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Biomedical subjects

L Klenerman

Publications and source records attributed to L Klenerman.

At least 19 recordsLinked to original sources
PubMed1992

An application of the fear avoidance model to three chronic pain problems.

The Fear Avoidance Model of Exaggerated Pain Perception was developed in an attempt to explain how, and why, some individuals develop a more substantial psychological overlay to their low back pain problem than do others. The present paper describes a study in which three chronic pain groups, consisting of Post-Herpetic neuralgia patients, Reflex Sympathetic Dystrophy patients and chronic low back pain patients were compared with three pain-free comparison groups using the Fear Avoidance Model of Exaggerated Pain Perception. The results show statistically significant differences between the chronic groups and the recovered comparison groups. These results demonstrate the usefulness of the Fear Avoidance Model as an explanation of psychological overlay in chronic pain conditions regardless of pathology.

Adaptation, Psychological↗
PubMed1992

The role of ultrasound and isotope scanning in the management of irritable hips.

Patients (n = 181) with the irritable hip syndrome were reviewed. Four of these were found to have Perthes disease and 3 cases had septic arthritis. Ultrasonography provides accurate information as to the presence or absence of an effusion in children with an irritable hip syndrome. The likelihood of a positive result is higher in the early course of the disease process (i.e. within 3 days). Bone scanning, if done routinely will help in the early diagnosis of Perthes disease. Recurrence of the symptoms occurred in 18% of patients and most of them were within 12 months of the first onset of symptoms.

Adolescent↗
PubMed1992

The development of the low profile Liverpool shear transducer.

The development of a shear transducer, small enough to be worn comfortably under a normal foot, is described, along with a microcomputer controlled data logger. Walks up to 8 s can be recorded and the information downloaded to any IBM compatible computer. Software then allows easy analysis of the peak shear stresses. Calibration curves show the transducers to have a linear response up to 35N and preliminary data from the measurement of shear stresses under the normal foot, and their relationship to vertical pressures, is presented. A patent application (number 9109463.1) has been filed for the device in the United Kingdom.

Adult↗
PubMed1992

Neuropathic foot ulceration treated by total contact casts.

Ulceration of the insensitive foot continues to cause great morbidity in diabetic patients. We treated 46 patients with neuropathic ulceration by applying total contact casts. Most neuropathic ulcers healed within six weeks but ischaemic ulcers did not heal. One patient developed gangrene and required partial amputation of the foot.

Adult↗
PubMed1991

Podiatry.

Explore the source record for details and available documents.

History, 18th Century↗
PubMed1991

The diagnosis of reflex sympathetic dystrophy using an algometer.

Thirty-three patients with reflex sympathetic dystrophy were studied prospectively to ascertain the pressure-pain threshold of affected and unaffected limbs. The affected side had a lower threshold which was found to be statistically significant. In all 18 patients with upper limb involvement, the pain threshold was reduced on the affected side, but this applied to only 11 of the 15 with leg involvement. This difference may be because patients with lower limb symptoms had been referred later in the course of the syndrome. We showed by repeated tests that after an average of 49 days there was a slow return to normality. The estimation of pressure-pain thresholds may help in the earlier diagnosis of reflex sympathetic dystrophy.

Arm↗
PubMed1991

Metatarsal head excision for rheumatoid arthritis. 4-year follow-up of 68 feet with and without hallux fusion.

Thirty-four painful deformed rheumatoid feet treated by excision of all five metatarsal heads were compared with 34 similar feet in which the lesser metatarsal heads were excised and the first metatarsophalangeal joint was arthrodesed. In the latter group, one third had failure of fusion of the hallux, and this produced the worst results. Metatarsalgia and plantar callosities were more common after excision arthroplasty, but shoe fitting and correction of deformity were better in this group. However, the results were more variable in the fusion group, and the complication and reoperation rates were higher. For this reason, excision arthroplasty, rather than fusion of the hallux, is recommended when the lesser metatarsal heads are removed.

