Biomedical subjects

R M Harrington

Publications and source records attributed to R M Harrington.

At least 37 records · Page 2Linked to original sources

PubMed1994

Biomechanical simulation of the anteroposterior compression injury of the pelvis. An understanding of instability and fixation.

Seven fresh cadaveric pelvic specimens were biomechanically analyzed. Testing was first performed on intact pelves and then after progressive disruption of the (1) symphysis pubis, (2) unilateral anterior and interosseous sacroiliac ligaments and capsule, (3) ipsilateral sacrospinous and sacrotuberous ligaments; and fixation with a 4.5-mm narrow dynamic compression plate at the symphysis pubis, or a 4.5-mm narrow dynamic compression plate at the anterior sacroiliac joint with and without the symphysis pubis plate, or a 7.0-mm sacroiliac lag screw anchored into the S1 vertebral body with and without the symphysis pubis plate. Symphyseal gapping occurred after isolated symphysis pubis disruption. With additional disruption of the unilateral sacroiliac joint ligaments, symphysis pubis displacement was unaffected; however, the injured sacroiliac joint gap displacement, and sacroiliac joint flexion angulation on both intact and injured sides increased as compared to the specimen in the intact state. Further disruption of the ipsilateral sacrotuberous and sacrospinous ligament complex produced little additional motion at either symphysis pubis or sacroiliac joints. Plate fixation of the symphysis pubis alone reduced symphysis pubis motion, but not sacroiliac motion. Use of sacroiliac fixation alone without a symphysis pubis plate did not affect symphysis pubis motion. The symphysis pubis plate is the key to stabilizing symphysis pubis motion, and similarly, sacroiliac joint fixation is required to control sacroiliac joint motion. Both single iliosacral screws and plates produced equivalent decreases in sacroiliac joint motion.

Biomechanical Phenomena↗

PubMed1994

Effect of sterilization and storage treatments on screw pullout strength in human allograft bone.

Many conflicting studies have been performed evaluating the effects of sterilization and storage treatments on the mechanical properties of allograft bone. In the current study, four right and left matched, sterile, deep-frozen, tibial pairs from human donors with an average age of 32 years were tested. One tibia from each pair served as a matched control for the opposite side. Each tibia was cut into four equal segments. One segment of each tibia underwent no treatment; the other three underwent one of the following treatments: irradiation, freeze drying, or ethylene oxide (ETO). Screw pullout tests were performed using four 3.5-mm cortical screws per segment. Sixteen screw pullout tests were performed for each allograft treatment. The freeze-dried specimens required significantly less force for screw pullout. The screw pullout force for the irradiated specimens and the ETO specimens did not significantly differ from their controls. These results indicate that freeze drying affected screw pullout strength. This method of processing should be questioned for structural allografts in which screw fixation is mandatory. The use of irradiation or ETO for sterilization may not have an adverse effect on screw pullout strength.

Biomechanical Phenomena↗

PubMed1993

Biomechanics of indirect reduction of bone retropulsed into the spinal canal in vertebral fracture.

The biomechanics of indirect reduction of bone fragments retropulsed into the spinal canal in a burst fracture were investigated. In this model, tunnels were created in vertebrae L1 and C5 oriented anterior-to-posterior, allowing access to the posterior longitudinal ligament. A probe containing a load-sensing tip was passed through the tunnel. Both the location of the tip and the load acting on it by posterior deflection of the posterior longitudinal ligament were measured. In the lumbar spine, distraction was applied by spinal instrumentation that also permitted independent kyphotic-lordotic alignment of the vertebrae. In the cervical spine, axial traction was applied through direct loading. Several clinically relevant observations were made. It was not possible to produce an anteriorly directed force in the posterior longitudinal ligament at less than 35% canal occlusion, partly because the posterior longitudinal ligament stands away from the midbody of the vertebra. Distractive forces of up to 150 N were applied in the lumbar spine, which were nearly equal to the tensile breaking strength of the isolated posterior longitudinal ligament. Regardless of the relative sagittal plane angulation of the vertebrae, distraction was the governing factor in generating force in the posterior longitudinal ligament. Because positioning the vertebrae in lordosis before applying distraction significantly slackens the posterior longitudinal ligament, it is suggested that distraction be applied before angular positioning of the vertebrae is performed.

