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Showing papers by "Nuffield Orthopaedic Centre published in 1989"


Journal ArticleDOI
TL;DR: In this paper, it was shown that a proportion of CFU-F demonstrates extensive proliferative potential both in vitro and in vivo, and that the progeny of a proportion are capable of differentiating into all the stromal cell lines necessary for the formation of bone and reconstitution of the hematopoietic inductive microenvironment.
Abstract: According to current hypothesis, cells of the osteogenic lineage, which includes both osteoblasts and chondroblasts, are derived from a stromal stem cell in the postnatal organism. That there exist osteogenic precursors in association with the soft, fibrous tissue of the marrow stroma is well established. An osteogenic tissue comprised of cartilage and bone is formed when marrow or marrow cell suspensions are cultured in vivo within diffusion chambers. Bone with a functional marrow organ is formed when marrow or marrow cell suspensions are transplanted heterotopically, e.g., under the renal capsule. Cultures of marrow stromal fibroblasts are readily established in vitro from single-cell bone marrow suspensions. Such cultures do not demonstrate overt differentiation in an osteogenic direction in vitro. When transplanted in vivo, however, they differentiate to form cartilage and bone in diffusion chambers and bone with a functional marrow organ when transplanted heterotopically. Single-cell bone marrow suspensions can be cultured in vitro under conditions that facilitate the formation of stromal fibroblast colonies. Circumstantial evidence supports the conclusion that each colony is derived from a single initiating cell termed a colony-forming unit-fibroblastic (CFU-F). A proportion of CFU-F demonstrates extensive proliferative potential both in vitro and in vivo. In vitro the extensive proliferative potential of a subset of CFU-F has been shown to be associated with a capacity for extensive self-renewal. On transplantation in vivo, the progeny of a proportion of CFU-F has been shown to be capable of proliferating and differentiating into all the stromal cell lines necessary for the formation of bone and reconstitution of the hematopoietic inductive microenvironment. These findings provide strong circumstantial evidence to support the hypothesis that there are stem cells present within the marrow stroma that are capable of giving rise to cells of a number of different lineages, including those of the osteogenic lineage (chondroblasts and osteoblasts).

377 citations


Journal ArticleDOI
TL;DR: There was a reduction in both the number and the mean relative area of vessels in the mid-section of the calcaneal tendon, which may be of significance in the pathogenesis of rupture.
Abstract: The microvascular anatomy of the calcaneal tendon was investigated in cadaver tendons by injection of barium sulphate and indian ink and a quantitative study of intratendinous blood supply was made, using a computer-assisted image analysis system. There was a reduction in both the number and the mean relative area of vessels in the mid-section of the tendon. This area of reduced vascularity may be of significance in the pathogenesis of rupture.

337 citations


Journal ArticleDOI
TL;DR: The systemic effect of lowpower helium‐neon laser irradiation on the recovery of the injured peripheral and central nervous system, as well as healing of cutaneous wounds and burns is focused on.
Abstract: In this paper, we direct attention to the systemic effect of low-power helium-neon (HeNe) laser irradiation on the recovery of the injured peripheral and central nervous system, as well as healing of cutaneous wounds and burns. Laser irradiation on only the right side in bilaterally inflicted cutaneous wounds enhanced recovery in both sides compared to the nonirradiated control group (P less than .01). Similar results were obtained in bilateral burns: irradiating one of the burned sites also caused accelerated healing in the nonirradiated site (P less than .01). However, in the nonirradiated control group, all rats suffered advanced necrosis of the feet and bilateral gangrene. Low-power HeNe laser irradiation applied to a crushed injured sciatic nerve in the right leg in a bilaterally inflicted crush injury, significantly increased the compound action potential in the left nonirradiated leg as well. The statistical analysis shows a highly significant difference between the laser-treated group and the control nonirradiated group (P less than .001). Finally, the systemic effect was found in the spinal cord segments corresponding to the crushed sciatic nerves. The bilateral retrograde degeneration of the motor neurons of the spinal cord expected after the bilateral crush injury of the peripheral nerves was greatly reduced in the laser treated group. The systemic effects reported here are relevant in terms of the clinical application of low-power laser irradiation as well as for basic research into the possible mechanisms involved.

