptake in the excised femoral heads of 30 patients with subcapital fractures treated by primary hemiarthroplasty. Twenty-four cases were diagnosed avascular by the scan, and this was confirmed by the absence of tetracycline labelling in all 24. Two cases were vascular by the scan, and this was confirmed by tetracycline labelling. The scan was inaccurate in only four cases, where the head appeared vascular by the scan, but avascular by tetracycline labelling. Sulphur colloid is helpful in predicting femoral head vascularity in the immediate postfracture phase.

Femur Head↗
PubMed1984

Allogenic transplants of bone revascularized by microvascular anastomoses: a preliminary study.

An area of experimental bone grafting that needs further study is the use of free vascularized allografts of bone. In 35 outbred mongrel dogs, the viability of vascularized bone allografts with and without azathioprine immunosuppression was compared to vascularized autogenous bone grafts. Viability was assessed by histologic techniques, fluorochrome bone labeling, and electron microscopy. Autogenous vascularized bone grafts remained viable, and it was concluded that microvascular technique was not the limiting factor in attaining survival of the grafts. The behavior of autogenous vascularized bone grafts with and without the influence of azathioprine was similar. Allogenic vascularized bone transplants uniformly failed at a period between 2 and 3 weeks. Immunosuppression with azathioprine did not appreciably affect survival of the osteocytes. However, the host response to the foreign tissue was slightly modified. The clinical ramifications of bone transplantations in humans are not analogous to the clinical situation of transplantation of other organs. If vascularized bone transplants are performed in humans, a relatively safe form of immunosuppression is necessary. This study suggests that azathioprine alone does not offer sufficient immunosuppression to insure viability of the vascularized transplant.

Animals↗