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Biomedical subjects

T M Moore

Publications and source records attributed to T M Moore.

At least 19 recordsLinked to original sources
PubMed1992

Graft perforations favor osteoinduction. Studies of rabbit cortical grafts sterilized with ethylene oxide.

The healing of freeze-dried, ethylene oxide sterilized, segmental, allogenic cortical bone grafts was investigated in 15 rabbits using a 2-cm ulnar diaphyseal defect. Five different groups of bone grafts were evaluated: 1) unperforated undemineralized, 2) perforated undemineralized, 3) unperforated demineralized, 4) perforated demineralized, and 5) perforated demineralized grafts enclosed by silicone rubber (Silastic) sheets. There were 3 animals in each group. At 18 days, the study was terminated, and the implants were examined using radiographs and qualitative histologic preparations. We observed that healing of perforated demineralized bone was superior to unperforated demineralized bone, that undemineralized bone was partially sequestered in reactive lacunae, and that perforations in demineralized bone became centers of osteoinduction. Demineralized bone sterilized with ethylene oxide by this method vigorously formed new bone.

Animals↗
PubMed1992

Bone response to invading tumors with spindle cell components: a report of findings in two patients.

Two case studies are presented in which quantitative bone histomorphometry is used to analyze bone changes in adult patients with diagnosed spindle cell sarcoma. Three tumor-involved sites and one noninvolved site from the iliac crest of patient 1 were evaluated. In the involved sites the percentage trabecular bone volume (11.0%) and the number of osteoblasts (0.6 cell/mm2) were significantly reduced, osteoid volume was significantly increased (8.1%), and woven osteoid was present. The total eroded surface (6.8%) was also significantly increased. In the noninvolved site the number of osteoblasts was decreased and both the percentage eroded and percentage osteoclast surfaces were increased. In the femoral epicondyle specimen from patient 2 the number of osteoblasts was 27.0 cells/mm2, percentage osteoid volume was 18.4%, percentage osteoid surface was 62.9%, and osteoid thickness was 20.0 microns. In tumor-involved sites in both patients indices of active bone resorption were similar and normal. These two case studies indicate that (1) distinctive morphologic changes occur in bone invaded by spindle cell sarcoma, and that (2) changes affect bone formation to a greater extent than bone resorption. Bone alterations are probably local in nature and related to the extent and duration of tumor invasion and the influence of local tumor factor(s).

Adult↗
PubMed1991

Analysis of 61 cases of vertebral osteomyelitis.

Sixty-one cases of bacterial vertebral osteomyelitis from July 1969 to July 1979 were analyzed. The ages of the 49 men and 12 women ranged from 21 to 66 years. The portal of entry was hematogenous in 58 cases, gunshot wounds in two cases, and and adjacent retroperitoneal abscess in one case. Biopsy was performed in 60 patients. There were 15 complications related to the disease. Gram-negative rods were the predominant bacteria isolated. Blood culture was positive in 13 of the 26 (50%) patients tested. Eleven of the 13 (85%) organisms isolated from the blood cultures correlated with organisms recovered from biopsy specimens. Eleven of the patients had more than one disk level involved. Of the 61 patients, 29 went on to spontaneous fusion, 17 were lost to follow-up study, 11 failed to fuse, three had surgical fusion, and one patient died. Recommendations for diagnosis included the collection of blood cultures and radionuclide bone scans. Management recommendations included systemic antibiotics for at least three weeks and immobilization with either bed rest or spinal orthoses. Surgery was indicated if an abscess was present, neurologic complications occurred, instability became a factor, or the medical treatment failed.

Adult↗
PubMed1990

Influence of postmortem time and temperature on osteoinductive activity of demineralized microperforated ethylene oxide-sterilized syngeneic bone implant in the rat.

Bone morphogenetic protein is labile and easily inactivated by many extracorporeal factors. It is crucial to establish whether delay in retrieval of donor bone and ambient holding temperature of the donor body influence osteoinductivity of bone left in situ. Of ten adult rats that were killed, five were kept at 4 degrees and five at room temperature. Femurs were harvested at 24, 36, 48, 72, and 168 hours. After processing, segments were implanted in 20 four-week-old syngeneic rats for 14 days. The level of osteoinduction was evaluated histologically. It was excellent in the 4 degrees group in the 24-, 36-, and 48-hour specimens but less advanced at 72 hours. Bone taken from the room temperature group showed findings identical to those kept at 4 degrees through 36 hours, but osteoinduction was less advanced at 48 hours and absent at 72 hours. No bone formed at 168 hours in either temperature group. The following observations were made. (1) Osteoinductivity of demineralized bone left in situ after death was unexpectedly stable. (2) Retrieval time was extended by donor cooling. (3) Microperforated demineralized bone actively induced new bone formation. (4) Ethylene oxide does not inhibit osteoinduction when correctly applied for sterilization. If confirmed in humans, retrieval of bone to be used for osteoinduction could be delayed for some hours, particularly if the donor was immediately refrigerated. This would increase the effective number of bone tissue donors and utilize an undeveloped resource.