273 citations


Journal ArticleDOI
01 Dec 1989
TL;DR: A geometric simulation of the tibio-femoral joint in the sagittal plane is developed which illustrates the central role played by the cruciate ligaments in the kinematics of the knee and which can be used for the analysis of ligament and contact forces.
Abstract: A geometric model of the tibio-femoral joint in the sagittal plane has been developed which demonstrates the relationship between the geometry of the cruciate ligaments and the geometry of the articular surfaces The cruciate ligaments are represented as two inextensible fibres which, with the femur and the tibia, are analysed as a crossed four-bar linkage The directions of the ligaments at each position of flexion are calculated The instant centre, where the flexion axis crosses the parasagittal plane through the joint, lies at the intersection of the cruciates It moves relative to each of the bones during flexion and extension The successive positions of the flexion axis relative to a fixed femur and to a fixed tibia are deduced The shapes of articular surfaces which would allow the bones to flex and extend while maintaining the ligaments each at constant length are calculated and are found to agree closely with the shapes of the natural articular surfaces The calculated movements of the contact point between the femur and the tibia during flexion also agree well with measurements made on cadaver specimens The outcome is a geometric simulation of the tibio-femoral joint in the sagittal plane which illustrates the central role played by the cruciate ligaments in the kinematics of the knee and which can be used for the analysis of ligament and contact forces

161 citations


Journal ArticleDOI
TL;DR: The nature of the heelstrike transient and the use of accelerometers and force platforms for skeletal transient investigation are outlined and the possible causative links between excessive impulsive loading and the progression of two pathological conditions-osteoarthritis and low back pain are discussed in detail.

138 citations


Journal ArticleDOI
22 Jul 1989-BMJ
TL;DR: Grip strength in the forearm is a good indicator of bone mineral content and both variables may be increased by brief periods of stressful exercise, which may provide a means of reversing osteoporosis.
Abstract: OBJECTIVE--To compare grip strength and bone mineral content in the forearm in women and to test the effects on bone mineral content of short periods of exercise that stresses the skeleton. DESIGN--Assessment of both wrists in 69 volunteers and of the non-fractured wrist in 30 patients followed by an exercise regimen entailing squeezing a tennis ball as hard as possible for 30 seconds each day for six weeks. SETTING--Old people's homes and outpatient departments of Hammersmith and Northampton general hospitals. PATIENTS--99 Women, of whom 69 were volunteers and 30 had a fractured forearm. MAIN OUTCOME MEASURE--Grip strength and bone mineral content after six weeks and at six months after the exercises had stopped. RESULTS--The bone mineral content of the women's forearms was measured with a densitometer and the grip strength with a semi-inflated bag connected to an anaeroid barometer. Measurements before exercise showed that the two variables correlated closely, irrespective of age, and that there were significant differences in both between the dominant and non-dominant arms of the volunteers. After six weeks of exercise there was a mean increase in grip strength of 14.5% (95% confidence interval 9.9 to 19.2%) and in bone mineral content of 3.4% (1.4 to 5.3%) in the stressed forearms of the 77 women who attended for examination. After six months without exercise the improvements in the 33 women who attended for follow up had reversed. Women who had had a fractured forearm (n = 13), however, had continued to gain grip strength and bone mineral content in the arm that had not been injured. CONCLUSIONS--Grip strength in the forearm is a good indicator of bone mineral content. Both variables may be increased by brief periods of stressful exercise. If this principle can be applied to the whole skeleton it may provide a means of reversing osteoporosis.

127 citations


Journal ArticleDOI
TL;DR: Soft tissue cervical spinal injuries occurred in 179 out of 1197 consecutive victims of road traffic accidents who needed to attend hospital; an incidence of 15 per cent.
Abstract: Soft tissue cervical spinal injuries occurred in 179 out of 1197 consecutive victims of road traffic accidents who needed to attend hospital; an incidence of 15 per cent. It was most common in female (P less than 0.01), restrained car occupants (P less than 0.05) in the 40-49 years age group (P less than 0.025). It was less common in rear seat passengers (P less than 0.001). Most were victims of collisions from the rear but significant numbers also occurred in other types of accidents. The incidence of associated injuries was low.

