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Biomedical subjects

M A McNally

Publications and source records attributed to M A McNally.

At least 19 recordsLinked to original sources
PubMed2006

Chronic sternal osteomyelitis complicating primary manubriosternal septic arthritis.

We present a 40-year-old woman complaining of worsening chest pain. She was previously treated with a prolonged course of antibiotics for suspected sternal osteomyelitis. Radiological investigations were suggestive of ongoing inflammation within the manubriosternal joint. Formal surgical debridement yielded evidence corroborating the diagnosis although microbiological samples were negative. Prolonged empirical treatment with intravenous antibiotics leads to a complete resolution of symptoms. Primary culture-negative manubriosternal septic arthritis is rare, and suboptimal treatment, particularly if confused with other conditions such as synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome, compounds its considerable morbidity.

Adult↗
PubMed2002

Altered venous function and deep venous thrombosis following proximal femoral fracture.

The effect of surgery for femoral neck fracture on lower limb venous blood flow and its relationship to deep vein thrombosis was investigated in 179 patients. Blood flow was measured using strain gauge plethysmography before surgery, in the 1st week after surgery, and at 6 week review. There was a significant reduction in both venous outflow and venous capacitance, affecting both fractured and non-fractured legs but significantly greater in the fractured leg. Venous function remained significantly impaired in both lower limbs 6 weeks after surgery. There was a significant correlation between the reduction in venous function and the development of deep vein thrombosis.

Aged↗
PubMed2001

Baumann's confusing legacy.

Dr Ernst Baumann has been credited with describing an angle that can be measured from radiographs taken of children's elbows. This article presents three variations in the definition of this angle that we found in the orthopaedic literature. Variation I is the angle between the long axis of the humerus and a line through the physis of the lateral condyle of the distal humerus. Variation II is the angle between the perpendicular to the long axis of the humerus and a line through the physis of the lateral condyle. Variation III is the angle between the line through the physis of the lateral condyle and a line connecting a point on the edge of the trochlea to a point at the lateral limit of the physis of the lateral condyle. By reading translations of two of Baumann's own articles, we have realised that he used variation I when assessing the radiographs. He did, however, believe that the reciprocal angle, variation II equalled the carrying angle of the elbow and this can be demonstrated by Fig. 1, which has been taken from an article that was published in 1929. The relationship between this angle and the carrying angle has since been proven to be more complex than Baumann believed. We recommend that a descriptive term such as the 'shaft-physeal' angle would cause less confusion and variation in the definition of this angle.

Child↗
PubMed2001

Changes in coagulability as measured by thrombelastography following surgery for proximal femoral fracture.

The effect of surgery for femoral neck fracture on whole blood coagulation and the relationship of altered coagulation to deep venous thrombosis were investigated in 250 patients. Whole blood coagulation was measured using thrombelastography preoperatively, in the early postoperative period and at 6-week review. Significant hypercoagulability was demonstrated after surgery and persisted to 6-week review. A significant correlation between hypercoagulability and the development of deep venous thrombosis is demonstrated. Hypercoagulability is shown to be a major factor in thrombosis formation following proximal femoral neck fracture surgery.

Aged↗
PubMed2001

Graduated compression stockings: knee length or thigh length.

The mechanisms by which graduated compression stockings prevent deep venous thrombosis are not completely understood. In the current study the physiologic effect of low-pressure graduated compression stockings on the venous blood flow in the lower limb and the practical aspects of their use were assessed. Patients having elective orthopaedic surgery at a university orthopaedic department were randomized into five groups to wear two different types of graduated compression stockings in thigh and knee lengths. Patients in the fifth control group did not wear graduated compression stockings. Venous occlusion strain gauge plethysmography was used to measure venous flow. After 20-minutes bed rest there was a highly significant increase in venous capacitance and venous outflow in patients in all of the four groups wearing stockings. There was no difference in the mean of the percentage change of venous capacitance in patients in the four groups wearing stockings. The knee length Brevet stockings were less efficient in increasing the venous outflow. There was no significant change in the venous capacitance and venous outflow in patients in the control group. Visual assessment of the fit and use of stockings was done, and patients' subjective opinion of comfort was sought. The knee length graduated compression stockings wrinkled significantly less, and significantly fewer patients reported discomfort with them. All stockings were reported to be difficult to use. Thigh and knee length stockings have a significant effect on decreasing venous stasis of the lower limb. Knee length graduated compression stockings are similarly efficient in decreasing venous stasis, but they are more comfortable to wear, and they wrinkle less.

Bandages↗
PubMed2000

Numerical model of deep venous thrombosis detection using venous occlusion strain gauge plethysmography.

