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Biomedical subjects

N J Goddard

Publications and source records attributed to N J Goddard.

At least 19 recordsLinked to original sources
PubMed2006

Heterotropic bone formation as a complication of elective joint replacement in haemophilic patients - a case report and literature review.

We report two cases of this rare postoperative condition. Both patients having undergone extensive surgery to their hips, developed increased bone growth in the soft tissue of the hip, accounting for the reduced range of movement, pain and stiffness. Plain x-rays taken confirmed the presence of heterotopic ossification, also known as a variant of myositis ossificans. We review the literature and discuss treatment options of this rare condition in patients with end-stage haemophilic arthropathy.

Aged↗
PubMed2005

Haemophilic arthropathy of the elbow.

Patients affected by haemophilia commonly have recurrent intra-articular bleeding which leads to progressive destruction and instability of joints. Severe arthropathy of the elbow is complicated by pain, stiffness and loss of function which can be debilitating. Conservative measures such as analgesics, physiotherapy and orthotics are commonly used in the management of these patients. Surgery is considered when conservative measures fail to control the symptoms. Total elbow replacement is now increasingly performed with the advances made in factor replacement therapy and evolution of better implants and techniques of total elbow arthroplasty. The pathogenesis, clinical features and radiological changes of haemophilic arthropathy of the elbow are described in this review article.

Acute Disease↗
PubMed2004

Novel variable volume injector for performing sample introduction in a miniaturised isotachophoresis device.

A microdevice design furnished with a novel sample injector, capable of delivering variable volume samples, for miniaturised isotachophoretic separations is presented. Micromachining by direct milling was used to realise two flow channel network designs on poly(methyl methacrylate) chips. Both designs comprised a wide bore sample channel interfaced, via a short connection channel, to a narrow bore separation channel. Superior injection performance was observed with a connection channel angled at 45 degrees to the separation channel compared to a device using a channel angled at 90 degrees. Automated delivery of electrolytes to the microdevice was demonstrated with both hydrostatic pumping and syringe pumps; both gave reproducible sample injection. A range of different sampling strategies were investigated. Isotachophoretic separations of model analytes (metal ions and an anionic dye) demonstrated the potential of the device. Separations of ten metal cations were achieved in under 475 s.

Anions↗
PubMed2003

Integrated moulded polymer electrodes for performing conductivity detection on isotachophoresis microdevices.

The feasibility of using integrated injection moulded polymer electrodes as drive and detection electrodes for performing miniaturised isotachophoresis (ITP) separations with conductivity detection has been demonstrated. Injection moulded electrodes were produced from three different grades of carbon-filled polymer. Two of the electrode designs were found to be suitable for performing on-chip conductivity detection. The high-voltage characteristics of the microdevices were found to be suitable for performing ITP, with a power dissipation up to 1.4 W m(-1) being achieved. Three model separations are presented to demonstrate the separation capability of the miniaturised injection moulded devices. Three anionic dyes, two inorganic anions and a mixture of eight alkaline earth, transition and lanthanide metal cations were analysed.

Electric Conductivity↗
PubMed2003

Elective orthopaedic surgery for inhibitor patients.

We report on a series of 108 elective orthopaedic surgical procedures. It includes 88 radiosynoviortheses and 20 major orthopaedic procedures, performed on 51 patients at nine centres worldwide. The average age of patients was 28.5 years (range 5-40 years), and the average follow-up time was 2 years (range 1-5 years). There were 82 good results, 15 fair and 11 poor. In the synoviorthesis group (41 patients, 88 synoviortheses) the average age was 14.3 years (range 5-40 years) and the average follow-up was 6.5 years (range 1-10 years). There were 66 good results, 14 fair and eight poor. There were no complications. In the group of major orthopaedic procedures, the average age of the 10 patients was 32.5 years (range 27-40 years), and the average follow-up was 2.3 years (range 1-5 years). There were 16 good results, one fair and three poor. Postoperative bleeding complications occurred in three of the 20 major orthopaedic procedures performed (15% complications rate). They occurred in three patients treated with insufficient doses of recombinant activated factor VII. Despite such complications, the study has shown that haemophilic patients with inhibitors requiring elective orthopaedic surgery (EOS) can undergo such procedures with a high expectation of success. In other words, EOS is now possible in haemophilic patients with inhibitors, leading to an improved quality of life for these patients. Thorough analysis of each case as part of a multidisciplinary team will allow us to perform elective orthopaedic procedures in patients with inhibitors.

