Biomedical subjects
Publications and source records attributed to R Owen.
A study of isotope scanning in children with irritable hip syndrome has demonstrated its role as a discriminator between Perthes disease and transient synovitis. Three children with normal radiographs had Perthes changes on scanning and went on to develop X-ray changes. An anatomical and pathological basis for the scan abnormalities is suggested.
Thirty-six patients with generalised anxiety disorder, panic disorder or agoraphobia with panic attacks, diagnosed by DSM-III criteria, were treated with a new non-benzodiazepine anti-anxiety drug, buspirone, and with diazepam and placebo, in a cross-over design. Each patient took buspirone, diazepam and placebo for one week each in flexible dosage and balanced order. Ratings of symptomatology using the Comprehensive Psychopathological Rating Scale were made after each week's treatment and a sub-scale used for measuring anxiety change alone was used separately. There was no overall difference in efficacy between the drugs, but when the scores for individual symptoms were analysed, diazepam was significantly superior to the other treatments for the symptom of muscle tension only. The results suggest that the common practice of giving short-term therapy with tranquilising drugs for anxiety in primary care is pharmacologically suspect.
Following pin fixation of the femoral neck, extrusion of a pin tip into the joint space cannot be excluded with conventional bi-plane radiography. A per-cervical pin was allowed to extrude from the head of a dried femur. Anteroposterior and lateral photographs and roentgenograms of this preparation, simulating corresponding intra-operative radiology, demonstrated misleadingly that the pin tip was wholly within the head. Careful intra-operative and post-operative screening is considered important to detect unwanted joint penetration and so avoid avascular necrosis and late degenerative change.
Valgus deformity of the hindfoot can occur at the subtalar joint, the ankle joint, or at both sites. In children suffering from spina bifida, the ankle is often the main site of deformity. Thirty-five ankles with valgus deformity of the hindfoot were studied in 23 children with spina bifida. A radiological triad was observed in all patients: shortening of the fibula, lateral wedging of the distal tibial epiphysis, and lateral tilt of the talus at the ankle mortise . There was a definite correlation between the severity of wedging and the degree of talar tilt, and a fair correlation between the severity of wedging and the extent of fibular shortening. The results of operation in 12 feet are presented. It is concluded that any operations performed below the ankle on these patients (subtalar fusion or triple arthrodesis) is unlikely to succeed; the deformity needs to be corrected above the ankle (by epiphysiodesis or supramalleolar osteotomy). Radiological assessment of the ankle by taking weight-bearing films in the anteroposterior plane is essential to determine the true extent of the deformity before undertaking any operation.
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41 outpatients who were long-term consumers of diazepam in therapeutic dosage were gradually withdrawn from the drug over 3 months by stepwise reduction. In a double-blind procedure half the patients began withdrawal immediately and half after 8 weeks. Of 36 patients who completed treatment, 16 (44.4%) experienced true withdrawal phenomena on reducing their drugs, but 8 other patients had pseudo-withdrawal reactions at a time when their drug treatment was unchanged. The pseudo-withdrawal reactions consisted of an increase in anxiety symptoms only, whereas true withdrawal symptoms also included perceptual changes and psychotic symptoms. Examination of pharmacological and clinical predictors of withdrawal phenomena and later relapse showed that personality factors were the most important, patients with passive-dependent traits having a significantly greater prevalence of withdrawal reactions.
We report for the first time the combination of congenital sacral agenesis and congenital absence of the pituitary gland. This rare association is described in a baby born to a diabetic mother. The baby died at the age of 11 weeks after a cardiorespiratory collapse. The findings at necropsy, which included unusual neurological and visceral anomalies, are reported. We draw attention to the increasing evidence that maternal diabetes is a factor in producing foetal malformations.
