Distal Stump Research Articles

17β-Estradiol Promotes Schwann Cell Proliferation and Differentiation, Accelerating Early Remyelination in a Mouse Peripheral Nerve Injury Model.

Estrogen induces oligodendrocyte remyelination in response to demyelination in the central nervous system. Our objective was to determine the effects of 17β-estradiol (E2) on Schwann cell function and peripheral nerve remyelination after injury. Adult male C57BL/6J mice were used to prepare the sciatic nerve transection injury model and were randomly categorized into control and E2 groups. To study myelination in vitro, dorsal root ganglion (DRG) explant culture was prepared using 13.5-day-old mouse embryos. Primary Schwann cells were isolated from the sciatic nerves of 1- to 3-day-old Sprague–Dawley rats. Immunostaining for myelin basic protein (MBP) expression and toluidine blue staining for myelin sheaths demonstrated that E2 treatment accelerates early remyelination in the “nerve bridge” region between the proximal and distal stumps of the transection injury site in the mouse sciatic nerve. The 5-bromo-2′-deoxyuridine incorporation assay revealed that E2 promotes Schwann cell proliferation in the bridge region and in the primary culture, which is blocked using AKT inhibitor MK2206. The in vitro myelination in the DRG explant culture determined showed that the MBP expression in the E2-treated group is higher than that in the control group. These results show that E2 promotes Schwann cell proliferation and myelination depending on AKT activation.

Dupuytren's disease and needle aponeurotomy: rupture of a deep common flexor tendon: A case report and literature review.

Introduction:The Percutaneous Needle Aponeurotomy (PNA) is a known and validated non-surgical treatment for Dupuytren’s disease with a low rate of complications. Initially described for purely palmar forms, the indications extended to digital adhesions. Numerous surgeons remain hesitant about performing the PNA for digital treatment because of the risk of lesions in the noble structures. In literature, one complication is still rare, even non-existent, i.e. the tendon rupture.Case Presentation:We are reporting here the case of a rupture of the deep common flexor tendon, secondary to a needle aponeurotomy, for a recurring digital form in a 72-year-old woman. We performed surgical treatment by tenodesis of the distal stump and resection of the proximal stump. The result was satisfactory.Conclusion:The purpose of describing this case is to report this rare complication leading to surgical revision. Within our team, we do not recommend performing PNAs for digital cases, and even less so for recurrences. For those who wish to perform the PNA, they need to know some technical artifices that enable these complications to be reduced, albeit not eliminated.

Rescuing axons from degeneration does not affect retinal ganglion cell death

After a traumatic injury to the central nervous system, the distal stumps of axons undergo Wallerian degeneration (WD), an event that comprises cytoskeleton and myelin breakdown, astrocytic gliosis, and overexpression of proteins that inhibit axonal regrowth. By contrast, injured neuronal cell bodies show features characteristic of attempts to initiate the regenerative process of elongating their axons. The main molecular event that leads to WD is an increase in the intracellular calcium concentration, which activates calpains, calcium-dependent proteases that degrade cytoskeleton proteins. The aim of our study was to investigate whether preventing axonal degeneration would impact the survival of retinal ganglion cells (RGCs) after crushing the optic nerve. We observed that male Wistar rats (weighing 200-400 g; n=18) treated with an exogenous calpain inhibitor (20 mM) administered via direct application of the inhibitor embedded within the copolymer resin Evlax immediately following optic nerve crush showed a delay in the onset of WD. This delayed onset was characterized by a decrease in the number of degenerated fibers (P<0.05) and an increase in the number of preserved fibers (P<0.05) 4 days after injury. Additionally, most preserved fibers showed a normal G-ratio. These results indicated that calpain inhibition prevented the degeneration of optic nerve fibers, rescuing axons from the process of axonal degeneration. However, analysis of retinal ganglion cell survival demonstrated no difference between the calpain inhibitor- and vehicle-treated groups, suggesting that although the calpain inhibitor prevented axonal degeneration, it had no effect on RGC survival after optic nerve damage.

