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Biomedical subjects

F W Heatley

Publications and source records attributed to F W Heatley.

36 records · Page 2Linked to original sources
PubMed1992

A quantitative histological study of the vascularity of the rotator cuff tendon.

Previous perfusion studies of the rotator cuff have demonstrated an area of hypovascularity in the distal part of the supraspinatus tendon. This has been implicated in the pathogenesis of its rupture. We performed a quantitative histological analysis of the vascularity of the tendons of supraspinatus and infraspinatus. Vessel number, size and the percentage of the tendon occupied by vessels were measured at 5 mm intervals from the humeral insertions to the muscle bellies. Both tendons were hypovascular in their distal 15 mm. No significant difference was demonstrated between the vascularity of supraspinatus and infraspinatus. We conclude that factors other than vascularity are important in the pathogenesis of supraspinatus rupture.

Aged↗
PubMed1992

Sympathetically mediated anterior knee pain. Scintigraphy and anesthetic blockade in 19 patients.

Nineteen patients with anterior knee pain without the classical features of reflex sympathetic dystrophy (RSD) were investigated by local anesthetic sympathetic blockade. Scintigraphy was performed before the sympathetic blockade in all the cases, and the scintigraphic appearances were correlated with the clinical response. Eleven patients responded to the blockade (9 good and 2 fair). Only 1 out of 10 patients with increased scintigraphic uptake failed to respond, whereas 7 out of 9 patients with normal uptake failed to respond. Our study suggests that a sympathetically mediated component may exist in patients with anterior knee pain without RSD, and that scintigraphy is useful in identifying those patients for whom sympathetic blockade may be helpful.

Adolescent↗
PubMed1991

Aspects of 'safe' surgery.

The differing concern among surgeons regarding the blood-borne transmissible infections HIV and hepatitis B virus (HBV), has prompted a confidential questionnaire of 250 consultant orthopaedic surgeons on some aspects of their current practice of 'safe' surgery. Only 154 replied. Hepatitis B vaccine uptake by surgeons was 70 per cent in this sample. This compares favourably with two recently published figures (47 per cent and 24 per cent). Unfortunately, we do not fare as well on routine screening for HBV in known 'at risk' groups, although 92 per cent of surgeons felt confident that they would recognize the 'inoculation risk' categories. The response to sustaining a needlestick injury by the majority of surgeons (87 per cent), was to change the affected glove. Only 7 per cent reported the incident as recommended to the Occupational Health Department and 6 per cent took no action at all. Current recommendations for 'safe' surgical practice as they apply to surgeons with regard to needlestick injury are discussed.

Adult↗
PubMed1991

Repair of cartilage lesions using biological implants. A comparative histological and biomechanical study in goats.

We report the experimental use of three different biological implants to restore articular surface defects: glutaraldehyde-fixed bovine meniscal xenograft, glutaraldehyde-fixed bovine costal cartilage xenograft, and viable osteochondral allografts. The grafts were implanted in the knees of 19 goats who were allowed free-field activity and were studied for up to one year. The natural articular surfaces of meniscal fibrocartilage provided excellent articular surfaces at all times. Equally good articular surfaces were restored by host tissue growth covering costal cartilage grafts at six months, but by 12 months this surface had degenerated. The majority of the allografts survived and integrated with the host at six months, but many showed signs of failure at 12 months. Only three out of seven ungrafted defects healed completely at six months and the healed surfaces were degenerating at 12 months.

Animals↗
PubMed1990

Scintigraphy in the assessment of anterior knee pain.

Sixty knees presenting with chronic anterior pain were investigated. A diffusely increased uptake indicated sympathetically mediated pain provided other diagnoses such as synovitis or widespread arthrosis were excluded. Focal uptake was not specific to any one condition, but could occur in chondromalacia patellae or recent dislocations. However, the commonest appearance found in chondromalacia patellae was a normal scan. A characteristic scintigraphic appearance in symptomatic postpatellectomy knees, which has not been previously reported, was increased uptake in the femoral groove. In all the cases where no clinical or arthroscopic diagnosis was made, the bone scan was normal. The use of radioisotope scintigraphy is recommended in the problem knee presenting with anterior pain.

