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Biomedical subjects

D P Moore

Publications and source records attributed to D P Moore.

At least 37 records · Page 2Linked to original sources
PubMed2002

Adolescent idiopathic scoliosis: natural history and prognosis.

Retrospective review of the scoliosis database showed adolescent idiopathic scoliosis to be the most common but least significant variety of spinal deformity. Data from 112 girls diagnosed on repeat screening showed the importance of menarche as a date in the natural history. In the whole database, there were 514 aged at least 15 years at last review, 45 boys and 469 girls. Braces were prescribed for a total of 38, mostly during the early part of the period and gradually abandoned without an increase in surgical rate. Progression depended on the age and maturity of the patient as well as the initial Cobb angle. Surgery was recommended for 27% overall. A sub-group with more complete data diagnosed after bracing had been discontinued confirmed the findings.

Adolescent↗
PubMed2002

The natural history of early onset scoliosis.

A retrospective analysis of the natural history and treatment outcome of scoliosis, both idiopathic and syndromic, presenting before age 10 years was undertaken. The pattern was generally one of relentless progression, with little discernible benefit from orthotic treatment and surgical correction as the outcome for the majority. This result makes imperative a properly constructed study on the evolution and long-term outcome of this less common but more significant type of spinal deformity.

Adolescent↗
PubMed2002

Growth patterns in patients with unoperated congenital vertebral anomaly.

Retrospective analysis of height and weight data recorded during routine clinic visits of children with congenital vertebral anomaly were related to decimal age and compared with national centiles. Individuals were dropped from the study at surgery. Growth followed a normal trajectory until puberty, although girls tended to be smaller than average. At puberty, they lagged behind their peers and at maturity were shorter than average. This does not appear to be a hormonal problem, and suggests a fundamental failure of growth.

Adolescent↗
PubMed2002

The rib hump after surgery for early onset spinal deformity.

Spinal deformity presenting early in childhood has a poor prognosis, in that progression is probable and severe respiratory compromise is a real possibility. Treatment is difficult, since these patients frequently do not respond to bracing, and surgery is sometimes performed in childhood in an attempt to control relentless progression. This carries the risk of continued deformation during subsequent growth, and the surgical procedures have been adapted in an attempt to minimise this. 25 children undergoing spinal fusion for progressive and severe deformity have sequential topographic scans which show that, despite measures to control the rib hump, progression after surgery is the rule.

Adolescent↗
PubMed2001

Surface topography, Cobb angles, and cosmetic change in scoliosis.

STUDY DESIGN: Preliminary analysis of the clinical value of surface topography in a spinal deformity clinic. OBJECTIVES: The Cobb angle is the gold standard for the monitoring of scoliosis. This study was designed to determine whether surface topography would reflect Cobb angle status with sufficient reliability to permit its safe use as an alternative means of documentation in some circumstances. SUMMARY OF BACKGROUND DATA: Surface topography offers the possibility of describing spinal deformity more fully than radiographic measures alone. To be useful, it must ignore changes due to varying posture and reliably detect differences that are clinically significant, while broadening the ability to assess deformity. METHODS: Surface topography using Quantec () was obtained routinely in all patients attending a spinal deformity unit. Intrasubject variation was reduced by taking the mean for each parameter of four repositioned scans, which gives a smallest detectable change on all measures of approximately 10 U. Fifty-nine patients with two sets of radiographs and topography scans were studied to determine the ability of the different measurements to detect significant change. RESULTS: There was a significant correlation between Cobb angle and Quantec spinal angle. A significant change in Cobb angle could be identified by associated change in at least one topographic measure in a significant proportion of cases. CONCLUSIONS: It is unlikely that topography will supplant radiography for the ascertainment of Cobb angles, because the error margins of both are wide, and the two are not measuring the same aspect of the deformity. The Quantec system is useful in patient monitoring as an alternative to radiography, without diminishing the standard of care.

Anthropometry↗
PubMed2001

Adolescent idiopathic scoliosis: the effect of brace treatment on the incidence of surgery.

