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Biomedical subjects

J Fisher

Publications and source records attributed to J Fisher.

At least 127 records · Page 7Linked to original sources
PubMed2000

Ipsilateral pedicled TRAM flaps: the safer alternative?

Transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction has become a commonly performed procedure in the 1990s. The original description of the procedure was that of an ipsilaterally based pedicle procedure. Concerns about potential folding of the pedicle with possible compromise of the vascular supply led many surgeons to prefer the contralateral pedicle. Subsequently, there have been several large clinical series of pedicled TRAM flaps showing a relatively high complication rate related to flap vascularity problems. Partial flap necrosis rates in pedicled TRAM series range from 5 to 44 percent. These findings resulted in many centers favoring free TRAM flap breast reconstruction, despite an increase in resource use and negligible differences in complication rates. Ipsilateral pedicle TRAM flap breast reconstruction is not a commonly reported procedure and is reserved for cases for which scars preclude use of the contralateral pedicle. Simplicity and versatility of flap shaping, improved maintenance of the inframammary fold, and lack of disruption of the natural xiphoid hollow give ipsilateral TRAM flaps further advantages. This study reports on a series of 252 consecutive ipsilateral TRAM flap reconstructions in 190 patients. The majority of patients underwent muscle-sparing procedures with preservation of a medial and a lateral strip of rectus muscle. Immediate reconstruction was done in 104 of the 190 patients. Skin-sparing (69 patients) or skin-reduction procedures (21 patients) were used in 90 of the 104 patients (87 percent) undergoing immediate reconstruction. Complication rates were comparable to those of series reported for contralateral TRAM flaps, except that partial flap necrosis (2.0 percent) was less in this series. Risk factors were analyzed with regard to the most common complications seen in this study. Ipsilateral TRAM flap breast reconstruction is our preferred method, if available, because we believe that it has several advantages over the contralateral pedicled TRAM and this report suggests a lower partial flap necrosis rate than previously reported.

Adult↗
PubMed2000

Chemical modification of a variant of human MIP-1alpha; implications for dimer structure.

A sequence variant of human MIP-1alpha, in which Asp26 has been replaced by Al alpha, has been chemically modified by the addition of 13C-labeled methyl groups at each of the lysine residues and the N-terminus. The sites of methylation have been verified by a combination of MALDI-TOF mass spectrometric experiments and tryptic digestion followed by N-terminal mapping. The effect of the modification on the structure and activity of the protein have been determined by analytical ultra-centrifugation, 13C NMR spectroscopy and receptor binding studies. The results of these experiments suggest that huMIP-alpha D26A (BB10010), when present as a dimer, adopts a globular structure, like MCP-3, rather than the elongated or cylindrical structure determined for dimers of huMIP-1beta and RANTES.

Alanine↗
PubMed2000

Surfactant metabolism in SP-D gene-targeted mice.

Mice with surfactant protein (SP)-D deficiency have three to four times more surfactant lipids in air spaces and lung tissue than control mice. We measured multiple aspects of surfactant metabolism and function to identify abnormalities resulting from SP-D deficiency. Relative to saturated phosphatidylcholine (Sat PC), SP-A and SP-C were decreased in the alveolar surfactant and the large-aggregate surfactant fraction. Although large-aggregate surfactant from SP-D gene-targeted [(-/-)] mice converted to small-aggregate surfactant more rapidly, surface tension values were comparable to values for surfactant from SP-D wild-type [(+/+)] mice. (125)I-SP-D was cleared with a half-life of 7 h from SP-D(-/-) mice vs. 13 h in SP-D(+/+) mice. Although initial incorporation and secretion rates for [(3)H]palmitic acid and [(14)C]choline into Sat PC were similar, the labeled Sat PC was lost from the lungs of SP-D(+/+) mice more rapidly than from SP-D(-/-) mice. Clearance rates of intratracheal [(3)H]dipalmitoylphosphatidylcholine were used to estimate net clearances of Sat PC, which were approximately threefold higher for alveolar and total lung Sat PC in SP-D(-/-) mice than in SP-D(+/+) mice. SP-D deficiency results in multiple abnormalities in surfactant forms and metabolism that cannot be attributed to a single mechanism.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed2000

Influence of admission body temperature on stroke mortality.

