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Biomedical subjects

E Dunstan

Publications and source records attributed to E Dunstan.

8 recordsLinked to original sources
PubMed2005

Metal ion levels after metal-on-metal proximal femoral replacements: a 30-year follow-up.

Metal-on-metal hip bearings are being implanted into younger patients. The consequence of elevated levels of potentially carcinogenic metal ions is therefore a cause for concern. We have determined the levels of cobalt (Co), chromium (Cr), titanium (Ti) and vanadium (Va) in the urine and whole blood of patients who had had metal-on-metal and metal-on-polyethylene articulations in situ for more than 30 years. We compared these with each other and with the levels for a control group of subjects. We found significantly elevated levels of whole blood Ti, Va and urinary Cr in all arthroplasty groups. The whole blood and urine levels of Co were grossly elevated, by a factor of 50 and 300 times respectively in patients with loose metal-on-metal articulations when compared with the control group. Stable metal-on-metal articulations showed much lower levels. Elevated levels of whole blood or urinary Co may be useful in identifying metal-on-metal articulations which are loose.

Adolescent↗
PubMed2002

Two contrasting presentations of localised pigmented villonodular synovitis of the knee.

Localised pigmented villonodular synovitis (LPNS) is a rare condition which most commonly affects the knee. We report two contrasting cases highlighting their different clinical presentations, investigations and subsequent treatments. Arthroscopic diagnosis was performed and used as a therapeutic tool. Pre-operative MRI was also an important contributor to diagnosis. LPNS should be included in the differential diagnosis of a young adult presenting with mechanical symptoms within the knee.

Adult↗
PubMed1996

. . . and a time to die: the medicine of old age.

Most deaths in Britain occur in old age, and old people dying have as many symptoms as do the young. Management is complicated by diagnostic difficulty, by the frequency of mental disorder (sometimes treatable) and of severe disability, and by the difficulty in ascertaining patients' feelings. Decisions about the management of dying are inevitable, and multifactorial, and views of others may be helpful. Cardiopulmonary resuscitation is not indicated if futile, and may or may not be wanted by the patient. Withholding or withdrawing life-prolonging treatment may be justified if the totality of life gained (length and quality) is not justified by the burden of treatment. Decisions are most difficult when the prognosis is poor but not definitely fatal. Palliative care is important, not only in cancer. Euthanasia is seldom requested at present, and in The Netherlands is carried out less in old people than young. It would do little for the most serious problems of old age.

Aged↗
PubMed1981

The role of the pineal gland in seasonality.

The life time reproductive performance of 2 flocks of Merino crossbred ewes pinealectomized at 7-60 days of age, and maintained in South Australia did not differ from that of sham-operated control animals kept in the same flocks. The pineal gland is therefore not a major determinant of reproductive success, but a role for the pineal in adjusting breeding activity to season is not excluded. It was confirmed that pineal denervation of adult ewes by cranial sympathectomy could have disruptive effects and evidence of a seasonal change in pineal function was obtained from studies of plasma levels of melatonin, a putative pineal hormone, and a pineal peptide with gonadotrophin releasing activity. That melatonin stems mainly, but not exclusively, from the pineal gland was confirmed by studies of urinary excretion values. Adult Merino ewes produced 39-90 micrograms melatonin/day, mostly (80%) during the dark period, whereas pinealectomized animals produced less than one-fifth this amount. A link was provided between the pineal gland and diet. Melatonin and other 5-methoxyindoles influenced the activity of alpha-chymotrypsin and may regulate the availability of precursor substances required for the synthesis of neurotransmitters important in reproduction.

Animals↗