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Biomedical subjects

W Petty

Publications and source records attributed to W Petty.

At least 19 recordsLinked to original sources
PubMed1998

2- to 10-year follow-up study of acetabular revisions using allograft bone to repair bone defects.

The failure rates of revision of acetabular components have been high; however, long-term success has been reported with the use of particulate allografts or autografts with large-diameter prosthetic cups to correct bone deficiencies when host-cup contact is at least 30% to 50%. The purpose of this study was to review 2- to 10-year follow-up data on complex acetabular revisions in which contact between allograft bone and the prosthetic cup was at least 50%. In the 47 hips monitored clinically and radiographically for a mean of 5 years, results were classified as excellent in 37%, good in 26%, fair in 17%, and poor in 19%. The mean Harris hip score was 82.5 (range, 39-100). The prosthetic cups migrated in 3 hips, but 2 stabilized within 1 year. Three cups had complete radiolucent lines without migration; the lines did not correlate with location of the allografts. Although bone ingrowth into porous surfaces from allografts is debatable, the results of the study show that massive allograft reconstruction of the acetabulum can provide both immediate and long-term stability of the prosthetic cup and restore bone stock.

Acetabulum↗
PubMed1996

Femoral artery and nerve compression by bulk allograft used for acetabular reconstruction. An unreported complication.

Absent pulses in the ipsilateral limb and a femoral nerve palsy occurred after revision total hip arthroplasty. Emergent arteriogram revealed an occlusion of the femoral artery inferior to the inguinal ligament. The femoral artery was found to be compressed by the bulk allograft bone used for reconstruction of an anterior segmental acetabular defect. No laceration or thrombosis of the artery was present. A high-speed burr was used to remove the anterior portion of the offending allograft. Pulses were immediately restored and the patient had no long-term vascular sequelae. The femoral nerve palsy has slowly resolved over 2 years.

Adult↗
PubMed1995

Operative management of the infected knee.

We have six choices in selecting treatment for infected TKA. My preference is two-stage revision arthroplasty combined with appropriate parenteral antibiotic therapy. This treatment provides a success rate of approximately 90% for cure of infection and good function in most instances.

Anti-Bacterial Agents↗
PubMed1995

Knee arthrodesis in the treatment of failed total knee replacement.

Twenty-six primary arthrodeses and 6 repeat arthrodeses were done for a total of 32 arthrodesis procedures in 26 patients, with followup from 2 to 10 years (mean, 4 years). The indications for arthrodesis were septic failure in 18 patients and aseptic loosening in 8 patients. Thirteen arthrodeses were done using external fixators, and 12 arthrodeses were done using a closed fluted intramedullary nail for fixation (1 arthrodesis was done with a custom proximal and distal interlocked nail). In addition, 6 repeat arthrodeses with intramedullary nail fixation were done for treatment of nonunions after external fixation. Five (38%) of the 13 patients who underwent arthrodesis with an external fixator had clinical and radiographic union at a mean of 5 months. All 13 patients with primary intramedullary nail arthrodesis achieved union. The knees of the 6 patients with nonunions after external fixation that were treated with repeat intramedullary nail arthrodesis achieved union. Patients with septic failure had staged debridements before intramedullary nail arthrodesis. Intramedullary nail arthrodesis can be done safely in patients with sepsis as a staged procedure. Knee arthrodesis using intramedullary nail fixation gives a much higher union rate than does external fixation and is associated with fewer complications.

Aged↗
PubMed1995

Long-term outcome of 42 knees with chronic infection after total knee arthroplasty.

