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Biomedical subjects

M T Galloway

Publications and source records attributed to M T Galloway.

18 recordsLinked to original sources
PubMed2001

Management of osteochondral injuries of the knee.

The management of articular cartilage lesions has yet to reveal a "right answer." Instead, it must be recognized as a multifactorial clinical challenge that requires the physician to consider surgical, biomechanical, and physiologic implications of the management chosen. The goal is to restore normal type II cartilage to the area of concern. Falling short of that, we must strive for the most reasonable of the facsimiles currently available. The science certainly will advance to assist our understanding of articular cartilage and the best way to approximate or replicate its properties. Continued research must examine which of the many variables are essential to address in contemplating these challenging cases. Basic science research appears to be the area of greatest promise. Perhaps elucidating the roles of Cartilage Derived Morphogenetic Proteins (CDMP) and other polyclonal stimulators of mesenchymal stem cells, and refining techniques of cartilage autotransplantation, should be included in the areas of focus. Studies evaluating stem cells as progenitors to cartilage-forming cells will bear watching. Long-term follow-up studies of all of the techniques reviewed are needed to give definitive answers about the durability of the repair and transplanted tissues. The orthopaedist taking care of these lesions is well served to have more than one option in managing these challenging clinical problems.

Arthroplasty↗
PubMed2001

Irreducible knee dislocations secondary to interposed menisci.

Dislocations of the knee are accompanied by a highly variable pattern of osseous and soft tissue injury. While much attention has been directed toward the various combinations of ligament involvement observed in these injuries, the patterns of associated meniscal injury are described less frequently. We report two cases of patients in whom displaced medial meniscal tears prevented closed reduction following knee dislocation. Displaced bucket-handle meniscal tears necessitated open reduction in these patients and should be considered when evaluating patients with knee dislocations.

Accidents, Traffic↗
PubMed1998

Platelet activation during dobutamine stress echocardiography.

BACKGROUND: Dobutamine stress echocardiography (DSE) is a common, useful test for the evaluation of coronary artery disease. Two of 650 patients who underwent DSE at our institution sustained nonfatal myocardial infarction either during DSE or shortly thereafter. Although DSE is associated with low morbidity rates, this rate is higher than our experience with exercise treadmill testing (ETT). METHODS: Six individuals who did not undergo DSE or ETT were enrolled to evaluate direct in vitro effects of dobutamine on platelets. Nine patients undergoing DSE and seven patients undergoing ETT were enrolled to evaluate in vivo platelet activation. We used flow cytometry and fluorescent-labeled monoclonal antibodies to activation-dependent platelet antigens to detect dobutamine-associated platelet activation both in vitro and in vivo. RESULTS: In vitro we found a synergistic increase in epinephrine-induced CD62 expression in the presence of dobutamine. The response to the combination of dobutamine and epinephrine was 151% to 565% of the expected response. In vivo there was a dose- and time-dependent rise in the percentage of platelets expressing CD62 in all nine subjects undergoing DSE. The median percentage of platelets expressing CD62 was 1.6% (range 0.1% to 6.8%), 6.5% (range 0.2% to 11.7%), 11.6% (range 5.9% to 19.1%), and 11.4% (range 7.2% to 25.0%) in the samples obtained at baseline, 20 microg/kg/min of dobutamine, 40 microg/kg/min of dobutamine, and during the recovery phase, respectively (repeated measures analysis of variance, p = 0.02). There was no increase in CD62 expression on platelets obtained from seven patients at peak ETT. The median percentage of CD62 at baseline ETT was 1.9% (range 0.2% to 7.3%) and at peak was 2.6% (range 0.4% to 7.0%) (p = 0.156, Wilcoxon signed rank test). CONCLUSION: We conclude that platelet activation occurs in vivo in patients undergoing DSE and that this may be caused by a synergistic effect of dobutamine with physiologic platelet agonists.

Adult↗
PubMed1997

The efficacy of regional anesthesia for outpatient anterior cruciate ligament reconstruction.

Arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. Until recently, the majority of these procedures have been performed on an impatient basis. This retrospective study evaluated 67 consecutive patients who underwent an arthroscopically assisted, autogenous bone-patellar ligament-bone ACL reconstruction that was supervised by the same surgeon. General endotracheal anesthesia was used for 36 patients and a femoral sciatic nerve block was used in 31 patients. Only patients who underwent either isolated ACL reconstructions, or those combined with either medial or lateral meniscectomies, were included. No statistically significant differences in either the mean anesthesia time or operative time existed between the general anesthesia and regional anesthesia groups. Patients receiving regional anesthesia did require a significantly longer recovery room stay than those who received general anesthesia. Most of the patients who received general anesthesia had inpatient procedures. In the general anesthesia group, 31 of 36 patients spent at least one night in the hospital. Three of 30 patients who received regional anesthesia required hospital admission. There were no differences between anesthesia-related complication between groups. The cost saving of performing ACL reconstructions under regional anesthesia compared with general anesthesia was calculated to be $2,907 per case and predominantly reflected the outpatient approach used in these cases. This study supports the use of femoral sciatic nerve block anesthesia as a safe and reliable alternative to general anesthesia for patients undergoing outpatient ACL reconstruction. The use of this technique was not found to compromise operating room efficiency. Patients receiving regional anesthesia did require a slightly longer recovery room stay. ACL reconstruction performed under regional anesthesia with same-day discharge was well tolerated by our patients and it provides a cost-efficient alternative to ACL reconstructions performed as inpatient procedures.

Adult↗
PubMed1997

Acute myocardial infarction associated with dobutamine stress echocardiography.

Acute myocardial infarction as a complication of dobutamine stress echocardiography (DSE) is described in two patients during or shortly after undergoing the procedure. Both clinical events resulted in characteristic elevations in cardiac enzymes and the development of new electrocardiographic Q waves in the inferior leads. Subsequent coronary angiography was performed in both cases; one patient required two-vessel coronary artery bypass grafting to his first obtuse marginal and posterior descending arteries, and the other underwent successful angioplasty of an occluded proximal right coronary artery. Only two cases of DSE-associated myocardial infarction have been reported previously in the literature.

Dobutamine↗
PubMed1997

Effect of red wine on endothelium-dependent relaxation in rabbits.

1. Published data on the effects of red wine, ethanol and flavonoids on endothelium-dependent relaxation are equivocal. The present study was undertaken to determine the effects of red wine, ethanol and selected flavonoids present in red wine on endothelium-dependent relaxation. 2. Aortic rings from New Zealand White rabbits were set up in organ baths (20 ml) and contracted with noradrenaline (10(-6) mol/l). An attempt was made to elicit dose-dependent relaxant responses to red wine (15, 30, 40, 80 or 120 microliters), ethanol (5.4, 10.8 and 16.2 microliters) and the flavonoids catechin, epicatechin, quercetin and polymeric phenols (10(-7) to 10(-4) mol/l). In some experiments, endothelium-dependent relaxation to cumulative doses of acetylcholine (10(-9) to 10(-6) mol/l) was determined before and after incubating the rings for 15 min with red wine (120 microliters), ethanol (16.2 microliters), quercetin (10(-5) mol/l), catechin (10(-5) mol/l), epicatechin (10(-5) mol/l) and PPs (10(-5) mol/l) respectively. cGMP was also measured in some rings in the control state and after addition of 120 microliters of red wine, sodium nitroprusside (10(-4) mol/l) and polymeric phenols (10(-5) mol/l). 3. Red wine evoked a dose-dependent relaxation in aortic rings. The highest volumes of wine (120 microliters) relaxed the vessels by 71.35 +/- 7.89% of the maximal contraction (8.95 +/- 0.97 g). Polymeric phenols also relaxed the precontracted rings. These responses were abolished by NG-L-arginine methyl ester (L-NAME) and by removal of endothelium. Addition of red wine, polymeric phenols and sodium nitroprusside increased the cGMP content of the rings. In tissues previously incubated with red wine and polymeric phenols, endothelium-dependent relaxation in response to acetylcholine was attenuated. Ethanol had no such effect. 4. Acute exposure of aortic rings to red wine and polymeric phenols evokes an endothelium-dependent relaxation which is mediated by nitric oxide. However, prior exposure to both red wine and polymeric phenols has a second effect in that it attenuates the endothelium-dependent relaxation evoked by acetylcholine. Since this effect is restored by arginine, it is likely to be due to depletion of substrate for nitric oxide synthase.