Biomechanical Phenomena↗

PubMed1992

Contact characteristics of the subtalar joint: load distribution between the anterior and posterior facets.

The pressure distribution properties of the normal talocalcaneal joint were studied in 13 fresh cadaver specimens using pressure-sensitive film. The film was inserted into the joint through a posterior approach for the posterior facet and an anteromedial approach for the anterior/middle facet. Specimens, comprising the distal half of the tibia and fibula and the intact ankle and foot, were positioned in neutral in the sagittal plane. In the coronal plane, specimens were positioned in neutral, inversion, or eversion, and the contact characteristics were determined in varying positions, with and without loading the fibula, under axial loads of 350 N, 700 N, 1,050 N, and 1,400 N. The transducers were video imaged for quantitative analysis of area and pressure. The contact/joint area ratio increased significantly with applied load in the posterior facet [e.g., in eversion from 0.336 (SD = 0.195) at 350 N to 0.631 (SD = 0.225) at 700 N], as did the proportion of the contact area greater than 6 MPa, indicating an increase in contact pressure. The contact/joint area ratio was significantly lower in inversion than in any other position of the foot; however, high-pressure zones were similar, indicating that higher pressures occur in inversion. In the anterior/middle facets both contact/joint area ratio and high pressure/contact area ratios increased significantly to 700 N, but not with further load increase. At 350 N the anterior/middle facet contact area was 31% that of the posterior facet, yet it carried 63.3% of the load of the posterior facet, so its mean contact pressure was 1.44 MPa compared with 0.93 MPa for the posterior facet.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Contact characteristics of the subtalar joint: the effect of talar neck misalignment.

In this study we determined the effects of misalignment of the talar neck on the contact characteristics of the subtalar joint. Each of seven fresh cadaver lower extremities was mounted in a loading jig and a vertical load was applied, 90% of which was directed through the tibia and 10% through the fibula. The foot was allowed to displace freely in the horizontal plane so that relative rotations, known to occur in the subtalar joint, would not be prevented. Pressure-sensitive film, inserted into the posterior and anterior/middle articulations, was used to quantify changes in contact characteristics. After testing in the normal condition, the talar neck was osteotomized and stabilized with internal and external skeletal fixation. Contact characteristics were then determined in each of the following stages: anatomic realignment, or with 2-mm displacement of the talar neck either dorsally, medially, laterally, or complex (dorsal and varus) with respect to the body of the talus. Measurements showed no significant changes in overall contact area or high pressure area in the posterior facet, although four of the seven specimens demonstrated increased localization of the contact area into two discrete regions. The combined anterior/middle facet, on the other hand, was significantly unloaded by all but medial displacement of the talar neck. An extraarticular load path and/or increased loading directly on the talonavicular joint was presumed to account for the loss of load transfer in the talocalcaneal joint.

Analysis of Variance↗

PubMed1992

Parathyroid hormone decreases HCO3 reabsorption in the rat proximal tubule by stimulating phosphatidylinositol metabolism and inhibiting base exit.

