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Biomedical subjects

P F Hill

Publications and source records attributed to P F Hill.

11 recordsLinked to original sources
PubMed2002

Contamination of ballistic fractures: an in vitro model.

This study allowed the development of an in vitro model of a high-energy ballistic fracture. Direct fractures are more heavily contaminated than indirect fractures, and the spread of contamination is more extensive than examination of the wounds, particularly the entry wounds, would suggest. The major spread of contamination is along tissue planes, and we would recommend that these are thoroughly lavaged in the management of the fracture. The fracture site is heavily contaminated, with endosteal spread in direct fractures. However, there appears to be relatively little bony contamination beyond the fracture site.

Animals↗
PubMed2002

Early intramedullary nailing in an animal model of a heavily contaminated fracture of the tibia.

An ovine model was developed to study the outcome following intramedullary nailing of a heavily contaminated fracture. Animals in the control group received no treatment directed at controlling infection, whereas those in the treatment group received wound debridement, lavage and the use of appropriate systemic antibiotics. Despite this, infection developed at the osteotomy site and along the entire length of the implant in all animals in both groups. It was felt that standard methods of wound management might be inadequate when applied at the time of intramedullary nailing since the spread of contamination following the use of reamers was demonstrated in all animals. Results from this study support the clinical impression that heavily contaminated fractures should not be treated by primary intramedullary nailing.

Animals↗
PubMed2001

Small fragment wounds: biophysics, pathophysiology and principles of management.

Military surgical doctrine has traditionally taught that all ballistic wounds should be formally managed by surgical intervention. There is now, however, both experimental and clinical evidence supporting the nonoperative treatment of selected small fragment wounds. Low energy-transfer wounds affecting the soft tissues, without neuro-vascular compromise and with stable fracture patterns, may be suitable for early antibiotic treatment. The management of ballistic wounds to the gastrointestinal tract requires surgical intervention but, advances in the treatment of these wounds, especially those involving the colon, may allow more effective treatment with a reduced morbidity.

Arm Injuries↗
PubMed2000

A porcine model of sepsis resulting from the combined insults of hemorrhage and peritonitis.

The physiological responses to either hemorrhage or sepsis have been well documented, however, their simultaneous delivery, as often seen in penetrating trauma, has not been extensively studied. A terminally-anesthetized porcine model of fixed-volume hemorrhage combined with intraperitoneal sepsis was developed. Large White pigs (45-60 kg) were bled 40% of blood volume and peritonitis was induced using an E. coil (O18:K1:H7) culture. Three groups of animals were sequentially studied. Group A (n = 8) received 10(8) bacteria, and Groups B (n = 4) and C (n = 5) received 10(10) organisms. All animals were maintained on a 2.5 mL/kg/h infusion of 0.9% saline. Group C was autotransfused at 1 h. Animals were monitored for up to 24 h. Cardiovascular features of hypovolemia were recorded in all animals. Animals in Group A improved clinically with little microbiological evidence of systemic sepsis. Group B showed rapid cardiovascular collapse, early E. coil-positive blood cultures, and an early rise in serum TNF-alpha levels. Autotransfusion of Group C significantly improved cardiopulmonary parameters, acid-base status, and survival. A reproducible model of hemorrhage and peritonitis, appropriate for abdominal trauma, which allows investigation of resuscitative and pharmacological interventions has been characterized.

Acid-Base Equilibrium↗
PubMed2000

Tibiofemoral movement 2: the loaded and unloaded living knee studied by MRI.

In 13 unloaded living knees we confirmed the findings previously obtained in the unloaded cadaver knee during flexion and external rotation/internal rotation using MRI. In seven loaded living knees with the subjects squatting, the relative tibiofemoral movements were similar to those in the unloaded knee except that the medial femoral condyle tended to move about 4 mm forwards with flexion. Four of the seven loaded knees were studied during flexion in external and internal rotation. As predicted, flexion (squatting) with the tibia in external rotation suppressed the internal rotation of the tibia which had been observed during unloaded flexion.

Adult↗
PubMed1999

Fibrinogen-impregnated collagen as a combined haemostatic agent and antibiotic delivery system in a porcine model of splenic trauma.

OBJECTIVE: To assess the effect of rifampicin on the haemostatic function of a fibrinogen-impregnated collagen fleece. DESIGN: Laboratory experiment. SETTING: Government research establishment, UK. MATERIAL: Six Large White pigs. INTERVENTIONS: Four 5 cm incisions were made in the spleen of each animal. Three of the wounds were each covered with a sheet of either dry, saline-soaked or rifampicin-soaked fibrinogen-impregnated collagen. MAIN OUTCOME MEASURES: The bleeding time and blood loss from each wound was recorded. Systemic serum rifampicin concentrations were measured using a Staphylococcus aureus inhibition assay. RESULTS: Dry fibrinogen-impregnated collagen resulted in significantly less blood loss (112 (21) compared with 39 (13)ml, p < 0.05) and shorter bleeding time (16 (2) compared with 9 (1) min, p < 0.01) than in untreated control wounds. Pre-soaking in saline or rifampicin solution had no significant effect on its haemostatic function. Rifampicin concentrations above the minimum inhibitory concentration were recorded in the systemic circulation 45 minutes after injury and persisted for the duration of the experiment. CONCLUSIONS: Fibrinogen-impregnated collagen is an effective haemostatic agent in splenic trauma that may be of use for both the local and systemic delivery of antibiotics.

Animals↗
PubMed1998

Assessing the competence of student nurses.

Competence is difficult to define. Continuous assessment of practice, which involves reviewing the literature, is complex. The study involved developing a suitable tool for assessing competent practice of student nurses. The problem was investigated using Personal Construct Theory and Repertory Grid Technique. The findings suggest that trained staff assess the socialisation process of becoming a children's nurse rather than the level of competence.

Attitude of Health Personnel↗
PubMed1996

Stress fracture of the pubic ramus in female recruits.

During a four-month period we observed 12 stress fractures of the inferior pubic ramus in 11 military recruits undergoing basic training. Eleven of these were in women. This high number was considered to be caused by the introduction of mixed training of male and female recruits; this forces women to increase their stride length when marching. The presenting symptom was chronic groin pain which failed to settle with rest, and the clinical diagnoses were confirmed by radiographs in all but one patient who was diagnosed by 99mTc bone scanning. Since the required stride length has been reduced there have been no new cases of stress fracture of the pelvis.

Adolescent↗
PubMed1989

The measurement of migration of the acetabular component of hip prostheses.

Individual components of a total hip replacement are difficult to evaluate and quantify. We have studied the assessment of the acetabular component, and conclude that the measurement of migration allows the comparison of implants, although there is no established link between migration and significant loosening. A method of measurement based on clinical radiographs has been developed, and its limitations estimated. The accuracy of the technique was calculated to be +/- 3 mm.

Acetabulum↗
PubMedDate not supplied

Stress fracture of the sternum: an unusual injury?

Stress fracture of the sternum is a rare condition which presents as acute anterior chest pain after repetitive upper-body exercise. Two case reports are presented and it is postulated that this is an often underdiagnosed condition which should be considered in the differential diagnosis of acute chest pain in the athlete. Awareness of the injury together with meticulous clinical examination supported by good quality radiographs or isotope bone scan may lead to an increase in the diagnosis of this injury.

Acute Disease↗