The outcome of treatment in 40 patients (42 knees) with chronic infections after total knee arthroplasty was reviewed. Eighteen knees were treated with a 2-stage reimplantation. Sixteen of these 18 knees were treated with antibiotic-containing beads between debridement and reimplantation, and 7 of these were also treated with antibiotics in the cement at reimplantation. Infection did not recur in any of these 18 knees. Clinically, the 2-stage reimplantation group averaged a score of 90 points on the Knee Society Clinical Rating System. Average function score was 86.5 points, with average range of motion from 2 degrees to 109 degrees. Sixteen knees were treated with an arthrodesis: 9 with a 1-stage technique with a uniplanar external fixator and 7 with a 2-stage technique with intramedullary nail internal fixation. Infection did not recur in 6 of 9 knees treated with the 1-stage technique, but only 2 had a solid arthrodesis. All 7 treated with the 2-stage intramedullary nail technique had no recurrence of infection and achieved a solid fusion. Reimplantation or arthrodesis was not attempted in 8 other knees because of recalcitrant infection, vascular complications, or medical infirmity. Of the 42 knees, 11 (26%) had a severely morbid outcome. The infection could not be eradicated in 7 knees: 6 required amputation and 1 had a solid fusion but chronic drainage. In 3 knees, the infection was cured but resection arthroplasties were required, and in 1 patient an amputation was needed as a result of an intraoperative vascular complication.

Activities of Daily Living↗
PubMed1995

The enemy is "us"!

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Abdominal Pain↗
PubMed1988

Effect of irrigation and tourniquet application on aminoglycoside antibiotic concentrations in bone.

Preoperative antibiotics are an important measure taken to prevent infection in joint replacement surgery. The local availability of these antibiotics in the operative site is absolutely necessary to ensure adequate prophylaxis against contaminant bacteria. Because pulsatile-lavage rapid-recovery systems have become a routine technique of bone preparation in joint reconstruction, we chose to study the effect of these systems on local antibiotic concentrations. We further investigated the effect of irrigation with and without use of a limb tourniquet. For our study, we obtained 23 bone specimens in 16 patients undergoing joint reconstruction (14) or amputation (2). The patients were classified into one of four groups based on whether a tourniquet was applied during the procedure and whether the bone specimens were irrigated. In addition, matched blood samples were obtained to establish that therapeutic serum levels were achieved. Nine patients contributed 13 bone specimens, which underwent vigorous irrigation in vitro. None of these specimens had detectable levels of antibiotics, regardless of whether a tourniquet was used. Seven patients yielded 10 bone specimens, which were not irrigated. Five of these seven patients had detectable levels of antibiotics. In addition, the specimens from limbs without tourniquets had levels that averaged 0.51 microgram/ml while those with tourniquets averaged below 0.2 microgram/ml. Therefore, the use of vigorous irrigation in bone preparation has a significant deleterious effect on the local presence of previously administered systemic antibiotics. This effect is compounded if the operative site is isolated from continuous blood flow by use of a tourniquet. We therefore recommend that additional measures be taken to ensure that adequate antibiotic levels are present.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Prevention of infection after total joint replacement. Experiments with a canine model.

An experiment was done in dogs to evaluate how efficient each of several techniques was in preventing infection after a total joint arthroplasty. The techniques that were studied were intraoperative irrigation with saline solution or with antimicrobial solution, perioperative systemic administration of antibiotics, and the addition of an antibiotic to bone cement. Irrigation with saline solution did not reduce the incidence of infection. A slight reduction was found after irrigation with neomycin solution and after systemic administration of cefazolin solution. The use of bone cement containing gentamicin caused a statistically significant reduction in the rate of infection; in fact, no infection developed in any animal that was treated with bone cement containing gentamicin. There was excellent but not absolute correlation between findings on culture that indicated the presence of infection and histological evidence of inflammation.

Animals↗
PubMed1986

Phase II trial of piperazinedione in the treatment of advanced or recurrent endometrial carcinoma. A Gynecologic Oncology Group Study.

Twenty-three patients with advanced or recurrent endometrial carcinoma no longer amenable to control with surgery and/or radiotherapy were entered into study. Twenty-two actually received therapy with piperazinedione at a dose of 9 mg/m2 intravenously every 3 weeks. One partial responder was observed. Adverse effects were primarily manifested as myelosuppression, and were significant but tolerable. Due to the low order of activity observed, this drug is not recommended for further study in the treatment of endometrial carcinoma.

Adult↗
PubMed1986

Arterial digital angiography in the evaluation of potential renal donors.

Twenty-two potential renal donors were examined by both arterial digital and conventional aortography. The digital studies accurately identified all of the renal arteries. Digital subtraction angiography may be a suitable alternative to conventional aortographic evaluation of the renal arterial supply of potential renal donors.

