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Biomedical subjects

R B Duthie

Publications and source records attributed to R B Duthie.

At least 19 recordsLinked to original sources
PubMed1994

The rise of academic orthopaedic surgery during the past 44 years.

In accepting this invitation to write a prefatory chapter as a mini professional autobiography, it has become all too obvious that this has touched a few nerve endings that had healed many years ago. Contemplating personal experiences, thoughts, and philosophies and then writing them should have a purpose. During these past 44 years, I have had the good fortune to share in the breaking away of orthopaedics as a clinical practice, into an academic and scientific subject. Such a radical and difficult birth has been in the presence of many able and good fellow travellers and perhaps, therefore, may serve as a guide for the future by those who care to follow. The mixture of clinical practice with caring for people, teaching, and research has to be bound securely together by academic professors. This has presented the greatest challenge to me and certainly the greatest difficulty, because we have all faced criticism, not always constructive, from these three separate cultures. Even so, our responsibility has been to integrate science and medicine sensibly. Richards described universities as being places of high technology and remoteness from reality. In my experience having spent most of my professional life in British and American universities, the reality has always been too near and real.

England↗
PubMed1993

Septic arthritis in haemophilia.

Septic arthritis has been regarded as rare in haemophiliacs, but its incidence may have increased since HIV infection has become widespread in these patients. We describe six cases treated at one haemophilia unit over a two-year period and discuss their investigation, diagnosis and treatment. Four of the patients were seropositive to anti-HIV.

Anti-Bacterial Agents↗
PubMed1993

Dialysis arthropathy of the hip.

Beta 2-microglobulin amyloid deposition is associated with a destructive arthropathy in the hip of chronic hemodialysis patients. Twenty-five hips from 18 patients were assessed for the presence and immunohistochemical type of amyloid. The hemodialysis group was compared with an age- and disease-matched control group that had no evidence of renal failure. Beta 2-microglobulin amyloid deposits were present in all patients who had been on hemodialysis for 18 months or more. Beta 2-microglobulin amyloid deposits were not found in patients who had been on hemodialysis for less than 18 months. Amyloid deposits were seen first in the articular cartilage and later involved the synovial membrane, joint capsule, and subchondral bone as well. The presence and amount of amyloid deposition correlated to the duration of hemodialysis. Severely affected hip roentgenographically had a concentric loss of joint space, periarticular erosions, and cystic lesions in the femoral head and acetabulum. These pathologic and roentgenographic changes suggest that amyloid deposition leads directly to the erosive hip arthropathy occurring in hemodialysis patients.

Adult↗
PubMed1992

Bone resorption by cells isolated from rheumatoid synovium.

Cellular mechanisms accounting for the osteolysis of rheumatoid erosions are poorly understood. Cells were isolated and characterised from the synovium of 16 patients with rheumatoid arthritis (RA) and four patients with osteoarthritis and their ability to resorb bone was assessed using a scanning electron microscope bone resorption assay. Macrophages were the major cell type isolated from the synovium of patients with RA. These produced extensive roughening of the bone surface without resorption pit formation. This low grade type of bone resorption was not affected by systemic (calcitonin, parathyroid hormone, 1,25-dihydroxyvitamin D3) or local (interleukin 1, prostaglandin E2) factors influencing bone resorption. Macrophage mediated bone resorption differs qualitatively and quantitatively from that of osteoclasts but is likely to play an important part in the development of marginal erosions in RA.

Adult↗
PubMed1991

Peripheral nerve lesions in hemophilia.

Between 1962 and 1986, eighty-one of the 1351 admissions of patients who had hemophilia to the Nuffield Orthopaedic Centre were for peripheral nerve lesions. Eighty-eight such lesions were identified in fifty-four patients, and thirty-nine of these patients (sixty-one lesions) had adequate follow-up (mean, 8.4 years; range, four months to eighteen years). The femoral nerve was most commonly involved, but involvement of other peripheral nerves also occurred. In thirty (49 per cent) of the sixty-one lesions, the nerve had full motor and sensory recovery; in twenty-one (34 per cent), a residual sensory deficit; and in ten (16 per cent), both a persistent motor and sensory deficit. Patients who had antibodies to factor VIII were significantly less likely to recover full motor or sensory function than were those who did not have such antibodies, and the time to full motor recovery in these patients was significantly longer.

