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PubMed1983

Hyaluronic acid content of deep and subcutaneous bursae of man.

To provide a comparison of the contents of subcutaneous and deep bursae we dissected these structures from unfixed cadavers without apparent joint disease. No free fluid was found within any olecranon or prepatellar bursae (examples of subcutaneous bursae), while viscous fluid was invariably present in the (deep) retrocalcaneal bursae. The hyaluronic acid content of the washings of 5 rectrocalcaneal bursae ranged from 142 to 591 nmol hexosamine (mean = 281 nmol hexosamine). In contrast, the hyaluronic acid content of 4 olecranon bursae was much lower (range 35-72 nmol, mean 53 nmol hexosamine), and hyaluronate was not detected in washings from either of 2 prepatellar bursae. The greater hyaluronate content of the retrocalcaneal bursae did not appear to be due to a greater surface area, since on the basis of calculations made from plaster casts the surface areas of the olecranon and prepatellar bursae were approximately 3 times and 2 times, respectively, greater than that of the retrocalcaneal bursae. The data suggest that, although hyaluronic acid may lubricate deep bursae, other factors may be more important in reducing friction within superficial bursae.

Aged↗
PubMed1988

Effect of intermittent stretch on immobilised muscle.

When muscle is immobilised in a shortened position there is a reduction in fibre length and an increase in the proportion of connective tissue. This results in reduced muscle compliance and a loss of range of joint motion. Experiments have been carried out to determine whether short periods of stretch are effective in preventing these changes. The soleus muscle of the mouse was immobilised in a shortened position for a period of 10 days by means of a plaster cast. Every two days the cast was removed and the muscle passively stretched for a 15 minute period. It was found that this treatment prevented the connective tissue changes but did not prevent the reduction in muscle fibre length, which in itself resulted in considerable loss of range of motion.

Animals↗
PubMed2004

An unusual presentation of immersion foot.

We report a case of "green foot" in a child with a plaster cast applied for a fractured metatarsal who subsequently re-presented with circulatory compromise. The foot was green and smelly and profuse Pseudomonas aeruginosa was cultured. The infection cleared with simple exposure to air. Perhaps this diagnosis should be considered in patients presenting with circulatory compromise in a cast as severe infection can result in amputation.

Casts, Surgical↗
PubMed1991

Avulsion fractures of the proximal tibial epiphysis.

Fractures of the tibia through the proximal epiphysis are rare. This injury usually results from severe direct or indirect force about the knee, and has not been described as resulting from a patellar tendon avulsion injury. Four patients presented with five avulsion fractures of the proximal tibial epiphysis. All were older adolescent males who had been engaged in jumping sports when the injury occurred; one had bilateral injury. All the patients were treated by closed reduction and plaster cast immobilization for 4-8 weeks, with satisfactory results. On the basis of our cases and five cases previously reported, the authors would agree with Ryu and Debenham's suggestion that the Watson-Jones classification, which divides avulsion fractures of the tibial tubercle into three types, should be expanded to include this fourth type - avulsion fracture of the proximal tibial epiphysis.

Adolescent↗
PubMed2001

Distal radial fractures in young goalkeepers: a case for an appropriately sized soccer ball.

OBJECTIVES: To assess the rate of wrist fractures in young goalkeepers sustained by the specific mechanism of "saving the ball" and the potential influence of ball size and environmental conditions. METHODS: A prospective, clinic based study in one institution over a 17 month period. Patients were identified by specific questioning. Information on play circumstances and subsequent clinical progress was documented. RESULTS: Twenty nine fractures of the distal radius were identified in young goalkeepers (age range 6-15 years) as a direct result of saving the ball. Most were managed simply in a plaster cast. Three patients required minor surgical interventions, and all fractures went on to unite without significant complications. Where ball size was known, 12 of the 15 fractures in children aged 11 years or less occurred as the result of impact with an adult sized ball compared with three when a junior ball was involved. This is statistically significant (p = 0.039). In the 10 children aged 12-15 years, only one fracture involved a junior ball; this is also statistically significant (p = 0.027). Six of the injuries (21%) occurred when the ball was kicked by an adult. Injuries occurred in both organised and informal games throughout the year. CONCLUSIONS: This specific mechanism of injury has not been widely acknowledged nor has the potential influence of ball size as a causative factor been examined. Recommendations for an appropriately sized soccer ball for young players exist but are not in universal use. Increased awareness of this particular injury mechanism is required.