79 citations


Journal ArticleDOI
TL;DR: A hypothesis is presented which proposes that oxygen-free radicals cause pericytic necrosis and fibroblastic proliferation and provides a potential avenue for therapy of DC and other fibrotic conditions.
Abstract: The fine structure of palmar fascia from patients with Dupuytren's contracture (DC) was compared with that from patients with carpal tunnel syndrome (CTS). In contrast to previous assumptions, the ultrastructure of fibroblasts both in vivo and in vitro from DC and CTS appeared identical, indicating that myofibroblasts are not specific to DC. The major differences between DC and CTS were: 1) a sixfold and fortyfold increase in fibroblast density in cord and nodular areas of DC compared with CTS; 2) a more disorganised pattern of collagen fibrils in DC; and 3) markedly narrowed microvessels surrounded by thickened, laminated basal laminae and proliferating fibroblasts in DC compared with CTS. To account for these morphological changes a hypothesis is presented which proposes that oxygen-free radicals cause pericytic necrosis and fibroblastic proliferation. This hypothesis provides a potential avenue for therapy of DC and other fibrotic conditions.

62 citations


Journal ArticleDOI
01 Jun 1989-Spine
TL;DR: In this paper, the Boston brace was evaluated on a group of 14 adolescents with adolescent scoliosis, and the impact of the brace on their biomechanical effectiveness was evaluated.
Abstract: The present study assesses the biomechanical effectiveness of the Boston brace on a group of 14 patients with adolescent scoliosis. Interface pressure measurements were performed at the appropriate compression pads within the brace when it was first applied and on two further sessions within the 6-m

61 citations


Journal ArticleDOI
TL;DR: The results for 27 subjects show that, with a rigid unilateral fixator, the axial movement occurring at the fracture site was initially small and can be increased slightly if the fixator is fitted with a module which permits additional fracture site movement, although the resultant increase in movement is only a small proportion of the potential available with this module.

51 citations


Journal ArticleDOI
01 Jun 1989
TL;DR: A non-invasive technique has been developed which analyses a vibration signal transmitted through the femur which can distinguish between a femoral component which is loose and one which is firmly fixed.
Abstract: Anatomical study: The common pathway to failure in total hip replacements is loosening of the acetabular and femoral components. The reliable diagnosis of this loosening is difficult. A non-invasive technique has been developed which analyses a vibration signal transmitted through the femur. This can distinguish between a femoral component which is loose and one which is firmly fixed. Charnley femoral components were cemented securely into ten cadaver femurs and the transmitted vibration signal recorded. The prostheses were then loosened first at the cement-prosthesis and then at the cement-bone interface. The tests were then repeated. Consistent and distinct differences between output vibration signals were observed between the firmly implanted and the loose prostheses.Pilot clinical study: Seven patients admitted for recision surgery because of clinical and radiological evidence of femoral implant loosening were tested using this technique. A further four patients with secure femoral components were tes...

