Thermochondroplasty of rabbit ear cartilage using the carbon dioxide laser

Remodelling of deformed cartilaginous tissue in the head and neck presents a difficult surgical problem since cartilage tends to return to its original shape because of its natural internal stresses. This is also true of cartilage autografts. Cartilage can be remodelled using heat and this paper describes the use of light from a carbon dioxide laser (λ=10.6 μm) to remodel cartilaginous tissue, in a procedure which we have called laser thermochondroplasty. Straight cartilage samples were removed from the ears of 12 rabbits, moulded with the CO₂ laser at an output power of 3 W with a spot diameter of 2 mm and exposure times of 0.5 s. After remoulding, the cartilage, together with a control, unmoulded sample, were implanted into the rabbits' back and retrieved 6–8 months later. Histological and morphological analysis showed that the treated cartilages retained both their shape and viability. This may well be a useful clinical technique for the in situ remoulding of difficult cartilage, such as that found in the nasal septum, with minimal damage, and the transplanting of autologous cartilage which has been remoulded in vitro.

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Перιλхψη H αпокαтάστααση τoν σχήμс τоς τωv παραμoρϕωμέvωv μoρϕoλoγικώv χóvδρωv, óπως επίσης και η μεταβoλή τoν σχήματoς τωv χóvδριvωv μoσχενμάτωv, εξακoλoνϑoύv vα πρoβάλoνv σημαvτικά πρoβλήματα. Aιτία είvαι η ύπαρξη εvóς σνστήματoς εσωτερικώv στoνς χóvδρoνς, πoν αvϑίσταται στη μεταβoλή τoν σχήματóς τoνς και τείvει vα τoνς επαvαϕέρει στηv αρχική τoνς μoρϕή. H περμoχovδρoπλαστική με laser ειvαι μια ελπιδoϕoρα vεα τεχvικη για τη μεταβoλη τℴν σχηματoς τωv χovδρωv. Eνϑεα χovδριvα τμηματα πoν παρεληϕϑησαv απo αντια κoνvελιωv, αλλαξαv τℴ σχημα τoνς μετα τηv ακτιvoβoληση τoνς με εvα CO₂ laser, σε επιλεγμέvες πνκvóτητες ισχύoς. Tα δείγματα αντά εμϕντεύϕηκαv στo νπoδóρειo της πλάτης τωv κoνvελιώv και παρελήϕϑησαv μετά απó 6–12 μήvες. Oλα τα δείγματα διατηρoύσαv τo vέo τoνς σχήμα, εvώ η ιστoλoγική μελέτη τωv δειγμάτωv με oπτικó και ηλεκτρovικó μικρoσκóπιo έδειξε έvα ζωvταvó και καλά αvεκτó απó τoνς περιϕάλλovτες ιστoύς χóvδρo. Πιστεύvνμε óτι με τηv τεχvική μας, είvαι εϕικτή η απoκατάσταση τωv παραμoρϕωμέωv μoρϕoλoγικώv χóvδρωv (π.χ. σκóλιωv ριvικ<v διαϕραγμάτωv) καϑώς και η τρoπoπoίηση τoν σχήματoς χóvδριvωv μoσχεvνμάτωv με ελάχιστη δνvατή καταστρoϕή τoν χóvδρoν.

     

Strap stabilization for proximal junctional kyphosis prevention in instrumented posterior spinal fusion

This is a retrospective, single-institution, cohort study. To evaluate the association of Mersilene tape use and risk of proximal junctional kyphosis (PJK), after surgical correction of adult spinal deformity (ASD) by posterior instrumented fusion (PIF). PJK, following long spinal PIF, is a complication which often requires reoperation. Mersilene tape, strap stabilization of the supra-adjacent level to upper instrumented vertebra (UIV) seems a preventive measure. Patients who underwent PIF for ASD with Mersilene tape stabilization (case group) or without (control group) between 2006 and 2016 were analyzed preoperatively to 2-year follow-up. Matching of potential controls to each case was performed. Radiographic sagittal Cobb angle (SCA), lumbar lordosis, pelvic tilt, sacral slope, and pelvic incidence were measured pre- and postoperatively, using a deformity measuring software program. PJK was defined as progression of postoperative junctional SCA at UIV ≥ 10°. Eighty patients were included: 20 cases and 60 controls. The cumulative rate of PJK ≥ 10° at 2-year follow-up was 15% in cases versus 38% of controls (OR = 0.28; P = 0.04) with higher latent period in cases, (20 vs. 7.5 months), P = 0.018. Mersilene tape decreased risk of PJK linked with the impact of the following confounders: age, ≥ 55 years old (OR = 0.19; 0.02 ≥ P ≤ 0.03); number of spinal levels fused 7–15 (OR = 0.13; 0.02 ≥ P ≤ 0.06); thoracic UIV (T12–T1) (OR = 0.13; 0.02 ≥ P ≤ 0.06); BMI ≥ 27 kg/m2 (OR = 0.22; 0.03 ≥ P ≤ 0.08); and osteoporosis (OR = 0.13; 0.02 ≥ P ≤ 0.08). Mersilene tape at UIV + 1 level decreases the risk of PJK following PIF for ASD. These slides can be retrieved under Electronic Supplementary Material.     

