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At least 505 records · Page 28Linked to original sources
PubMed2006

Histomorphometric and mechanical analysis of the hydroxyapatite-bone interface after electromagnetic stimulation: an experimental study in rabbits.

We investigated the effect of stimulation with a pulsed electromagnetic field on the osseointegration of hydroxyapatite in cortical bone in rabbits. Implants were inserted into femoral cortical bone and were stimulated for six hours per day for three weeks. Electromagnetic stimulation improved osseointegration of hydroxyapatite compared with animals which did not receive this treatment in terms of direct contact with the bone, the maturity of the bone and mechanical fixation. The highest values of maximum push-out force (F(max)) and ultimate shear strength (sigma(u)) were observed in the treated group and differed significantly from those of the control group at three weeks (F(max); p < 0.0001; sigma(u), p < 0.0005).

Animals↗
PubMed1992

Silicone rubber implants for arthrosis of the scaphotrapezial joint.

Between 1980 and 1983, 10 patients received high performance silicone rubber condylar implants for the treatment of isolated degenerative changes of the scaphotrapezial joint. Early clinical and radiographic results (at a mean of 15 months) were excellent. Late follow up of these 10 together with a further 11 patients, however, showed migration of the implant and radiological signs of silicone particle synovitis in all but two. We no longer recommend this operation for treatment of isolated arthrosis of the scaphotrapezial joint.

Aged↗
PubMed2000

Prosthesis cost containment in total joint replacement: a physician-driven free-market approach.

As an alternative to a limited vendor/volume discount approach, our hospital employed a physician-driven free market strategy aimed at reducing joint implant costs. Surgeons were provided with vendor pricing and peer profile comparisons of implant cost data and asked to select implants providing the best value based on patient need. Vendors were challenged to reduce prices where appropriate. Total savings based on the 1995-1997 volume-adjusted cost difference were $1,059,159, a 17.5% decrease. These results demonstrate the possibility of reducing joint implant costs using a strategy that does not limit vendors or cap prices.

Arthroplasty, Replacement↗
PubMed1976

An introduction to the biomechanics and biomaterials of bone, joints, and implants.

Biomechanics and biomaterials of bone, joints, and implants has been presented in an overview manner with the use of selected examples. The musculoskeletal system is a living, dynamic entity that is constructed so that changes in mechanics, if the body does not have time to compensate, can lead to major problems over a period of time. The mechanics of the tissues ensure a smoothly operating system.

Biocompatible Materials↗
PubMed1999

Extent of inflammation predicts cardiovascular disease and overall mortality in seropositive rheumatoid arthritis. A retrospective cohort study from disease onset.

OBJECTIVE: To identify predictors for cardiovascular disease (CVD) and for overall survival in patients with rheumatoid arthritis (RA) followed from disease onset. METHODS: A retrospective cohort of patients with seropositive RA and disease onset between 1974 and 1978 (n = 211) was followed up at the end of 1995. Potential predictors for CVD, as measured by "the first cardiovascular event," and for overall survival were registered. The predictors were identified by extended Cox regression models. RESULTS: In simple Cox regression analysis, male sex, higher age at disease onset, HLA-B27, high disease activity, corticosteroid treatment early in disease, and hypertension significantly increased risk of cardiovascular event. Higher educational level, extensive disease modifying antirheumatic drug (DMARD) treatment, and corticosteroids > or =1 yr before event decreased the risk. In multiple Cox regression analysis, male sex, high age at disease onset, hypertension, higher haptoglobin level at disease onset, and corticosteroid treatment early in disease increased risk of CVD. In a multiple model comprising only patients with CVD, corticosteroids delayed the event. A high last registered erythrocyte sedimentation rate (ESR) value before event increased CVD risk, in particular when early in disease progression. Decreased life span was predicted by higher age at disease onset, male sex, low education level, high disease activity, hypertension, and CVD. HLA-B27 was associated with decreased life span, as was early, but not extensive corticosteroid treatment. DMARD treatment was associated with decreased mortality risk, as was the presence of joint prosthesis. In multiple regression, male sex, higher age at disease onset, atlantoaxial subluxation early in disease, hypertension, and cardiovascular event increased mortality. A high last registered ESR value before event or death added to that risk. CONCLUSION: The study emphasizes the importance of inflammation as an important risk indicator for CVD and mortality in RA. The positive impact of disease activity reducing treatment on CVD risk and survival is suggested.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Group G streptococcal bacteraemia in a community teaching hospital.

The group G streptococci are beta-haemolytic streptococci which are characterised by the presence of the Lancefield group G antigen, and have been implicated in a variety of infections. Underlying malignancy has been reported in up to 67% of patients with group G streptococcal bacteraemia in some series. The clinical records of 11 patients with positive blood cultures for group G streptococci over the period from January 1993 to December 1997 were evaluated. Group G streptococci were recovered from only 0.025% (19 out of 77,323 total cultures) of blood cultures during this period. The source of bacteraemia was determined to originate from skin in seven patients (64%). Bacteraemia in the other four patients was probably due to endometritis, septic arthritis, osteomyelitis, and a central venous catheter. All of the patients had an underlying chronic disease or other predisposing factor such as a joint prosthesis or venous catheter. Only one patient in this series had an underlying malignancy, a metastatic pelvic sarcoma. One patient died of multiple organ failure after several days in the hospital. All surviving patients were successfully treated with antibiotics, typically a beta-lactam agent. This study suggests that in the community-hospital setting, skin infection is the most common source of group G streptococcal bacteraemia, typically in patients with underlying chronic disease; however, malignancy appears to be an uncommon predisposing factor.