A comparison between laparoscopic and retroperitoneoscopic approach for partial nephrectomy in children with duplex kidney: a multicentric survey

To compare the outcome of laparoscopic and retroperitoneoscopic approach for partial nephrectomy in infants and children with duplex kidneys. Data of 102 patients underwent partial nephrectomy in a 5-year period using MIS procedures were analyzed. Fifty-two children underwent laparoscopic partial nephrectomy (LPN), and 50 children underwent retroperitoneoscopic partial nephrectomy (RPN). Median age at surgery was 4.2years. Statistical analysis was performed using χ (2) test and Student's t test. The overall complications rate was significantly higher after RPN (15/50, 30%) than after LPN (10/52, 19%) [χ (2)=0.05]. In LPN group, complications [4 urinomas, 2 symptomatic refluxing distal ureteral stumps (RDUS) and 4 urinary leakages] were conservatively managed. In RPN group, complications (6 urinomas, 8 RDUS, 1 opening of remaining calyxes) required a re-operation in 2 patients. In both groups no conversion to open surgery was reported. Operative time (LPN:166.2min vs RPN: 255min; p<0.001) and hospitalization (LPN: 3.5days vs RPN: 4.1days; p<0.001) were significantly shorter in LPN group. No postoperative loss of renal function was reported in both groups. Our results demonstrate that RPN remains a technically demanding procedure with a significantly higher complications and re-operation rate compared to LPN. In addition, length of surgery and hospitalization were significantly shorter after LPN compared to RPN. LPN seems to be a faster, safer and technically easier procedure to perform in children compared to RPN due to a larger operative space and the possibility to perform a complete ureterectomy in refluxing systems.

Evaluation and outcome of the distal ureteral stump after nephro-ureterectomy in children. A comparison between laparoscopy and retroperitoneoscopy

In children with a poorly functioning kidney due to vesicoureteral reflux (VUR) or ureteropelvic junction obstruction, management is by nephrectomy with total or proximal ureterectomy. The complete removal of all the ureter minimizes the risk of future morbidity associated with the distal ureteral stump (DUS), including febrile urinary tract infections (UTIs), lower quadrant pain and hematuria, the so-called ureteral stump syndrome. To assess the outcome of the DUS after nephroureterectomy, we analyzed our recent experience of nephrectomy performed via retroperitoneoscopy and via laparoscopy. The records of 21 consecutive patients (median age 3.5 years, range 1-10 years) who underwent nephroureterectomy via laparoscopy or via retroperitoneoscopy were retrospectively reviewed for symptoms caused by DUS and their management. Nephrectomy was undertaken for a poorly functioning dysplastic (4), scarred from VUR (10) or hydronephrotic (7) kidney. In the laparoscopic group (11 pts), 6 cases required nephrectomy for reflux while 5 patients were operated for hydronephrotic or dysplastic non-functioning kidney. In the retroperitoneoscopic group (10 pts), nephrectomy was performed for reflux in 4 cases versus 6 patients affected by hydronephrotic or dysplastic non-functioning kidney. The patients were evaluated using ultrasound (US) to check DUS length and clinically to evaluate symptoms due to a symptomatic DUS. The average length of surgery was 50 min for laparoscopy and 80 min for retroperitoneoscopy. The average of follow-up was 5 years. The length of DUS after laparoscopic nephrectomy was shorter (range 3-7 mm, statistically significant) than the DUS after retroperitoneoscopy (range 2-5 cm) (p < 0.001). Laparoscopic patients were all asymptomatic. Two patients, after retroperitoneoscopic nephrectomy, presented with recurrent UTIs; a voiding cystography revealed a VUR on the residual DUS and a redo surgery was performed in both the patients to remove the DUS (Figure). Several authors have stated that, in case of subtotal ureterectomy, the incidence of symptomatic DUS after nephrectomy for high-grade vesicoureteric reflux is low. However, in our series, the incidence of symptomatic DUS after nephroureterectomy was not insignificant (2/21, 9.5%). Symptoms related to a refluxing DUS occurred only in patients undergoing retroperitoneoscopic nephroureterectomy, where the DUS was longer than the DUS detected in laparoscopic patients. Considering that laparoscopy permits removal of all the ureter near the bladder dome, in children with non-functioning kidney due to VUR, it is advisable to always perform a laparoscopic rather than a retroperitoneoscopic nephrectomy to prevent problems related to a symptomatic DUS.

