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Biomedical subjects

J V Luck

Publications and source records attributed to J V Luck.

At least 19 recordsLinked to original sources
PubMed2001

32P chromic phosphate radiosynovectomy for chronic haemophilic synovitis.

The principal medical consequence of haemophilia is the development of arthropathy, initiated by a haemarthrosis giving rise to chronic synovitis. Traditional methods of synovectomy include open excision and arthroscopy each of which require substantial amounts of clotting factor concentrate for several weeks, and in the case of open synovectomy, is often associated with loss of range of motion and arthrofibrosis. Radiosynovectomy, the intra-articular injection of low penetration radiocolloids, has been utilized outside the United States for over 20 years. Since 1988, our centre has performed 170 radiosynovectomies utilizing 32P chromic phosphate (32P). This study reports results of 130 32P radiosyovectomies with an average follow-up of 36.5 months (6-140 months). For primary procedures, excellent and good results (haemarthrosis reduction from 75 to 100%) were obtained in 79.2% of cases at 6 months to 8 years. For repeat procedures a combination of excellent and good results were obtained in 62.4% of cases at 6 months to 3 years. Regression analysis showed no correlation between results and age or degree of arthropathy. Radiation was well contained within the joint. There were no observed or identified complications. The procedure is highly cost effective in comparison to open surgical or arthroscopic synovectomy.

Adolescent↗
PubMed2001

Phosphate-32 colloid radiosynovectomy in hemophilia: outcome of 125 procedures.

Radiosynovectomy offers a potentially effective, minimally invasive option for patients with chronic hemarthrosis and synovitis. The long-term outcome of patients with hemophilia who were treated with phosphate-32 chromic phosphate radiosynovectomy was evaluated. One hundred twenty-five procedures in 81 patients were done. Two- to 10-year followup by age and joint included joint bleeding and quality-of-life assessment. In addition, a relative cost comparison, scintigraphic imaging, and evaluation of biodistribution of the radionuclide were done. Of 125 procedures, 54% resulted in complete cessation of bleeding into the treated joint after the procedure, and 73% of patients reported improved mobility of the treated joint. Of patients 18 years old and younger, 79% had a greater than 75% reduction in bleeding incidence, and of patients older than 40 years, only 56% had a similar reduction. Seventy-nine percent of patients surveyed had a significant improvement in quality of life attributable to the treated joint. No evidence of significant leakage was observed. Billing records analysis indicated that radiosynovectomy costs less than 5% of surgical synovectomy. Phosphate-32 chromic phosphate radiosynovectomy is a clinically useful, safe, and cost-effective outpatient procedure in the treatment of patients with chronic hemarthrosis and synovitis.

Adolescent↗
PubMed2001

Characteristics of degeneration in an unstable knee with a coronal surface step-off.

To investigate the effect of instability on the remodelling of a minor articular surface offset, we created a 0.5 mm coronal step-off of the medial femoral condyle in 12 New Zealand white rabbits and transected the anterior cruciate ligament (ACL). A control group of 12 rabbits had only ACL resection and the opposite knee was used as the non-operated control. The osteoarthritic changes at 6, 12 and 24 weeks after surgery were evaluated histologically. In addition, changes in the immunological detection of 3-B-3(-) and 7-D-4 chondroitin-6-sulphate epitopes were determined because of the previous association of such changes with repair of cartilage and early osteoarthritis. In the instability/step-off group there was rapidly progressing focal degeneration of cartilage on the high side of the defect, not seen in previous step-off studies in stable knees. The rest of the femoral condyles and the tibial plateaux of the instability/step-off group had moderate osteoarthritis similar to that of the instability group. 3-B-3(-) was detectable in the early and the intermediate stages of osteoarthritis but no staining was seen in the severely damaged cartilage zones. Immunoreactivity with 7-D-4 increased as degeneration progressed.

Animals↗
PubMed1999

Benign and malignant cartilage tumors of bone and joint: their anatomic and theoretical basis with an emphasis on radiology, pathology and clinical biology. II. Juxtacortical cartilage tumors.

