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Biomedical subjects

M S Gilbert

Publications and source records attributed to M S Gilbert.

At least 19 recordsLinked to original sources
PubMed2002

Haemophilic pseudotumours of the limbs and their percutaneous treatment.

The percutaneous treatment of limb pseudotumours is a nonaggressive method of treating haemophilic pseudotumours. However, efforts should be directed to the prevention of such pseudotumours by ensuring that all patients receive adequate treatment of their bleeding episodes through education and the elimination of geographical or social barriers that prevent access to such treatment. Prevention of pseudotumours by means of early substitution treatment of muscular bleeding episodes is the best treatment.

Administration, Cutaneous↗
PubMed2001

The history of synoviorthesis in haemophilia.

The history of synoviorthesis and recent studies have shown that it is a safe procedure and that the results are similar to those seen following open surgical and arthroscopic synovectomy. If the safety of this procedure is definitively proven in long-term studies it will become the procedure of choice for treatment of recurrent haemarthroses and synovitis. That is, until the time when the haematologists and geneticists eliminate the need for orthopaedic intervention in the care of persons with haemophilia.

Arthroscopy↗
PubMed1999

Management of fixed flexion contracture of the elbow in haemophilia.

The authors stress that prevention of flexion contractures and artropathy by early factor replacement and physical therapy for every haemophiliac is the standard of care. Physical therapy, serial casting, and Quengel cast correction have not proven successful in correction of fixed flexion contractures at the elbow. In the patient who has a flexion contracture that interfered with function, an attempt at physical therpay combined with the use of either the Dynasplint or Flowtron will be tried. If there is no response, a surgical synovectomy combined with a possible radial head resection and anterior capsular release would be the authors' procedure of choice. In the face of advanced arthropathy, the authors would consider a distraction arthroplasty.

Contracture↗
PubMed1998

Unipolar or bipolar prosthesis for the displaced intracapsular hip fracture? An unanswered question.

Modular bipolar prostheses were developed to address the problems of loosening, cartilage wear, and protrusio which were seen with single unit endoprostheses. Modular unipolar prostheses address many of these problems and are significantly less expensive than the bipolar prosthesis. Recent data suggest that use of the modular unipolar prosthesis is indicated in elderly patients with low demands.

Aged↗
PubMed1997

The role of shoulder fusion in the era of arthroplasty.

The indications, surgical techniques, results and complications of shoulder fusion are described. The indications are bacterial infection, paralytic disorders in infancy, combined deltoid and rotator cuff paralysis, post-traumatic brachial plexus lesions, inflammatory arthritis with severe rotator cuff involvement, failed arthroplasty, recurrent dislocation, after resection of tumours, irreparable rotator cuff tear, painful arthritis in a patient whose activities require power but not movement, the immunocompromised patient, and tuberculosis. Satisfactory results are achieved in children with isolated shoulder paralysis, but in adults loss of glenohumeral movement is associated with about 50% loss of function. The best results are obtained in cases of isolated shoulder paralysis with a normal arm and hand distally. The most frequent complications are nonunion (5-20%), fracture of the ipsilateral humerus (10-15%) and infection (3-5%). Other causes of failure are functional limitation, fusion in malposition, functional involvement of the distal joints, acromioclavicular dislocation, suprascapular traction neuritis, failure or migration of an internal fixation device, epiphyseal problems, and the complications of using an allograft. Shoulder replacement is most likely to be chosen for most destructive shoulder disorders, but fusion is useful in certain cases.

Adult↗
PubMed1997

Therapeutic options in the management of hemophilic synovitis.

There is a complex relationship between recurrent bleeding, synovitis, and the development of arthritis in the patient with hemophilia. There are many options available for the treatment of recurrent bleeding and hemophilic synovitis, indicating that none works very well. Conservative treatment, including replacement of the missing clotting factor for 3 to 6 months, intermittent steroids, immobilization, and physical therapy should be tried before synovectomy is indicated. Synovectomy can be achieved through an open procedure, arthroscopically, or by injection of a radioactive material into the joint. Radioactive synovectomy is indicated in patients with inhibitors to the clotting factor, patients with advanced human immunodeficiency virus and advanced hepatitis, and in those patients with multiple joint involvement. Arthroscopic synovectomy is the procedure the authors recommend for the knee and ankle joints, although open synovectomy offers an excellent alternative. The greatest risk to these procedures is a decreased range of motion, and this is most problematic in the young child who cannot cooperate with a program of physical therapy.

Ankle Joint↗
PubMed1996

Association of BCL-2 with membrane hyperpolarization and radioresistance.

