Ascending cluster pinning of the humerus inserted through the deltoid tuberosity

Summary Goal of Surgery Stable internal fixation of extraarticular proximal humeral fractures. Indications Extraarticular fractures angulated more than 30° which can be reduced closely or through a small incision. Epiphysiolysis. Fracture-dislocation of the humeral head. Contraindications Pathological fractures. Four part fractures. Segmental fractures of the humerus. Positioning and Anaesthesia Supine; the affected shoulder overhanging the edge of the table and supported by a radiolucent board. General or regional anaesthesia. Surgical Technique Closed pinning of two part and certain three part fractures of the proximal humerus being displaced, unstable, and mainly at the metaphyseal level. Introduction of Kirschner wires through a diaphyseal window and advancement into the proximal fragments after reduction which is controlled by image intensification. Postoperative Management Temporary immobilization in a sling. Passive and active assisted movements after a few days. Active movements after 2 weeks. Removal of wires after 3 months. Possible Complications Fracture of the humerus at the site of the cortical window. Injury to the radial nerve. Results 32 patients, mean age 49 years, 30 two part fractures and 2 three part fractures. Number of Kirschner wires used: 3 to 6, mean 4. Two out of 3 patients complained of pain at the site of wire insertion. All fractures consolidated. No avascular necrosis nor infection. Complications: Partial loss of internal fixation in 3 patients. One fracture of the humeral shaft. Sympathetic reflex dystrophy in 3 patients. Half of the patients had a normal range of motion. Time of follow-up: 6 to 24 (mean 10) months. Division of Orthopaedics and Traumatology, Purpan Hospital, Toulouse, France.     

中指近节背侧岛状皮瓣

介绍中指近节背侧岛状皮瓣的应用解剖,该皮瓣的营养动脉为第2掌背动脉,位置表浅,解剖容易,安全可靠。自1990年11月以来,应用该皮瓣修复手部软组织缺损共6例,均获成功。     

改良尿道板重建卷管尿道成形术与尿道板纵切卷管尿道成形术治疗儿童尿道下裂的疗效对比

目的 比较改良尿道板重建卷管尿道成形术（又称Koyanagi术）与尿道板纵切卷管尿道成形术（TIP）在儿童尿道下裂中的临床疗效。方法 回顾性分析2018年1月—2021年10月甘肃省妇幼保健院收治的104例尿道下裂患儿的临床资料,其中53例患儿行改良Koyanagi术（研究组）,51例患儿行TIP（对照组）。两组患儿术后均随访12个月。比较两组手术时间、术中出血量、术后疼痛及排尿功能、手术成功情况,对比两组术后并发症发生情况。结果 两组手术时间、术中出血量比较,差异均无统计学意义（P >0.05）。两组患儿术后4、12、24和48 h的FLACC评分比较,采用重复测量设计的方差分析,结果 ①不同时间点FLACC评分差异有统计学意义（F =10.871,P =0.000）;②研究组与对照组FLACC评分差异无统计学意义（F =1.849,P =0.157）;③研究组与对照组FLACC评分变化趋势差异无统计学意义（F =2.516,P =0.085）。两组患儿术后12个月的最大尿流率、平均尿流率、排尿量、尿流时间、手术成功率比较,差异均无统计学意义（P >0.05）。研究组术后总并发症发生率低于对照组（P <0.05）。结论 改良Koyanagi术与TIP治疗儿童尿道下裂疗效相近,均可获得满意效果,但改良Koyanagi术在降低术后并发症方面具有优势。     

Stereological study of the developing distal femoral growth plate

The distal femoral growth plate has a uniquely convoluted structure comprised of four mammillate processes. Factors contributing to the development of these processes and overall plate geometry were explored using three-dimensional image analysis of the canine distal femoral epiphysis. The growth plate at birth remains relatively flat until ossification of the epiphysis begins at 1 week of age. Epiphyseal ossification proceeds eccentrically, projecting in the medial-lateral and anterior-posterior directions. Growth plate activity indexed by [3H]thymidine labeling and plate thickness revealed regional differences in cell proliferation. This was measured as a decreased labeling index and thinning of the growth plate in areas capped by the ossifying epiphysis. The eccentric ossification pattern and associated variations in growth plate activity result in definition of an "intraphyseal" groove and medial-lateral oriented sulcus. The groove and sulcus bisect the plate into four quadrants, giving rise to a convoluted structure composed of four areas of plate elevations termed mammillary processes (MP). By 5 weeks, the pattern of ossification results in greater development of the MP in the anterior-medial quadrant and in decreasing order, in the posterior-medial, anterior, and posterior-lateral quadrants. By 10 weeks, a uniform rate of cell proliferation was observed coincident with completion of ossification of the epiphysis. The data suggest that localized variations in growth plate proliferation are associated with ossification of the epiphysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

AO肩锁钢板钩治疗重型肩锁关节脱位

目的评估AO肩锁钢板钩治疗重型肩锁关节脱位的手术疗效.方法回顾性分析两年来27例手术病人的手术治疗和疗效.结果手术方法符合生理结构,手术时间平均30分钟,内固定牢靠.根据Murley和Constant[1]评分,优良率94%.结论 AO肩锁钢板钩治疗重型肩锁关节脱位,手术方法简单,疗效可靠,允许病人术后早期功能锻炼.     

