Feroz Khan - Academia.edu (original) (raw)
Papers by Feroz Khan
Irish Journal of Medical Science, 2000
Background Of over 20 different scoring systems to evaluate outcome following calcaneal fracture,... more Background Of over 20 different scoring systems to evaluate outcome following calcaneal fracture, the Maryland Foot Score has broad current acceptance. A general health survey, the Short Form 36 (SF 36) has also been used. Aims The study compared two scoring systems for assessing the outcome of open reduction and internal fixation of displaced intra-articular calcaneal fractures. Methods Over a four-year period, 31 displaced intra-articular calcaneal fractures were categorised by the Sanders classification and treated by open reduction and internal fixation. Outcome was assessed by the Maryland Foot Score and by the Short Form 36 (SF 36) general health questionnaire. Results Thirty-five per cent of fractures were Sanders class 2, 57% were class 3 and 8% were class 4. The average follow-up was 2.5 years (range 1–4 years). Using the Maryland Foot Score, seven fractures had an excellent result, 13 had a good result, six had a fair result and one was a failure. There was a correlation between pain (coefficient = 0.780, p Conclusion The Maryland Foot Score measures what it attempts to measure and therefore it has content validity for pain and physical function.
Archives of Orthopaedic and Trauma Surgery, 2004
Osteoid osteomas involving the phalanges of the toes are a rare occurrence. We report a case of a... more Osteoid osteomas involving the phalanges of the toes are a rare occurrence. We report a case of an osteoid osteoma of the distal phalanx of the second toe which was treated successfully with surgical excision. Although soft-tissue swelling with a typical clinical history is suggestive of the diagnosis, differentiation from subacute infection is subtle and may ultimately depend on tissue analysis.
Archives of Orthopaedic and Trauma Surgery, 2005
Introduction MR imaging has emerged as an important modality in the non-invasive evaluation of os... more Introduction MR imaging has emerged as an important modality in the non-invasive evaluation of osseous and soft-tissue structures in the post-traumatic knee. However, it is sometimes impossible to determine with confidence if a focus of high signal intensity in the meniscus is confined to the substance of the meniscus or if it extends to involve the joint surface. This is a critical differentiation because the latter represents meniscal tears that can be found and treated arthroscopically, whereas the former represents degeneration, intrasubstance tears or perhaps normal variants that are not amenable to arthroscopic intervention. The aim of this study was to investigate the occurrence of such borderline findings in relation to the posterior horn of the medial meniscus and to correlate the arthroscopic results. Materials and methods Sixty-four patients with suspected post-traumatic internal derangements of the knee who underwent MR imaging prior to arthroscopy were evaluated retrospectively. There were 48 men and 16 women. Their mean age was 28.2 years. Results Tears of the posterior horn of the medial meniscus were diagnosed unequivocally (grade 3 signal) in 18 patients and equivocally (grade 2/3 signal) in 10 patients. Arthroscopic correlation revealed 16 tears (89%) in the unequivocal group and only 1 tear (10%) in the equivocal group. Conclusion A meniscal tear is unlikely when MR shows a focus of high signal intensity in the posterior horn of the medial meniscus that does not unequivocally extend to involve the inferior or superior joint surface. An appropriate trial of conservative treatment is recommended in such questionable cases. MR is a useful diagnostic tool—however, it should be used selectively, and in conjunction with history and clinical examination in evaluating internal derangements of the knee.
Injury Extra, 2007
The mean length of hospital stay was 32 nights in the traditional group and 19 nights in the earl... more The mean length of hospital stay was 32 nights in the traditional group and 19 nights in the early active group ( p < 0.001). Excluding severely injured patients the mean stay was 29 nights and 10 nights ( p < 0.001), respectively. There was no significant difference in the mal-union rate between the two groups. Ten patients were short at 3 months (0.5-3 cm) and eight of these had been treated by EHS. None were short at 2 years. Eight children were long at 2 years. Seven of these were treated with anatomical reduction. At 2 years they all had good clinical and functional results. Four cases (which were treated with an ExFix) had complications. In our population, a 40% reduction in the incidence of femoral fractures over the 6-year period was noted. The reduction has been in falls and sports injuries.
Vascular Medicine, 1999
Elevated blood cholesterol is a major risk factor for atherosclerosis. Recent studies show that l... more Elevated blood cholesterol is a major risk factor for atherosclerosis. Recent studies show that lowering cholesterol reduces the risk of vascular disease, but the precise mechanisms for vascular improvement are not fully understood. Furthermore, it is not known whether the beneficial effects of cholesterol lowering extend to the skin microvasculature. In this unrandomized, open design study, we used iontophoresis and laser Doppler flowmetry to examine forearm skin perfusion in hypercholesterolaemic patients with PAOD before and after cholesterol-lowering therapy with fluvastatin.