The mechanism of inhibition of HCO3 transport by parathyroid hormone (PTH) in the proximal tubule is not clearly defined. Previous studies in vitro have suggested that this effect is mediated via cAMP generation, which acts to inhibit Na/H exchange, resulting in cell acidification. To examine this question in vivo, intracellular pH (pHi) was measured in the superficial proximal tubule of the rat using the pH-sensitive fluoroprobes 4-methylumbelliferone (4MU) and 2',7'-bis(carboxyethyl)-(5, and 6)-carboxyfluorescein (BCECF). PTH was found to alkalinize the cell. This alkalinization suggested inhibition of basolateral base exit, which was confirmed by in situ microperfusion studies: lowering HCO3 in peritubular capillaries acidified the cell, an effect blunted by PTH. Removal of luminal Na promoted basolateral base entry, alkalinizing the cell. This response was also blunted by PTH. Readdition of luminal Na stimulated the luminal Na/H exchanger, causing an alkalinization overshoot that was partially inhibited by PTH. cAMP inhibited luminal H secretion but did not alkalinize the cell. Stimulation of phosphatidylinositol-bis-phosphate turnover by PTH was suggested by the effect to the hormone to increase cell Ca. Blocking the PTH-induced rise in cell Ca blunted the effect of the hormone to alkalinize the cell, as did inhibition of phosphatidylinositol breakdown. Furthermore, stimulation of protein kinase C by a phorbol ester and a diacylglycerol applied basolaterally alkalinized the cell and inhibited luminal H secretion. The findings indicate that both arms of the phosphatidylinositol-bis-phosphate cascade play a role in mediating the effect of PTH on the cell pH. The results are consistent with the view that PTH inhibits base exit in the proximal tubule by activation of the phosphatidylinositol cascade. The resulting alkalinization may contribute, with cAMP, to inhibit apical Na/H exchange and the PTH-induced depression of proximal HCO3 reabsorption.

Animals↗

PubMed1992

Force applied during tracheal intubation.

This study quantitated the force applied during tracheal intubation to determine (a) whether the force differed among novice and experienced intubators, and (b) whether the force required differed when intubating patients' tracheas versus intubating the trachea of a commonly used training mannequin. We studied 27 tracheal intubations performed by 17 experienced (greater than 100 prior intubations) and 10 novice (less than 10 prior intubations) intubators. Each intubation was performed with a No. 3 Macintosh blade instrumented with strain gauges to determine force applied in the sagittal plane. The mean force applied was 24.6 +/- 2.9 N (mean +/- SEM) and the maximum force applied by each intubator was 47.6 +/- 3.8 N. There was no difference between groups in the mean force applied (28.8 +/- 6.1 N for the novice group vs 22.3 +/- 2.7 N for the experienced group, P = 0.27) nor in the maximum force applied (55.1 +/- 6.5 N for the novice group vs 43.2 +/- 4.7 N for the experienced group, P = 0.08). The only difference was in the impulse (force x duration), which was more for the novice group largely because of the longer average duration of intubation (40 +/- 12 s vs 19 +/- 4 s, P = 0.06). Among experienced intubators, we found that applied force correlated with patient weight and Mallampati class. Intubation of the Laerdal Airway Management Trainer required mean forces comparable to those required in patients (26.6 +/- 2.5 N vs 22.3 +/- 2.9 N), although the maximum force applied during the intubation effort was greater (58.3 +/- 4.7 N vs 43.2 +/- 4.7 N, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesiology↗

PubMed1990

The effects of age and peripheral vascular disease on the circulatory and mechanical response of skin to loading.

The skin and subcutaneous soft tissues of amputation residual limbs are required to withstand externally applied loads of greater magnitude than similar tissues of the intact lower limb. Increased age and poor circulatory status may contribute to the increased risk of tissue injury seen in this population. This study evaluates the effects of age and circulatory status as risk factors for skin injury resulting from externally applied forces. Twelve young control (YC), six elderly control (OC) and 11 subjects with peripheral vascular disease (PVD) were studied. After base-line ankle arm index (AAI) measurements, TcPO2 electrodes were applied 10 cm below the knee over the medial surface of the tibia and the muscle belly of tibialis anterior. TcPO2 measurements and tissue displacements were obtained under the influence of incremented, normally oriented, external loads. The sensitivity of the tissues to applied loads was determined by calculating the load at which the TcPO2 reached zero. The stiffness of the tissues (displacement/load) was calculated under high (greater than 40 mm Hg) and low (less than 20 mm Hg) loading conditions. No difference was noted in tissue sensitivity to applied loads between the OC and YC populations. The TcPO2 decreased to zero in the PVD population at significantly lower applied loads than both the OC and YC populations. The tissue stiffness of the PVD and the OC populations over bone was greater than the YC population, but no significant differences were noted between the PVD and the OC populations. In summary, increased age does not result in a greater tissue sensitivity to externally applied loads, in spite of the demonstrated increased tissue stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

Circulatory and mechanical response of skin to loading.