Dimensional changes of proximal tubules and cortical capillaries in chronic obstructive renal disease

Summary The study was carried out to determine the proximal tubular length, surface area and length of peritubular capillaries and the nephron numbers in kidneys with chronic nephropathy and varying increase in the cortical interstitial volume. Kidneys of pigs with varying chronic obstructive nephropathy were used for the experiments. Two subgroups of ureterobstructed kidneys were defined arbitrarily according to the volume of cortical interstitium. One subgroup (I) comprised kidneys with a volume fraction of cortical interstitium less than 30% (mean 17.2%; mean of controls 9.7%). The other subgroup (II) consisted of kidneys with severe chronic nephropathy and with a volume fraction of interstitium more than 30% (mean 44.5%). Proximal tubular length and length and surface area of peritubular capillaries were assessed by conventional morphometric techniques on 1 m thick sections of plastic embedded material. Nephron numbers were determined by a stereological method for counting glomeruli.The results demonstrated that proximal tubular length and capillary dimensions were significantly reduced in subgroup II, whereas no significant changes were observed in subgroup I. The mean number of glomeruli was not significantly different from control values in any of the subgroups.The results are in line with observations from previous quantitative analyses of proximal tubular cross-sections indicating that proximal tubular dimensions become reduced mainly at advanced stages of chronic nephropathy. The results also indicate that shortening of individual tubules rather than loss of entire nephrons is responsible for the observed reduction in total length of proximal tubules. Finally, the present observations suggest that reduced dimensions of the cortical capillary network may have pathogenetic significance for ongoing proximal tubular atrophy in chronic renal desease.     

单钉——沟槽柱翼钢板的生物力学实验研究

作者自行研究设计的单钉－沟槽柱翼钢板复位固定治疗腰椎滑脱症。预先采用６具成人尸体的Ｌ３－Ｓ３骨骼做成椎弓崩裂并滑脱模型，采用临床Ｉ型手术方法进行了复位固定，在每片钢板上粘贴６片电阻应变片，进行中心和偏心加载试验，同时进行了弯矩和扭矩试验，在５８６微机上进行了线性回归分析，求出了线性方程及线性相关系数ｒ，中心和偏心加载达到９００Ｎ未出现钢板松动，扭矩和弯矩在８３３Ｎ；ｃｍ和６６６．４Ｎ．ｃｍ以内左右     

System for inducible expression of cre-recombinase from the Foxa2 locus in endoderm, notochord, and floor plate.

We targeted the reverse tetracycline controlled transactivator (rtTA) to the Foxa2 locus (Foxa2(ITA)) to generate a system for regulating Cre-recombinase activity within Foxa2 expression domains, including the endoderm, notochord, and floor plate of early mouse embryos. The use of an internal ribosomal entry site to obtain rtTA expression preserves Foxa2 function of the targeted allele. Cre activity with this system reflects the level of endogenous Foxa2 activity and is also tightly controlled by doxycycline. The location of Cre activity within the broader Foxa2 expression domain can be restricted by altering the timing of doxycycline administration. Isolated floor plate expression can be obtained in this manner. This system will provide a useful tool for manipulating gene expression in endoderm, notochord, and floor plate, all of which are tissues with important structural and patterning functions during embryogenesis.     

Fluid Flow through Filtering Appendages of Insects

Many organisms use structures composed of arrays of cylindersto capture particulate food or molecules form the water or airaround them. The performance of such filters depends on thevelocity of fluid movement through them; hence, mathematicalmodels of flow through fibrous structures can provide insightsabout the functional morphology of biological filters. In thispaper, the authors address the case of feather-like biologicalfilters of finite width and assess several possible models forfluid motion through them by comparing model predictions withobservational data. Two examples of insect appendages are considered:the cephalic fans of black fly aquatic larvae that capture particulatefood and the antennae of adult male moths that catch sex-attractantmolecules released by female moths. The results suggest thatflow through such structures can be much slower than ambientcurrents, that the finest hairs in the structure are the morphologicalfeatures with the greatest effect on leakiness, and that thevelocity of movement (or of ambient flow), as well as the morphologyof such filters, can be critical in determining their performance.     

Micropuncture studies on the influence of antidiuretic hormone on tubular fluid reabsorption in rats with hereditary hypothalamic diabetes insipidus

Summary Micropuncture studies were carried out on rats with hereditary hypothalamic diabetes insipidus, in order to measure net sodium and water reabsorption in proximal convolutions and short loops of Henle during water diuresis and ADH-induced antidiuresis. Intravenous infusion of 0.15 mU ADH per minute reduced urine flow from 74.5 l per kidney per minute to 10.8 l, and increased urine osmolality from 117 to 605 mOsm/kg. These changes could be reversed by stopping ADH.ADH did not alter the fractional reabsorption of fluid or the reabsorptive capacity for sodium in the proximal tubules. Nor did it change glomerular filtration rates of single superficial nephrons or of the entire kidney.Fractional reabsorption of the glomerular filtrate up to the early distal convolution was significantly higher (82.0%) in water diuresis than in antidiuresis (74.4%). Since this reabsorption remained unchanged in the proximal convolutions, the decreased reabsorption during antidiuresis must have occurred in the short loops. Fractional reabsorption of sodium up to the early distal tubule was essentially identical during water diuresis and antidiuresis, indicating that ADH does not enhance urinary concentration by increasing the reabsorption of sodium from short loops.On leave of absence from the Department of Physiology, Dartmouth Medical School, Hannover, N. H., from January to June, 1967. Recipient of USPHS Research Career Program Award 5-K3-GM-21, 786.