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Biomedical subjects

E Panagiotopoulos

Publications and source records attributed to E Panagiotopoulos.

At least 19 recordsLinked to original sources
PubMed2006

In vitro effects of non-steroidal anti-inflammatory drugs on cytokine, prostanoid and matrix metalloproteinase production by interface membranes from loose hip or knee endoprostheses.

OBJECTIVE: To study the effects of the non-steroidal anti-inflammatory drugs (NSAIDs) aceclofenac, piroxicam, tenoxicam and indomethacin on cytokine, matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs) and prostaglandin E2 (PGE2) production, by interface membranes (IFT), obtained at revision surgery for aseptic loosening of total joint arthroplasty. Involvement of these soluble factors is well documented and probably, a pharmaceutically induced inhibition of them might retard loosening. METHODS: IFTs from 10 patients with a loose hip or knee endoprosthesis were collected. The possibility of septic loosening was thoroughly excluded by histopathologic and microbiologic evaluation. IFTs were cultured in the absence or presence of the tested drugs and the levels of the soluble mediators were determined, using electrophoretic and enzyme-linked immunosorbent assay techniques. Paracetamol was used as neutral drug. RESULTS: All NSAIDs exhibited a pronounced inhibitory effect upon the production of interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha). This specific effect on IL-6 is reported in the literature for the first time. The majority of NSAIDs also induced the production of IL-1beta in an adequate portion of samples. These drugs did not have a clear effect on MMP synthesis, but they had a stimulatory tendency on TIMP-1 production. Paracetamol, significantly decreased the synthesis of TNF-alpha and that of the gelatinases. CONCLUSION: Our in vitro results are encouraging, since it appears that the action of NSAIDs, globally considered, may be beneficial upon the loosening process. The inhibitory effect of paracetamol upon TNF-alpha and gelatinases is intriguing. Our data, if supported by similar observations, probably justify performance of long-term clinical trials.

Aged↗
PubMed2006

Osteoarthritis severity of the hip by computer-aided grading of radiographic images.

A computer-aided classification system was developed for the assessment of the severity of hip osteoarthritis (OA). Sixty-four radiographic images of normal and osteoarthritic hips were digitized and enhanced. Employing the Kellgren and Lawrence scale, the hips were grouped by three experienced orthopaedists into three OA-severity categories: Normal, Mild/Moderate and Severe. Utilizing custom-developed software, 64 ROIs corresponding to the radiographic Hip Joint Spaces were manually segmented and novel textural features were generated. These features were used in the design of a two-level classification scheme for characterizing hips as normal or osteoarthritic (1st level) and as of Mild/Moderate or Severe OA (2nd level). At each classification level, an ensemble of three classifiers was implemented. The proposed classification scheme discriminated correctly all normal hips from osteoarthritic hips (100% accuracy), while the discrimination accuracy between Mild/Moderate and Severe osteoarthritic hips was 95.7%. The proposed system could be used as a diagnosis decision-supporting tool.

Aged↗
PubMed2006

Intramedullary knee arthrodesis as a salvage procedure after failed total knee replacement.

Septic and aseptic loosening with or without extensive bone loss after total knee replacement are the most common indications for knee fusion. Both external fixation and intramedullary nailing can be used for the treatment, though the latter appears to be the method of choice for most patients. Nine patients were treated after a total knee replacement failure using intramedullary nailing. A long intramedullary nail with a proximal interlocking screw was used in five cases, and a customised nail was used in four cases. Successful fusion occurred in eight of nine patients (89%). Average time for the joint union was 6.5 months, and average operative blood loss was 860 ml. In two patients, iliac crest and patellar bone graft were also used. In conclusion, intramedullary nailing can give excellent results in achieving knee fusion after a failed knee replacement as it allows early weight bearing and at the same time offers stability, pain relief, and a high rate of union, even though the surgical technique is demanding.

Aged↗
PubMed2006

Assessing hip osteoarthritis severity utilizing a probabilistic neural network based classification scheme.