Journal ArticleDOI
TL;DR: It is reported that oxygen free radicals in lower concentrations stimulate fibroblast proliferation, a finding confirmed by the observation that free radical scavengers when added alone inhibit fibro Blast proliferation (Murrell et al., 1 0 8 9 ~ ) .
Abstract: Oxygen free radials, including superoxide (0; 1 and hydroxyl (OH.) radicals, and H 2 0 , in high concentrations are toxic in a number of ischaemic animal models and t o cultured cells. Here we report that oxygen free radicals in lower concentrations stimulate fibroblast proliferation. Passage 3-5 fibroblasts from skin biopsies or operative Dupuytren's contracture palmar fascia specimens (Murrell et ul., 1087) were cultured in Dulbecco's modification o f Eagle's medium supplemented with 10%, (v /v) fetal calf serum. Each well of a 1.6 cm 24 multiwcll tissue culture plate was seeded with 4 x 10\" fibroblasts and cultured for 48 h (near confluence). The medium was then replaced with 1.0 ml of medium containing the agents to be tested. In thymidine incorporation experiments, this medium also contained 1.0 pCi of [3H]thymidinc and carrier thymidine t o a final concentration of 5.0 pM-thymidine (Puzas & Brand. 1986). After 4 h of incubation at 37\"C, the cell layer was harvested, processed and the radioactive, acid-insoluble fraction measured by liquid scintillation spectrometry to give an estimation of the rate of cell proliferation. Cell density was determined using a 1 mm? eyepiece graticule at 6 and 24 h. Cell morphology parameters were calculated at 4 h using a Zeiss modulator system for quantitative digital image analysis (MOP AM02). Oxygen free radicals were generated by three systems (xanthine oxidase and hypoxanthine. glyceraldehyde in phosphate-buffered saline and H,O,). Oxygen free radicals in high concentrations ( > 10 units of xanthine oxidase/ml with lo' M-hypoxanthine; > lo' M H ~ O ? ; > lo' Mglyceraldehyde) visibly damaged cultured human fibroblasts, reduced cell density and inhibited thymidine incorporation. In contrast, lower concentrations of free radicals ( 10-'-10-' units xanthine oxidase/ml; IWJ10 -\" M-glyceraldehydc; 10 -' M-H~O:) stimulated thymidine incorporation and increased mean cell area, maximum length and cell density (Fig. 1). Both the stimulatory and inhibitory effects of xanthine oxidase were inhibited if xanthine oxidase was heat inactivated for 10 min at 1 00°C or lo' ~-allopurinol (a competitive inhibitor of xanthine oxidase) was added. or 0; and HzOz scavengers added (60 pg of superoxide dismutase/ ml and 250 units catalase/ml). The concentrations of free radicals which stimulated proliferation were similar to those produced by cultured fibroblasts themselves (Murrell et al., 1989b), a finding confirmed by the observation that free radical scavengers when added alone inhibit fibroblast proliferation (Murrell et al., 1 0 8 9 ~ ) . These results it7 vitro may help explain fibroblast proliferation in fibrotic conditions such as Dupuytren's contracture where localized hypoxia can induce free radical production (Murrell er ul., 1987). * * * T

Journal ArticleDOI
TL;DR: Simultaneous correction both above and below the hip is considered to be the best treatment for the older child with congenital hip dislocation.
Abstract: We reviewed the cases of 38 children with 45 congenitally dislocated hips who presented for primary treatment after the age of three years. Of these, 34 hips were managed by the 'direct approach' of Somerville and Scott (1957); 14 of these required secondary operations for subluxation, often with a poor outcome. Eleven hips were treated by combined pelvic and femoral osteotomy which, in general, gave good results. At a mean follow-up of 16.7 years, 80% of the whole series had a good or excellent clinical result and 51% were good or excellent radiologically. Simultaneous correction both above and below the hip is considered to be the best treatment for the older child with congenital hip dislocation.

Journal ArticleDOI
TL;DR: Magnetic resonance imaging was used in one of the authors' cases and was the only imaging modality to demonstrate the true nature of the condition.
Abstract: An area of fibrous dysplasia of bone may undergo rapid enlargement which may be due to either cystic degeneration or malignant transformation. These complications may be clinically and radiologically indistinguishable and, unless both are borne in mind, incorrect management may follow. Magnetic resonance imaging was used in one of our cases and was the only imaging modality to demonstrate the true nature of the condition.

Journal ArticleDOI
TL;DR: Taking into account coexisting variables such as motivation and discomfort at the limit of the range, which are likely to fluctuate, the simple inclinometer as described provides a relatively objective and accurate method of measuring neck movements.

Journal ArticleDOI
TL;DR: The relationships between the initial loading rate of the lower limb (ignoring the contribution of the heelstrike transient) and the general gait parameters--cadence, stride length, and velocity--have been examined.

Journal ArticleDOI
TL;DR: A case of pseudarthrosis of the radius successfully treated by free vascularised bone grafting and the use of callus distraction of an incorporated vascularisedBone graft to achieve bone lengthening is reported.
Abstract: We report a case of pseudarthrosis of the radius successfully treated by free vascularised bone grafting. After a comprehensive review of the literature, we recommend this as the treatment of choice in this condition. We also report the use of callus distraction of an incorporated vascularised bone graft to achieve bone lengthening.