Adolescent↗
PubMed1977

Cuirass respirator treatment of chronic respiratory failure in scoliotic patients.

The results are reported of domiciliary cuirass respirator treatment, using tailor-made shells, in four patients with severe thoracic scoliosis. Three of the patients had suffered from poliomyelitis. All complained of increasing dyspnoea on exertion, ultimately interfering with almost every activity of daily life; three patients had severe acute respiratory failure necessitating urgent admission to the Respiratory Care Unit. Right heart failure was present in two. Two patients required mechanical treatment via an endotracheal tube. All the patients were discharged home with a cuirass respirator. Standard type shells were used initially with low efficiency due to the poor fit of the cuirass shell to the deformed thoracic cage. Tailor-made shells were constructed from polyester reinforced with glass fibre, modelled on plaster casts of the thoracic cage. Subjectively the patients improved greatly and were able to resume and increase many activities. One patient committed suicide for reasons unconnected with treatment but the other three patients have been doing well from the time the cuirass respirator treatment was started, respectively, 3, 6, and 10 years ago. This treatment seems particularly effective in younger patients with severe paralytic scoliosis and cardiorespiratory failure, although the possibility of using it in older patients suffering from scoliosis of other aetiology should certainly be explored.

Adolescent↗
PubMed1983

Tissue compensator fabrication using a simple photographic technique.

A simple method of fabricating photon beam tissue compensators is described. A plaster cast of the patient's surface contours is partially immersed in a mixture of India ink and water to obtain a topographic map relative to a reference plane which is perpendicular to the photon beam. The contours are photographed, and successive contours corresponding to different missing tissue thicknesses are used to fabricate a compensator from lead sheets cut to the same shape with the proper magnification.

Humans↗
PubMed1977

Time course of muscular atrophy during immobilization of hindlimbs in rats.

The hindlimbs of rats were immobilized, in plaster casts, for varying durations, and the time course for atrophy of muscle and of selected proteins in these muscles was determined. In those muscles whose lengths were at less than resting length during the fixation procedures, exponential decay to a new apparent steady state after atrophy was shown by wet and dry muscle weights and by the amounts of biuret protein, cytochrome c, and citrate synthase. The time taken to decrease to one-half of the final decrease at the new apparent steady state level was about 4-6 days for the above parameters which decayed exponentially. In contrast, the myoglobin concentration increased during atrophy and the amount of myoglobin remain unchanged during atrophy. When fixation procedures on limbs were such that muscles were stretched to lengths greater than resting length, then the onset of atrophy was delayed; indeed, in some cases muscles hypertrophied when fixed in the stretched position.

Animals↗
PubMed1982

Effects of testosterone propionate on hindlimb-immobilized rats.

Forty albino male rats were randomly divided into 4 groups of 10. Group I served as the nonimmobilized control and received daily placebo injections of sesame oil. The rats in group II were castrated, their hindlimbs were immobilized using a plaster cast, and they received daily injections of sesame oil. The group III rats were also castrated and casted but received a daily injection of 5 mg testosterone propionate. The animals in group IV were not castrated but were casted and received daily testosterone propionate injections. The duration of each treatment was 15 days for each rat. The gastrocnemius, quadriceps, soleus, and cardiac muscles were weighed after treatment. O2 consumption capacity (QO2), citrate synthase activities, and percentages of water were measured in the gastrocnemius, quadriceps, and cardiac tissues. Along with the atrophy of muscle and reduction in body size, the immobilization significantly reduced the aerobic capacity of affected muscle groups and cardiac tissue. The greatest reductions in body weight, muscle size, heart size, and QO2 were seen in the castrated group that received only placebo injections of sesame oil. The anticatabolic effects of the anabolic steroid were evident in groups III and IV. The results indicate that hindlimb immobilization not only causes severe atrophy in those muscles immobilized but has an overall catabolic effect on the animal. Testosterone, or the lack of it, can significantly affect the amount of muscle atrophy.

Animals↗
PubMed1982

Daily in vivo neuromuscular stimulation effects on immobilized rat hindlimb muscles.