Local effect of celecoxib on peripheral nerve repair combined with silicone tubulization in rat

ObjectiveTo assess local effect of celecoxib on nerve regeneration in a rat sciatic nerve transection model. MethodsForty-five male healthy white Wistar rats were randomly divided into three experimental groups (n=15 for each): sham-operation (SHAM), control (SIL) and celecoxib treated (SIL/CLX) groups. In SHAM group after anesthesia left sciatic nerve was exposed and after homeostasis muscle was sutured. In SIL group the left sciatic nerve was exposed in the same way and transected proximal to tibioperoneal bifurcation leaving a 10mm gap. Proximal and distal stumps were each inserted into a silicone tube and filled with 10 µl phosphate buffered solution. In SIL/CLX group defect was bridged using a silicone tube filled with 10 µl celecoxib (0.1 g/L). ResultsFunctional study and gastrocnemius muscle mass confirmed faster and better recovery of regenerated axons in SIL/CLX than in SIL group (P<0.05). Morphometric indices of regenerated fibers showed number and diameter of the myelinated fibers in SIL/CLX were significantly greater than those in control group. In immunohistochemistry, location of reactions to S-100 in SIL/CLX was clearly more positive than that in SIL group. ConclusionResponse to local treatment of celecoxib demonstrates that it influences and improves functional recovery of peripheral nerve regeneration.

Chronic Achilles tendon rupture reconstructed using hamstring tendon autograft

BackgroundChronic rupture of the Achilles tendon (delayed diagnosis of more than 4 weeks) can result in retraction of the tendon and inadequate healing. Direct repair may not be possible and augmentation methods are challenging when the defect exceeds 5–6cm, especially if the distal stump is grossly tendinopathic. MethodsWe describe our method of Achilles tendon reconstruction with ipsilateral semitendinosis autograft and interference screw fixation in a patient with chronic rupture, a 9cm defect and gross distal tendinopathy. ResultsPatient reported outcome measures consistently demonstrated improved health status at 12 months post surgery: MOXFQ-Index 38–25, EQ5D-5L 18–9, EQ VAS 70–90 and VISA-A 1–64. The patient was back to full daily function, could single leg heel raise and was gradually returning to sport. No complications or adverse events were recorded. ConclusionReconstruction of chronic tears of the Achilles tendon with large defects and gross tendinopathy using an ipsilateral semitendinosis autograft and interference screw fixation can achieve satisfactory improvements in patient reported outcomes up to 1 year post-surgery.

Handcrafted multilayer PDMS microchannel scaffolds for peripheral nerve regeneration.

Injuries that result in the loss of limb functionality may be caused by the severing of the peripheral nerves within the affected limb. Several bioengineered peripheral nerve scaffolds have been developed in order to provide the physical support and topographical guidance necessary for the naturally disorganized axon outgrowth to reattach to distal nerve stumps as an alternative to other procedures, like nerve grafting. PDMS has been chosen for the base material of the scaffolds due to its biocompatibility, flexibility, transparency, and well-developed fabrication techniques. The process of observing the axon outgrowth across the nerve gaps with PDMS scaffolds has been challenging due to the limited number and fineness of longitudinal sections that can be extracted from harvested nerve tissue samples after implantation. To address this, multilayer microchannel scaffolds were developed with the object of providing more refined longitudinal observation of axon outgrowth by longitudinally 'sectioning' the device during fabrication, removing the need for much of the sample preparation process. This device was then implanted into the sciatic nerves of Lewis rats, and then harvested after two and four weeks to analyze the difference in nerve regeneration between two different time periods. The present layer by layer structure, which is separable after nerve regeneration and is treated as an individual layer during the histology process, provides the details of biological events during axonal regeneration. Confocal microscopic imaging showed the details of peripheral nerve regeneration including nerve branches and growth cones observable from within the microchannels of the multilayer PDMS microchannel scaffolds.