BACKGROUND AND PURPOSE: The influence of body temperature on stroke outcome remains uncertain. The aim of this study was to investigate the prognostic role of admission body temperature on short-term and long-term mortality in a retrospective cohort study of patients with acute stroke. METHODS: A retrospective cohort of 509 patients with acute stroke, admitted to a tertiary hospital between July 1, 1995, and June 30, 1997, was studied. The relationship between admission body temperature and mortality both in-hospital and at 1-year mortality was evaluated. Body temperature on admission was classified as hypothermia (</=36.5 degrees C), normothermia (>36.5 degrees C and </=37.5 degrees C), and hyperthermia (>37.5 degrees C). Logistic regression and proportional hazards function analysis were performed after adjustment for clinical predictors of stroke outcome. RESULTS: In ischemic stoke, mortality was lower among patients with hypothermia and higher among patients with hyperthermia. The odds ratio for in-hospital mortality in hypothermic versus normothermic patients was 0.1 (95% CI, 0.02 to 0.5). The relative risk for 1-year mortality of hyperthermic versus normothermic patients was 3.4 (95% CI, 1.6 to 7.3). A similar but nonsignificant trend for in-hospital mortality was seen among patients with hemorrhagic stroke. CONCLUSIONS: An association between admission body temperature and stroke mortality was noted independent of clinical variables of stroke severity. Hyperthermia was associated with an increase in 1-year mortality. Hypothermia was associated with a reduction in in-hospital mortality.

Aged↗
PubMed2000

Biological reactions to wear debris in total joint replacement.

The vast majority of total hip prostheses currently implanted consist of a hard metal or ceramic femoral head articulating against an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. Over the last 10 years, evidence has accumulated to show that these prostheses are prone to failure due to late aseptic loosening and few survive beyond 25 years. With an increasing need to implant hip prostheses in the younger, more active patient the need to understand the mechanisms of failure and to develop artificial hip joints using alternative materials have become major issues in the orthopaedic community. This review focuses initially on our current understanding of the biological reactions to UHMWPE prosthetic wear debris in vivo and in vitro since this is believed to be the main cause of late aseptic loosening. While the precise mechanisms of osteolysis induced by UHMWPE wear debris have not been elucidated, the major message to emerge is that it is not the wear volume that determines the biological response to the debris, but the concentration of the wear volume that is within the critical size range (0.2-0.8 micron) for macrophage activation. The review then considers whether the problem of wear-debris-induced osteolysis may be overcome with the use of new generation metal-on-metal or ceramic-on-ceramic prostheses. For metal-on-metal prostheses, the prospects for increasing the osteolysis free life of the implant are good but additional biological problems associated with the nanometre size and reactivity of the wear particles in vivo may emerge. For the ceramic-on-ceramic prostheses, although initial prospects are encouraging, more data are needed on the characteristics of the wear particles generated in vivo before predictions can be made. It is concluded that the pre-clinical testing of any new materials for joint replacement must include an analysis of the wear particle characteristics and their biological reactivity in addition to the usual assessment of wear.

Biocompatible Materials↗
PubMed2000

Investigation into the tribological condition of acetabular tissue after bipolar joint replacement hip surgery.

The aim of this research was to investigate the tribological condition of acetabular tissue before and after bipolar hip surgery. Articular cartilage was taken from the femoral head of patients undergoing primary joint replacement as a control. Tissue was also taken from the acetabular cups of patients undergoing revision hip surgery after primary bipolar surgery and compared with the control cartilage. The biomechanical characteristics of the two tissue types were tested using friction and compression tests. The friction tests were carried out on a sliding friction rig under nominal contact stresses of 0.5 and 4 MPa. The compression tests were carried out under a 0.8 MPa contact stress. The majority of the bipolar patients produced friction coefficients that were significantly higher than those produced by the control group, and the compression tests highlighted that the tissue from the bipolar patients produced a much greater rate of increase in displacement compared with the control cartilage. Histology showed major differences between the control cartilage and the bipolar tissue. The control cartilage showed a healthy collagen structure with a good distribution of proteoglycan whereas the majority of the bipolar tissue had lost tissue architecture and had a sparse fibrous structure. The high friction coefficients with the bipolar tissue imply that the frictional torque at the outer head of the bipolar prosthesis would be large compared with the inner bearing frictional torque. It was therefore predicted that the motion of the bipolar prosthesis should occur at the inner bearing.