Strain gauge plethysmography (SGP) is a non-invasive method used in the detection of deep venous thrombosis (DVT). The technique is based on the measurement of calf volume changes in response to venous occlusion by a thigh cuff, the volume changes reflecting the rates of arterial inflow and venous outflow. A numerical model of the blood circulation within the limb and the response of this to a SGP test has been derived, based on treating the different parts of the circulatory system in the leg as resistance and capacitance elements. The simulation results were compared with clinical studies and support the ability of SGP to detect non-occlusive clots of more than 50-60% of the lumen, as well detecting calf vein occlusion. The non-linear behaviour of the venous compliance with intra-luminal pressure appears to be a particularly important factor within the model. In addition, increases in venous tone due to post-operative venospasm were shown to be a potential source of false positive results.

Humans↗
PubMed1997

The effect of active movement of the foot on venous blood flow after total hip replacement.

Surgeons often encourage patients to move their feet in an attempt to prevent venous stasis, but there is little evidence that this measure is beneficial. We investigated the effect of active movement of one foot on the venous blood flow four days after total hip replacement. The actual venous outflow at rest was measured with use of venous occlusion strain-gauge plethysmography in thirty-eight patients. The patients were randomly allocated to the control group (eighteen patients) or the exercise group (twenty patients). A baseline measurement was followed by a one-minute period of rest (control group) or of maximum plantar flexion and dorsiflexion of the foot, ankle, and toes at a rate of thirty cycles per minute (exercise group). The venous outflow was measured again at two, seven, twelve, and thirty minutes in both groups. Movement of the foot for one minute produced a significant and sustained increase (p < 0.002) in the venous outflow (mean maximum increase, 22 per cent). The value remained greater than the baseline level for thirty minutes (mean increase, 6.5 per cent) (p < 0.2). The increase was gradual, reaching a maximum twelve minutes after the completion of exercise. Our results confirm the beneficial hemodynamic effects of active movement of the foot in the postoperative period and suggest that patients should move the feet and ankles postoperatively as part of a prophylactic regimen directed at decreasing the risk of venous thrombosis.

Aged↗
PubMed1997

Venous haemodynamics in both legs after total knee replacement.

We studied the effect of total knee replacement on venous flow in 110 patients. Resting venous blood flow was measured using strain-gauge plethysmography before operation, after surgery and after discharge from hospital. There was a significant reduction in mean venous capacitance (p < 0.001) and mean venous outflow (p < 0.004) affecting only the operated leg. Both improved significantly after mobilisation in the early postoperative period, returning to preoperative levels by six days after surgery and before discharge from hospital. Our findings showed that venous stasis may contribute to deep-vein thrombosis only in the first few days after total knee replacement. This would be the most important period for the use of flow-enhancing prophylactic devices. Comparison with changes in blood flow after total hip replacement identified different patterns of altered haemodynamics suggesting that there are different mechanisms of venous stasis and thrombogenesis in hip and knee arthritis and during surgery for these conditions.

Adult↗
PubMed1997

Attitudes to, and utilization of, low molecular weight heparins in joint replacement surgery.

A postal survey was carried out to determine the attitudes to the use of low molecular weight heparin (LMWH) in joint replacement among two representative groups of orthopaedic surgeons practising in the UK. 72% of hip surgeons and 51% of knee surgeons replying had used LMWHs for deep vein thrombosis prophylaxis in joint replacement patients. Of these, 48% had discontinued LMWH use due to bleeding complications. Among those continuing to use LMWHs, 88% had witnessed excessive bruising around the wound and 53% had experienced increased wound bleeding or haematomas. Although LMWHs have been shown to reduce post-operative thromboembolism in these groups, clinical experience has revealed an increased incidence of bleeding complications associated with their use. This has prevented their routine use in joint replacement, as was the case with unfractionated heparin in the past.

Arthroplasty, Replacement, Hip↗
PubMed1996

Conditions peculiar to the tongue.

The tongue is the organ of taste, and it functions in speech, mastication, and the deglutition of food. This muscular organ is affected by many conditions and diseases, including a variety of developmental, traumatic, inflammatory, infectious, and neoplastic lesions.

Humans↗
PubMed1996

Selection of murine lymphoid and hematopoietic cells using polystyrene tissue culture devices containing covalently immobilized antibody.

We have established rapid procedures that negatively deplete and positively select for specific murine cell populations. By using polystyrene tissue culture flasks containing a covalently bound mouse anti-rat antibody and specific anti-mouse, cell-surface antigen antibodies, we easily and efficiently depleted greater than 90% of the mature lineage cells from murine bone marrow. This selection procedure resulted in an enrichment of progenitor colonies (CFU-Cs) in murine bone marrow. Using the same polystyrene tissue culture devices, we can directly isolate CD117+ (c-kit+) murine hematopoietic cells. As few as 2000 of these CD117+ cells rescued and reconstituted lethally irradiated recipients in a murine bone marrow transplant model.

