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Biomedical subjects

T Duckworth

Publications and source records attributed to T Duckworth.

At least 37 records · Page 2Linked to original sources
PubMed1983

Forefoot rotation--a hindfoot problem?: preliminary communication.

A type of valgus deformity of the foot which differs from those commonly recognized is described. In this foot, correction of the hindfoot valgus results in the talus assuming an abnormally horizontal position, so that the forefoot is markedly rotated relative to the hindfoot. The condition is usually present at birth and may occur in paralytic and non-paralytic forms. Its recognition is important as the deformity may lead to difficulties later in life.

Child↗
PubMed1981

Paget's disease: improvement of spinal cord dysfunction with diphosphonates and calcitonin.

The clinical and radiographic features of spinal cord dysfunction secondary to Paget's disease are described. Long-term medical management with the use of the diphosphonates, calcitonins and mithramycin resulted in marked and rapid clinical improvements in 8 of 10 of our own patients. These results are comparable to those seen in 19 other patients previously described in the literature, and are also similar to those obtained by surgical treatment. The recurrence rate and mortality (approximately 10%) of surgical treatment suggest that drug treatment now has a place in the management of paraparesis, particularly when this is of gradual onset. Medical management may also provide a valuable adjunct in those cases where surgery is required (e.g. sudden onset of paraparesis). In patients with cord dysfunction, but without significant anatomical compression of the spinal cord, it is suggested that paraparesis may be caused by a "vascular steal" syndrome, a notion which is supported by the rapidity with which drug-induced remission occurs.

Adult↗
PubMed1981

Spinal cord dysfunction in Paget's disease of bone. Has medical treatment a vascular basis?

The medical treatment of eight patients with paraparesis associated with Paget's disease of the vertebrae is described. Treatment, for 3 to 87 months, with calcitonin or with diphosphonates produced marked clinical improvement in seven of these patients. From this series and a review of 19 additional case reports it is concluded that favourable clinical response is seen in about 90 per cent of patients, and that this may occur very rapidly. Results are as good or better than those obtained by surgical decompression. It seems possible that paraparesis in some cases may be due to diversion of blood supply from the spinal cord to the highly vascular Pagetic bone giving rise to a vascular "steal" syndrome. It is suggested that medical treatment should be used more widely to avoid or delay the need for operation and reduce the risks of recurrence. These patients, however treated, require lifelong follow-up because relapses are common.

Adult↗
PubMed1980

Effect of dichloromethylene diphosphonate in Paget's disease of bone and in hypercalcaemia due to primary hyperparathyroidism or malignant disease.

30 patients with disorders of calcium metabolism were treated with dichloromethylene diphosphonate (C1(2)MDP, or clodronate disodium), an inhibitor of bone resorption. 13 patients with Paget's disease of bone were given C1(2)MDP by mouth (1.6 g/day). Serum-alkaline-phosphatase and urinary hydroxyproline fell to normal or near-normal within 3-7 months, and there was a clinical improvement in all but 1 patient. C1(2)MDP (0.8-3.2 g/day) also reduced plasma-calcium and urinary calcium in 17 patients with hypercalcaemia due to primary hyperparathyroidism or secondary to malignant disease. C1(2)MDP seems to be an effective oral drug for inhibiting excessive bone resorption in man.

Alkaline Phosphatase↗
PubMed1980

Biochemical and clinical responses to dichloromethylene diphosphonate (Cl2MDP) in Paget's disease of bone.

Dichloromethylene diphosphonate (Cl2MDP, or clodronate disodium) is one of the most potent of the known diphosphonates as an inhibitor of bone resorption and differs from EHDP in that it does not inhibit skeletal mineralization. It is one of the second generation diphosphonates now undergoing clinical evaluation. In the study described here Cl2MDP was given by mouth (800-1600 mg/day for 6 months) to 35 patients with symptomatic Paget's disease of bone. Cl2MDP induced a marked fall in serum alkaline phosphatase and urinary hydroxyproline to normal or near normal values in all patients. This was accompanied by clinical improvement in all but 4 patients. Cl2MDP appears to be another effective oral drug for the treatment of Paget's disease of bone and compares favorably with the calcitonins and EHDP.

