Dorsal Extension Research Articles

Inhibition of axonal outgrowth in the tumor environment: Involvement of class 3 semaphorins

That tumors lack innervation is dogma in the field of pathology, but the molecular determinants of this phenomenon remain elusive. We studied the effects of conditioned media from Colon 26 and B16 mouse tumor cell lines on the axonal outgrowth and cellular differentiation of embryonic Institute of Cancer Research (ICR) mouse dorsal root ganglion cells. Tumor-conditioned media suppressed dorsal root ganglion axonal extension but had no effect on neuronal or glial differentiation. We found that the tumor cells expressed most of the class 3 semaphorins - axon guidance molecules. Blocking the activity of class 3 semaphorins with the soluble receptor neuropilin-1 significantly counteracted the tumor-induced inhibition of axonal extension. Together, these results suggest a role for tumor-secreted class 3 semaphorins in selectively inhibiting axonal outgrowth of dorsal root ganglion neurons.

Long term results of compartment syndrome of the lower limb in polytraumatised patients

Acute compartment syndrome represents a severe complication after trauma of the lower extremity. To date, there is limited knowledge about the outcome of compartment syndrome of the lower limb in patients with multiple injuries. We hypothesised that multiple injuries worsen the long term results of compartment syndrome of the lower leg. Patients who underwent fasciotomy for established compartment syndrome of the lower leg from 1999 to 2004 in our level 1 trauma centre were included. Demographic data, additional injuries (Injury Severity Score) and method of treatment were analysed. Outcome assessments included clinical examination and isokinetic strength testing of plantar flexion and dorsal extension at two different angular velocities (60 degrees /s; 120 degrees /s). The mean age was 38.0+/-4.4 years at the time of injury; males were affected twice as often as females. The mean ISS of patients with multiple injuries was 20.2+/-2.3 points. The time between admission and surgical treatment of compartment syndrome was extended in patients with multiple injuries (38.6+/-13.8h versus 13.2+/-3.8h; p=0.04). At follow-up, 15.4% of all patients complained of pain at rest and 26.9% reported pain on exertion. A significant reduction of torque and work was found in the dorsal extensors on the injured side (p<0.05). Polytraumatised patients did not show extended weakness compared to those with isolated injuries. No difference was seen between the two groups regarding pain and function. Polytraumatised patients did not suffer from worse long term effects regarding sensory or motor deficits. Associated injuries did not seem to influence the outcome of the compartment syndrome.

Immediate Conservative Breast Reconstruction Technique using Lateral Thoracodorsal Fasciocutaneous Flap

Purpose: A lateral thoracodorsal fasciocutaneous flap (LTFF) is a local fasciocutaneous flap that has been used in breast reconstructions since the 1980s. Although the LTFF is a wellstudied reconstruction procedure after radical surgery in Western countries, there is no report in Korea. By introducing the LTFF procedure, we suggest an easy reconstruction technique that can be performed by the breast surgeon directly. Methods: Patients with lateral breast cancer and redundant lateral thoracic region might be candidates for this procedure. The flap consists of the lateral and dorsal extensions of the inframammarian fold as well as an extended line from the anterior axillary line. A quadrantectomy is performed through a planned skin incision, and an axillary lymph node dissection can be performed simultaneously if the sentinel lymph node is positive. The skin and subcutaneous fat with the fascia of the serratus anterior and latissimus dorsi muscle should be dissected carefully. A wedge-shaped flap can be acquired successfully. The lateral breast defect is then reconstructed by a rotation of the flap. The axis of the flap is drawn following the inframammarian fold so that the final scar would be under the brassiere line. Results: Nineteen patients were treated with the LTFF after breast conserving surgery. All tumors were located in lateral breast regions. Seroma occurred in three and partial fat necrosis and partial flap necrosis were observed in each one. The cosmetic result based on four-point scoring system of breast cosmesis showed excellent in seventeen and good in two. Conclusion: Despite its long scar line, with appropriate patient selection, a LTFF might be a useful method for breast reconstructions.

