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PubMed1996

Coping with crises: an examination of the impact of traumatic events on religious beliefs.

The impact of traumatic events on empirical and metaphysical assumptions was examined, by comparing assumptions of a group of 25 persons who had recently experienced a major stressor with assumptions of a group of 25 persons who had not had such an experience. Each group was composed of 22 women and 3 men, with a mean age of 20 years. Participants completed written measures assessing levels of adjustment, empirical world assumptions, religious motivation, and religious and spiritual experiences. Naturalistic interviews were conducted with the trauma group. The trauma group obtained significantly higher scores on symptoms of psychological distress but did not differ in evaluations of the empirical world as predictable, safe, or controllable. Interviews suggested that the metaphysical assumptions were not challenged by trauma; rather, they provided a framework for understanding and coping with trauma.

Adaptation, Psychological↗
PubMedDate not supplied

Rickets in yearling steers wintered on a swede (Brassica napus) crop.

Rickets was diagnosed in a group of 80 yearling Angus steers wintered for three months on a crop of swedes (Brassica napus) in the Kimbolton area. Growth rate was poor and several steers developed lameness during the final three weeks on the crop. Five animals were euthanased after developing bone fractures. Necropsy of two animals revealed soft ribs, enlarged costochondral junctions and irregularly thickened growth plates in long bones. Histologically there were islands of hypertrophic cartilage within metaphyses and disruption of metaphyseal trabeculae. Thickened, irregular, trabeculae were sometimes lined by wide osteoid seams. Phosphorus deficiency was considered to be the most likely aetiology of the osteodystrophy. The dry matter content of the swedes was only six percent, and in order to satisfy their phosphorus requirements each steer would have had to ingest approximately 330 kg of swedes per day. Rickets is an uncommon disease of grazing animals in New Zealand and to our knowledge this is the first report of its occurrence in cattle.

Journal Article↗
PubMed2006

Head-at-risk signs in Legg-Calvé-Perthes disease: poor inter- and intra-observer reliability.

BACKGROUND: The head-at-risk signs are used as prognostic indicators in Legg-Calvé-Perthes disease. These signs have been assessed only once regarding inter-observer reliability, however. Intra-observer reliability seems not to have been studied to date. METHOD: 76 anteroposterior pelvic radiographs of unilateral Legg-Calvé-Perthes disease were assessed by 5 observers on 2 occasions, in order to assess the inter- and intra-observer reliability in identifying head-at-risk signs. The observers included 1 consultant pediatric orthopaedic surgeon, 1 consultant radiologist, 2 specialist registrars and 1 senior house officer. Inter- and intra-observer reliabilities were assessed using the kappa coefficient. RESULTS: The intra-observer reliability was good for lateral subluxation and metaphyseal cystic changes, moderate for lateral calcification, and fair for Gage's sign and horizontal growth plate. The inter-observer reliability was moderate for lateral subluxation, fair for lateral calcification and metaphyseal cystic changes, and slight for Gage's sign and horizontal growth plate. INTERPRETATION: There was considerable variation in the diagnosis of the head-at-risk signs between observers. This makes the classification difficult to use in clinical practice.

Calcinosis↗
PubMed1998

Mutation of the type X collagen gene (COL10A1) causes spondylometaphyseal dysplasia.

Spondylometaphyseal dysplasia (SMD) comprises a heterogeneous group of heritable skeletal dysplasias characterized by modifications of the vertebral bodies of the spine and metaphyses of the tubular bones. The genetic etiology of SMD is currently unknown; however, the type X collagen gene (COL10A1) is considered an excellent candidate, for two reasons: first, Schmid metaphyseal chondrodysplasia, a condition known to result from COL10A1 mutations, shows a significant phenotypic overlap with SMD; and, second, transgenic mice carrying deletions in type X collagen show SMD phenotypes. Hence, we examined the entire coding region of COL10A1 by direct sequencing of DNA from five unrelated patients with SMD and found a heterozygous missense mutation (Gly595Glu) cosegregating with the disease phenotype in one SMD family. This initial documented identification of a mutation in SMD expands our knowledge concerning the range of the pathological phenotypes that can be produced by aberrations of type X collagen (type X collagenopathy).

Child↗
PubMed1999

Effect of a poly(propylene fumarate) foaming cement on the healing of bone defects.

