Browsing by Author "S.M. Tuli"

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Ainhum in a female child involving a great toe
(1967) V.N. Sehgal; S.M. Tuli; I.M. Gupta
An early case of ainhum involving the great toe in a female child is recorded and the relevant literature on the subject is briefly reviewed. © 1967 S. Karger AG, Basel.
Allogenic decalbone in the repair of benign cystic lesions of bone
(Springer-Verlag, 1992) S.C. Goel; S.M. Tuli; H.P. Singh; S.V. Sharma; S.K. Saraf; T.P. Srivastava
Forty-six cases of benign cystic lesions of bone were treated by curettage and compact filling using partially decalcified allogenic bone graft (Decalbone); of these, 35 were available for study. Decalbone was prepared by partial decalcification with 0.6 N hydrochloric acid (HCl) of human bones generally obtained from freshly amputated limbs. The commonest lesions of bone were giant cell tumours (14) and aneurysmal bone cysts (15), and the commonest bones involved were the femur (23) and the tibia (12). There was one failure and four recurrences. Five cases were infected but this did not interfere with healing of the primary lesion. Radiological incorporation of the graft was seen at about 3 months in unicameral bone cysts, at 4-6 months in aneurysmal bone cysts and at 6-9 months in giant cell tumours. There was no recurrence in any case of giant cell tumour, but three aneurysmal bone cysts recurred. There was no clinical immune reaction. © 1992 Springer-Verlag.
Anomalous M. palmaris longus producing carpal tunnel-like syndrome
(Springer-Verlag, 1991) S.K. Saraf; S.M. Tuli
A case of median nerve compression due to an anomalous fleshy palmaris longus tendon is presented. © 1991 Springer-Verlag.
Anterior approach to the cervical spine
(1979) S.M. Tuli
Twenty patients consisting of tuberculosis (6), post-traumatic instability (2), bone tumor (2), spondylotic myelopathy (7), and cervical disc prolapse (3) were reviewed. 18 patients at the time of operation had advanced objective neural deficit, 2 of post-traumatic instability had recovered from prior quadriparesis. For localisation in the absence of compatible radiological signs, myelography was considered mandatory. All patients were in skull traction (4-6 weeks) pre-operatively, during operation and post-operatively. While operating in the absence of an obvious mass, lateral operative radiograph localised the site. It was a safe procedure for effective decompression and arthrodesis from the lower border of the second cervical to the first dorsal vertebra. Up to 3 consecutive disc spaces and intervening vertebral bodies could be conveniently tackled. A suitable sized block of bone graft snuggly fitted in the gap with few special instruments, provided a stable fixation. Postoperative skull traction and four-post collar ensured success of arthrodesis in all cases despite subluxation of the graft in 2 patients. Neurological deficit recovered in all except 2 with generalised radiological cervical spondylosis.
Autoclaved partially decalcified bone as osteogenic substances--an experimental study.
(1991) S.K. Saraf; K. Agarwal; S.M. Tuli; S. Khanna
A large osteoperiosteal gap was created in rabbit's ulna. A total of 18 allogenic decalbone grafts in left ulnar gap and 20 autoclaved allogenic decalbone grafts on right ulnar gaps were implanted. Five gaps were left unbridged to serve as controls. The results were assessed by clinical, radiological, macroscopic, histological and tetracycline fluorescent studies. It is observed that whereas the decalbone can successfully bridge a large gap in a vast majority of cases; the standard autoclaving of decalbone denatures its proteins which melt and cover the outer surface. The union, incorporation and remodelling of autoclaved decalbone grafts are slower as compared to that with unautoclaved decalbone.
Bacteriological study in osteo articular tuberculosis
(1976) V.P. Lakhanpal; H. Singh; P.C. Sen; S.M. Tuli
One hundred and five specimens were submitted for culture for acid fast bacilli, positive cultures were obtained in 49.53% of cases, when 20.95% of specimens which were contaminated were counted as negative. Excluding contaminated materials, culture for acid fast bacilli was positive in 62.65% of cases. In this study cultures were incubated for 20 weeks. Seventy three per cent of the positive cultures appeared within 8 weeks, 27% of the positive cultures appeared when incubated between 8 and 20 weeks. There were 14 cultures which were positive during the first 4 weeks, these patients had had no antitubercular drugs before this investigation. Out of the positive cultures 90.38% were typical Mycobacterium tuberculosis, 9.62% were chromogens, one of which was in association with typical Mycobacterium. Out of typical Mycobacterium tuberculosis 16.66% were found to be resistant to streptomycin only, 12.5% were resistant to P.A.S. only, 20.83% were resistant to I.N.H. alone and 8.33% were resistant to thiacetazone exclusively. All chromogenic acid fast bacilli were resistant to all the first line anti tubercular drugs streptomycin, P.A.S., I.N.H. and to thiacetazone.