Alkaline Phosphatase↗
PubMed1980

Electron microscopical studies of vessels in diabetic peripheral neuropathy.

the results of an electron microscopical study of sural nerve biopsies from 11 patients with diabetic neuropathy are presented. Thrombi were seen in six cases in at least one intraneural vessel; nine cases showed hyperplasia of endothelial cells, and in seven out of these nine the hyperplasia was sufficient to occlude completely the lumen of small vessels; six cases showed degenerate pericytes and endothelial cells, and in some cases endothelial cells had been shed from the vessel wall, exposing the blood within the vessel to the underlying basement membrane; in five cases large lipid droplets were seen within endothelial cells. Abnormalities of the vessel wall would result in decreased fibrinolytic activity and a reduction of the antiplatelet aggregating proprties of the vessel. Desquamation of endothelial cells from the vessel wall, with exposure of platelets to underlying collagen, may act as a trigger for thrombus formation, particularly as the blood of diabetic patients is often in a hypercoagulable state. The significance of hyperplasia of endothelial cells is at present unknown but, once established, this too would result in profound alterations of loal blood flow and ischaemia of nerve. Damage to endothelial cells may also allow seepage of haematological constituents into the vessel wall, resulting in its progressive thickening.

Adult↗
PubMed1980

Critical light reflection at a plastic/glass interface and its application to foot pressure measurements.

The necessary properties of plastic materials for use in a method of foot pressure distribution measurements have been assessed, and the mechanisms in operation at an illuminated plastic to glass interface underload have been investigated. A hypothesis is given of the physical principles upon which the operation of this technique is based and it is shown that a calibrated analysis of both the static and dynamic distribution of pressure under the foot is possible by this technique.

Biomechanical Phenomena↗
PubMed1977

The correction of genu valgum by epiphysial stapling.

Forty-nine patients treated by epiphysial stapling for idiopathic genu valgum are reviewed. The children were aged from eleven to fourteen and a half years. The severity of the condition and subsequent correction were assessed by measuring the inter-malleolar distance. Results show that femoral stapling is the treatment of choice for most patients with inter-malleolar separation of up to 12-5 centimetres. The optimum age for stapling for both boys and girls is eleven and a half years. Stapling of both epiphyses is advised for those patients presenting late, for example, between thirteen and fourteen and a half years, or where the deformity is greater than 12-5 centimetres of separation. Correction rarely takes more than one year, and was cosmetically satisfactory in all cases. The operation is virtually free from complication except for a tendency for the scars to be broad and conspicuous. Stapling has proved to be a safe, effective and predicatable operation for idiopathic genu valgum.

Adolescent↗
PubMed1976

A reassessment of vascular factors in relation to intravascular coagulation.

Sural nerve biopsy was performed in twenty-four diabetic patients, with clinical and electrophysiological evidence of diabetic neuropathy. Material from an autopsy case was also examined. Vessels plugged with fibrin were seen within nerve in nine cases. In three cases fibrin was observed tracking into the vessel wall and in four, older thrombus was observed in vessels. Areas of necrosis in nerve bundles were seen in two of the latter. In two patients there had been a preceding episode of intravascular coagulation. Fibrin deposition within small vessels could well play a part in damaging the diabetic nerve and a disturbance of the balance between deposition and removal by fibrinolysis could explain phasic variation in the symptoms of neuropathy.

Adult↗
PubMed1976

Somatosensory evoked cortical responses: detection in normal infants.

The detection of evoked cortical potentials to a peripheral stimulus is a possible method of studying sensory innervation in children. The purpose of the present study was to determine the consistency with which evoked responses to the electrical stimulation of nerve trunks can be recorded, and to assess the validity of computer analysis of the records. Automated analysis was felt to be desirable because the identification of evoked potentials is usually subjective. Recording sessions were carried out on 37 normal children between the ages of one and six months, and where possible were repeated on three occasions at intervals of at least one month. Using a rigid recording regime, evoked responses could be obtained in 90 to 95 per cent of sessions, the success rate varying with the site of stimulation. An objective computer analysis of records has been developed which is able to recognise evoked potentials as successfully as an experienced human observer.

Evoked Potentials↗
PubMed1976

Somatosensory evoked cortical responses in children with spina bifida.

The sensory pathways of 18 infants and children with myelomeningocele were studied by recording somatosensory evoked cortical responses to standardised electrical stimuli over major nerve trunks in the arms and legs. The 12 infants were tested between the ages of three days and eight months and the six children were tested between two and three years of age. In the majority of patients the results obtained by this technique correlated well with the clinical testing of sensation.

Child, Preschool↗
PubMed1976

The management of deformities of the foot in children with spina bifida.

A simple photographic technique is described which measures the weight-bearing and non-weight-bearing areas of the feet in the standing child. The child stands on a rectangular sheet of thick glass which is set into the floor. Beneath the floor is a cellar, from which the soles of the feet may be observed and photographed. A transparent grid placed over the photographic print enables the weight-bearing and non-weight-bearing areas of the foot to be measured, and thus to express the weight-bearing areas as a percentage of the total area of the sole of the foot. The procedure was used to assess 55 spina-bifida children who had had surgical correction of deformities of the feet. The findings are discussed.

Adolescent↗