Animals↗
PubMed1993

The role of exercise in the treatment of inflammatory arthritis.

A routine of regular exercise is important in patients with inflammatory arthritis. Most patients with stage I and stage II RA are capable of engaging in an exercise program. Benefits include increased cardiovascular and muscle endurance, as well as improved muscle strength (Table 1). This in turn allows patients to function more independently and with an improved quality of life. Exercise programs are designed to restore range of motion, improve strength and endurance, and at the same time provide a social outlet and opportunity for improved self esteem. Exercises should progress slowly during which time patients should be closely monitored for symptoms of increased joint inflammation.

Arthritis, Rheumatoid↗
PubMed1992

Cystic degeneration of the patella after arthroscopic chondroplasty and subchondral bone perforation.

Chondromalacia of the patella is frequently encountered in patients with anterior knee pain. Arthroscopic chondroplasty with perforation of subchondral bone remains a popular treatment alternative in spite of the inferior mechanical properties of the fibrocartilaginous tissue that this procedure is designed to promote. We report a case of cystic degeneration of the patella as a previously unrecognized complication following the procedure.

Adult↗
PubMed1992

Achilles tendon overuse injuries.

Overuse injuries of the Achilles tendon are common in patients engaging in recreational athletics. Achilles tendon overuse injuries exist as a spectrum of diseases ranging from inflammation of the paratendinous tissue (paratenonitis), to structural degeneration of the tendon (tendinosis), and finally tendon rupture. Factors known to predispose patients to Achilles tendinitis include inadequate stretching, training errors, mechanical malalignment of the lower extremities, rigid training surfaces, and occasionally systemic disease. Treatment of the patient with paratenonitis and tendinosis is initially conservative, emphasizing passive stretching, concentric and eccentric strengthening, correction of training errors, and restoration of normal limb alignment. Patients resistant to this protocol often exhibit a more advanced degree of tendon change. A high percentage of these patients can benefit from surgical debridement of the involved tendon, and they can anticipate successful return to recreational athletics. Steroid injections should not be routinely used in patients with Achilles tendinitis. Rupture of the Achilles tendon following intratendinous injection has been reported.

Achilles Tendon↗
PubMed1984

Evidence implicating substantia nigra in regulation of kindled seizure threshold.

We studied the effects of microinjected drugs and brainstem lesions on motor and limbic seizures in the kindling model of epilepsy. The duration of motor seizures was determined by timing the colonic and tonic movements of the extremities. The duration of limbic seizures was determined by measuring afterdischarge recorded on the electroencephalogram. Bilateral microinjection of a gamma-aminobutyric acid (GABA) agonist, muscimol, into the area of the substantia nigra (SN) markedly suppressed both motor and limbic seizures induced by stimulation of amygdala, olfactory structures, or lateral entorhinal cortex. Microinjection of saline did not suppress seizures. The suppressive effect of muscimol: (i) dissipated after several hours and was dependent on dose; (ii) was due to an elevation of the seizure threshold, since typical seizures could be elicited with electrical current far exceeding the threshold; and (iii) exhibited spatial specificity since muscimol injections 1 to 2 mm dorsal to the SN or into neocortex did not suppress the seizures. The actions of muscimol were probably mediated by its GABA agonist properties, since microinjection of an irreversible inhibitor of GABA transaminase (gamma-vinyl GABA) into the area of the SN also suppressed kindled seizures. Destruction of brainstem structures was produced by microinjection of the neurotoxin, N-methyl-D,L-aspartate. Seizures were markedly suppressed in animals with bilateral destruction of the SN but not in animals in which the SN was spared bilaterally. We interpret the data to indicate that the SN is the site at which the GABA agonists and lesions act to raise the threshold for kindled seizures. The suppression of limbic seizures indicates that this brainstem nucleus can regulate the intrinsic neuronal excitability of hemispheric sites.