THE MALE OF SUFFASIA ATTIDIYA (ARANEAE, ZODARIIDAE)

Abstract Suffasia attidiya was previously known only from females. This paper describes males collected from the type locality. Males of S. attidiya can be recognized by the following combination of characters: tibia with stout retrolateral apophysis; triangular dorsal cymbial extension; cymbial flange attached at its center to the cymbium; embolus with a base positioned under the proximal part of tegulum; long tapering, outwards pointing tegular apophysis.

Dynamic Intradigital External Fixation for Proximal Interphalangeal Joint Fracture Dislocations

Dynamic Intradigital External Fixation for Proximal Interphalangeal Joint Fracture Dislocations

Decreased intramuscular blood flow in patients with lateral epicondylitis

The purpose of this pilot study was to investigate intramuscular microcirculation in extensor carpi radialis brevis (ECRB) in patients with lateral epicondylitis. Ten patients with unilateral epicondylitis, mean duration of symptoms of 39 (12-96) months participated. The diagnosis was based on clinical examination and none was under treatment for the last 6 months. Isometric handgrip strength, 2-pinch grip strength and muscle strength during radial deviation and dorsal extension were determined. Functional perceived pain was evaluated by a modified behaviour rating scale and perceived pain during contraction by visual analogue scale. Intramuscular and skin blood flow was recorded by a laser-Doppler flowmetry system technique (LDF) during stable temperature condition. Intramuscular blood flow was significantly lower in the affected side, 22.7+/-9.8 perfusion units (PU), as compared with 35.2+/-11.9 PU in the control side (P=0.01). There was no difference in skin blood flow or temperature between the affected and the control side. A positive correlation was found between the duration of symptoms and the difference in intramuscular blood flow between the affected and the control arm (r=0.65, P=0.06). The present data indicate that decreased microcirculation and anaerobic metabolism in ECRB may contribute to the lateral epicondylitis symptoms.

Treatment of equinus deformity with Ilizarov fixator

目的 探讨应用Ilizarov外固定支架治疗创伤性马蹄足的疗效.方法2003年2月～2005年8月应用Ilizarov外固定架治疗17例创伤所致马蹄足患者.将组装好的Ilizarov外固定架按照Ilizarov的穿针固定原则安装在患侧小腿和足部.术后3 d开始转动螺纹杆上的螺母,第1周旋转螺母2～4圈/d,4次/d;1周后旋转螺母1～2圈/d,4次/d,分别逐渐缩短和延长前、后螺纹杆,矫正马蹄足畸形.用伊氏架将踝关节固定在中立位2～3个月.去除外固定架后让患者逐渐增加负重量直至完全负重.不负重时穿戴支具保持踝关节处于中立位至少3个月.结果17例患者均得到随访,平均随访10个月(7～14个月).术后4～6周踝关节恢复到中立位.平均带外固定架14.5周(10～16周).无血管、神经损伤.3例各1处针道轻度感染,对症处理后感染消失.1例诉矫正过程中疼痛,术后10周去除外固定架,去除外固定架后6周时僵直在跖屈20°.1例去除外固定架4个月后僵直在跖屈10°.1例小腿前后肌群损伤严重合并胫骨骨缺损重建术后踝关节矫正到中立位后1.5个月行踝关节融合术,融合术后3个月去除外固定架.其余14例达到0°全足负重,行走时无明显足下垂.2例负重时疼痛.踝关节背伸肌群功能存在的患者,踝关节可主动背伸10°.结论Ilizarov外固定架是治疗创伤性马蹄足的微创技术。

Selective effect of conjugated linoleic acid isomers on atherosclerotic lesion development in apolipoprotein E knockout mice