STUDY DESIGN: Retrospective analysis of outcome in terms of incidence of surgery for adolescent idiopathic scoliosis during a period when bracing was not practiced. OBJECTIVES: To determine whether centers with an active bracing policy have lower numbers undergoing surgery for adolescent idiopathic scoliosis than a center where nonintervention is the practice. BACKGROUND DATA: Two major recent publications have claimed that bracing significantly improves the outcome in adolescent idiopathic scoliosis. However, one had no control subjects and the other did not examine the final status of the subjects under review. While statistically significant differences in progression have been observed, what will convince patients to submit to an onerous treatment is the conviction that it will make a substantial difference, such as the avoidance of surgery. METHODS: Since 1991, bracing has not been recommended for children with adolescent idiopathic scoliosis at this center. The scoliosis database was searched for patients with adolescent idiopathic scoliosis who were at least 15 years of age at last review and who had adequate documentation of curve parameters. The incidence of surgery was compared with that of published data from other centers. RESULTS: A total of 153 children, 11 boys and 142 girls, fitted the criteria. Forty-three of these (28.1%) have undergone surgery. This was not statistically different from the surgery rate reported from an active bracing center. CONCLUSIONS: If bracing does not reduce the proportion of children with adolescent idiopathic scoliosis who require surgery for cosmetic improvement of their deformity, it cannot be said to provide a meaningful advantage to the patient or the community. Recent studies notwithstanding, the question of the efficacy of orthoses in idiopathic scoliosis remains unresolved.

Adolescent↗
PubMed2001

Neck-shaft angle remodelling after derotation varus osteotomy for severe Perthes disease.

Sixteen patients with a severe form of Perthes disease who underwent containment derotation varus osteotomy (DVO) of the proximal femur were studied retrospectively for the neck-shaft angle (NSA) remodelling. Analysis of results after a mean follow-up of 7 years (minimum of 5 years and maximum of 8.7 years) showed mean preoperative, immediate postoperative and the latest follow-up neck-shaft angles (NSA) as 135 degrees, 110 degrees (none had varus less than 90 degrees) and 125 degrees, respectively. A statistically significant relationship between NSA remodelling and the immediate post-op NSA (P = 0.0035) was established. Patients with smaller postoperative NSA showed better remodelling compared with those who had higher degrees of NSA immediately after the surgery. No significant relationship was found between the degree of NSA remodelling and the patient's age at diagnosis, age at surgery, severity of Perthes or the Stulberg grading at maturity. The authors conclude that up to 90 degrees or more varization after DVO for Perthes disease can remodel with time, and the remodelling process is independent of the patient's age at diagnosis, age at surgery, or severity of Perthes or Stulberg grading at maturity.

Age Factors↗
PubMed2000

Management of the floating elbow injury in children. Simultaneous ipsilateral fractures of the elbow and forearm.

Simultaneous ipsilateral fracture of the elbow and forearm--floating elbow--is an uncommon injury. During a 7-year period we prospectively followed 12 children who presented with completely displaced supracondylar fractures of the humerus associated with a forearm fracture of the same limb. All patients underwent emergency operative reduction and percutaneous K-wire stabilisation. At a minimum of 18 months, all patients were assessed clinically and radiologically and the results evaluated according to a conventional scoring system. Ten patients had good or excellent outcomes, and there were two fair results. The incidence of open fractures and nerve injury and the need to perform an open reduction were higher than those recorded for isolated supracondylar fractures. The floating elbow is an indicator of a high energy injury and requires aggressive operative management.

Age Factors↗
PubMed2000

Typical Friedreich's ataxia without GAA expansions and GAA expansion without typical Friedreich's ataxia.

We clinically assessed and performed polymerase chain reaction analysis for the GAA trinucleotide repeat expansion in 103 patients from 73 families in Ireland, with a prior clinical diagnosis of Friedreich's ataxia (FA) or an unclassified progressive ataxic syndrome. The patients were classified as "typical" or "atypical" FA according to Harding's mandatory clinical diagnostic criteria. All patients underwent blood glucose analysis, and electrocardiography and echocardiography was performed in 99 and 101 patients, respectively. Mutation screening for expanded CAG trinucleotide repeats, associated with spinocerebellar ataxia (SCA) 1, 2, 3 and 6 was performed in 86 patients overall, including all GAA negative patients. Forty-nine of 56 typical patients and 13 of 47 atypical patients were either homozygous or heterozygous for the GAA expansion. Seven patients with a typical FA phenotype were negative for the GAA expansion. Although one of these patients had vitamin E deficiency, and two had raised alpha-fetoprotein levels, three other GAA negative patients with a typical FA phenotype had no other identifiable cause for their ataxia, once again raising the possibility of locus heterogeneity in FA. It is also possible that these patients have two point mutations in the X25 gene, or that they have another ataxic syndrome mimicking the FA phenotype. Two families who were homozygous for the GAA expansion exhibited intrafamilial phenotypic variability. Only one GAA negative patient had the SCA 3 mutation, and this was the only patient in the study with a possible autosomal dominant inheritance pattern. In the homozygous GAA population typical patients had significantly more repeats on the smaller allele than atypical patients, and there was an inverse relationship between the number of repeats on the smaller allele and the age at presentation. There was also an inverse relationship between the repeat size on both the larger and the smaller of the two alleles and the age at becoming wheelchair bound. There was no significant relationship between repeat size and the other indices of disease severity, including the presence or absence of diabetes or cardiomyopathy. This is the first large study of an Irish population with progressive ataxia that has shown a similar phenotype/genotype relationship to studies of FA in other European and non-European populations. The relatively low sensitivity and specificity of Harding's clinical diagnostic criteria must be appreciated when clinically assessing patients with a progressive ataxic syndrome. Although molecular genetic analysis now plays an essential role in diagnosis and classification, patients with a typical FA phenotype without any identifiable cause for their ataxia exist.