Behaviour of autoclaved massive autologous bone grafts - an experimental study
(1977) S.M. Tuli; S.C. Chopra; G. Chakraverty
Comparative behaviour of massive autogenous bone grafts was studied in 3 groups: Group-A (control), Group-B (autoclaved), and Group-C autoclaved supplemented with fresh autogenous cancellous bone (composite). The parameters of study were radiological, macroscopic, histological and tetracycine fluorescence observed up to a period of 36 weeks after reimplantation. No foreign body reaction or immunological rejection phenomenon was found. The grafts were reasonably cellular, vascular and incorporated by 18 weeks in the control (Group-A) and by 36 weeks in the autoclavd-composite graft (Group-C). Even in the autoclaved graft (Group-B) macroscopic adhesion, pink colour, appreciable cellularity and presence of tetracycline fluorescence was observed between 24 and 36 weeks. The cancellous region in general showed early and intensive vascularity, cellularity and fluorescence. Correlating the radiological, macroscopic, histological and tetracycline fluorescence observations in the present study it may be stated that an autoclaved autologous bone segment can provide an inert durable frame work to bridge a gap in a major bone when a better graft is not available. In clinical practice this may be applicable in cases of tumours which could be resected en-bloc. The resected mass of bone by heat treatment could be sterilised of malignant cells as well as of any organisms, and reimplanted to bridge the defect by the easily available material. Revascularisation and resorption could be speeded up by increasing the porosity of the heat-treated bone by a chemical or physical method. Bone forming property of the autoclaved implant could also be improved by impregnating the graft with fresh autologous cancellous bone or any other suitable osteoinductive agent. Thus the scaffolding of the autoclaved bone segment could be used as an expander of the bone forming capacity of fresh autologous cancellous bone.
Bridging large bone defects with a xenograft composited with autologous bone marrow - An experimental study
(Springer-Verlag, 1982) D. Gupta; S. Khanna; S.M. Tuli
We have investigated the role of defatted, decalcified xenogenic bone implants composited by impregnation with fresh autologous marrow in bridging large cortical defects. Diaphyseal cortical implants were obtained from orthopaedic operations on humans and from guinea pigs and prepared by treatment with acetone, 0.6 M HCl and ethanol. The composited graft was used to bridge a 3 cm defect in the diaphysis of the ulna of rabbits. Periodic investigations were made clinically, radiographically and histologically and by tetracycline, fluorescence studies up to 20 weeks. Abundant new bone formation was observed in 85.7% of composited human xeno-autografts and in 83.3% of composited guinea pig xeno-autografts. New bone formation was seen in 13.3% of noncomposited xeno-implants. No appreciable antigenicity was observed either clinically or histologically in the grafts. The high degree of success obtained justifies further studies on implants composited by fresh autologous marrow and offers hope for the enhancement of new bone formation clinically, particularly in reconstructive operations for significant skeletal defects. We feel that the osteo-inductive potential of autologous marrow was responsible for the healing of the defects aided by the better internal milieu provided by defatted decalcified xeno implant. © 1982 Springer-Verlag.
Bridging of large chronic osteoperiosteal gaps by allogeneic decalcified bone matrix implants in rabbits
(1981) S.M. Tuli; K.B. Gupta
A circumferential complete osteoperiosteal gap (1 to 1.5 cm) was produced in the diaphysis of ulna of rabbits, and the ipsilateral radius was kept intact. In no case did spontaneous bridging of the gap occur. By 6 weeks after the creation of the gap the bone ends became smooth and tapered towards the ipsilateral radius and the defect was observed to be filled by thin fibrous tissue. Established defects at least 6 weeks old were then bridged by inserting a snugly fitting allogeneic bone matrix implant. The bone matrix was prepared by demineralization of tubular bones from healthy rabbits, using 0.6 M HC1, preserved in 75% alcohol and used within 3 weeks. The fate of the implant was observed clinically, radiologically, histologically and by tetracycline fluorescence for up to 12 weeks. Radiologic evidence of bone formation was present in a majority by 6 weeks, and complete bridging of the gap was seen in 75% of cases by 12 weeks after implantation. Most of the initial bone that formed was the woven bone, i.e., immature bone formed directly from the mesenchymal cells, or formed in membrane, though areas of enchondral ossification were also observed in some cases. By 12 weeks, the bone had remodeled almost to the texture of a mature tubular bone. Successful bridging of chronic massive bone defects by allogeneic bone-matrix was confirmed in 75% of cases. © 1981 by The Williams and Wilkins Co.