Repair of Acute Type A Aortic Dissection With Ascending Aorta Replacement Combined With Open Fenestrated Stent Graft Placement

In the conventional ascending replacement for acute type A aortic dissection, the distal aortic anastomosis is frequently performed at the dissected site, and postoperative residual dissection in the arch and downstream aorta still occurs in most patients. We used open placement of a fenestrated stent graft during this operation. During the conventional ascending replacement in 41 patients with acute type A aortic dissection, a fenestrated stent graft was inserted into the arch and the proximal descending aorta through the distal ascending transection. The distal ascending transection incorporating the proximal end of the fenestrated stent graft wasdirectly anastomosed to the Dacron (DuPont, Wilmington, DE) tube graft. Survivors were examined by computed tomography angiography. The cardiopulmonary bypass time was 134.46 ± 19.03 minutes, aortic cross-clamp time was 46.38 ± 8.57 minutes, and selective cerebral perfusion and lower body arrest time was 12.50 ± 2.19 minutes. There was 1 in-hospital death but no difficult bleeding from the distal aortic anastomosis. On postoperative computed tomography, the false lumen closed, with complete thrombus formation around the inserted fenestrated stent graft found in all survivors (100%), at the diaphragmatic level in 28 patients (70%), and at the superior mesenteric arterial level in 3 (8%). An open fenestrated stent graft placement provided extensive primary repair of the thoracic aorta and a strong distal aortic stump during the conventional ascending aorta replacement for acute type A aortic dissection but did not increase the risk or technical difficulty of the operation.

A rare case of distal ulna giant cell tumour – Wide excision and stabilisation using extensor carpi ulnaris tendon

Giant Cell Tumour is a common benign tumour of bone accounting for 3 to 5% of all primary bone tumour. It commonly affects in second decade of life between 18 years to 40 years. Distal ulna is less commonly affected site with reported incidence varying from 0.45% to 3.2%. The current available literature is non-conclusive regarding treatment protocol of distal ulna giant cell tumour and whether stabilization procedure of ulna is required or not after excision of distal ulna to avoid the symptoms of ulnar impingement syndrome. We are reporting a case of right distal ulna Giant cell tumour in 51 year old right hand dominant female patient who presented to us with persistent pain and restricted wrist movements. We performed a wide excision of tumour with dynamic stabilization of distal ulnar stump using extensor carpi ulnaris split tendon graft. We have 2 year follow up of the patient with no recurrence and a good functional outcome having a Mayo wrist score of 80.

Loop Nerve Graft Prefabrication in Peripheral Nerve Defect Reconstruction

INTRODUCTION: Bridging strategies are inevitable to repair nerve defects and nerve grafts are the treatment of choice in reconstruction.1,2 In this study, we prefabricated a loop nerve graft through combination of end-to-end and end-to-side coaptation3 methods in a staged peripheral nerve defect repair model. We investigated feasibility of improving and accelerating regeneration in conventional interpositional autologous nerve grafts with loop nerve graft prefabrication. MATERIALS AND METHODS: Twenty-four Sprague-Dawley rats were allocated into 3 experimental groups to evaluate regeneration in a 1.5 cm long peroneal nerve defect: Single-stage conventional interpositional nerve graft (Group 1), staged loop nerve graft prefabrication (Group 2), staged conventional interpositional nerve graft (Group 3). In loop nerve graft prefabrication group (Group 2) grafts were sutured end-to-end to the proximal peroneal nerve stumps. Distal ends of the grafts were sutured end-to-side to the peroneal nerve stumps proximal to the end-to end repair sites in first stage. In second stage distal ends of the prefabricated grafts were transposed and sutured to distal nerve stumps. Peroneal function index (PFI), electrophysiology and histological assessments were performed. p < 0.05 was considered significant for statistical analysis. RESULTS: PFI results of group 1 (-22.75±5.76) and group 2 (-22.08±6) did not show statistical difference (p>0.05). Group 3 presented poorest PFI value (-33.64±6.4) compared to other groups (p<0.05). Nerve conduction amplitudes for groups 1, 2 and 3 were 16.19±2.15mV, 15.95±2.82mV and 10.44±1.96mV, whereas velocity values were 1.16±0.21ms, 1.17±0.16ms and 1.51±0.15ms respectively. Electrophsiological assesments of group 1 and group 2 did not present statistical difference (p>0.05), however both groups had a statistical difference compared to group 3 (p<0.05). Axon counts of group 1 (2227±260.4) and group 3 (2194±201.1) did not show difference (p>0.05). Group 2 showed highest axon count (2531±91.18) compared to group 1 and 3 (p<0.05). CONCLUSION: Loop nerve graft prefabrication improves axonal regeneration. Loop nerve graft prefabrication in two-stages yields a favorable nerve healing, comparable to a single-stage nerve graft repair. Loop nerve graft prefabrication can be used efficiently to promote healing particularly for the injuries indicating a delayed nerve graft reconstruction.