Adult↗
PubMed1986

Osteonecrosis.

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Femur Head↗
PubMed1985

The influence of skeletal implants on incidence of infection. Experiments in a canine model.

We have performed experiments in 187 dogs in order to evaluate the effect of commonly used implant materials on rate of infection. We opened the femoral canal with a hand drill and awl, instilled a suspension of bacteria, and then inserted one of the implants. The implants--stainless-steel and cobalt-chromium alloys, high-density polyethylene, prepolymerized polymethylmethacrylate, and polymethylmethacrylate polymerized in vivo--were compared with no implant (control). The effect of the different implants on the incidence of infection with Staphylococcus epidermidis, Staphylococcus aureus, and Escherichia coli was compared by determining the number of bacteria required to produce infection in 50 per cent of the femora. All of the implants were significantly more likely than the controls to be associated with infection with Staphylococcus aureus. Polymethylmethacrylate polymerized in vivo was found to be significantly more likely than all other implants to be associated with infection with Escherichia coli and Staphylococcus epidermidis. In addition to evaluating all specimens bacteriologically, we carried out a histological evaluation, and found that infection was highly correlated with an increased inflammatory response for all three bacteria. However, even with this highly statistically significant correlation, the correlation was not absolute; when only limited portions of randomly selected specimens of tissue were examined, the correlation was reduced.

Animals↗
PubMed1982

Osteonecrosis of the femoral head and condyle in the post transplantation courses of children and adolescents.

The clinical courses of 29 children and adolescents who received their first renal allografts at the University of Florida from 1973 to 1979 were reviewed for the development of osteonecrosis. A minimum follow-up period of 24 months with adequate allograft function was required for inclusion in the study. The incidence of post transplantation osteonecrosis was 21%. The presence of osteodystrophy prior to transplant was strongly correlated with osteonecrosis. Dialysis against high calcium baths prior to transplantation played a protective role. Extensive reviews of their records failed to clearly identify other predisposing factors. Osteonecrosis of the knee was treated with plaster immobilization and osteonecrosis of the femoral head by resection arthroplasty and angulation osteotomy. Improved functional results were obtained on the Iowa Hip Rating Scales.

Adolescent↗
PubMed1982

Girdlestone arthroplasty for infected total hip arthroplasty.

Results of a previous study of 21 patients who underwent conversion of infected total hip arthroplasties to Girdlestone resection arthroplasties suggested that Girdlestone resection arthroplasty provides a functionally poor salvage technique and is often painful. The present study was undertaken to assess further the salvage value of Girdlestone arthroplasties for the treatment of infected total hips. Fourteen additional cases were reviewed, summarizing the clinical experience of the past three years. These more recent data support the conclusion that resection arthroplasty provides a poor functional result when used as a salvage procedure following removal of infected total hip components. Of the 14 patients reviewed, only one obtained an acceptable functional result. The initial 21 patients studied were re-reviewed to obtain further follow-up data. The functional results obtained were essentially unchanged and are comparable with those from the series of 14 patients reviewed in this study. In some cases of infected total hip arthroplasty, resection arthroplasty is the best method of treatment available, but the results are often far from ideal. Direct or indirect prothesis exchange is an alternative in some cases. Total hip arthroplasty should not be recommended for the young patient who has one or two joint diseases and no limiting systemic factors, with the expectation that when the total hip fails, it can be converted to a resection arthroplasty and the patient improved as compared with the pre-total hip status. It may be wiser to utilize another procedure, e.g., fusion, resection arthroplasty, or osteotomy, primarily, and then revise to a total hip, if necessary, when the patient is older.

Adult↗
PubMed1981

Carcinoma of the cervix involving the duodenum: case report and review of the literature.

We report a patient with squamous cell carcinoma of the cervix metastatic to the duodenum in whom the diagnosis was made at endoscopic biopsy of an obstructing pyloric mass. Failure to consider metastatic disease as the cause of an abnormal appearance of the duodenum resulted in a considerable delay in diagnosis. We present a brief review of cervical carcinoma metastatic to the bowel.

Barium Sulfate↗