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Biomedical subjects

C S Galasko

Publications and source records attributed to C S Galasko.

At least 19 recordsLinked to original sources
PubMed1992

Delay in diagnosis of intradural spinal tumors.

Fifty-seven patients with primary intradural spinal tumors operated on in North Manchester and Salford between 1978 and 1988 were reviewed retrospectively. The commonest diagnoses were meningioma and nerve sheath cell tumors (neurilemmomas and neurofibromas). The median delay in diagnosis was 2.5 years (range 3 days to 24 years). Fifty-eight percent were initially referred to orthopaedic surgeons and 95% percent to specialties other than neurosurgery. The commonest presenting symptom was back pain, but later neurologic and urinary symptoms came to predominate. Eighty-eight percent are disease-free at a mean follow-up of 5.7 years. Symptoms were partially or completely relieved in the majority of patients. Delay in diagnosis of these tumors arises from failure to consider the diagnosis in patients with longstanding back pain or neurologic problems.

Diagnostic Errors↗
PubMed1992

Spinal stabilisation in Duchenne muscular dystrophy.

Of 55 patients with Duchenne muscular dystrophy offered surgical stabilisation of the spine, 32 accepted and 23 refused. We compared both groups pre-operatively and at six-month intervals in respect of survival, forced vital capacity, peak expiratory flow rate and severity of scoliosis. In the nonoperated patients, the forced vital capacity deteriorated by a mean of 8% per annum; in the operated group it remained static for 36 months and diminished slightly thereafter. Spinal stabilisation resulted in an improvement in the peak expiratory flow rate which was maintained for up to five years. In the nonoperated patients the scoliosis progressed from a mean of 37 degrees to a mean of 89 degrees at five years; in the stabilised spines it was improved from a mean of 47 degrees to a mean 34 degrees at five years. There was significantly improved survival in the patients who had undergone spinal stabilisation.

Adolescent↗
PubMed1992

The irritable hip. Scintigraphy in 192 children.

Over a 4-year period, 192 patients with a typical transient synovitis syndrome underwent radionuclide scintigraphy shortly after presentation. Three different patterns were found suggesting that all the cases may not be of the same etiology. Fifteen patients had evidence of ischemia of the femoral head, but only 4 patients went on to develop the typical radiographic features of Perthes' disease. The other 11 patients are thought to represent a minor, radiographically silent form of Perthes' disease.

Adolescent↗
PubMed1991

Dose-response relationships for the effects of insulin on glucose and fat metabolism in injured patients and control subjects.

1. Twenty-four patients were studied at around 7 days after musculoskeletal injuries in order to define the nature of the impairment of sensitivity to insulin. Insulin was infused at 6, 35, 200 or 1200 m-units min-1 m-2 for 2 h and the plasma glucose concentration was 'clamped' at 5 mmol/l. Forearm (uninjured) glucose extraction and blood flow were measured, and whole-body substrate oxidation and energy production rates were assessed by indirect calorimetry. The patients were compared with normal control subjects. 2. Plasma insulin concentrations during infusion were similar in patients and control subjects, showing a similar metabolic clearance of insulin. At each infusion rate, the rate of glucose infusion needed to maintain euglycaemia was less in the patients than in the control subjects. The dose-response curve for whole-body glucose infusion rate against plasma insulin concentration showed diminished sensitivity and diminished maximal response in the patients. A similar pattern was seen for forearm glucose uptake, with a marked impairment of both sensitivity to insulin and maximal responsiveness. 3. The resting metabolic rate was increased in the patients compared with the control subjects, but failed to respond to insulin infusion, so that final metabolic rates were similar in patients and control subjects. At the higher insulin infusion rates, the final rate of whole-body oxidation of carbohydrate was significantly less in the patients than in the control subjects, and that of fat was significantly greater.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Spinal instability secondary to metastatic cancer.