Adolescent↗
PubMed2000

Neuromuscular rehabilitation and electrodiagnosis. 5. Myopathy.

This self-directed learning module highlights hypotonia, facioscapulohumeral dystrophy, and herbal supplements causing muscle weakness. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This section presents advances in the diagnosis of myotubular dystrophy, myoblast transfer, and problems associated with the increased use of herbal supplements.

Counseling↗
PubMed1999

Improved preservation solutions for organ storage: a dynamic study of hepatic metabolism.

BACKGROUND: Organ cold storage times may be extended by modifications to organ preservation solutions. METHODS: Three preservation solutions were investigated for their ability to maintain viable hepatic bioenergetics in stored pig livers: modified University of Wisconsin (mUW); mUW+adenosine (1.34 g/L), and mUW+ iloprost (10(-8)mol/L), a prostacyclin analogue. Using human liver retrieval and storage techniques, pig livers were stored on ice for either 2 or 16 hr, after which phosphorus-31 spectra were collected every 2 min during the period of cold ischemia and hypothermic reperfusion (HtR). During HtR, metabolite concentration changes associated with phosphomonoesters, inorganic phosphate, gamma-nucleotide triphosphate (NTP), and beta-NTP were measured for all solutions. RESULTS: After a 2-hr storage, beta-NTP regeneration in mUW+iloprost produced +57.7% (P<0.01) more beta-NTP, at a faster initial rate of +66.3% (P<0.001), compared with mUW, and mUW+adenosine regenerated +35.6% (P<0.05) more beta-NTP, compared with mUW. Storage for 16 hr did not slow the rates of regeneration, and the total NTP produced during the course of the experiment remained unchanged for the respective preservation solutions. Cessation of HtR invoked a net accumulation of nucleotide diphosphate, indicating differential kinetics of adenine nucleotide hydrolysis. CONCLUSION: This large animal model study suggests significant improvements to human organ preservation solutions using prostacyclin analogues and adenosine with respect to hepatic bioenergetics.

Adenine Nucleotides↗
PubMed1999

Left thoracic curve patterns and their association with disease.

STUDY DESIGN: Analysis of clinical database material collected prospectively. OBJECTIVE: Examination of the association between lateralization of scoliotic curves and the existence of underlying disease. SUMMARY OF BACKGROUND DATA: It has been suggested that left thoracic scoliosis configurations are intrinsically pathologic, whereas the more usual right curve is, in a sense, "normal." METHODS: Research-based records were analyzed. Scoliosis configuration, patient gender, and diagnostic group were correlated. The results were interpreted within a biologic framework. RESULTS: Congenital and infantile idiopathic scoliosis showed a random right-left curve distribution. In older age groups, boys were more likely to have a left thoracic curve and to have underlying disease, but there was no association between the two. In girls, occurrence in childhood itself and left thoracic patterns within that group were associated with disease. Nevertheless, most curves were in the right thoracic pattern, regardless of cause. CONCLUSIONS: Although an association exists between left thoracic curves and disease, it is not strong enough to determine who should be intensively investigated, to the exclusion of other clinical findings, and it seems inappropriate for a different approach to be adopted on the basis of scoliosis pattern alone. Gender in males and age at occurrence in females are more important risk factors than in scoliosis configuration. All new cases of scoliosis treated by a physician warrant equally meticulous assessment, with more sophisticated investigative techniques where indicated by the complete clinical picture, of which curve lateralization is only a part. Biologic theories of left and right are more capable of dealing with the phenomenon of scoliosis lateralization than are simple mechanics or concepts of specific diseases.

Adolescent↗
PubMed1998

The cohesion protein MEI-S332 localizes to condensed meiotic and mitotic centromeres until sister chromatids separate.