Über Gynäkomastie

Ohne Zusammenfassung Zum 70. Geburtstag des Herrn Prof. Dr.Alexander Fraenkel. Mit 12 Abbildungen. „Γυναιϰυμασϱόν έστι παρά φύσιν αϋξησις τ ς ύπoϰɛιμένης τo μασϱo ς πιμɛλ ς.”Galen, Definition Vol. 2, p. 273.     

Relative position of sacral base in the pelvis and its correlation with spino-pelvic parameters

To investigate the relationship between relative location of the sacral base and spinal alignment in standing healthy adult volunteers. One hundred seventy-two volunteers (men = 83, mean age = 39.3 years [20–70], women = 89, mean age = 39.6 years [20–62]) with no history of spinal disease were imaged using a low-dose biplanar slot-scanning 3D X-ray imaging system. A circle was drawn around three points: cranial vertex of the iliac crest (A), caudal vertex of the ischium (B), and anterior vertex of the pubis. Pelvic height (PH) was defined as the diameter (A–B). A tangent line perpendicular to PH (C) was drawn by passing through (A). Sacral height (SH) was defined as the distance between (C) and the center of the sacral base parallel to PH. Relative SH (rSH) was calculated as SH/PH × 100. Mean (SD) rSH was 18.3 ± 3.2 (men 20.0 ± 2.9, women 16.7 ± 2.6). rSH significantly positively correlated with thoracic kyphosis (r = 0.20, p < 0.05), lumbar lordosis (r = 0.28, p < 0.05), pelvic incidence (r = 0.28, p < 0.05), and sacral slope (r = 0.32, p < 0.0001), and significantly negatively correlated with pelvic thickness (r =  − 0.66, p < 0.0001). rSH did not correlate with pelvic tilt. The center of the sacral base is normally located 3.8 ± 0.8 cm caudal to the cranial vertex of the iliac crest. The sacral base was located more caudally in men than in women, regardless of age. The more caudal the sacral base, the angle of the spino-pelvic parameters (TK, LL, PI, SS) progressively increases along with a decrease in the sacro-acetabular distance (Pth). Pelvic tilt did not correlate with the location of the sacrum.     

Utilization of distal radius and ulna classification scheme in predicting growth peak and curve progression in idiopathic scoliosis girls undergoing bracing treatment

Distal radius and ulna (DRU) classification scheme has been proposed for predicting skeletal maturity in patients with idiopathic scoliosis (IS). However, the utilization of DRU classification scheme in the assessment of growth peak and curve progression in IS was still inconclusive. This study aimed to correlate the distal radius and ulna stages with several indicators for growth potential and to evaluate the predictive value of DRU system for curve progression in braced female IS patients. This was a consecutive longitudinal study including physically immature IS girls receiving standardized bracing treatment and regularly followed up every 3–6 months until brace weaning. The following data of each visit were collected: chronologic age, standing height, Cobb angle, spinal length, Risser sign, digital skeletal age (DSA) scores and DRU scores. The height velocity (HV), spinal growth velocity (SGV) and angle velocity (AV) of each visit were calculated. The correlation among radius stage, ulna stage, Risser sign, height, spinal length, HV, SGV and AV was studied. Forty braced IS girls with 349 longitudinal whole spine X-rays were reviewed. The average DRU scores at initial visit were R6.5 ± 1.1 and U4.5 ± 1.2 for radius and ulna, respectively. Both the radius stages between R5 and R8 and ulna stages between U3 and U6 indicated high SGV and high HV. The DSA scores were 402.1 ± 48.8 and 430.8 ± 44.4 at R7 and R8, respectively. The AV values were − 5.9 ± 12.4°/y and − 0.4 ± 1.5°/y at R5 and R6, which increased to 5.9 ± 17.3°/y, 3.1 ± 15.7°/y and 4.2 ± 12.2°/y at R7, R8 and R9, respectively. The DSA scores were 387.3 ± 65.7 for U5 and 432.9 ± 48.5 for U6, respectively. The AV values were − 3.1 ± 0.3°/y at U3, − 1.7 ± 9.3°/y at U4, 2.3 ± 16.1°/y at U5, 5.4 ± 15.5°/y at U6 and 4.4 ± 12.9°/y at U7. Both distal radius and ulna scores correlate with the longitudinal growth potential, and thus, the DRU scoring scheme is an alternative predictor for growth potential and curve progression in girls with IS. These slides can be retrieved under Electronic Supplementary Material.     