Anaesthesia, 2007
The vasodilator properties of lidocaine are believed to be due mainly to the inhibition of action... more The vasodilator properties of lidocaine are believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves. However, mechanisms involving the vascular endothelium may also play a role, and in this study we investigated the potential influences of nitric oxide release, the cyclo-oxygenase pathway and the β-adrenoceptors of vascular smooth muscle. Laser Doppler imaging was used to measure microvascular blood flow responses to intradermal injection of lidocaine 2%, with or without the addition of preservatives, in eight healthy, male volunteers. Co-injection of the nitric-oxide–synthase inhibitor Nω-nitro-l-arginine methyl ester caused a 60% reduction in the response after about 20 min, and this reduction was enhanced with the lidocaine solution containing the preservatives methylhydroxybenzoate and propylhydroxybenzoate. No reduction in response was seen after blocking the cyclo-oxygenase or β-adrenoceptor pathways. Nitric oxide release contributes to the vasoactivity of lidocaine in human skin.
Anaesthesia, 2003
Summary We investigated the roles of the endothelial nitric oxide and cyclo-oxygenase pathways in... more Summary We investigated the roles of the endothelial nitric oxide and cyclo-oxygenase pathways in mediating the vasoactivity of prilocaine in the skin. We injected prilocaine 1% intradermally into forearm skin of 10 healthy, male subjects. Nitric oxide synthesis was inhibited at a second site by co-injecting prilocaine with l-NAME 1%. We then repeated the injections while blocking the cyclo-oxygenase pathway with aspirin (4 × 600 mg). We measured blood flow responses to the injections using laser Doppler imaging. We found that, after the traumatic effects of injection had subsided, l-NAME reduced the vascular response to prilocaine by a third (p = 0.012), indicating an influence specifically on the drug response. Aspirin had no effect on the response (p = 0.588). We conclude that the vasoactive effects of prilocaine in human skin are mediated partly through the release of endothelial nitric oxide and, although other mechanisms might also be involved, the cyclo-oxygenase pathway does not appear to play a role.
Diabetes Care, 1998
A b b re v i a t i o n s : ACh, acetylcholine; ANOVA, analysis of variance; ELISA, enzyme-linked ... more A b b re v i a t i o n s : ACh, acetylcholine; ANOVA, analysis of variance; ELISA, enzyme-linked immunosorbent assay; GSH, red cell glutathione; ICAM-1, intercellular cell adhesion molecule-1; PSH, plasma thiol; SHBG, sex hormone binding globulin; SkEF, skin ery t h rocyte flux; SOD, superoxide dismutase; vWF, von Wi l l e b r a n d f a c t o r.
British Journal of Surgery, 2005
Background:Most patients with critical leg ischaemia (CLI) have co-existing coronary heart diseas... more Background:Most patients with critical leg ischaemia (CLI) have co-existing coronary heart disease, which is the main cause of their increased mortality rate. The aim of this study was to investigate whether any markers of endothelial function could predict death in these patients.Most patients with critical leg ischaemia (CLI) have co-existing coronary heart disease, which is the main cause of their increased mortality rate. The aim of this study was to investigate whether any markers of endothelial function could predict death in these patients.Methods:In a cohort of 39 patients with CLI who were scheduled for lower-limb amputation, blood levels of vascular endothelial growth factor, homocysteine, endothelin (ET) 1, von Willebrand factor and vascular cell adhesion molecule 1 were measured, as well as forearm vascular responses to the endothelium-dependent vasodilator acetylcholine.In a cohort of 39 patients with CLI who were scheduled for lower-limb amputation, blood levels of vascular endothelial growth factor, homocysteine, endothelin (ET) 1, von Willebrand factor and vascular cell adhesion molecule 1 were measured, as well as forearm vascular responses to the endothelium-dependent vasodilator acetylcholine.Results:Levels of ET-1 were significantly higher in patients who subsequently died within 3 years than in those who were still alive (P = 0·002) and Cox proportional hazards regression analysis demonstrated that ET-1 was an independent predictor of all-cause mortality : hazard ratio 3·53 (95 per cent confidence interval (c.i.) 1·29 to 9·70; P = 0·007) and cardiovascular mortality : hazard ratio 4·15 (95 per cent c.i. 1·30 to 13·23); P = 0·014.Levels of ET-1 were significantly higher in patients who subsequently died within 3 years than in those who were still alive (P = 0·002) and Cox proportional hazards regression analysis demonstrated that ET-1 was an independent predictor of all-cause mortality : hazard ratio 3·53 (95 per cent confidence interval (c.i.) 1·29 to 9·70; P = 0·007) and cardiovascular mortality : hazard ratio 4·15 (95 per cent c.i. 1·30 to 13·23); P = 0·014.Conclusion:ET-1 was an independent predictor of death in these patients with CLI. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.ET-1 was an independent predictor of death in these patients with CLI. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Rheumatology, 2008
Objective. RA is a chronic autoimmune inflammatory condition associated with increased cardiovasc... more Objective. RA is a chronic autoimmune inflammatory condition associated with increased cardiovascular morbidity and mortality. Endothelial dysfunction, a marker of early atherosclerotic disease, occurs in some inflammatory diseases but this relationship has not been previously explored within the microvasculature of patients with RA. We therefore assessed forearm microvascular endothelial function in patients with RA and determined its relationship to RA disease activity and inflammation. Methods. A total of 128 RA patients with no previous history of cardiovascular disease were evaluated. Endothelium-dependent and -independent forearm skin microvascular function was measured using laser Doppler imaging after iontophoretic delivery of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively. Parameters of RA disease activity and inflammation were also checked.
