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Biomedical subjects

S M Tuli

Publications and source records attributed to S M Tuli.

At least 37 records · Page 2Linked to original sources
PubMed1988

The bridging of large osteoperiosteal gaps using 'Decalbone'.

'Decalbone' was prepared by partial decalcification of human bones obtained from recently amputated specimens. It was then stored in 80 to 90% ethanol in a domestic refrigerator. The decalbone was used to fill large osteoperiosteal gaps in 25 patients. The commonest lesion was a giant cell tumour (21 cases) and various long bones were affected. There were 6 failures with recurrence of the tumour in 3 and uncontrolled infection in 3. The remaining 19 cases were followed up for from 2 1/2 to 7 years. In 10 the decalbone incorporated well, but further reconstructive procedures were needed in 9. Our studies showed that incorporation began at around 6 to 9 months and was complete at about 2 years in the upper limb and 4 years in the lower limb. There was no clinical evidence of an immune response.

Adult↗
PubMed1988

Carbon fibre reinforced epoxy implants for bridging large osteoperiosteal gaps.

An experimental study was undertaken to evaluate the suitability or otherwise of carbon fibre reinforced epoxy (CFRE) implants for bridging large osteoperiosteal gaps, devoid of periosteum. Using the basic principles of composite mechanics and simple design criteria, CFRE implants were designed and developed. These implants were put in simulated osteoperiosteal gaps in the ulna of healthy mature rabbits. Ten wk postoperative results clearly demonstrated that implants made of CFRE induced callus bone formation (in the form of woven bone) which totally encapsulated the implant thereby providing reunion of the two bone segments. Further follow-up showed formation of lamellar bones and formation in the pores of the implant. Radiological and scanning electron microscopical evidence is presented.

Animals↗
PubMed1985

Skeletal overgrowth with modelling error in neurofibromatosis.

Ten cases of neurofibromatosis, nine involving the lower extremity and one, the upper extremity, were analysed for growth and modelling errors. The elongated bones showed over-tubulation or under-tubulation. Long as well as short bones were affected. Modelling errors mostly affected the metaphysis but, in a few cases, especially where there was isolated involvement of the fibula, the diaphysis was also affected. In two patients the whole length of paired bones of the leg showed evidence of over-tubulation. The rule of polarity which influences growth and modelling was not applicable to these cases of neurofibromatosis. Soft-tissue masses of neurofibromatosis often determined the segment of the bone involved but, in cases without such an external influence, inherent mesodermal dysplasia was thought to be the causative factor.

Adolescent↗
PubMed1982

Bridging large bone defects with a xenograft composited with autologous bone marrow. An experimental study.

We have investigated the role of defatted, decalcified xenogenic bone implants composited by impregnation with fresh autologous marrow in bridging large cortical defects. Diaphyseal cortical implants were obtained from orthopaedic operations on humans and from guinea pigs and prepared by treatment with acetone, 0.6 M HCl and ethanol. The composited graft was used to bridge a 3 cm defect in the diaphysis of the ulna of rabbits. Periodic investigations were made clinically, radiographically and histologically and by tetracycline, fluorescence studies up to 20 weeks. Abundant new bone formation was observed in 85.7% of composited human xeno-autografts and in 83.3% of composited guinea pig xeno-autografts. New bone formation was seen in 13.3% of noncomposited xeno-implants. No appreciable antigenicity was observed either clinically or histologically in the grafts. The high degree of success obtained justifies further studies on implants composited by fresh autologous marrow and offers hope for the enhancement of new bone formation clinically, particularly in reconstructive operations for significant skeletal defects. We feel that the osteo-inductive potential of autologous marrow was responsible for the healing of the defects aided by the better internal milieu provided by defatted decalcified xeno implant.

Animals↗
PubMed1982

Osteoinductivity of partially decalcified alloimplants in healing of large osteoperiosteal defects.

About 3.5 cm osteoperiosteal circumferential gaps in rabbit ulnae were bridged by partially decalcified (by 0.6 M HCl) allogenic implants, 8-12 weeks after implantation complete bridging of the gap by new bone formation and union at host-graft junctions was observed in 97.2 per cent of the experiments. Instant permeability and the powerful osteo-inductive potential of the implant coupled with some degree of mechanical stability provided by partial decalcification ensured successful bone formation in almost all the experiments. It is suggested that partially decalcified allogenic bone matrix preserved in 70 per cent ethanol may be a reasonably good substitute for autologous bone graft.