Fentanyl versus sufentanil: plasma concentrations during continuous epidural postoperative infusion in children

No pharmacokinetic data are available with respect to the plasmaconcentrations and fentanyl or sufentanil during epidural administrationin children. This double-blind randomized study included 12children (5–12 yr). Patients in group F were givenan epidural loading dose of fentanyl 1.5 µg kg^–1and in group S sufentanil 0.6 µg kg^–1.Both groups then received a continuous epidural infusion ofbupivacaine 5 mg kg^–1 day^–1 witheither fentanyl 5 µg kg^–1 day^–1or sufentanil 2 µg kg^–1 day^–1.An epidural PCA system was also given to the children (bolus:bupivacaine 0.2 mg kg^–1 and fentanyl 0.2 µg kg^–1or sufentanil 0.08 µg kg^–1). Maximal medianconcentrations of plasma (0.117–0.247 ng ml^–1for fentanyl and 0.027–0.074 ng ml^–1 forsufentanil) were reached approximately 30 and 20 min respectivelyafter the loading doses. These values were similar to thosemeasured after 48 h. Br J Anaesth 2000; 85: 615–7 ^* Corresponding author: Service d’Anesthésie et deRéanimation Chirurgicale, Hôtel-Dieu, F-44093 Nantescedex 01, France     

Body growth in primary de Toni-Debré-Fanconi syndrome

.Body growth in nine children with primary de Toni-Debré-Fanconi syndrome was followed from birth to adolescence or adult life. At the time of diagnosis, corresponding to the start of treatment, the median age was 2.3 (range 0.4 – 13.9) years and height standard deviation score (SDS) was always decreased (median  – 3.5, range  – 6.8 to  – 2.1). Despite continuous electrolyte and bicarbonate supplementation only four patients showed a slight improvement in growth. At the time of the last observation at the age of 17.2 (4.5 – 20.1) years median height was  – 4.7 ( – 5.9 to  – 1.8) SDS. The median difference between height at last observation and target height was  – 4.5 SDS. Final height (n = 5) ranged between  – 1.8 and  – 5.5 (median –4.3) SDS. The pubertal growth spurt was absent in two children. Metabolic acidosis was identified as a significant growth-retarding factor. Mean serial blood bicarbonate levels and height SDS at the last observation were correlated (r =  – 0.87, P<0.01). No correlation was observed between last height SDS and the degree of hypokalemia, hypophosphatemia, or hypercalciuria. In conclusion, patients with primary de Toni-Debré-Fanconi-syndrome present severe growth failure at the time of diagnosis which persists into adult life. Supportive therapy is frequently unable to prevent further loss of relative height. Received December 14, 1995; received in revised form and accepted April 17, 1996     

Myocardial metabolism on off-pump surgery; a randomized study of 50 cases

Objective --To study the inflammatory reaction and myocardial metabolism in off-pump and on-pump coronary artery bypass patients. Design --Fifty coronary artery bypass patients were randomized to off-pump or on-pump operations. Myocardial biopsies were taken to determine myocardial metabolism and inflammation (glutathione (GSH), superoxide dismutase (SOD) and myeloperoxidase (MP)) and plasma samples for indicators of oxidative stress (conjugated dienes (s-BDC), oxidative products of proteins (s-ox-Prot) and low-density lipoprotein (LDL)-total peroxyl radical trapping antioxidant potential (s-TRAP)). Results --s-ox-Prot 10 &#114 min was 2.11 &#114 &#45 &#114 0.75 vs 2.69 &#114 &#45 0.60 ( p &#114 = &#114 0.014), s-TRAP 5 &#114 min was 861 &#114 &#45 &#114 180 vs 969 &#114 &#45 &#114 192 ( p &#114 = &#114 0.032) and s-TRAP 10 &#114 min 857 &#114 &#45 &#114 176 vs 985 &#114 &#45 &#114 166 ( p &#114 = &#114 0.011), GSH 10 &#114 min 0.55 &#114 &#45 &#114 0.19 vs 0.72 &#114 &#45 &#114 1.16 ( p &#114 = &#114 0.007) (off-pump vs on-pump). The monobasic (MB) fraction of the creatinine kinase 24 &#114 h after the operation was significantly lower in the off-pump group, 20.5 &#114 &#45 &#114 24.2 vs 61.8 &#114 &#45 &#114 84.6 ( p &#114 = &#114 0.023). Conclusion --GSH levels from the biopsies were increased in the perfusion group early in the reperfusion time showing that myocardial tissue was well protected and recovered more rapidly after cross-clamping than after the occlusion of the coronary arteries. However, release of creatinine kinase was lower in the off-pump group showing that cardiopulmonary bypass has more deleterious effects later after the operation.     

