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Biomedical subjects

R H Fitzgerald

Publications and source records attributed to R H Fitzgerald.

At least 91 records · Page 5Linked to original sources

Early dynamic bone-imaging as an indicator of osseous blood flow and factors affecting the uptake of 99mTc hydroxymethylene diphosphonate in healing bone.

We determined the uptake of 99mTc-labeled hydroxymethylene diphosphonate in a surgically created defect in the canine tibia with early dynamic and delayed static bone scans. The defect consisted of a cortical bone window, ten by five millimeters, centered over the middle of the tibia. The dynamic bone scans consisted of sixty one-second images of the tibia, recorded immediately after the injections of 99mTc, and the static scans were single forty-five-minute uptake images of the tibia. These were performed and the dogs were killed at seven, fourteen, and twenty-eight days postoperatively. The dynamic scans detected the postoperative increase in tibial blood flow because the values calculated from these scans demonstrated a significant linear relationship to tibial blood flow determined with radioactive microspheres (r = 0.76, p less than 0.001). The increased uptake of 99mTc in the cortical defect that was detected with static scans was attributable not only to the increased blood flow but also to uptake by immature bone. Early dynamic bone-imaging increases the versatility of bone scintigraphy. The significant correlation between the dynamic scans and bone blood flow suggests that this non-invasive technique can provide a quantitative comparison of changes in regional blood flow in bone.

Animals↗

Dynamic radioisotope bone imaging as a noninvasive indicator of canine tibial blood flow.

The relative values of dynamic and static bone imaging with hydroxymethylenediphosphonate technetium 99m (99mTc HDP) as an indicator of bone blood flow was investigated in the tibia of mature dogs. The dynamic bone scan consisted of 60 1-s images formed after the intravenous injection of 99mTc HDP, and the static bone scan was a 45-min uptake image. Blood flow to the tibia was determined by using radioactively labeled microspheres. Studies were carried out in control dogs, in dogs in which blood flow was increased in one leg with ATP, and in dogs in which blood flow was decreased in one leg with norepinephrine. A significant (p less than 0.001) linear relationship between the dynamic scan values and bone blood flow was found at a wide range of blood flow rates. When blood flow increased by more than 50%, the effects of "diffusion limitation" were seen in the static scans: increase in tracer uptake was disproportionately small for a significant increase in blood flow. There is no method currently available for estimating bone blood flow by a noninvasive technique. The method described here may be useful for providing a semiquantitative measure of bone blood flow. This improved versatility of bone imaging may have a role in the management of osteomyelitis or complicated fractures, or in assessing the viability of vascularized bone grafts.

Adenosine Triphosphate↗

Surgical treatment of ligamentous instability after total knee arthroplasty.

During the period of January 1, 1972 through October 31, 1982 seven knees in seven patients had ligamentous reconstructions for instability following total knee arthroplasty. The type of ligamentous instability included severe medial instability in six and a combined severe medial and mild lateral instability in one patient. The surgical technique utilized to reconstruct the ligaments included proximal and distal advancement of the medial collateral ligament. In five of the seven, additional soft tissue surgery was combined with tightening of the medial collateral ligament. Unfortunately, ligamentous reconstruction failed to restore stability to the knee in any of the seven patients. Four patients required revision total knee arthroplasty. Instability of the knee necessitated full-time support with a brace and the seventh patient manages his instability without a brace. Ligamentous reconstruction without component revision is inappropriate in the treatment of the unstable knee following total knee arthroplasty.

Adult↗

Scintigraphic evaluation in musculoskeletal sepsis.

In this article, the mechanism of technetium, gallium, and indium-labeled white blood cell localization in septic processes is detailed, and the method of interpretation of these three isotopes with relationship to musculoskeletal infection is outlined. Specific clinical application of technetium, gallium, and indium-labeled white blood cell imaging for musculoskeletal sepsis is reviewed.

Bone Diseases↗

Chronic osteomyelitis treated with a muscle flap.

The use of local muscle flaps in the treatment of chronic osteomyelitis is outlined. The defect treated must be in an anatomic location that permits rotation of the muscle flap. A recent review of 42 patients treated with this technique showed the local muscle flap to be efficacious in 39 of the 42 patients treated.

Adult↗

Anaerobic septic arthritis and osteomyelitis.

Anaerobic septic arthritis and osteomyelitis are more common than previously believed. Recent experience suggests that because of the high morbidity associated with these conditions, a very aggressive surgical and medical treatment program is indicated.