Regeneration of skeletal tissues has been recognized as a new means for reconstruction of skeletal defects. We investigated the feasibility of an injectable and expandable porous implant system for in situ regeneration of bone. Therefore, a composite biodegradable foaming cement based on poly(propylene fumarate) was injected into a critical size defect made in the rat tibia. Animals were divided into two groups comparing the foam in the experimental group against sham-operated animals having a drill hole but no implant in the control group. Eight animals were included in each group. Animals were sacrificed at 1, 3, and 7 weeks postoperatively. Implantation sites were then evaluated with histologic and histomorphometric methods. Results of this study showed that defects did not heal in sham-operated animals. In the experimental group, metaphyseal and cortical defects healed within the first postoperative week by formation of immature woven bone. At the site of the cortical drill hole defect, healing was noted to progress to complete closure by formation of mature bone. Histomorphometry corroborated these findings and showed that metaphyseal bone remodeling peaked at 1 week postoperatively and then decreased as healing of the cortical defect progressed. This suggests that near-complete restoration of the original state of the tibial bone occurred in this animal model supporting the concept of in situ bone regeneration by application of engineered biodegradable porous scaffolds. () ()

Animals↗
PubMed1995

Nature and grace: the paradox of Catholic ethics.

Roman Catholic bioethics seems to be caught in a paradox. On the one hand it is committed to the natural law tradition and the power of reason to understand the structures of creation and the moral law. On the other hand there is a greater and greater appeal to Scripture and revelation. The tradition maintains that reason is capable of understanding the rational structures of reality and that ethics is properly built on metaphysics. In this way ethics, bioethics, is non-sectarian. However, the tradition also recognizes the effects of Original Sin on the will and intellect and the broad cultural changes that have affected our understanding of metaphysics. The appeal to Revelation is a corrective to many contemporary trends in ethics and bioethics. This article will examine the interplay of reason and revelation in the Church's teaching on sexuality (particularly contraception and in vitro fertilization), suffering, and death. Catholic bioethics is in the end prophetic and ecumenical and not gnostic and non-ecumenical.

Abortion, Induced↗
PubMed1974

The dilemma of science and morals.

The conflicts between science and morals which still continue to arise despite the apparent hegemony of atheistic scientism over traditional Judeo-Christianity in the twentieth century reflect a basic contradiction in the metaphysical foundation of Western lives. As was set forth by Machiavelli, the contradiction inherent in Western ethics is that it is based on the simultaneous belief in both objectively valid moral truths and purely relative values of communal purpose. The achievements of twentieth century science have intensified these contradictions. Modern physics has put in question the validity of its own metaphysical basis, namely the belief in Natural Law, and modern biology has been unable to come to terms with the Cartesian dualism of body and soul. By contrast, Chinese lives are comparatively free of these contradictions, being founded on the philosophies of Confucianism and Taoism, to which the concepts of objectively valid truth or Natural Law are foreign. Recent developments in Western attitudes regarding science and morals can be interpreted as a movement away from the traditional belief in absolute truths towards a Chinese relativism.

China↗
PubMed1990

Lead lines in young infants with acute lead encephalopathy: a reliable diagnostic test.

Fifteen Omani infants, ranging between 2 and 4 months of age, with acute lead encephalopathy underwent plain skeletal radiology. X-rays in all 15 infants revealed dense metaphyseal bands in long bones. These were best seen around the knee joint. Six infants had evidence of multiple lead lines indicating previous episodes of exposure to lead while four infants also had lead lines in the axial skeleton. We suggest that any young infant presenting with an unexplained encephalopathy should undergo an X-ray of the knee and that the presence of dense metaphyseal bands strongly supports the diagnosis of lead poisoning. A plain X-ray of the knee is a cheap, widely available investigation which can be rapidly obtained.

Bone and Bones↗
PubMed1996

Radiological, biochemical, and hormonal changes in malnourished children with rachitic manifestations.

