Biomedical subjects
Publications and source records attributed to K D Johnson.
In seven cases of Lisfranc joint injury after trauma, bunion deformity developed. This "traumatic bunion" occurs over a prolonged period of time after injury. A high index of suspicion is needed to identify the deformity as being traumatic in origin. Injury about the first metatarsophalangeal joint complex may also contribute to this deformity. When recognized, it may need to be treated with a first metatarsal-cuneiform fusion and distal soft tissue realignment.
We performed a randomized, prospective study to compare the results of two methods for the operative fixation of fractures of the tibial plafond. Surgeons were assigned to a group on the basis of the operation that they preferred (randomized-surgeon design). In the first group, which consisted of eighteen patients, open reduction and internal fixation of both the tibia and the fibula was performed through two separate incisions. An additional patient, who had an intact fibula, had fixation of the tibia only through an anteromedial incision. The second group consisted of twenty patients who were managed with external fixation with or without limited internal fixation (a fibular plate or tibial interfragmentary screws). Ten (26 per cent) of the thirty-nine fractures were open, and seventeen (44 per cent) were type III according to the classification of Rüedi and Allgöwer. There were fifteen operative complications in seven patients who had been managed with open reduction and internal fixation and four complications in four patients who had been managed with external fixation. All but four of the complications were infection or dehiscence of the wound that had developed within four months after the initial operation. The complications after open reduction and internal fixation tended to be more severe, and amputation was eventually done in three patients in this group. At a minimum of two years postoperatively (average, thirty-nine months; range, twenty-five to fifty-one months), the average clinical score was lower for the patients who had had a type-II or III fracture, regardless of the type of treatment. With the numbers available, no significant difference was found between the average clinical scores for the two groups. All of the patients, in both groups, who had had a type-II or III fracture had some degree of osteoarthrosis on plain radiographs at the time of the latest follow-up. With the numbers available, there was no significant difference between the two groups with regard to the osteoarthrotic changes. We concluded that external fixation is a satisfactory method of treatment for fractures of the tibial plafond and is associated with fewer complications than internal fixation.
Many bacterial capsular polysaccharides are regularly repeating units of oligosaccharides. Bacterial oligosaccharides have been used in neoglycoconjugate vaccines and as reagents in the study of specific antibody binding. Unfortunately, separation methods have not been adequate for the purification of preparative quantities of bacterial oligosaccharides. Here we describe a size-exclusion procedure that resulted in the resolution of group B Streptococcus type III oligosaccharides composed of 4-25 sugars.
Intramedullary (IM) nails were prospectively placed in 32 consecutive femoral shaft fractures without the use of a fracture table. All fractures were reduced using manual traction. Pathologic and nonacute fractures and those requiring a reconstruction nail were excluded. The results are compared with results of two prior study groups from this institution that underwent IM nailing with or without a fracture table using a femoral distractor. Ten patients had unstable spine or pelvis fractures. Four nailings followed exploratory laparotomy. Twelve patients underwent two or more procedures on the lower extremities under the same preparation and drape. Six fractures were open. Sixty-seven percent of results were anatomic, 27% had < 5 mm lengthening/shortening or < 5 degree varus/valgus, and 7% had > 5 mm lengthening/shortening or > 5 degree varus/valgus. Average operative time was 95 min. No complications occurred that were attributable to the technique. Compared with the prior study groups, no statistical difference in the fracture types or results was found. However, operative time was significantly less in the manual traction group (p < .05). We feel that this technique is a safe, simple, and effective alternative to using a fracture table. The technique is especially useful in the polytrauma patient, significantly decreasing anesthetic time.
Thirty-seven patients with 37 proximal femoral fractures were treated with a reconstruction locked femoral nail. There were four ipsilateral intracapsular femoral neck and shaft fractures, two intertrochanteric fractures, 18 intertrochanteric fractures with diaphyseal extension, eight subtrochanteric fractures with involvement of the lesser trochanter, and five subtrochanteric fractures without involvement of the lesser trochanter. The overall union rate was 92%. Twenty-one complications developed in 13 patients (35%) which included three of the four femoral neck and shaft fractures, and six of 18 intertrochanteric fractures with diaphyseal extension. Of the five intertrochanteric fractures with diaphyseal extension in which anatomic reduction was not achieved, four developed a complication. Of the nine proximal screws in nine fractures, which were placed short (below the subchondral bone of the femoral head), six fractures developed a complication. The complications included three nonunions, one delayed union, two leg-length discrepancies of > 2.5 cm, two cases of varus deformity of > 10 degrees, two varus deformities < 10 degrees, four instances of revision surgery including one broken 13-mm nail, four proximal screws that backed out and required removal, two cases of pudendal nerve palsy, and one case of heterotopic ossification. Seven patients developed more than one complication. Eleven of the 13 patients with complications required a second surgery to treat the complication. We conclude that the reconstruction locked femoral nail is not a good choice for ipsilateral intracapsular neck and shaft fractures. Our recommendation is that anatomic reduction should be achieved for all cases using the reconstruction femoral nail, but it is absolutely required when treating the intertrochanteric fracture with diaphyseal extension. Reconstruction femoral nails have a high rate of complication due to the complex nature of the fractures as well as the device.
