Biomedical subjects
W A Wallace
Publications and source records attributed to W A Wallace.
A classification of acute acromioclavicular dislocation: a clinical, radiological and anatomical study.
Forty-eight patients with acute acromioclavicular dislocation were assessed clinically and radiologically before random allocation to non-operative management (28) or open reduction and coracoclavicular screw fixation (20) and followed for a minimum of 4 years. In 6 patients, late salvage surgery was required, the results of which were inferior to early operative intervention. Early surgery also gave better results than non-operative treatment in severe disruptions which could be identified in the acute stage. Three types of acromioclavicular dislocation which have predictable clinical outcomes could be distinguished on radiographs. When treated non-operatively, type A dislocations (19 per cent) may develop painful subluxation, type B (68 per cent) remain dislocated but retain sufficient muscle attachment to avoid fatigue on activity, and type C (12 per cent) leave a weak and unsightly shoulder. In type C dislocations, the clavicle is displaced 2 cm or more from the acromion on plain anteroposterior radiographs and the attached origin of the anterior deltoid is avulsed. Type C dislocations may benefit from early operative reconstruction.
Alveolar atypical hyperplasia in association with primary pulmonary adenocarcinoma: a clinicopathological study of 10 cases.
BACKGROUND: A distinctive cytologically atypical lesion has been found in patients with primary adenocarcinoma of the lung. The aim of this study was to characterise the lesion and assess its role in tumour pathogenesis. METHODS: Lung parenchyma from 175 consecutive resection specimens for primary pulmonary adenocarcinoma were examined. Foci of atypical hyperplasia were identified. Cell proliferation state and expression of S100 and carcinoembryonic antigens were evaluated by immunohistochemistry. Clinical data on cigarette smoking and occupational exposure to carcinogens were abstracted from inpatient case notes. RESULTS: Ten cases (5.7%) with these distinctive cytologically atypical lesions were identified. The lesions showed immunohistochemical evidence of increased cell proliferation and focal carcinoembryonic antigen expression. The associated adenocarcinomas were of peripheral (parenchymal) type. There was an association with cigarette smoking and two of the 10 patients had synchronous carcinomas elsewhere in the lung. CONCLUSION: The clinical and pathological associations of these lesions suggest that they may be important in the histogenesis of primary pulmonary adenocarcinoma.
Intra-alveolar macrophage numbers in current smokers and non-smokers: a morphometric study of tissue sections.
BACKGROUND: The alveolar macrophage is believed to be important in the defence of the lung and possibly in the pathogenesis of lung disease. Cell counts in bronchoalveolar lavage fluid have suggested that smokers have an increased number of alveolar macrophages but have not enabled the number to be related to a measure of lung structure. METHODS: The number of alveolar macrophages was counted in histological sections from lung resection specimens from a group of smokers and non-smokers. The results were related to a measurement of lung structure obtained by means of an automated morphometric technique and expressed in terms of units of lung volume or of lung surface area. RESULTS: The smokers had a significantly increased number of alveolar macrophages per unit lung volume and per unit surface area, through the relative increase was less than has appeared from bronchoalveolar lavage studies. When smokers and non-smokers with similar lung structure were compared the smokers had more alveolar macrophages, indicating that smoking and not loss of lung structure is responsible for the increase. CONCLUSIONS: Smokers had more alveolar macrophages than non-smokers when the number was expressed quantitatively with respect to the underlying architecture. Changes in cell populations postulated to be important in the pathogenesis of disease within the lung should be related to lung architecture because this may vary considerably between individuals.
The significance of pes planus in juvenile hallux valgus.
Pes planus of the foot is believed to be an important etiological factor in hallux valgus. This study compares the degree of pes planus in normal and hallux valgus feet. The arch index, or ratio of the area of the middle third of the foot to the total footprint area, was calculated on 128 footprints. An unpaired t-test determined no significant difference between the arch index of 32 11-year-old children with hallux valgus and 11-year-olds with no first metatarsophalangeal joint deformity (P greater than .05). The height of the arch is not relevant to the hallux valgus deformity. Arch supports designed to raise the height of the arch can play only a palliative role in the management of the condition.
Diagnosis and assessment of pectoralis major rupture by dynamometry.
Four patients with pectoralis major ruptures underwent clinical and dynamometric assessment and one patient underwent late surgical repair. The operation is described. Dynamometry proved a useful and objective method of estimating the loss of strength and indicating patients who might benefit from surgical repair.
The strength of surgical repairs of the rotator cuff. A biomechanical study on cadavers.
Using 26 cadaver shoulders, we produced a standard defect in the supraspinatus tendon and performed one of three types of repair. Their strength was found by testing in tension the force required to produce a gap of 3 mm, then 6 mm, and finally total disruption of the repair. The use of a polyethylene patch to spread the forces over the lateral bone surface and of extra sutures to grasp the tendon end raised by 2.6 times the load at which a 3 mm gap in the repair occurred and by 1.7 times the load to failure.
Toxic shock-like syndrome due to streptococcal hand infection.