Rheumatology, 2001
Objectives. To assess microvascular activity in the skin of patients with fibromyalgia syndrome (... more Objectives. To assess microvascular activity in the skin of patients with fibromyalgia syndrome (FMS) as compared with normal controls.
Journal of Foot & Ankle Surgery, 2002
The study investigated whether the effects of dermal replacement therapy on wound healing are ass... more The study investigated whether the effects of dermal replacement therapy on wound healing are associated with an increase in blood flow at the base of diabetic foot ulcers treated with Dermagraft®. Seven full-thickness ulcers were assessed in five patients with type 2 diabetes mellitus and peripheral neuropathy. All lesions had been present for at least 3 months with no recent change in size, despite routine foot care and protective dressings. Dermal replacement therapy was applied weekly to the base of each wound for 8 weeks, after which regular dressing was resumed. Microvascular blood flow was assessed using laser Dopp ler imaging immediately before and after 2, 5, and 8 weeks of treatment. Blood flow increased by an average of 72% in the base of five out of the seven ulcers studied. Five of the lesions healed by 12 weeks and the other two reduced in size by approximately 25 %. The changes in blood flow observed in this pilot study might reflect angiogenesis in the newly formed granulation tissue and/or vasodilatation of existing vessels, processes that are po ssibly enhanced by the intervention.
Diabetes Care, 2000
A b b re v i a t i o n s : A N O VA, analysis of variance; mC, millicoulomb; PU, perfusion unit; ... more A b b re v i a t i o n s : A N O VA, analysis of variance; mC, millicoulomb; PU, perfusion unit; SkEF, skin ery t h rocyte flux. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Rheumatology, 2009
Increased arterial stiffness, an independent risk factor for premature coronary artery disease, h... more Increased arterial stiffness, an independent risk factor for premature coronary artery disease, has been reported in patients with RA. The objectives of this study were first to assess, in patients with RA, the relationship between disease activity, inflammation and augmentation index, which is a combined measure of arterial stiffness and pulse wave reflection. The second objective was to establish any effect anti-rheumatic treatment may have on augmentation index. One hundred and forty-eight RA patients with no previous history of cardiovascular disease (CVD) had their augmentation index corrected for a heart rate of 75 beats per minute (AIx@75), and parameters of RA disease activity and CV risk measured. Forty-seven patients were then treated with either MTX (n = 21) or etanercept (ETAN) (n = 26), and assessments were repeated at 2 and 4 months. Patients with high CRP (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 10 mg/l) showed significantly higher mean AIx@75 than those with low CRP (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 10 mg/l) (33 +/- 8 vs 30 +/- 8%; P = 0.033). On regression analysis, log(10) CRP (beta = 0.298; P = 0.002), gender (beta = 0.257; P = 0.007), BMI (beta = -0.292; P = 0.004), diastolic blood pressure (beta = 0.260; P = 0.009) and age (beta = 0.194; P = 0.046) were independently associated with AIx@75. Treatment with ETAN (35 +/- 9, 32.5 +/- 1 and 32.5 +/- 8%; P = 0.025) but not MTX (31 +/- 1, 31 +/- 1 and 31 +/- 1%; P = 0.971) attenuated the AIx@75 significantly from baseline to Visits 2 and 3. Systemic inflammation (CRP) is an independent predictor of arterial stiffness and pulse wave reflection in patients with RA. ETAN but not MTX therapy reduces arterial stiffness and pulse wave reflection and may thus improve CV morbidity in RA.
Angiology, 1995
Although the diagnosis of Raynaud's phenomenon (RP) is usually made easily from a careful... more Although the diagnosis of Raynaud's phenomenon (RP) is usually made easily from a careful history, the assessment of RP severity is difficult, for the vasopastic attacks are not easily induced under experimental conditions. In this study, the laser Doppler flowmetry (LDF) technique was used to quantify digital blood flow, which was standardized by body cooling and warming in patients with RP. Twenty-one healthy subjects and 56 RP patients were studied: 7 had primary RP, 22 had suspected secondary Raynaud's syndrome (susp RS), and 27 had systemic sclerosis (SSc)-associated secondary Raynaud's syndrome (SSc RS). The inherent variability in the acral cutaneous circulation was minimized by whole-body warming and cooling. Digital blood flow values at environmental temperatures of 40 degrees C, 12 degrees C, and after rewarming, to 40 degrees C were recorded, as was the time taken for blood flow to reach 25%, 50%, and 75% of the full effects of whole-body cooling and rewarming. Patients with primary RP and susp RS had normal blood flow values at ambient temperatures of 40 degrees C, 12 degrees C, and after rewarming to 40 degrees C when compared with controls, but they had significantly faster vasoconstrictor responses to whole-body cooling, suggesting a heightened sympathetic activity. Additionally, they had slower vasodilator responses with longer 25%max response time to whole-body rewarming. Patients with SSc RS had significantly lower blood flow values at 40 degrees C after initial warming and following subsequent rewarming, and despite a normal vasoconstrictor response to cooling, it took longer for them to vasodilate during rewarming, suggesting that poor digital blood flow in these patients may be more related to digital vasculature abnormalities and not an increase in sympathetic activity. In conclusion, our assessment technique can be used to quantify digital blood flow in patients with RP and may be potentially useful in the investigation of the etiologic role of the sympathetic nervous system in RP.