Journal ArticleDOI
TL;DR: C cultured human fibroblasts also release superoxide radical, and release was similar in form and magnitude to unstimulated granulocytes, and endothelial cells, as previously observed for stimulatedgranulocytes.
Abstract: T h e superoxide radical (0;) is released during the rcspiratory burst of phagocytic cells and by cultured cndothelial cells (Matsubara &L Ziff. 1Y86). In phagocytic cells, 0; release is mediated by a membrane bound 'respiratory burst oxidase'. dormant in unactivated cells. that catalyses the oneelectron reduction of O2 to 0; at the expense of NADPH (Babior. 1087). Activation of thc respiratory burst oxidase is via a general activating system involving phosphatidylinositol phosphates, changes in intracellular Ca' + concentration and protein kinase C stimulation via 1 ,2-diacylglycerol. Here we report that cultured human fibroblasts also release 0;. Passage 3-5 fibroblasts from skin biopsies o r operative Dupuytren's contracture palmar fascia specimens (Murrell et al., 1 YX7) were cultured in Dulbecco's minimal essential medium supplemented with 10% ( v / v ) fetal calf serum. Homogeneity and ultrastructural features o f fibroblasts were checked by light and electron microscopy. Cells (10') were seeded into each I .O cm well o f 24 multiwell culture plates, cultured for 24 h and the cell layer washed three times with 1 .0 ml o f phosphate-buffered saline (pH 7.4). 0; release was estimated using the superoxide dismutasc inhibitable reduction of cytochrome c (Weening er al., 1Y75). A reaction buffer containing I .O mM-CaCI,, 2 mM-glucose and 5 0 p ~ cytochrome c dissolved in phosphate-buffered saline (pH 7.4) was added to each well. For each parameter assessed, half of the wells were incubated with 60 pg of superoxide dismutase/ml and half without. The final volume of the reaction mixture was 1 .O ml. After incubation at 37°C for 80 min without agitation, reactions were terminated by the addition of 1 . 0 ml o f 2 mM-Nethyhaleimidc. T h e amount of 0; release was determined by dividing the average difference in absorbance at 5 5 0 nm in samples cultured with and without superoxide dismutase by the cxtinction coefficient for reduction o f cytochrome c. In this system there was a superoxide dismutase-inhibitable reduction in cytochrome c that increased with time and cell density. T h e shape of the 0; release versus fibroblast seeding density curve was similar t o that previously observed for stimulated granulocytes (Weening et al., 1 Y75). while the time course of 0; release by cultured fibroblasts was similar in form and magnitude to unstimulated granulocytes, and endothelial cells (Fig. 1). Superoxide release doublcd when cultured fibroblasts were agitated at 2 cyclcs/second. Like phagocytic and endothelial cells, 0; release was affected by changes in C a 2 + and protein kinasc C stimulation. No 0; release was demonstrated in the absence o f C a 2 + . In the presence of CaCl and 10 ng o f phorbol 12-myristate 13acetate/ml (PMA; a synthetic analogue of I ,2-diacylglycerol ) or 10 ' ~ A 2 3 187 (a Ca2+ ionophore), 0; release increased 0 20 40 60 80 120

Journal ArticleDOI
TL;DR: It is shown that bracing may improve the cosmetic appearance of a scoliotic back although the underlying curve remains unchanged, and roentgenographic measurements should be considered in conjunction with corresponding surface shape measurements in the assessment of brace treatment of scoliosis.
Abstract: This preliminary study has shown that bracing may improve the cosmetic appearance of a scoliotic back although the underlying curve remains unchanged. Thirty-two patients treated with the Boston brace for adolescent idiopathic scoliosis were assessed both roentgenographically and by integrated shape imaging system scanning before and after treatment. The mean follow-up time was 16 months. Surface shape improved in 41% of the patients, whereas roentgenographic improvement occurred in only 9%. Roentgenographic measurements should, therefore, be considered in conjunction with corresponding surface shape measurements in the assessment of brace treatment of scoliosis.

