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Biomedical subjects

A S Paul

Publications and source records attributed to A S Paul.

16 recordsLinked to original sources
PubMed1998

Failure of the spiral blade module of the AO unreamed femoral nail.

The treatment of subtrochanteric femoral fractures remains difficult despite the introduction of modern intramedullary nailing techniques. Accurate fracture reduction, correct siting of the proximal entry point and restoration of medial support remain essential for a successful outcome. We report a case of failure of the spiral blade module of the AO unreamed femoral nail, which may have been precipitated by incorrect siting of the entry point, resulting in poor implant positioning within the femoral head.

Accidental Falls↗
PubMed1997

Improving the results of ganglion aspiration by the use of hyaluronidase.

We present the results of a prospective randomized trial comparing the treatment of ganglia by aspiration under local anaesthetic and either instillation of steroid alone or with the prior use of hyaluronidase. Thirty-five patients were treated in each group and followed up for 2 years. The cure rate with the combined use of hyaluronidase and methylprednisolone was 89%, compared to 57% when treated by aspiration and instillation of methylprednisolone alone.

Administration, Topical↗
PubMed1996

Arthroscopic portals: the importance of blade selection.

Arthroscopy of the knee is a commonly performed procedure with a low reported complication rate. We have experienced two cases during which no. 15 scalpel blades disengaged from the handle and remained within the joint. Although both the blades were successfully retrieved arthroscopically without injury to the knee, the procedures were prolonged, and there remained a potential risk of causing damage. We have subsequently altered our practice and now routinely use a no. 11 blade, with which we have had no complications. We discuss the importance of correct blade selection and surgical technique in avoiding this complication and present two illustrative case histories.

Adult↗
PubMed1995

A new osteotome for performing chevron trochanteric osteotomy.

We report on the use of a new modified osteotome for performing chevron trochanteric osteotomy during hip arthroplasty. It is easy to use and the apex of the chevron is directed distally, thus producing a large segment of osteotomized trochanter, while avoiding the problems of fragmentation and splintering. At the end of the procedure, the trochanter is easily seated back within its concave bed, automatically achieving anatomical reduction and allowing easier fixation using the cruciate wiring technique. In a series of 77 primary hip arthroplasties, bony trochanteric union was achieved within 6 months in all patients.

Femur↗
PubMed1995

The huckstep nail. Stable fixation of mechanically deficient femoral bone.

A Huckstep intramedullary nail was used to treat 23 fractures in which the femur was mechanically deficient due to pathologic fracture, nonunion, or complex fracture in osteoporotic bone. All nailings were performed by open surgery, and in some cases this was augmented by corticocancellous bone grafting. The Huckstep nail allows the use of multiple cross screws at 15-mm intervals, providing immediate and adequate stability with successful early postoperative weightbearing. The results at followup were good in functional and radiologic terms, with no cases of fixation failure or infection. The quality of instrumentation allowed the nail and screws to be inserted without difficulty; however, the straight profile of the nail may cause problems in the distal femur, as seen in 1 patient. The authors conclude that this device offers significant mechanical and practical advantages over most other forms of fixation, where early weightbearing is desired in the presence of deficient bone. It is not ideal for distal femoral fractures, particularly in the presence of excessive femoral bowing.

Aged↗
PubMed1994

Different Trypanosoma brucei guide RNA molecules associate with an identical complement of mitochondrial proteins in vitro.

RNA editing is a mitochondrial transcript maturation process which evolved in kinetoplastid protozoa. It entails the insertion and deletion of exclusively uridine nucleotides directed by gRNAs into pre-mRNAs. Other participating components are not currently known. The aim of this study was to identify mitochondrial proteins that are in direct physical contact with gRNAs thereby possibly involved in the editing reaction. At low monovalent cation concentration (30 mM KCl) 8 polypeptides with apparent molecular weights ranging from 124 to 9 kDa specifically cross-linked to gRNAs. Three of the proteins, 90, 21, and 9 kDa in size, were able to bind at higher salt concentrations (> or = 100 mM) indicating an enhanced affinity to the gRNA molecules. No cross-links were identified at > or = 250 mM KCl. Four gRNAs, specific for different editing domains of the ATPase 6 and ND7 pre-mRNAs, were in contact with the same set of mitochondrial polypeptides suggesting the assembly of an identical RNP complex that does not include pre-mRNA molecules. The binding of the 90 kDa protein was sensitive to the presence of U-nucleotides at the 3'-end of the gRNAs and could specifically be blocked by modifying free sulfhydryl groups. The interaction with the 124 kDa polypeptide was inhibited by vanadyl ribonucleosides, implicating a role for 2', 3' hydroxyl groups in the gRNA-protein interaction.

Animals↗
PubMed1994

Fixation of closed metacarpal shaft fractures. Transverse K-wires in 22 cases.

22 patients who had closed displaced metacarpal shaft fractures, treated by transverse percutaneous K-wire fixation were reviewed. In 11 cases, 1 distal and 1 proximal wire were inserted and in the rest, 2 distal and 1 proximal wire were used. The results in patients treated with a single distal wire were unsatisfactory due to pivoting of the distal fragment on the wire with consequent angulation and cosmetic deformity. In those who had 2 wires inserted distally, the reduction position was maintained throughout.

Bone Wires↗
PubMed1993

Avoidable complications of arthroscopic surgery.

The incidence of complications from arthroscopic surgery is low. Between 1978 and 1991, 8500 arthroscopies were performed by the two senior authors (J.N. and D.R.A.D.). Several significant complications were recorded, and these are presented to show how they occurred, and how our practice of arthroscopy was subsequently modified. There were four cases of clinically detectable deep vein thrombosis of which three were associated with pulmonary embolus, three cases of haemarthrosis, two deep infections, three compartment syndromes with one case of impending compartment syndrome, six cases of instrument failure and one case of persistent synovial fistula.

Adult↗
PubMed1992

A new femoral cement restrictor.

The authors report on the clinical trial of a new femoral cement restrictor for use during hip arthroplasty. Instrumentation and technique are described. The restrictor has three components made of high-density polyethylene that fit one inside the other and is available in small, medium, and large sizes. The advantages of this new restrictor are ease of use and secure fixation in the femoral canal when deployed. Because of its inherent strength and design, small particles do not break off during insertion. The apex of the restrictor points proximally and is cupped. This helps in centralizing the stem. It also assists in obtaining good cement pressurization as it does not distally migrate in the femoral canal when pressurization is attempted. Also, no cement escapes distally beyond it. Furthermore, should revision surgery be required, the restrictor can be easily removed without the need for windowing the femoral cortex.

Cementation↗
PubMed1992

Surgical treatment of adult trigger finger under local anaesthetic: the method of choice?

A prospective trial releasing 25 adult trigger fingers under a local anesthetic (5 ml 1% lignocaine with 1500 units hyalase) and a tourniquet was undertaken. All patients had excellent results and there was no complication. The adequacy of the release could be checked on the table by asking the patient to make a first actively, and any further measures necessary were carried out at the same time. It is recommended that the release of trigger fingers be carried out by this technique to minimize failures, as coexisting pathology causing two-level triggering can be identified and treated at the same time. The potential of complications is far less than with a general anaesthetic or a regional anaesthetic.

Adult↗