Vascular Medicine, 1999
Elevated blood cholesterol is a major risk factor for atherosclerosis. Recent studies show that l... more Elevated blood cholesterol is a major risk factor for atherosclerosis. Recent studies show that lowering cholesterol reduces the risk of vascular disease, but the precise mechanisms for vascular improvement are not fully understood. Furthermore, it is not known whether the beneficial effects of cholesterol lowering extend to the skin microvasculature. In this unrandomized, open design study, we used iontophoresis and laser Doppler flowmetry to examine forearm skin perfusion in hypercholesterolaemic patients with PAOD before and after cholesterol-lowering therapy with fluvastatin.
British Journal of Anaesthesia, 2005
Background. Epinephrine is added to local anaesthetic preparations to prolong their action and re... more Background. Epinephrine is added to local anaesthetic preparations to prolong their action and reduce their systemic absorption. Bupivacaine and levobupivacaine cause vasodilatation at clinical doses, but lower doses appear to cause vasoconstriction. The aim of this study was to characterize fully the vasoactive effects of these anaesthetics, using an objective measure of blood flow, and to assess the influence of adding epinephrine.
Rheumatology International, 1991
Raynaud's syndrome (RS) is characterized by intense blood vessel spasm resulting in finger blanch... more Raynaud's syndrome (RS) is characterized by intense blood vessel spasm resulting in finger blanching. Treatment primarily involves vasodilation. Thromboxane A2 (TXA2) has been shown to be a potent vasoconstrictor and platelet aggregant. It may be possible to produce a vasodilatory and anti-thrombotic effect by blockade of the TXA2 receptors. ICI 192,605 is a potent TXA2 receptor antagonist and we studied its effects on platelet aggregation and digital blood flow in patients with RS. Sixteen patients with RS completed this doubleblind, randomized, placebo controlled study. Each patient was seen on three separate occasions and was given ICI 192,605 (100 mg orally) on one occasion and matching placebo tablets on the other two. We measured platelet aggregation using platelet rich plasma (PRP) stimulated by U46619, a thromboxane (TX) mimetic. The concentration of U46619 required to cause just over 50% platelet aggregation before the administration of either ICI 192,605 or placebo (pre-dose) was noted. The same concentration of U46619 was used to stimulate the PRP sample at 1h after the administration of ICI 192,605 or placebo (post-dose) and the percentage of platelet aggregation was again noted. Fingertip skin blood flow was also measured 1.25 h post-dose using a laser Doppler flowmeter. Patients were seated in a temperature controlled chamber which was initially heated to 40°C to induce centrally mediated vasodilatation. The temperature was then lowered to 12°C followed by rewarming to 40°C. Steady blood flow values at these temperatures were measured and the rates of cooling and rewarming were also noted. There was significant inhibition of platelet aggregation 1 h following the administration of ICI 192,605 {post-dose % platelet aggregation [mean (standard deviation)]=4.8 (12.7)% vs control values of 65.6 (10.5)% and 62.7 (21.3)%, PRaynaud's phenomenon further evaluation of this group of drugs in patients with RS is required.
Equine Veterinary Journal, 2010
A combined laser Doppler flowmetry and iontophoresis (LDFI) technique, used routinely to assess h... more A combined laser Doppler flowmetry and iontophoresis (LDFI) technique, used routinely to assess human microvascular function, was evaluated as a noninvasive technique for assessment of equine microvascular function, to facilitate the study of diseases such as laminitis. Baseline and vasoactive agonist-induced (acetylcholine and nitroprusside) microvascular flux was quantified at 2 sites (on the dorsal pastern adjacent to the coronary band and over the gluteals) in 6 clinically normal horses on 5 or 6 separate occasions under standardised conditions. Both agonists significantly increased microvascular flux. Skin pigmentation significantly attenuated the baseline flux, but not the magnitude of the agonist-mediated vasodilatory response. While LDFI was simple to perform, its value as a clinical and research tool for assessing the equine cutaneous microcirculation is limited by its poor reliability, as indicated by the marked intra- and intersubject variability in baseline and agonist-mediated microvascularflux.
