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Biomedical subjects

D R Bickerstaff

Publications and source records attributed to D R Bickerstaff.

At least 19 recordsLinked to original sources
PubMed1999

Degradation of cartilage type II collagen precedes the onset of osteoarthritis following anterior cruciate ligament rupture.

OBJECTIVE: To determine if degradation of cartilage matrix in primary osteoarthritis (OA) or in OA secondary to rupture of the anterior cruciate ligament (ACL) is a gradual response to excessive loading or an early, initiating event in the disease process. METHODS: Biopsy samples were obtained from the low-weight-bearing articular cartilage of the intercondylar notch, in patients undergoing knee arthroscopy (ACL injury) or arthroplasty (late-stage primary OA) or in controls. In some cases, biopsy samples were also removed from the high-weight-bearing articular cartilage of the femoral condyles. Biopsy specimens were extracted and assayed for total and denatured type II collagen (CII) by inhibition enzyme-linked immunosorbent assay and for proteoglycan using a colorimetric method. All patients were assessed radiographically for cartilage erosion. In addition, the cartilage of patients with ACL injury was assessed at arthroscopy, and the knee function of patients with primary OA was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Increased CII degradation was detected in the low- as well as the high-weight-bearing cartilage of patients with late-stage OA, and there was a positive correlation between the percentage denatured collagen and the WOMAC score. Most of the patients with ACL injury had no clinical signs of OA or macroscopic cartilage erosion. However, the low-weight-bearing articular cartilage from these patients showed a significant increase in CII degradation, similar to that observed in late-stage OA. The proteoglycan content of articular cartilage did not change significantly in patients with OA or ACL injury compared with controls. CONCLUSION: CII degradation is an early event following ACL injury and is unlikely to be a direct result of mechanical loading, since it was observed in cartilage obtained from a low-weight-bearing site.

Adolescent↗
PubMed1999

Mucoid cystic degeneration of the cruciate ligament.

A 35-year-old man was seen with pain in the back of the knee. MRI showed a mass in the anterior cruciate ligament. Biopsy indicated mucoid degeneration. Arthroscopic resection of the ligament was carried out, with relief of symptoms.

Adult↗
PubMed1999

The popliteofibular ligament. An anatomical study of the posterolateral corner of the knee.

We designed an experimental study to prove the existence of the popliteofibular ligament (PFL) and to define its role in providing static stability of the knee. We also examined the contribution of the lateral collateral ligament (LCL). We found this ligament to be present in all eight human cadaver knees examined. These specimens were mounted on a specially designed rig and subjected to posterior, varus and external rotational forces. We used the technique of selective sectioning of ligaments and measured the displacement with a constant force applied, before and after its division. We recorded the displacement in primary posterior translation, coupled external rotation, primary varus angulation and primary external rotation. Statistical analysis using the standard error of the mean by plotting 95% confidence intervals, was used to evaluate the results. The PFL had a significant role in preventing excessive posterior translation and varus angulation, and in restricting excessive primary and coupled external rotation. Isolated section of the belly of popliteus did not cause significant posterolateral instability of the knee. The LCL was also seen to act as a primary restraint against varus angulation and secondary restraint against external rotation and posterior displacement. Our findings showed that in knees with isolated disruption of the PFL stability was restored when it was reconstructed. However in knees in which the LCL was also disrupted, isolated reconstruction of the PFL did not restore stability.

Aged↗
PubMed1998

Synovial osteochondromatosis of the cruciate ligament.

An unusual case of synovial chondromatosis of the cruciate ligaments is reported that resulted principally in a loss of function, secondary to a mechanical block to extension. Magnetic resonance imaging was useful in directing surgery, but not in making the formal diagnosis.

Anterior Cruciate Ligament↗
PubMed1994

Algodystrophy: an under-recognized complication of minor trauma.

Algodystrophy is a poorly recognized condition of uncertain aetiology which presents with pain and tenderness, vascular instability, swelling and stiffness of an affected limb. It is most commonly seen after trauma. In order to ascertain its incidence, natural history and the degree of morbidity induced we studied prospectively 274 patients with Colles' fracture. Algodystrophy, as judged by the presence of bone pain or tenderness, vasomotor symptoms, swelling and stiffness of the hand was noted in 28% of patients. There was a significant association between the presence of these features (P < 0.0001). The degree of trauma sustained was identified as a predisposing factor. Actuarial analysis showed a gradual resolution of symptoms. Six months after injury, the proportion of patients complaining of pain and swelling had fallen to 20-30%, vascular instability and tenderness to 50% and stiffness to 80%. Failure to improve was associated with a significant loss of hand function (P < 0.0001). By 1 yr, pain and tenderness, vascular instability and swelling had decreased still further but stiffness was still apparent in 50%. We believe that algodystrophy is a neglected disorder and is far more common than formerly appreciated. Although it often resolves spontaneously, it is associated with a significant increase in short-term morbidity in the majority of patients and persistent dysfunction in a minority.

Aged↗
PubMed1993

Changes in cortical and trabecular bone in algodystrophy.

