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Biomedical subjects

T D Bunker

Publications and source records attributed to T D Bunker.

At least 19 recordsLinked to original sources
PubMed2001

Primary glenoid dysplasia. A review of 12 patients.

We reviewed 12 patients with primary glenoid dysplasia. Ten were assessed clinically and two from case notes and radiographs. We identified two groups according to the age at onset of symptoms. The first (seven patients) consisted of boys and younger men, all of whom developed symptoms before the age of 40 years. All four children were free from pain, whereas the three adults in this group had varying degrees of this. Four patients had symptoms of instability. The second group consisted of older men (five patients) all of whom had noted the onset of symptoms, in the form of pain and stiffness, after the age of 40 years. All five had radiological evidence of osteoarthritis. Although the four children in our study had minimal symptoms, all eight adults had ongoing shoulder pain and dysfunction, despite a specific rehabilitation programme. Four patients required surgery; one had posterior stabilisation for instability and three arthroplasties of the shoulder for osteoarthritis.

Adolescent↗
PubMed2000

Expression of growth factors, cytokines and matrix metalloproteinases in frozen shoulder.

Frozen shoulder is a chronic fibrosing condition of the capsule of the joint. The predominant cells involved are fibroblasts and myofibroblasts which lay down a dense matrix of type-I and type-III collagen within the capsule. This subsequently contracts leading to the typical features of pain and stiffness. Cytokines and growth factors regulate the growth and function of the fibroblasts of connective tissue and remodelling of the matrix is controlled by the matrix metalloproteinases (MMPs) and their inhibitors. Our aim was to determine whether there was an abnormal expression or secretion of cytokines, growth factors and MMPs in tissue samples from 14 patients with frozen shoulder using the reverse transcription/polymerase chain reaction (RT/PCR) technique and to compare the findings with those in tissue from four normal control shoulders and from five patients with Dupuytren's contracture. Tissue from frozen shoulders demonstrated the presence of mRNA for a large number of cytokines and growth factors although the frequency was only slightly higher than in the control tissue. The frequency for a positive signal for the proinflammatory cytokines Il-beta and TNF-alpha and TNF-beta, was not as great as in the Dupuytren's tissue. The presence of mRNA for fibrogenic growth factors was, however, more similar to that obtained in the control and Dupuytren's tissue. This correlated with the histological findings which in most specimens showed a dense fibrous tissue response with few cells other than mature fibroblasts and with very little evidence of any active inflammatory cell process. Positive expressions of the mRNA for the MMPs were also increased, together with their natural inhibitor TIMP. The notable exception compared with control and Dupuytren's tissue was the absence of MMP-14, which is known to be a membrane-type MMP required for the activation of MMP-2 (gelatinase A). Understanding the control mechanisms which play a part in the pathogenesis of frozen shoulder may lead to the development of new regimes of treatment for this common, protracted and painful chronic fibrosing condition.

Cytokines↗
PubMed1997

Rotator-cuff tear of the hip.

We describe an apparently unreported finding during hip operations: a tear at the insertion of gluteus medius and gluteus minimus. This defect may well be known to many surgeons with experience of hip replacement and hemiarthroplasty for fractures of the neck of the femur, but a Medline search has failed to find a previous description. We made a prospective study of 50 consecutive patients with fractures of the neck of the femur to quantify the incidence of this condition: 11 (22%) had such a tear.

Aged↗
PubMed1995

The pathology of frozen shoulder. A Dupuytren-like disease.

Of 935 consecutive patients referred with shoulder pain, 50 fitted the criteria for primary frozen shoulder. Twelve patients who failed to improve after conservative treatment and manipulation had excision of the coracohumeral ligament and the rotator interval of the capsule. The specimens were examined histologically, using special stains for collagen. Immunocytochemistry was performed with monoclonal antibodies against leucocyte common antigen (LCA, CD45) and a macrophage/synovial antigen (PGMI, CD68) to assess the inflammatory component, and vimentin and smooth-muscle actin to evaluate fibroblasts and myofibroblasts. Our histological and immunocytochemical findings show that the pathological process is active fibroblastic proliferation, accompanied by some transformation to a smooth muscle phenotype (myofibroblasts). The fibroblasts lay down collagen which appears as a thick nodular band or fleshy mass. These appearances are very similar to those in Dupuytren's disease of the hand, with no inflammation and no synovial involvement. The contracture acts as a check-rein against external rotation, causing loss of both active and passive movement.