We investigated the tolerance of skin to mechanical loading over the tibia and over the tibialis anterior muscle in 12 normal volunteers. Surface load, subcutaneous tissue pressure, skin deformation under load, and transcutaneous partial pressure of oxygen (TcPO2) were simultaneously monitored. The skin over bone showed a significantly stiffer load deformation relationship than the skin over muscle (p less than 0.001). The displacement required to reduce TcPO2 to 0 over bone, 1.1 +/- 0.3 mm (mean +/- standard deviation), was significantly less than that required over tibialis anterior muscle, 5.4 +/- 1.1 mm (p less than 0.001). The applied pressure required to reduce TcPO2 to 0 was significantly greater for skin over muscle (71 +/- 16 mm Hg) than for skin over bone (42 +/- 8 mm Hg) (p less than 0.001). However, the subcutaneous pressure required to reduce TcPO2 to 0 was not significantly different for skin over muscle (36 +/- 11 mm Hg) than for skin over bone (28 +/- 10 mm Hg) (p greater than 0.05). Our results indicate that skin over muscle tolerates greater locally applied loads and deformations because the pressure is lower within the tissue than when similar loads and deformation are applied to skin over bone. Cutaneous perfusion, as indicated by TcPO2, seems to be linked more closely to the subcutaneous tissue pressure than to the surface load or deformations. These results provide some data for predicting mechanical and physiologic response to locally applied loads such as those that may be encountered in prosthetic wear.

Adult↗

PubMed1988

Transcutaneous oxygen tension as a predictor of success after an amputation.

We measured local transcutaneous oxygen tension at the foot and proximal and distal to the knee in 162 patients who then had 206 amputations. When the values for oxygen tension at the foot and distal to the knee were compared with the success or failure of healing after an amputation of the foot or distal to the knee, respectively, a clearly increasing probability of failure was correlated with decreasing transcutaneous oxygen tension. However, even at a tension of zero the probability of failure was not 100 per cent. The results were similar for diabetic and non-diabetic patients. Preoperative values for transcutaneous oxygen tension were a much more consistent predictor of success or failure of healing after an amputation of the foot or distal to the knee than were measurements of systolic blood pressure at the ankle, but neither was predictive of the outcome after an above-the-knee amputation.

Amputation, Surgical↗

PubMed1987

Torsion and bending analysis of internal fixation techniques for femoral neck fractures: the role of implant design and bone density.

To evaluate pin/screw/plate fixation for management of femoral neck fractures, 39 proximal femora were tested in both torsion and flexion under physiological loading conditions. Three, four, or five implants of six commonly used multiple-fixation devices, and a sliding hip screw with and without an additional 6.5-mm cancellous screw were examined in paired femora. The intact and postfixation femora were initially subjected to a single applied moment, and the torsion and bending stiffness were determined from the load-deformation data. Postfixation femora were also subjected to cyclic loading in flexion at three load ranges, and fixation was judged successful if no failure occurred on or before 1,500 cycles of 667 to 2,000 N of a combined compressive force and moment. Anterior-posterior and lateral radiographs of each specimen were taken after fixation in order to evaluate Singh's index of bone density, fracture reduction, implant placement, and cross-sectional diameter of the femoral neck. Bone density was also evaluated by computed tomography (CT) and physical measurement of core samples obtained from the femoral head. The results indicate that there appears to be no justification for the use of more than three pin/screw implants for management of femoral neck fractures. Bone density was found to correlate with fracture stability and may be a useful predictor of fixation success.

Aged↗

PubMed1987

Axial heterogeneity of intracellular pH in rat proximal convoluted tubule.