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The clinical mechanical failures of small diameter intramedullary interlocking nails were evaluated to determine the relationship of failure modes to the type or location of tibial fractures. Methods were developed to duplicate failure modes in vitro in standardized tests to simulate the clinical situations. Where standard test methods were inadequate, new methods were developed to provide quantifiable, reliable methods of evaluating potential clinical performance. The modes and rates of mechanical failure in the clinical series were consistent among participating centers: (1) In diaphyseal fractures with secondary trauma, the intramedullary nail bent at the fracture site where the working length was unsupported; (2) failures that occurred several weeks after nailing were the result of fatigue fractures of the locking screws, usually at the distal end; and (3) nail and screw failures occurred most commonly in proximal and distal tibial fractures. The strength of the 8- and 9-mm sizes of Synthes and Russell-Taylor nails were comparable.
Ipsilateral femoral neck and shaft fractures occur in 2.5% to 6% of femur fractures. The injury results from high energy trauma. Victims are usually young, with multiple associated injuries. The diagnosis of the neck fracture is delayed in 19% to 31% of patients. The neck fracture line is almost vertical and nondisplaced, or minimally displaced in 26% to 59% of cases. The shaft fracture is often midshaft and open, and/or comminuted in 47% to 67% of cases. Ipsilateral knee injuries occur in 20% to 40% of patients. Two major complications, osteonecrosis of the femoral head and nonunion of the neck, result from the neck fracture. Therefore, treatment of the neck fracture takes precedence. The rate of osteonecrosis is unknown, but probably is in the range of 4% to 22%. Union rate of the neck is high and related to stable, anatomic reduction. The timing of operative fixation often is dictated by the patient's status as a multiple trauma victim, but a delay of days to weeks in the fixation of the neck fracture does not seem to increase the complication rate. The goal of any treatment plan should be anatomic reduction of the neck fracture, and stable fixation of both fractures, so that the patient can be mobilized.
Eight-seven acetabular fractures in eighty-seven patients underwent open reduction and internal fixation at Vanderbilt University Hospital from 1984 to 1989. Fifty-six were treated by orthopaedic traumatologists. Fifty-six patients returned for long-term follow-up (range 24-80 months, average 43). Harris hip ratings were used to clinically grade the results. Poor results were found in 43%. Eighty-three percent of the patients with poor results had satisfactory surgical reductions with < 3 mm of residual displacement. Factors other than surgical reduction contributed significantly to the poor results. These included hip dislocation associated with the fracture, class III or IV heterotopic ossification, development of avascular necrosis, and age > 40 years. These factors in addition to adequacy of surgical reduction allow us to better counsel patients as to long-term prognosis.
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The relation of the olfactory bulbs and photoperiod to the regulation of body weight was studied in male golden hamsters. Animals underwent sham operation, bilateral olfactory bulbectomy, or unilateral bulbectomy. They were left on long photoperiod for 5 weeks and then were transferred to short photoperiod for 11 weeks. The unilaterally olfactory bulbectomized hamsters gained less weight on long or short photoperiod than the sham operated group, while the bilaterally bulbectomized hamsters gained at least as much weight as the sham group. Thus, we report the novel finding that unilateral but not bilateral olfactory bulbectomy reduces body weight gain in male golden hamsters.
Intramedullary nails were placed prospectively in 25 acute femoral shaft fractures in 25 patients without the use of a fracture table. A femoral distractor was used in 21 of the 25 patients to aid in obtaining and holding a reduction. Our goals were to determine if the technique was safe and effective for insertion of intramedullary nails in a wide spectrum of femoral fractures--with no increase in morbidity when compared to the use of the more familiar fracture table--and to determine the potential complications and pitfalls of using this technique. A retrospective evaluation of the most recent 25 patients with 27 femoral fractures that underwent intramedullary nailing on a fracture table was done to compare operative time, estimated blood loss, complications, and postoperative fracture alignment. In addition to the clinical evaluation, cadaveric dissections were undertaken to determine the exact location of the proximal distractor screw in relation to the contents of the femoral triangle. The femoral nerve was a minimum of 2.5 cm, and the femoral artery a minimum of 3.0 cm from the proximal screw. In comparing the two studies, no significant difference was noted in the age of the patients, fracture types or locations, associated injuries, operative time, estimated blood loss, final fracture reduction, or nail position. No complications were encountered in the placement of the proximal femoral distraction screw. Although the distraction method is technically difficult because the reduction is obtained entirely during the procedure, there are certain situations when this technique could be employed with the benefit of decreasing intraoperative patient manipulation, thereby shortening operative time.(ABSTRACT TRUNCATED AT 250 WORDS)
Tonoplast intrinsic protein (TIP) is a member of a family of putative membrane channels found in bacteria, animals, and plants. Plants have seed-specific, vegetative/reproductive organ-specific, and water-stress-induced forms of TIP. Here, we report that the seed-specific TIP is a phosphoprotein whose phosphorylation can be monitored in vivo by allowing bean cotyledons to take up [(32)P]orthophosphate and in vitro by incubating purified tonoplasts with gamma-labeled [(32)P]ATP. Characterization of the in vitro phosphorylation of TIP indicates that a membrane-bound protein kinase phosphorylates TIP in a Ca(2+)-dependent manner. The capacity of the isolated tonoplast membranes to phosphorylate TIP declined markedly during seed germination, and this decline occurred well before the development-mediated decrease in TIP occurs. Phosphoamino acid analysis of purified, radiolabeled TIP showed that serine is the major, if not only, phosphorylated residue, and cyanogen bromide cleavage yielded a single radioactive peptide peak on a reverse-phase high-performance liquid chromatogram. Estimation of the molecular mass of the cyanogen bromide phosphopeptide by laser desorption mass spectroscopy led to its identification as the hydrophilic N-terminal domain of TIP. The putative phosphate-accepting serine residue occurs in a consensus phosphorylation site for serine/threonine protein kinases.
