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Biomedical subjects

C S Galasko

Publications and source records attributed to C S Galasko.

At least 55 records · Page 3Linked to original sources
PubMed1990

Outcome after acute osteomyelitis in preterm infants.

Eight cases of skeletal infection in preterm infants were studied. All the infants were systemically unwell, with polymorpholeucocytosis. Diagnosis was by blood culture, and any radiographic changes were apparent at the time of presentation. Infection was often multifocal, with sites around the knee being most commonly affected. Staphylococcus aureus was the pathogen isolated in six of the eight cases; in these treatment with fusidic acid was effective and well tolerated, even at doses that were less than the recommended therapeutic minimum. Even with prompt diagnosis and aggressive treatment orthopaedic sequelae are common.

Acute Disease↗
PubMed1990

The Matrix seating system.

The Matrix seating system is an adaptable orthosis made of interlocking plastic components which can be shaped to fit the needs of the disabled. Twenty-five patients who had used this system for a minimum of 12 months have been assessed clinically. It was found to have several advantages over its rivals particularly in patient and guardian acceptance, versatility and on economic grounds. However, it was found not to prevent deterioration in spinal deformity nor to prevent hip dislocation.

Adolescent↗
PubMed1989

Back pain in childhood.

Sixty-one children with back pain presented to the authors' department between 1978 and 1984, accounting for less than 2% of referrals in this age group. Approximately 50% had serious spinal disease, yet clinical findings could be unreliable in distinguishing such patients. In the absence of compelling physical signs, children with normal radiographs, white cell count, and sedimentation rate can be treated symptomatically and observed for some months before more invasive investigations are considered.

Adolescent↗
PubMed1989

Does myeloma secrete an osteoblast inhibiting factor?

Unlike most other tumours, myeloma causes bone destruction without an osteoblastic reaction; we tried to assess whether myeloma secretes a humoral factor that inhibits osteoblasts. Human bone-derived cells were either co-cultured with myeloma cells, or cultured in medium conditioned by myeloma cells. Bone-derived cell growth was measured by cell counts and by uptake of tritiated thymidine (3H-Tdr); growth was inhibited when cultured in medium conditioned by myeloma cells and some inhibition was seen when the bone-derived cells were co-cultured with myeloma cells. The inhibiting effect was dose-dependent and also dependent upon the density of the myeloma cells conditioning the medium. The results of our study suggest that myeloma secretes an osteoblast inhibiting factor of less than 50,000 Dalton molecular weight.

Cell Count↗
PubMed1989

The management of bone and joint infection.

Although infection of bone and joint does not occur frequently in the developed world, it is a serious condition when it occurs. Early diagnosis and prompt treatment are necessary to minimize the later complications of chronic osteomyelitis and destruction of articular cartilage. Despite early diagnosis and treatment, damage to the articular cartilage or growth plate may already have occurred.

Arthritis, Infectious↗
PubMed1989

The development of skeletal metastases.

The search into the way in which skeletal metastases develops has not only shown that there are several mechanisms for the progressive bone destruction and bone formation that occur simultaneously in the majority of skeletal metastases, but also that an understanding of these basic mechanisms has significant therapeutic implications. Our results have shown that there are two main mechanisms for the bone formation: stromal bone formation and reactive bone formation. The former occurs in tumours which tend to be acellular, with a large fibrous stroma, whereas the latter occurs in virtually all metastases. There is no difference in the basic pathological process of sclerotic or lytic metastases, the radiographic appearance purely indicating the net balance between the different types of bone formation and the simultaneous progressive bone destruction. An understanding of the pathophysiological response to skeletal metastases explains why skeletal scintigraphy can be used to diagnose these lesions and the different mechanisms underlying the 'three-phase scintigram'. The first phase indicates the vascularity of the lesion; the second phase or 'blood-pool' image indicates the concentration in the extracellular fluid and the third phase or 'skeletal or delayed image' indicates the uptake in the reactive new bone. The secretion of an osteoblast inhibiting factor by myeloma indicates why there is no reactive bone produced by the majority of lesions in the absence of a fracture, and why scintigraphy is less reliable than plain radiographs for the detection of the lesions. There are two main mechanisms for the bone destruction, the most important being mediated via osteoclasts. An understanding of the humoral mechanisms stimulating the osteoclast proliferation may lead to more effective treatment of malignant hypercalcaemia and lytic metastases. Early results of use of APD are encouraging, and our results also suggest that clinical trials should be established to evaluate the effect of combination therapy with APD or prostaglandin inhibitor combined with the agents normally used in the management of patients with disseminated mammary carcinoma. The development of treatments to inhibit tumour-induced osteolysis will minimise the complications of pathological fracture, spinal instability, etc., and even if these treatments do not affect the primary tumour, its ability to metastasize, or the patient's survival, such treatment will be a major advance in the management of patients with carcinoma, because of the significant morbidity currently associated with the development of skeletal metastases and their complications.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone Neoplasms↗
PubMed1988

