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Biomedical subjects

A G Sutherland

Publications and source records attributed to A G Sutherland.

16 recordsLinked to original sources
PubMed2003

Disturbance of pro-inflammatory cytokines in post-traumatic psychopathology.

BACKGROUND: Post-traumatic psychopathology (PTP) is important to the orthopaedic surgeon as it may complicate the recovery from musculoskeletal injury. PTP is associated with a disturbance of the hypothalamic-pituitary-adrenal axis, and may lead to impaired healing. We have investigated the relationship between PTP and pro-inflammatory markers of the metabolic response to trauma. MATERIALS AND METHODS: A prospective cohort study of 82 patients with musculoskeletal injuries, correlating development of psychopathology (measured by general health questionnaire) and pro-inflammatory markers (CRP, IL-6, sIL-6r, TNF-alpha) two and six months after their injury. RESULTS: Psychological disturbance was found in 39% of patients at two months and 18% at six months. This disturbance was associated with significantly increased levels of IL-6 at two months and of sIL-6r and TNF-alpha at six months. CRP levels were not related to the development of PTP. CONCLUSIONS: The relationship between PTP and disturbances of pro-inflammatory markers needs further exploration, but may explain in part the impaired functional recovery when musculoskeletal trauma is complicated by psychological disturbance.

Accidents, Traffic↗
PubMed2001

C-reactive protein and interleukin 6 receptor in post-traumatic stress disorder: a pilot study.

BACKGROUND: it has been reported that psychological stress in humans is associated with a derangement of biological homeostasis. This pilot study aimed to examine the inflammatory response to post-traumatic stress disorder (PTSD) through measurements of the serum levels of the receptor to interleukin 6 (sIL-6r) and C-reactive protein (CRP), in relation to measures of psychological disturbance. METHODS: 15 patients with established PTSD and eight control patients with musculoskeletal injuries were studied at least three months after their index trauma. All completed revised impact of events scale (RIES), Davidson's trauma scale (DTS) and the general health questionnaire (GHQ), and gave blood samples that were assayed for CRP and sIL-6r. Statistical analysis was by the Mann-Whitney U-Wilcoxon rank sum tests. RESULTS: positive relationships were found between sIL-6r and the RIES intrusion score (P=0.026), and between CRP and DTS intrusion scores (P=0.016), GHQ depression (P=0.028), and RIES intrusion (P=0.044) in the case group. DISCUSSION: we have demonstrated a relationship between post-traumatic psychological and biological disturbance, which provides the basis for further research on the effects of psychological disturbance on physical recovery after injury.

Adolescent↗
PubMed2000

Urinary soluble IL-6 receptor levels after cardiopulmonary bypass.

To investigate the possible role of soluble interleukin 6 receptor (sIL-6r) in the inflammatory response to cardiopulmonary bypass (CPB) with extracorporeal circulation (ECC), we examined the levels of sIL-6r in the urine of 50 patients undergoing coronary artery bypass surgery. The presence of sIL-6r in urine was confirmed in these patients, with levels rising from 6 pg/ml preoperatively to 19.5 pg/ml at 6 h and 41 pg/ml at 24 h after the start of cardiopulmonary bypass. Cardiopulmonary bypass leads to a rise in sIL-6r in urine that has not returned to normal after 24 h, suggesting a role for sIL-6r and IL-6 in the inflammatory response to such surgery. Determination of cytokine receptor presence in urine offers a non-invasive approach to the monitoring of the immune and inflammatory response to the stress of surgical and traumatic injury.

Adult↗
PubMed2000

Removal of the subchondral plate in acetabular preparation.

Retention of the subchondral plate during acetabular preparation in total hip replacement is believed to be an important part of modern cementing techniques. We have constructed a two-dimensional finite element analysis to assess the effect of retention and removal of this relatively stiff structure. The finite element analysis demonstrates increased stiffness and stress concentrations at the bone-cement interface that may have an adverse effect. Although further study is required, it may be that subchondral bone retention is not advantageous.

Acetabulum↗
PubMed2000

Bilateral fractured clavicles--a pair of cases.

The authors present two cases of bilateral fractured clavicles, both resulting from direct trauma to both shoulders. In both cases, the fractures healed uneventfully with non-operative treatment.