A computer-based classification system is proposed for the characterization of hips from pelvic radiographs as normal or osteoarthritic and for the discrimination among various grades of osteoarthritis (OA) severity. Pelvic radiographs of 18 patients with verified unilateral hip OA were evaluated by three experienced physicians, who assessed OA severity employing the Kellgren and Lawrence scale as: normal, mild/moderate and severe. Five run-length, 75 Laws' and 5 novel textural features were extracted from the digitized radiographic images of each patient's osteoarthritic and contralateral normal hip joint spaces (HJSs). Each one of the three sets of textural features (run-lengths, Laws' and novel features) was separately utilized for assigning hips into the three OA severity categories, by means of a probabilistic neural network (PNN) classifier based hierarchical tree structure. The highest classification accuracy (100%) for characterizing hips as normal, of mild/moderate or of severe OA was obtained for the novel textural features set. Additionally, the novel textural features were used to design a mathematical regression model for providing a quantitative estimation of OA severity. Measured OA severity values, as expressed by HJS-narrowing, correlated highly (r=0.85, p<0.001) with the predicted values by the mathematical regression model. The proposed system may be valuable in OA-patient management.

Aged↗
PubMed2006

Evaluation of modal damping factor as a diagnostic tool for osteoporosis and its relation with serum osteocalcin and collagen I N-telopeptide for monitoring the efficacy of alendronate in ovariectomized rats.

Osteoporosis is a metabolic bone disease characterized by reduced bone mass and deterioration of bone microarchitecture. It results from the shift of the osteoblast-osteoclast activity equilibrium in favor of the later. Although, a number of biochemical markers, such as collagen I N-telopeptide (NTx) and osteocalcin (OC), have been used for monitoring bone remodeling, a new, monitoring, non-invasive method, which is based on the measurement of the dynamic characteristic of bone and is known as modal damping factor (MDF), has not been evaluated as a diagnostic tool for osteoporosis. Bisphosphonates, such as alendronate, have an established role in the treatment of osteoporosis. The aim of the present study was, therefore, to evaluate the effects of alendronate on the levels of MDF, serum NTx and OC on osteoporosis induced by ovariectomy in rats. Furthermore, the effects of alendronate on osteoporosis have been histologically evaluated. Fifteen adult female Wistar rats were bilaterally ovariectomized and osteoporosis was histologically confirmed and by the use of peripheral quantitative computerized tomography (pQCT). MDF was applied to assess the bone structural integrity. The serum levels of NTx (37.4+/-0.5 nM bone collagen equivalents, BCE) and OC (111.0+/-8.2 ng/mL) were found to significantly increase following ovariectomy (72.0+/-2.9 nM BCE and 213.5+/-12.1 ng/mL, respectively, p<0.001). As assessed by histology and the levels of NTx and OC in sera, animals treated with alendronate presented a statistically significant deceleration in the progression of the disease in comparison to the no-therapy control group (alendronate group NTx levels: 146.3+/-8.9 nM BCE versus no-therapy control group NTx levels: 265.3+/-14.0 nM BCE, p<0.001, alendronate group OC levels: 205.6+/-18.2 ng/mL versus no-therapy group OC levels: 353.9+/-26.1 ng/mL, p<0.001). Data obtained from the vibration analysis performed illustrated that the change in damping was equal or greater to the change in total and trabecular density, respectively. Damping increased with decreasing bone density, as expected, given that damping accounts for the structural integrity of bone (MDF value before ovariectomy: 0.058+/-0.003 versus MDF value after ovariectomy: 0.098+/-0.003, p<0.001). The higher damping values correspond to more deteriorated structures. In particular, both total and trabecular density were significantly decreased following ovariectomy (total density before ovariectomy: 702.4+/-19.0 versus total density after ovariectomy: 542.2+/-12.8, p<0.001, trabecular density before ovariectomy: 445.3+/-13.0 versus trabecular density after ovariectomy: 396.7+/-8.4, p<0.05). MDF value of the alendronate group (0.07+/-0.002) was significantly lower (p<0.001) as compared to MDF value after ovariectomy (0.098+/-0.003) and that of the no-therapy group (0.1+/-0.004, p<0.001). The administration of alendronate seemed to have no effect on either total or trabecular density, since both parameters continued to decrease (alendronate group total density: 549.4+/-12.3, alendronate group trabecular density: 368.4+/-14.7). However, when this was compared to the no-therapy group, a statistically significant difference of total density at the 0.05 level was observed (no-therapy total density: 464.8+/-9.1). The results of this study suggest that combined measurements of MDF, NTx and OC may be a potential diagnostic tool for osteoporosis and monitoring bone integrity during treatment with bisphosphonates. Furthermore, administration of alendronate showed to offer a critical deceleration in the progression of osteoporosis.