Adolescent↗
PubMed2002

Total knee replacement in haemophilia.

We believe that total knee replacement (TKR) is a safe and effective procedure for the management of haemophiliac joint arthropathy; however, the increased risk of infection and non-infective complications remain a cause for concern. TKR in haemophilic patients carries with it an increased risk of post-operative infection in comparison to non-haemophiliac patients. Those patients at particular risk are the HIV-positive haemophiliac patients whose CD4 count is less than 200 cells mm-3. The latest techniques have gone a long way to reducing the complication rate and to achieving results that match those of a similar non-haemophiliac population.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Identification of a novel low-temperature-response element in the promoter of the barley (Hordeum vulgare L) gene blt101.1.

Two winter barley (Hordeum vulgare L. cv. Igri) genomic clones, lambda gblt101.1 and lambda gblt101.2, encoding the blt101 gene family, were isolated from a genomic library. Deletion analysis of the blt101.1 promoter, using transient beta-glucuronidase (GUS) reporter expression assays, indicated that it contains at least three regulatory regions. A 107-bp region between nucleotides -168 and -275 with respect to the translation initiation codon, confers high-level GUS reporter expression at low temperature and contains a sequence (designated CR1) that is highly conserved in equivalent positions within the promoters of both members of the blt101 gene family. A 10-bp motif contained within CR1 binds proteins present in nuclear extracts from both control and low-temperature-treated barley tissue. Loss-of-function experiments, using transient-expression analysis, confirmed that this motif acts as a previously unreported low-temperature-responsive element. Nuclease sensitivity analysis of intact chromatin indicated that the blt101.1 promoter becomes more susceptible to DNase and micrococcal nuclease at low temperature, consistent with chromatin reorganisation upon transcriptional induction. It is proposed that both the 10-bp motif and chromatin reorganisation are involved in the regulation of blt101.1 at low temperature. This is the first detailed analysis of a low-temperature-specific plant promoter and identifies a novel low-temperature-response element.

Adaptation, Physiological↗
PubMed2001

Embossed polymer leaky waveguide devices for spectroscopic analysis.

A combination of UV embossing, hot embossing and laminating techniques have been exploited during the fabrication of grating-coupled waveguiding devices in which the flow channel materials and geometry are designed for the effective support of light condenser modes through a sample solution. Used in conjunction with LED sources, these devices have been employed as optical platforms to obtain fluorescence emission and molecular absorption spectra in aqueous media for microTAS (micro total analytical system) applications.

Journal Article↗
PubMed2001

The technique of synoviorthesis.

Synoviorthesis (medical synovectomy) is a commonly utilized procedure employed in the management of recurrent intra-articular bleeds and secondary chronic synovitis in haemophilic patients. The procedure involves the intra-articular administration of an agent in order to induce fibrosis in the inflamed synovium so reducing the bleeding tendency. Such agents may either be chemical based (osmic acid, rifampicin) or radioactive (yttrium, gold or phosphorus). Whichever agent is employed care must be taken to avoid extra-articular complications (radiation burn and/or inflammatory reaction) as a result of extravasation or needle track contamination. The most frequently affected joints in haemophilia are the elbows, knees and the ankles, and to a lesser extent the shoulders and hips. This article outlines the techniques of injection of the five aforementioned joints, with details of the anatomical landmarks to perform the injections correctly. Injection of the elbows, knees and ankles may be carried out simply on an out-patient basis under local anaesthesia. However, it is advisable to perform injection of the shoulder or hip under radiographic control in order to ensure accurate placement. Very young children may require either sedation or a general anaesthetic. Strict asepsis is naturally a paramount requirement.