Journal ArticleDOI
TL;DR: Energy at the wavelength of 632.8 nm (CW He-Ne laser), delivered transcutaneously along the projections of the nerve, prevents the drop in the functional nerve activity as measured by the combined action potential (AP) after crush injury.
Abstract: Twenty rats underwent a crush injury to their sciatic nerve, followed immediately by a single low-power coherent or non-coherent irradiation administered transcutaneously on the projection of an injured peripheral nerve. Five wavelengths were tested: 632.8, 660, 830, 880 and 950 nm. The electrical activities of the crushed nerve, immediately after irradiation and on the following first, third and seventh day post-crush, were compared to the precrush activity. The results indicate that energy at the wavelength of 632.8 nm (CW He-Ne laser), delivered transcutaneously (10 J cm−2 at each point) along the projections of the nerve, prevents the drop in the functional nerve activity as measured by the combined action potential (AP) after crush injury. Other wavelengths were either less effective (660 nm) or totally ineffective under the same conditions. The beneficial effects were temporary and lasted only one day after injury and the single irradiation session.

Journal ArticleDOI
TL;DR: The results presented are the first direct experimental evidence to support the existence of appreciable systemic absorption of a dietary lectin, and only a small proportion of the non-toxic tomato lectin is absorbed systemically.
Abstract: There was no evidence of accumulation of PHA in any particular organ although trichloroacetic acid-precipitable and total counts (not shown) were high in kidneys, particularly when calculated on a tissue weight basis. Only the liver of tomato-lectin-treated rats contained as much radioactivity as that from PHA-intubated animals. It has been shown previously (Pusztai et al., 1986) that the toxicity of dietary PHA is dependent not just on its local disruptive effects on the small intestine but also on ensuing systemic toxic responses to the lectin. This gives an indirect indication that dietary PHA or other lectins might breach the gut absorptive barrier in appreciable quantities. The results presented (Table 1) are, however, the first direct experimental evidence to support the existence of appreciable systemic absorption of a dietary lectin. It is particularly significant that under the same experimental conditions only a small proportion of the non-toxic tomato lectin is absorbed systemically. This was apparently not due to differential survival of the lectins in the gut, but was more probably due to differences in their binding specificity to and extent of endocytosis by small intestinal cells. As recently shown, even lectins less toxic than PHA gain access to the body by passing through the gut wall and thus are good immunogens by the oral route (de Aizapurua & Russell-Jones, 1988). In a recent review on oral drug delivery (Pusztai, 1989) the potential effectiveness of lectins for such an application was explored. The results in the present paper go a long way to underpin such theoretical considerations and form a basis for practical exploration of this potential.

Journal ArticleDOI
TL;DR: In this paper, axial forces across the growth plate of the upper tibia during controlled distraction were studied in 24 rabbits close to skeletal maturity, and the results showed that response to controlled distraction was dependent upon both the level of force acting across the tibia and the rate of distraction; hyperplasia was achieved with lower rates of distraction up to a
Abstract: Axial forces across the growth plate of the upper tibia during controlled distraction were studied in 24 rabbits close to skeletal maturity. Distraction rates of 0.13, 0.26, and 0.53 mm every 24 hours were applied through a dual-frame external fixator. Strain gauges were bonded to the fixator, and axial forces were estimated prior to and following distraction. The results demonstrate two distinct patterns. In one group, forces increased to maximum values of 20–32 newtons and then suddenly decreased on subsequent distraction. This force pattern indicated fracture of the growth plate with associated hyperplasia. In the other group, lower maximum forces of 6–18 newtons were produced at the end of the distraction period, which were associated with physeal hyperplasia without fracture. These results showed that response to controlled distraction was dependent upon both the level of force acting across the growth plate and the rate of distraction; hyperplasia was achieved with lower rates of distraction up to a...

Journal ArticleDOI
01 Feb 1989-Spine
TL;DR: In this paper, a method is described by which these changes can be measured and compared with the shape of the normal spine, using an automated stereophotogrammetric technique (ISIS).
Abstract: Measurement of height in scoliotic patients is complicated by changes in spinal shape in both the coronal and sagittal planes. A method is described by which these changes can be measured and compared with the shape of the normal spine, using an automated stereophotogrammetric technique (ISIS). The resultant height change may be of use in the prediction of respiratory function.