The purpose of the investigation was to determine the effects of a daily regimen of near-maximal contractions, produced via in vivo electrical stimulation of peripheral nerve, on functional and histochemical properties of rat hindlimb muscles immobilized for 28 days in a plaster cast. Rats had knee and ankle joints of one hindlimb immobilized; then while anesthetized, half of the group was subjected to a daily regimen of 480 semifused tetanic contractions (50 Hz) via fine-wire electrodes chronically implanted around the sciatic nerve. Immobilization caused significant decreases in soleus and gastrocnemius muscle weights, fiber cross-sectional areas, and twitch and tetanic strength measured in situ. In addition, immobilized soleus muscles had faster time to peak tension (TPT) and higher proportions of fast-twitch fibers, whereas immobilized gastrocnemius muscles demonstrated faster half-relaxation times (RT1/2) and total twitch durations (TPT plus RT1/2). The only significant effects of the imposed contractions were evident in the gastrocnemius in which stimulation prevented the shortening of RT1/2 and total twitch duration and resulted in significantly higher relative tensions at 50 Hz and higher fatigue resistance. Muscle activity of this type imposed on immobilized muscle is ineffective in attenuating atrophy but can, in fast muscle such as gastrocnemius, prevent changes in twitch characteristics resulting from immobilization, as well as augment contractile responses during semifused and fatiguing contractions.

Animals↗
PubMed1985

Arterial CO2 partial pressure affects diaphragmatic function.

The purpose of this study was to examine in an in vivo preparation acute variations of PCO2 on diaphragmatic contractility. Plaster casts were snugly fit around the abdomen of six open-chested dogs, moving the abdominal contents rostrally. Diaphragmatic contractions against this very fixed load in response to phrenic nerve stimulation (supramaximal voltage at 1, 20, 50, and 80 Hz) or during spontaneous inspiratory efforts were virtually isometric (quasi-isometric). Transdiaphragmatic pressure (Pdi) measured by an abdominal balloon was used as an index of diaphragmatic contractility. Arterial PCO2 (PaCO2) was reduced by hyperventilation and raised by increasing PICO2. Pdi values in response to stimulation at 1, 20, 50, and 80 Hz in ranges I (PaCO2 = 0-19 Torr) and II (PaCO2 = 20-34 Torr) did not differ statistically from the control Pdi values (range III; PaCO2 = 35-45 Torr). In range IV (PaCO2 = 46-70 Torr) Pdi values for stimulations of 20, 50, and 80 Hz were significantly lower than control. In range V (PaCO2 = 71-90 Torr), VI (PaCO2 = 91-101 Torr), and VII (PaCO2 greater than or equal to 102 Torr) Pdi values were significantly less than those in range IV at all frequencies of stimulation. In the four dogs measured during spontaneous inspiratory efforts the integrated diaphragmatic electromyogram (Edi) was correlated with the Pdi. As PaCO2 rose (range III to VII), the Pdi values observed at 25, 50, 75, 100% of the maximum Edi (of range III) were significantly lower than the Pdi value of range III.(ABSTRACT TRUNCATED AT 250 WORDS)

Alkalosis, Respiratory↗
PubMed1985

Effects of uncompensated and compensated metabolic acidosis on canine diaphragm.

We investigated the effects of metabolic acidosis and compensated metabolic acidosis on force of contraction of the diaphragm in anesthetized dogs. Mechanically ventilated animals were prepared with an open thorax. A balloon was positioned beneath the diaphragm to measure transdiaphragmatic pressure (Pdi), and a plaster cast was placed around the abdomen to maintain length and geometry of the diaphragm. The force of contraction was evaluated by measuring Pdi during supramaximal phrenic stimulation at different frequencies and also during spontaneous inspiratory efforts. In 13 dogs with an arterial pH (pHa) of 7.38 and arterial PCO2 (PaCO2) of 36.5 Torr, metabolic acidosis was produced by infusion of HCl until pHa equaled 6.98 and PaCO2 equaled 36.4 Torr. Pdi at all frequencies greater than 10 Hz was significantly reduced (P less than 0.05). The dogs were then hyperventilated until pHa was 7.34 and PaCO2 was 12.8 Torr. Pdi was significantly reduced again at all frequencies (P less than 0.05) except 5 Hz. The percent reduction in Pdi by compensated acidosis was significantly greater at low-frequency stimulation than at high (P less than 0.05). Similar qualitative results were observed during spontaneous inspiratory efforts where Pdi was compared at constant magnitudes of diaphragmatic electromyograms. Twitch characteristics revealed that metabolic acidosis led to a significant shortening of twitch relaxation time (P less than 0.05), and compensated metabolic acidosis added to this effect a significant decrease in twitch amplitude (P less than 0.05).