Alendronate↗
PubMed2006

The use of the Ilizarov method as a salvage procedure in infected nonunion of the distal femur with bone loss.

We reviewed 13 patients with infected nonunion of the distal femur and bone loss, who had been treated by radical surgical debridement and the application of an Ilizarov external fixator. All had severely restricted movement of the knee and a mean of 3.1 previous operations. The mean length of the bony defect was 8.3 cm and no patient was able to bear weight. The mean external fixation time was 309.8 days. According to Paley's grading system, eight patients had an excellent clinical and radiological result and seven excellent and good functional results. Bony union, the ability to bear weight fully, and resolution of the infection were achieved in all the patients. The external fixation time was increased when the definitive treatment started six months or more after the initial trauma, the patient had been subjected to more than four previous operations and the initial operation had been open reduction and internal fixation.

Activities of Daily Living↗
PubMed2005

Correlation between radiological parameters and patient-rated wrist dysfunction following fractures of the distal radius.

The present study investigates the correlation between radiological parameters of wrist fractures and the clinical outcome expressed by objective clinical parameters and the level of patient-rated wrist dysfunction. Thirty consecutive cases of unstable distal radial fractures treated with closed reduction and percutaneous fixation were prospectively studied for a period of one year. The outcome parameters included objective clinical and radiological parameters and the previously described and validated patient-rated wrist evaluation (PRWE) score. Analysis showed that for unstable (AO classification types 23-A2, -A3, -C1 and -C2) fractures the fracture type affects the range of wrist palmarflexion (p=0.04) and that the presence of postoperative articular 'step-off' affects the range of wrist dorsiflexion and the patient-rated wrist function at the final time of the study (p<0.01 and p=0.02, respectively). It is also shown that permanent radial shortening and loss of the palmar angle were associated with prolonged wrist pain (p<0.01 and p=0.03, respectively). Our finding that residual articular incongruity correlates with persisting loss of wrist dorsiflexion and wrist dysfunction contradicts the view that loss of articular congruity is associated with late development of articular degeneration but not with early wrist dysfunction. Additionally, this study failed to show any association between the fracture type and the functional outcome as rated by the patients.

Adolescent↗
PubMed2005

Impact energy absorption by specimens from the upper end of the human femur.

A cadaveric biomechanical study was performed to investigate the fracture energy absorbed by strips of bone from the proximal femur in relation to age and gender, under impact loading conditions. Four groups (young male, young female, old male, old female) of four cadaveric proximal femurs were used in each case. Four bone strips were taken from the neck and four from the subtrochanteric area and these were tested under dynamic-impact conditions using the Charpy impact test. The fracture energy was calculated as the energy needed to achieve fracture per unit area, and expressed in J/m2. Bone specimens from young males are significantly tougher under impact conditions to those of females (p = 0.001), whereas between the old male and female groups, fracture energy does not significantly differ (p = 0.165). There was also significant difference (p < 0.0005) between the young and the old groups in both genders. The fracture energy absorption of the subtrochanteric area compared to that of the femoral neck for the same group of age and gender is in general slightly higher for all groups. In conclusion, gender in the young age group played a significant role in bone resistance in breaking whereas in the older age group it played a less important role.

Absorptiometry, Photon↗
PubMed2003

Deformations and intrusions of the passenger compartment as indicators of injury severity and triage in head-on collisions of non-airbag-carrying vehicles.

In motor vehicle collisions the mechanism of injury is important in determining severity as well as for triage decisions in the pre-hospital phase of patient management. This study correlates deformation of the basic structures of the passenger compartment [windscreen, control panel (dashboard) and steering wheel] with occupants' injuries in passenger vehicle head-on collisions involving non-airbag-carrying vehicles, with or without compartment intrusion. The study took place in the broad urban area of Patras, over an 18-month period (January 2000-June 2001) and evaluated 48 vehicle crashes. Car and compartment deformation are significant factors affecting occupants' injuries and consequently the appropriate type of further treatment, either in the hospital setting or primary health-care centres. It would be particularly useful to transmit the post-crash condition of a vehicle to the trauma dispatch centre, utilising satellite technology, thus allowing the centre to organise the rescue teams, plan triage in advance and provide the emergency medical personnel with all necessary information before their arrival at the scene of the accident.

Accidents, Traffic↗
PubMed2001

Intramedullary nailing in the treatment of aseptic tibial nonunion.