This paper reports on 41 immature patients whose scoliosis was treated by fixation of ribs on the convexity. All had progressive scoliosis, the curve deteriorating at more than 10 degrees p.a., or the rib-vertebra angle difference being greater than 20 degrees. Of the 24 with infantile idiopathic scoliosis examined 5 years after operation, 10 maintained the improvement obtained at operation and in a further 19 the rate of deterioration had been slowed. Factors leading to a favourable outcome included: 1) An initial rib-vertebra angle difference of less than 30 degrees. 2) Success in achieving convex rib fusion. 3) The use of the operation in patients with infantile idiopathic scoliosis. There was a less favourable outcome in congenital and adolescent scoliosis. Spirometric volumes were diminished immediately after operation. Costodesis is therefore contraindicated in patients with precarious respiratory function.
Two cases of non-union of fractures of the carpal scaphoid in children are described, which were successfully treated by cancellous bone grafting with Kirschner wife fixation.
Intestinal mucosal cells from the rat have been isolated by a new technique involving intravascular perfusion of an intestinal segment with collagenase. Detached cells were flushed from the intestinal lumen with a second perfusion circuit containing an oxygenated buffered solution with 1% bovine serum. Sequential collection of cells at intervals during the period of perfusion revealed that villus-tip cells are recovered first (after 15 min of collagenase perfusion), followed by midvillus (after 25 min) and lower villus cells (after 35 min). The isolated cells were judged intact and viable by the criteria of trypan blue dye exclusion, ultrastructural appearance, and metabolic activity. They were characterized as villus-tip, midvillus, and lower villus-crypt cells by their alkaline phosphatase and sucrase activity, glycoprotein formation, and [3H]thymidine incorporation. Microsomal monooxygenase activity was four to five times greater in villus-tip than in lower villus cells, whereas heme oxygenase exhibited a reverse gradient. The isolated cells synthesized heme and bilirubin under cell culture conditions.
Eighty midshaft fractures of the forearm bones in children are reviewed. These fractures occur predominantly in boys and are more frequent in the left forearm. The fractures can occur at any age, but the majority are seen between 6 and 8 years of age. They are divided into two groups: greenstick (Type 1) and displaced fractures (Type 2). Greenstick fractures (Type 1, 82.5 per cent) need only correction of the deformity without breaking the intact cortex, followed by supervized splintage for 6 weeks. Type 2(a) (3.8 per cent) fractures, where only one bone is displaced, were treated conservatively, but the displaced bone tends to heal with lateral angulation causing limited rotation unless adequately aligned surgically. Type 2(b) (13.7 per cent) fractures, where both bones are displaced, occur in young teenagers. The majority of these should be treated by internal fixation if adequate alignment cannot be achieved or maintained by conservative means.
The mechanism of impairment of ventilatory function in idiopathic scoliosis has been studied in 23 children, all girls, and compared with 27 normal children and 24 normal young adult females. The vital capacity, FEV 1, gas transfer factor, and the maximum static expiratory airway pressure were all significantly reduced. total lung capacity and the maximum inspiratory pressure were lower than in the normal subjects, but the difference was not significant. Restriction of thoracic cage movement by a belt showed that the thorax in the children with scoliosis was as mobile as in the normal subjects. The results are explained in terms of the characteristic deformity in scoliosis which causes one hemi-thorax to become relatively smaller than the other. It is concluded that this causes an inherent mechanical inefficiency of ventilation which is likely to contribute to respiratory failure in these subjects.
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Seventy per cent of cases of osteoarthrosis of the hip are regarded as being 'idiopathic' in type. Idiopathic osteoarthrosis of the hip is twice as common in females as in males. Osteoarthrosis of the hands shows a definite association with idiopathic osteoarthrosis of the hip, especially in women. Osteoarthrosis of the knees is found in over half the cases of idiopathic osteoarthrosis of the hip and of the hands, although there are sex differences in the distribution of hand and knee osteoarthrosis in these cases. Hand osteoarthrosis is not related to hand laterality, although osteoarthritic changes are likely to be more severe in the dominant hand when there is osteoarthrosis of both hands. No convincing evidence was found of a relationship between the various slab radiograph patterns from femoral heads and idiopathic osteoarthrosis of the hip. There was no definite association between idiopathic osteoarthrosis and the presence of various tissue antigens. The identification of a group of patients with idiopathic osteoarthrosis suggests a generalised cartilage abnormality, with the development of osteoarthrosis being possible related to subsequent stress changes.