Aminocaproates↗
PubMedDate not supplied

A history of low back injury is a risk factor for recurrent back injuries in varsity athletes.

In this prospective study, we investigated whether a history of previous low back injury and dissatisfaction with a coach and teammates could predict future low back injury in varsity athletes during a 1-year follow-up period. Of 679 Yale varsity athletes surveyed in 1999, 18.3% (124) reported that they had sustained a low back injury within the past 5 years, and 6.8% (46) sustained a low back injury in the follow-up season. There were no differences in incidence rates between men and women or between athletes involved in contact or noncontact sports. A history of low back injury was the significant predictor for sustaining low back injury in the following year, and athletes who reported previous low back injury were at three times greater risk. Athletes who still had pain at the time of the survey were six times more likely to sustain a low back injury than were athletes without a history of low back injury. These results suggest that some risk factors associated with a history of low back injury predispose athletes to sustain recurrent injury. They may be congenital or a result of insufficient recovery time after the first low back injury episode.

Adult↗
PubMedDate not supplied

Posterior cruciate ligament reconstruction. An in vitro study of femoral and tibial graft placement.

We studied posterior cruciate ligament reconstruction in a cadaveric model using two substitutes: a 1-mm diameter flexible cable and an 11-mm diameter Achilles tendon autograft. The thin cable allowed us to study five femoral and five tibial attachments in each knee. A nearly isometric attachment was located after cutting the posterior cruciate ligament while the tibia was reduced with a 100 N anterior force. The five femoral locations studied were the isometric location and four locations centered around this isometric point. The Achilles tendon reconstruction was used with both an isometric and a nonisometric femoral site, allowing us to confirm the results with the wire cable. Posterior motion limits were measured under a 100 N posterior force in the intact, posterior cruciate ligament-deficient, and posterior cruciate ligament-reconstructed knees. We found that the restoration of knee stability in flexion depended strongly on the femoral attachment location. A femoral attachment that was nonisometric by intraoperative measurement, but within the posterior cruciate ligament anatomic footprint, most closely reproduced the intact knee's posterior motion limits. Variations in the tibial attachment site produced only minor changes in the posterior motion limits. We concluded that the proximal-distal location selected for the femoral attachment of a posterior cruciate ligament substitute was particularly important in the restoration of normal posterior motion limits.

Achilles Tendon↗
PubMedDate not supplied

Aging successfully: the importance of physical activity in maintaining health and function.

Physicians caring for middle-aged and older patients frequently overlook the importance of regular physical activity. Exercise on a routine basis is an important component of successful aging. It has been shown that many age-related declines in musculoskeletal function can be markedly reduced by participation in some form of regular exercise. Examination of records from masters athletic competitions has been used to determine the true rate of age-related functional declines in highly trained, healthy individuals and further supports these findings. Declines in physical abilities for masters athletes are gradual, which suggests that for many, the potential for participation in competitive athletics can persist well into the seventh decade of life. Recent studies indicate that health gains can be achieved with relatively low volumes of exercise. Indeed, the greatest benefit is seen when one "goes from doing nothing to doing something." Current data suggest that a cumulative total of 30 to 50 minutes of aerobic exercise a day performed 3 to 5 days a week and one set of resistance exercises targeting the major muscle groups twice a week can produce significant health benefits. The aerobic conditioning requirement need not be a formal or structured activity, but can be satisfied through regular participation in many common physical tasks (e.g., walking, gardening, housekeeping). Musculoskeletal injuries are a major cause of noncompliance with any exercise regimen and are especially debilitating for older individuals. Prompt recognition of injury and treatment that emphasizes alternative conditioning exercises and minimizes "downtime" are especially important. Orthopaedists should be aware of the pattern of musculoskeletal injuries seen in this population, so as to assist their patients in avoiding these problems.

Aged↗