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Biomedical subjects

D R Bickerstaff

Publications and source records attributed to D R Bickerstaff.

34 records · Page 2Linked to original sources
PubMed1991

Effects of amino-butylidene diphosphonate in hypercalcemia due to malignancy.

We studied the effect of a single 5 mg intravenous infusion of amino-butylidene diphosphonate (ABDP) in nine patients with hypercalcemia of malignancy, in whom serum calcium values were stable or rising after intravascular volume expansion. Serum calcium fell progressively in all patients and in seven reached the normal reference range by day 6 (p less than 0.001). The decrease in serum calcium was associated with a decrease in the fasting urinary calcium/creatinine ratio (p less than 0.05). Hypercalcemia recurred in seven of the patients by day 12, but two patients remained normocalcemic for 21 days. We conclude that ABDP is a highly potent diphosphonate and that a single intravenous infusion is capable of inhibiting tumour-mediated bone resorption for several days.

Adult↗
PubMed1991

The use of nasal calcitonin in the treatment of post-traumatic algodystrophy.

Calcitonin is widely used in the treatment of algodystrophy but a major disadvantage is the need for its parenteral administration. For this reason, we evaluated the effect of 400 iu of nasal calcitonin in the treatment of post-traumatic algodystrophy in a prospective randomized double-blind study. We found no demonstrable effect on the clinical or skeletal progression of the disorder using sensitive methods of measuring the response to treatment. There was, however, a small but significant hypocalcaemic response in the treatment group despite no change in the other indices of bone turnover. Possible reasons for this lack of clinical and skeletal effect are discussed.

Administration, Intranasal↗
PubMed1991

An investigation into the etiology of irritable hip.

A prospective review has been made of 111 children who presented with acute hip pain to determine it's etiology and assess the need for multiple investigations at presentation. There was no clinical hematological, serological or bacteriological evidence to identify positively patients with an irritable hip, neither was there good correlation with a history of infection. An effusion was diagnosed by ultrasound in 71% but there were no factors, either clinically or by investigation, to differentiate between patients with or without an effusion. We conclude that multiple investigations to find a source of infection in patients with irritable hip are not warranted as they are rarely positive, seldom affect management and are of no help in investigating the etiology of irritable hip.

Adolescent↗
PubMed1990

Treatment of Paget's disease of bone with aminohydroxybutylidene bisphosphonate.

This study examined the effects of aminohydroxybutylidene bisphosphonate in 30 patients with Paget's disease of bone, administered as an intravenous infusion for 5 consecutive days. Treatment (5 mg IV daily) induced marked suppression of biochemical indices of disease activity. Urinary excretion of hydroxyproline fell to 50% of pretreatment values within 2 weeks and was followed by a similar, but later, decline in the serum activity of alkaline phosphatase. Disease activity remained suppressed throughout the 6 months of observation, and only 1 patients showed biochemical signs of an early relapse. Symptomatic improvement was noted in 27 of the 30 patients. Bone biopsies, undertaken in 10 patients, indicated no adverse effects on mineralization. Transient falls were noted in the total white cell count, particularly the lymphocyte and neutrophil fractions, and were associated with short-lived fever in 3 patients. We conclude that short courses of intravenous AHButBP provide a promising treatment for active Paget's disease of bone.

Aged↗
PubMed1990

A comparison of the acute effects of subcutaneous and intranasal calcitonin.

1. We studied the acute effects of intranasal and subcutaneous calcitonin in 40 patients with active Paget's disease of bone. Patients received a single dose of either 400 units of calcitonin delivered as a nasal spray, or 1, 10 or 100 units of subcutaneous calcitonin, or placebo. 2. Subcutaneous salmon calcitonin, administered at doses of 1, 10 and 100 units to nine patients with Paget's disease of bone, induced a dose-dependent fall in the serum calcium. This calcium-lowering effect was not seen with a second group of nine patients receiving placebo. 3. The lower doses of calcitonin had significant effects, and these were more pronounced in patients with lower rates of bone turnover. 4. Four hundred units of calcitonin administered as a nasal spray induced effects qualitatively similar to those seen with subcutaneous calcitonin, with an efficacy equivalent to approximately 30 units of subcutaneous calcitonin. 5. We conclude that the bioequivalence of calcitonin given by intranasal insufflation is low compared with its parenteral administration. The intranasal route may be more appropriate for managing patients with disorders associated with low bone turnover.

Administration, Intranasal↗
PubMed1990

Broadband ultrasound attenuation in the os calcis: relationship to bone mineral at other skeletal sites.