Different concentrations of two small stress proteins, αB crystallin and HSP27 in human urological tumor tissues

Concentrations of two small stress proteins, αB crystallin and the 27-kDa heat shock protein (HSP27) were quantitated in tissues of the human normal genitourinary system and their tumors. Levels of HSP27 in renal cell carcinomas (mean ± SE: 1450 ± 262 ng/mg protein, n = 15) were significantly higher than in normal kidney (the cortex: 540 ± 99 ng/mg protein, n = 13; the medulla: 600 ± 106 ng/mg protein, n = 13) while those of αB crystallin tended to be increased without statistical significance. These findings were similar to those previously reported for renal cell tumors chemically induced in rats. Concentrations of αB crystallin in prostatic carcinoma tissues (410 ± 129 ng/mg protein, n = 10) were also significantly higher than in benign prostatic hyperplasia (54 ± 12 ng/mg protein, n = 14), whereas αB crystallin levels in testicular tumors including seminomas (2.1 ± 0.8 ng/mg protein, n = 11) and non-seminomas (5.2 ± 2.3 ng/mg protein, n = 9) were significantly lower than in normal testicular tissues (29.7 ± 6.2 ng/mg protein, n = 5). Both αB crystallin and HSP27 could be immunohistochemically localized in the normal kidney and renal cell carcinoma tissues. Received: 1 December 1997 / Accepted: 16 June 1998     

Comparison of intubating conditions following propofol and succinylcholine with propofol and remifentanil 2 micrograms kg-1 or 4 micrograms kg-1

We evaluated the intubating conditions, haemodynamic responsesand duration of apnoea in 60 healthy adult patients after propofol2 mg kg^–1 combined with either a bolus of remifentanil2 µg kg^–1 or 4 µg kg^–1,or succinylcholine 1 mg kg^–1. Patients intubatedfollowing remifentanil showed dose-dependent intubating conditions,similar at 4 µg kg^–1 to the conditionsproduced with succinylcholine. Post-induction mean arterialpressure decreased from baseline values by 21% (P<0.0001),28% (P<0.0001) and 8% (P>0.05) in the remifentanil 2 µg kg^–1,remifentanil 4 µg kg^–1 and succinylcholine1 mg kg^–1 groups, respectively. The mean (SD)duration of apnoea following induction was 9.3 (2.6) minand 12.8 (2.9) min in the remifentanil 2 µg kg^–1and 4 µg kg^–1 groups, and 6.0 (0.9) minin the succinylcholine group (P<0.001 between groups). Br J Anaesth 2000; 85: 623--5     

Association between height loss and bone loss, cumulative incidence of vertebral fractures and future quality of life: the Miyama study

Introduction The study aimed to clarify associations between height loss, bone loss and the quality of life (QOL) score among general inhabitants of Miyama, a rural Japanese community. This population-based epidemiological study was conducted in Miyama, a village located in a mountain area in Wakayama Prefecture, Japan. Methods A list of all inhabitants comprising 1,543 inhabitants (716 men, 827 women) born in this village between 1910–1949 was compiled. From the above whole cohort, a subcohort to measure bone mineral density (BMD) was recruited, consisting of 400 participants, divided into four groups of 50 men and 50 women each, and stratified into age decades by decade of birth-year (1910–1919, 1920–1929, 1930–1939 or 1940–1949). BMD measurement, physical measurements of height (cm) and body weight (kg) were taken, and body mass index (BMI; kg/m²) were calculated. BMD and anthropometric measurements were repeated on the same participants at 3, 7 and 10 years after baseline measurement (1993, 1997 and 2000). Results and discussion Among 299 of 400 participants, changes in height over 10 years for men in their 40s, 50s, 60s and 70s were −0.7 cm, −0.5 cm, −1.2 cm and −1.5 cm, respectively, compared with −0.7 cm, −1.4 cm, −2.1 cm and −3.7 cm in women, respectively. No significant relationships between change in height and rate of change in BMD at the lumbar spine and femoral neck after adjustment for age in men (lumbar spine, β = 0.058, standard error of the mean (SE) = 0.031, P = 0.501, R² = 0.038; femoral neck, β = 0.100, SE = 0.038, P = 0.228, R² = 0.121) were identified. By contrast, among women, a significant positive association was identified between height change and change rate of BMD at the lumbar spine after adjusting for age (β = 0.221, SE = 0.039, P = 0.012, R² = 0.069), while no significant relationship was found between height change and change rate at the femoral neck (β = 0.107, SE = 0.039, P = 0.229, R² = 0.048). No significant relationship was noted between vertebral fractures (VFx) and height at baseline in men and women (men: odds ratio (OR) 0.93, 95% confidence interval (CI) 0.81–1.05, P = 0.24; women: OR 0.97, 95% CI 0.87–1.08, P = 0.58) or between VFx and height loss (men: OR 1.31, 95% CI 1.00–1.71, P = 0.051; women: OR 1.20, 95% CI 0.94–1.53, P = 0.14). In both men and women, no significant relationship was identified between utility of the EuroQol EQ5D questionnaire and height at baseline (men: β = −0.148, SE = 0.003, P = 0.202, R² = 0.076; women: β = 0.127, SE = 0.004, P = 0.235, R² = 0.048), and height change (men: β = −0.078, SE = 0.008, P = 0.452, R² = 0.065; women: β = 0.053, SE = 0.010, P = 0.608, R² = 0.038).     

Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. A meta-analysis

The risk of ventriculostomy-related hemorrhage among patients requiring antiplatelet therapy (AT) for the endovascular treatment of acutely ruptured intracranial aneurysms needed further investigation. The authors performed a systematic review and meta-analysis of the literature examining the EVD-related hemorrhage rate among patients with and without AT (controls). According to PRISMA guidelines, a comprehensive review of studies published between January 1990 and April 2018 was carried out. The authors identified series with > 5 patients reporting the EVD-associated hemorrhage rate among the AT group and the control group. Variables influencing outcomes were analyzed using a random-effects meta-analysis model. We included 13 studies evaluating 516 (with AT) and 647 (without AT) patients requiring ventriculostomy. EVD-related hemorrhage rates were higher among the AT group (125/516 = 20.9%, 95% CI = 11.9–30%, I2 = 90% vs 57/647 = 9%, 95% CI = 5.5–12.5%, I2 = 45.8%) (p < 0.0001). Major EVD-associated hemorrhage rates were low in both the AT and control group (25/480 = 4.4%, 95% CI = 1.7–7.7%, I2 = 53.9% vs 6/647 = 0.7%, 95% CI = 0.03–1.7%, I2 = 0%) (p < 0.0001). Ventriculostomy before embolization and intraprocedural AT were associated with lower rates of EVD-related bleeding (32/230 = 9.6%, 95% CI = 2.1–17.1%, I2 = 75.4% vs 6/24 = 25.1%, 95% CI = 8.8–41%, I2 = 0%) (p < 0.02). The rate of major hemorrhage was higher after dual AT (CP + ASA) compared to single AT (ASA or CP) used as an intraprocedural loading dose (13/173 = 7%, 95% CI = 3.3–10.7%, I2 = 0% vs 6/210 = 1.7%, 95% CI = 0.1–3.4%, I2 = 0%) (p < 0.009). AT during endovascular treatment of acutely ruptured intracranial aneurysms increases the risk of EVD-related hemorrhages, although most of them are small and asymptomatic. When ventriculostomy is performed before endovascular procedures requiring antiplatelet administration, the hemorrhagic risk is minimized. A single antiplatelet therapy is associated with a lower rate of major bleeding than a dual therapy.     

Protein Kinase C-ζ is Critical in Pancreatitis-Induced Apoptosis of Kupffer Cells

Protein kinase C-zeta (PKC-ζ) regulates cell death via NF-κB; therefore, we tested the hypothesis that PKC-ζ plays a critical role in pancreatitis-induced Kupffer cell apoptosis. Acute pancreatitis was induced in rats by cerulein injection 24 h later, livers were assayed for PKC-ζ, IKKα, IKKβ, IKKγ, NF-κB, Fas/FasL, and apoptosis was assessed with Caspase-3 and DNA fragmentation. Kupffer cells from unoperated rats were infected with a PKC-ζ domain-negative adenovirus (AdPKCζ-DN) to inhibit PKC-ζ, or transfected with pCMVPKC-ζ to overexpress PKC-ζ, and then stimulated with pancreatic elastase; cellular extracts were assayed for PKC-ζ, IKKα, IKKβ, IKKγ, NF-κB, Fas/FasL, Caspase-3, and DNA fragmentation. Cerulein-induced pancreatitis upregulated PKC-ζ protein and activity, IKKβ, IKKγ, NF-κB, Fas/FasL, Caspase-3 and increased DNA fragmentation in rat livers (all p < 0.001 vs control). AdPKCζ-DN abolished elastase-induced upregulation of PKC-ζ activity, IKKβ, IKKγ, NF-κB, Fas/FasL, Caspase-3 and DNA fragmentation (all p < 0.001 vs infection control), whereas overexpression of PKC-ζ augmented elastase-induced upregulation of IKKβ, IKKγ, Fas/FasL, Caspase-3 and DNA fragmentation (p < 0.001 vs control). PKC-ζ plays a critical role in pancreatitis-induced Kupffer cell apoptosis via NF-κB and Fas/FasL. The ability of Kupffer cells to autoregulate their stress response by upregulating their death receptor/ligand and key proapoptotic cell signaling systems warrants further investigation. Presented as a poster during the Annual Meeting of the SSAT, Los Angeles, May 2006.     