Aged↗

Antibiotic distribution in normal and osteomyelitic bone.

Antibiotics are able to penetrate normal and osteomyelitic bone in a fashion that permits concentrations equivalent to those found in the serum following intravenous administration. There is no osseous barrier or gradient in osseous tissue to antibiotic penetration.

Aminoglycosides↗

Moxalactam penetration of normal and osteomyelitic bone.

The ability of moxalactam, a new cephalosporin, to cross the capillary membrane and enter the interstitial fluid space of normal and osteomyelitic bone in the dog was investigated. Moxalactam was noted to readily traverse the capillary membrane of both normal and osteomyelitic bone. The calculated concentrations of moxalactam in the interstitial fluid space corresponded to the simultaneously obtained serum concentrations determined with a bioassay.

Animals↗

Diagnostic radiation exposure in trauma patients.

Thermoluminescent dosimeters (TLDs) were read from 31 patients with multisystem trauma after emergency stabilization to determine radiation dosage from diagnostic studies. Exposures did not greatly exceed permissible dose limits for the general population.

Child↗

Experimental osteomyelitis: description of a canine model and the role of depot administration of antibiotics in the prevention and treatment of sepsis.

UNLABELLED: Osteomyelitis of the proximal portion of the tibia was consistently produced in the dog by the instillation of a suspension of Staphylococcus aureus about an intramedullary foreign body consisting of acrylic bone cement. The clinical, histological, and roentgenographic manifestations of the infectious process were consistent with those of subacute osteomyelitis, such as may be encountered in infections following total joint arthroplasty. The osteomyelitic process persisted in six of the seven tibiae even after removal of the acrylic bone cement. Using this model, gentamicin-impregnated acrylic bone cement (Palacos) prevented the development of osteomyelitis in nine of ten tibiae that were concomitantly exposed to Staphylococcus aureus in concentrations ranging from 1 x 10(3) to 1 x 10(9) organisms. However, Palacos in bulk form was ineffective in the treatment of three of five tibiae in which osteomyelitis caused by Staphylococcus aureus was already established. CLINICAL RELEVANCE: A variety of new antimicrobial agents has been introduced, but evaluation of the value of these agents in infections of the musculoskeletal system has relied almost exclusively on clinical trials. Preclinical trials in an animal model could permit earlier detection of promising agents and proper dosage schedules. Newer surgical procedures utilized in the treatment of osteomyelitis, such as local muscle flaps and free vascularized flaps, could also be evaluated to determine how they influence the local blood supply and microbial persistence. In addition, the animal model might aid in the evaluation of newer and non-invasive diagnostic scanning techniques used in the study of infection.

Animals↗

Fluid spaces in normal and osteomyelitic canine bone.

When cortical bone is afflicted by an infectious process, significant alterations in the physiology and anatomy occur at the cellular level. Included in these alterations are modulations of the various fluid spaces of cortical bone. Volume of distribution studies with 14C-labeled sucrose and 99Tc-labeled red blood cells in an animal model of acute, subacute, and chronic osteomyelitis of the tibia were performed to quantitate the various fluid spaces in cortical bone. Additionally, the studies were performed in cortical bone from the radius and tibiae (following sham operations) to allow comparison with normal and control values. The total exchangeable water, vascular, and interstitial fluid spaces were increased in all three types of osteomyelitic bone. With one-way analysis of variance and Duncan's multiple range test, the alterations observed in each type of osteomyelitic bone (acute, subacute, or chronic) were statistically different from those observed in normal bone (p = 0.001) and controls (p less than or equal to 0.01). The differences of the mean values observed among the three types of osteomyelitic bone were not statistically significant (p greater than 0.05). These pathophysiologic alterations in osteomyelitic bone must be considered when one studies the ability of various antimicrobials to reach bactericidal concentrations in the interstitial fluid space, the primary site of drug-microorganism interaction.

Acute Disease↗

Metastasis to the choroid complicating adenoid cystic carcinoma.

Two months after a complete response to doxorubicin hydrochloride and cyclophosphamide administered for systemic effects, with the disappearance of pulmonary and pleural metastases from adenoid cystic carcinoma of salivary origin, a patient experienced symptomatic choroidal metastasis with no other evidence of active disease. Irradiation produced complete disappearance of the choroidal metastasis and restoration of visual acuity. The literature is reviewed, and the unusual nature of this metastasis is discussed.

Carcinoma, Adenoid Cystic↗