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Biomedical subjects

J G Howe

Publications and source records attributed to J G Howe.

17 recordsLinked to original sources
PubMed1992

The measurement of anterior cruciate ligament strain in vivo.

This article describes the use of the Hall Effect strain transducer (HEST) in a new arthroscopic technique to study the normal anterior cruciate ligament (ACL) in-vivo. Study participants were patient volunteers with normal ACLs undergoing diagnostic arthroscopic or meniscal surgery under local anaesthesia. The HEST was implanted into the Anterior Medial Band (AMB) of the ACL. Anterior shear loading of the tibia in relation to the fixed femur at 30 degrees of knee flexion (Lachman test), produced significantly greater strain values in comparison to anterior shear loading at 90 degrees (Anterior Drawer test). During isometric quadriceps contraction a significant increase in AMB strain was measured with the knee flexed to 30 degrees, while no significant change was measured at 90 degrees. For quadriceps contraction there were significantly higher values of AMB strain measured at 30 degrees of knee flexion in comparison to that observed at 90 degrees. For active range of motion (AROM) the AMB was strained between 10 degrees and 48 degrees, and unstrained between 48 degrees and 110 degrees. During passive range of motion (PROM) the AMB remained unstrained until the joint was brought into extension. There were significant differences in strain values found between AROM and PROM at the flexion angles 10 degrees, 20 degrees, 30 degrees and 40 degrees, while between 50 degrees and 110 degrees there were no significant differences. These results confirm previous studies that the Lachman test is a superior technique in comparison to the classic anterior drawer test for evaluating the AMB. They suggest that isometric quadriceps activity at 90 degrees of knee flexion can be prescribed for rehabilitation immediately after ACL reconstruction. These data indicate that AROM (between the limits of 50 degrees and 110 degrees) and PROM may also be performed with minimal risk of strain to a reconstructive replacement. The PROM data may also serve as an important standard for the reconstruction of the ACL.

Adult↗
PubMed1992

The effect of functional knee-braces on strain on the anterior cruciate ligament in vivo.

Functional knee-braces are widely used to protect injured or reconstructed anterior cruciate ligaments, despite the fact that few scientific data support their efficacy. We studied seven functional braces, representative of both the typical custom-fit and off-the-shelf designs. The braces were tested on subjects who had a normal anterior cruciate ligament and were scheduled for arthroscopic meniscectomy or exploration of the knee under local anesthesia. After the operative procedure, a Hall-effect strain-transducer was applied to the anterior cruciate ligament. Under low anterior shear loads, two braces provided some protective strain-shielding effect compared with no brace, but this strain-shielding effect did not occur at the higher anterior shear loads expected during the high-stress activities common to athletic events. The DonJoy, Townsend, C.Ti., and Lenox Hill braces demonstrated a strain-shielding effect on the anterior cruciate ligament with an internal torque of five newton-meters applied to the tibia. None of the braces had any effect on strain on the anterior cruciate ligament during active range of motion of the knee from 10 to 120 degrees or during isometric contraction of the quadriceps. Wearing of a brace did not produce an increase in the value for strain on the anterior cruciate ligament. For the activities that were evaluated in this study, none of the braces produced adverse effects on the anterior cruciate ligament, and there were no significant differences in the strain on the anterior cruciate ligament between the use of a custom-fit or an off-the-shelf brace design. There were no apparent advantages of the more expensive custom-made braces compared with the off-the-shelf designs.

Adult↗
PubMed1992

Clinical versus instrumented knee testing on autopsy specimens.

The accuracy, reliability, and reproducibility of the Genucom Knee Analysis System and Knee Signature System (KSS) for anteroposterior knee laxity evaluations were compared. The devices detected the same relative change in laxity between normal and anterior cruciate ligament-deficient specimens during Lachman and drawer testing; however, the absolute values differed. In a clinical study, two examiners performed three independent Lachman and drawer tests using the Genucom, KSS, and a subjective clinical examination on ten patients. The Genucom demonstrated interexaminer differences during the Lachman test. The clinical examination proved to be more reliable than either instrumented device for both Lachman and drawer testing. The intraexaminer variability of the Genucom and KSS was large, with the average 95% confidence limits about the mean for the Genucom and KSS equal to +/- 4.2 and +/- 2.8 mm, respectively. These findings question the accuracy, reliability, and reproducibility of the instrumented methods.

Adolescent↗
PubMed1991

ACL reconstruction: in vivo measurement of patellar tendon graft elongation.