Ampullary Carcinoma Associated With Removing Fractured Percutaneous Transhepatic Biliary Drainage Catheter for Hilar Cholangiocarcinoma

Percutaneous transhepatic biliary drainage (PTBD) is an established method for decompression of biliary tract. Many complications related to PTBD have already been reported, however, spontaneous and complete fracture of PTBD catheter just after procedure is considered to be quite rare. We encountered a case, which PTBD catheter completely fractured on the next day of insertion for biliary obstuction due to hilar cholangiocarcinoma and advanced ampullary carcinoma was appeared at only ten months after removal of the fractured PTBD catheter. A 73-year-old man was diagnosed as hilar cholangiocarcinoma and PTBD was performed. PTBD catheter completely fractured on the next day of insertion. When the fractured PTBD catheter was endoscopically removed though papilla of Vater, there was no abnormality in both papilla of Vater and lower bile duct. Endoscopic biliary drainage was simultaneously performed. Consequently, he underwent extended right hepatectomy with resection of extrahepatic bile duct for Bismuth type IV hilar cholangiocarcinoma. Pathological examination of the resected specimen demonstrated that the tumor mainly composed of moderately differentiated adenocarcinoma and directly invaded to the hepatic parenchyma of the right lobe of the liver; therefore, the tumor was finally diagnosed to be stage IIA (pT3pN0M0) according to TNM classification. The distal stump of bile duct, which was transected at upper border of the pancreas, was pathologically confirmed to be free of cancer. At eight months after surgery, ampullary cacinoma was presented in the follow-up examination.Subtotal stomach-preserving pancreaticoduodenectomy was performed. Because pathological investigation revealed that the tumor was 4-cm in diameter and involved to both pancreas and duodenum, it was diagnosed as stage IIB (pT3pN1M0) according to TNM classification. The postoperative course was uneventful, however, he died of recurrence of ampullary carcinoma at fifteen months after the second operation in another hospital and an autopsy was not performed. We experienced a rare complication that was spontaneous and complete fracture of PTBD catheter on the next day of insertion. When the fractured PTBD catheter was removed by endoscopically, there were no abnormal findings in papilla of Vater and lower bile duct. Therefore, it was presumed that ampullary carcinoma was strongly associated with the removal of the fractured catheter through papilla of Vater. Endoscopic biliary drainage is recommended for decompression of malignant biliary obstruction.

The topographic specificity of muscle reinnervation predicts function.

Functional testing has assumed a progressively dominant role in validating the success of experimental nerve repair. Results obtained in one model, however, cannot predict the results in others because they reflect the coordinated interaction of several muscles across multiple joints. As a result, many combinations of topographically correct and incorrect muscle reinnervation could produce the same result. We have developed a binary model in which elbow flexors and extensors are reinnervated, and elbow flexion and extension are the functions tested. The musculocutaneous and radial nerves of Lister-Hooded rats were subjected to axonotmetic injuries that produced increasing degrees of axonal misdirection at the site of injury ranging from simple crush to transection and rotational offset of proximal and distal stumps. Elbow function was tested with a device that requires coordinated elbow extension to reach sugar pellets and flexion to return them to the mouth. After 12 weeks of regeneration, motoneurons projecting to the distal musculocutaneous nerve were retrogradely labelled with WGA-Ruby and scored regarding their location within musculocutaneous or radial motoneuron pools. The severity of axonal misdirection resulting from the initial surgery was mirrored by progressive degrees of inappropriate reinnervation of the musculocutaneous nerve by radial nerve axons. The specificity of reinnervation predicted elbow function (r = 0.72), whereas the number of motoneurons regenerating did not. This model is thus well suited to study the interaction of regeneration specificity and function across a single joint, and to produce data that can be generalized more broadly than those obtained from more complex models.

