Biomedical subjects
Publications and source records attributed to J R Ryan.
A case of a fracture of the lateral malleolus with a missed diagnosis of associated tear of the deltoid ligament of the ankle is presented to emphasize the importance of examination of injuries about the ankle. The method of examination for this injury is described so that proper treatment may be undertaken.
Ninety consecutive nonpathologic traumatic fractures of the shaft of the femur in pediatric patients above 3 years of age were seen from 1972 to 1976. Patients with less than 6 months' followup, patients with concomitant trauma to the same extremity, and one patient with decerebrate rigidity were excluded from the study. This left for evluation 60 fractures in 59 patients, all treated by 90-90 femoral skeletal traction. The average length of followup was 17.4 months. There were no pin tract infections. All patients had a full range of active and passive motion of the involved extremity. All of the children were engaged in the normal activities of their age group. Final femoral lengths by teleroentgenograms in patients followed over 1 year could not be correlated with the original fracture position whether distracted, end-on, or overriding. It is recommended that no more than 5 mm of overriding be accepted when using this method of treatment.
Forty-three fractures of the shaft of the femur secondary to low-velocity gunshot wounds were evaluated to determine healing time, fracture alignment after healing, complications, and fracture characteristics. This study confirmed the previous reports of low infection rates and the need for minimal debridement for such fractures. The healing time was faster than that of closed fractures treated by similar means: the average healing time was 144.3 days. Alignment was easy to obtain and maintain, the average angular deformity being 5 degree or less with no rotational deformities. Three characteristic fracture types were noted: the double butterfly configuration of the shaft of the femur, the drill-hole fracture of the distal third of the femur as previously described experimentally, and a third type of fracture with an incomplete fracture secondary to the gunshot wound which acted as a stress riser with a resultant spiral fracture either proximal or distal to the impact site.
Eleven medial subtalar dislocations, two of them open, were treated during the decade from 1969 to 1978 in four metropolitan Detroit hospitals. There was one open lateral dislocation. Eight patients were available for follow-up study. None of the dislocations was associated with a major fracture of the talus. The average time between injury and our follow-up was twenty-eight months. A simple qualitative method of measuring range of motion of the subtalar joint was devised. All of the patients had some loss of subtalar motion, but the lateral dislocation was the only one causing important disability.
A case of delayed diagnosis of dislocation of the carpal lunate is presented emphasizing the difficulty in diagnosing injuries about the carpal lunate. The types of fractures and dislocations about the carpal lunate are described, along with the clinical and radiographic findings that are helpful in making the diagnosis.
The antihypertensive effects of a clonidine-chlorthalidone combination (Combipres) as a single daily dose at bedtime and the same amount in twice-daily doses were compared in an open-label, crossover study in 14 patients. An analysis of the blood pressure and pulse data in nine patients who completed the study revealed no statistically significant differences between the two regimens, and no difference in the incidence of side effects was noted.
The activity of deoxythymidine kinase was assayed in implanted sponge connective tissue in three groups of subjects: 1) five normal controls (having normal levels of plasma and red cell zinc); 2) four patients with sickle cell anemia who had low zinc in red cells and hair; and 3) two volunteers (under strict dietary controls), after 6 mo of zinc restriction (2.7 mg/day) and repeated after 3 mo of zinc repletion (30 mg/day). Total protein, total collagen, RNA/DNA, and deoxythymidine kinase activity were measured by techniques reported previously. In sickle cell anemia patients, deoxythymidine kinase activity was not detected, and RNA/DNA, total collagen, and total protein contents were decreased compared to normal controls (statistically significant). In human volunteers deoxythymidine kinase activity was not detected during the zinc restriction phase. After supplementation with zinc, deoxythymidine kinase activity became 70% of normal control levels, and RNA/DNA, total collagen, and total protein contents of sponge connective tissue increased. In conclusion, an adverse effect of zinc deficiency on deoxythymidine kinase activity of implanted sponge connective tissue of man has been demonstrated for the first time.
Ticrynafen, 125--250 mg/day was compared with probenecid 0.5--1.0 g/day in patients with elevated serum uric acid values in a randomized, double-blind crossover study. Each treatment period lasted 12 weeks. The mean reduction in serum uric acid from 9.4 +/- 1.2 to 6.22 +/- 1.2 mg/dl (33.8%) during ticrynafen was greater (p less than 0.01) than that from 9.46 +/- 1.1 to 7.0 +/- 1.3 mg/dl (26%) during probenecid treatment. There were slight increases in serum creatinine and BUN and decreases in body weight during ticrynafen treatment. There were no statistically significant changes in serum electrolytes. The hypouricemic effect of ticrynafen was well maintained during its subsequent open-label administration for 18 months without any deterioration of renal function.
The anti-hypertensive effect of 250 mg tienilic acid was comparable to that of 50 mg hydrochlorothiazide. Unlike hydrochlorothiazide, tienilic acid caused a statistically significant decrease in the serum uric acid values. Clinically non-significant rises in blood urea nitrogen and serum creatinine occurred with both diuretics. The hypouricaemic effect of tienilic acid given in a daily dose of 125 mg was significantly greater than that of 500 mg probenecid. Glucose tolerance in patients with mild maturity onset diabetes mellitus deteriorated with both tienilic acid and hydrochlorothiazide treatments with no statistically significant difference noted between the two treatments. Tienilic acid was well tolerated and no clinically significant haematological or biochemical abnormalities were noted.