The implantation of a free autogenous patellar tendon graft is the surgical technique that currently offers the best results in anterior cruciate ligament reconstruction. However, numerous aspects regarding both technique and postoperative rehabilitation can still be improved. The aim of this study was to measure the elongation of the patellar tendon in vivo in the operating room after reconstructive surgery, subjecting the knee to normal strain such as passive mobilization or anterior displacement of the tibia. Three volunteers were studied. Our results were different from those reported in a previous study conducted in vivo on a normal anterior cruciate ligament (ACL). In spite of the isometric position of the tendon, passive mobilization provoked a progressive increase in the elongation of the graft within each cycle of flexion-extension and between one cycle and the next. This also occurred during the Lachman test. These findings suggest that the graft undergoes a process of tensile adjustment when it is first put under strain. Continued elongation once this process appears stabilized raises doubts as to the reliability of isometric measuring devices.

Adult↗
PubMed1991

Longitudinal crack propagation in bone around femoral prosthesis.

Intraoperative femoral fracture is a well-recognized technical complication of cementless total hip arthroplasty. This study was designed to establish an in vitro model for initiation and propagation of fractures of the proximal femur in cementless THA and to assess the effect of fracture fixation in the form of cerclage wiring and drilling a hole in the distal extent of the fracture line. Fourteen human anatomic femur specimens were studied. Longitudinal cracks were made and propagation was performed on a materials testing system machine. A drill hole at the tip of a longitudinal crack does not prevent crack propagation. However, cerclage wiring has a statistically significant effect (p less than 0.025) on the ability of the fractured femur to withstand increased load.

Aged↗
PubMed1990

Arthroscopic strain gauge measurement of the normal anterior cruciate ligament.

This article describes a new arthroscopic technique to study the anterior cruciate ligament (ACL) in vivo. A Hall effect strain transducer (HEST) is inserted arthroscopically into the anterior medial band (AMB) of the ACL. The strain is calculated from HEST displacement data. This method determines a reference length of the AMB when it becomes taut and load bearing. Data from HEST implantation in five patients with normal ACLs are reported. The HEST was implanted in the AMB with patients under local anesthesia. Strain was calculated during anterior-posterior shear testing and isometric quadriceps contractions at 30 and 90 degrees of knee flexion. The results demonstrate that this technique is safe and reliable. Lachman testing (anterior shear testing at 30 degrees) caused significantly higher strain in comparison to the drawer tests (anterior shear testing at 90 degrees). A significant increase in strain occurred during isometric quadriceps contraction when the knee was flexed at 30 degrees. No significant change in strain was measured, however, during isometric quadriceps contraction at 90 degrees of flexion. These results confirm previous studies showing that the Lachman test is a more sensitive clinical method for evaluating the AMB. They suggest that isometric quadriceps activity at 90 degrees of knee flexion can be prescribed for rehabilitation without risk of increased strain of the AMB.

Adult↗
PubMed1989

Epstein-Barr virus small RNA (EBER) genes: unique transcription units that combine RNA polymerase II and III promoter elements.

The Epstein-Barr virus-encoded small RNA (EBER) genes appear to comprise an interesting subset of class III genes different from any previously identified, including U6 and 7SK. EBER genes have functional A and B box intragenic control regions. In addition, they contain three upstream elements that together stimulate in vivo expression 50-fold and resemble sites associated with typical class II promoters. DNAase I footprinting analyses using purified proteins or oligonucleotide competition demonstrate that nucleotides -40 to -55 bind activating transcription factor (ATF) or a related protein, while nucleotides -56 to -77 bind Sp1 protein or a related protein. The element between positions -23 and -28 resembles a TATA box. EBERs are unusual RNA polymerase III transcripts shown to be controlled by ATF- and Sp1-like promoter elements, suggesting mechanisms for their high level expression in EBV-transformed lymphocytes.

Base Sequence↗
PubMed1989

Influence of Burkitt's lymphoma and primary B cells on latent gene expression by the nonimmortalizing P3J-HR-1 strain of Epstein-Barr virus.

The Epstein-Barr virus (EBV) genes expressed in B lymphocytes immortalized in vitro or in Burkitt's lymphoma (BL) cells infected in vivo have been characterized previously; however, the viral products which are essential for immortalization or for establishment of EBV latency are still not known. To approach this question, we compared the kinetics of expression of EBV nuclear antigens and the two EBV-encoded small RNAs, EBER1 and EBER2, after infection of primary B cells or EBV genome-negative BL cells with either an immortalizing EBV strain (B95-8) or the nonimmortalizing deletion mutant (HR-1). Following infection of primary cells with B95-8 virus, EBV nuclear antigen (EBNA)-2 was expressed first, followed by EBNA-1, -3, and -4 (also called leader protein [LP]) and the two small RNAs. Infection of EBV genome-negative BL cells with the same strain of virus resulted in a similar pattern of gene expression, except that the EBNAs appeared together and more rapidly. EBERs were not apparent in one BL cell line converted by B95-8. The only products detected after infection of primary B lymphocytes with the HR-1 deletion mutant were the EBNA-4 (LP) family and trace amounts of EBER1. Although HR-1 could express neither EBNA-1, EBNA-3, nor EBER2 in primary cells, all these products were expressed rapidly after HR-1 infection of EBV genome-negative BL cell lines. The results indicate that the mutation in HR-1 virus affects immortalization not only through failure to express EBNA-2, a gene which is deleted, but also indirectly by curtailing expression of several other EBV genes whose coding regions are intact in the HR-1 virus and normally expressed during latency. The pattern of latent EBV gene expression after HR-1 infection is dependent on the host cell, perhaps through products specific for the cell cycle or the state of B-cell differentiation.