Baroreceptor-heart rate reflex sensitivity enhancement after urinary bladder distention in essential hypertensives

Our objective was to determine if urinary bladder distention modifies the sensitivity of the baroreceptor-heart rate reflex in hypertensive and control subjects. The baroreceptor-heart rate reflex sensitivity was measured in 15 male patients (mean age 37 ± 8 years) with mild untreated hypertension (mean 163 ± 8/95 ± 12 mmHg) and 17 age- and sex-matched control subjects before and after urinary bladder distention. Bladder filling was performed infusing saline heated to 37°C via a urinary catheter; the volume infused in each patient corresponded to that which caused the urge to void without reaching the pain threshold. The baroreceptor-heart rate reflex sensitivity was determined correlating the variations of the systolic pressure and of the peak blood flow velocity in the common carotid artery with the variations of the ECG RR′ interval of the following heart beat, both during spontaneous and phenylephrine-induced fluctuations of the haemodynamic variables. After bladder distention the diastolic pressure of the hypertensive subjects increased significantly (95 ± 12 vs. 100 ± 12 mmHg; P < 0.02), whereas the heart rate decreased (RR=873 ± 70 vs. 926 ± 80 ms; P < 0.005). These parameters were unchanged in the normotensive subjects (84 ± 9 vs. 83 ± 8 mmHg and 914 ± 158 vs. 913±140 ms, respectively). The baroreceptor-heart rate reflex sensitivity, measured on the basis of spontaneous pressure and carotid blood flow velocity fluctuations in relationship to RR changes, decreased in the normotensive subjects after bladder distention (10.7 ± 4.6 vs. 9.4 ± 2.7 ms/mmHg; P < 0.05 and 423 ± 99 vs. 356 ± 102 ms/kHz; P < 0.01, respectively), whereas it increased in the hypertensive patients (6.9 ± 3.6 vs. 8.3 ± 2.8 ms/mmHg; P < 0.03, and 332 ± 86 vs. 381 ± 97 ms/kHz; P < 0.03 respectively). After bladder distention and phenylephrine administration the baroreceptor-heart rate reflex sensitivity, measured by the correlation between systolic pressure and RR interval, increased only in the hypertensive group (10.2 ± 5.4 vs. 15.2 ± 7.7 ms/mmHg; P < 0.005). In conclusion urinary bladder distention provokes in hypertensives but not normotensive controls a brisk parasympathetic response of the component of the baroreceptor-heart rate reflex which controls heart rate. Received: 17 June 1998 / Accepted: 20 October 1998     

Evaluation of certain constituents of antioxidant defense in youth treated in the past for steroid-sensitive idiopathic nephrotic syndrome

Disorders of lipid metabolism and antioxidant defense capacity reported during idiopathic nephrotic syndrome (INS) exacerbations are known. The aim of this study was to evaluate constituents of antioxidant defense [total antioxidant potential: ferric-reducing antioxidant power (FRAP), paraoxonase-1 (PON-1), tocopherols, ascorbic acid] in patients formerly treated for INS. The studied group consisted of 30 patients (20 males and 10 females) treated 4–15 years ago for INS. The control group consisted of 30 healthy teenagers. There were no statistically significant differences in PON-1 activity (156.4 ± 97.1 vs 137.7 ± 80.2 U/l), α-tocopherol levels (23.9 ± 7.3 vs 22.4 ± 3.2 μmol/l) and sum of β- and γ-tocopherols (2.1 ± 1.0 vs 2.3 ± 0.6 μmol/l), and in FRAP (484.9 ± 87.2 vs 452.8 ± 76.9 μmol/l) between groups. In the study group, a significantly lower concentration of ascorbic acid (53.0 ± 20.8 vs 69.4 ± 16 μmol/l; p < 0.002), decreased values of α-tocopherol/cholesterol (4.9 ± 0.7 vs 5.5 ± 1.2; p = 0.03), and total tocopherol/cholesterol (5.3 ± 0.8 vs 6.1 ± 1.4; p = 0.016) ratios were observed. A positive correlation between tocopherol/total cholesterol (TCh) (r = 0.41; p < 0.05) and α-tocopherol/TCh (r = 0.50; p < 0.001) ratios and INS relapse frequency was reported. The relationship between the study parameters and group of variables (relapse frequency, duration of the last remission, age, gender) was tested using the multiple linear regression analysis. The results of this study suggest that the nonenzymatic antioxidant defense in young persons formerly treated for INS is weaker than in their healthy counterparts.     