Animals↗
PubMed1990

Fat embolism syndrome complicating intraarterial chemotherapy with cis-platinum.

A 19-year-old man with telangiectatic osteosarcoma of the left proximal femur was started on a course of neoadjuvant chemotherapy consisting of intraarterial administration of cis-platinum. Within 72 hours of receiving the first intraarterial dose, the patient developed signs and symptoms of fat embolism syndrome (FES). A physical examination revealed cyanosis, tachycardia, and seizure activity. Laboratory studies demonstrated a pO2 of less than 65 mmHg, lipuria, and a drop in hematocrit of three percentage points. There was no clinical or roentgenographic evidence of pathologic fracture. Tumor necrosis secondary to intraarterial cis-platinum therapy in this patient with osteosarcoma may have caused a sudden release of free fatty acids and embolization of fat macroglobules that precipitated this episode of FES. FES in association with the intraarterial administration of cis-platinum seems not to have been previously reported.

Adult↗
PubMed1989

Susceptibility to AIDS: what college students do and don't believe.

In-depth, qualitative discussion using the nominal group technique examined freshmen's perceived susceptibility to AIDS and barriers to prevention. Groups were led by dormitory resident advisors as a follow-up to a survey questionnaire of college students' knowledge and beliefs about AIDS. Students' comments showed that many misunderstandings lay behind an apparent understanding of the facts about AIDS. These findings underscore how imperative it is that college health education programs be attuned to the needs and address the deficiencies of the particular student body. In-depth, qualitative research techniques such as the nominal group are described as useful in tailoring AIDS prevention to the specific campus audience and are an appropriate introduction to an AIDS-education session. Suggestions, based on students' comments, are made for improving AIDS-prevention programs on campus.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Morphometric analysis of epithelial cells of frog urinary bladder, II. Effect of ADH, calcium ionophore (A23187) and verapamil on isolated dissociated cells.

Isolated frog urinary bladder epithelial cells, upon dissociation lose their polarity and develop microridges and occasional microvilli in a global fashion. These cells, when exposed only to isotonic Ringer's solution manifest a membrane conformation with smooth discontinuous microridges, a cytoplasm with numerous free ribosomes, rough ER, thin Golgi cisternae, mitochondria, small vacuoles, electron-dense granules, few microtubules, and numerous microfilaments and intermediate filaments with an apparent random distribution, the dissociated cells, when treated with ADH or calcium ionophore (A23187), have the appearance of numerous elongated microvilli over the entire cell surface. The cytoplasm, under these conditions, is occupied by large vacuoles with a distribution of long profiles of aggrephores and associated vesicles. The peripheral cytoplasm as well as the cavities of the elongated microvilli of these cells contain large concentrations of microfilaments often showing a strong axial orientation to the long axis of the microvilli. Many of these filamentous elements appear in contact with the apical membrane of these microvilli with an alignment with the external glycocalyx. There is an indication that these morphocytological changes as revealed by SEM and TEM studies, correlated with a redistribution and realignment of microfilaments and possibly microtubules as detected by fluorescent microscopy using immunofluorescent antibody labeling for actin and tubulin. Cells treated with verapamil, a calcium antagonist, presented dwarf and stout microvilli with little detectable alterations in the cytoplasmic compositions from that of non-hormonal treated cells. Verapamil prevented ADH induction of microvilli, with the membrane, under these conditions, appearing as compact microridges. The results indicate that calcium ionophore, like ADH, produces intense formation of microvilli in dissociated cells, mobilization and realignment of microfilaments, microtubules, increase in the density of vesicles, aggrephores and possibly secretory granules, whereas the calcium antagonist, verapamil, opposes these actions. The results suggests a prominent role of calcium in the morphological changes induced by ADH.

Animals↗
PubMed1988

Diaphyseal intraosseous ganglion.

Ganglion cysts of bone are noted to occur most often in the metaphysis of epiphysis of a long bone. A unique ganglion cyst, developing in a diaphyseal location, was excised from the leg of a 14-year-old boy. The follow-up examination showed no recurrence one year following surgery.