Carbon fibre reinforced epoxy implants for bridging large osteoperiosteal gaps
(1988) R. Prakash; S. Marwah; S.C. Goel; S.M. Tuli
An experimental study was undertaken to evaluate the suitability or otherwise of carbon fibre reinforced epoxy (CFRE) implants for bridging large osteoperiosteal gaps, devoid of periosteum. Using the basic principles of composite mechanics and simple design criteria, CFRE implants were designed and developed. These implants were put in simulated osteoperiosteal gaps in the ulna of healthy mature rabbits. Ten wk postoperative results clearly demonstrated that implants made of CFRE induced callus bone formation (in the form of woven bone) which totally encapsulated the implant thereby providing reunion of the two bone segments. Further follow-up showed formation of lamellar bones and formation in the pores of the implant. Radiological and scanning electron microscopical evidence is presented. © 1988.
Comparative study of bone formation by allogenic decalcified bone matrix and by plaster of Paris in osteo-periosteal gaps
(1980) S.V. Sharma; Y.S.N. Murthy; S.M. Tuli
A comparative study of the bone forming potential of demineralised homologous bone matrix and plaster of Paris implants was made by implanting an appropriate size of each implant, in a large circumferential osteo-periosteal gap of the diaphysis of the ulna in rabbits. Periodic observations of the implants were made clinically, radiologically, histologically and by tetracycline fluorescence up to 14 weeks. By 12 weeks after operation 78.5% of the animals revealed bone formation in the demineralised bone matrix implant and complete bridging of the proximal part of the gap. The distal part of the gap having plaster of Paris implant, however, was absorbed by 6 weeks and evoked no bone formation; the gap had been filled with fibrous tissue. Plaster of Paris was considered to act only as a space occupying inert material with no osteo-inductive property. The osteoinductive property of demineralised bone matrix was further confirmed by this study.
Congenital Anomalies Of The Hand
(Georg Thieme Verlag, 2023) N.N. Khanna; S.M. Tuli
A brief review of literature on congenital hand anomalies has been presented along with our observations in 43 cases of such anomalies. The current concepts in the aetiology of congenial hand anomalies have also been described. © 2023 Georg Thieme Verlag. All rights reserved.
Congenital macrodactyly
(1969) S.M. Tuli; N.N. Khanna; G.P. Sinha
Four cases of congenital macrodactyly are reported. Clinical, radiological, plethysmographic, operative and histological observations are presented. Findings of other workers and the pathogenesis of this rare condition are discussed. Principles of surgical treatment are briefly described. Plethysmographic observations and histological changes in the skin seem to have been mentioned for the first time. © 1969.
Effect of preimplantation treatment on the bone-forming potential of decalcified allogeneic and xenogeneic bone-matrix implants
(Springer-Verlag, 1979) S.M. Tuli; R.H. Chaudhuri
Bone-forming property of 0.6 M HCl decalcified (a) allogeneic bone matrix preserved in 70% alcohol, (b) allogeneic bone matrix preserved in anaesthetic ether, (c) allogeneic 'Ossein' provided by the Leather Research Institute, Madras, and (d) xenogeneic bone-matrix preserved in alcohol was studied by fitting the implants in surgically created complete circumferential osteo-periosteal gaps in the ulna of rabbits. Bone formation was assessed radiologically, macroscopically, histologically, and by tetracycline fluorescence up to 16 postimplantation weeks. Successful bridging of the gap by new bone formation was observed in 75% of (a) and 28.6% of (d) preserved up to 2 weeks. Ether-preserved implants did not induce bone formation. The 'Ossein' implants remained as inert material neither invaded by host cells nor inducing any bone formation. The xenogeneic implants exhibited local immune response which was probably responsible for poor osteogeneic response. Bone forming quality of bone-matrix implants appears to be influenced by the chemical treatment during preparation and preservation, host cellular response and immune reaction invoked by the implant. © 1979 J.F.Bergmann Verlag.