Adolescent↗
PubMed1990

The vascular repair of an experimental osteotomy held in an external fixator.

The vascular repair of a lower tibial transverse osteotomy in the New Zealand white rabbit held in an external fixator was studied in three groups. In the first group, composed of 18 animals, the osteotomy gap was maintained throughout repair. Three animals were killed every two weeks up to 12 weeks postoperatively. In the second group, composed of three animals killed at six weeks, the fragments were brought into contact. In a third and similar group, the osteotomy was compressed. Plain roentgenograms were taken weekly, and intraarterial perfusion with Micropaque was performed when the animals were killed. Roentgenography using fine-grain film, microradiography, and histology were carried out on a midsagittal tibial slice. The results showed that following transverse osteotomy in which the gap was maintained, vascular union of the proximal and distal cortices and associated external callus masses had usually occurred by ten weeks postoperatively. However, an occasional hypovascular zone at the osteotomy site at 12 weeks was associated with fibrous delayed union. In contrast, when apposition or compression of the fragments was used, repair was accelerated, and cortical bone union was established at six weeks. Vascular union of the fragments occurred predominantly through the medullary vessels. The results emphasize the overriding clinical importance of abolition of a fracture gap to achieve rapid revascularization of a fracture and its union by bone.

Angiography↗
PubMed1989

Measurement of acetabular erosion. The effect of pelvic rotation on common landmarks.

Using dried bones which could be tilted and rotated, we assessed the accuracy of published radiographic methods for measuring the migration of prosthetic acetabular components and compared the results with a new method. The new line linking acetabular margins was significantly more accurate for proximal migration than the teardrop, the sacroiliac line or the sacroiliac-symphysis line. For medial migration, a new line tangential to the brim and through the horizontal mid-point of the obturator foramen was more accurate than Köhler's line, the ilio-ischial line or the iliopubic line. In combination, the two new lines can give a more accurate assessment of acetabular erosion than previous methods, since they are less affected by the differences in rotation commonly found in a series of radiographs.

Acetabulum↗
PubMed1988

Functional restoration of an articular surface using a heterotopic xenograft: biology of host-implant interactions in the canine patella.

Glutaraldehyde-treated bovine meniscal fibrocartilage has been used as a heterotopic bioprosthesis to repair large osteochondral defects in the canine patella. An efficient, functional articulating surface was reformed and the graft did not elicit a significant immunological response. Although tissue bonding between the host and graft was often excellent, the implant did not become revascularized or replaced by host tissue but acted as an inert space occupier. This material may offer some potential for conservative treatment of articular defects in the patella in appropriate circumstances.

Animals↗
PubMed1987

Evaluation of preserved bovine tendon xenografts: a histological, biomechanical and clinical study.

Glutaraldehyde treated bovine tendon xenografts have been introduced into clinical trials as human knee ligament replacements recently, following animal experiments. This paper reports a further clinical study in which complications arose from implant debris. A laboratory study showed that the implants were not absorbed or integrated into the tissues of the host animals, as had been claimed by the originators. Mechanical tests of tendon reconstructions showed that the implants were not functional. It was concluded that this material is not suitable for clinical use within the knee joint as a cruciate ligament prosthesis.

Animals↗
PubMed1987

Avascular necrosis of the femoral head in sickle cell syndrome: a report of 5 cases.

The course and management of avascular necrosis of the femoral head (AVNFH) in six hips of 5 sickle cell syndrome patients (3 with Hb SS, 1 with Hb SC and 1 with Hb S/beta+-thalassaemia) are described. Two patients (aged 13 and 17 years) presented with Perthes- and osteochondritis dessicans-type lesions. These hips progressed to roller-bearing-type joints with good function and no pain following conservative management of weight restriction and rest. Three patients (aged 14, 22 and 30 years at original presentation) suffered whole-head necrosis. Initially, these 3 patients had four hip joints replaced, two cemented-stemmed types, one cemented double-cup and one uncemented hemi-arthroplasty. All four joints failed and were revised 21-61 months after the original operation. One of the revision hips has now failed and is awaiting further surgery. These results demonstrate that it is very difficult to achieve a successful hip arthroplasty in the sickle cell syndrome patient.