Research suggests that conjugated linoleic acid (CLA) may inhibit atherosclerosis, but there are contradictory results in different animal models fed heterogeneous mixtures of CLA isomers. This study addressed the hypothesis that the individual CLA isomers may exert different atherogenic properties. ApoE −/− mice were fed isocaloric, isonitrogenous westernized diets containing 0.15% cholesterol and enriched with 1% (w/w) cis-9, trans-11-CLA (c9,t11-CLA), trans-10, cis-12-CLA (t10,c12-CLA) or linoleic acid (control diet) for 12 weeks. At the end of the dietary intervention, the effects of CLA isomers on the development of atherosclerotic vascular lesions, lipid metabolism, inflammation and oxidative stress were assessed. The t10,c12-CLA diet had a profound pro-atherogenic effect, whereas c9,t11-CLA impeded the development of atherosclerosis. En face aortic lesion assessment showed more dorsal and lumbar extensions presenting atherosclerotic foci after the t10,c12-CLA diet. Furthermore, animals fed t10,c12-CLA had pronounced hyperlipidemia, higher 8- iso-prostaglandin F 2α levels, higher vulnerable atherosclerotic plaque with a lower smooth muscle and fibre contents and higher macrophage content and activation, assayed as plasma chitotriosidase compared to the control or c9,t11-CLA dietary groups. Plasma chitotriosidase activity was more closely associated with the extent of the plaque than with MOMA staining or than monocyte chemoattractant protein-1 levels. Our results demonstrate that CLA isomers differentially modulate the development of atherosclerosis, c9,t11-CLA impedes, whereas t10,c12-CLA promotes atherosclerosis. These opposing effects may be ascribed to divergent effects on lipid, oxidative, inflammatory and fibro muscular components of this pathology. Plasma chitotriosidase is a better indicator of dietary fat interventions that alter plaque monocyte activity in this murine model.

Long term results of arthrodesis of the wrist: A 6–15 year follow up of 35 patients

A total of 40 wrists in 35 patients were investigated 10.5 (range 6-15) years after arthrodesis. The most common diagnosis was rheumatoid disease. There were 21 Mannerfelt, and 21 plate, arthrodeses. The patients were assessed clinically and up-to-date radiographs obtained. Two Mannerfelt arthrodeses had failed to fuse. Pain during the last week before review and total satisfaction with the operation were excellent in 28 and 30 wrists, respectively. The mean score on the "Disability of arm, shoulder and hand" (DASH) questionnaire was 38 (range 2-75). Plate arthrodeses gave better results than Mannerfelt arthrodeses for all variables studied. Wrists plated in dorsal extension gave the best scores for function and strength. We conclude that either method gives good long term results. Although few of the individual differences were statistically significant, we think that fusion with plates, and in particular plates with dorsal extension, is preferable.

Dynamic Intradigital External Fixation for Proximal Interphalangeal Joint Fracture Dislocations

Dynamic Intradigital External Fixation for Proximal Interphalangeal Joint Fracture Dislocations

P02.12: Characteristics, associations and outcome of Partial Agenesis of Corpus Callosum in the fetus

sinus, the Torcula Herophili, dural folds of the inferior attachments of the falx cerebelli, or bridging arachnoid septations. Through improved knowledge of posterior fossa embryology, anatomy and malformations and our own observations in fetuses and neonates, we believe that these septa represent a remnant of Blake’s pouch, a normal dorsal extension of the developing 4th ventricle. We also demonstrate the probable relationship between these septa, the Dandy-Walker continuum, mega cisterna magna and Blake’s pouch cyst. Results: Observations that we will demonstrate on fetal and neonatal cranial sonography include:

P02.10: The cisterna magna septa—a probable vestigial remnant of the roof of the rhombencephalic vesicle