Adolescent↗
PubMed1991

Joint and systemic distribution of dialysis amyloid.

Deposition of beta 2-microglobulin amyloid in the joints of dialysis patients is common and begins early in the course of treatment, but its pathogenic significance in the production of dialysis arthropathy is uncertain. The joints (hip, knee, shoulder, elbow, wrist, cervical and lumbar spine, sacroiliac joint) and systemic tissues of 19 autopsied patients who had undergone haemodialysis for between 6 and 231 months were examined histopathologically for the presence of beta 2-microglobulin amyloid; it was present in all joints examined, including those unassociated with radiological changes and those of patients who had been on haemodialysis alone for only 24 months. Osteoarticular beta 2-microglobulin amyloid deposits were also found in patients who had been treated mainly by continuous ambulatory peritoneal dialysis. Systemic amyloid deposition was only seen in patients who had been haemodialysed for more than 13 years and consisted of sparse tiny deposits in blood vessel walls.

Aged↗
PubMed1989

A review of fatal road accidents in Oxfordshire over a 2-year period.

The records of 131 road accident fatalities which occurred in Oxfordshire over a 2-year period were reviewed. Aspects of the accident circumstances, the injuries incurred and the cause of death were examined. The majority of fatal accidents occurred during daylight hours and in dry weather. Deaths were mainly due to cerebral injury (34.4 per cent) or uncontrollable (mainly thoracic) haemorrhage (25.2 per cent), or a combination of both (8.4 per cent). A number of deaths occurred in hospital from complications rather than from the injury itself. In addition to this, there were four deaths from natural causes. Where death occurred at the scene of the accident, blood alcohol levels were determined. Almost 50 per cent of the drivers for whom a level was obtained had measurable alcohol in their bloodstream, and 28 per cent of such drivers were over the legal limit. Three cases who reached hospital alive were, on review, assessed to have potentially survivable injuries, and a further two patients died in the post-accident period of potentially survivable complications.

Accidents, Traffic↗
PubMed1989

Injury to the elderly in road traffic accidents.

It is widely accepted that the elderly are more vulnerable to trauma than other groups. We examined our records of more than 6,000 accident cases, 312 over 65 years of age, and found that not only were older people more likely to sustain more serious injury in any given accident, but that the risk of life was significantly greater for a given injury severity. The mortality rate for all grades of injury rose from approximately 1% in the age group less than 20 years old to almost 11% in the age group more than 70. As none of the existing injury scales take age into account when predicting the outcome, it is suggested that such scales should be weighted to reflect more accurately the likely outcome or injury in the elderly.

Accidents, Traffic↗
PubMed1989

The recovery of growth cartilage after removal of bone bridge between epiphysis and metaphysis.

The in vitro proliferation of chondrocytes from the tibial growth plate of rabbits has been examined following bone bridge formation and its resection in vivo. In vitro 3H-thymidine incorporation by growth cartilage with bone bridges was 53.5% of the contralateral normal growth cartilage, whereas it was 95.7%, following removal of the bone bridges performed five days before sacrifice. Relative 3H-thymidine incorporation into the growth cartilage decreased with increasing discrepancy of tibial length caused by persisting bone bridges. These experiments demonstrated that growth cartilage can recover its proliferative potential following removal of a mechanical growth inhibition caused by the formation of a bone bridge.

Animals↗
PubMed1989

Oxygen free radical in human osteoarthritis.

