Showing papers by "Nuffield Orthopaedic Centre published in 1984"
TL;DR: The voluntary isometric strength of the quadriceps muscles of healthy women in their 70s and in their 20s is measured and compared with the mid‐thigh cross‐sectional area of the same muscles.
Abstract: Muscle weakness and wasting may be evaluated objectively by dynamometry and compound ultrasound imaging. We have measured the voluntary isometric strength of the quadriceps muscles of healthy women in their 70s (n = 25) and in their 20s (n = 25) and have compared it with the mid-thigh cross-sectional area of the same muscles. The two groups of women showed similar variability when strength was measured on consecutive days (coefficients of variation: 8%). The older women were 35% weaker than the young women (P less than 0.001) and their quadriceps cross-sectional area was 33% less (P less than 0.001). Quadriceps strength and cross-sectional area were correlated (r = 0.66, P less than 0.001, elderly; r = 0.53, P less than 0.01, young) and the principal axis of the relationship was closely similar for the two groups of women. There is therefore no difference in the intrinsic strength of the quadriceps muscles of healthy women in their third and eighth decades. This report also provides normative data for the objective evaluation of quadriceps weakness and/or wasting in female patients. The techniques involved are straightforward, the dynamometer is easily made, and compound ultrasound imaging is widely available.
435 citations
TL;DR: In this article, a brief discussion of the contribution of atrophy to muscle weakness is presented, focusing on inhibition of quadriceps activation and suggesting some therapeutic implications, but not dealing with reduced oxidative capacity and increased fatiguability of disused muscle since, although important, these have not been part of their programme of work.
Abstract: ‘Arthrogenous muscle weakness’ is weakness of muscles acting about an injured or inflamed joint. The weakness may be due to loss of muscle or to inability to activate the muscle (Fig. 1). Weakness of the thigh muscles, and of the quadriceps in particular, is a common and important consequence of knee trauma, surgery or arthritis. Muscle weakness contributes significantly to disability and probably also renders the joint vulnerable to further damage (Fig. 1). This review starts with a brief discussion of the contribution of atrophy to weakness. It concentrates, however, on inhibition of quadriceps activation and suggests some therapeutic implications. It does not deal with the reduced oxidative capacity and increased fatiguability of disused muscle since, although important, these have not been part of our programme of work.
321 citations
TL;DR: Results are consistent with the hypothesis that the osteogenic precursor cells of marrow belong to the fibroblast colony-forming cell fraction, and indicate that these cells, although found throughout the marrow, are concentrated close to the bone surface.
Abstract: Rabbit bone marrow has been separated into core, intermediate, and endosteal cell populations. When plated outin vitro, each of the fractions gave rise to colonies of fibroblastic cells. The colony-forming efficiency increased from the core population by a factor of 4 to a maximum of 3.4 × 10−6 in the endosteal fraction. The osteogenic potential of each fraction was determined following their implantation in diffusion chambers into host rabbits. Each of the indices of osteogenesis (alkaline phosphatase activity, Ca and P accumulation) were significantly lower in the core population than in the two populations closer to the bone surface. Our results are consistent with the hypothesis that the osteogenic precursor cells of marrow belong to the fibroblast colony-forming cell fraction, and indicate that these cells, although found throughout the marrow, are concentrated close to the bone surface.
95 citations
TL;DR: Examination of the hip using ultrasound is described with anatomical correlation; an effusion was detected in 16 patients and the management was significantly influenced by the results of ultrasound examination.
71 citations
TL;DR: The results confirm that measurements of these parameters in tissue formed by cells incubated in diffusion chambers in vivo may be used as a method for assay of osteogenesis.