Linear echoes are often seen in the fetal and neonatal cisterna magna. These lines have been variously described as the straight sinus, the Torcula Herophili, dural folds of the inferior attachments of the falx cerebelli, or bridging arachnoid septations. Through improved knowledge of posterior fossa embryology, anatomy and malformations and our own observations in fetuses and neonates, we believe that these septa represent a remnant of Blake's pouch, a normal dorsal extension of the developing 4th ventricle. We also demonstrate the probable relationship between these septa, the Dandy-Walker continuum, mega cisterna magna and Blake's pouch cyst. The parallel septa consistently observed in the cisterna magna are seen infero-posterior to the cerebellar vermis. The falx cerebelli is visible separately. There is continuity of the parallel septa with the inferior aspect of the fourth ventricle at the caudal aspect of the cerebellar vermis. The CSF space between the cisterna magna septa is in direct continuity with the fourth ventricle. The CSF between the lines is completely anechoic because it is intra-axial. The CSF outside the lines is usually slightly echogenic because it is in the subarachnoid space which is trabeculated by pial extensions. On sagittal views the superior margin of Blake's pouch can be seen separately from the dural fold that forms the inferior margin of the falx cerebelli. Sometimes the lines are bowed outwards giving the impression of a cyst. In light of these observations we propose that it is likely that the cisterna magna septa represent the walls of Blake's pouch, a phylogenetically vestigial structure observed during ontogeny. Additionally our observations support current opinion that Blake's pouch cyst and mega-cisterna magna may represent (less severe) abnormalities within the Dandy-Walker continuum.

Small‐cell carcinoma of the lung resembling a brachial plexus tumour

A small-cell carcinoma of the lung was identified in a six-year-old female German shepherd dog with a history of chronic lameness of the left forelimb, Horner's syndrome and sensory deficits on the caudal portion of the left forelimb below the elbow. A mass, the exact location of which was difficult to ascertain, was identified during radiographic examination of the thorax. It was easily identified, using magnetic resonance imaging, as an apical tumour of the left lung with dorsal extension and involvement of paraspinal structures, such as spinal nerve roots C8 to T1 and the sympathetic trunk. Postmortem examination confirmed a mass in the left apical lobe of the lung, compatible with a diagnosis of small-cell carcinoma by histopathology and immunohistochemistry. This clinical presentation is similar to Pancoast syndrome described in humans.

Optimizing independent finger flexion with zone V flexor repairs using the Massachusetts General Hospital flexor tenorrhaphy and early protected active motion

Independent FDS action has been cited to be problematic with repair of multiple tendons in zone V owing to adhesion formation between the flexor digitorum superficialis (FDS) and the flexor digitorum profundus (FDP) tendons. Of the several described flexor repair techniques the ideal tendon repair should be strong enough to allow for early active motion to minimize adhesion formation and maximize tendon healing. Biomechanical studies have proven the Massachusetts General Hospital (MGH) repair to be strong enough to allow for early active motion. The purpose of this study was to examine the use of the MGH technique for zone V flexor tendon injuries to allow for early protected active motion to achieve independent finger flexion through better differential gliding of the tendons. We performed a retrospective review 168 zone V finger flexor tendon repairs for 29 patients performed consecutively over 4 years when early active motion was not contraindicated. The same early protected active motion protocol was used for all of these patients. We reviewed total active motion, independent flexion, rupture, and need for tenolysis. These injuries involved 103 FDS and 65 FDP tendons to 103 fingers. The median follow-up period was 24 weeks. Of these 29 patients 19 were men and 10 were women. The average patient age was 28 years. The total active motion for these zone V repairs was 236 degrees +/- 5 degrees Overall 97 of 103 digits attained good to excellent function and 88 of 103 developed some differential glide. One of these patients required a tenolysis. Three repairs ruptured in 1 patient owing to suture breakage that was associated with noncompliance with the dorsal extension block splint. Our retrospective review of 168 consecutive flexor tendon repairs showed that the MGH technique allowed for early protected active motion, which provided good to excellent functional outcomes with 88 of 103 developing independent finger flexion at an acceptably low complication risk.