In part I, we reviewed the varied clinical presentations, pathogenesis, histologic findings, radiologic findings, and treatment of intramedullary cartilaginous lesions of bone. In this section, we will evaluate our cases and consultations of juxtacortical cartilaginous tumors. Radiographic differential diagnosis includes the numerous juxtacortical lesions particularly osteochondroma, parosteal chondroma, Trevor's disease, trauma (fracture and periostitis ossificans), and the low- and high-grade surface osteosarcomas. By emphasizing pathogenesis in conjunction with radiographic and histologic findings, pitfalls in diagnosis and subsequent treatment can be avoided in such cases.

Bone Neoplasms↗
PubMed1998

Cartilage changes caused by a coronal surface stepoff in a rabbit model.

Coronal stepoffs of 0.5 mm (equal to the cartilage height) were created on the medial femoral condyles of adult, skeletally mature rabbits as a model for articular surface incongruity. After 3, 6, 12, and 24 weeks, tissue was analyzed histologically using hematoxylin and eosin and Safranin O staining, autoradiographs were made of the femoral condyles, and immunohistologic analysis was done for 3-B-3(-) and 7-D-4 chondroitin sulfate epitopes. An overlapping flap from the high toward the low side and an increase of the cartilage height on the low side of the defect were observed as permanent features of adaptation throughout the entire followup. Significant degeneration was not seen around the lesion or in the tibial cartilage opposing a stepoff defect. Autoradiography showed a three-phase response to the lesion: an early increase in radiolabeled sulfate (35SO4) uptake, a sharp decline of 35SO4 uptake, and finally a late recovery of the autoradiographic signal indicating partial recovery of proteoglycan synthetic activity. After an early increase, immunohistologic analysis for 3-B-3(-) showed a subsiding tendency by 24 weeks, and the staining with 7-D-4 remained elevated uniformly in the vicinity of the lesion. A rabbit femoral stepoff defect with an offset of 0.5 mm may remodel and not lead to degeneration within the first 6 months after injury in a stable joint.

Adaptation, Physiological↗
PubMed1998

Capitated reimbursement for medical services returns control of the patient to the surgeon.

Limiting the spending on healthcare services is a societal necessity, whether externally budget-driven with reduced fee for service or salary, or internally controlled through prospective payment capitation. No reimbursement system is inherently good or bad. Ethical physicians will place patient well-being first and focus on the delivery of quality care, regardless of the payment method. There are several methods for the distribution of capitation payments to physicians, each with different levels of financial incentive to provide services. In one fully evolved embodiment of capitation, a payer carves out the entire orthopedic disease segment and contracts with an orthopedic organization for all musculoskeletal services within a defined geographic region. This form of capitation offers the advantage of returning control of patient care to the orthopedic surgeon.

Capitation Fee↗
PubMed1997

Radiosynovectomy's clinical applications and cost effectiveness: a review.

It is apparent that from the work of the authors and many others, including the work of Rivard, Sledge, Zuckerman, among others, that radiosynovectomy has an important role to play in providing effective treatment of affected joints associated with rheumatoid arthritis and other forms of arthritis as well as the hemophiliac joint. The treatment offers relief from the effects of recurrent joint effusion with an approximately 60% to 66% favorable response and from recurrent hemarthrosis in the hemophiliac joint with an approximately 75% to 80% favorable response. The impact of providing radiosynovectomy as an alternative to surgical synovectomy is seen, where postoperative side effects such as joint stiffness are avoided, improved quality of life is repeatedly documented, and the cost savings in health care dollars, particularly evident in the hemophiliac joint in this relatively small population, are potentially enormous. With almost two million people in the United States suffering from rheumatoid arthritis, the potential savings in health care dollars is also enormous. As with any use of in vivo radiopharmaceuticals, the potential for radiation-induced damage exists. However, with a 25 plus year record of use, more optimally configured radiopharmaceuticals, and the addition of maneuvers to minimize potential joint leakage, the risk of radiation induced damage appears to be minimal. It appears as though radiosynovectomy is an effective as well as cost-effective alternative to surgical synovectomy and is becoming the procedure of choice particularly in the hemophiliac patient with recurrent hemarthrosis and synovitis who has failed medical therapy. It is also the procedure of choice in patients for whom surgery is contraindicated because of the presence of clotting factor inhibitors.