We evaluated the radiological, biochemical and growth hormone (GH)/insulin-like growth factor-I (IGF-I) changes in 10 children with severe protein-energy malnutrition (PEM) who had rachitic manifestations (group 1), 10 children with severe PEM without clinical signs of rickets (group 2), and 10 children with normal body weight-for-length and -age, suffering from vitamin-D-deficiency with signs of florid rickets (group 3) and 10 normal age-matched children (group 4). Serum calcium (Ca2+), phosphorus (PO4), and albumin concentrations were markedly decreased in the two groups with PEM. Malnourished children with rickets had significantly higher serum alkaline phosphatase (ALP) concentrations compared to the malnourished group without rachitic manifestations. Radiological evaluation of the two groups who had rachitic manifestations revealed demineralization of long bones, thinning of the bony cortex, increased formation of osteoid tissue, and metaphyseal changes including cupping, fraying, and flaring. The incidence of these radiological findings did not differ among the well-nourished and the malnourished groups with clinical signs of rickets. However, the incidence of fracture of the shaft was higher (40 per cent) in the malnourished group compared to the well-nourished group (10 per cent) with rickets. In the malnourished group without clinical evidence of rickets, demineralization and cortical thinning was detected in 40 per cent without significant metaphyseal changes. Basal concentrations of GH and peak GH response to clonidine were significantly elevated and IGF-I concentrations were significantly depressed in the malnourished groups v. the other two groups. There were no significant differences in the fasting and the clonidine provoked GH levels or IGF-I concentrations between the rachitic children (group 3) and the normal children. These data suggest that in rachitic children there is not a major role for circulating GH (and by implication IGF-I) on bone mineralization. However, during malnutrition decreased IGF-I production can slow or stop epiphyseal growth and might contribute to the demineralization of the cortex of long bones.

Bone and Bones↗
PubMed1997

Tapered design for the cementless total hip arthroplasty femoral component.

The long-term behavior of total hip arthroplasty ultimately is determined by adaptive bone remodeling. Stress adaptation creating various degrees of metaphyseal bone atrophy has occurred with prostheses designed for tight distal fit and fill. This phenomenon has been explained as bone adaptation resolving the conflict between femoral component stiffness and bone flexibility. However, clinical observations indicate that a different premise may be operational when prostheses with tapered geometries are used. The results of four published reports (748 arthroplasties) using cementless femoral components of a tapered design were reviewed. The review found a low incidence of aseptic loosening (0.5%) and significant thigh pain (0.5%), and a radiographic incidence of proximal bone atrophy of 6%. In no case was the metaphyseal bone atrophy described as severe or extensive. These findings challenge the premise that reactive bone adaptation is related to the issues of femoral component stiffness exclusively and propose that femoral component geometry may have an influence on bone adaptation.

Arthroplasty, Replacement, Hip↗
PubMed1998

Fixation of osteotomies using bioabsorbable screws in the canine femur.

The purpose of this study was to compare the healing properties of femoral osteotomies fixed by bioabsorbable screws (20:80 polyglycolic copolylactic acid copolymer) to standard stainless steel screws of a similar design in a dog femoral model. Two osteotomies were used, the trephine osteotomy (10 mm diameter) in the metaphyseal lateral femoral condyle and in the femoral diaphysis, and a unilateral osteotomy in the lateral femoral condyle. Two months after the trephine osteotomies, the femurs that contained the polymer screws were not significantly different in mechanical strength from the femurs treated with the stainless steel screws, either in the diaphyseal or metaphyseal model. There was no histological difference in bone healing between the metallic and polymer screws for all periods (2, 9, and 17 months). There was no adverse inflammatory response to the polymeric or metallic screws. By month 17, the polymer screws were resorbed completely. All the diaphyseal screw tracks had healed with bone and areas of remodeling were evident in two specimens. For the femoral condyle osteotomy model at 2 months, the polymer screws were present and intact, and all osteotomies healed with no evidence of inflammation. By 9 months, only one specimen had polymeric material left in the screw track. At 15 months, the screw tracks still were present but no evidence of any polymer remained. The tracks were filled with fibrous and adipose connective tissue. All osteotomies stabilized with either bioabsorbable polymer screws or stainless steel screws did heal satisfactorily without any complications, inflammation, or osteolysis. The polyglycolic polylactic acid copolymer may have a clinical role as a bioabsorbable material without the concerns for the osteolysis, foreign body reaction, and sterile abscess formation that have occurred with bioabsorbable fixation methods in the past.

Absorbable Implants↗
PubMed2000

Fixation of large segment femoral allografts using plates augmented with cerclage wires.