Abstract: The alkaline phosphatase activity and the calcium and phosphorus content of osteogenic tissue formedin vivo following the implantation of diffusion chambers loaded with rabbit bone marrow cells is reported. (In this study the term osteogenic includes osteoblastic and chondroblastic.) Chambers examined 14–70 days after implantation revealed progressive accumulation of mineral. Alkaline phosphatase activity increased until day 30 and declined thereafter. The osteogenic potential of the marrow cells decreased with increasing weight (age) of the cell donor rabbit when measured either as the percentage of chambers containing osteogenic tissue or as the amount of calcium, phosphorus, or alkaline phosphatase activity within the chambers. The results confirm that measurements of these parameters in tissue formed by cells incubated in diffusion chambersin vivo may be used as a method for assay of osteogenesis.
64 citations
TL;DR: The study has highlighted the need for biomechanical outcome measures as well as for more objective clinical outcome measures in the assessment of physical performance in patients with a shorter history of Achilles tendinitis.
Abstract: Thirty-three subjects entered a blind-observer, random, prospective study of three forms of conservative treatment of sports-induced Achilles tendinitis, results being assessed by clinical and biomechanical parameters. Two patient groups received heel pads, ultrasound, and exercises, while the third received only ultrasound and exercises. All three groups showed some improvement at both 10 day and 2 month assessment, but the claimed benefit of viscoelastic pads widely used by athletes was not substantiated. The more striking benefit from ultrasound and exercises alone occurred in patients with a shorter history; a comparison of duration of injury in all three groups suggested this was an important factor influencing outcome. The study has highlighted the need for biomechanical outcome measures as well as for more objective clinical outcome measures in the assessment of physical therapy.
62 citations
TL;DR: A 3-year prospective study of road traffic accidents was carried out in Oxfordshire, and it is suggested that oblique and transverse forces to the chest as well as rapid deceleration are aetiological factors in this condition.
Abstract: A 3-year prospective study of road traffic accidents was carried out in Oxfordshire by a combined team of surgeons and engineers. This liaison permitted the comparison of injuries with details of the collisions. Twelve cases of rupture of the thoracic aorta were recorded and in 10 cases the lesion was just distal to the origin of the left subclavian artery. The mean velocity change during the impacts was 38.3 mph, and it is suggested that oblique and transverse forces to the chest as well as rapid deceleration are aetiological factors in this condition.
38 citations
TL;DR: The results suggest the feasibility of using limb bud mesenchymal cell cultures as an in vitro assay for bone matrix derived, extractable bioactive factors which effect the conversion of mesenchyal cells into chondrocytes as a requisite step inin vivo osteogenesis.
Abstract: Urea and guanidine extracts of demineralized beef and rabbit bone matrix were assayed bothin vivo andin vitro. One month following intramuscular implantation into mouse thighs, these extracts induced ectopic cartilage and bone. Seven days following continuousin vitro exposure to the same extracts, stage 24 chick limb bud mesenchymal cells in cultures had differentiated into greater numbers of chondrocytes than controls. These results suggest the feasibility of using limb bud mesenchymal cell cultures as anin vitro assay for bone matrix derived, extractable bioactive factors which effect the conversion of mesenchymal cells into chondrocytes as a requisite step inin vivo osteogenesis.
37 citations
TL;DR: The overall incidence of broken ribs in front seat passengers was not affected by the wearing of belts but the incidence of those with four or more broken ribs was considerably reduced by wearing belts.
Abstract: A 3-year prospective study of road traffic accidents in which injuries of the chest wall were accurately recorded and related to the use of seat belts was performed in Oxfordshire by a combined team of surgeons and engineers. An increased incidence of soft tissue injuries was noted in restrained front seat occupants though this was not the case for fractures of the clavicle or sternum. The overall incidence of broken ribs in front seat passengers was not affected by the wearing of belts but the incidence of those with four or more broken ribs was considerably reduced by wearing belts.
31 citations
TL;DR: A patient with familial adult-onset hypophosphataemia, whose myopathy was closely related to the plasma phosphate concentration, was investigated by phosphorus nuclear magnetic resonance spectroscopy in vivo of the right flexor digitorum superficialis muscle.