We studied the pattern of bone loss in the hand of 77 patients with Colles' fracture using metacarpal morphometry, single photon absorptiometry and a radiographic scoring system. Forty-four patients had post-traumatic algodystrophy and the remainder served as controls. Both groups were immobilized in the same manner and for the same period of time and both showed loss of bone during immobilization. The loss of bone 7 weeks after fracture was significantly greater in algodystrophy than in controls both at cortical (P < 0.05) and at trabecular sites (P < 0.001). Recovery of bone occurred in the control patients by 19 weeks after fracture at cortical sites and by 31 weeks in trabecular bone. In contrast, the bone loss seen in patients with algodystrophy persisted for the 6-month duration of the follow-up, and up to 1 year in all nine patients studied for longer. These findings indicate that post-traumatic algodystrophy is associated with regional skeletal losses greater than those following uncomplicated fracture and may result in irreversible changes in the structure and thus the strength of the bony architecture.

Absorptiometry, Photon↗
PubMed1991

Radiographic changes in algodystrophy of the hand.

It is not certain to what extent the radiographic features of post-traumatic algodystrophy can be differentiated from disuse atrophy following trauma. A semi-quantitative scoring system has been devised, grading the dominant features seen on radiography in both conditions following Colles' fracture. The technique had intra- and inter-observer errors of 14% and 17% respectively. When applied prospectively 7 weeks after Colles' fractures, there was a significantly greater score in patients with algodystrophy (p less than 0.001) than those without. Analysis of the scores was performed to identify a score for the optimal identification of algodystrophy. At a score of four or greater, 87.5% of patients with algodystrophy were positively identified with a positive predictive value of 83%. It is suggested that use of this scoring system will aid in the early diagnosis of algodystrophy.

Atrophy↗
PubMed1991

Partial meniscectomy using the neodymium:YAG laser. An in vitro study.

We have evaluated, in an in-vitro study, the thermal effects of the neodymium:YAG (Nd:YAG) contact laser on meniscal tissue. There was no significant difference with regard to time taken to divide the meniscus or depth of necrosis between the two power settings used (25 and 30 W). A significantly greater (p less than 0.005) amount of energy, however, was expended at the higher power setting. The heat from the laser probe dissipated rapidly into the surrounding water without causing significant lateral thermal tissue damage. The Nd:YAG contact laser has features such as the ability to be transmitted through aqueous solutions, fiberoptic delivery, precise thermal tissue effects, and tactile feedback that would be beneficial in arthroscopic surgery. Although experimental, we suggest further clinical evaluation of its potential.

Humans↗
PubMed1991

Effects of amino-butylidene diphosphonate in hypercalcemia due to malignancy.

We studied the effect of a single 5 mg intravenous infusion of amino-butylidene diphosphonate (ABDP) in nine patients with hypercalcemia of malignancy, in whom serum calcium values were stable or rising after intravascular volume expansion. Serum calcium fell progressively in all patients and in seven reached the normal reference range by day 6 (p less than 0.001). The decrease in serum calcium was associated with a decrease in the fasting urinary calcium/creatinine ratio (p less than 0.05). Hypercalcemia recurred in seven of the patients by day 12, but two patients remained normocalcemic for 21 days. We conclude that ABDP is a highly potent diphosphonate and that a single intravenous infusion is capable of inhibiting tumour-mediated bone resorption for several days.

Adult↗
PubMed1991

The use of nasal calcitonin in the treatment of post-traumatic algodystrophy.

Calcitonin is widely used in the treatment of algodystrophy but a major disadvantage is the need for its parenteral administration. For this reason, we evaluated the effect of 400 iu of nasal calcitonin in the treatment of post-traumatic algodystrophy in a prospective randomized double-blind study. We found no demonstrable effect on the clinical or skeletal progression of the disorder using sensitive methods of measuring the response to treatment. There was, however, a small but significant hypocalcaemic response in the treatment group despite no change in the other indices of bone turnover. Possible reasons for this lack of clinical and skeletal effect are discussed.

Administration, Intranasal↗
PubMed1991

An investigation into the etiology of irritable hip.

A prospective review has been made of 111 children who presented with acute hip pain to determine it's etiology and assess the need for multiple investigations at presentation. There was no clinical hematological, serological or bacteriological evidence to identify positively patients with an irritable hip, neither was there good correlation with a history of infection. An effusion was diagnosed by ultrasound in 71% but there were no factors, either clinically or by investigation, to differentiate between patients with or without an effusion. We conclude that multiple investigations to find a source of infection in patients with irritable hip are not warranted as they are rarely positive, seldom affect management and are of no help in investigating the etiology of irritable hip.

Adolescent↗
PubMed1990

Treatment of Paget's disease of bone with aminohydroxybutylidene bisphosphonate.