Animals↗
PubMed1994

Efficient and sustained gene expression in primary T lymphocytes and primary and cultured tumor cells mediated by adeno-associated virus plasmid DNA complexed to cationic liposomes.

We have used cationic liposomes to facilitate adeno-associated virus (AAV) plasmid transfections of primary and cultured cell types. AAV plasmid DNA complexed with liposomes showed levels of expression several fold higher than those of complexes with standard plasmids. In addition, long-term expression (> 30 days) of the gene, unlike the transient expression demonstrated by typical liposome-mediated transfection with standard plasmids, was observed. Southern analysis of chromosomal DNA further substantiated the hypothesis that the long-term expression was due to the presence of the transgene in the AAV plasmid-transfected group and not in the standard plasmid-transfected group. AAV plasmid-liposome complexes induced levels of transgene expression comparable to those obtained by recombinant AAV transduction. Primary breast, ovarian, and lung tumor cells were transfectable with the AAV plasmid DNA-liposome complexes. Transfected primary and cultured tumor cells were able to express transgene product even after lethal irradiation. High-level gene expression was also observed in freshly isolated CD3+, CD4+, and CD8+ T cells from normal human peripheral blood. Transfection efficiency ranged from 10 to 50% as assessed by intracellular interleukin-2 levels in interleukin-2-transfected cells. The ability to express transgenes in primary tumor and lymphoid cells may be applied toward tumor vaccine studies and protocols which may eventually permit highly specific modulation of the cellular immune response in cancer and AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Postphlebitic syndrome after hip arthroplasty. 43 patients followed at least 5 years.

We reviewed 43 patients using clinical scoring for evidence of postphlebitic syndrome at least 5 years after hip replacement. All had had a venogram as part of a screening study at the time of surgery. The postphlebitic syndrome was identified in 13 patients and was disabling in 6. The syndrome was present in 9 of the 11 patients with a venographically proven deep vein thrombosis (DVT) and in 4 of the 32 without DVT. Postphlebitic sequelae had developed despite anticoagulant therapy for the acute DVT. The postphlebitic syndrome following asymptomatic deep vein thrombosis is an important long-term complication of total hip replacement.

Anticoagulants↗
PubMed1994

Long-term reconstitution of mice after ex vivo expansion of bone marrow cells: differential activity of cultured bone marrow and enriched stem cell populations.

In this report, we evaluated the short-term expansion of murine bone marrow mononuclear cells (BMMNC) and enriched stem cell populations to determine the capacity of these cells for long-term rescue and engraftment to lethally irradiated recipients. In our study, nonadherent bone marrow mononuclear cell (NBM-MNC) and Thy1+Lin- stem cells populations were cultured with interleukin-3 (IL-3) or IL-3 plus stem cell factor (SCF) for periods up to 6 days. By day 6 of culture, the mononuclear cells (MNC) decreased to 6% of input cell number, whereas Thy1+Lin- cells increased by 2310%. Doses of 95,000; 100,000; 50,000; and 250,000 NBM-MNCs at 0, 1, 2, and 6 days of culture, respectively, rescued 50% of lethally irradiated mice. When 250,000 MNCs were cultured for 0, 1, 2, and 6 days, 71, 61, 100, and 50% of the animals survived lethal irradiation for greater than 24 weeks. In contrast, doses of 8,000 and 21,000 Thy1+Lin- cells cultured 0 and 1 day, respectively, yielded 50% survival rates. These same cells cultured for 6 days failed to rescue recipients even at high doses. Twenty thousand Thy1+Lin- cells cultured for 0, 1, 2, and 6 days, even in the presence of SCF, produced decreasing survival rates of 86, 43, 26, and 0%, respectively. The proliferative responses of these different populations in combination with their long-term rescue abilities indicated that the absolute number of long-term rescue units (LD50, 24 weeks) in the cultured Thy1+Lin- population decreased faster than in similarly cultured NBM-MNCs. Studies evaluating donor cell engraftment demonstrated that animals rescued with cultured Thy1+Lin- and NBM-MNCs maintained high levels of donor reconstitution [7]. The percent donor T cell engraftment did not significantly change between 2 and 17 months post-bone marrow transplantation (post-BMT). Therefore, those animals who received sufficient cells to survive lethal irradiation generally established and maintained high levels of donor engraftment. The data suggest a role for accessory cells and/or factors in the preservation of stem cell activity.

Animals↗