Arthritis, Rheumatoid↗
PubMed1995

Effects of valgus tibial angulation on cartilage degeneration in the rabbit knee.

Thirteen adult female rabbits underwent unilateral osteotomy of the proximal tibia. In nine animals, 30 degrees of valgus angulation was created; in four animals, osteotomy without angulation was performed. After a 12-week survival period, the knee joints were processed for histology by staining with hematoxylin and eosin and safranin O. Additionally, the chondroitin sulphate epitopes 3-B-3(-) and 7-D-4 were evaluated immunohistochemically as markers of osteoarthritis. Changes of the articular surface of the tibia were visualized by scanning electron microscopy. Light microscopic evaluation by the Mankin et al. scoring system revealed mild or moderate damage of the cartilage in the lateral compartment of angulated extremities when compared with the control side. Immunohistology with the monoclonal 3-B-3 and 7-D-4 antibodies showed no increased expression of these epitopes in the lateral compartments of the knee. Scanning electron microscopic evaluation of the tibial surfaces revealed slight surface damage localized to the central, weight-bearing portion of the lateral tibial plateau of angulated extremities. Angulation of 30 degrees led to only mild degenerative changes of the cartilage. These results indicate that, in the short term, cartilage has considerable capacity to withstand the effects caused by severe angulation of the limb.

Animals↗
PubMed1994

Hemarthrosis and synovitis associated with hemophilia: clinical use of P-32 chromic phosphate synoviorthesis for treatment.

PURPOSE: To evaluate the clinical usefulness of phosphorus-32 chromic phosphate synoviorthesis in patients with hemophilia, recurrent hemarthrosis, and synovitis. MATERIALS AND METHODS: Forty-four P-32 colloid synoviorthesis procedures were performed in 38 patients with these abnormalities. P-32 colloid was injected intramuscularly in a dose of 1.0 mCi (37.0 MBq) in adult knees and 0.5 mCi (18.5 MBq) in adult elbows. A thin-window Geiger-Müller counter was used to survey treated joints, lymph nodes, and liver in order to detect leakage from the joint. Follow-up extended to a maximum of 4 years after treatment. RESULTS: No evidence of clinically significant leakage was seen. Twenty-two of 28 treatments (78%) with longer than 6 months follow-up were associated with improvement in range of motion and frequency of hemorrhage. Of 15 treatments with longer than 2 years follow-up, 10 (67%) were associated with improvement in range of motion; 12 (80%), with improvement in frequency of hemorrhage; and 12 (80%) with improvement in quality-of-life activities. CONCLUSION: P-32 colloid synoviorthesis is a clinically useful out-patient procedure in patients with hemophilia, recurrent hemarthrosis, and synovitis in whom hemostatic therapy has failed.

Adolescent↗
PubMed1994

Immunocytochemical detection of cyclin A and cyclin D in formalin-fixed, paraffin-embedded tissues: novel, pertinent markers of cell proliferation.

Cyclin proteins in association with cyclin-dependent protein kinase subunits represent a new class of potentially oncogenic serine/threonine protein kinases that function to execute critical cell cycle transitions in all eukaryotic cells. Characterized by dramatic fluctuations in abundance, which occur in accordance with the periodicity of the cell cycle, the expression patterns of specific cyclins provide a unique and relevant indicator of cellular activation and cell cycle progression. In this study, we introduce a series of monospecific antibodies that are selective for human cyclin A and cyclin D, respectively, and we assess the feasibility of utilizing these reagents for immunocytochemical analyses. Conditions were optimized for detecting cyclin A and cyclin D in formalin-fixed, paraffin-embedded sections of the postnatal human palatine tonsil, in which normal cell proliferation is well characterized. Subsequent studies demonstrated the performance of these antibodies in the examination of pediatric bone tumors, in which decalcification methods are additionally performed. In both cases, the proliferative status of individual cells was monitored with an exceedingly high degree of resolution. Taken together with the available biochemical data, the results of these studies reveal a novel means of characterizing the proliferative status of normal as well as neoplastic tissues. The demonstrated utility of these immunochemical reagents will potentially facilitate retrospective studies aimed at examining cell proliferation in a wide variety of archival histopathologic specimens.

