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Biomedical subjects

K Eyres

Publications and source records attributed to K Eyres.

10 recordsLinked to original sources

Vascular complications of osteotomies in limb reconstruction.

Osteotomies are commonly carried out in orthopaedic surgery, particularly in limb reconstruction. Complications are uncommon provided that sufficient care is taken and a sound technique used. We describe three cases of formation of false aneurysm after osteotomy, with acute, delayed and asymptomatic onset. The diagnosis was supported by ultrasound investigation, and confirmed by angiography. Embolisation with coils was a successful method of treatment. We recommend a safe method of osteotomy with good bone exposure and adequate soft-tissue protection.

Adolescent↗

Rationale for the use of clodronate in osteoporosis.

Bisphosphonates are widely used in disorders associated with increased resorption of bone, particularly in Paget's disease of bone and in the hypercalcemia of malignancy. Because of their undoubted efficacy and relatively low toxicity, bisphosphonates are attractive candidates for the management of osteoporosis. Clodronate, one of the many bisphosphonates being tested in osteoporosis, may be given intravenously or by mouth. In contrast to etidronate, even high doses of clodronate do not impair the mineralization of bone, making it suitable for long-term use in osteoporosis. As do all the bisphosphonates tested thus far, clodronate appears to delay the rate of bone loss in osteoporosis. Long-term studies are relatively few, so that its steady-state effects on bone mass are not yet known. Most data suggest clodronate is capable at least of delaying the rate of bone loss, but several pilot studies with this agent suggest that increments of bone mass might be sustainable for several years. Clodronate is likely to decrease the frequency of osteoporotic fractures, but there is no evidence for this at present. Well-controlled, long-term prospective studies are needed.

Bone Remodeling↗

Effective treatment of malignant hypercalcaemia with a single intravenous infusion of clodronate.

Thirty patients with hypercalcaemia due to malignancy that persisted following rehydration, were treated with a single dose of the bisphosphonate, clodronate. Clodronate (1.5 g) was administered intravenously in 500 ml normal saline over 4 h. Serum and urine biochemistry were measured before and after treatment and the results were compared with data from 15 patients given the recommended regimen 300 mg intravenous clodronate daily for 5 consecutive days. The single infusion induced a rapid and significant fall in serum calcium, apparent at day 3 (P < 0.0001) that persisted to the end of follow-up at day 10 (P < 0.001). Eighty per cent (24/30) of patients became normocalcaemic. The response was associated with a significant decrease in fasting urinary calcium excretion, and no change in renal function, as judged by serum creatinine. The same dose of clodronate, given as 5 daily infusions, induced a comparable decrease in serum calcium, but was less rapid in onset so that at day 3 the serum calcium was significantly lower with the single infusion (P = 0.02). The calcium lowering effect of both regimens depended on the tumour type. We conclude that the single infusion of 1500 mg clodronate is as effective in reducing serum calcium as the same dose given over 5 days. The single infusion has a more rapid onset of effect, is more convenient than multiple infusions, and has no adverse effect on renal function.

Adult↗

Common peroneal nerve dysfunction after high tibial osteotomy.

We assessed 16 patients before and after high tibial osteotomy by electrophysiological recordings, creatine phosphokinase levels, radiographs and intracompartmental pressure monitoring. We found mild electrophysiological abnormalities pre-operatively in 12 of the 16 patients, but postoperatively these had deteriorated in 11 of the 14 patients studied. Creatine phosphokinase levels, compartment pressure and radiological deformity were not predictive of the development of postoperative common peroneal nerve palsy. Patients who also had a proximal fibular osteotomy had greater electrical abnormalities postoperatively and two of them developed common peroneal palsies. Proximal fibular osteotomy appears to be a causative factor in the development of common peroneal nerve palsy; more work is needed on the blood supply of the nerve.

Adult↗

Malignant Langerhans' cell histiocytosis of the clavicle: a rare pathological fracture.

Langerhans' cell histiocytosis (LCH) is an extremely heterogeneous disorder which is uncommon, making therapeutic guidelines difficult. The malignant features seen in this case have been described presenting in the skin but not in the bone. Although pathological fractures through bone affected by eosinophilic granuloma have been described, this is the first reported case of LCH with malignant features presenting in such a way.

Child↗

An aid for the removal of compression hip screws.

The compression hip screw has a wide application in fracture management and elective orthopaedics. Due to the design of the sliding screw, bone ingrowth behind the threads can lead to difficulties in metalwork removal, especially in the younger patient. A simple technique is described using the plate to assist nail removal.

Bone Screws↗

Complement and glomerular disease - a natural history study.

Over a 5-year period we have performed sequential measurements of a range of complement components in 127 patients. Each had a well-characterised glomerular lesion and there was no evidence of an underlying connective tissue disorder. In 17 patients with varied histopathology, who did not have C3 nephritic factor, there was a persisting complement defect which was present during remission in the patients we were able to study. The finding of such defects is consistent with the thesis that primary complement system abnormalities predispose to the development of glomerular lesions. Interestingly, these abnormalities did not influence the prognosis of our patients. In 12 other cases without C3 nephritic factor, complement levels were below the normal range when the glomerular lesion was active but returned to it in remission; these were secondary changes. We showed by discriminant analysis that some circulating complement component levels, assessed in relation to each other and without reference to a statistically derived 'normal' range, discriminated between histological subgroups and had prognostic significance as well. These patterns could not be distinguished until the data were stored and analysed by computer.

Analysis of Variance↗

Evidence for cell-mediated immunity to renal antigens in minimal-change nephrotic syndrome.

A direct lymphocytotoxicity test was used to investigate 12 patients with minimal-change nephrotic syndrome and 12 patients with proliferative glomerulonephritis for cell-mediated immunity against an epithelial cell culture derived from human kidney. Lymphocytes from patients with minimal-change nephritis but not from those with proliferative disease had significantly greater lymphocytotoxicity against the cultures than did lymphocytes from normal controls.

Antigen-Antibody Reactions↗

Allograft immunity to histocompatibility and organ-specific antigens.

An experimental model has been developed in the dog in which a renal allograft was placed in the neck, leaving one of the dog's own kidney in situ. Five nonimmunosuppressed pairs of dogs have been studied by using the leucocyte migration test (LMT) as an in vitro measure of cell-mediated immunity. Antigen preparations from leucocytes, kidney, liver, and skeletal muscle from both the kidney donor and the recipient were used in the LMT in order to study responses against transplantation and organ-specific antigens. Inhibition of migration with donor-specific leucocyte and kidney antigens was detectable prior to clinical evidence of rejection, which was confirmed histologically. Concurrently, inhibition was also observed with autologous kidney antigen and histological damage was noted in the recipient's own nontransplanted kidney, accompanied by increasing proteinuria. Autologous serum withdrawn daily and added to the test culture medium abolished the inhibition of migration, thus suggesting the development of blocking factor.

Animals↗