Irish Journal of Medical Science, 2000
Background Of over 20 different scoring systems to evaluate outcome following calcaneal fracture,... more Background Of over 20 different scoring systems to evaluate outcome following calcaneal fracture, the Maryland Foot Score has broad current acceptance. A general health survey, the Short Form 36 (SF 36) has also been used. Aims The study compared two scoring systems for assessing the outcome of open reduction and internal fixation of displaced intra-articular calcaneal fractures. Methods Over a four-year period, 31 displaced intra-articular calcaneal fractures were categorised by the Sanders classification and treated by open reduction and internal fixation. Outcome was assessed by the Maryland Foot Score and by the Short Form 36 (SF 36) general health questionnaire. Results Thirty-five per cent of fractures were Sanders class 2, 57% were class 3 and 8% were class 4. The average follow-up was 2.5 years (range 1–4 years). Using the Maryland Foot Score, seven fractures had an excellent result, 13 had a good result, six had a fair result and one was a failure. There was a correlation between pain (coefficient = 0.780, p Conclusion The Maryland Foot Score measures what it attempts to measure and therefore it has content validity for pain and physical function.
Archives of Orthopaedic and Trauma Surgery, 2004
Osteoid osteomas involving the phalanges of the toes are a rare occurrence. We report a case of a... more Osteoid osteomas involving the phalanges of the toes are a rare occurrence. We report a case of an osteoid osteoma of the distal phalanx of the second toe which was treated successfully with surgical excision. Although soft-tissue swelling with a typical clinical history is suggestive of the diagnosis, differentiation from subacute infection is subtle and may ultimately depend on tissue analysis.
Archives of Orthopaedic and Trauma Surgery, 2005
Introduction MR imaging has emerged as an important modality in the non-invasive evaluation of os... more Introduction MR imaging has emerged as an important modality in the non-invasive evaluation of osseous and soft-tissue structures in the post-traumatic knee. However, it is sometimes impossible to determine with confidence if a focus of high signal intensity in the meniscus is confined to the substance of the meniscus or if it extends to involve the joint surface. This is a critical differentiation because the latter represents meniscal tears that can be found and treated arthroscopically, whereas the former represents degeneration, intrasubstance tears or perhaps normal variants that are not amenable to arthroscopic intervention. The aim of this study was to investigate the occurrence of such borderline findings in relation to the posterior horn of the medial meniscus and to correlate the arthroscopic results. Materials and methods Sixty-four patients with suspected post-traumatic internal derangements of the knee who underwent MR imaging prior to arthroscopy were evaluated retrospectively. There were 48 men and 16 women. Their mean age was 28.2 years. Results Tears of the posterior horn of the medial meniscus were diagnosed unequivocally (grade 3 signal) in 18 patients and equivocally (grade 2/3 signal) in 10 patients. Arthroscopic correlation revealed 16 tears (89%) in the unequivocal group and only 1 tear (10%) in the equivocal group. Conclusion A meniscal tear is unlikely when MR shows a focus of high signal intensity in the posterior horn of the medial meniscus that does not unequivocally extend to involve the inferior or superior joint surface. An appropriate trial of conservative treatment is recommended in such questionable cases. MR is a useful diagnostic tool—however, it should be used selectively, and in conjunction with history and clinical examination in evaluating internal derangements of the knee.
Injury Extra, 2007
The mean length of hospital stay was 32 nights in the traditional group and 19 nights in the earl... more The mean length of hospital stay was 32 nights in the traditional group and 19 nights in the early active group ( p < 0.001). Excluding severely injured patients the mean stay was 29 nights and 10 nights ( p < 0.001), respectively. There was no significant difference in the mal-union rate between the two groups. Ten patients were short at 3 months (0.5-3 cm) and eight of these had been treated by EHS. None were short at 2 years. Eight children were long at 2 years. Seven of these were treated with anatomical reduction. At 2 years they all had good clinical and functional results. Four cases (which were treated with an ExFix) had complications. In our population, a 40% reduction in the incidence of femoral fractures over the 6-year period was noted. The reduction has been in falls and sports injuries.
Vascular Medicine, 1999
Elevated blood cholesterol is a major risk factor for atherosclerosis. Recent studies show that l... more Elevated blood cholesterol is a major risk factor for atherosclerosis. Recent studies show that lowering cholesterol reduces the risk of vascular disease, but the precise mechanisms for vascular improvement are not fully understood. Furthermore, it is not known whether the beneficial effects of cholesterol lowering extend to the skin microvasculature. In this unrandomized, open design study, we used iontophoresis and laser Doppler flowmetry to examine forearm skin perfusion in hypercholesterolaemic patients with PAOD before and after cholesterol-lowering therapy with fluvastatin.
