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Biomedical subjects

R M Atkins

Publications and source records attributed to R M Atkins.

At least 55 records · Page 3Linked to original sources
PubMed1993

Reconstruction nailing for pathological subtrochanteric fractures with coexisting femoral shaft metastases.

We describe the use of intramedullary reconstruction nails in the treatment of 14 patients with pathological subtrochanteric fractures and coexisting metastases in the femoral shaft. After nailing, all patients were free from pain and regained mobility. They were followed up clinically and radiologically until death from the primary disease. There were no mechanical failures even when a less than ideal reduction had been achieved.

Aged↗
PubMed1993

Intra-articular fractures of the calcaneum. Part I: Pathological anatomy and classification.

We have studied the radiographic and CT features of 120 displaced intra-articular fractures of the calcaneum in order to define the pathological anatomy. In 96% of cases, the CT scans identified three main fragments: sustentacular, lateral joint and body. The sustentacular fragment was often rotated into varus, the lateral joint fragment into valgus and the body fragment impacted upwards, in varus and displaced laterally. The displacement of these fragments varied according to which of three fracture types was present, as defined by the composition of the fractured lateral wall of the calcaneum. In type 1 it was formed by the lateral joint fragment alone; in type 2 by both body and lateral joint fragments; and in type 3 by the body fragment alone. Fracture fragment displacement differs from that previously described, in that true uniform depression of the lateral joint fragment is rare.

Adolescent↗
PubMed1993

Intra-articular fractures of the calcaneum. Part II: Open reduction and internal fixation by the extended lateral transcalcaneal approach.

The classification of intra-articular fractures of the calcaneum described in part I is related to an operative approach which allows accurate reduction and stable fixation of the fracture fragments. An extended lateral incision is used to avoid sural nerve damage and problems of soft-tissue healing. In type 3 fractures, access to the lateral joint fragment requires an osteotomy of the lateral wall, but after this the lateral joint fragment can be rotated out of the subtalar joint to allow transcalcaneal reduction of the medial wall. Reduction of the body fragment and lateral joint fragment on to the sustentacular fragment allows the three fragments to be stabilised by a 3.5 mm Y-shaped reconstruction plate. Our early results have been successful in terms of fracture reduction and the restoration of heel shape and joint congruity, but extended follow-up will be necessary to define the indications for this difficult procedure.

Adolescent↗
PubMed1993

Algodystrophy and osteoporosis after tibial fractures.

We made a prospective study of the incidence and natural history of algodystrophy and associated changes in bone mineral density in the ankles and feet of 60 consecutive patients who had suffered unilateral fractures of the tibial shaft. At bone union, 18 patients showed signs of algodystrophy. Its development was independent of the type of fracture management and of the severity of injury. Patients with algodystrophy lost significantly more bone mineral than did those without but the degree of this loss was independent of the type of treatment and of the time to fracture union. In most cases the symptoms resolved within six months of fracture union but in four patients they were still present at one year and two of these had not returned to work.

Absorptiometry, Photon↗
PubMed1993

Hypothesis: cartilage catabolic cofactors in human arthritis.

Cartilage degradation in rheumatoid arthritis (RA) and osteoarthritis (OA) is commonly thought to be mediated by interleukin 1 (IL-1) and tumor necrosis factor (TNF). However, recent new evidence suggests that IL-1 and TNF on their own do not mediate all the cartilage changes seen in RA and OA. We propose that cartilage degradation is mediated by a complex network of cytokines, including IL-1, TNF and at least one cofactor present in synovial fluid.

Arthritis, Rheumatoid↗
PubMed1992

Treatment of fixed flexion deformities of the knee in rheumatoid arthritis using the Flowtron intermittent compression stocking.

Thirty established fixed flexion deformities of the knee in 18 rheumatoid arthritis patients were studied prospectively to assess the results of 8 weeks of out-patient treatment using the Flowtron intermittent compression stocking. A 44% mean correction of the fixed flexion deformity was obtained from an initial mean of 29 +/- 1 degrees to 16 +/- 1 degrees (P less than 0.001). More than 85% of this correction was obtained in the first 4 weeks of treatment. There was a significant correlation between the correction obtained and the inflation pressure (P less than 0.05), but the time of daily use (minimum 60 min) was not a significant factor. The modified Stanford Health Assessment Disability Index fell from an initial mean of 2.17 to 2.03 (P less than 0.01).

Ambulatory Care↗
PubMed1992

Susceptibility of normal and arthritic human articular cartilage to degradative stimuli.

Recombinant interleukin-1 (IL-1) alpha and beta stimulated significant loss of glycosaminoglcan (GAG) content from normal (non-arthritic) articular cartilage explants but only after incubation for 14 days and only in specimens from 8/21 (38%) individuals. By contrast, all cartilage specimens but one from patients with osteoarthritis (OA) and rheumatoid arthritis (RA) were degraded (as judged by their reduced GAG content) by the recombinant cytokines but again only after 14 days' incubation. The reduction in GAG induced by IL-1 was also greater for both OA and RA cartilage than normal cartilage. Synovial fluids (SFs) from RA patients stimulated greater loss of GAG content from OA cartilage explants than normal explants although in both cases the loss was evident within 2 days. It is concluded that cartilage explants from some individuals are susceptible to the degradative effects of IL-1 whereas others are refractory and that arthritic cartilage is more susceptible to degradation by both IL-1 and RA SFs than non-arthritic cartilage.