Adult↗
PubMed1995

Frozen shoulder and lipids.

We prospectively studied 50 patients with the diagnosis of primary frozen shoulder. The serum lipid levels were measured in 43 of these patients and compared with those in 43 age-matched and sex-matched control subjects. The fasting serum triglyceride and cholesterol levels were significantly elevated in the frozen-shoulder group (cholesterol p < 0.01; triglyceride p < 0.02).

Case-Control Studies↗
PubMed1990

Reduction of post-traumatic swelling and compartment pressure by impulse compression of the foot.

Following the discovery of a powerful venous pump in the foot that is activated by weight-bearing independently of muscular action, a pneumatic impulse device was developed to actuate this pump artificially. In a multicentre international trial the device was shown to reduce post-traumatic and postoperative swelling; pain also was alleviated. Evidence is also presented that dangerously high compartment pressures may be reduced to acceptable levels and fasciotomy avoided. We present an explanation of the clinical effects of activation of the venous footpump, based on recent improved understanding of the physiology of the microcirculation. The hyperaemic response that follows the liberation of endothelial-derived relaxing factor (EDRF) by sudden changes of pressure after weight-bearing or impulse compression is particularly important.

Adolescent↗
PubMed1989

Continuous passive motion following flexor tendon repair.

A prospective study was performed of 20 consecutive patients with 35 flexor tendon lacerations, in whom post-operative mobilisation was carried out using the Toronto Mobilimb Continuous Passive Motion machine for the first 4 1/2 weeks. Overall the results assessed by Buck Gramcko criteria were 17 (85%) excellent or good, 3 (15%) fair and no poor results. Taking the 17 fingers with zone II lacerations, 14 (82%) were excellent or good, 3 (18%) fair and no poor results.

Adult↗
PubMed1988

Radiation dosage during AO locking femoral nailing.

Radiation dosages to both the patient and the surgeon were measured during 10 consecutive AO locking nail procedures. The total screening time for each procedure averaged 12 min 8 s; the average screening time for distal locking was 6 min 52 s. Radiation dosages to surgeons' hands, thyroid and gonads and to the patients were well within permitted safety levels.

Bone Nails↗
PubMed1987

The Herbert screw for scaphoid fractures. A multicentre study.

The results of a prospective multicentre study of the Herbert differential pitch bone screw used to treat 50 scaphoid fractures and non-unions are presented. All fresh fractures and four of the five fracture-dislocations united, an overall union rate of 92%. Although the technique is demanding, the Herbert screw can achieve excellent results in the management of scaphoid fractures.

Adult↗
PubMed1985

The Herbert differential pitch bone screw in displaced radial head fractures.

The Herbert bone screw (Herbert and Fisher, 1984) has been used in the treatment of ten segmental fractures of the radial head. This differential pitch bone screw provides rigid fixation with compression, has no protruding head, is easily introduced and is of such a small diameter that more than one screw can be used. The early results achieved are reported.

Adolescent↗
PubMed1985

The use of a microcomputer for inpatient audit in an orthopaedic department.

A microcomputer has been used to assist in the inpatient audit of an orthopaedic unit in a district general hospital. The aims were to provide a more detailed, accurate audit, more rapidly than previous manual methods had allowed. The clinical details of 609 patients treated over a 9-month period were fed into the computer and various statistical analyses performed. The results of the audit are presented. The extent to which our aims have been achieved is discussed together with the specific problems encountered with computer hardware, software and organisation of the system.

Computers↗
PubMed1984

Orthopaedic audit: one year's experience in a district general hospital.

In 1982 a prospective Audit of complications and mortality and a quarterly retrospective analysis of work done were undertaken on the orthopaedic unit of Southmead Hospital, Bristol. Since no account has been presented of Orthopaedic Audit it was felt that a discussion of the method, results and whether the aims had been achieved and at what cost would be of interest to other surgeons, and to orthopaedic surgeons in particular. Two orthopaedic surgeons treated 1811 inpatients during the year; 73.7% of the patients undergoing surgery at Southmead Hospital were emergencies. Mortality, excluding fractures of the neck of femur, was 0.22% and total mortality 1.8%; 16.7% of patients had a recorded complication of which the largest group was technical failure (2.7%) followed by wound infection (2.4%).

England↗