Adolescent↗
PubMed1988

Ipsilateral diaphyseal femur fractures and knee ligament injuries.

Three hundred and nine consecutive patients with 320 diaphyseal femur fractures were retrospectively reviewed to determine the incidence of ligament injury in the ipsilateral knee. Ligamentous injuries were diagnosed if serious (Grades II and III) instability was apparent on admission, found at surgery for femoral stabilization, or disclosed on roentgenograms during closed management. Seventeen patients with unilateral shaft fractures of the femur had ipsilateral knee ligament injuries, or 5.3%. There was no relationship between specific ligament damage and the cause of the injury or level of fracture. Twelve patients were followed for an average of 34 months. Five patients lacked full extension and ten lacked full flexion. Two of seven patients with ligament repair and three of five patients without ligament repair had at least one unstable ligament. Better range of knee motion was obtained when both the femur and ligament injuries were surgically managed, but most (seven of 12) patients were disabled.

Adult↗
PubMed1987

Alteration in osteoblast cell number and cell activity in the presence of invading malignant fibrous histiocytoma.

Correct prediction of tumor behavior and interpretation of local factors in the tumor microenvironment rely in part upon accurate determination of tissue changes after tumor invasion. The authors examined local bone changes in primary malignant fibrous histiocytoma (MFH) of bone in a 59-year-old woman. Three noninvolved and three tumor-involved sites were evaluated by quantitative determinations of bone structural and dynamic features. Compared to noninvolved sites, tumor-involved bone was characterized by significantly increased osteoblast index (89.4 +/- 15.6 [mean +/- SEM] versus 7.3 +/- 6.0, P = 0.008), percent osteoid area (12.1 +/- 2.7 versus 1.2 +/- 0.5, P = 0.02), percent of trabecular surface covered by osteoid (70.0 +/- 6.0 versus 14.5 +/- 4.8, P = 0.002), and percent osteoid lined by osteoblasts (36.4 +/- 3.6 versus 3.7 +/- 3.0, P = 0.002). Bone 7.8 mm distant from invading tumor cells showed features characteristic of noninvolved sites, whereas bone completely surrounded by tumor showed markedly decreased osteoblast features. Osteoblast function also was affected by tumor; the amount of matrix laid down per day bore a significant positive correlation with the osteoblast index. These data indicate the following: distinctive bone morphologic changes occur in situ during invasion by MFH; changes affect aspects of bone formation but not resorption during invasion; both osteoblast number and osteoblast activity are significantly altered; and changes are local in nature and probably reflect the osteoblast response to local tumor factor(s) and are dependent upon the extent of tumor invasion.

Bone Neoplasms↗
PubMed1987

Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction.

Results of a decade of experience with 988 tibial plateau fractures are presented. Maximum plateau depression was measured on initial and follow-up x-ray studies, and knee instability was clinically evaluated to identify minor and major fractures as a guide to management. Demographic, treatment, and complication data were gathered prospectively in 753 fractures. Four hundred thirty-seven "major" tibial plateau fractures (44% of cases) were treated operatively; the remainder were treated by traction. Three hundred twenty patients who sustained only a plateau fracture were followed from 1 to 10 years, with an average of 3.7 years. Nonsurgical treatment included Buck's traction (89% of closed treatment cases) or a "knee exerciser" device utilizing skeletal traction in a Hodgson-Pearson apparatus. Early intermittent passive and active knee motion was encouraged. The complication rate of traction was 8%. The complication rate in operated patients was 19%, much of which was due to infection. Methods for objective and subjective scoring of both traction and operative results were developed and utilized. Results show that anatomic reduction of plateau fractures, in addition to early motion, is a major factor contributing to successful management of this potentially disabling injury.

Adolescent↗
PubMed1986

Limb salvage and prosthetic joint reconstruction for low-grade and selected high-grade sarcomas of bone after wide resection and replacement by autoclaved [corrected] autogeneic grafts.