Adult↗
PubMed1986

Glutaraldehyde treated bovine fibrocartilage arthroplasty for the scaphoid: a case history and discussion.

Avascular necrosis of the proximal pole of the carpal scaphoid following fracture often leads to degeneration and carpal collapse. Replacement arthroplasty as a treatment for this condition using a variety of materials has not been universally successful. A case is described in which a new arthroplasty material-glutaraldehyde treated bovine fibrocartilage-was used as a spacer to restore carpal height.

Adult↗
PubMed1986

Tibial tubercle advancement for anterior knee pain. A temporary or permanent solution.

In a prospective study of 29 consecutive cases of tibial tubercle advancement, the patients were assessed on the Larson knee chart preoperatively, three years postoperatively, and again after a minimum of six years (range, six to eight years; mean, 7.2 years). Only one patient was lost to follow-up evaluation. The overall results show that at three years, 65.5% of the knees were excellent or good, 13.8% were fair, and 20.7% were poor. By six years a significant change occurred in five knees. Four knees deteriorated, while one improved. The remainder maintained their three-year postoperative grade. The patients provide clinical evidence to support the biomechanical and morphological observations that form the basis of the Maquet principle. Two considerations influence the final result: surgical complications (three out of four cases with complications had a poor result) and the preoperative status (in patellofemoral osteoarthritis a preoperative Larson score of over 60 is necessary for a satisfactory outcome).

Adolescent↗
PubMed1985

The use of meniscal fibrocartilage as a surface arthroplasty to effect the repair of osteochondral defects: an experimental study.

Meniscal fibrocartilage autografts, homografts, glutaraldehyde treated homografts and glutaraldehyde treated xenografts were inserted into articular defects in the rabbit patello-femoral groove. They appeared capable of restoring a functional articular surface. Considerable variation in the type of bond formed between the host and graft occurred but no evidence of rejection was observed. This tissue would appear to offer potential for restoring localized articular osteochondral defects.

Animals↗
PubMed1980

The meniscus--can it be repaired? An experimental investigation in rabbits.

In rabbits, repair of incisions in the central part of the meniscus has been demonstrated after surgical excision of the peripheral rim. Healing took place via a highly cellular but relatively avascular fibrous tissue stroma which proliferated from the synovial margin and invaded along the cut edge of the meniscus. Suturing facilitated this healing process by providing stability and possibly by supplying bridges for synovial cells to migrate onto the meniscus. Transformation of fibrous tissue into fibrocartilage has also been observed.

Animals↗
PubMed1978

Flucloxacillin in bone.

Ten patients undergoing total hip replacement for osteoarthritis were each given intramuscular flucloxacillin about two hours preoperatively; bone and serum were sampled simultaneously at operation. Trabecular and compact bone were separated, partly dried, reduced to powders, and then extracted with buffer. The concentration of flucloxacillin in bone washings and serum was determined by well-diffusion assay. The mean concentration of flucloxacillin in serum was 8.9 mg/l, in trabecular bone washings, 1.3 mg/l, and in compact bone washings 0.9 mg/l. The amount of blood contaminating the bone washings was measured, and was calculated to account for at most 26% of the flucloxacillin present. The significance of these findings is discussed in relation to the prophylactic use of flucloxacillin in hip replacement surgery.

Aged↗
PubMed1976

Slipping of the upper femoral epiphyses in patients with intracranial tumours causing hypopituitarism and chiasmal compression.

Four cases of slipped upper femoral epiphyses in patients with intracranial tumours causing hypopituitarism and chiasmal compression are presented. Detailed endocrine studies in three cases showed severe deficiencies of growth hormone as well as of gonadotrophin and sex hormones. The literature is reviewed and the aetiology is discussed with special reference to Harris's hypothesis that an increase in growth hormone relative to oestrogen predisposes to slipping of the upper femoral epiphysis in humans, which these cases do not seem to support. In all cases the slip was bilateral, and it is emphasised that surgical treatment can provide only temporary fixation because fusion is dependent on correct hormonal therapy.

Adolescent↗