Abstract: 1 A patient with familial adult-onset hypophosphataemia, whose myopathy was closely related to the plasma phosphate concentration, was investigated by phosphorus nuclear magnetic resonance spectroscopy ( 31 P nmr) in vivo of the right flexor digitorum superficialis muscle 2 During hypophosphataemia induced by stopping oral phosphate a significant reduction in measured muscle strength occurred, but the ratios of the intramyocellular levels of phosphocreatine (PCr), adenosine triphosphate (ATP) and inorganic phosphate (P i ) remained unchanged at rest During exercise these levels changed, as did the intramyocellular pH, but they did not differ from the pattern previously recorded in normal subjects 3 In four adults with inherited infantile-onset hypophosphataemia (vitamin D-resistant rickets, VDRR) without myopathy, the nmr measurements were normal at rest and during exercise 4 In one patient with inherited hyperphosphataemia (tumoral calcinosis) the resting PCr: P i ratio was significantly reduced
30 citations
TL;DR: The major γ-carboxyglutamic acid-containing protein of rabbit cortical bone isolated and purified from near-neutral EDTA-extracts by DEAE-cellulose and Sephadex G 75 column chromatography had a molecular weight of about 5600 based on integral amino-acid composition; this was confirmed by high-performance liquid chromatography.
TL;DR: A patellar-tendon-bearing, weight-relieving cast is described that allows early walking by patients with comminuted fractures of the os calcis and is especially useful for bilateral fractures.
Abstract: A patellar-tendon-bearing, weight-relieving cast is described. This allows early walking by patients with comminuted fractures of the os calcis and is especially useful for bilateral fractures.
TL;DR: A method for calculating the displacement of the centre of body mass in lateral, horizontal and vertical directions during pathological gait is presented and is shown to be more convenient, more direct and less expensive than techniques in present use.
TL;DR: The procedure is simple, rapid and produces good results even in instances when histological sectioning is unsatisfactory, even though the relationship between hard and soft tissues was well preserved and the integrity of the mineralized component maintained.
Abstract: SUMMARY
To eliminate sectioning artefacts, we devised a method for the preparation of surfaces of plastic embedded hard tissues and their examination by incident light fluorescence microscopy. Flat surfaces produced by cutting on a microtome or using a low-speed saw were stained with dyes in aqueous solutions. Best results were obtained in tissues embedded in glycol-methacrylate. This polymer allowed good penetration of the dyes and its optical properties render cutting defects invisible with the present method. The relationship between hard and soft tissues was well preserved and the integrity of the mineralized component maintained. Cellular details and the distinction between osteoid and bone could be clearly demonstrated. The procedure is simple, rapid and produces good results even in instances when histological sectioning is unsatisfactory.
TL;DR: The anterior compartment of the leg of 4 volunteers was used to study the transmission of externally applied pressure into a limb and the pressure from a pneumatic splint was found to be transmitted directly into the leg and was added to the resting intramuscular pressure.
Abstract: The anterior compartment of the leg of 4 volunteers was used to study the transmission of externally applied pressure into a limb. The pressure from a pneumatic splint was found to be transmitted directly into the leg and was found to be added to the resting intramuscular pressure. The median inflation pressure of such a splint applied by trained ambulance personnel was 25 mm Hg (range 15–36 mm Hg). When the resting intramuscular pressure was raised experimentally, either by voluntary muscular contraction or venous engorgement, numerical addition of externally applied pressure was again observed. A moderate rise in compartment pressure commonly occurs after injury. Due care should be taken in the use of pneumatic splints or compressive dressings as the total pressure generated within a limb may be sufficient to induce ischaemia.
TL;DR: The Western World today faces a new and alarming epidemic-osteoporosis, i.e. a loss of bone mass affecting the elderly, which there is no satisfactory explanation of why it occurs and w hat the underlying mechanisms involved are.