The treatment of gunshot wounds involving bones or joints remains controversial. Antibiotics and thorough debridement may not be necessary for many of these wounds (stable fractures with minimal soft-tissue damage). However, as in the treatment of open fractures and joint injuries from blunt trauma, the damage to the skin frequently is not a good indicator of the amount of soft tissue to be found underneath.
Six integral membrane proteins of bacterial, animal, and plant origin, which are believed to function in solute transport, share sequence identity and are grouped together as members of the MIP family. These include the Escherichia coli glycerol facilitator, the major intrinsic protein from bovine lens fibre junction membranes, a plant tonoplast membrane protein, a soybean protein from the peribacteroid membrane, and a Drosophila neurogenic protein. These proteins, each of which appears to consist of six transmembrane helical segments per subunit, apparently arose by internal duplication of a three-transmembrane segment. Phylogenetic 'trees' interrelating these proteins and segments are presented.
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The tonoplast mediates the transport of various ions and metabolites between the vacuole and cytosol by mechanisms that remain to be elucidated at the molecular level. The primary structure of only one tonoplast protein, the H(+)-ATPase, has been reported to date. Here we report the primary structure of tonoplast intrinsic protein (TIP), a 27-kilodalton intrinsic membrane protein that occurs widely in the tonoplasts of the protein storage vacuoles (protein bodies) of seeds [Johnson, K.D., et al. (1989). Plant Physiol. 91, 1006-1013]. Hydropathy plots and secondary structure analysis of the polypeptide predict six membrane-spanning domains connected by short loops and hydrophilic, cytoplasmically oriented N- and C-terminal regions. TIP displays significant homology with several other membrane proteins from diverse sources: major intrinsic polypeptide from bovine lens fiber plasma membrane; NOD 26, a peribacteroid membrane protein in the nitrogen-fixing root nodules of soybean; and interestingly, GIpF, the glycerol facilitator transport protein in the cytoplasmic membrane of Escherichia coli. Based on the homology between TIP and GIpF and the knowledge that the protein storage vacuolar membrane and the peribacteroid membrane are active in solute transport, we propose that TIP transports small metabolites between the storage vacuoles and cytoplasm of seed storage tissues.
In a 2-yr study a total of 120 Suffolk and Suffolk-cross ewe lambs, approximately 3 mo of age, were assigned within weight strata to one of three treatments: 1) control, pasture only (C), 2) .09 kg soybean meal/(hd.d) (SBM) plus pasture or 3) .45 kg whole shelled corn/(hd.) plus pasture to compare growth and reproductive performance and to determine lamb selectivity of forage quality and type. Each year, supplements were offered from June through the 3rd wk in November. Ewe lambs were managed as one flock on Kentucky bluegrass (Poa pratensis L.) and tall fescue (Festuca arundinacea Schreb.) pastures except for a brief daily supplementation period when all lambs were brought into a corral and sorted into treatment groups for the feeding. Ewe lambs were exposed to fertile rams from October 1 through the 3rd wk of November each year. Growth rates of ewe lambs grazing pasture alone were slower than those of corn-supplemented ewe lambs and were comparable to those of SBM-supplemented ewe lambs, but reproductive performances were similar (P greater than .05). Date of first detected rise in serum concentrations of progesterone and date of first observed estrus and lambing performance were similar (P greater than .05) among treatments for each year. Compared to hand-clipped forage, forage samples collected by esophageally fistulated lambs were higher (P less than .05) in crude protein and lower (P less than .05) in acid detergent fiber each year, indicating that lambs selectively grazed higher-quality forage. These data indicate that neither protein nor energy limited growth or reproductive performance of these ewe lambs.