Cross-tongue procedure: a new treatment for long-standing numbness of the tongue

The lingual nerve may be injured during oral procedures, usually during extraction of lower third molars. Patients often complain of numbness of the hemitongue postoperatively. If this persists for 3 months or more, microsurgical exploration and reconstruction of the lingual nerve is required, and better outcomes are achieved after early repair. After 18-24 months the production of axoplasmic fluid through the axons of the proximal stump is reduced, and neurorrhaphy between the proximal and distal stumps is not recommended. In such cases we suggest that a portion of the opposite lingual nerve should be used as an additional nerve source.

Hypoxia-Induced Upregulation of miR-132 Promotes Schwann Cell Migration After Sciatic Nerve Injury by Targeting PRKAG3.

Following peripheral nerve injury, hypoxia is formed as a result of defects in blood supply at the injury site. Despite accumulating evidence on the effects of microRNAs (miRNAs) on phenotype modulation of Schwann cells (SCs) after peripheral nerve injury, the impact of hypoxia on SC behaviors through miRNAs during peripheral nerve regeneration has not been estimated. In this study, we confirmed our previous microarray data on the upregulation of miR-132 after sciatic nerve injury in rats and observed that overexpression of miR-132 significantly promoted cell migration of primary cultured SCs. Interestingly, hypoxia-increased expression of miR-132 also enhanced SC migration while inhibition of miR-132 suppressed hypoxia-induced increase in SC migration. miR-132 downregulated PRKAG3 through binding to its 3'-UTR, and PRKAG3 knockdown compromised the reducing effect of miR-132 inhibition on SC migration under normal or hypoxia condition. Moreover, in vivo injection of miR-132 agomir into rats with sciatic nerve transection accelerated SC migration from the proximal to distal stump. Overall, our results suggest that the hypoxia-induced upregulation of miR-132 could promote SC migration and facilitate peripheral nerve regeneration.

Minimally Invasive Approach to Achilles Tendon Pathology

Many surgical procedures have been described for Achilles tendon pathology; however, no overwhelming consensus has been reached for surgical treatment. Open repair using a central or paramedian incision allows excellent visualization for end-to-end anastomosis in the case of a complete rupture and detachment and reattachment for insertional pathologies. Postoperative wound dehiscence and infection in the Achilles tendon have considerable deleterious effects on overall functional recovery and outcome and sometimes require plastic surgery techniques to achieve coverage. With the aim of avoiding such complications, foot and ankle surgeons have studied less invasive techniques for repair. We describe a percutaneous approach to Achilles tendinopathy using a modification of the Bunnell suture weave technique combined with the use of interference screws. No direct end-to-end repair of the tendon is performed, rather, the proximal stump is brought in direct proximity of the distal stump, preventing overlengthening and proximal stump retraction. This technique also reduces the suture creep often seen with end-to-end tendon repair by providing a direct, rigid suture to bone interface. We have used the new technique to minimize dissection and exposure while restoring function and accelerating recovery postoperatively.

Long-term effect on foot and ankle donor site following vascularized fibular graft resection in children.

This study was carried out to evaluate the long-term effect on the donor side of the foot and ankle following vascularized fibular graft resection in children. Eight patients underwent resection of the fibula for the purpose of a vascularized fibular graft by a surgical team who practiced leaving at least 6 cm residual distal fibula. The age of these children at the time of surgery was between 3 and 12 years. They were reviewed between 3 and 12 years after surgery. Two patients who underwent resection of the middle shaft of the fibula at 3 and 5 years of age developed abnormal growth of the distal tibia, leading to ankle valgus. They were treated with growth modulation of the distal tibial physis and supramalleolar osteotomy with tibiofibular synostosis. Another patient who underwent the entire proximal fibula resection at the age of 6 years had developed hindfoot valgus because of weakness of the tibialis posterior muscle. He required talonavicular fusion and flexor hallucis to tibialis posterior muscle transfer. Patients operated at the age of older than 8 years neither had ankle nor hindfoot deformity. We concluded that resection of the middle shaft of the fibula for the purpose of a vascularized fibula graft, leaving a 6 cm distal fibular stump in children younger than 6 years old, may give rise to abnormal growth of the distal tibial physis, leading to valgus ankle. The entire proximal fibular resection for the similar purpose in a 6-year-old child may give rise to weakness of tibialis posterior and hindfoot valgus.