In the proximal convoluted tubule (PT), the HCO3- reabsorptive rate is higher in early (EPS) compared with late proximal segments (LPS). To examine the mechanism of this HCO3- reabsorption profile, intracellular pH (pHi) was measured along the superficial PT of the rat under free-flow and stationary microperfusion using the pH-sensitive fluorescence of 4-methylumbelliferone (4MU). With 4MU superfusion, pHi was found to decline along the PT. Observation with 365-nm excitation revealed that EPS were brightly fluorescent and always emerged away from their star vessel. Midproximal segments were darker and closer to the star vessel which was surrounded by the darkest LPS. Decreasing luminal HCO3- from 15 to 0 mM lowered pHi in both EPS and LPS, but pHi remained more alkaline in EPS with both perfusates. Thus the axial decline in pHi along the PT is due to both luminal factors and intrinsic differences in luminal H+ extrusion in PT cells.

Absorption↗

PubMed1987

Relationship between transcutaneous oxygen tension, ankle blood pressure, and clinical outcome of vascular surgery in diabetic and nondiabetic patients.

We measured ankle systolic blood pressure (ABP) and limb transcutaneous oxygen tension (TcPO2) before and after 53 vascular procedures performed to relieve limb-threatening ischemia. We compared changes in ABP and TcPO2 and also compared these measurements of limb hemodynamics with the clinical outcome of the vascular procedures. For the procedures performed on patients without diabetes, both ABP and TcPO2 registered similar changes after surgery. Furthermore, those nondiabetic patients who had a postoperative ABP greater than 75 mm Hg or TcPO2 greater than 20 mm Hg showed resolution of the clinical symptoms within 60 days after surgery. All patients falling below these levels underwent a subsequent limb amputation. The results differed somewhat for procedures performed on patients with diabetes. First, a number of diabetic patients showed high ABP in conjunction with low TcPO2. We attribute these observations to the high incidence in diabetic patients of calcific medial stenosis leading to artificially elevated ABP measurements. Second, the clinical outcome among diabetic patients was uncorrelated with the postoperative ABP and was poorly correlated with postoperative TcPO2. Those diabetic patients with postoperative TcPO2 below 20 mm Hg showed unfavorable clinical outcomes, but many patients with postoperative TcPO2 greater than 20 mm Hg and postoperative ABP greater than 75 mm Hg also showed unfavorable clinical outcome (slow healing of ulcers, persistence of rest pain, and/or an amputation on the limb). These data suggest that among our patients with diabetes, simple relief of limb ischemia was not sufficient to result in a trouble-free clinical course. We conclude that TcPO2 is a useful replacement or adjunct to ABP measurements for evaluating the hemodynamic outcome of vascular surgery. Our results also suggest that it is extremely important to evaluate the outcome of such surgeries separately in patients with and without diabetes.

Adult↗

PubMed1986

Effects of chlorine dioxide on thyroid function in the African green monkey and the rat.

In a previous study from this laboratory, chlorine dioxide (ClO2) treated drinking water depressed thyroxine (T4) levels in the African green monkey. The present study again demonstrated a decrease in T4 levels in the same species after 4 wk of oral exposure. However, after 8 wk of treatment T4 levels rebounded to above pretreatment levels, coinciding with an increase in thyroid radioiodide uptake. This T4 rebound phenomenon and increased iodide uptake may be due to a compensatory endocrinological mechanism. In rats, T4 levels dropped during the 8-wk ClO2 treatment period in a dose-dependent manner, and no rebound effect was observed. Iodide uptake values in the rat were not affected. It appears that ClO2 may have an effect on thyroid function in both species.

Animals↗

PubMed1986

Mechanistic aspects of ingested chlorine dioxide on thyroid function: impact of oxidants on iodide metabolism.

