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Biomedical subjects

C S Galasko

Publications and source records attributed to C S Galasko.

At least 73 records · Page 4Linked to original sources
PubMed1982

An evaluation of APTT monitoring of low-dose heparin dosage in hip surgery.

The activated partial thromboplastin time has been used to monitor the effects of low-dose subcutaneous heparin in two groups of patients undergoing hip surgery. The study was performed to determine the degree of anticoagulation required to protect these high-risk patients from post-operative deep vein thrombosis. The patients were randomised to receive a fixed regimen of subcutaneous calcium heparin (5,000 units eight-hourly) or a dose of calcium heparin monitored by maintaining the standardised APTT at 50 secs. In the adjusted group the APTT achieved the target figure in 46% of observations compared to 27% in the fixed group (p less than 0.005). Nine patients showed positive 125I-fibrinogen scans and in all, the APTT was below the target value the day before the scan became positive. In contrast, in six of the nine thrombotic patients heparin was detected by antifactor Xa clotting assay. The APTT, therefore, appears to give a better guide to the antithrombotic effect of heparin than the antifactor Xa clotting assay. These preliminary observations suggest that prolonging the standardised APTT method to just above 50 secs improves prophylaxis in high-risk cases. Furthermore, an increased dose of heparin is required than is proved during the conventional low-dose regime of 5,000 units tds. With regular control using the standardised APTT, increasing the dose to the target value does not increase post-operative haemorrhage. Further studies with larger numbers of patients are required in order to show a significant reduction in the incidence of post-operative deep vein thrombosis in hip surgery patients receiving low-dose adjusted heparin.

Adult↗
PubMed1982

University of Manchester sports injury clinic.

This paper reviews the work of the sports injury clinic based at the Student Health Centre, University of Manchester during its first eighteen months. A total of 852 patients including 46 Centre of Excellence athletes were treated. The results indicate that the establishment of such a specialised clinic is worthwhile, that the injured sportsmen should be treated by individuals trained and interested in the treatment of injured patients in general and that the commonest injuries are soft tissue injuries to the knee of ankle joint. A record card, designed for future computer analysis, is illustrated. It includes details of the sport, training, mechanism of injury, pathology and treatment.

Athletic Injuries↗
PubMed1982

Pseudomembranous colitis following cephradine prophylaxis.

Two patients on antibiotic prophylaxis with cephradine after orthopaedic implant surgery developed pseudomembranous colitis. Routine administration of antibiotics after such surgery is the policy at many centres. Development of diarrhoea in these patients should be viewed seriously lest this condition is overlooked. Despite recent advances, pseudomembranous colitis can still have a fatal outcome.

Aged↗
PubMed1982

Mechanisms of lytic and blastic metastatic disease of bone.

In the majority of skeletal metastases, new bone develops simultaneously with bone destruction. The roentgenogram indicates the net effect of these two processes. Where the bone formation predominates, the lesion appears sclerotic. Where bone destruction predominates, it appears lytic. Mixed lesions may also occur. There are two main mechanisms for the new bone formation. Those tumors associated with a suitable fibrous stroma develop islands of intramembranous ossification within the stroma, e.g., metastases from prostatic carcinoma. In the vast majority of metastases bone destruction is associated with reactive new bone formation. The latter is similar to callus associated with fracture repair. Myelomata and lymphomata are not associated with this reactive new bone formation. There are at least two main mechanisms for the bone destruction. The earlier and quantitatively more important phase is mediated via osteoclasts, neoplasms secreting a variety of osteoclast stimulating factors. The main humoral factor in myeloma and the lymphomata is probably osteoclast activating factor (OAF), whereas in the carcinomata it may be prostaglandin. Two thirds of human mammary carcinomata are osteolytically active in vitro. In a co-culture model, the osteolysis can be significantly reduced by prostaglandin inhibitors, diphosphonates and particularly, their combination. At a late stage, neoplastic or monocytic cells are directly responsible for the continuing bone destruction.

Animals↗
PubMed1981

Patterns in the excretion of muscle markers after trauma and orthopedic surgery.