Arthroscopy↗
PubMed2000

Classification of traumatic hip dislocation.

The commonly used classification systems of hip dislocation are based on the direction of the dislocation and the presence of associated lesions. However, no rating system can reliably predict the patient's outcome and prognosis based on the initial presentation and classification. In general, patients with anterior dislocations have the best prognosis. Other factors affecting the prognosis are the associated injuries and more importantly the delay between dislocation and reduction.

Hip Dislocation↗
PubMed2000

Current attitudes to total hip replacement in the younger patient: results of a national survey.

A postal questionnaire was sent to all practicing consultant orthopaedic surgeons in the UK seeking information regarding their usual total hip replacement practice, the age at which they would define a patient as falling into the 'young hip group' and whether this might modify their practice. In particular, in the 'younger' age group, we were interested in the frequency of usage of uncemented implants, the choice of implant and the bearing surfaces. Of 1242 surgeons surveyed, we had a response from 935 who currently undertake total hip arthroplasty. Their responses confirm that approximately 60,645 total hip replacements are performed annually in the UK of which 9,376 are performed in the younger age group (mean age 57.5 years). As with our previous survey, the most popular prosthesis in the 'older' age group overall was the Charnley (51%) followed by the Exeter (15%). These implants also proved to be the most popular in the 'younger' age group (40% Charnley, 18% Exeter), with 75% of surgeons choosing a cemented stem, and 65% also opting to cement the socket. 23% of surgeons used hydroxy-apatite coated implants on both the femoral and acetabular sides of the joint. Stainless steel remained the most popular choice of femoral head bearing surface (42%) followed by chrome-cobalt (33%) and ceramic (25%). On the acetabular side, high density polyethylene predominated--accounting for 95%, with only 3% using chrome cobalt and 2% ceramic. There would appear to be a remarkably conservative attitude among British surgeons, the majority of whom prefer to stick with tried and tested cemented femoral implants when dealing with the younger patient. There are a small number of uncemented acetabulae and the hybrid configuration. Hydroxy-apatite coatings seem to be the most popular choice for the non-cemented prostheses. Ceramic femoral heads are used more frequently than the ceramic acetabular bearing, and equally metal/metal bearings remain infrequently used.

Adult↗
PubMed1998

Development of a green fluorescent protein reporter for a yeast genotoxicity biosensor.

A reporter system, constructed for a laboratory screen for new genes involved in DNA repair in the brewer's yeast Saccharomyces cerevisiae, has been developed for use in a genotoxicity biosensor. The strain produces green fluorescent protein (yEGFP) when DNA damage has occurred. yEGFP is codon optimised for yeasts. The reporter does not respond to chemicals which delay mitosis, and responds appropriately to the genetic regulation of DNA repair. Data is presented which demonstrate strain improvements appropriate to biosensor technology: improved signal to noise ratio, ease of data collection and uncomplicated material handling.

Biosensing Techniques↗
PubMed1998

Acute percutaneous scaphoid fixation using a cannulated screw.

Fractures of the scaphoid are most commonly seen in young males where immobilisation in a cast will lead to a prolonged period away from work and from athletic activities. Early rigid fixation has recently been advocated to promote a rapid functional recovery. Open reduction and internal fixation of the scaphoid is however technically demanding, damages the anterior radiocarpal ligaments, violates the scapho trapezial joint, further endangers the already compromised blood supply of the scaphoid and not infrequently leads to troublesome hypertrophic scars. These problems can be overcome in minimally displaced or undisplaced fractures by percutaneous fixation. We present the first 50 cases from our ongoing study of patients treated acutely in this way. No cast immobilisation was used and the patients were allowed to mobilise immediately postoperatively. Union was obtained in all cases after an average of 55 days (37-79). Range of movement at the time of fracture union was equal to that of the contralateral limb at three months and grip strength was 98% of the contralateral side at three months. Patients returned to sedentary work within 4 days and to manual work/sports within 5 weeks. We have found percutaneous scaphoid fixation for acute fractures a rapid and very satisfactory intervention which leads to a rapid functional recovery.

Adolescent↗