Foreshortened Dorsal Extension of the Central Sulcus in Williams Syndrome

Williams syndrome (WMS) is a genetic condition resulting from a hemideletion on chromosome 7 that causes cognitive impairment, and a variety of growth and physical abnormalities. Little is currently known about brain morphology in WMS, although one recent MRI report suggested that the central sulcus was abnormally short on its dorsal end compared to normal IQ controls. We sought to replicate this finding in a group of 28 persons with WMS in comparison to both an age and sex matched normal IQ control group (n = 22). In addition, we sought to test the specificity of this finding by a further comparison to an IQ matched control group (n = 20). Using high resolution isotropic voxel MRI, the dorsal and ventral extension of the central sulcus was traced and the distance from the interhemispheric and sylvian fissures was measured. The dorsal extension of the central sulcus in both hemispheres was significantly more distant from the interhemispheric fissure in WMS compared to the lower IQ group and to the normal control group (p's < 0.001). There was no significant difference between groups in the ventral end of the central sulcus. These results suggest that the abnormal dorsal end of the central sulcus may be a specific characteristic of WMS not shared with general mental retardation or low IQ.

Redescription of the Australian endemic nudibranch Dendrodoris maugeana Burn, 1962 (Gastropoda: Opisthobranchia: Doridoidea): new and reviewed features important for future phylogenetic analyses of porostomes

The anatomy of the temperate Australian doridoidean nudibranch Dendrodoris maugeana Burn, 1962 was examined for the first time. This investigation was undertaken to address a recognised gap in our taxonomic knowledge and to increase our understanding of the structural diversity found within the radula-less taxon Dendrodoris. The structural detail of the ptyaline gland, oesophagus and pharynx in D. maugeana were the same as that found in other members of the genus. However, ptyaline gland shape, gonad position and form, prostate gland arrangement and vaginal-wall structure were different to any other member of the genus previously investigated. The ptyaline gland was found to have elongate, dorsal extensions, the gonad was totally separated from the digestive gland, the prostate gland was intimately folded around the bursa copulatrix, and the vagina contained ciliated pouches. In addition, the results contradict previous interpretations of the pharynx, oesophagus and salivary glands used in recent phylogenetic analyses of porostomes. This knowledge will contribute to elucidation of homologous structures and clarification of the relationships between radula-less (porostome) and radula-bearing doridoidean nudibranchs.

Treatment of closed unstable extra articular proximal phalangeal fractures of hand by closed reduction and dorsal extension block cast

Background: Unstable fractures of proximal phalanges have enormous divergence of opinion regarding the treatment. Treatment options range from fancy over the counter splints to the more exotic forms of internal fixation. Method: A total of 62 cases with 72 fractures with ages from 10­65 yrs of both sexes were treated. After closed reduction under local anaesthesia the dorsal extension block cast was applied with the metacarpophalangeal joints in full flexion and interphalangeal joints in full extension. This method works on the principle of the intact dorsal soft tissue hinge (extensor apparatus) over the fractured proximal phalanx. The intrinsic plus position keeps the intrinsics lax and prevents them from acting as a displacing force pulling the proximal fragment of the fracture into volar angulation. On an average the cast was used for 3 weeks. Results: Fifty eight fractures had united by 3 weeks. The results were judged according to modified Buck-Gramcko's point assessment system for finger fractures, which showed 80.64% excellent, 4.83% good, 8.06% satisfactory and 6.45% poor results. The complications were minimal which included only 3 cases with malunion. Conclusion: Conservative management of unstable proximal phalangeal fractures with dorsal extension block cast has produced excellent results. It maintains mobility of the fingers without compromising the stability of the fracture and prevents future stiffness of hands. It avoids the complications of operative methods and is simple to use.

Altered expression of GABA a and GABA b receptor subunit mRNAs in the hippocampus after kindling and electrically induced status epilepticus