The resting membrane potential of parental, neomycin control, and Bcl-2 transfected cells was measured, and the effect of membrane hyperpolarization or depolarization on radiosensitivity was studied. Bcl-2 transfected cells were significantly more radioresistant than control cells and were significantly hyperpolarized compared to parental and neomycin control transfected PW and HL60 cells. Hyperpolarization of the parental and neomycin control transfected cells by valinomycin significantly increased the radioresistance of these cells to such an extent that there was no longer a significant difference in the survival of the valinomycin treated and irradiated control cells compared to similarly irradiated Bcl-2 transfected cells. In contrast, depolarization of the Bcl-2 transfected PW and HL60 cells decreased the radioresistance of the Bcl-2 transfectants to a level similar to that of the control cells. The data presented here suggest that overexpression of Bcl-2 affects membrane potential and that this hyperpolarization is associated with increased radioresistance of cells that overexpress Bcl-2. Furthermore, Bcl-2 transfected cells were also less susceptible to the specific Na+/K(+)-ATPase inhibitor ouabain, suggesting that Bcl-2 may act at the level of the Na+/K(+)-ATPase pump.

Apoptosis↗
PubMed1996

Long term evaluation of septic arthritis in hemophilic patients.

Before 1983, septic arthritis was rare in patients with hemophilia. With the advent of human immunodeficiency virus infection in the hemophilia population, many centers noted an increasing incidence of patients with septic arthritis. Fifteen septic joints in 10 patients with severe hemophilia were documented. Eight patients were human immunodeficiency virus positive, 1 was human immunodeficiency virus negative, and 1 was not tested. The diagnosis was delayed in 5 patients because the symptoms are similar to an acute hemarthrosis. An elevated temperature was common. The white blood cell count was elevated in only 1/3 of the infections, being modified by human immunodeficiency virus infection. Associated risk factors included infected angioaccess catheters (2), pneumonia (2), and generalized sepsis (1). All but 1 joint responded to appropriate antibiotics and either repeated aspiration or arthrotomy. However, 6 patients died of acquired immunodeficiency syndrome from 2 to 109 months after infection. Three patients are alive 29, 86, and 96 months, respectively, after infection.

Adolescent↗
PubMed1996

Over-expression of Bcl-2 protects against apoptosis induced by the bioreductive cytotoxic drug SR4233 (Tirapazamine).

The human B-cell lymphoma cell line PW undergoes radiation-induced programmed cell death (PCD). Bcl-2 transfected PW cells, that overexpressed Bcl-2, were significantly more radioresistant than parental or neomycin control transfected PW cells. The viability of Bcl-2 transfected cells was significantly greater than that of parental PW cells treated with the bioreductive cytotoxin SR4233 under aerobic conditions. Bcl-2 transfectants were also significantly more resistant to hypoxia-induced PCD. However, there was no significant difference in the viability of parental and Bcl-2 transfected cells exposed to SR4233 under hypoxic conditions (pO(2)<100 ppm). Incubation of parental PW cells with N-acetyl cysteine decreased the cytotoxicity of SR4233 under aerobic but not anaerobic conditions. Depletion of cellular glutathione with buthionine sulphoxamine killed nearly 100% of control PW cells, but none of the Bcl-2 transfectants under the same conditions. The TBARS assay for lipid peroxidation showed that Bcl-2 transfectants had a significantly lower level of lipid peroxidation than parental PW cells following a 24 hour constant exposure to SR4233 under aerobic conditions. These results suggest that Bcl-2 overexpression inhibits PCD induced by the bioreductive cytotoxin SR4233 under aerobic conditions as well as PCD induced by hypoxia, and that there are other pathways leading to PCD that are unaffected by Bcl-2 overexpression.

Journal Article↗
PubMed1995

Hip arthroplasty in hemophilic arthropathy.

As hemophilic arthropathy infrequently affects the hip joint, we performed a multicenter retrospective study to determine the results of hip arthroplasty in hemophilic patients. Thirty-four hip arthroplasties were performed in twenty-seven male patients at four major hemophilia centers from October 1972 through September 1990. Twenty-six patients had classic hemophilia and one had factor-IX deficiency. The mean age of the patients at the time of the operation was thirty-eight years (range, fifteen to seventy-three years). The mean duration of follow-up was eight years, with a minimum of two years for all patients who were still alive at the time of this review. Four patients were seropositive for the human immunodeficiency virus at the time of the operation, and sixteen patients were seropositive at the time of the most recent follow-up examination. Nine patients (33 per cent) died before the time of this review; seven had been seropositive for the human immunodeficiency virus. There were twenty-six total hip arthroplasties performed with cement, six total hip arthroplasties performed without cement, one total hip arthroplasty in which the femoral component was inserted with cement and the acetabular component was inserted without it (so-called hybrid arthroplasty), and one bipolar arthroplasty performed with cement. There were no early infections after these thirty-four primary arthroplasties. There were three late infections around prostheses inserted with cement, and all led to a resection arthroplasty. Six (21 per cent) of the twenty-eight cemented femoral components and six (23 per cent) of the twenty-six cemented acetabular components were revised because of aseptic loosening.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1993

Hemophilia: the changing role of the orthopedic surgeon in the era of HIV infection.