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Intra-articular distension and steroids in the management of capsulitis of the shoulder.
OBJECTIVE: To determine whether there is any synergistic effect in the administration of intraarticular steroids with distension in the management of early capsulitis of the shoulder. DESIGN: Prospective randomised trial of three treatments--namely distension only, steroid only, and steroid with distension. SETTING: Academic department of orthopaedic and accident surgery at Queen's Medical Centre, Nottingham. SUBJECTS: 47 patients (30 women) with capsulitis affecting 50 shoulders. INTERVENTIONS: Three intra-articular injections into the shoulder given at six week intervals by the same technique. MAIN OUTCOME MEASURES: Passive range of abduction, forward flexion, and external rotation; results of shoulder dynamometry measuring work done and torque produced; pain levels at rest and with resisted movement. RESULTS: All patients reported improvement during the study. Analysis of the mean improvements in abduction and forward flexion showed these to be significantly greater in the steroid with distension and steroid only groups than in the distension only group (mean improvements in abduction (degrees/week (95% confidence interval)) 4.3 (3.4 to 5.2), 3.4 (2.4 to 4.5), and 1.0 (-0.8 to 2.8) in the three groups respectively; mean improvements in flexion (degrees/week (95% confidence interval)) 3.6 (3.2 to 4.0), 3.3 (2.3 to 4.3), and 1.5 (0.5 to 2.5) respectively). Shoulder dynamometry failed to show a significant difference among the treatment groups. No severe complications occurred as a result of the injections, but two patients reported facial flushing related to the use of steroids. CONCLUSION: Intra-articular steroid injections have a useful role in the outpatient management of early capsulitis.
Reconstruction of the femur with the aid of a combination of a joint replacement and an intramedullary nail.
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Adenosquamous carcinoma of the hypopharynx.
A rare case of adenosquamous carcinoma of the hypophraynx is presented. The importance of primary surgical treatment is emphasised.
Shoulder arthrodesis using an external fixator.
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The geometry of the humeral head and the design of prostheses.
The articular surface of the humeral head is usually described as facing posteromedially, making an angle of between 16 degrees and 35 degrees with the transepicondylar plane. At hemiarthroplasty the articular surface also appears to be offset posteriorly with respect to the humeral shaft. Coracoid impingement may occur if this offset is not accommodated. An analysis was made of 29 cadaveric humeri using an industrial co-ordinate measuring machine. The position of the centre of the head was defined with respect to the humeral shaft and transepicondylar plane. The humeral articular surface was found to be retroverted by 21.4 degrees and its centre offset posteriorly by 4.7 mm. Previous interpretation of retroversion did not take into account the posterior displacement, and this may be of importance in improving future prosthetic design.
Metatarsus primus varus. A statistical study.
A survey of 6000 schoolchildren discovered 36 cases of unilateral and 60 cases of bilateral hallux valgus, defined as a metatarsophalangeal angle of more than 14.5 degrees, measured on standing radiographs. Metatarsus primus varus was found not only in the early stages of hallux valgus but in the unaffected feet of children with unilateral hallux valgus. Adduction of the first metatarsal is not due to differential growth of the cortices of the first metatarsal nor is it a consequence of malalignment of the metatarsocuneiform joint. The intermetatarsal angle did not correlate with the angle of metatarsus adductus nor with the intercuneiform angle.
Orthotic effect on metatarsophalangeal joint extension. A preliminary study.
The authors evaluated the effect of modified Root orthoses on first metatarsophalangeal joint extension. Motion within the joint was measured dynamically following the insertion of bone markers into the first metatarsal and the hallux. Extension at the joint was greatest when the subjects were barefoot, the mean angle being 62 degrees. Plimsolls restricted extension of the joint to a mean angle of 57 degrees, while orthoses further reduced the angle of metatarsophalangeal joint extension to a mean angle of 55 degrees. The marginal reduction in first metatarsophalangeal joint extension caused by functional orthoses may be of therapeutic value in the early stages of hallux rigidus, when restricting motion at the joint may slow or prevent development of subchondral sclerosis.
Fate of frozen intercalary allograft at one year after implantation with adjuvant chemotherapy treatment. A case report.
The proximal humerus of a 21-year-old man was reconstructed with a frozen allograft combined with a Neer shoulder prosthesis. At graft retrieval one year later, the proximal end of the allograft had revascularized with some osteogenic activity, but distally neither vascular ingrowth nor osteogenic activity was seen. Allografts should not be used unsupported because of their potential weakness with time. Intramedullary stems should be used to support functional allografts which primarily facilitate soft-tissue reattachment.
One-stage bilateral thoracoscapular fusion using allografts. A case report.
A 28-year-old woman with fascioscapulohumeral muscular dystrophy was treated with a one-stage bilateral scapulothoracic fusion. At operation, cortical allografts with screw fixation for anchorage were used, supplemented with autologous cancellous bone. A proper balance and symmetry of the shoulder girdle can be restored more easily when fusion is performed bilaterally at the same time.