Adult↗
PubMedDate not supplied

Management of the patient with a total joint replacement: the primary care practitioner's role.

The primary care practitioner assumes chief responsibility for patients with arthritis. More than 40 million Americans experience some form of arthritis. Management of the patient with arthritis may include a referral to an orthopedic surgeon for surgical intervention. As estimated, up to 500,000 total joint replacement procedures are performed by orthopedic surgeons each year in the United States. Presurgical evaluation for a total joint replacement is imperative to ensure that the patient can safely undergo this surgical procedure. Postsurgical care of a patient with total joint replacement involves coordinating care with the physical therapist and orthopedic surgeon to ensure adequate follow-through with the recommended rehabilitation program, prophylactic antibiotic coverage, and observation for any complications including infection, deep-vein thrombosis, or loosening of the total-joint prosthesis.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[The limits of controlled clinical studies: the case of rheumatology].

The double blind, placebo controlled, randomized clinical trial is the best tool for gathering evidence concerning the efficacy and safety of a drug. However, in some clinical situations--rheumatology is one--these trials have an intrinsic difficulty in representing the clinical reality: e.g., indicating how a drug influences course of a disease over the long-term. Beginning with the distinction between the "activity" of a drug as confirmed by randomized clinical trials, and its "efficacy" over time, as desired by the patient, we attempt to question why this difficulty arises. Several differentiating elements are involved. The objective of the randomized clinical trial design, that is, activity on acute parameters, may not coincide with the interests of the patient, i.e., efficacy in controlling disability or chronic pain. The duration of a randomized clinical trial is sufficient to measure drug activity but not to provide an indication of its effects on the course of the disease. In the randomized clinical trial, the size of the sample, generally from 10(2)-10(3) patients can, at the most, lead to the conclusion that a drug is "active" while the measurement of efficacy is based on a much greater number of observations. With regard to recruitment criteria, clinical trial patients are chosen on the basis of defined disease severity and activity, while in clinical practice, it is known that this often waxes and wanes. The presence of co-morbidity often leads to the exclusion of patients, yet it is known that up to 17% of rheumatoid arthritis patients are depressed. While concomitant therapy is not permitted during randomized clinical trials, it is generally almost always implemented in normal clinical practice. Drug dosage in a clinical trial is not variable, while in practice it is. The greatest difference is found in the measurement of efficacy, where the randomized clinical trial emphasizes the number of tender and swollen joints, acute phase reactants, disease activity indexes, to assess improvement, while for a typical patient, efficacy is measured in terms of non-evolution of radiologic alterations, work capacity and deformity, and/or the need for a joint prosthesis. The objective of the clinical trial is to seek improvement, while a patient with rheumatoid arthritis may consider simply the lack of worsening over a 5-10 year period as a success. Contrary to clinical trials, observational studies function well in this situation. In response to the difficulty that randomized trials have in reflecting the clinical reality of rheumatological outcomes, the solution is to utilize within the trial, the aspects of the disease course considered fundamental by the patient (that is, chronic pain, disability, radiographic alterations), parameters that are generally omitted from trials. A radical alternative, already proposed, is to abandon the randomized clinical trial model completely and adopt open approaches--much less stringent than randomized trials although as stringent as possible outside the framework of the trial model--that are able to reflect the problems of the patient and to respond to them.

Controlled Clinical Trials as Topic↗
PubMed2000

Evaluation of technetium-99m ciprofloxacin (Infecton) in the imaging of infection.

INTRODUCTION: The aim of this study was to evaluate the usefulness of technetium-99m (Tc-99m) ciprofloxacin in imaging inflammation/infection. The ciprofloxacin for labelling, as a kit, was obtained from St Bartholomew's Hospital in London. MATERIALS AND METHODS: Patients were injected intravenously with Tc-99m ciprofloxacin and imaging was done at 10 minutes, 4 hours and 24 hours if necessary. Tomographic images (SPECT) were obtained in a few patients. Ninety-six patients were studied using Tc-99m ciprofloxacin. Forty-eight patients had bone scans and 22 had Tc-99m IgG scans. Eight patients were imaged using Tc-99m HMPAO labelled white blood cell, and bacteriological culture results were available in 24 patients. Organisms cultured included Acinetobacter baumanii, Streptococcus, Staphylococcus aureus, Pseudomonas, Klebsiella, Blastococidia, Methicillin-resistant S. aureus, Salmonella and Candida. RESULTS: Findings were evaluated against microbiology, alternative imaging modalities and clinical outcome. There were 47 true positives, 33 true negatives, 5 false positives and 11 false negatives, giving a sensitivity of 81% and specificity of 87%. The positive and negative predictive values were 90% and 75%, respectively. There were no side effects and the scan was particularly useful in the evaluation of painful joint prosthesis to exclude infection. Repeat studies on 8 patients given antibiotics over a long period were very useful in deciding on termination of the antibiotic treatment.

Abscess↗