Fifty patients suffering from aseptic tibial nonunion underwent reamed intramedullary nailing (I.N.) and were retrospectively reviewed. Thirty-six patients were initially treated with external fixation, six with plate and screws, one with a static I.N., and seven with plaster of Paris. Eighteen of the fractures were initially open (A: 5, B: 6, and C: 7 according to the Gustilo classification). In 34 cases a closed procedure was performed, whereas in sixteen, an opening at the nonunion site was unavoidable either to remove metalwork or realign the fragments. Following failed external fixation, secondary I.N. was performed at least 10 days after removal of the device. Bone grafts from the iliac crest were used in three cases, and a fibular osteotomy was performed in 33. Patients were followed up for an average of 2.5 years after nailing, ranging from 10 months to 7 years. A solid union was achieved in all patients within a period of 6 months. One patient developed late infection, which settled after nail removal and one patient developed impending compartment syndrome which was detected on the first post-operative day and was treated with a fasciotomy. Transient peroneal nerve palsy occurred in one patient and this recovered in 3 months, whereas in nine patients a clinically acceptable deformity was noticed. In conclusion, we believe that reamed intramedullary nailing is a highly effective treatment for aseptic tibial nonunions. Early and late complications are rare and bone graft is rarely needed. The method allows early weight bearing even before solid union occurs, short hospitalisation time and early return to work without external support.

Adolescent↗
PubMed2001

Gelatinolytic and collagenolytic activity in periprosthetic tissues from loose hip endoprostheses.

OBJECTIVE: To study the contribution of different members of the metalloproteinases (MMP) family in gelatinolytic and collagenolytic potential, namely dinitrophenyl-Pro-Gln-Gly-Ile-Ala-Gly-Gln-D-Arg (DNP-S) sensitive proteolytic activity, in loose total hip arthroplasty (THA) endoprostheses. METHODS: Periprosthetic tissues and fluid samples were collected from patients subjected to hip endoprosthesis replacement. DNP-S sensitive proteolytic activity was evaluated by the degradation of synthetic DNP-S and reverse phase high performance liquid chromatography, while gelatinolytic activity was assessed by gelatin zymography. The isolation and separation of gelatinases was performed by gelatin- and concanavalin A-Sepharose affinity chromatographies and the identification of collagenases by immunoblot analysis. RESULTS: High gelatinolytic activity was observed in all periprosthetic tissue extracts and fluid samples. All samples also exhibited DNP-S degrading activity, without pretreatment by activating agents. Upon fractionation of MMP by gelatin-Sepharose affinity chromatography it was found that the gelatin-unbound collagenases are exclusively responsible for DNP-S degrading activity. Activated species of both MMP-1 and 13 were detected in most samples, but not the soluble form of MT1-MMP. Separation of gelatinases from each other and treatment with 4-aminophenylmercuric acetate (APMA) revealed that both enzymes mainly existed in complex with tissue inhibitor of metalloproteinase (TIMP). CONCLUSION: MMP-1 and MMP-13, which exist in activated form, could be responsible for the DNP-S-degrading activity in periprosthetic tissues and fluids, while the gelatinases do not contribute in this potential, since they mainly exist in complex with TIMP. The 2 collagenases may play a key role in the loosening of THA endoprostheses.

Aged↗
PubMed2000

Strain development in carpal scaphoid for various wrist positions: a cadaveric study using strain gauges.

In order to investigate the ideal position in which the wrist should be immobilized during scaphoid fracture, treatment the strains which are developed in the carpal scaphoid for various wrist positions has been recorded in cadaveric wrists, using strain gauges. The data obtained shows that during radial deviation with neutral or slight palmar flexion of the wrist the waist of the scaphoid tends to compress because of the development of strong compressive strains, while the strain development parallel to the fracture site that tends to shift the scaphoid waist is minimum. This position seems to be the best for stable scaphoid fracture immobilization.

Cadaver↗
PubMed1999

Rigid or sliding plate. A mechanical evaluation of osteotomy fixation in sheep.