Regression of target organ damage in children and adolescents with primary hypertension

We assessed the effects of 12 months of non-pharmacological and pharmacological therapy on 24-h ambulatory blood pressure, regression of target organ damage (TOD) and metabolic abnormalities in 86 children (14.1 ± 2.4 years) with primary hypertension. Twenty-four hour systolic and diastolic blood pressure (BP) decreased (130 ± 8 vs 126 ± 8, 73 ± 7 vs 70 ± 7, p = 0.0001 and 0.004 respectively). Body mass index (BMI) did not change, but waist-to-hip (0.85 ± 0.07 vs 0.83 ± 0.05, p = 0.01) and waist-to-height ratio (WHtR; 0.49 ± 0.07 vs 0.48 ± 0.05, p = 0.008) decreased. Left ventricular mass index (LVMi; 38.5 ± 10.7 vs 35.2 ± 7.5 g/m^2.7, p = 0.0001), prevalence of left ventricular hypertrophy (46.5% vs 31.4%; p = 0.0001), carotid intima-media thickness (cIMT; 0.44 ± 0.05 vs 0.42 ± 0.04 mm, p = 0.0001), wall cross sectional area (WCSA; 7.5 ± 1.3 vs 6.9 ± 1.2 mm², p = 0.002), hsCRP (1.1 ± 1.0 vs 0.7 ± 0.7 mg/l, p = 0.002), and LDL-cholesterol (115 ± 33 vs 107 ± 26 mg/dl, p = 0.001) decreased. Patients who had lowered BP had a lower cIMT at the second examination (0.41 ± 0.04 vs 0.43 ± 0.04 mm, p = 0.04) and lower initial hsCRP values (0.9 ± 0.7 vs 1.5 ± 1.3 mg/l, p = 0.04) in comparison to non-responders. Regression analysis revealed that the main predictor of LVMi decrease was a decrease in abdominal fat expressed as a decrease in waist circumference (WC) (R ² = 0.280, β = 0.558, p = 0.005), for WCSA-SDS a decrease in WC (R ² = 0.332, β = 0.611, p = 0.009) and for a cIMT-SDS decrease the main predictor was a decrease in hsCRP concentrations (R ² = 0.137, β = 0.412, p = 0.03). Standard antihypertensive treatment lowered BP and led to regression of TOD in hypertensive children. Lean body mass increase and decrease in abdominal obesity correlated with TOD regression.     

Improvement of left ventricular mass with antihypertensive therapy in children with hypertension

There is paucity of data on the regression of left ventricular hypertrophy (LVH) in hypertensive children. This study assessed the effects of antihypertensive therapy on left ventricular mass in children with and without LVH. Medical records of hypertensive patients who had a baseline and follow-up echocardiogram (echo 1, echo 2) were reviewed. Fifteen of 22 treated patients had LVH at echo 1. Enalapril alone or combined was used in 21/22 cases. Echo 2 was performed at a mean interval of 15 ± 7 months. The LVH group showed significant decrease in systolic blood pressure z-score (SBPZ) (2.89 ± 1.61 to 1.40 ± 1.19; p = 0.01), diastolic blood pressure z-score (DBPZ) (1.44 ± 0.90 to 0.26 ± 0.82; p < 0.001), and LV mass index (LVMI) (56.2 ± 12.50 to 43.7 ± 8.30; p = 0.001), but no significant change in body mass index z-score (BMIZ) (1.79 ± 0.75 to 1.69 ± 0.69; p = 0.74). In the no-LVH group, SBPZ (3.03 ± 1.68 to 2.27 ± 1.81; p = 0.356), DBPZ (1.00 ± 0.87 to 0.63 ± 0.68; p = 0.409), BMIZ (1.08 ± 0.98 to 1.27 ± 0.89; p = 0.672), and LVMI (29.47 ± 5.51 to 33.89 ± 3.06; p = 0.374) did not change significantly. Simple linear regression demonstrated that the change in LVMI in the combined group had a significant correlation (r = 0.477; p = 0.025) with the percentage change in SBPZ. This study demonstrates that LVH in hypertensive children improves with effective blood pressure control.     