Comparison of the efficacy of naproxen sodium and dihydrocodeine tartrate in the treatment of post-operative pain.

A single-blind, parallel study was carried out in 54 patients with post-operative pain after minor orthopaedic procedures to compare the efficacy and tolerance of naproxen sodium and dihydrocodeine tartrate. Patients were allocated at random to receive oral treatment as soon as analgesia became necessary with an initial dose of either 550 mg naproxen sodium or 30 mg dihydrocodeine tartrate, then doses of 275 mg and 30 mg, respectively, when required up to a maximum of 5 doses per day for 3 days. Assessments were made of pain severity and pain relief 2 and 4 hours after the first dose and at the end of each day. The results indicated that naproxen sodium gave statistically significantly greater pain relief than dihydrocodeine tartrate after the first dose. Both treatments were well tolerated and few side-effects were reported. Three patients in each group were withdrawn due to lack of efficacy (combined with adverse effects in 1 naproxen sodium patient), and 1 patient in each group was withdrawn because of side-effects.

Administration, Oral↗
PubMed1987

The disposal of intravenous glucose studied using glucose and insulin clamp techniques in sepsis and trauma in man.

Whole body glucose uptake and oxidation during a hyperglycemic clamp have been shown to be depressed in hypermetabolic septic patients compared to control subjects despite similar plasma insulin concentrations. Forearm glucose uptake was similarly impaired. Metabolic rate was not increased further by the glucose infusion in the patients although a 20% rise was elicited in the controls. This resistance to the effects of insulin was also clearly demonstrated in trauma patients using the euglycemic clamp technique. The maximal rate of glucose disposal after injury was half that found in controls and the pattern of response was consistent with the insulin resistance being a post-receptor defect.

Glucose↗
PubMed1986

Delay in diagnosing Duchenne muscular dystrophy in orthopaedic clinics.

For clinical, psychological and social reasons the diagnosis of Duchenne muscular dystrophy should be established as early as possible. In a survey of 83 families with 93 affected boys, the diagnosis was missed in every case referred to an orthopaedic surgeon (37 patients). In the whole group there was a mean delay of 2.0 years (0 to 6 years) during which time inappropriate treatment, difficulties in communication with parents, much parental anxiety and further pregnancies occurred. A serum creatine kinase estimation is a simple outpatient test which should be carried out on any boy with clumsy or abnormal gait, with flat feet or with an unexplained equinus deformity.

Child↗
PubMed1986

Skeletal metastases.

During the past ten to 20 years, there have been many advances in the understanding of the way in which skeletal metastases develop and great strides in the methods of detection, particularly with the development of the gamma camera and axial or whole-body skeletal scintigraphy. Skeletal metastases may present with pain, hypercalcemia, large lytic lesions, pathologic fracture, spinal cord or cauda equina compression, or spinal instability. Much has been learned about the management of skeletal metastases, and many of these developments have occurred in Great Britain.

Bone Neoplasms↗
PubMed1985

The significance of peak expiratory flow rate in assessing prognosis of elderly patients undergoing operations on the hip.