Acetabulum↗
PubMed2000

Influence of gelatin and bovine serum lubricants on ultra-high molecular weight polyethylene wear debris generated in in vitro simulations.

Ultra-high molecular weight polyethylene (UHMWPE) wear debris induced osteolysis has a major role in the late aseptic loosening and ultimate failure of total hip replacements (THR). Clinically relevant in vitro simulations of wear are essential to predict the osteolytic potential of bearing surfaces in artificial hip joints. Newborn calf or bovine serum has been accepted as a boundary lubricant for such in vitro tests, but its biological stability has been questioned. This study compared the wear factors, number of wear particles and levels of microbial contamination produced in bovine serum and a gelatin-based lubricant. The wear factors produced by the two lubricants were not significantly different, however the wear debris morphology produced was substantially different. The bovine serum became contaminated with micro-organisms within 28 h, whereas the protein-based lubricant remained uncontaminated. The results showed that bovine serum was not a stable boundary lubricant. They also showed that although the wear factors for the two solutions were not significantly different, the protein-based lubricant was not a suitable alternative to bovine serum because the wear debris produced was not clinically relevant.

Animals↗
PubMed2000

Analysis and modelling of wear of cobalt-chrome alloys in a pin-on-plate test for a metal-on-metal total hip replacement.

The complex interaction between wear and bearing surfaces of two contacting solids was investigated in this study, with particular reference to the use of metal-on-metal material combinations for artificial hip joint replacements. The contact mechanics model was coupled with the wear model and solved simultaneously as a function of time for a simple case of a uniaxial pin-on-plate wear test. Both a spherical pin and a flat-ended spherical pin were considered. It was shown that the contact pressure between the pin and the plate was substantially reduced by the wear process, particularly during the initial running-in period and for the spherical pin. The theoretical prediction of the worn profiles of the pin and the plate was found to be in good agreement with previous experimental measurements by Tipper et al. in 1999.

Biocompatible Materials↗
PubMed2000

A hip joint simulator study using new and physiologically scratched femoral heads with ultra-high molecular weight polyethylene acetabular cups.

This study validates a hip joint simulator configuration as compared with other machines and clinical wear rates using smooth metal and ceramic femoral heads and ultra-high molecular weight polyethylene (UHMWPE) acetabular cups. Secondly the wear rate of UHMWPE cups is measured in the simulator with deliberately scratched cobalt-chrome heads to represent the type of mild and severe scratch damage found on retrieved heads. Finally, the scratching processes are described and the resulting scratches compared with those found in retrieved cobalt-chrome heads. For smooth cobalt-chrome and zirconia heads the wear rates were found to be statistically similar to other simulator machines and within the normal range found from clinical studies. An increased wear rate was found with cobalt-chrome heads scratched using either the diamond stylus or the bead cobalt-chrome but the greatest increase was with the diamond scratched heads which generated scratches of similar dimensions to those on retrieved heads. A greater than twofold increase in wear rate is reported for these heads when compared with smooth heads. This increased wear rate is, however, still within the limits of data from clinical wear studies.

Acetabulum↗
PubMed2000

Comparison of gas plasma and gamma irradiation in air sterilization on the delamination wear of the ultra-high molecular weight polyethylene used in knee replacements.

Early failure of knee replacements is thought to be due to the combination of sterilization by gamma irradiation in air and the high cyclic stresses that they endure during use. Such failures are shown through delamination and permanent deformation of the ultra-high molecular weight polyethylene (UHMWPE) component. This study investigated whether gas plasma sterilization, as an alternative to gamma irradiation in air, would give better performance after ageing in a knee replacement using a metal pin on polymer plate wear test. Fourier transform infrared (FTIR) analysis was performed on the components to assess oxidation levels and a finite element stress analysis model is presented to estimate strain at failure in the UHMWPE. Delamination occurred in the majority of the gamma-irradiated plates but did not occur in any of the gas-plasma-sterilized plates. The FTIR analysis showed that the plates gamma irradiated in air were highly oxidized when compared with the gas-plasma-sterilized plates. Plastic strain at failure was determined for the gamma-irradiated plates and found to be less than 2.4-14 per cent.

