Influences of the protected passive mobilization interval on flexor tendon healing. A prospective randomized clinical study

A prospective multicenter clinical study was carried out to determine whether improved tendon gliding could be achieved with greater durations of daily passive-motion rehabilitation after flexor tendon repair. Fifty-one patients were placed randomly into two controlled passive-motion protocols. Group 1 patients received greater intervals of passive-motion rehabilitation using a continuous passive-motion device. Group 2 patients were treated with a traditional early passive-motion protocol for tendon rehabilitation. For Group 1 patients, the mean interval of controlled motion rehabilitation was 75 hours a week, and the mean number of cycles was 12,000. For Group 2 patients the mean interval of controlled passive motion was four hours a week, and the mean number of cycles was 1000. The minimum follow-up time was six months (mean, 10.8 months). Using Strickland and Glogovac's formula, the mean active motion for digits in Group 1 was 138 degrees +/- 6 degrees. Mean motion for tendons in Group 2 was 119 degrees +/- 8 degrees. The difference between Groups 1 and 2 was statistically significant. The effect of the number of tendons injured per digit within each group was not significant. The data from this experiment indicate that the duration of the daily controlled motion interval is a significant variable insofar as postrepair flexor tendon function is concerned.     

Decreased removal of triglycerides from the blood — a mechanism for the hypertriglyceridemia in male patients with coronary artery disease

We determined serum apolipoprotein A I and A II concentrations and triglyceride and cholesterol concentrations in serum lipoprotein density classes in 28 male patients with severe ischaemic heart disease (IHD) and with angiographically verified coronary artery disease (CAD) and in age-matched controls. Both triglyceride and cholesterol concentrations in very low density lipoproteins and in low density lipoproteins were higher in IHD-patients than in the controls. The triglyceride but not the cholesterol concentration in serum was higher in IHD-patients than in the controls. The cholesterol in high density lipoproteins and the serum apolipoprotein A I concentration were lower in IHD-patients than in the controls. At least in part the higher triglyceride concentration in very low density lipoproteins could be attributed to a decreased removal of triglycerides from the blood since the fractional removal rate of an i.v. injected artificial triglyceride emulsion (Intralipid) was slower in IHD-patients than in the controls.     

Targeted disruption of the mouse sphingolipid activator protein gene: a complex phenotype, including severe leukodystrophy and wide-spread storage of multiple sphingolipids

The four established or putative sphingolipid activator proteins derive from a large precursor protein encoded by a single gene. In addition to generating the four sphingolipid activator proteins, the precursor protein is suspected of having functions of its own, as, for example, a lipid binding/transport protein or a neurotrophic factor. The gene also appears to encode the Sertoli cell major sulfated glycoprotein. Sequence similarities have been noted with many other proteins of diverse functions. One patient and a fetus in a single family with a complete defect of this gene due to a mutation in the initiation codon exhibited complex pathological and biochemical abnormalities. Mutant mice homozygous for an inactivated gene of the sphingolipid activator protein precursor exhibit two distinct clinical phenotypes-neonatally fatal and later-onset. The latter develop rapidly progressive neurological signs around 20 days and die by 35-38 days. At 30 days, severe hypomyelination and periodic acid-Schiff-positive materials throughout the nervous system and in abnormal cells in the liver and spleen are the main pathology. Most prominently lactosylceramide, and additionally ceramide, glucosylceramide, galactosylceramide, sulfatide, and globotriaosylceramide are abnormally increased in the brain, liver, kidney, and their catabolism abnormally slow in cultured fibroblasts. Brain gangliosides are generally increased, particularly the monosialogangliosides. The clinical, pathological and biochemical phenotype closely resembles that of the human disease. This model not only allows further clarification of the physiological functions of the four individual sphingolipid activator proteins but also should be useful to explore putative functions of the precursor protein.      

Vertebral osteomyelitis: assessment using MR

Thirty-seven patients who were clinically suspected of having vertebral osteomyelitis were prospectively evaluated with magnetic resonance (MR), radiography, and radionuclide studies. These findings were correlated with the final clinical, microbiologic, or histologic diagnoses. Based on the results of these latter studies, 23 patients were believed to have osteomyelitis. MR examinations consisted of at least a sagittal image (TE = 30 msec, TR = 0.5 sec) and an image obtained at TE = 120 msec, TR = 2-3 sec. All patients underwent radiographic and MR examinations, 36 underwent technetium 99m-HDP bone scanning, and 20 patients underwent gallium 67 scanning. Nineteen patients underwent both bone and gallium scanning. The imaging studies were reviewed independently by investigators blinded to the final diagnoses. MR had a sensitivity of 96%, specificity of 92%, and accuracy of 94%. Combined gallium and bone scan studies (19 cases) had a sensitivity of 90%, specificity of 100%, and accuracy of 94%. Bone scans alone had a sensitivity of 90%, specificity of 78%, and accuracy of 86%. Plain radiographs had a sensitivity of 82%, specificity of 57%, and accuracy of 73%. The MR appearance of vertebral osteomyelitis in this study was characteristic, and MR was as accurate and sensitive as radionuclide scanning in the detection of osteomyelitis.     

Growth of fat grafts after operation for partial bone growth arrest: demonstration by computed tomography scanning

Three patients who had fat grafts implanted at operation for partial bone growth arrest had computed tomography scanning of the operated bone 3-10 years after operation so that the fate of the grafts could be clarified. Two patients had a bridge in the tibia and one in the femur. The density in Hounsfield Units in the enlarged cavities showed that the fat grafts had grown in parallel with regained bone growth. In two adult patients, the grafts, enlarged during the period of growth, remained as adipose tissue for years. A thick layer of compact bone formed around the cavities. Partial regeneration of the growth plates occurred.