Anaesthesia, 2007
The vasodilator properties of lidocaine are believed to be due mainly to the inhibition of action... more The vasodilator properties of lidocaine are believed to be due mainly to the inhibition of action potentials via sodium channel blocking in vasoconstrictor sympathetic nerves. However, mechanisms involving the vascular endothelium may also play a role, and in this study we investigated the potential influences of nitric oxide release, the cyclo-oxygenase pathway and the β-adrenoceptors of vascular smooth muscle. Laser Doppler imaging was used to measure microvascular blood flow responses to intradermal injection of lidocaine 2%, with or without the addition of preservatives, in eight healthy, male volunteers. Co-injection of the nitric-oxide–synthase inhibitor Nω-nitro-l-arginine methyl ester caused a 60% reduction in the response after about 20 min, and this reduction was enhanced with the lidocaine solution containing the preservatives methylhydroxybenzoate and propylhydroxybenzoate. No reduction in response was seen after blocking the cyclo-oxygenase or β-adrenoceptor pathways. Nitric oxide release contributes to the vasoactivity of lidocaine in human skin.
Anaesthesia, 2003
Summary We investigated the roles of the endothelial nitric oxide and cyclo-oxygenase pathways in... more Summary We investigated the roles of the endothelial nitric oxide and cyclo-oxygenase pathways in mediating the vasoactivity of prilocaine in the skin. We injected prilocaine 1% intradermally into forearm skin of 10 healthy, male subjects. Nitric oxide synthesis was inhibited at a second site by co-injecting prilocaine with l-NAME 1%. We then repeated the injections while blocking the cyclo-oxygenase pathway with aspirin (4 × 600 mg). We measured blood flow responses to the injections using laser Doppler imaging. We found that, after the traumatic effects of injection had subsided, l-NAME reduced the vascular response to prilocaine by a third (p = 0.012), indicating an influence specifically on the drug response. Aspirin had no effect on the response (p = 0.588). We conclude that the vasoactive effects of prilocaine in human skin are mediated partly through the release of endothelial nitric oxide and, although other mechanisms might also be involved, the cyclo-oxygenase pathway does not appear to play a role.
Diabetes Care, 1998
A b b re v i a t i o n s : ACh, acetylcholine; ANOVA, analysis of variance; ELISA, enzyme-linked ... more A b b re v i a t i o n s : ACh, acetylcholine; ANOVA, analysis of variance; ELISA, enzyme-linked immunosorbent assay; GSH, red cell glutathione; ICAM-1, intercellular cell adhesion molecule-1; PSH, plasma thiol; SHBG, sex hormone binding globulin; SkEF, skin ery t h rocyte flux; SOD, superoxide dismutase; vWF, von Wi l l e b r a n d f a c t o r.
British Journal of Surgery, 2005
Background:Most patients with critical leg ischaemia (CLI) have co-existing coronary heart diseas... more Background:Most patients with critical leg ischaemia (CLI) have co-existing coronary heart disease, which is the main cause of their increased mortality rate. The aim of this study was to investigate whether any markers of endothelial function could predict death in these patients.Most patients with critical leg ischaemia (CLI) have co-existing coronary heart disease, which is the main cause of their increased mortality rate. The aim of this study was to investigate whether any markers of endothelial function could predict death in these patients.Methods:In a cohort of 39 patients with CLI who were scheduled for lower-limb amputation, blood levels of vascular endothelial growth factor, homocysteine, endothelin (ET) 1, von Willebrand factor and vascular cell adhesion molecule 1 were measured, as well as forearm vascular responses to the endothelium-dependent vasodilator acetylcholine.In a cohort of 39 patients with CLI who were scheduled for lower-limb amputation, blood levels of vascular endothelial growth factor, homocysteine, endothelin (ET) 1, von Willebrand factor and vascular cell adhesion molecule 1 were measured, as well as forearm vascular responses to the endothelium-dependent vasodilator acetylcholine.Results:Levels of ET-1 were significantly higher in patients who subsequently died within 3 years than in those who were still alive (P = 0·002) and Cox proportional hazards regression analysis demonstrated that ET-1 was an independent predictor of all-cause mortality : hazard ratio 3·53 (95 per cent confidence interval (c.i.) 1·29 to 9·70; P = 0·007) and cardiovascular mortality : hazard ratio 4·15 (95 per cent c.i. 1·30 to 13·23); P = 0·014.Levels of ET-1 were significantly higher in patients who subsequently died within 3 years than in those who were still alive (P = 0·002) and Cox proportional hazards regression analysis demonstrated that ET-1 was an independent predictor of all-cause mortality : hazard ratio 3·53 (95 per cent confidence interval (c.i.) 1·29 to 9·70; P = 0·007) and cardiovascular mortality : hazard ratio 4·15 (95 per cent c.i. 1·30 to 13·23); P = 0·014.Conclusion:ET-1 was an independent predictor of death in these patients with CLI. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.ET-1 was an independent predictor of death in these patients with CLI. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
Rheumatology, 2008
Objective. RA is a chronic autoimmune inflammatory condition associated with increased cardiovasc... more Objective. RA is a chronic autoimmune inflammatory condition associated with increased cardiovascular morbidity and mortality. Endothelial dysfunction, a marker of early atherosclerotic disease, occurs in some inflammatory diseases but this relationship has not been previously explored within the microvasculature of patients with RA. We therefore assessed forearm microvascular endothelial function in patients with RA and determined its relationship to RA disease activity and inflammation. Methods. A total of 128 RA patients with no previous history of cardiovascular disease were evaluated. Endothelium-dependent and -independent forearm skin microvascular function was measured using laser Doppler imaging after iontophoretic delivery of acetylcholine (ACh) and sodium nitroprusside (SNP), respectively. Parameters of RA disease activity and inflammation were also checked.