Equipment Failure Analysis↗
PubMed2000

Accelerated hyperfractionation in patients with non-small cell bronchogenic cancers as a cost-effective and user- and patient-friendly schedule.

We developed an accelerated hyperfractionation schedule with acceptable effect and toxicity in non-small cell bronchogenic carcinomas. An evolutionary institutional pilot was initiated in March 1995 as a modification of Radiation Therapy Oncology Group (RTOG) 9205, thrice-daily fractionation schedule. Twenty-nine patients with bronchogenic and 7 with head and neck cancers had treatment initiated and completed. A dose of 1.2 Gy was delivered to a mediastinal plus tumor field concomitantly with synchronous boost of 0.6 Gy to a limited volume of gross tumor (twice daily for 21 treatments days in 4 weeks) with a total dose being 75.60 Gy to the primary gross tumor and 50.4 Gy to the elective volume. The bronchogenic cancers were stages IB (medically unresectable, n = 3), IIB (n = 4), IIIA (n = 4), or IIIB (n = 18). Eleven patients had squamous cell cancers, 13 adenocarcinomas, 1 large cell, and 2 carcinomas not specified. With 12 months median follow-up, tolerance has been excellent without any patient complaining of at least Oncology Nursing Society (ONS) grade 3 esophagitis; treatment interruptions occurred in only one patient after 8 days. Weight loss occurred in 12 patients, averaging 4.8% for these patients and 2% overall. Seven patients had a complete response and 20 a partial response. Median survival was 12 months, 1-year survival 58%, 2-year 21%, and 3-year 18%. Seven patients with bronchogenic cancer are still alive. Seven head and neck cancer patients were treated, in which five had base of tongue tumors stage T2 to 4, N0 to N1. Pharyngitis and mucositis were problematic in at least four patients. The outcomes are comparable with other RTOG experience. Hyperfractionated synchronous concomitant boost of total tumor dose to 75.6 Gy in 4 weeks for bronchogenic patients was well tolerated and acceptable to physicians and patients.

Aged↗
PubMed2000

Fatigue analysis of clinical bioprosthetic heart valves manufactured using photooxidized bovine pericardium.

BACKGROUND AND AIM OF THE STUDY: Recent reports have given details of early clinical failures of bioprosthetic heart valves manufactured using dye-mediated photooxidized bovine pericardium. These failures were attributed to abrasion of the inflow surface of the leaflets against the cloth-covered inner face of the outer valve frame. These failures had not been detected during preclinical testing of such valves. The aim of this study was to determine if such failure modes could be replicated during fatigue testing of the photooxidized valves, and whether lining of the inflow face of the outer frame with pericardium could eliminate these failures. METHODS: The fatigue properties of six lined and six unlined PhotoFix(R) alpha valves was determined using two Rowan Ash fatigue testers which were cycled at 15 Hz for a maximum of 210 million cycles. The closing pressure within in each chamber was 110+/-10 mm Hg. Each valve was inspected every 40 million cycles for any signs of fatigue failure. All valves were tested to at least 210 million cycles. RESULTS: In all six lined PhotoFix alpha valves there was no evidence that wear, tear or abrasion of the inflow aspect of the leaflets adjacent to the inflow face of the outer frame had occurred. Only one unlined valve showed any signs of damage adjacent to the outer frame, as evidenced by loss of loose connective tissue, but this did not have the imprint of the cloth covering, which would have suggested actual wear. Effectively, after 200 million cycles, no fatigue failures of either the lined or the unlined PhotoFix alpha valves had occurred. Moreover, the leaflet tears that had been observed clinically were not replicated in this study. CONCLUSION: Previous studies have shown a good qualitative, quantitative association between fatigue failure in Rowan Ash accelerated fatigue testers, and clinical experience in glutaraldehyde-treated bovine pericardial valves. The accelerated fatigue tester did not provide an adequate model for the prediction of clinical failure for the photooxidized pericardial valves.

Bioprosthesis↗
PubMed2000

Frictional behaviour of bovine articular cartilage.

The experimentally measured indentation displacement and friction of normal and degraded (treated with chondroitinase AC) bovine articular cartilage plugs against a smooth steel plate were compared with the predictions based on the biphasic theory using the finite element method. It was found that the measured indentation displacement of both cartilage specimens could be predicted from the biphasic theory and the permeability for the degraded cartilage specimen was increased approximately three times. However, the measured friction coefficient was much lower for short period of loading, and the difference in the finite element prediction of friction coefficient between the normal and degraded cartilage specimens was not observed in the experiment. Therefore, it was concluded that both biphasic and other mechanisms were important in controlling the frictional and lubricating characteristics of articular cartilage in mixed and boundary lubrication regimes.