Peak expiratory flow rate (PEFR) was measured using a Wright peak flow meter in 190 patients with fracture of the proximal part of the femur, and in 110 patients who underwent elective total hip replacement. PEFR was significantly lower in the fracture group than in the elective group when similar age ranges were compared. In the fracture group, PEFR of less than 100 was associated with a 69.6 per cent mortality rate, whereas no deaths occurred where the PEFR was greater than 300. It is suggested that the patients' PEFR is a good indicator of their prospects and it can be easily measured on admission.

Age Factors↗
PubMed1985

Trial of oral flupirtine maleate in the treatment of pain after orthopaedic surgery.

A clinical trial was carried out in 66 patients to compare the effectiveness of oral flupirtine maleate (100 to 200 mg) and oral pentazocine (50 to 100 mg) in the treatment of pain after hip replacement surgery. The trial analgesics were used as sole analgesia from the second to the fifth post-operative day. Similar numbers of patients were withdrawn from the trial in each group (flupirtine 6, pentazocine 5) because of poor efficacy or the appearance of symptoms, the relationship to treatment of which was uncertain. Indices of the quality, speed and degree of pain relief were similar in both groups on all days of the study, no significant differences being seen. High proportions of patients in each group expressed overall satisfaction with the trial medication, somewhat more so with flupirtine (85% to 95%) than pentazocine treatment (67% to 79%). Reports of dizziness/lightheadedness were significantly more common with pentazocine (23% affected) than with flupirtine (3%). Other side-effects were reported by only small numbers of patients, but the relationship of reported symptoms to treatment was uncertain in most cases. The results suggest that flupirtine is likely to be at least as effective and acceptable as pentazocine for the treatment of pain after orthopaedic surgery and that flupirtine may offer advantages in terms of fewer central nervous system side-effects.

Administration, Oral↗
PubMed1984

Metabolic control in non-septic patients with musculoskeletal injuries.

Changes in gaseous exchange, plasma substrates and hormones and excretion of nitrogen were followed in 13 non-septic male patients, all of whom had sustained at least 1 fracture of a long bone. Results were compared with normal subjects given glucose to produce a range of substrate and hormone concentrations. Over the 3 weeks following injury, oxidation of fat decreased from high levels whilst oxidation of carbohydrate rose. This reflected to some extent changes in availability of substrate, but early after injury oxidation of fat was higher than expected for the concentration of free fatty acids in plasma and later oxidation of carbohydrate was increased relative to concentrations of glucose and insulin. Concentrations of insulin in plasma were high for the prevailing concentrations of glucose, and peak urinary excretion of nitrogen coincided with maximum levels of insulin. It was concluded that in the injured patient there are changes at the level of utilization and oxidation of plasma substrates as well as in their availability, and that there is marked unresponsiveness of protein metabolism to the normal anabolic effect of insulin.

Adolescent↗
PubMed1984

The management of equinus deformity in Duchenne muscular dystrophy.

Equinus deformity of the ankle is one of the serious orthopaedic problems associated with Duchenne muscular dystrophy. Sixty-nine patients (age range 4 to 17 years) were treated, 43 conservatively and 26 operatively. They were followed up at six-monthly intervals for a minimum of two years and a maximum of six years. The patients were divided into three groups: independently mobile, mobile in calipers, and wheelchair-bound. It was found that conservative treatment could at best only minimise progression of the deformity. The indications for surgery, the operative procedure and the postoperative management are described; all varied according to the stage of the disease. The postoperative follow-up suggests that, though the deformity recurs, the patients have several years of benefit from the procedure.

Adolescent↗
PubMed1983

Persistence of high plasma glucose, insulin and cortisol concentrations in elderly patients with proximal femoral fractures.

Plasma glucose, insulin and cortisol concentrations were measured in elderly patients with femoral neck fractures. The results have been compared with those in younger injured patients as well as younger and elderly control subjects. There was a prolonged elevation of plasma glucose, insulin and cortisol concentrations after femoral neck fractures, in contrast to a rapid return to normal in younger injured patients. Comparison with the control groups suggested that this might reflect the effects of immobility rather than of age or of injury per se. The pattern of insulin resistance together with a high cortisol concentration could hinder recovery.

Adolescent↗