Antibodies↗
PubMed1994

Orthopaedic surgery on the HIV-positive patient: complications and outcome.

Orthopaedic surgeons practicing in areas with high prevalence of HIV-infected individuals may anticipate that up to 10% of their emergent cases and a highly variable percentage of elective cases will be HIV-positive. Basic science studies have demonstrated impairment of defenses to routine orthopaedic pathogens as well as opportunistic organisms. Clinical studies show that this impairment has not resulted in an increased incidence of postoperative infections or failure of wound healing in the asymptomatic HIV-positive patient. Current medical management seems adequate to prevent increased risk of early postoperative infection in the symptomatic HIV-positive patient undergoing orthopaedic procedures. The HIV-positive patient with a prosthetic implant may be at increased risk of late hematogenous implant infection as host defenses diminish. Regular medical attention, prophylactic antibiotics before dental work and any invasive procedures, and early evaluation and treatment of possible infections are especially important in this group. Because the risk of surgical complications increases with progression of the disease, guidelines for elective surgery should include an assessment of the HIV-positive patient's immune status. The CD4 cell count, history of opportunistic infection, serum albumen, skin anergy, and state of nutrition and general health probably provide the best information regarding the risk of postoperative complications. Based on current knowledge, orthopaedic surgeons should develop a general philosophy or guideline for elective and emergent surgery on the HIV-positive patient in various stages of disease.

AIDS-Related Opportunistic Infections↗
PubMed1993

Synthetic posterior cruciate ligament reconstruction and below-knee prosthesis use in Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome (EDS) has been associated with irreparable arterial disruption, spontaneous and traumatic, necessitating amputation. Recurrent and chronic joint dislocation is a common component. Because of the very thin, hypermobile skin and "tissue paper scars," these patients would be expected to be poor candidates for the use of lower extremity prostheses. A review of the literature failed to show any reports of lower extremity prosthesis use in EDS patients or of recurrent and chronic joint dislocation treated by synthetic ligament reconstruction. The case of a 21-year-old woman is an example of both.

Adult↗
PubMed1991

The effect of simulated fracture-angulations of the tibia on cartilage pressures in the knee joint.

The effects of angular deformities of the tibia on the contact areas and pressures on cartilage in the knee were measured with use of pressure-sensitive film. Six cadaver knees were mounted in a test-frame, such that the offset and tilt of the knee relative to the load-axis simulated that due to angular deformities of the tibia of 5, 10, 15, or 20 degrees of varus or valgus at the levels of the proximal, middle, and distal thirds. Angulation had little effect on the contact area. The change in pressure was least for fractures of the distal third and greatest for fractures of the proximal third. For example, a 20-degree angulation of the distal third increased the maximum contact pressure by an average of 26 per cent in the compartment toward the load-axis and reduced it by 32 per cent in the opposite compartment. With an angulation of 20 degrees at the level of the proximal third of the tibia, the increase in pressure averaged 106 per cent and the decrease averaged 89 per cent. The changes in pressure with fractures at the middle third were between these extremes.

Biomechanical Phenomena↗
PubMed1989

Surgical management of advanced hemophilic arthropathy. An overview of 20 years' experience.

Advanced hemophilic arthropathy often causes moderate to severe pain and significant incapacity by the third or fourth decade of life. Most of these patients can be managed conservatively with clotting factor replacement on demand, therapeutic exercises, antiinflammatory drugs, orthoses, and activity restriction. Some patients, however, have such severe pain and disability and frequent need for clotting factor replacement that reconstructive surgery is required. Over the last 20 years at the present authors' institution, 168 such procedures have been performed. Of these, 141 were primary procedures and 27 were reoperations for persisting or recurring symptoms, failed prostheses, and infection. End-result analysis at the latest follow-up examination indicates that all patients are improved in terms of recurrent hemarthroses and pain, and all but two are improved in terms of function. Results are analyzed and compared with existing reports in the world literature in order to determine appropriate indications for surgery and which procedures are most successful.

Adult↗