Animals↗
PubMed2000

Cardiac valve replacement: a bioengineering approach.

The second most common major heart operation in the western world is valve replacement. Any one of the four heart valves may become either so stenotic or regurgitant that it needs to be replaced in order to restore normal heart function. Although replacement surgery of dysfunctional heart valves has a very high success rate, it can provide the surgeon with a difficult decision regarding the choice of a suitable prosthesis for the individual patient. Over the years many different types of artificial heart valves have been devised. Surgeons typically deal with a heart valve replacement by installing a mechanical prosthesis or by using a bioprosthetic valve, hand-crafted from animal tissue. Least commonly, valves can be taken from human organ donors. Mechanical valve substitutes have a long fatigue life but the central flow occluders often induce blood cell trauma. Tissue substitutes have an unimpeded central orifice when open, cause minimal cell damage but have a relatively short fatigue life, especially in children where calcification may be a major problem. More recently alternative materials, such as polyurethane, have been used in artificial heart valve design while the new concept of tissue-engineering has enhanced the prospects towards an ideal cardiac valve replacement. Today's artificial valves are designed with a better understanding of the cardiovascular system with the aid of computers. Advances in computer software have allowed simulations of fluid flows through valve substitutes, both in cardiac flow simulators and the heart itself.

Animals↗
PubMed2000

Comparison of the response of primary murine peritoneal macrophages and the U937 human histiocytic cell line to challenge with in vitro generated clinically relevant UHMWPE particles.

The response of primary murine macrophages and the U937 human histiocytic cell line to challenge with clinically relevant UHMWPE wear debris of known particle size and dose was evaluated. Particles with mean sizes of 0.24, 0.45, 1.71, 7.62 and 88 microm were co-cultured with cells for 24 hours prior to assessment of cell viability and production of the osteolytic mediators IL-1beta, IL-6, TNFalpha and, in supernatants from murine phagocytes, PGE2 and GM-CSF. All particle fractions were evaluated at particle volume (microm3) to cell number ratios of 10 : 1 and 100 : 1 (and, additionally, 0.1 : 1 and 1 : 1 for U937 cells). These ratios had previously been identified as the most stimulatory and clinically relevant. Although the results for the cell line were highly variable, stimulation with phagocytosable particles (range 0.1 to 15 microm) resulted in enhanced levels of cytokine secretion by both murine macrophages and U937 histiocytes. The most biologically active particles were sub-micrometre in size. However, U937 cells responded to wear debris at much lower particle volume to cell number ratios (>0.1 microm3 per cell) than the murine cells (> 10 microm3 per cell). No GM-CSF was produced by particle or LPS stimulated murine macrophages. Similarly, U937 histiocytes failed to secrete any IL-1beta. Neither macrophage population responded to stimulation with the largest (88 microm) particles. These results confirm earlier findings and suggest that the size of UHMWPE wear particles is a critical factor in macrophage activation. Moreover, primary murine macrophages have been demonstrated to be a suitable model for studying cell-particle interactions in vitro.

Animals↗
PubMed2000

Every man his own farrier in Australia: the origins and growth of a veterinary business in colonial New South Wales.

The life and work is told of John Pottie (1832-1908), a Scotsman who graduated from Edinburgh Veterinary College in 1858. A year later, he contracted to provide veterinary care to a consignment of horses bound for Australia. Once there, he founded a firm that has survived to the present day, still marketing products that originated in his own veterinary remedies. John Pottie brought with him a European tradition of livestock care and treatment that was epitomised in Clater's title and book, Every man his own farrier. His career is of interest for several reasons. Firstly it is because he used this tradition to launch a business enterprise in a new and different market in Australia. Secondly, although his training lay in what may be termed the pre-scientific era of the profession's history, he was able to adapt old traditions successfully to the changes that came in the age of Pasteur and Koch. Finally, the manner in which he did this, besides demonstrating his business acumen, also shows how the professional veterinary qualification gained in value in a new age of science.

Australia↗