Antigens, Viral↗
PubMed1988

Total knee arthroplasty kinematics. An in vivo evaluation of four different designs.

Thirty-four patients who had 42 total knee arthroplasties during the past 5 years were examined. Four types of total knee arthroplasties (Tricon-M, PCA, Variable Axis, and Anametric) were evaluated, using a computerized knee evaluation system. The patients and 10 controls with normal knees were tested for anteroposterior stability with the Lachman test, medial/lateral stability at 20 degrees, varus/valgus stability at 20 degrees, internal/external rotation at 80 degrees and 20 degrees of flexion, and internal/lateral rotation (screw home) over the active range of motion. At 30 degrees of flexion, the Variable Axis prosthesis was 54% more constrained than the normal knee to anterior/posterior shear. The Anametric and the Variable Axis were more lax under varus/valgus stress than the normal knee by 85% and 71%, respectively. There were no statistical differences for any of the other tests.

Aged↗
PubMed1988

Structural analyses of EBER1 and EBER2 ribonucleoprotein particles present in Epstein-Barr virus-infected cells.

The ribonucleoprotein (RNP) particles containing the Epstein-Barr virus-associated small RNAs EBER1 and EBER2 were analyzed to determine their RNA secondary structures and sites of RNA-protein interaction. The secondary structures were probed with nucleases and by chemical modification with single-strand-specific reagents, and the sites of modification or cleavage were mapped by primer extension. These data were used to develop secondary structures for the two RNAs, and likely sites of close RNA-protein contact were identified by comparing modification patterns for naked RNA and RNA in RNP particles. In addition, sites of interaction between each Epstein-Barr virus-encoded RNA (EBER) and the La antigen were identified by analyzing RNA fragments resistant to digestion by RNase A or T1 after immunoprecipitation by an anti-La serum sample from a lupus patient. Our results confirm earlier findings that the La protein binds to the 3' terminus of each molecule. Possible functions for the EBER RNPs are discussed.

Autoantigens↗
PubMed1988

Isolation and characterization of the genes for two small RNAs of herpesvirus papio and their comparison with Epstein-Barr virus-encoded EBER RNAs.

Genes for the Epstein-Barr virus-encoded RNAs (EBERs), two low-molecular-weight RNAs encoded by the human gammaherpesvirus Epstein-Barr virus (EBV), hybridize to two small RNAs in a baboon cell line that contains a similar virus, herpesvirus papio (HVP). The genes for the HVP RNAs (HVP-1 and HVP-2) are located together in the small unique region at the left end of the viral genome and are transcribed by RNA polymerase III in a rightward direction, similar to the EBERs. There is significant similarity between EBER1 and HVP-1 RNA, except for an insert of 22 nucleotides which increases the length of HVP-1 RNA to 190 nucleotides. There is less similarity between the sequences of EBER2 and HVP-2 RNA, but both have a length of about 170 nucleotides. The predicted secondary structure of each HVP RNA is remarkably similar to that of the respective EBER, implying that the secondary structures are important for function. Upstream from the initiation sites of all four RNA genes are several highly conserved sequences which may function in the regulation of transcription. The HVP RNAs, together with the EBERs, are highly abundant in transformed cells and are efficiently bound by the cellular La protein.

Autoantigens↗
PubMed1986

Localization of Epstein-Barr virus-encoded small RNAs by in situ hybridization.

Human B lymphocytes latently infected with Epstein-Barr virus (EBV) synthesize two low molecular weight RNAs designated EBER 1 and 2. Using an in situ hybridization technique we have localized EBER 1 and 2 within the nucleus of single EBV-harboring B lymphocytes from established and recently transformed cell lines. As controls, the locations of the small nuclear RNA, U1, and the small cytoplasmic RNA, 7SL, were examined in HeLa and EBV-harboring cells. Because of possible functional similarities between EBERs and the adenovirus-associated (VA) RNAs, VAI was also localized; it appeared to be in the nucleus and cytoplasm, implying that VAI may have a different role than that of the nuclear-localized EBERs.

Cell Nucleus↗
PubMed1986

Preparation and release characteristics of tobramycin-impregnated polymethylmethacrylate beads.