Rheumatology, 2001
Objectives. To assess microvascular activity in the skin of patients with fibromyalgia syndrome (... more Objectives. To assess microvascular activity in the skin of patients with fibromyalgia syndrome (FMS) as compared with normal controls.
Journal of Foot & Ankle Surgery, 2002
The study investigated whether the effects of dermal replacement therapy on wound healing are ass... more The study investigated whether the effects of dermal replacement therapy on wound healing are associated with an increase in blood flow at the base of diabetic foot ulcers treated with Dermagraft®. Seven full-thickness ulcers were assessed in five patients with type 2 diabetes mellitus and peripheral neuropathy. All lesions had been present for at least 3 months with no recent change in size, despite routine foot care and protective dressings. Dermal replacement therapy was applied weekly to the base of each wound for 8 weeks, after which regular dressing was resumed. Microvascular blood flow was assessed using laser Dopp ler imaging immediately before and after 2, 5, and 8 weeks of treatment. Blood flow increased by an average of 72% in the base of five out of the seven ulcers studied. Five of the lesions healed by 12 weeks and the other two reduced in size by approximately 25 %. The changes in blood flow observed in this pilot study might reflect angiogenesis in the newly formed granulation tissue and/or vasodilatation of existing vessels, processes that are po ssibly enhanced by the intervention.
Diabetes Care, 2000
A b b re v i a t i o n s : A N O VA, analysis of variance; mC, millicoulomb; PU, perfusion unit; ... more A b b re v i a t i o n s : A N O VA, analysis of variance; mC, millicoulomb; PU, perfusion unit; SkEF, skin ery t h rocyte flux. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Rheumatology, 2009
Increased arterial stiffness, an independent risk factor for premature coronary artery disease, h... more Increased arterial stiffness, an independent risk factor for premature coronary artery disease, has been reported in patients with RA. The objectives of this study were first to assess, in patients with RA, the relationship between disease activity, inflammation and augmentation index, which is a combined measure of arterial stiffness and pulse wave reflection. The second objective was to establish any effect anti-rheumatic treatment may have on augmentation index. One hundred and forty-eight RA patients with no previous history of cardiovascular disease (CVD) had their augmentation index corrected for a heart rate of 75 beats per minute (AIx@75), and parameters of RA disease activity and CV risk measured. Forty-seven patients were then treated with either MTX (n = 21) or etanercept (ETAN) (n = 26), and assessments were repeated at 2 and 4 months. Patients with high CRP (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 10 mg/l) showed significantly higher mean AIx@75 than those with low CRP (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 10 mg/l) (33 +/- 8 vs 30 +/- 8%; P = 0.033). On regression analysis, log(10) CRP (beta = 0.298; P = 0.002), gender (beta = 0.257; P = 0.007), BMI (beta = -0.292; P = 0.004), diastolic blood pressure (beta = 0.260; P = 0.009) and age (beta = 0.194; P = 0.046) were independently associated with AIx@75. Treatment with ETAN (35 +/- 9, 32.5 +/- 1 and 32.5 +/- 8%; P = 0.025) but not MTX (31 +/- 1, 31 +/- 1 and 31 +/- 1%; P = 0.971) attenuated the AIx@75 significantly from baseline to Visits 2 and 3. Systemic inflammation (CRP) is an independent predictor of arterial stiffness and pulse wave reflection in patients with RA. ETAN but not MTX therapy reduces arterial stiffness and pulse wave reflection and may thus improve CV morbidity in RA.
Angiology, 1995
Although the diagnosis of Raynaud's phenomenon (RP) is usually made easily from a careful... more Although the diagnosis of Raynaud's phenomenon (RP) is usually made easily from a careful history, the assessment of RP severity is difficult, for the vasopastic attacks are not easily induced under experimental conditions. In this study, the laser Doppler flowmetry (LDF) technique was used to quantify digital blood flow, which was standardized by body cooling and warming in patients with RP. Twenty-one healthy subjects and 56 RP patients were studied: 7 had primary RP, 22 had suspected secondary Raynaud's syndrome (susp RS), and 27 had systemic sclerosis (SSc)-associated secondary Raynaud's syndrome (SSc RS). The inherent variability in the acral cutaneous circulation was minimized by whole-body warming and cooling. Digital blood flow values at environmental temperatures of 40 degrees C, 12 degrees C, and after rewarming, to 40 degrees C were recorded, as was the time taken for blood flow to reach 25%, 50%, and 75% of the full effects of whole-body cooling and rewarming. Patients with primary RP and susp RS had normal blood flow values at ambient temperatures of 40 degrees C, 12 degrees C, and after rewarming to 40 degrees C when compared with controls, but they had significantly faster vasoconstrictor responses to whole-body cooling, suggesting a heightened sympathetic activity. Additionally, they had slower vasodilator responses with longer 25%max response time to whole-body rewarming. Patients with SSc RS had significantly lower blood flow values at 40 degrees C after initial warming and following subsequent rewarming, and despite a normal vasoconstrictor response to cooling, it took longer for them to vasodilate during rewarming, suggesting that poor digital blood flow in these patients may be more related to digital vasculature abnormalities and not an increase in sympathetic activity. In conclusion, our assessment technique can be used to quantify digital blood flow in patients with RP and may be potentially useful in the investigation of the etiologic role of the sympathetic nervous system in RP.