Animals↗
PubMed1981

Ewing's sarcoma: A combined approach in the management.

Twenty-seven histologically confirmed cases of localised Ewing's sarcoma were treated by two different regimes. Radiotherapy alone was used in 13 cases and a combination of chemotherapy and radiotherapy in 14. Single agent chemotherapy (cyclophosphamide) was given sequentially in nine patients and cyclophosphamide and actinomycin-D in five. There is a significant difference in the response to these different regimes. Only 69.2% of patients treated by radiotherapy alone were disease-free, for a median period of 10.4 months and metastases were noticed in 53.8% of cases. The disease-free survival in patients treated by combination therapy (radiotherapy and chemotherapy) was 18.4 months and metastases were seen in only 42.9%. However, no metastases were seen in patients who received cyclophosphamide and actinomycin-D, during a period of 14 months and only one patient showed residual disease. It is concluded that the addition of cyclophosphamide alone is not adequate in the management of Ewing's sarcoma. Actinomycin-D in addition to cyclophosphamide has improved the disease-free survival period significantly. The optimum dose of radiotherapy and its combination with other chemotherapeutic agents needs further trials to find the best and most suitable schedule.

Adolescent↗
PubMed1981

Bridging of large chronic osteoperiosteal gaps by allogeneic decalcified bone matrix implants in rabbits.

A circumferential complete osteoperiosteal gap (1 to 1.5 cm) was produced in the diaphysis of ulna of rabbits, and the ipsilateral radius was kept intact. In no case did spontaneous bridging of the gap occur. By 6 weeks after the creation of the gap the bone ends became smooth and tapered towards the ipsilateral radius and the defect was observed to be filled by thin fibrous tissue. Established defects at least 6 weeks old were then bridged by inserting a snugly fitting allogeneic bone matrix implant. The bone matrix was prepared by demineralization of tubular bones from healthy rabbits, using 0.6 M HCl, preserved in 75% alcohol and used within 3 weeks. The fate of the implant was observed clinically, radiologically, histologically by tetracycline fluorescence for up to 12 weeks. Radiologic evidence of bone formation was present in a majority by 6 weeks, and complete bridging of the gap was seen in 75% of cases by 12 weeks after implantation. Most of the initial bone that formed was the woven bone, i.e., immature bone formed directly from the mesenchymal cells, or formed in membrane, though areas of enchondral ossification were also observed in some cases. By 12 weeks, the bone had remodeled almost to the texture of a mature tubular bone. Successful bridging of chronic massive bone defects by allogeneic bone-matrix was confirmed in 75% of cases.

Animals↗
PubMed1981

Excision arthroplasty for tuberculous and pyogenic arthritis of the hip.

Thirty patients with chronic pyogenic or tuberculous arthritis of the hip treated by Girdlestone's excision arthroplasty were reviewed two to seven years after operation. There was marked or complete relief of pain in 29, control of infection in 27, squatting and sitting cross-legged was possible in 27, and 16 were able to stand on the operated limb. Overall results were good in 16, fair in nine, and poor in five. Tuberculous disease was not reactivated and the use of traction for 12 weeks and a weight-relieving caliper for 12 months after operation helped to reduce the shortening to an average of 3.8 centimetres. Excision arthroplasty is considered a sound operation to restore the ability to squat and sit cross-legged.

Adolescent↗
PubMed1980

Symptomatic vertebral haemangiomas.

Twelve cases of symptomatic vertebral haemangioma are reported in respect of their clinical presentation and radiological findings. One patient was only 10 years old, the youngest patient ever reported. Less commonly known findings of associated paravertebral mass and the displacement of the thoracic paraspinal line are discussed.

Adult↗
PubMed1980

Mycobacterium kansasii and osteoarticular lesions.