Aged↗
PubMed1992

Treatment of haemophilic flexion deformities using the Flowtron intermittent compression system.

We have studied prospectively the use of the Flowtron intermittent compression system for the home treatment of fixed flexion deformities of elbows and knees, resulting from chronic haemophilic arthropathy. A total of 16 elbows (six unilateral and five bilateral), and 10 knees (six unilateral and two bilateral) in 11 patients were studied. Treatment caused a decrease in flexion contracture of the elbows from 41 +/- 3 degrees to 28 +/- 3 degrees (P < 0.001), an improvement of 32%. The knees showed a decrease in flexion contracture from 31 +/- 3 degrees to 20 +/- 2 degrees (P < 0.0001), an improvement of 35%. Prophylactic factor replacement was not used during the study and there were no bleeds attributable to the treatment. We conclude that the use of the Flowtron in home treatment of fixed flexion deformities in haemophiliac patients is safe, effective and cheap.

Chronic Disease↗
PubMed1992

The distal course of the sural nerve and its significance for incisions around the lateral hindfoot.

Twenty preserved cadaver limbs were dissected to show the distal course of the sural nerve and the number and site of origin of its branches. The mean position of the main nerve trunk was calculated at various points related to bony landmarks of the fibula and the fifth metatarsal base. Ninety-five percent confidence limits for the course of the main nerve trunk could be described. A fibula incision may damage the nerve if it extends more than 7 mm inferior to the lateral malleolar tip with the foot in equinus. Dorsolateral foot incisions may damage both the main trunk and the major anterior branch.

Aged↗
PubMed1991

Human cartilage is degraded by rheumatoid arthritis synovial fluid but not by recombinant cytokines in vitro.

Rheumatoid arthritis (RA) synovial fluid (SF) stimulated significant loss of glycosaminoglycans (GAG) from normal and pathological human cartilage biopsies over 2 days as compared with normal human serum. By contrast, 15 RA SFs failed to degrade killed normal cartilage, and degraded killed RA cartilage less effectively than living RA cartilage. Four RA SFs were treated with neutralizing anti-cytokine antisera prior to incubation with normal cartilage. The degrading effects of two of the fluids were reversed by anti-interleukin-1 alpha (IL-1 alpha) while degradation by the third and fourth fluids were reversed by anti-interleukin-1 beta (IL-1 beta) and anti-tumour necrosis factor-alpha (TNF-alpha), respectively. However, recombinant human IL-1 alpha, IL-1 beta, TNF alpha or a combination of all three cytokines had no degrading effect in this 2-day culture system. It is concluded that RA SF degrades cartilage by a mechanism involving a synergistic interaction between cytokines and some other component of SF.

Arthritis, Rheumatoid↗
PubMed1991

Differential responses of human and rat cartilage to degrading stimuli in-vitro.

Human cartilage biopsies incubated for 2 days in-vitro with 15% synovial fluid from rheumatoid arthritis patients contained less glycosaminoglycans (GAG) than control biopsies. Recombinant human (rHu)-interleukin-1 alpha (IL-1 alpha) and IL-1 beta at 10 or 100 ng mL-1 had no effect on human cartilage GAG levels. Similarly, GAG loss from human cartilage biopsies into medium over 5 days was significantly increased by synovial fluid but unaffected by 100 ng mL-1 IL-1 alpha or IL-1 beta compared with controls. However, when rat femoral head cartilage samples were incubated with 100 ng mL-1 rHu-IL-1 alpha or IL-1 beta for 5 days there was a significant increase in GAG loss from the cartilage into medium, whilst human synovial fluid significantly decreased the loss of GAG from rat cartilage into medium, compared with controls. The results demonstrate that human and rat cartilage differ from each other in their responses to degrading stimuli and suggest that animal cartilage may have limited application for the screening of drugs intended for the treatment of human arthritides.

Animals↗
PubMed1991

Degradation of human cartilage by synovial fluid but not cytokines in vitro.

Synovial fluids from patients with rheumatoid arthritis and from patients with osteoarthritis degraded the matrix of living, but not killed, normal human cartilage as judged by loss of glycosaminoglycans. Normal human serum did not degrade living cartilage and neither, unexpectedly, did recombinant human cytokines.

Arthritis↗
PubMed1991

Revision total hip arthroplasty for aseptic failure. A review of 276 cases.

The results of 276 cemented revision total hip arthroplasties performed for aseptic failure between 1977 and 1986 have been reviewed. The mean time between revision and review was 75 months (range 30 to 144). Of 220 cases available for review, 159 were assessed clinically and radiographically, and 32 by postal questionnaire. Eighteen hips required further revision, 12 for loosening, two for sepsis, two for persistent pain, and one each for fracture and recurrent dislocation. A further six hips were radiologically and symptomatically loose. Pain was mild or absent in 83%. Over half were able to walk a mile or more; 70% flexed more than 70 degrees; 15% had a flexion deformity, but in only 7% was this more than 10 degrees. The mean Harris hip score was 74. Survival at five years was 95% and at 10 years, 77%.

Activities of Daily Living↗
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↗
PubMed1990

An algometer for the automated measurement of pain threshold.

An automated device is described which enables operator independent measurement of pain threshold. Pressure is applied across a joint of the digit by means of a controlled pneumatic actuator. Testing 10 normal subjects indicated good reproducibility (r2 = 0.75, one-way analysis of variance).

Adult↗