Results using plates augmented with cerclage wires to stabilize eight large segment femoral allografts are described. Two patients had plates augmented with cerclage wires placed at the time of tumor resection, and six patients had plates augmented with cerclage fixation placed to manage allograft nonunions or fractures. These internal fixation techniques spanned 10 osteotomy sites: two metaphyseal and eight diaphyseal. The goal of operations that involved internal fixation with plates augmented by cerclage fixation was to obtain osseous union. Osseous union was achieved at both metaphyseal osteotomy sites and at one of the diaphyseal osteotomy sites. Internal fixation of large segment allografts with plates that are augmented with cerclage wires yield poor results when osseous union is the goal of treatment.

Adolescent↗
PubMed2000

Langerhans' cell histiocytosis in patients older than 21 years.

In this retrospective review of 541 patients with Langerhans' cell histiocytosis, 211 (39%) patients were older than 21 years of age, whereas 330 (61%) were younger than 21 years of age. The adult patients had a mean age of 32 years (range, 21-69 years) with 159 (75%) men and 52 (25%) women, whereas the pediatric patients consisted of 176 (55%) boys and 144 (45%) girls. This male predominance in adults was statistically significant. Three adults had the Hand-Schuller-Christian variant, whereas the remaining adults (208) had eosinophilic granuloma. The rib accounted for 25% of the adult lesions and only 8% of the pediatric lesions. Spine involvement was less common in the adult group (3% versus 10%) and was predominantly thoracic. The adult patients had 40 (77%) diaphyseal lesions, 12 (23%) metaphyseal lesions, and no epiphyseal lesions. The pediatric patients had 75 (54%) diaphyseal, 59 (42%) metaphyseal, and five (4%) epiphyseal lesions. Radiographic evaluation revealed similar margin and matrix patterns in both groups, with a geographic lesion without sclerotic borders being the most common pattern. Langerhans' cell histiocytosis is considered a pediatric disease. However, this study showed a significant number (39%) of patients older than 21 years of age with this condition.

Adult↗
PubMed2001

High-energy extracorporeal shock wave treatment of nonunions.

Forty-three consecutive patients who did not have healing of tibial or femoral diaphyseal and metaphyseal fractures and osteotomies for at least 9 months after injury or surgery were examined prospectively for use of high-energy extracorporeal shock waves. Former treatment modalities (cast, external fixator, plate osteosynthesis, limitation of weightbearing) remained unchanged. In all cases a 99mTechnetium dicarboxyphosphonate regional two-phase bone scintigraphy was performed before one treatment with 3,000 impulses of an energy flux density of 0.6 mJ/mm2. Radiologic and clinical followups were done at 4-week intervals starting 8 weeks after shock wave treatment. The success criterion was bridging of all four cortices in the anteroposterior and lateral radiographic views, in oblique views, or by conventional tomography. An independent observer described bony consolidation in 31 of 43 cases (72%) after an average of 4 months (range, 2-7 months). Twenty-nine of 35 (82.9%) patients with a positive bone scan had healing of the pseudarthrosis compared with two of eight (25%) patients with a negative bone scan. Six of these eight patients with negative scans were heavy smokers. No complications were observed. High-energy shock wave therapy seemed to be an effective noninvasive tool for stimulation of bone healing in properly selected patients with a diaphyseal or metaphyseal nonunion of the femur or tibia. Additional controlled studies are mandatory.

Adolescent↗
PubMed2002

Distraction osteogenesis for nonunion after high tibial osteotomy.

The purpose of this study was to determine whether distraction osteogenesis can be used to treat hypertrophic nonunion associated with angular deformity and shortening after Coventry style high tibial osteotomy. Five consecutive patients were retrospectively reviewed. In all patients the alignment had collapsed into excessive varus or valgus and leg length discrepancy was present. The leg length discrepancy, malalignment, and nonunion were treated simultaneously with distraction. Union was achieved by the time of fixator removal, which averaged 4.4 months. The Hospital for Special Surgery knee score significantly improved from 42 to 89. The mechanical axis deviation significantly improved by 5 cm. The coronal plane deformity significantly improved by 13 degrees, and leg length discrepancy improved significantly from 2.3 to 0.5 cm. Metaphyseal bone stock increased by 43%, and the Insall-Salvati ratio increased from 1.1 to 1.2 and remained within normal limits. All patients were satisfied with the procedure, and none have had or need a total knee replacement at an average followup of 4 years. Distraction osteogenesis of nonunion after high tibial osteotomy is a minimally invasive and successful procedure. It leads to bony union with correction of deformity and leg length discrepancy and prevents the need for total knee replacement at intermediate-term followup. The increase in metaphyseal bone stock may make total knee replacement technically easier.

