Biomedical subjects
Publications and source records attributed to C Ogilvie.
We report a case of spontaneous asymmetric premature closure of the upper humeral physis after fracture through a juxtaphyseal simple bone cyst in a 10-year-old boy. Five years later, there was 7.5 cm of humeral shortening and varus deformity of the humeral head.
A group of first-time paraplegic users of a particular ambulatory orthosis was studied to assess the physiological benefits of changing from a wholly sedentary lifestyle to one which included regular periods of upright weight-bearing and walking. Little clinically apparent benefit was noted in respiratory mechanics. There was a subjective reduction in urinary tract infections, but without a corresponding reduction in the level of bacteria. A possible improvement in bone density was noted in a small subgroup. It is concluded that, at least in the shorter term, the physiological benefits to paraplegics of using walking orthoses are not as great as has generally been claimed in the literature.
A group of 35 paraplegic subjects using reciprocating walking orthoses have been examined in order to gain an insight into the potential functional benefits of using such devices. Measurements have been made of walking speeds and of the energy costs of ambulation using an established technique based on heart rate recordings. It was found that orthotically aided walking for paraplegics was slow and energy costly compared with both normal walking and wheelchair propulsion and, as it additionally requires the use of a walking aid in both hands, cannot be considered to confer the functional benefits frequently claimed for it. Nevertheless, the majority of the subjects studied liked their orthosis and did well in it, with many subjectively reporting improvements in mobility and independence.
Non-invasive transcutaneous blood gas monitoring techniques have been used as indicators of the effect of standing exercise on circulation in paraplegic subjects. Oxygen (tPO2) and carbon dioxide (tPCO2) electrodes were positioned on the chests and legs of a group of normal control subjects and a group of paraplegic subjects in both rested sitting and post-ambulatory standing. It has been shown that, with one possible exception, there is no significant difference in the transcutaneous blood gas partial pressures of O2 and CO2, and thus, by inference, in the circulation of paraplegics when either sitting or standing.
Severe, fulminating carpal tunnel compression due to gout has not previously been described. We report such a case.
Three point fixation to stabilise joints using a rigid orthosis is relatively simple. When movement is required in a single plane, a hinge can be incorporated preventing superfluous movement and consequent loss of stability and function. Alternatively the Reciprocating Gait Orthosis (RGO) which utilises a system of Bowden cables with a HKAFO to provide reciprocal flexion and extension forces at the hip joint may be used. Free standing is achieved in the RGO by trunk and arm movements, the cable tension effectively "locking" the hips in neutral. Force transfer through the cables also produces reciprocal gait. The upper limbs acting through external supports provide the initiating force, producing truncal extension and subsequent hip extension of the stance leg. The resulting flexion of the swing leg produces a forward step. Currently 40 patients have been fitted with the orthosis in Salford, of whom 22 are Spina Bifida patients (aged 3-34 years). Most have Thoraco-lumbar or upper Lumbar lesions. The device has performed well with 1 episode of "knee clash" and 3 patients have had structural failures. Functional walking has been achieved with the orthosis.
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In paralytic lesions in which the triceps surae is the only active muscle in the leg, elongation or division of the tendo calcaneus alone may not be enough to prevent recurrence of equinus deformity. In 10 patients (13 limbs) with this pattern of muscle activity, equinus deformity was treated by hemitransplantation of the tendo calcaneus. At follow-up, which was beyond the end of growth in seven limbs, there was no recurrence of deformity in nine. In three of the four failures, a technical fault may have caused loss of activity in the transplanted part of the tendon. The two-stage operation described is recommended in the management of this pattern of paralytic deformity.
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From 1967 to 1972 12 patients were operated on for emphysematous bullae in the Liverpool regional cardiothoracic centre. The patient with the poorest lung function died in the immediate postoperative period but the remainder survived for more than five years. All but one of the survivors showed evidence of benefit three to six months after surgery and all those not retired returned to full-time employment for at least five years. Nine patients were reviewed 5-10 years after surgery. These all reported a gradual return of dyspnoea, which was matched by a falling one-second forced expiratory volume (FEV1) (mean fall 82 ml a year); but five were still maintaining some of their postoperative improvement. When mean preoperative lung function values were compared with the values obtained 5-10 years later there was still a significant improvement in forced vital capacity; but FEV1, residual volume, transfer coefficient, and arterial oxygen and carbon dioxide tensions were unchanged. Chest radiographs showed no new bullae or (except in one case) any increase in size of pre-existing bullae. We conclude that the removal of large emphysematous bullae did not hasten the progress of the underlying emphysema and that in most patients some benefit lasted for more than five years after the operation. Patients treated by lobectomy fared at least as well as those treated by bullectomy alone. It may be relevant to the relatively good progress of patients in this series that only three had suffered from chronic bronchitis before operation or smoked after operation, all but two had bullae occupying half or more of one hemithorax, and none had hypercapnia.
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An attempt was made to achieve earlier detection of busulphan lung (fibrosing alveolitis) and to determine its incidence by means of serial studies during life, including measurement of the gas transfer factor. Twenty-three patients were investigated over an average period of nearly two years of busulphan treatment. One case of busulphan lung was detected and subsequently confirmed at necropsy, but in the remainder there was no clinical, radiological, or physiological evidence of fibrosing alveolitis. It is concluded that the development of fibrosing alveolitis may be related to individual genetic or immunological factors rather than to busulphan dosage.
Regional lung function was measured, using radioactive xenon-133, in a group of normal subjects and in three carefully defined groups of patients with obstructive lung disease. When compared with the normal subjects, patients in the emphysematous group showed a relative reduction of ventilation and perfusion to the upper zones, while patients having chronic bronchitis without cardiac or respiratory failure showed a predominantly lower zone defect. In the group of patients with chronic bronchitis with cardiac and respiratory failure no consistent pattern was found.
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