1. We have examined the relationship between broadband ultrasound attenuation in the os calcis and measurements of bone mineral in the distal forearm and lumbar spine of normal and postmenopausal osteoporotic women. 2. Values of broadband ultrasound attenuation in postmenopausal women with vertebral osteoporotic fractures were significantly lower (35%) than in normal pre- and peri-menopausal women (55.4 +/- 3.8 and 79.6 +/- 0.8 dB/MHz, respectively). 3. Broadband ultrasound attenuation correlated significantly with bone mineral content measured in the distal forearm by single-photon absorptiometry (r = 0.77, P less than 0.0001) and with bone mineral content (r = 0.66, P less than 0.0001) and bone mineral density (r = 0.72, P less than 0.0001) measured in the lumbar spine by dual-photon absorptiometry. 4. Although significant, these correlations are not sufficiently close to be predictive. However, the accuracy of broadband ultrasound attenuation in discriminating between normal subjects and patients with vertebral fracture compared very favourably with direct measurements in the spine by dual-photon absorptiometry. 5. Broadband ultrasound attenuation, but not the other measurements, correlated significantly with age in the osteoporotic patients (r = 0.50, P less than 0.05). 6. These findings may reflect the partial dependence of broadband ultrasound attenuation on the intrinsic trabecular architecture of cancellous bone, the disruption of which contributes to an increase in fracture risk.

Absorptiometry, Photon↗
PubMed1990

Improvement in the deformity of the face in Paget's disease treated with diphosphonates.

We studied nine patients with Paget's disease affecting the skull or facial bones, who were subsequently treated with either dichloromethylene diphosphonate (clodronate) or ethylene-1-hydroxy-1,1-diphosphonate (etidronate). Long-term treatment induced a clinical and biochemical improvement in eight, and this was associated with a reduction in maxillary or skull volume as assessed by quantitative stereophotogrammetry. The one patient whose disease was resistant to treatment with diphosphonate, showed no change in maxillary shape. These studies suggest that the long-term control of disease activity attained with diphosphonates, results in the improvement of skeletal deformity.

Aged↗
PubMed1990

Ultrasound examination of the irritable hip.

We made a prospective study of 111 children with acute hip pain to assess whether ultrasound can replace traditional radiography. An effusion was diagnosed in 71% by ultrasound but in only 15% by radiography. This effusion persisted for a mean of nine days; symptoms lasted for five days. Two patients found to have Perthes' disease had longer-lasting effusion and symptoms. Patients without an effusion had no obvious cause for their pain, so the pressure of an effusion from a transient synovitis does not account for all patients with irritable hips. Patients with an effusion persisting for over 24 days (the mean + 2 s.d. of our series) had more symptoms, a significantly larger effusion and greater limitation of movement. They may be more at risk for avascular necrosis. We found that radiographic examination influenced the immediate management of only two patients, those with Perthes' disease. We therefore propose a protocol of management for irritable hip, using ultrasonography at the first presentation of certain categories of patients. This would reduce the number of early radiographs by 75%.

Adolescent↗
PubMed1989

Carpal malalignment in Colles' fractures.

Thirty-two unilateral Colles' fractures were reviewed after one year to assess the evidence for carpal malalignment. Various radiographic parameters on the injured and uninjured wrists were correlated with a functional score. There was significant correlation with respect to the angles measuring carpal alignment on the late films and the functional score which was not present on either the initial or post-manipulation films. The carpus aligns in a dorsal instability pattern. Radial angulation or shortening was not found to be as significant in either the early or late films. This suggests that dorsal instability as the cause of morbidity after Colles' fracture is far commoner than originally thought.

Aged↗
PubMed1989

The measurement of osteoporosis in clinical practice. Comparison of histological and radiological methods.

In a prospective study of the measurement of osteoporosis in patients with fracture of the femoral neck, we compared a histological with a radiological method. We found no significant correlation between histological planimetry and the radiological six metacarpal hand index in patients with either cervical or trochanteric fractures. This demonstrates that metacarpal morphometry cannot predict histological osteoporosis of the iliac crest.

Aged↗
PubMedDate not supplied

How your "free" tail liability policy is funded.

The Extended Reporting Endorsements for Claims-made Professional Liability policies are provided to insured doctors in the event of death, disability, and retirement (DDR) with no additional premium charge if certain criteria are met. However, this "free tail" policy is actually pre-funded via a percentage loading applied to all insureds' ongoing premium. The amount of this loading is determined by continual monitoring of the demographics of the insured population. This article sheds light on the process used by professional liability companies to price "free tail" policies and reviews the key concepts involved.

Humans↗
PubMedDate not supplied

Posterior cruciate ligament injuries.

Until recently, the function of the posterior cruciate ligament has been poorly understood and the traditional wisdom is that injuries to this ligament do not result in any appreciable functional disability. There is increasing evidence, however, that the natural history may not be as benign as was originally assumed. This review seeks to analyse current knowledge concerning the function, diagnosis, natural history and treatment of this injury.

Arthroscopy↗