βB2-Crystallin Promotes Axonal Regeneration in the Injured Optic Nerve in Adult Rats.

The purpose of the study was to further scrutinize the potential of βB2-crystallin in supporting regeneration of injured retinal ganglion cell axons both in vitro and in vivo. Retinal explants obtained from animals after treatment either with lens injury (LI) alone or with combined LI 5 days or 3 days before or simultaneously with an optic nerve crush (ONC) were cultured for 96 h under regenerative conditions, and the regenerating axons were quantified and compared with untreated controls. These measurements were then repeated with LI replaced by intravitreal injections of γ-crystallin and β-crystallin at 5 days before ONC. Finally, βB2-crystallin-overexpressing transfected neural progenitor cells (βB2-crystallin-NPCs) in the eye were studied after crushing the optic nerve in vivo. Regeneration was monitored with the aid of immunoblotting of the retina and optic nerve both distal and proximal to the lesion site, and this was compared with controls that received injections of phosphate buffer only. LI performed 5 days or 3 days before ONC significantly promoted axonal outgrowth in vitro (p < 0.001), while LI performed alone before explantation did not. Intravitreal injections of β-crystallin and γ-crystallin mimicked the effects of LI and significantly increased axonal regeneration in culture at the same time intervals (p < 0.001). Western blot analysis revealed that crystallins were present in the proximal optic nerve stump at the lesion site in ONC, but were neither expressed in the undamaged distal optic nerve nor in uninjured tissue. βB2-crystallin-NPCs supported the regeneration of cut optic nerve axons within the distal optic nerve stump in vivo. The reported data suggest that βB2-crystallin-producing "cell factories" could be used to provide novel therapeutic drugs for central nervous system injuries.

Giant Cell Tumor of Distal Ulna

Tumours of distal ulna are rare and its treatment is complicated by proximity of the distal radio-ulnar joint and the carpus. We report the case of a 35 year old male with giant cell tumour of the distal ulna treated by wide resection of distal ulna, fixation of iliac bone graft to distal end of radius and stabilisation of distal ulnar stump by tenodesis. At one year follow up patient had pain free movements of the wrist and did not have any recurrence.

The relationship between changes in the expression of growth associated protein-43 and functional recovery of the injured inferior alveolar nerve following transection without repair in adult rats.

The objective of this study was to analyze the changes in the expression of growth associated protein-43 (GAP-43) in trigeminal ganglions (TGs) and in the distal stumps of transected inferior alveolar nerves (IANs), and to clarify the relationship between these changes and functional recovery of the transected IAN without repair using a rat IAN axotomy model. Following transection, GAP-43 expression was measured at multiple time points. The functional recovery of the transected IAN was evaluated based on the compound muscle action potentials recorded from the digastric muscle. GAP-43 expression in TGs was significantly higher at 2, 7, 14, 28, and 56 days following IAN transection compared to that in samples from sham-operated rats (p < 0.0005, p < 0.0005, p < 0.0005, p = 0.007, and p = 0.023, respectively). GAP-43 expression in the distal stumps of transected IANs was significantly higher at 2, 7, 14, and 28 days following IAN transection compared to that in samples taken from sham rats (p < 0.0005, p < 0.0005, p < 0.0005, and p = 0.009, respectively). GAP-43 expression in the distal stumps of transected IANs returned nearly to sham levels by day 56 following IAN transection. On days 7, 14, 28, and 56 following transection, the amplitude of the compound muscle action potential gradually increased, the latency gradually decreased, and the duration gradually increased. The amplitude, latency, and duration of the compound muscle action potentials nearly returned to sham levels on post-transection day 56. Time-dependent changes in the expression of GAP-43 in both TGs and distal stumps of transected IANs without repair are synchronously consistent with the regeneration and functional recovery of the transected IAN. The recovery of the amplitude, latency, and duration of the compound muscle action potentials indicates increased myelination and increased axon density of the regenerated nerve fibers.