Epilepsy may result from altered transmission of the principal inhibitory transmitter GABA in the brain. Using in situ hybridization in two animal models of epileptogenesis, we investigated changes in the expression of nine major GABA A receptor subunits (α1, α2, α4, α5, β1-β3, γ2 and δ) and of the GABA B receptor species GABA BR1a, GABA BR1b and GABA BR2 in 1) hippocampal kindling and 2) epilepsy following electrically-induced status epilepticus (SE). Hippocampal kindling triggers a decrease in seizure threshold without producing spontaneous seizures and hippocampal damage, whereas the SE model is characterized by spontaneous seizures and hippocampal damage. Changes in the expression of GABA A and GABA B receptor mRNAs were observed in both models, and compared with those seen in other models and in human temporal lobe epilepsy. The most prominent changes were a relatively fast (24 h after kindling and electrically-induced SE) and lasting (7 and 30 days after termination of kindling and SE, respectively) reduction of GABA A receptor subunit δ mRNA levels (by 43–78%) in dentate granule cells, accompanied by increases in mRNA levels of all three β-subunits (by 8–79%) and subunit γ2 (by 11–43%). Levels of the minor subunit α4 were increased by up to 60% in dentate granule cells in both animal models, whereas those of subunit α5 were decreased 24 h and 30 days after SE, but not after kindling. In cornu ammonis 3 pyramidal cells, downregulation of subunits α2, α4, α5, and β1–3 was observed in the ventral hippocampus and of α2, α5, β3 and γ2 in its dorsal extension 24 h after SE. Similar but less pronounced changes were seen in sector cornu ammonis 1. Persistent decreases in subunit α2, α4 and β2 transcript levels were presumably related to SE-induced cell loss. GABA B receptor expression was characterized by increases in GABA BR2 mRNA levels at all intervals after kindling and SE. The observed changes suggest substantial and cell specific rearrangement of GABA receptors. Lasting downregulation of subunits δ and α5 in granule cells and transient decreases in subunit α2 and β1–3 mRNA levels in cornu ammonis 3 pyramidal cells are suggestive of impaired GABA A receptor-mediated inhibition. Persistent upregulation of subunits β1–3 and γ2 of the GABA A receptor and of GABA BR2 mRNA in granule cells, however, may result in activation of compensatory anticonvulsant mechanisms.

Résultats de la prothèse trapézométacarpienne ARPE™ : à propos de 37 implantations

We report the outcome of the ARPE trapezometacarpal prosthesis in the treatment of primary osteoarthritis of the thumb. The prosthesis based on a ball and socket system and is uncemented. This study presents the results of 37 consecutive implantations in 29 patients; 28 women, one man, eight bilateral (21 right, 16 left). The mean age at operation was 67 years at a mean of 36 months follow-up (maximum 7 years). Four patients were excluded (1 died, 3 lost to follow up). Preoperative radiological grading according to Comtet was 1 or 2. Patients all had low functional demand. Most of the patients were satisfied and pain free. Mobility was increased, including dorsal extension of the first metacarpal. Radiographic analysis and measurement of the scaphometacarpal index demonstrated a postoperative increased length of the thumb column, with a slight decrease at follow up. This phenomenon is due to sinkage of the prothesis into the cancellous bone. Mechanical complications occurred in four patients within the first four years. Removal of the prosthesis, trapeziectomy and tendon strip plasty were performed in three cases with good final results. This prothesis is a good surgical treatment of primary, isolated TM osteoarthritis in patients with minimal osteoporosis and low functional demands.

Hedgehog and Decapentaplegic instruct polarized growth of cell extensions in the Drosophila trachea.

The migration of cellular extensions is guided by signals from tissues with which they contact. Many axon guidance molecules regulate growth cone migration by directly regulating actin cytoskeletal dynamics. Secreted morphogens control global patterns of cell fate decisions during organogenesis through transcriptional regulation, and constitute another class of guidance molecules. We have investigated the guidance roles of the morphogens Hedgehog and Decapentaplegic during directed outgrowth of cytoplasmic extensions in the Drosophila trachea. A subset of tracheal terminal cells adheres to the internal surface of the epidermis and elongates cytoplasmic processes called terminal branches. Hedgehog promotes terminal branch spreading and its extension over the posterior compartment of the epidermis. Decapentaplegic, which is expressed at the onset of terminal branching, restricts dorsal extension of the terminal branch and ensures its monopolar growth. Orthogonal expression of Hedgehog and Decapentaplegic in the epidermis instructs monopolar extension of the terminal branch along the posterior compartment, thereby matching the pattern of airway growth with that of the epidermis.