Four patients with an unusual type of bone lesion are reported. The histological diagnosis in two of them was non-specific chronic inflammation and one case was diagnosed as chronic eosinophilic granuloma. On subjecting the material to culture Mycobacterium Kansasii (a photochromogen) were isolated. It is suggested that M. Kansasii are capable of producing osteoarticular lesions with a rather vague clinical and radiological picture not typical of osteoarticular tuberculosis.

Adolescent↗
PubMed1979

Effect of preimplantation treatment on the bone-forming potential of decalcified allogeneic and xenogeneic bone-matrix implants.

Bone-forming property of 0.6 M HCl decalcified (a) allogeneic bone matrix preserved in 70% alcohol, (b) allogeneic bone matrix preserved in anaesthetic ether, (c) allogeneic 'Ossein' provided by the Leather Research Institute, Madras, and (d) xenogeneic bone-matrix preserved in alcohol was studied by fitting the implants in surgically created complete circumferential osteo-periosteal gaps in the ulna of rabbits. Bone formation was assessed radiologically, macroscopically, histologically, and by tetracycline fluorescence up to 16 postimplantation weeks. Successful bridging of the gap by new bone formation was observed in 75% of (a) and 28.6% of (d) preserved up to 2 weeks. Ether-preserved implants did not induce bone formation. The 'Ossein' implants remained as inert material neither invaded by host cells nor inducing any bone formation. The xenogeneic implants exhibited local immune response which was probably responsible for poor osteogeneic response. Bone forming quality of bone-matrix implants appears to be influenced by the chemical treatment during preparation and preservation, host cellular response and immune reaction invoked by the implant.

Animals↗
PubMed1978

The osteoninductive property of decalcified bone matrix. An experimental study,.

Demineralised homologous bone-matrix implant was used to bridge a large circumferential osteoperiosteal gap in the diaphysis of the ulna of rabbits. Periodic observations of the graft were made clinically, radiologically, histologically and by tetracycline fluorescence up to forty-two weeks. By the twelfth week after operation 81 per cent of the animals revealed bone formation in the implant and complete bridging of the gap. The new bone was laid on the surface and in the substance of the matrix, suggesting that the inductive principle was acting locally. The bone, once formed, remodelled to the texture of a mature tubular bone and did not undergo absorption during a long follow-up period. Demineralise bone-matrix proved to be a highly osteoinductive and readily osteoconductive material. The graft did not evoke any appreciable local foreign-body or immunogenic reaction. The high degree of success in bridging massive bone defects justifies further serious studies and hopes for a useful substitute for massive autologous bone grafts.

Animals↗
PubMed1977

Penetration of antitubercular drugs in clinical osteoarticular tubercular lesions.

In 79 consecutive cases of skeletal tuberculosis the concentration of streptomycin and ethambutol was analysed. The material for analysis was obtained from the diseased joints of 14 patients and from cold abscesses from spinal or osseous lesions in 65 patients. The concentration of the drugs in the serum and in the tuberculous material was measured 3 hours after the systemic administration of the drugs in therapeutic doses. The concentration was expressed as microgram per ml of the tuberculous material and the data were subjected to statistical analysis. Streptomycin and ethambutol penetrated freely into the tuberculous joints; their concentration in the cold abscesses, however, was half to one third of the concentration in the serum. There was a wide range of concentrations; however, in the tuberculous joints as well as in the cold abscesses the concentrations were much higher than those considered to have an inhibitory effect on mycobacterium tuberculosis in clinical material.

Adolescent↗
PubMed1975

Results of treatment of spinal tuberculosis by "middle-path" regime.

The efficacy of modern drugs in the treatment of tuberculosis of the spine has been evaluated by a personal follow-up for three to ten years. Operation on the vertebral lesion was done only for those patients with or without neural complications who failed to respond favourably to drug therapy and rest. Thus absolute indications for operation were present in only 6 per cent of cases without neural involvement and in 60 per cent of patients with neural deficit. Of patients who responded to drug therapy alone, only 19 per cent revealed increase of kyphosis by more than 10 degrees. The diseased area showed radiological evidence of osseous replacement of 29-6 per cent of cases, of fibro-osseous union in 50 per cent and of fibrous replacement in 20-2 per cent. The overall results of this regime compare favourably with those of radical operation. It is suggested that treatment should in the first place be by modern antitubercular drugs.

Abscess↗