The results of the Deyerle method of pin plate fixation for intracapsular fracture of the neck of the femur are less satisfactory than the results in the original literature. We treated 143 intrascapsular neck fractures of the femur by the Deyerle method during the period from 1969 to 1975. Seventy-four patients had follow-ups of one year or had a major complication leading to failure prior to one year for evaluation. The failures were the result of avascular necrosis in 17.6% of the patients, non-union in 27% of the patients, and pin breakage in 1.35% of patients. Eight cases with combined avascular necrosis and non-union resulted in an overall failure rate of 26 patients or 35% of the 74 patients. These observations corroborate other reports in the literature on a high failure rate with multiple pin and plate fixation.
In two double-blind randomized, balanced, single oral dose studies with 140 women, a combination of 800 mg aspirin and 64 mg caffeine (aspirin-caffeine) was compared to 650 mg aspirin and to placebo. In patients with moderate to severe uterine or episiotomy pain, there was greater analgesic response with active drugs when the initial pain intensity was more severe. In patients with severe episiotomy pain, aspirin-caffeine was more effective than 650 mg aspirin (p less than 0.05) at the second and third hours. There was no difference between analgesic effects of aspirin and aspirin-caffeine in women with severe uterine pain.
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Three congenital synostoses of the knee occurred in 2 patients. Complete bony epiphyseal fusion was present on the radiographs. This condition is a failure of joint formation in the early mesenchymal stage at 4--5 weeks gestation and appears as connected cartilaginous cell masses which later ossify. Involvement of other joints has been reported in the literature, but these may be the first documented cases of the condition in knee joints.
The effect of sulindac and tolbutamide on the control of diabetes was studied in 12 tolbutamide-treated maturity-onset diabetics with stable glycemic control. After one week of hospitalization on a metabolic ward for adjustment of diet and activity, the patients were treated with sulindac, 200 mg twice daily for one week. The time-to-peak plasma tolbutamide concentration was 3.1, 3.1, and 3.2 hr, respectively, after tolbutamide alone, after the first dose of sulindac, and after sulindac for a week. The areas under the plasma tolbutamide curve were 23.68, 22.10, and 22.78 for the same periods. The half-life for plasma tolbutamide was 7.46, 7.15, and 7.38 hr, respectively. None of the differences were statistically significant. The mean fasting plasma sugar was lower after the sulindac treatment (from 12.5 to 112.9 mg/100 ml, p less than 0.05), but the postprandial values increased slightly (from 137.7 to 142.6). It was concluded that there was no clinically significant interaction between sulindac and tolbutamide.
Fifty-five patients with mild to moderately severe essential hypertension were treated with guanabenz (2, 6-dichlorobenzylidene aminoguanidine acetate) in doses from 4 to 16 mg twice daily in a randomized, placebo-controlled study. The patients treated with placebo in the initial phase of the study were subsequently treated with guanabenz. The mean arterial pressure in the guanabenz group decreased from 130.6 to 107.6; that in the placebo group decreased from 129.6 to 126.6 standing and from 126.6 tp 109.9 and 128.8 to 120.5, respectively, supine. The principle adverse effects included sedation, dry mouth, weakness, and tiredness. Of the guanabenz-treated patients 84% had sustained decrease in supine diastolic blood pressure of 10 mm Hg or more, whereas in the placebo-treated patients only 32% had such a response. There was no significant orthostatic hypotension. Guanabenz thus appears to be an effective antihypertensive drug in patients with mild to moderately severe hypertension.
In 12 hospitalized patients with hypertension, clonidine 3 times a day led to better control of blood pressure than did the same total dose administered once daily. Compared to the uniform control of blood pressure on divided dose regimen, the single daily 8 P.M. dose led to wider fluctuations and inadequate control 18 hr after dosing. However, 10 of the 12 patients preferred the single daily dose at 8:00 P.M. to the divided dose regimen because of no drowsiness during the day. In 2 patients administration of clonidine twice daily resulted in better control of blood pressure than that during the single or thrice-daily dose regimens. Since there appeared to be a correlation between the dose and the duration of adequate blood pressure control, administration of clonidine twice a day with a larger dose at bedtime and a smaller dose before noon could limit unwanted drowsiness and combine the convenience of less frequent dosing with superior blood pressure control.
Nineteen patients with type II, III, IV, or V hyperlipoproteinemia received gemcadiol (2,2,9,9,-tetramethyl-1,10-decanediol) in daily doses between 1.2 and 2 g. The patients were hospitalized for dose titration and then followed as outpatients on appropriate doses of gemcadiol. In Type II hyperlipoproteinemia, serum cholesterol was lowered by an average of 24%. The serum triglycerides in Type IV hyperlipoproteinemia decreased by an average of 51%. Serum uric acid was not altered. There were no changes of subjective feelings or of clinical or laboratory findings, including creatine phosphokinase. This study indicates that gemcadiol is an effective antilipemic agent that is very well tolerated.
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