The xanthine oxidase catalysed release of superoxide free radicals (O2-) from endogenous hypoxanthine was determined in homogenates of synovium obtained from three groups of patients, those undergoing primary or revision total hip replacement (THR) for osteoarthritis and those undergoing arthroscopy of the knee for semilunar disc injuries. The concentrations of hypoxanthine in homogenates obtained during THR were found to be significantly higher than those in the group with semilunar disc injuries. The results suggest that there is a greater predisposition to free radical release and tissue damage in osteoarthritis.

Free Radicals↗
PubMed1988

Injuries to pedestrians in road traffic accidents.

Although there have been many reports on injuries to occupants of cars in road traffic accidents, there have been few prospective studies of injuries to pedestrians in such accidents. For this reason a two year prospective study of pedestrians in road traffic accidents in the Oxford region was carried out. The incidence of death in pedestrians was significantly higher than in car occupants or motorcyclists. The principal determinant of death was the weight of the vehicle concerned. The most common site of injury was the head because of a high incidence of brief concussion, but the most common site of serious injuries was the leg. Injuries to all regions of the body increased with age and with the weight of the vehicle in the collision. Accidents most often concerned young children or the elderly.

Accidents, Traffic↗
PubMed1988

Localization of specific carbohydrate configurations in the hemophilic synovial membrane.

Fluorescein isothiocyanate-conjugated lectins include: concanavalin A (Con-A), Dolichos biflorus agglutinin (DBA), Griffonia simplicifolia-I (GS-I), Griffonia simplicifolia-II (GS-II), Arachis hypogaea agglutinin (PNA), Maclura pomifera agglutinin (MPA), Ricinus communis agglutinin-I (RCA-I), Glycine max agglutinin (SBA), Ulex europaeus agglutinin-I (UEA-I), and wheat germ agglutinin (WGA). These lectins were used to histochemically demonstrate lectin bindings on hemophilic synovial membrane. GS-I (galactose and galactosamine specific) and SBA (galactosamine specific) was shown to bind strongly in the cytoplasm of the lining cells. Lymphocytes and mast cells were largely bound by Con-A (mannose and glucose specific) and GS-II (glucosamine specific) positive. UEA-1 (fucose specific) was shown to bind specifically to synovial vascular endothelial cells. Lectin histochemistry is a useful method for classification of the cells on the synovial membrane.

Carbohydrate Metabolism↗
PubMed1987

Joint contractures in the hemophilias.

Hemophilic contracture is seen most commonly as an equinus deformity of the ankle, or at the knee or elbow in the form of a flexion deformity. The cause is either fibrosis following intramuscular hematoma, which may be complicated by a peripheral nerve palsy causing muscle imbalance, or is associated with chronic hemophilic arthropathy following recurrent hemarthroses. The introduction of home therapy is an important preventive measure, and treatment is primarily by physiotherapy, splintage, and corrective devices. The late or severe case may require surgical correction in the form of soft tissue procedures. Arthrodesis or total arthroplasty must be carried out with meticulous hemostasis and with replacement of the appropriate blood clotting factors.

Adolescent↗
PubMed1987

Nuclear magnetic resonance studies of experimentally induced delayed fracture union.

Delayed fracture union was produced in the rat tibia with parenteral administration of prednisolone. Phosphorus nuclear magnetic resonance spectroscopy was used to monitor the local pH changes that occurred at the fracture site throughout repair. During the fracture healing in control animals, the pH of the fracture site changed from 7.2 on Day 2 to 7.5 on Day 20 following fracture, i.e., alkaline with respect to the pH of normal extracellular fluid. Deposition of radioopaque callus occurred mainly during the alkaline phase. In the steroid-treated rats the rate and extent of pH change were significantly less and the fracture site became alkaline five to ten days later than in the control animals. Because radiopaque callus deposition still occurred predominantly in the alkaline phase, union was also delayed by about the same interval of time. The rat prednisolone model differs significantly from the human condition of delayed union. Clinical investigations are indicated to ascertain whether abnormalities of fracture site pH occur in delayed union in humans.

Animals↗