Acidosis↗
PubMed1986

Diaphragmatic function during hypoxemia: neonatal and developmental aspects.

The effect of acute hypoxemia on diaphragmatic force output was studied in five young (age 4-8 days, wt 1.3-2.2 kg) and five older (age 16-19 days, wt 2.8-3.3 kg), anesthetized, spontaneously breathing piglets. Diaphragmatic force output was assessed by analysis of the transdiaphragmatic pressure (Pdi) generated during an occluded inspiratory effort, at end-expiratory lung volume, triggered by supramaximal transvenous stimulation of both phrenic nerves at frequencies of 20, 30, 50, and 100 Hz. During pressure measurements, the piglets were fitted with a rigid plaster cast covering the abdomen and lower third of the chest to ensure a consistency in diaphragmatic shortening during phrenic nerve stimulation. Pdi was measured under base-line conditions [inspired O2 fractional concentration (FIO2) = 0.50] and after 10 min of hypoxemia induced by breathing 12-14% FIO2. Pdi was significantly less than base line during acute hypoxemia at all frequencies of stimulation in both young and older piglets. The decline in the older piglets' Pdi during hypoxemia was significantly greater than that seen in younger piglets. We conclude that acute hypoxemia impairs the capacity of the developing piglet diaphragm to generate force. Furthermore, our data suggest that the young piglet is more resistant to the depressant effects of hypoxemia when compared to its older counterpart.

Age Factors↗
PubMed1987

Electrical and mechanical changes in immobilized human muscle.

After forearm fracture, the human thumb was unilaterally immobilized in eight subjects for 6 wk in a standard plaster cast. Changes of contraction properties were studied in the adductor pollicis muscle. The contralateral muscle remained unrestrained and served as control. After immobilization, the maximal voluntary contraction was reduced by 55% (P less than 0.05), and the electrically evoked maximal tetanic contraction (Po) was reduced by 33% (P less than 0.05). The decrease of Po was associated with increased maximal rate of tension development (10%) and decreased maximal rate of tension relaxation (22%). The twitch times to peak and to half relaxation were increased by 16 and 14%, respectively, but the twitch tension (Pt) was not significantly changed and the Pt/Po ratio was increased by 43% after immobilization. The muscle surface action potential presented an increase of its duration (19%) and a decrease of the amplitude and the total area (15 and 26%, respectively). The comparison of the electrical and mechanical alterations recorded during voluntary contractions, and in contractions evoked by electrical stimulation of the motor nerve, suggests that immobilization not only modifies the peripheral processes associated with contraction but also changes central and/or neural command of the contraction. At peripheral sites, it is proposed that the intracellular processes of contraction play the major role in the contractile impairment recorded during immobilization.

Electromyography↗
PubMed2000

IGF-I restores satellite cell proliferative potential in immobilized old skeletal muscle.

One of the key factors responsible for the age-associated reduction in muscle mass may be that satellite cell proliferation potential (number of doublings contained within each cell) could become rate limiting to old muscle regrowth. No studies have tested whether repeated cycles of atrophy-regrowth in aged animals deplete the remaining capacity of satellite cells to replicate or what measures can be taken to prevent this from happening. We hypothesized that there would be a pronounced loss of satellite cell proliferative potential in gastrocnemius muscles of aged rats (25- to 30-mo-old FBN rats) subjected to three cycles of atrophy by hindlimb immobilization (plaster casts) with intervening recovery periods. Our results indicated that there was a significant loss in gastrocnemius muscle mass and in the proliferative potential of the resident satellite cells after just one bout of immobilization. Neither the muscle mass nor the satellite cell proliferation potential recovered from their atrophied values after either the first 3-wk or later 9-wk recovery period. Remarkably, application of insulin-like growth factor I onto the atrophied gastrocnemius muscle for an additional 2 wk after this 9-wk recovery period rescued approximately 46% of the lost muscle mass and dramatically increased proliferation potential of the satellite cells from this muscle.

Aging↗
PubMed2005

Disuse atrophy increases the muscle mechanoreflex in rats.