Wide resection is an acceptable alternative to amputation for the management of primary sarcomas of the long bones or pelvis. The resected bone can be debrided of gross tumor tissue, autoclaved, and then replaced over intramedullary fixation to reconstruct the limb anatomically. The procedure can be combined with prosthetic reconstruction of adjacent joints with sufficient strength to allow early unprotected weight-bearing. Resection and replacement for 28 low-grade (G1) and 14 selected high-grade (G2) sarcomas were performed in 42 patients. The hemipelvis was resected and replaced four times, the proximal or distal femur 28 times, the proximal or distal tibia eight times, and the proximal humerus two times. Replacement of an adjacent joint, most commonly using a long-stemmed hip or knee prosthesis, was accomplished in 33 patients. All patients had been followed for a minimum of two years, nine months after treatment. The mean follow-up period is four years, ten months. Six individuals, all with high-grade sarcomas, developed tumor-related complications. Two evidenced a local recurrence of tumor, and four developed distant metastases. None of the patients with low-grade sarcomas developed a recurrence or metastases. Fifteen patients suffered complications unrelated to tumor control; 13 required reoperation, including two who required amputations for persistent pseudoarthrosis and graft infection, respectively. There was one other infection, successfully eradicated by drainage followed by local and systemic antibiotics. Due to mechanical failure or loosening, six patients were treated by successful revision of their joint arthroplasties. Two years after initial surgery, five patients had failures of union at the graft-host junction. Four healed after cancellous grafting and one was revised to a custom prosthesis. There were no late fatigue fractures of the grafts. The technique does not compromise the margins for adequate tumor resection. It preserves a graft strong enough to support a joint arthroplasty and to allow early weight-bearing with a low risk of pseudarthrosis or late fatigue fracture.

Adolescent↗
PubMed1985

The stabilizing effect of soft-tissue constraints in artificial Galeazzi fractures.

Shortening of the radius is observed in Galeazzi (Piedmont) fractures and results from muscle pull after distal radioulnar joint disruption. A cadaver study was designed to examine the normal laxity at the distal radioulnar joint and contributions of the fibrocartilaginous complex (triangular ligament) and the interosseous membrane in prevention of proximal displacement of the distal radius fragment. It was found that up to 5 mm of radial shortening occurred after osteotomy alone. Shortening of over 10 mm did not occur unless both the interosseous ligament and the triangular ligament were sectioned. Some Galeazzi-type fractures may occur in the absence of distal radioulnar joint disruption, and others may result in disruption of the interosseous membrane of the forearm in addition to disruption of the triangular ligament at the wrist. Diaphyseal fractures of the distal radius may occur in several stages of severity. Attempts to produce a Galeazzi lesion by axial loading and pronation of the forearm above the dorsiflexed wrist caused a variety of injuries but did not result in an isolated fracture of the distal radius or disruption of the distal radioulnar joint.

Cadaver↗
PubMed1985

Results of compression-plating of closed Galeazzi fractures.

Diaphyseal fractures of the distal third of the radius that are associated with disruption of the distal radio-ulnar joint accounted for eighty-four (6.8 per cent) of 1236 fractures in the forearm that were treated during a five-year period at the Los Angeles County-University of Southern California Medical Center. Thirty-six closed Galeazzi fractures, twenty-eight in male and eight in female patients, were followed for 1.5 to seven years after treatment using standard AO-compression plates with four to seven holes. Complications included seven injuries to the sensory or dorsal interosseous branch of the radial nerve, two infections, two non-unions, two re-fractures after plate removal, and shortening of the radius of five millimeters in one patient. The complication rate was 39 per cent. The average grip strength at follow-up was 71 per cent of the calculated normal value. The loss of strength was not related to use of a volar or dorsal surgical approach, the patient's age, or a delay of surgery for more than ten days after injury. The average loss of grip strength in the seven upper extremities with restricted motion of the wrist and forearm was 48 per cent, compared with an average loss of 29 per cent in the whole group. Of the twelve patients who were operated on more than ten days after injury, six had loss of motion at follow-up, compared with three who had such a loss among the twenty-four patients who were operated on within ten days after injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Use of antibiotics in open tibial fractures.

Data concerning 1102 open fractures are presented with bacteriologic and antibiotic considerations analyzed in 363 open tibiae fractures treated in three prospective one-year studies during the period from 1970 to 1980. The highest infection rate was in open tibiae receiving no antibiotics (24%, 6 infections in 25 open tibial fracture wounds), and the lowest was in the group receiving a cephalosporin and an aminoglycoside (4.5%, 5 infections in 109 open tibial fracture wounds).

Anti-Bacterial Agents↗
PubMed1983

Considerations in reducing the infection rate in open tibial fractures.

During the period from 1979 to 1980, 109 patients with open tibial fractures were treated by a cephalosporin and an aminoglycoside, and by saline and topical antibiotic wound irrigation; partial closure was used for Types I and II open tibial wounds, and all Type III wounds were left open. Stabilization was accomplished by plaster alone, external pins in plaster, or an external fixator with full transfixion pins. The overall infection rate was 4.5% (5 of 109 wounds) in this study. This represents a significant reduction from the previous infection rate of 14% in 254 open tibial fractures treated by the authors in previous years by all methods.

Adolescent↗