Fifty-five patients with severe pain from spinal instability secondary to metastatic cancer were referred to Hope Hospital, none being judged to be in a terminal condition. One patient had too extensive disease for surgery so 54 were treated by 55 spinal stabilisations; 49 obtained complete relief of pain and two had partial relief. There were three failures. Twenty-eight of the patients had clinical evidence of spinal cord or cauda equina compression and were decompressed at the time of stabilisation. Of these, 20 had major recovery of neurological function. Patients with pre-operative evidence of extradural tumour had 'prophylactic' decompression at the time of stabilisation; none of these patients later developed signs of cord or cauda equina compression. The results suggest that alleviation of pain and restoration of mobility are best achieved by segmental spinal stabilisation; a few patients require a combined anterior and posterior stabilisation. Postoperative radiotherapy should be given whenever possible, and the causative tumour should be treated by endocrine or chemotherapy, as indicated.

Cauda Equina↗
PubMed1990

Effect of donor age on the growth in vitro of cells obtained from human trabecular bone.

The proliferation of human bone-derived cells (BDCs) was assessed in vitro, using [3H]thymidine incorporation and cell counting in a haemacytometer. The cells were cultured from human trabecular bone from 87 patients aged 2-88 years. The in vitro growth of these cells was unaffected by the chronological age of the donor. However, the cell number at confluence was shown to decrease with increasing donor age, this trend being most marked after 60 years of age. Other assays of the metabolic efficiency of the BDCs, namely, total protein, osteocalcin, and alkaline phosphatase synthesis, did not show any change with increasing donor age. These results suggest that while the ability of individual cells to divide and to perform specific synthetic activities is unimpaired with increasing age, other subtler changes may occur, leading to a decrease in the bone's osteogenic capacity.

Adolescent↗
PubMed1990

Outcome after acute osteomyelitis in preterm infants.

Eight cases of skeletal infection in preterm infants were studied. All the infants were systemically unwell, with polymorpholeucocytosis. Diagnosis was by blood culture, and any radiographic changes were apparent at the time of presentation. Infection was often multifocal, with sites around the knee being most commonly affected. Staphylococcus aureus was the pathogen isolated in six of the eight cases; in these treatment with fusidic acid was effective and well tolerated, even at doses that were less than the recommended therapeutic minimum. Even with prompt diagnosis and aggressive treatment orthopaedic sequelae are common.

Acute Disease↗
PubMed1990

The Matrix seating system.

The Matrix seating system is an adaptable orthosis made of interlocking plastic components which can be shaped to fit the needs of the disabled. Twenty-five patients who had used this system for a minimum of 12 months have been assessed clinically. It was found to have several advantages over its rivals particularly in patient and guardian acceptance, versatility and on economic grounds. However, it was found not to prevent deterioration in spinal deformity nor to prevent hip dislocation.

Adolescent↗
PubMed1989

Back pain in childhood.

Sixty-one children with back pain presented to the authors' department between 1978 and 1984, accounting for less than 2% of referrals in this age group. Approximately 50% had serious spinal disease, yet clinical findings could be unreliable in distinguishing such patients. In the absence of compelling physical signs, children with normal radiographs, white cell count, and sedimentation rate can be treated symptomatically and observed for some months before more invasive investigations are considered.

Adolescent↗
PubMed1989

Does myeloma secrete an osteoblast inhibiting factor?

Unlike most other tumours, myeloma causes bone destruction without an osteoblastic reaction; we tried to assess whether myeloma secretes a humoral factor that inhibits osteoblasts. Human bone-derived cells were either co-cultured with myeloma cells, or cultured in medium conditioned by myeloma cells. Bone-derived cell growth was measured by cell counts and by uptake of tritiated thymidine (3H-Tdr); growth was inhibited when cultured in medium conditioned by myeloma cells and some inhibition was seen when the bone-derived cells were co-cultured with myeloma cells. The inhibiting effect was dose-dependent and also dependent upon the density of the myeloma cells conditioning the medium. The results of our study suggest that myeloma secretes an osteoblast inhibiting factor of less than 50,000 Dalton molecular weight.

Cell Count↗
PubMed1989

The management of bone and joint infection.