The urinary output of 3-methylhistidine (3-MeHis), creatinine, creatine, and zinc has been followed in 13 patients after accidental injuries and in nine patients undergoing elective orthopedic operations. The accidental injuries were classified by their Injury Severity Score (ISS) and according to the amount of muscle damage by the method of Grant and Reeve (15). The latter method gave two groups, (I) "very severe," and (II) "severe." The changes in the urine were not related to ISS. The initial output of 3-MeHis and zinc was greater in Group I than in Group II or in patients after total hip replacement, in whom muscle damage was least. The pattern of excretion of the excess 3-MeHis in Group I and after hip replacement suggested that it was derived from the breakdown of muscle injured in the accident or operation. Only in Group II and after total knee replacement were there additional changes which could be attributed to a generalized increase in muscle breakdown, said to be typical of the post-traumatic "flow" phase, e.g., the simultaneous increase in the output of all four muscle markers, to a peak about 6 days after the injury. In these patients the relative importance of muscle at the injury site and elsewhere is not clear. The most constant changes after accidental or operative trauma were delayed increased in the excretion of creatine and zinc. These changes, and the abnormality of the 3-MeHis/creatinine ratio, showed that alterations in muscle metabolism could persist for long periods after trauma.

Adolescent↗
PubMed1980

The effect of prostaglandin synthesis inhibitors and diphosphonates on tumour-mediated osteolysis.

Previous studies have shown that the prostaglandin synthesis inhibitor indomethacin reduced osteolysis produced by the experimental VX2 carcinoma, probably by inhibiting the stimulation of osteoclasts by prostaglandin E2. This study was carried out to determine whether prostaglandin inhibitors affect the tumour osteolysis produced by human mammary carcinoma as well as the VX2 carcinoma. The effect of diphosphonates on reducing tumour osteolysis was also investigated, since diphosphonates directly affect bone resorption. The results indicated that various non-steroidal, anti-inflammatory agents which inhibit prostaglandin synthesis reduced the osteolysis produced by human mammary or rabbit VX2 carcinomas. The diphosphonate compounds also produced a significant inhibition of tumour osteolysis. The results confirm the findings of Powles and his colleagues (1) that aspirin (also a prostaglandin synthesis inhibitor) reduced the osteolysis induced by human mammary carcinoma. It is suggested that these agents be evaluated as adjuvant therapy in patients with apparently 'early' mammary cancer in a controlled clinical trial.

Animals↗
PubMed1980

Detection of congenital dislocation of the hip by an early screening program, with particular reference to false negatives.

The incidence of hip abnormality was investigated in 11,980 children born at Hope Hospital, Salford, between 1975 and 1978. Of 179 neonates (14.9/1,000 livebirths) found to have an abnormal hip, only 22 (1.8/1,000 livebirths) required treatment with an abduction splint. Despite this high detection rate of hip abnormalities, 10 children (0.83/1,000 livebirths) presented with late congenital dislocation of the hip, i.e., CDH diagnosed after the age of six weeks. It is suggested that the hips should be reexamined in all children at the age of six to seven months.

England↗
PubMed1979

Timing of indomethacin in the control of prostaglandins, osteoclasts and bone destruction produced by VX2 carcinoma in rabbits.

Rabbits were injected with VX2 cancer cells into the left thigh or tibia, and given indomethacin 1-16 mg/kg daily starting on the day before tumour implantation or 7, 14 or 21 days after implantation. Indomethacin at 2 mg/kg and above from before tumour implantation reduced osteoclast proliferation and the amount of prostaglandin-like material extracted from homogenates of excised tumours, but the inhibition of bone destruction in vivo was significant only with indomethacin at 4 mg/kg and above. Indomethacin at 8 mg/kg reduced osteoclast proliferation and bone destruction, but the effect was statistically significant only when given within 7 days of inoculation with the tumour. The place of indomethacin and other inhibitors of prostaglandin synthesis has not yet been established in the management of patients with skeletal metastases. Drug administration might need to be started at the time of diagnosis and removal of the primary tumour, rather than when skeletal metastases are evident.

Animals↗