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S Trumble

Publications and source records attributed to S Trumble.

9 recordsLinked to original sources
PubMed1999

Proteins bound to polyethylene components in patients who have aseptic loosening after total joint arthroplasty. A preliminary report.

BACKGROUND: Immunological responses to proteins that adhere to ultra-high molecular weight polyethylene have not, to our knowledge, been examined previously in patients who have aseptic loosening. In the current study, polyethylene components from forty-nine failed prostheses recovered during revision procedures were examined for the presence of antibodies that were bound to the polyethylene surface or that were reactive with other proteins that were bound to the polyethylene surface. METHODS: The polyethylene components consisted of thirty acetabular cups recovered during revision total hip arthroplasties and nineteen tibial components recovered during revision total knee arthroplasties. After extensive washing, bound proteins were extracted from the polyethylene components with use of 0.1-molar glycine-hydrogen chloride solution followed by four-molar guanidine hydrochloride solution. RESULTS: Sufficient protein for analysis was recovered from forty-two polyethylene components. Polyacrylamide gel electrophoresis demonstrated a minimum of one and a maximum of twelve protein bands, with molecular weights ranging from thirteen to 231 kilodaltons. Immunoblotting revealed the presence of type-I collagen in most (thirty-four) of the forty-two explants, whereas aggrecan proteoglycans were detected in eight samples. Immunoglobulin also was detected in most (thirty-three) extracts, whereas type-II collagen was consistently absent. The presence of autologous antibodies directed against polyethylene-bound proteins in sera drawn at the time of the revision was investigated. Antibodies that were reactive against the ultra-high molecular weight polyethylene-bound proteins were detected in twenty-six of the forty-two patients with use of the Western blot technique. The number of reactive bands ranged from one to six, and the strongest binding was directed against a 103-kilodalton protein. Assays for specificity revealed that these sera autologous antibodies were reactive against the type-I collagen that was present in the explant solutions. CONCLUSIONS: We hypothesize that immunoglobulin complexed with polyethylene may fix complement and that the complement cascade may in turn attract inflammatory cells to the polyethylene surface. Our data support the hypothesis that an immunological response to antigens bound to the polyethylene surface may contribute to aseptic loosening. CLINICAL RELEVANCE: Despite improvements in materials and designs of prostheses, aseptic loosening is the most common complication of total joint replacement, frequently leading to revision operations. We examined the immunological response to proteins that bind to ultra-high molecular weight polyethylene in patients who had aseptic loosening and discovered a high prevalence of antibodies to polyethylene-bound proteins. This immunological response may contribute to an inflammatory reaction in the periprosthetic tissue, ultimately leading to increased bone resorption around the prosthesis.

Antigen-Antibody Complex↗
PubMed1999

Dementia in Down syndrome. Untangling the threads.

Despite frequent neuropathological findings, the prevalence of dementia in people with Down syndrome is thought to be no higher than in the general population. The age of onset, however, is approximately two decades earlier. The most important factor in the general practitioner's assessment of a person with this syndrome who appears to be dementing is the exclusion of medical problems that may be masquerading as Alzheimer disease. This article presents an efficient system for the clinical review of people with Down syndrome who are declining in function. The system is also adaptable for use with people who do not have this syndrome.

Age of Onset↗
PubMed1993

Fluorescent histochemical localization of lipid peroxidation during brain reperfusion following cardiac arrest.

Rats were subjected to cardiac arrest and resuscitation, 90 min of reperfusion, and in situ perfusion fixation. Thiobarbituric acid (TBA) was included in the aldehyde-free perfusion fixative, the TBA reaction was driven in situ by heating, and fluorescence microscopy was utilized to characterize the location of products of the TBA reaction. Absorbance-difference spectra were performed on butanol-extracted brain homogenates to confirm in situ formation of TBA adducts with aldehydic products of lipid peroxidation. Nissl-stained sections revealed good cellular fixation without shrinkage artifacts. Fluorescence was not seen microscopically when TBA was omitted from the perfusion fixative, and little fluorescence was present in normal brains or brains after ischemia only. However, after 90-min reperfusion, intense granular fluorescence was seen in the neuronal perikarya (especially at the base of the apical dendrite) of numerous pyramidal neurons in cortical layers 5 and 6 and in the pyramidal layer of Ammon's horn in the hippocampus. The nuclei of these cells exhibited no fluorescence. Fluorescence was also present in some striatal neurons, but was absent in the adjacent radial bundles. Neither glia nor white matter exhibited similar fluorescence. These observations indicate that neurons in the selectively vulnerable zones of the cortex and hippocampus are early and specific targets of lipid peroxidation during post-ischemic reperfusion.

Animals↗
PubMed1993

Communicating with people who have intellectual disabilities.

Much of the art of general practice lies in the ability to communicate. For this reason, successful general practitioners tend to have highly developed skills in listening and talking to their patients. The process, however, becomes more difficult when patients do not share these verbal skills. The worldwide move towards the reintegration of previously institutionalised people means that most Australian general practitioners will encounter more intellectually disabled people in their practices. This accessing of mainstream health services appears to result in better quality care being available to this previously neglected group, although many people with intellectual disabilities report frustration in communicating effectively with their general practitioners.

Adult↗
PubMed1993

Advocacy, guardianship and the GP.

Australians have come to realise that they have a right to access high quality health care through their general practitioner. It is essential that people with cognitive impairments through intellectual disability, psychiatric disorders, senility or brain damage are not denied equity of access through their inability to seek medical attention. Those who cannot make reasonable decisions or who cannot understand and give legal consent to operative procedures may need to have a guardian appointed to protect their rights. In other situations an advocate may be appointed if the person's rights are in jeopardy. The general practitioner is often the first person to become aware of the needs of disabled people and is well placed to intervene to ensure the protection of their rights. This includes the right to good health care.

Australia↗
PubMedDate not supplied

Depression of the medial tibial plateau in early-onset Blount disease: myth or reality?

Patients with severe early-onset Blount disease (Langenskiold III or greater) often have the radiographic appearance of depression of the medial tibial plateau and delayed ossification of the epiphysis, adjacent physis, and metaphysis. Schoenecker and other authors recommended elevation of the medial plateau of the tibia for correction of this deformity. The purpose of this study was to assess the nature of the medial proximal tibia in these severe cases. Eight girls and two boys (17 tibiae) with severe early-onset Blount disease had standing radiographs and magnetic resonance imaging (MRI) evaluation. Average patient age was 5.8 years (range, 3-8 years). Eleven knees in eight patients underwent arthrography at the time of surgical correction of deformity. No tibia had MRI or arthrographic evidence of medial tibial joint "depression." The "empty" radiographic space was occupied by cartilage-density material. A smooth dye contour without pooling parallel to the femoral condyles was noted arthrographically in all instances. These findings do not support the concept of routine joint elevation in the correction of severe deformity associated with early-onset Blount disease.

Age of Onset↗