The Drosophila MEI-S332 protein has been shown to be required for the maintenance of sister-chromatid cohesion in male and female meiosis. The protein localizes to the centromeres during male meiosis when the sister chromatids are attached, and it is no longer detectable after they separate. Drosophila melanogaster male meiosis is atypical in several respects, making it important to define MEI-S332 behavior during female meiosis, which better typifies meiosis in eukaryotes. We find that MEI-S332 localizes to the centromeres of prometaphase I chromosomes in oocytes, remaining there until it is delocalized at anaphase II. By using oocytes we were able to obtain sufficient material to investigate the fate of MEI-S332 after the metaphase II-anaphase II transition. The levels of MEI-S332 protein are unchanged after the completion of meiosis, even when translation is blocked, suggesting that the protein dissociates from the centromeres but is not degraded at the onset of anaphase II. Unexpectedly, MEI-S332 is present during embryogenesis, localizes onto the centromeres of mitotic chromosomes, and is delocalized from anaphase chromosomes. Thus, MEI-S332 associates with the centromeres of both meiotic and mitotic chromosomes and dissociates from them at anaphase.

Anaphase↗
PubMed1998

Topical morphine in a canine model: a pilot study.

OBJECTIVE: To determine if topical morphine can enter the synovial cavity and the effect of ultrasound on this process. DESIGN: A randomized control trial to investigate which body fluids morphine enters after topical application. SETTING: A university animal laboratory. SUBJECTS: Ten mongrel dogs raised by the Comparative Medicine Department. All animals were certified to be free of disease, all had received standard scheduled immunizations, and none had been used for any other research. INTERVENTION: Topical morphine and ultrasound or topical morphine and sham ultrasound was applied to the knees of the dogs. Samples were obtained afterward from synovial fluid, serum, and urine, and were analyzed for the presence of morphine. MAIN OUTCOME MEASURES: Blood samples were collected every 60 minutes for 240 minutes, urine samples were collected at 120 minutes and 240 minutes, and synovial joint fluid was collected at 120 minutes and 240 minutes. The process of collection and analysis was the same for dogs treated with topical morphine and ultrasound and those treated with topical morphine and sham ultrasound. Fisher's exact test was used to test for an association between the use of ultrasound and the presence of morphine in the synovial fluid, serum, or urine. Two-sample t tests were used to test for group differences in mean body weight. RESULTS: All samples (synovial fluid, serum, and urine) were negative at time zero. All of the subsequent serum samples were negative for morphine. Two or three of the dogs in each group of five (ultrasound or sham ultrasound) had positive urine and synovial fluid samples at 120 and 240 minutes. Ultrasound did not affect the results. Body weight of the dogs influenced the results, with lighter animals having a significantly larger percentage (p=.03) of synovial fluid samples positive for morphine. CONCLUSION: Ultrasound did not affect the absorption of topical morphine in this canine model. Body weight may have influenced the results. Dogs that tested positive for morphine in synovial fluid had a lower mean body weight than dogs that did not test positive (p=.03).

Administration, Topical↗
PubMed1998

Spontaneous regression of tumoral calcinosis in an infant: a case report.

A case of tumoral calcinosis presenting as a supraclavicular mass in an infant is reported. After confirmation by incisional biopsy, the lesion spontaneously resolved without further surgical or medical treatment. This phenomenon has not been described previously in a child with this condition.

Biopsy↗
PubMed1998

Chromosome segregation during meiosis: building an unambivalent bivalent.

Faithful chromosome segregation during anaphase requires that stable microtubule connections are established between chromosomes and both spindle poles by metaphase. Bipolar orientation follows an active period of transient connections between the kinetochores and poles, and tension mediated through attachments between the chromosomes stabilizes those bivalents that have connections to opposite poles. This review focuses on how the chromatids are tied together in the bivalent to ensure proper segregation in the two meiotic divisions. Homologs are partitioned in meiosis I, and reciprocal crossovers, cytologically defined as chiasmata, usually hold the homologs together for this division. The crossovers themselves must be prevented from migrating off the chromatid arms. Binding substances localized to the crossover and sister-chromatid cohesion distal to the crossover have been proposed to prevent loss of chiasmata. Spontaneous nondisjunction events and mutations that disrupt the maintenance of chiasmata are analyzed in the context of these models. Homologs that segregate in meiosis I without chiasmata are briefly discussed. The bivalent must also be constructed so that four chromatids present only two functional kinetochores prior to anaphase I. Cytology and genetic data suggest that the sister kinetochores are duplicated but constrained to act as a single kinetochore. Additionally, centromeric regions of sister chromatids preserve their cohesion until anaphase II, even as cohesion on the sister-chromatid arms is lost at anaphase I. Mutations that specifically disrupt this process are presented.

Animals↗