Adult↗
PubMedDate not supplied

Osseous overgrowth after amputation in adolescents and children.

We retrospectively studied the incidence of primary surgical revision for stump overgrowth in a population of childhood and adolescent amputees. The anatomic location and the etiology of amputation are critical to the occurrence of overgrowth needing revision. Metaphyseal-level amputations are the most likely to develop overgrowth requiring revision (50%), whereas diaphyseal amputations are slightly less likely (45%). Joint disarticulations never develop overgrowth. Traumatic amputations are the most frequent mode of injury requiring revision of overgrowth (43%), followed by congenital or intrauterine amputations (30%) and elective amputations (20%). Radiographic classification of the osseous overgrowth helps define its severity and degree of ossific progression. Surgical revisions are usually performed when overgrowth reaches a grade 3 classification. The majority of skeletally immature diaphyseal- or metaphyseal-level amputees, including those with certain preexisting orthopaedic conditions, retain the ability to develop osseous overgrowth at the apex of the stump skeleton.

Adolescent↗
PubMedDate not supplied

Biomechanical comparison of hybrid external fixators.

OBJECTIVES: To determine the stiffness characteristics of the hybrid ring fixator in the treatment of (OTA 41-C) proximal metaphyseal and shaft tibial fractures. DESIGN: Five identical composite tibiae were fixed with a Synthes, ACE Fischer, Howmedica Monticelli-Spinelli, or Smith & Nephew Trauma Ilizarov hybrid external fixator or with the conventional Ilizarov wire fixator. The Synthes and Monticelli-Spinelli fixators were tested twice, the first time with the connectors on the outside of the ring and the second time with the connectors on the inside of the ring. MAIN OUTCOME MEASUREMENTS: A materials testing machine was used to apply pure compression, anterior and posterior bending, medial and lateral bending, and torsion. Stiffness values were calculated from the load deformation and torque angle curves. RESULTS: Overall, the Synthes and Monticelli-Spinelli fixators were the most rigid of the fixators when the wire-to-ring connectors were placed inside the ring. In general, the fixators were stiffest in axial compression and least stiff in posterior bending. Wire length had a significant effect on overall stiffness. CONCLUSIONS: This study suggests that the four hybrid external fixators in standard configuration have stiffness characteristics similar to those of the conventional Ilizarov fixator when used to treat proximal metaphyseal and shaft fractures of the tibia.

Biomechanical Phenomena↗
PubMed2000

Retrograde nailing of humeral shaft fractures: a biomechanical study of its effects on the strength of the distal humerus.

OBJECTIVES: The purpose of this study was to evaluate the loss of strength in the distal humerus that resulted from the creation of two different entry portals used for retrograde humeral nailing. DESIGN: Nine pairs, treated as blocks of size two, of fresh frozen humeri from individuals free of musculoskeletal disease were randomly divided into three groups in a balanced incomplete block experimental design. INTERVENTION: The specimens were tested intact (control) or with an entry portal drilled in either the distal metaphyseal triangle or the proximal slope of the olecranon fossa. Two of these three conditions were applied to each pair of the bones. Therefore, three pairs of bones accommodated testing of all possible combinations of the two treatments. All specimens were tested in torsion at a rate of 30 degrees per second until failure or fracture. RESULTS: The creation of an entry portal reduced the ultimate torque to 63 percent of that of the intact specimens (p = 0.044) and the energy absorbed to failure to 27 percent of that of the intact specimens (p = 0.039). The metaphyseal entry portal reduced the torque to failure to 71 percent of that of the intact specimens (p = 0.143) and the energy absorbed to failure to 37 percent of that of the intact specimens (p = 0.073), The olecranon fossa entry portal reduced the torque to failure to 55 percent of that of the intact specimens (p = 0.035) and the energy absorbed to failure to 18 percent (p = 0.058) of that of the intact specimens. CONCLUSIONS: Surgeons should be aware of the loss of strength in the distal humerus after retrograde humeral nailing. This is especially important when prescribing postoperative mobilization in which the upper extremities will be used for weight-bearing in either transfers or ambulation.

Aged↗