Vascular Medicine, 1999
Elevated blood cholesterol is a major risk factor for atherosclerosis. Recent studies show that l... more Elevated blood cholesterol is a major risk factor for atherosclerosis. Recent studies show that lowering cholesterol reduces the risk of vascular disease, but the precise mechanisms for vascular improvement are not fully understood. Furthermore, it is not known whether the beneficial effects of cholesterol lowering extend to the skin microvasculature. In this unrandomized, open design study, we used iontophoresis and laser Doppler flowmetry to examine forearm skin perfusion in hypercholesterolaemic patients with PAOD before and after cholesterol-lowering therapy with fluvastatin.
British Journal of Anaesthesia, 2005
Background. Epinephrine is added to local anaesthetic preparations to prolong their action and re... more Background. Epinephrine is added to local anaesthetic preparations to prolong their action and reduce their systemic absorption. Bupivacaine and levobupivacaine cause vasodilatation at clinical doses, but lower doses appear to cause vasoconstriction. The aim of this study was to characterize fully the vasoactive effects of these anaesthetics, using an objective measure of blood flow, and to assess the influence of adding epinephrine.
Rheumatology International, 1991
Raynaud's syndrome (RS) is characterized by intense blood vessel spasm resulting in finger blanch... more Raynaud's syndrome (RS) is characterized by intense blood vessel spasm resulting in finger blanching. Treatment primarily involves vasodilation. Thromboxane A2 (TXA2) has been shown to be a potent vasoconstrictor and platelet aggregant. It may be possible to produce a vasodilatory and anti-thrombotic effect by blockade of the TXA2 receptors. ICI 192,605 is a potent TXA2 receptor antagonist and we studied its effects on platelet aggregation and digital blood flow in patients with RS. Sixteen patients with RS completed this doubleblind, randomized, placebo controlled study. Each patient was seen on three separate occasions and was given ICI 192,605 (100 mg orally) on one occasion and matching placebo tablets on the other two. We measured platelet aggregation using platelet rich plasma (PRP) stimulated by U46619, a thromboxane (TX) mimetic. The concentration of U46619 required to cause just over 50% platelet aggregation before the administration of either ICI 192,605 or placebo (pre-dose) was noted. The same concentration of U46619 was used to stimulate the PRP sample at 1h after the administration of ICI 192,605 or placebo (post-dose) and the percentage of platelet aggregation was again noted. Fingertip skin blood flow was also measured 1.25 h post-dose using a laser Doppler flowmeter. Patients were seated in a temperature controlled chamber which was initially heated to 40°C to induce centrally mediated vasodilatation. The temperature was then lowered to 12°C followed by rewarming to 40°C. Steady blood flow values at these temperatures were measured and the rates of cooling and rewarming were also noted. There was significant inhibition of platelet aggregation 1 h following the administration of ICI 192,605 {post-dose % platelet aggregation [mean (standard deviation)]=4.8 (12.7)% vs control values of 65.6 (10.5)% and 62.7 (21.3)%, PRaynaud's phenomenon further evaluation of this group of drugs in patients with RS is required.
Equine Veterinary Journal, 2010
A combined laser Doppler flowmetry and iontophoresis (LDFI) technique, used routinely to assess h... more A combined laser Doppler flowmetry and iontophoresis (LDFI) technique, used routinely to assess human microvascular function, was evaluated as a noninvasive technique for assessment of equine microvascular function, to facilitate the study of diseases such as laminitis. Baseline and vasoactive agonist-induced (acetylcholine and nitroprusside) microvascular flux was quantified at 2 sites (on the dorsal pastern adjacent to the coronary band and over the gluteals) in 6 clinically normal horses on 5 or 6 separate occasions under standardised conditions. Both agonists significantly increased microvascular flux. Skin pigmentation significantly attenuated the baseline flux, but not the magnitude of the agonist-mediated vasodilatory response. While LDFI was simple to perform, its value as a clinical and research tool for assessing the equine cutaneous microcirculation is limited by its poor reliability, as indicated by the marked intra- and intersubject variability in baseline and agonist-mediated microvascularflux.