Although infection of bone and joint does not occur frequently in the developed world, it is a serious condition when it occurs. Early diagnosis and prompt treatment are necessary to minimize the later complications of chronic osteomyelitis and destruction of articular cartilage. Despite early diagnosis and treatment, damage to the articular cartilage or growth plate may already have occurred.

Arthritis, Infectious↗
PubMed1989

The development of skeletal metastases.

The search into the way in which skeletal metastases develops has not only shown that there are several mechanisms for the progressive bone destruction and bone formation that occur simultaneously in the majority of skeletal metastases, but also that an understanding of these basic mechanisms has significant therapeutic implications. Our results have shown that there are two main mechanisms for the bone formation: stromal bone formation and reactive bone formation. The former occurs in tumours which tend to be acellular, with a large fibrous stroma, whereas the latter occurs in virtually all metastases. There is no difference in the basic pathological process of sclerotic or lytic metastases, the radiographic appearance purely indicating the net balance between the different types of bone formation and the simultaneous progressive bone destruction. An understanding of the pathophysiological response to skeletal metastases explains why skeletal scintigraphy can be used to diagnose these lesions and the different mechanisms underlying the 'three-phase scintigram'. The first phase indicates the vascularity of the lesion; the second phase or 'blood-pool' image indicates the concentration in the extracellular fluid and the third phase or 'skeletal or delayed image' indicates the uptake in the reactive new bone. The secretion of an osteoblast inhibiting factor by myeloma indicates why there is no reactive bone produced by the majority of lesions in the absence of a fracture, and why scintigraphy is less reliable than plain radiographs for the detection of the lesions. There are two main mechanisms for the bone destruction, the most important being mediated via osteoclasts. An understanding of the humoral mechanisms stimulating the osteoclast proliferation may lead to more effective treatment of malignant hypercalcaemia and lytic metastases. Early results of use of APD are encouraging, and our results also suggest that clinical trials should be established to evaluate the effect of combination therapy with APD or prostaglandin inhibitor combined with the agents normally used in the management of patients with disseminated mammary carcinoma. The development of treatments to inhibit tumour-induced osteolysis will minimise the complications of pathological fracture, spinal instability, etc., and even if these treatments do not affect the primary tumour, its ability to metastasize, or the patient's survival, such treatment will be a major advance in the management of patients with carcinoma, because of the significant morbidity currently associated with the development of skeletal metastases and their complications.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone Neoplasms↗
PubMed1988

Comparison of the efficacy of naproxen sodium and dihydrocodeine tartrate in the treatment of post-operative pain.

A single-blind, parallel study was carried out in 54 patients with post-operative pain after minor orthopaedic procedures to compare the efficacy and tolerance of naproxen sodium and dihydrocodeine tartrate. Patients were allocated at random to receive oral treatment as soon as analgesia became necessary with an initial dose of either 550 mg naproxen sodium or 30 mg dihydrocodeine tartrate, then doses of 275 mg and 30 mg, respectively, when required up to a maximum of 5 doses per day for 3 days. Assessments were made of pain severity and pain relief 2 and 4 hours after the first dose and at the end of each day. The results indicated that naproxen sodium gave statistically significantly greater pain relief than dihydrocodeine tartrate after the first dose. Both treatments were well tolerated and few side-effects were reported. Three patients in each group were withdrawn due to lack of efficacy (combined with adverse effects in 1 naproxen sodium patient), and 1 patient in each group was withdrawn because of side-effects.

Administration, Oral↗
PubMed1987

The disposal of intravenous glucose studied using glucose and insulin clamp techniques in sepsis and trauma in man.

Whole body glucose uptake and oxidation during a hyperglycemic clamp have been shown to be depressed in hypermetabolic septic patients compared to control subjects despite similar plasma insulin concentrations. Forearm glucose uptake was similarly impaired. Metabolic rate was not increased further by the glucose infusion in the patients although a 20% rise was elicited in the controls. This resistance to the effects of insulin was also clearly demonstrated in trauma patients using the euglycemic clamp technique. The maximal rate of glucose disposal after injury was half that found in controls and the pattern of response was consistent with the insulin resistance being a post-receptor defect.

Glucose↗