Abstract: The Western World today faces a new and alarming epidemic-osteoporosis, i.e. a loss of bone mass affecting the elderly (Lane & Vigorita 1983). It has taken us by surprise. We do not understand its cause and therefore we have at present no cure. The osteoporosis may be so severe that our bones fracture for no good reason. In youth and early adult life we successfully mineralize the organic matrix of our skeletons. Inevitably as we pass from middle to old age we may suffer a loss of bone mass that affects both mineral and matrix. This skeletal deterioration varies in severity in different individuals. There is no satisfactory explanation of why it occurs and w hat the underlying mechanisms involved are; nor is it known what can be done to prevent or cure it. Hospital organization here in England is disorganized because beds are occupied by elderly people with broken bones (Dix 1983). Chemists and biologists face a double challenge. First, why and how does the matrix of the bone mineralize? Secondly, why, with increasing age, is there a deterioration both in matrix and in mineralization?
TL;DR: The data suggest that normal chondrocytes carry IGF2-type receptors as well as the IGF1 type previously described, andMultiplication-stimulating activity (125I-MSA) has been shown to bind to isolated rabbit chondrobates, the binding being dependent on time, temperature, and cell density.
Abstract: Multiplication-stimulating activity (125I-MSA) has been shown to bind to isolated rabbit chondrocytes, the binding being dependent on time, temperature, and cell density. Nonspecific binding was approximately 15%. Unlabelled MSA at 100 ng/ml inhibited 125I-MSA binding by 50%. Porcine insulin (0.5-10 micrograms/ml) did not compete with MSA but resulted in a 10-15% increase in 125I-MSA binding. The data suggest that normal chondrocytes carry IGF2-type receptors as well as the IGF1 type previously described.
01 Jan 1984
TL;DR: The first nerve homograft was used to bridge a 3 cm deficit in a median nerve by Phillipeaux and Vulpian (1870) as mentioned in this paper, who demonstrated that nerve fibres would grow through a graft.
Abstract: Publisher Summary
Early attempts at restoring the continuity of the divided peripheral nerve depended on as accurate as possible coaptation of the epineurium. As suggested by the foregoing anatomical details, malrotation, buckling, and a low nerve to connective tissue ratio provided a uniformly poor functional result. To minimize fibrosis and neuroma formation, various materials were introduced as barriers or tubes around the anastomosis. Tantalum shields stopped the ingrowth of fibrous tissue and gave improved structure and initial function but unfortunately fragmented giving rise to scar tissue and a secondary reduction of function. The late 19th century saw the introduction of grafts to bridge deficits in peripheral nerves. Phillipeaux and Vulpian (1870) demonstrated that nerve fibres would grow through a graft and shortly afterward, the first nerve homograft was used to bridge a 3 cm deficit in a median nerve. Immunological rejection has plagued the use of homografts ever since, although the use of irradiated homografts was considered a feasible method of bridging a nerve defect.
TL;DR: If that use of the term is adhered to, then osteoid with more than four birefringent lamellae is not hyperosteoidosis, it is an indication of mineralisation failure (in other words, histological osteomalacia).
Abstract: The review article by Dr Revell' contains a sentence which is confusing and requires clarification. On p 1326, under the heading \"Normal values,\" he makes the following statement: \"Up to four such lamellae are present in normal bone, so that a greater number than this is an indicator of hyperosteoidosis.\" The confusing word is \"hyperosteoidosis.\" In 1961, at a time when osteomalacia was identified by measurement of \"surface cover,\" \"mean seam thickness,\" and \"volume,\" Lichtwitz et al2 pointed out that there were diseases in which the rate of new bone formation was greatly increased, to an extent that all the criteria then in use for the morphometric diagnosis of osteomalacia were fulfilled, but the osteoid was mineralising normally. Bone disease due to primary hyperparathyroidism and active Paget's disease are the most commonly encountered causes of this situation. The term hyperosteoidosis was used by those authors to distinguish greatly increased, but normal bone formation from mineralisation failure. If that use of the term is adhered to, then osteoid with more than four birefringent lamellae is not hyperosteoidosis. It is an indication of mineralisation failure (in other words, histological osteomalacia).