Effect of size and shape of the allogeneic bone grafts in bridging experimental ulnar gap in rabbits.
(1994) S.K. Saraf; A. Kumar; S.M. Tuli; S. Khanna
Partially decalcified allogeneic bone matrix was cut into the sizes and shapes of cylinders, bone strips and pulverized bone powder. Large osteoperiosteal gaps were created in rabbit's ulnae. A total of 14 gaps were filled with bone strips, 20 with powder, six with cylinders and two were left unbridged to serve as control. The healing of gap was assessed at intervals with a maximum follow up of 24 weeks. Clinically at 12 weeks the bone strips could not be moved separately from each other, the whole tubular bone had also united whereas gaps filled with bone powder did not diminish in size. Radiologically union occurred earlier (around 12 weeks) in bone strips as compared to cylinders (approx-18 weeks). With bone powder only a faint line of the remnants was visible. Gross examination findings of the grafted area were in concurrence with the clinical and radiological findings. Overall the gaps filled with bone strips had 100 per cent success with early osteo induction and remodelling as compared to long cylinders whereas gaps filled with bone powder had complete failure.
Ewing's sarcoma: A combined approach in the management
(1981) G.C. Pant; B. Sanyal; K. Sahni; S.M. Tuli; T.P. Srivastava
Twenty-seven histologically confirmed cases of localised Ewing's sarcoma were treated by two different regimes. Radiotherapy alone was used in 13 cases and a combination of chemotherapy and radiotherapy in 14. Single agent chemotherapy (cyclophosphamide) was given sequentially in nine patients and cyclophosphamide and actinomycin-D in five. There is a significant difference in the response to these different regimes. Only 69.2% of patients treated by radiotherapy alone were disease-free, for a median period of 10.4 months and metastases were noticed in 53.8% of cases. The disease-free survival in patients treated by combination therapy (radiotherapy and chemotherapy) was 18.4 months and metastases were seen in only 42.9%. However, no metastases were seen in patients who received cyclophosphamide and actinomycin-D, during a period of 14 months and only one patient showed residual disease. It is concluded that the addition of cyclophosphamide alone is not adequate in the management of Ewing's sarcoma. Actinomycin-D in addition to cyclophosphamide has improved the disease-free survival period significantly. The optimum dose of radiotherapy and its combination with other chemotherapeutic agents needs further trials to find the best and most suitable schedule. © 1981 Royal College of Radiologists.
Ewing's tumour of the vertebrae
(1988) V. Mohan; S.K. Gupta; S.M. Tuli; B. Sanyal
[No abstract available]
Excision arthroplasty for tuberculous and pyogenic arthritis of the hip
(1981) S.M. Tuli; S.K. Mukherjee
Thirty patients with chronic pyogenic or tuberculous arthritis of the hip treated by Girdlestone's excision arthroplasty were reviewed two to seven years after operation. There was marked or complete relief of pain in 29, control of infection in 27, squatting and sitting cross-legged was possible in 27, and 16 were able to stand on the operated limb. Overall results were good in 16, fair in nine, and poor in five. Tuberculous disease was not reactivated and the use of traction for 12 weeks and a weight-relieving caliper for 12 months after operation helped to reduce the shortening to an average of 3.8 centimetres. Excision arthroplasty is considered a sound operation to restore the ability to squat and sit cross-legged.
Giant cell tumour of metacarpals
(1975) T.P. Srivastava; S.M. Tuli; B.P. Varma; S. Gupta
Four cases of giant cell tumours of the metacarpals are reported. One patient was treated with en bloc resection and 2 patients with en bloc resection and reconstruction with iliac crest autografts. There was no recurrence in these 3 cases during follow up. One patient with fungation and soft tissue involvement was treated with amputation of the involved ray. There was local soft tissue recurrence in this case 6 months later, for which amputation of the adjacent ray was performed. The patient has been free from further recurrence.
Giant-cell tumour of bone - A study of natural course
(Springer-Verlag, 1978) S.M. Tuli; B.P. Varma; T.P. Srivastava
Thirty-nine patients with giant-cell tumours of bone were reviewed. Twelve of these were unusually large. Fungation of the tumours did not occur spontaneously but only after incision or trauma. Fungation of the tumour or local infiltration of soft tissues was not always associated with histological signs or a clinical course of malignancy. Radical resection in the lower limbs lead to frequent complications with fracture through the bone graft and thorough but more conservative local curretage is recommended particularly in the weight bearing bones. © 1978 Springer-Verlag.