Toxicological studies dealing with recent findings of health effects of drinking water disinfectants are reviewed. Experiments with monkeys and rodents indicate that the biological activity of ingested disinfectants is expressed via their chemical interaction with the mucosal epithelia, secretory products, and nutritional contents of the alimentary tract. Evidence exists that a principal partner of this redox interaction is the iodide of nutritional origin that is ubiquitous in the gastrointestinal tract. Thus the observation that subchronic exposure to chlorine dioxide (ClO2) in drinking water decreases serum thyroxine levels in mammalian species can be best explained with changes produced in the chemical form of the bioavailable iodide. Ongoing and previously reported mechanistic studies indicate that oxidizing agents such as chlorine-based disinfectants oxidize the basal iodide content of the gastrointestinal tract. The resulting reactive iodine species readily attaches to organic matter by covalent bonding. Evidence suggests that the extent to which such iodinated organics are formed is proportional to the magnitude of the electromotive force and stoichiometry of the redox couple between iodide and the disinfectant. Because the extent of thyroid uptake of the bioavailable iodide does not decrease during ClO2 ingestion, it seems that ClO2 does not cause iodide deficiency of sufficient magnitude to account for the decrease in hormonogenesis. Absorption of one or more of iodinated molecules, e.g., nutrients, hormones, or cellular constituents of the alimentary tract having thyromimetic or thyroid inhibitory properties, is a better hypothesis for the effects seen.

Animals↗

PubMed1985

Effects of ClO2 on the absorption and distribution of dietary iodide in the rat.

Aqueous chlorine dioxide (ClO2), an alternative disinfectant for drinking water, was found to decrease gastrointestinal (GI) bioavailability of dietary iodide. It has been previously reported that subchronic exposure to ClO2 decreases thyroxine (T4) levels in nonhuman primates. In this study in vitro experiments with animal feed, isolated rat stomachs, as well as in vivo studies with intact rats, showed that ClO2 in drinking water (at in situ concentrations as low as 2 ppm) oxidizes iodide to its reactive elemental (radical) state, binding it to organic substances present in the GI tract. A single instance of acute exposure to ClO2, however, did not decrease blood iodide levels, or thyroid glandular uptake of iodine.

Animals↗

PubMed1982

A comparison of convergent and bi-plane X-ray photogrammetry systems used to detect total joint loosening.

X-ray photogrammetry is an accurate method of measuring structural displacements within the musculoskeletal system. Total joint implant alignment, migration and loosening are important clinical parameters which can be measured by X-ray photogrammetry. The purpose of this paper is to compare two different X-ray photogrammetry systems which are being used to study total joint parameters. The Seattle system uses a convergent geometry and the Cleveland system a bi-plane geometry. The accuracy of the two systems was compared by individually measuring the relative motion produced in an articulated plastic model. The model was designed to simulate the relative motion which can take place between the bone and a loose implant. The displacements of the model components were determined physically and photogrammetrically, and the error in the measurements was calculated for several conditions. Both systems measured relative component motion in the model with a root mean square error of 0.1 mm or less. In clinical use stainless steel markers are implanted in human subjects, and both systems measure distances with a r.m.s. error of 0.2 mm or less. The ease of usage, efficiency and flexibility of the two systems based on actual clinical experience reveals strengths and weaknesses in each which should be recognized when selecting a particular system.

Ankle Joint↗

PubMed1979

Biomechanical study of the pitching elbow.

Medial-tension injuries of the pitching elbow are well recognized. One contributing factor is the extreme valgus which has been noted to occur during the acceleration phase of throwing. It is hypothesized that breaking pitches generate higher medial loading because of the pronation and supination required to impart spin to the ball. The pitching motion is a complex action of all body segments to produce maximum linear and angular acceleration of the ball. The purpose of this study was to correlate elbow loading with pitching style. We measured the forearm segment for axial and tangential (varus-valgus plane) acceleration using accelerometers attached to the forearm and hand. Muscle activity was measured by EMG. Forearm rotation was assessed by stroboscopic photography. Despite different delivery styles when throwing breaking pitches, each pitcher demonstrated patterns of muscle activity and acceleration which were similar. Deceleration forces were lower than acceleration forces. Pronation and supination were documented and contribute to the direction of ball spin. Accelerometers can be used to evaluate pitching mechanics. We suggest that the main factors causing an elbow injury are the amount of throwing and the force with which the ball is thrown.

Baseball↗