Preparation of tobramycin-impregnated polymethylmethacrylate (PMMA) bone cement beads and release of tobramycin from the beads in vitro and after implantation in a patient are described. Tobramycin sulfate powder 1.2 g was mixed with Palacos PMMA bone cement 40 g in a custom-made mold to produce 25 beads containing 3.26 mg tobramycin (as the sulfate salt) per bead. Chains of the beads, strung on stainless-steel suture, were sterilized with ethylene oxide. Three single beads were each placed in multiple-electrolyte solution (pH 7.4); the solution was removed and replaced with fresh solution every 24 hours for 28 days. The tobramycin content of each day's solution was determined by fluorescence polarization immunoassay. After day 28, solution was removed weekly for assay until day 84. Tobramycin concentrations were measured in drainage from the surgical wound after six chains of tobramycin-PMMA bone cement beads were implanted in the right acetabulum and femur of a patient whose hip prosthesis had been removed because of infection. Tobramycin concentrations in the dissolution medium averaged 34.3 micrograms/mL initially, and 7.5 micrograms/mL on day 2, gradually decreasing to 0.6 microgram/mL on day 28. Release of tobramycin followed a predictable pattern, and variation among samples was small. Over 12 weeks, less than 20% of the theoretically available tobramycin from a single bead was released. Tobramycin concentration in wound drainage was 90.0 micrograms/mL during the first 24 hours after surgery, while serum tobramycin concentrations were less than 0.5 microgram/mL. Extemporaneously prepared beads of bone cement are effective for delivering high concentrations of tobramycin to an infection site.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Cements↗
PubMed1978

Anticonvulsants and thyroid function.

Serum total and free thyroid hormone concentrations were estimated in 42 patients with epilepsy taking anticonvulsants (phenytoin, phenobarbitone, and carbamazepine either singly or in combination). There was a significant reduction in total thyroxine (TT4), free thyroxine (FT4), and free triiodothyronine (FT3) in the treated group compared with controls. Free hormone concentrations were lower than total hormone concentrations, suggesting that increased clearance of thyroid hormones occurs in patients receiving anticonvulsants. Detailed analysis indicated that phenytoin had a significant depressant effect on TT4, FT4, FT3, and reverse T3 (rT3). Phenobarbitone and carbamazepine had no significant main effects, but there were significant interactions between phenytoin and carbamazepine for TT4 and FT4. phenobarbitone and carbamazepine for FT3, and phenytoin and phenobarbitone for rT3.

Adolescent↗
PubMedDate not supplied

Anterior cruciate ligament reconstruction using quadriceps patellar tendon graft. Part I. Long-term followup.

Eighty-three patients with ACL reconstructions using the quadriceps patellar tendon graft were evaluated in a 10 year (mean, 5.5 years) follow-up study. A five-part analysis, consisting of physical examination, questionnaire, Genucom analysis, operative note review, and radiographs, was performed. Seventy-six percent were categorized as satisfactory. Ninety-two percent were content with their results, while only 4% were unsatisfied. Ninety-three percent of the patients had no significant pain and 95% had no giving way postreconstruction. Ninety-two percent had no more than a mild functional deficit. Eighty-seven percent and 90% of the patients had no significant Lachman or pivot shift by examination, respectively. Our results showed no increase in failure over time (1 to 10 years), although those operated on during the initial 5 years showed more radiographic degenerative changes. Plotting our results in classification systems of other authors yielded success rates as good as or better than those using our own criteria. An objective means by which to quantify laxity did not reliably correlate with the quantifying of laxity made by physical examination. Only the lack of a formal rehabilitation program greater than 4 months postoperatively and repaired tears of the medial or lateral collateral ligaments proved to be significant risk factors for poor recovery.

Anterior Cruciate Ligament↗
PubMedDate not supplied

Anterior cruciate ligament reconstruction using quadriceps patellar tendon graft. Part II. A specific sport review.

Eighty-three patients, from a 10 year follow-up study, who underwent ACL reconstruction with a quadriceps patellar tendon graft were reviewed. A questionnaire qualifying their sports performance in 20 possible sports compared their preinjury status to postinjury and postreconstructive surgery. Successful and unsuccessful patients, as determined by our previous investigation, were likewise compared. Sports performance, regardless of the sport or level of competition, decreased substantially postinjury and then rose significantly to near but not equal to patient preinjury status. The most strenuous sports dipped to the lowest performance level after injury and returned with a correspondingly more modest gain after the reconstruction. Not surprisingly, successful patients had a more impressive return in performance than unsuccessful patients, mirroring their clinical grading. Of those deemed unsatisfactory (N = 20), graft failures were no worse off in performance rating than those that were classified as unsatisfactory because of persistent symptoms.

Anterior Cruciate Ligament↗