We investigated the effect of disuse atrophy on the magnitude of the muscle mechanoreflex. The left leg of eight rats (6-7 wk, male) was put in a plaster cast for 1 wk. The rats were decerebrated at the midcollicular level. We recorded the pressor and cardioaccelerator responses to 30-s stretch of the calcaneal tendon, which selectively stimulated the muscle mechanosensitive receptors in the left atrophied and right control triceps surae muscles. Atrophied muscles showed significantly lower mass control muscles (1.0 +/- 0.1 vs. 1.4 +/- 0.1 g; P < 0.05). At the same stretch tension (229 +/- 20 g), the pressor response to stretch was significantly greater in the atrophied muscles than in the control muscles (13 +/- 3 vs. 4 +/- 2 mmHg, P < 0.05). The cardioaccelerator response was not significantly different (8 +/- 4 vs. 4 +/- 2 beats/min). Comparing responses at the same relative tension (57 +/- 6 vs. 51 +/- 8% of maximal tension), the pressor response was still significantly greater in the atrophied triceps surae than in the control (14 +/- 4 vs. 4 +/- 2 mmHg; P < 0.05). These results suggest that disuse atrophy increases the magnitude of muscle mechanoreflex.

Animals↗
PubMed2001

Changes in muscles and tendons due to neural motor disorders: implications for therapeutic intervention.

Patients with an upper motor neurone syndrome (CP) suffer from many disabling primary symptoms: spasms, weakness, and loss of dexterity. These primary 'neurogenic' symptoms often lead to secondary disabilities, muscle contractures, and tertiary effects, bone deformations. A common symptom of CP is hypertonia, with the consequence that the involved muscles remain in an excessively shortened length for most of the time. As a normal reaction of the muscle tissue, the number of sarcomeres is reduced and the muscle fibers shorten permanently: a contracture develops. A possible second type of contracture is that normal muscle lengthening along with bone growth is affected. Current treatments for the secondary effects include (1) reduction of muscle force, (2) lengthening of the muscle fibers by serial plaster casts, and (3) surgical lengthening of tendons or aponeurosis. The choice of treatment depends on the cause of the functional deficit. Bone tissue also adapts itself to abnormal forces, especially in the growth period. The hypertonias or contractures of CP so may give rise to bone malformations that interfere with function (e.g. femur endorotation) or may reduce the action of muscles by changing the lever arm (e.g. ankle varus). Although prevention should always be preferred, a timely surgical intervention cannot always be avoided. The differences in treatment for the various groups require and justify an extensive laboratory investigation, including EMG recordings in gait, measurement of passive elastic properties, and long-term observation of the hypertonia.

Cerebral Palsy↗
PubMed2000

Immediate intraoral adaptation of mandibular advancing appliances of thermoplastic material for the treatment of obstructive sleep apnea.

BACKGROUND: In the treatment of obstructive sleep apnea (OSA), mandibular advancing devices (MAD) are usually individually fabricated on plaster casts of both jaws from polymethyl-methacrylate. The potential disadvantages of these devices are (1) the costs and (2) the time required to construct the device. OBJECTIVE: In this study, the efficacy and feasibility of a cheap MAD consisting of thermoplastic material (SnorBan((R))), which can be directly moulded intraorally, were evaluated. METHODS: In a prospective study, the effect of an MAD consisting of thermoplastic material was investigated in 22 consecutive patients with OSA [respiratory disturbance index (RDI) 32.6 +/- 18.4/h]. Polysomnographic sleep was recorded prior to treatment and after 3 months of treatment with the MAD. RESULTS: Three of the 22 patients who did not tolerate the MAD were excluded from the analysis, whereas 11 patients were classified as responders. In the responder group, the mean RDI decreased from 27.6 +/-7.3 to 7.3 +/- 2.9 (p < 0. 01), correspondingly the sleep quality and the Epworth Sleepiness Scale improved (p < 0.05). Eight patients proved to be non-responders without relevant changes for the measured parameters. CONCLUSIONS: In 50% (11 of 22) of the patients, the MAD improved the OSA to a clinically relevant degree. In contrast to the majority of established MAD, the MAD investigated is cheap and immediately adaptable and thus a feasible strategy to 'screen' the efficacy of this therapeutic principle. Thus the construction of unnecessary MAD is avoided.

Adult↗