HIV infection and AIDS have posed additional challenges to the orthopedic surgeon and they are discussed in this paper. The acute hemarthrosis. 1. Undertreatment has resulted in further joint degeneration 2. A hemarthrosis with an unusual pain pattern or an elevated temperature may be a pyarthrosis and aspiration and culture are necessary for diagnosis. This complication was very rare prior to HIV infection. Synovitis. 1. In the past we suggested factor replacement and steroids as the primary method of treatment. The use of steroids may be contraindicated in the HIV positive patient. 2. Radioactive synovectomy should be considered in the immune compromised patient. 3. The risks to the surgical team of arthroscopic synovectomy are discussed. Advanced arthropathy. 1. A late infection rate of 10.4% in HIV positive patients with total knee replacements has changed the indications for this procedure. 2. Lesser procedures such as arthrotomy and osteotomy should be considered. Pseudotumor. 1. The indications for pseudotumor surgery must include an evaluation of the risk-benefit ratio in the patient with HIV infection. 2. The orthopedic surgeon must accept the challenge of stimulating and training his students and residents in the principles of orthopedic care of the person with hemophilia.

HIV Infections↗
PubMed1992

Antibodies to the rat substance P receptor: production and characterization.

1. A protein A-rat substance P receptor (SPR) fusion protein was genetically engineered and used as an immunogen to raise a polyclonal antiserum to the SPR. The fusion protein was expressed in Escherichia coli driven by the heat-inducible lambda promoter (lambda Pr). 2. The fusion protein was purified using an IgG-Sepharose column, which specifically binds proteins containing the protein A moiety. The IgG fraction obtained after the immunization was cleaved to produce Fab fragments, which were subsequently purified using a fusion protein affinity column. The serum (anti-SPR Fab serum) was analyzed by fluorescence-activated cell sorting (FACS) and immunohistochemistry on both a constitutive cell line for the SPR (AR42J) and a cell line transfected with the SPR (KNRKSPR). 3. Specificity of the antiserum for SPR was confirmed by immunohistochemistry on cells using antiserum that had been preincubated with the protein A fusion protein (blocked). 4. The Ca2+ signal normally observed on stimulation of SPR with SP in AR42J cells and SP binding to KNRKSPR cells was shown to be diminished in the presence of anti-SPR Fab serum. SPR from both cell lines was immunoprecipitated using the anti-SPR Fab serum. The antiserum itself did not induce intracellular Ca2+ mobilization normally observed when cells were incubated with SP. 5. This specific SPR antiserum will be a useful tool to investigate further the mechanisms of SP/SPR interactions.

Amino Acid Sequence↗
PubMed1992

Hemophilia: evaluation of musculoskeletal involvement with CT, sonography, and MR imaging.

The purpose of this essay is to illustrate features of the musculoskeletal complications of hemophilia as shown by CT, sonography, and MR imaging. MR can be used to detect early synovial and cartilaginous changes that may not be evident on conventional radiography and to differentiate between acute and chronic bleeding in soft tissues. CT is useful in evaluating subtle bony erosion and intra- and extraosseous pseudotumors. Sonography is valuable in following progression and regression of soft-tissue hematomas.

Bone Diseases↗
PubMed1991

Expression and partial purification of human prolactin in Escherichia coli.

1. Human prolactin has been expressed in Escherichia coli. A cDNA fragment coding for the signal sequence and the full length prolactin molecule was cloned into the expression vector pUR291 which directs the synthesis of a beta-galactosidase prolactin fusion protein when expressed in E. coli. 2. Cultures of E. coli harbouring the recombinant plasmid pJMBG62 produced a fusion protein of the appropriate molecular weight which was detected by Western blot analysis using a polyclonal antibody raised against pituitary-derived human prolactin. 3. The fusion protein was isolated from inclusion bodies in a partially pure form and it was used as immunogen to raise antibodies against human prolactin. 4. When this partially purified fusion protein was injected into rabbits it generated antisera with good prolactin titres in animals which were rested for one year following a disappointing primary immunization with purified human prolactin.

Blotting, Western↗
PubMed1988

Carpal tunnel syndrome in patients who are receiving long-term renal hemodialysis.

In forty-six (9 per cent) of 485 patients who were receiving long-term renal hemodialysis, a carpal tunnel syndrome developed in at least one hand. A total of sixty-four surgical procedures were performed for this problem in forty-one patients. All of the forty-one patients reported symptomatic relief, although three had recurrent symptoms. There was no correlation between the time of onset of the carpal tunnel syndrome and such factors as the patient's age, sex, or race; the cause of renal failure; the site of vascular access for hemodialysis; or a history of parathyroidectomy. There was a correlation, however, between the development of the carpal tunnel syndrome, the side of the longest functional vascular access, and the presence of arterial calcifications. In all eleven patients in whom a radial steal syndrome developed, an ipsilateral carpal-tunnel syndrome also developed. It was concluded that factors other than those involving the site of vascular access must have important etiological roles.

Adult↗