Adult↗
PubMed1991

Combined prophylactic effect of ultraclean air and cefuroxime for reducing infection in prosthetic surgery.

One hundred seventy-four elective operations for hip and knee prostheses were undertaken in conditions of ultra-clean air and antibiotic prophylaxis (with cefuroxime), as the recent Medical Research Council multicenter study suggested that this combination was most likely to give the lowest infection rate. No acute infections of a prosthesis occurred (early infection rate less than 0.6%), while the rate was 2.9% for purulent wound infection which did not involve the prostheses. Late infections, at 3 months and 1 year, occurred in only 2 patients (a rate of 1.1%), resulting from probable bacteremia, which necessitated removal of the prosthesis. These results are considered satisfactory, especially in a compromised patient population of mean age 71 years. Such low infection rates underscore the need to continue the combined use of ultraclean air and antibiotics for hip and knee prosthetic surgery, or to introduce them where absent, to prevent the occurrence of airborne staphylococcal infection; either technique alone was shown to be less effective in the Medical Research Council multicenter study.

Aged↗
PubMed1990

High indices of remodelling in iliac trabecular bone predict reduced forearm cortical bone mass indices in patients with proximal femoral fractures.

To investigate whether high bone turnover could be a predictor of cortical bone loss and a candidate risk factor for fractures of the proximal femur, 33 7.5-mm transiliac biopsies taken at fracture fixation from 48 patients who participated in a study of potential risk factors have been quantitated. Twenty-four of the 33 patients made good recoveries and about 6 weeks postoperatively consented to bone densitometry of the forearm midshaft. Forearm bone density correlated negatively (r = 0.77, P = 0.001) with the surface of trabecular bone covered with osteoid, which in osteoporotic patients with crush fractures of the vertebrae was previously shown to relate both to rates of bone formation and resorption. An important minority of these femoral fracture patients appeared to be suffering from high rates of iliac trabecular bone resorption. Thus, high bone remodelling activity could lead to excessive cortical thinning. This has pathogenetic implications which may be clinically important.

Aged↗
PubMed1990

Selective depression of metabolic activities in cortical osteoblasts at the site of femoral neck fractures.

The aim of this investigation was to determine whether some metabolic defect might be related to the propensity of osteoporotic femoral necks to fracture acutely. To this end, the activities of two dehydrogenases of the glycolytic Embden-Meyerhof pathway, two of the pentose phosphate pathway, two mitochondrial enzymes, and alkaline phosphatase were measured in the cortical and in the trabecular osteoblasts. Comparison was made with such activities in iliac crest biopsies from patients with these fractures and from the equivalent femoral and iliac crest samples from patients with osteoarthritis of the hip, in biopsies from the iliac crests from seven patients with no bony abnormality, and in specimens from the fracture site of six traumatic fractures. The results showed a highly significant decrease in the activities of the two enzymes of the pentose phosphate pathway (p less than 0.001) in the cortical, but not in the trabecular, osteoblasts in the osteoporotic fractures. This could not be attributed to the trauma of acute fracture since it was not found in traumatic fractures. Other experimental evidence has indicated that a relationship may occur between depressed activity of these enzymes and a retardation of bone formation.

Aged↗
PubMed1990

Tarsometatarsal involvement in juvenile spondyloarthropathy.

Patients with juvenile spondyloarthropathy who carry HLA B27 antigen or have a family history of ankylosing spondylitis may have marked tarsometatarsal arthritis. This may be associated with hindfoot involvement and result in a supination deformity. Spontaneous fusion with complete obliteration of the tarsometatarsal joints may occur.

Adolescent↗
PubMed1990

The importance of the toes in walking.