Journal ArticleDOI
TL;DR: The use of Flowtron, an intermittent compression system in treatment of knee flexion contractures in haemophiliac patients is described.
Abstract: Description of the use of Flowtron, an intermittent compression system in treatment of knee flexion contractures in haemophiliac patients


Journal ArticleDOI
TL;DR: There are several groups of disorders where ultrasound has the potential to make a positive contribution to clinical management and these are set out below.

Journal ArticleDOI
TL;DR: Temporal studies of antigen expression in the chambers indicated that the antigen occurs at sites of bone formation after the appearance of alkaline phosphatase but before the formation of a mineralized matrix.
Abstract: A monoclonal antibody of immunoglobulin class G1 has been produced which reacts with a high molecular weight antigen apparently present exclusively in osteogenic tissues. Immunohistochemical studies have shown that the antigen is present throughout the mineralized matrix and in osteoid. None of the other tissues examined namely liver, intestine, kidney, spleen, thymus, heart, lung, skin, cartilage and skeletal muscle showed evidence of specific antibody binding. Immunohistochemical staining was also demonstrated in tissues developing from rabbit marrow cultured in vitro and in diffusion chambers in vivo. Temporal studies of antigen expression in the chambers indicated that the antigen occurs at sites of bone formation after the appearance of alkaline phosphatase but before the formation of a mineralized matrix. The results of these studies suggest that the monoclonal antibody recognises a product of differentiated osteoblasts. This antibody may therefore prove useful in studies of osteogenic differentiation.


Journal ArticleDOI
TL;DR: The clinical findings in two children with Pierre-Robin syndrome were similar to those described in patients with poliomyelitis and both showed iliotibial band contractures following splintage of the hips in a Pavlik harness for over six months in a position which allowed the iliOTibial bands to shorten.
Abstract: The Pavlik harness is widely used to splint unstable hips in the first months of life. Complications are well described : the hips may fail to stabilise ; avascular necrosis may occur (Iwasaki 1983); minor problems of soreness and transient foot cavus may develop (Bradley, Weathenill and Benson 1987). The complication we describe has not, as far as we know, been reported previously. Case 1. An eight-month-old boy with Pierre-Robin syndrome was found to have a subluxable right hip. There were no neurological abnormalities of his lower limbs and he was treated for seven months in a Pavlik harness. At completion of treatment deep stable reduction was demonstrated but there were bilateral hip flexion contractures of 40#{176} with limitation of adduction in extension. Abducting the hips abolished the flexion contractures (Figs la and 1b) indicating that the primary contracture was of the iliotibial bands. Release of tensor fascia lata, its overlying fascia and the iliotibial band with its attached lateral intermuscular septum just distal to the greater trochanter resulted in correction of the hip deformity. The corrected position was maintained in splintage for several months and a full range of hip movement resulted. Case 2. An otherwise normal six-month-old girl was found to have a dislocated right hip ; unusually it was stable in flexion and dislocated only with extension. Treatment by splintage in a Pavlik harness for seven months resulted in stable reduction. However, she had developed bilateral flexion abduction deformities of both hips due to shortening of the iliotibial bands. The hips were stretched regularly and splinted in extension for several months. The contractures slowly improved and a full range of movement was regained. Discussion. The clinical findings in our two children were similar to those described in patients with poliomyelitis. Both showed iliotibial band contractures following splintage of the hips in a Pavlik harness for over six months in a position which allowed the iliotibial band to shorten. They had no evidence ofmuscular weakness and

Journal ArticleDOI
TL;DR: The Lie Femurett(Tm)1 adjustable training prosthesis was evaluated on above-knee amputees attending the Oxford Disablement Services Centre and in the elderly it proved superior to the Pneumatic Post-Amputation Mobility Aid in the assessment of their ability to use a prosthesis.
Abstract: The Lie Femurett(Tm)1 adjustable training prosthesis was evaluated on 51 above-knee amputees attending the Oxford Disablement Services Centre. In the elderly it proved superior to the Pneumatic Post-Amputation Mobility Aid (P.P.A.M.-Aid) (Tm)2 in the assessment of their ability to use a prosthesis, and is useful for walking training once the stump is fully healed; it does not replace the P.P.A.M-Aid at the early post-operative stage.