This study examined the effects of aminohydroxybutylidene bisphosphonate in 30 patients with Paget's disease of bone, administered as an intravenous infusion for 5 consecutive days. Treatment (5 mg IV daily) induced marked suppression of biochemical indices of disease activity. Urinary excretion of hydroxyproline fell to 50% of pretreatment values within 2 weeks and was followed by a similar, but later, decline in the serum activity of alkaline phosphatase. Disease activity remained suppressed throughout the 6 months of observation, and only 1 patients showed biochemical signs of an early relapse. Symptomatic improvement was noted in 27 of the 30 patients. Bone biopsies, undertaken in 10 patients, indicated no adverse effects on mineralization. Transient falls were noted in the total white cell count, particularly the lymphocyte and neutrophil fractions, and were associated with short-lived fever in 3 patients. We conclude that short courses of intravenous AHButBP provide a promising treatment for active Paget's disease of bone.

Aged↗
PubMed1990

A comparison of the acute effects of subcutaneous and intranasal calcitonin.

1. We studied the acute effects of intranasal and subcutaneous calcitonin in 40 patients with active Paget's disease of bone. Patients received a single dose of either 400 units of calcitonin delivered as a nasal spray, or 1, 10 or 100 units of subcutaneous calcitonin, or placebo. 2. Subcutaneous salmon calcitonin, administered at doses of 1, 10 and 100 units to nine patients with Paget's disease of bone, induced a dose-dependent fall in the serum calcium. This calcium-lowering effect was not seen with a second group of nine patients receiving placebo. 3. The lower doses of calcitonin had significant effects, and these were more pronounced in patients with lower rates of bone turnover. 4. Four hundred units of calcitonin administered as a nasal spray induced effects qualitatively similar to those seen with subcutaneous calcitonin, with an efficacy equivalent to approximately 30 units of subcutaneous calcitonin. 5. We conclude that the bioequivalence of calcitonin given by intranasal insufflation is low compared with its parenteral administration. The intranasal route may be more appropriate for managing patients with disorders associated with low bone turnover.

Administration, Intranasal↗
PubMed1990

Broadband ultrasound attenuation in the os calcis: relationship to bone mineral at other skeletal sites.

1. We have examined the relationship between broadband ultrasound attenuation in the os calcis and measurements of bone mineral in the distal forearm and lumbar spine of normal and postmenopausal osteoporotic women. 2. Values of broadband ultrasound attenuation in postmenopausal women with vertebral osteoporotic fractures were significantly lower (35%) than in normal pre- and peri-menopausal women (55.4 +/- 3.8 and 79.6 +/- 0.8 dB/MHz, respectively). 3. Broadband ultrasound attenuation correlated significantly with bone mineral content measured in the distal forearm by single-photon absorptiometry (r = 0.77, P less than 0.0001) and with bone mineral content (r = 0.66, P less than 0.0001) and bone mineral density (r = 0.72, P less than 0.0001) measured in the lumbar spine by dual-photon absorptiometry. 4. Although significant, these correlations are not sufficiently close to be predictive. However, the accuracy of broadband ultrasound attenuation in discriminating between normal subjects and patients with vertebral fracture compared very favourably with direct measurements in the spine by dual-photon absorptiometry. 5. Broadband ultrasound attenuation, but not the other measurements, correlated significantly with age in the osteoporotic patients (r = 0.50, P less than 0.05). 6. These findings may reflect the partial dependence of broadband ultrasound attenuation on the intrinsic trabecular architecture of cancellous bone, the disruption of which contributes to an increase in fracture risk.

Absorptiometry, Photon↗
PubMed1990

Improvement in the deformity of the face in Paget's disease treated with diphosphonates.

We studied nine patients with Paget's disease affecting the skull or facial bones, who were subsequently treated with either dichloromethylene diphosphonate (clodronate) or ethylene-1-hydroxy-1,1-diphosphonate (etidronate). Long-term treatment induced a clinical and biochemical improvement in eight, and this was associated with a reduction in maxillary or skull volume as assessed by quantitative stereophotogrammetry. The one patient whose disease was resistant to treatment with diphosphonate, showed no change in maxillary shape. These studies suggest that the long-term control of disease activity attained with diphosphonates, results in the improvement of skeletal deformity.

Aged↗
PubMed1990

Ultrasound examination of the irritable hip.

We made a prospective study of 111 children with acute hip pain to assess whether ultrasound can replace traditional radiography. An effusion was diagnosed in 71% by ultrasound but in only 15% by radiography. This effusion persisted for a mean of nine days; symptoms lasted for five days. Two patients found to have Perthes' disease had longer-lasting effusion and symptoms. Patients without an effusion had no obvious cause for their pain, so the pressure of an effusion from a transient synovitis does not account for all patients with irritable hips. Patients with an effusion persisting for over 24 days (the mean + 2 s.d. of our series) had more symptoms, a significantly larger effusion and greater limitation of movement. They may be more at risk for avascular necrosis. We found that radiographic examination influenced the immediate management of only two patients, those with Perthes' disease. We therefore propose a protocol of management for irritable hip, using ultrasonography at the first presentation of certain categories of patients. This would reduce the number of early radiographs by 75%.

Adolescent↗