Biomechanical considerations in ‘biological’ femoral osteosynthesis: an experimental study of the ‘bridging’ and ‘wave’ plating techniques

Although traditional compression plate fixation aims to abolish interfragmentary movement and achieve primary bone healing, the more recent ‘biological’ plate fixation methods such as the ‘bridging’ and ‘wave’ plate techniques aim to maintain fracture alignment without absolute stability and promote union by callus formation. Furthermore, some mechanical advantages have been attributed to the ‘wave’ plate fixation. Since no data have been published on the mechanical characteristics of the ‘bridging’ and ‘wave’ plate fixation methods, the aim of this biomechanical comparative study was to investigate the rigidity of those fixation methods in various types of femoral diaphyseal fractures. Using a composite femoral model, the rigidity characteristics of three fixation methods (short DCP, ‘bridging’ and ‘wave’ plates) were investigated. The results showed that when cortical contact between the main fragments is present, a ‘bridging’ plate can be equally rigid to the ‘wave’ plate in mediolateral bending by displaying a similar tension-band effect. Furthermore, in the absence of cortical contact, the axial fixation rigidity of the long ‘bridging’ plate is superior to that of the ‘wave’ plate. Both methods showed a significant ‘stress-shielding’ effect on the intact femur. In conclusion, this in vitro study failed to show any significant mechanical advantages of the ‘wave’ plate technique over the ‘bridging’ plating method. It appears that the ‘bridging’ plate fixation may be the mechanically optimal ‘biological’ plating method for the femoral diaphysis. Received: 26 May 1999     

Ultrasonic Value is Not Useful to Detect Bone Changes Following a Biliopancreatic Diversion

To study the evolution of the bone mass by ultrasonic transmission after biliopancreatic diversion. Forty eight morbid obese patients were prospectively studied during 36 months following the Larrad biliopancreatic diversion. The bone metabolism was studied by PTHi and the urinary pirydinolines. The bone mass by echography and bone densitometry, which correlate to the levels of PTHi and pyridinolines. After 3 years the bone mass decreased from 50.15 +/− 7.31 kg/m², preoperatively, to 34.03 +/− 4.53 kg/m2 (p < 0.001). There was an increase of the PTHi value (from 71.4 +/− 79.6 to 91.65 +/− 43.06 pg/ml) (p = 0.01), and the urinary pirydinolines (from 7.93 +/− 4.06 an 11.4 +/− 10.12 nM/mM) (p < 0.05). The ultrasonic transmission speed increased (from 1,990.93 +/− 62.38 to 2,035.25 +/− 53.98 m/s). However, the bone mineral content (BMC) did not show changes (from 3,016.5 +/− 562.8 to 2,909.6 +/− 304.2 g), as well as the Bone Mineral Density (BMD) (of 1,174.2 +/− 98.8 g/cm2). Neither correlation was found between the BMD (r = 0.212; p = 0.6), the BMC (r =−0.125; p = 0.768), and the T-score (r = 0.592, p = 0.093). The study of the bone mass through ultrasonic transmission speed revealed low sensitivity during the assessment of the morbid obese patients. A percentage of cases of osteopenia were observed despite the fact that they are not reflected in the bone content or in the bone mass. Ultrasonic evaluation of bone mass has no value in the morbidly obese, by the clear negative correlation between ultrasound velocity and thickness of soft tissue.     

Biomechanical properties of prolapsed vaginal tissue in pre- and postmenopausal women

The aim of this study was to explore the relationship between biomechanical properties and the occurrence of pelvic organ prolapse (POP) through analysis on biomechanical properties of vaginal tissue. The biopsy specimens were obtained from 43 patients undergoing transvaginal hysterectomy, who were assigned into premenopausal POP, postmenopausal POP, premenopausal control and postmenopausal control groups. Tissue specimens were biomechanically assessed by a purpose-built tissue puller system, and stress–strain curves were digitally recorded. The Young’s modulus, Poisson’s ratio, maximum elongation, maximum fracture of vaginal tissue were 9.45 ± 0.70, 0.43 ± 0.01, 1.50 ± 0.02, 0.60 ± 0.02 in premenopausal POP group; 12.10 ± 1.10, 0.39 ± 0.01, 1.14 ± 0.05, 0.27 ± 0.03 in postmenopausal POP group; 6.65 ± 1.48, 0.46 ± 0.01, 1.68 ± 0.11, 0.79 ± 0.05 in premenopausal control group and 10.26 ± 1.10, 0.42 ± 0.01, 1.37 ± 0.04, 0.42 ± 0.03 in postmenopausal control group. There was significant difference in biomechanical properties between premenopausal POP group and premenopausal control group (p < 0.01). There was significant difference in biomechanical properties between postmenopausal POP group and postmenopausal control group (p < 0.01). Biomechanical properties in POP group were significantly lower than that in control group, suggesting that degeneration of biomechanical properties in pelvic support construction might lead to the occurrence of POP. Grant Fujian Science & Technology Bureau Foundation No. 2000I1003.