The importance of well-functioning toes has long been recognised but has not previously been assessed in biomechanical studies. We have examined the weight-bearing function of the foot in 160 normal subjects by use of the pedobarograph. The function of the toes was assessed by reference to the time they were in contact with the ground and the peak pressures they exerted individually in comparison with other parts of the foot. The toes were in contact for about three-quarters of the stance phase of gait and exerted peak pressures similar to those of the metatarsal region. When the foot was bearing the second peak of total force, the area in contact with the ground (the metatarsal heads and toes) was decreasing.

Adolescent↗
PubMed1989

Comparative metabolic enzymatic activity in trabecular as against cortical osteoblasts.

On the basis of studies with bone-seeking isotopes, it is generally believed that the metabolic activity of osteoblasts of the trabecular bone is greater than that of the osteoblasts of the cortex. This implies that the oxidative activity, which provides the energy for biosyntheses, will also be greater in the former than in the latter. In the present study, direct measurement of the activities of representative enzymes of the major oxidative pathways, as well as of alkaline phosphatase, showed that the reverse pertained. However, owing to the greater cellularity of trabecular bone, the activity per unit mass of bone may be higher in the trabecular bone.

3-Hydroxyacyl CoA Dehydrogenases↗
PubMed1989

Avascular necrosis of lesser metatarsal heads following forefoot surgery.

Three cases of avascular necrosis of the lesser metatarsal heads following forefoot surgery are presented. The variable blood supply of the metatarsal heads is described. Interruption of this delicate circulation at the time of surgery is thought to be a major etiological factor. Repeated trauma following transference of load to the lesser metatarsal heads after operation may also play an important role. Although not previously described this may be a cause of persistent pain following surgery to the forefoot which is easily overlooked.

Adult↗
PubMed1988

Bringing gait analysis out of the laboratory and into the clinic.

The potential value of objective assessment of gait in geriatric medicine cannot be explored fully whilst gait analysis remains a laboratory research tool, imposing special conditions which often preclude its use in the elderly. We describe a method of gait analysis suitable for the geriatric clinic and illustrate its use in documenting the response to interventions in three patients presenting with falls due to parkinsonism. Irregularity between gait cycles was noted, a finding previously described in Parkinson's disease, dementia and normal old men at a fast walking speed. Such irregularity may prove to be a major risk factor for falls. Where multiple pathologies which disturb gait coexist, measurement of changes in gait in response to treatment may provide a much needed means of audit.

Accidental Falls↗
PubMed1988

A comparison of teicoplanin and cefuroxime as prophylaxis for orthopaedic implant surgery: a preliminary report.

The relative merits of different antibiotic regimens for prophylaxis in orthopaedic implant surgery are difficult to evaluate because of the low frequency of infection. Factors other than infection prevention may influence choice. We have compared 400 mg teicoplanin given intravenously on induction of anaesthesia with three perioperative injections of cefuroxime, in 146 patients undergoing total hip or total knee replacement. These interim results suggest that cefuroxime selects for increased extraintestinal carriage of faecal streptococci and teicoplanin for Proteus species. There were no significant differences between the regimen in the acquisition of coagulase-negative staphylococci or Clostridium difficile, post-operative diarrhoea, wound healing or wound infection. Both regimens were equally safe.

Adult↗
PubMed1988

A comparison of Wilson and Hohmann osteotomies in the treatment of hallux valgus.

In a retrospective study we compared the results of 31 Wilson and 31 Hohmann osteotomies of the first metatarsal in the treatment of hallux valgus. There were no differences between the two operations in terms of patient satisfaction, pain relief, appearance, footwear and walking ability. First metatarsal shortening was the same after both operations, and the degree of shortening was unrelated to either the clinical or the pedobarographic findings. Although the long-term radiographic changes after the Hohmann osteotomy were more worrying, the pedobarographic patterns tended to be worse after the Wilson osteotomy. There were no poor results and the numbers of feet with the same final grade were identical in each group. However, there was abnormal loading of the lateral metatarsal heads after both osteotomies when compared with the normal foot, and hallux-contact time during the stance phase was also significantly reduced after osteotomy.

Hallux Valgus↗