Accidents, Traffic↗
PubMed1999

Abductor weakness and stresses around acetabular components of total hip arthroplasty: a finite element analysis.

Abductor weakness, and the resulting Trendelenburg gait, after total hip arthroplasty is believed to be associated with a poor long-term outcome. We have constructed a two-dimensional finite element analysis using load cases to mimic this abductor weakness. The finite element analysis demonstrates slightly increased stresses, particularly at the bone-cement interface in the DeLee-Charnley zone I, which does not seem sufficient to explain the adverse effect of abductor weakness.

Acetabulum↗
PubMed1999

Who actually does orthopaedic operating?

Recent correspondence in the British Medical Journal suggested that up to 80% of orthopaedic trauma surgery is carried out by unsupervised trainees. We examined our own experience by gathering theatre computer system data over a six month period and case note verification. Unsupervised trainees carried out 48% of the trauma surgery, but only 13% of the elective surgery. Case sheet review demonstrated that the computer system over-attributed operating to the senior surgeon, and under-recorded the presence of unscrubbed consultants. Supervision of trainees is important for both training and service provision, and needs to be tailored to the needs of individual trainees, but we were disappointed with our results. Theatre computer records may not be accurate enough to allow assessment of the level of supervision.

Emergency Medical Services↗
PubMed1998

Screening times with image intensifier in orthopaedic trauma surgery.

Image intensifier technology has been of great benefit to orthopaedic, but not a benign aid. We have examined the image intensifier screening times for trainees and consultants over a seven month period. Consultants did not always have shorter screening times, and there were no differences between radiographers, Surgeons of all grades should depend more upon anatomical knowledge and spatial orientation, and less upon the image intensifier.

Health Personnel↗
PubMed1997

Infection associated with the use of allograft bone from the north east Scotland Bone Bank.

To assess the rate of infection associated with use of banked allograft bone, the case records of patients receiving banked bone over one year were reviewed. The notes of patients undergoing autografting procedures during the same period were reviewed as controls. Eighty-two patients received 98 banked allograft femoral heads and there were 10 proven infections (12.2%). Fifty-seven patients had autograft procedures, with two cases of infection (3.5%). The results of bacteriological surveillance of grafts harvested during the same period were analysed; there was a discard rate due to bacterial contamination of 1.3%, and two patients received three contaminated grafts, one of these patients suffering a postoperative infection. The failure rate of procedures was 50% where there was postoperative infection and 4.2% where there was none. Procedures using banked allograft bone have a substantial infection risk, and this is associated with a much higher rate of failure of the procedure. Prospective audit of allograft use should be applied to reduce this risk.

Bone Banks↗
PubMed1996

Differing injury patterns in snowboarding and alpine skiing.

This is a study of all people presenting to ski patrollers with ski and snowboard injuries during the 1995 season. There were 476 casualties of whom 396 were skiers and 57 were snowboarders. Information was collected retrospectively on the mechanism, region and injury, and also personal details of the casualties. The information was compared with the numbers of ski and snowboard injuries for the 1994 season. Injuries due to snowboarding increased in frequency, from 4 per cent in 1994 to 11 per cent in 1995. Snowboarders were younger, predominantly male, and were more often beginners than were skiers. They most commonly sustained ligament strains, dislocations and fractures, with the hand and forearm and shoulder most affected. Skiers sustained more ligament strains and soft tissue bruising, particularly of the knee and thumb. Snowboarders sustain a different pattern of injuries compared with skiers, and this has important implications for preventing accidents in the instruction of novices.

Adolescent↗
PubMed1996

Gastric lymphoma in Grampian Region: presentation, treatment and outcome.

Forty cases of gastric lymphoma presenting in Grampian Region (1974-91) were reviewed to examine the effects of changing ideas in the fields of chemotherapy, gastric surgery and diagnostic techniques, as well as the impact of Helicobacter pylori. Presentation was non-specific, and the diagnosis was made pre-operatively in only 12 cases. Survival was related to tumour size, staging (Ann Arbor), and grade, with a crude 5-year survival of 49%. Helicobacter pylori was found in all specimens reviewed. Patients who underwent "potentially curative' surgery followed by adjuvant therapy had the best survival (85% at 5 years). There remains a need for larger studies to define the best treatment for this uncommon condition.

Adult↗