Fracture fixation using rigid plates leads to direct bone union, but it also may lead to complications because of stress protection osteopenia. This study aims to compare the mechanical characteristics restored during the callus formation after an osteotomy is fixed with two types of internal plate fixation. Twenty-four adult female sheep were divided randomly into three groups of eight each, which were euthanized at 2, 4, and 6 months after operation. Half of them had their osteotomized radius fixed with a seven hole dynamic compression plate, whereas in the remainder a sliding plate was used. The sliding plate consists of two halves connected together in such a way as to permit axial sliding of the one within the other, thus allowing cyclic axial load transfer at the fracture site. Bone strips obtained from the healthy (control) and the surgically treated side were subjected to four-point bending tests. The effective modulus of elasticity, ultimate bending strength, and energy absorption to fracture (toughness) were calculated. All parameters were restored more quickly in the sliding plate group, but there was no statistically significant difference observed at 6 months when all the osteotomies were united completely. Thus, the sliding plate, by allowing axial loading at the fracture site, led to a faster callus maturation and hence bony union, which, hopefully, will permit earlier full weightbearing and functional recovery of the injured limb.

Animals↗
PubMed1998

Resorbable continuous-fibre reinforced polymers for osteosynthesis.

Four institutes from three countries in the European Union have collaborated under the BRITE-EURAM framework programme for the development of processing technologies for resorbable osteosynthesis devices. The devices should be continuous-fibre reinforced, and the technology should offer the possibility of orienting the fibres in the main trajectories. Poly-L-lactide and poly-L-DL-lactides have been synthesized for reinforcement fibres and matrix material, respectively. Melt-spun P-L-LA fibres of a strength of 800 MPa have been embedded in an amorphous P-L-DL-LA 70 : 30 matrix by compression moulding. Ethyleneoxide sterilized samples have been tested in vitro and in vivo. A satisfying bending modulus has been reached (6 GPa). Yet with 50% strength retention after ten weeks, fast degradation occurred that could be related to residual monomers. By this fast degradation 70% resorption after one year could be observed in the non-functional animal studies in rabbits. There was only a mild inflammatory reaction, which confirmed the good biocompatibility of the materials even during the resorption period. Further effort has to concentrate on the reduction of initial monomer content. The great advantage of the processing method to orient fibres in the device will be utilized in prototype samples, e.g. an osteosynthesis plate with fixation holes.

Journal Article↗
PubMed1997

Soft tissue and cancellous bone reaction to the implantation of novel biodegradable pins and plates in rabbits.

Biodegradable implants for osteosynthesis have had insufficient strength and a fast degradation rate. We produced a polymer based lactide to increase the molecular weight and strength of the implant and delay the degradation rate. This novel fiber-reinforced material in the form of plates and pins was tested in vitro for mechanical performance and in vivo in a neutral mechanical environment to assess biocompatibility. 21 rabbits with implants in the tibia and femoral condyles were killed at 1, 6, 12 months after implantation. Only a mild foreign-body reaction was observed and the implant was encapsulated by a thin 0.8-1.6 mm layer of connective tissue. Only a few lymphocytes and giant cells were detected in the early stages, dense fibroblasts in the middle stage, and giant cells clearing material particles in the late stage. In conclusion, the novel fiber-reinforced polymer based on polylactides was found mechanically superior to former degradable implants and biocompatible, showing no late inflammatory tissue response.

Biodegradation, Environmental↗
PubMed1996

Intramedullary nailing: experience in 427 patients.

In the Orthopaedic Department in Patras University 427 intramedullary nailings in the lower limbs were performed between 1989 and 1994 and retrospectively reviewed to evaluate the range of complications. One hundred and seventy-two were nailings of the femur; 80 gamma nails mainly for subtrochanteric and intertrochanteric with subtrochanteric extension fractures were included, (total 252/59%); 175 (41%) were nailings of the tibia. Union was achieved in all case. Overall the complication rate in this series was 3.3% (14 cases) and included infection (4 cases), neuropraxia (2 cases), implant failure (5 cases), limb length deficiency (2 cases) and malrotation (1 case).

Femoral Fractures↗
PubMed1995

Delayed diagnosis of a peroneal artery false aneurysm at a concomitant tibial fracture. A case report.

A 49-year-old man had posttraumatic persistent calf swelling and a tibial and fibular fracture. Despite the intramedullary nailing of the fracture, the swelling did not improve, and at the 6th postoperative week it was misdiagnosed (using venogram) as deep vein thrombosis. Therefore, it was mistreated with anticoagulants, which led to great deterioration of the local signs. An arteriogram revealed an initially missed false peroneal artery aneurysm. Surgical treatment was performed immediately. The 6-week delay had led to some atrophy of the posterior compartment muscles, fortunately without any permanent disability. The importance of proper and early diagnosis of posttraumatic persistent calf swelling is stressed.

Aneurysm, False↗