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At least 343 records · Page 19Linked to original sources

Cervical myelopathy caused by pseudoarthrosis between the atlas and axis associated with diffuse idiopathic skeletal hyperostosis.

STUDY DESIGN: This is a report of a patient with severe cervical myelopathy due to pseudoarthrosis between the posterior tubercle of the atlas and the spinous process of the axis, associated with diffuse idiopathic skeletal hyperostosis. Radiographs of 170 patients with neck pain were reviewed to identify lesions involving abnormal contact between the atlas and axis. OBJECTIVE: Based on an analysis of 170 radiographs, the prevalence of the reported condition was estimated. SUMMARY OF BACKGROUND DATA: A number of histologic studies on pseudoarthrosis involving the lumbar spine have been reported. In contrast, lesions between the posterior tubercle of the atlas and the spinous process of the axis have not been reported in association with cervical myelopathy. METHODS: Clinical and pathologic features of a patient with pseudoarthrosis between the posterior tubercle of the atlas and the spinous process of the axis were investigated. Radiographs of 170 Japanese patients over 40 years old were examined, and abnormal contact between the atlas and axis was classified into two groups based on the degree of spinal hyperostosis. RESULTS: Of 170 patients, 53 showed abnormal contact between the atlas and axis. The prevalence of abnormalities in the pronounced hyperostosis group (Forestier's stages II and III) was much higher than in the group with normal or slight hyperostosis. Two men had radiographic patterns showing osteophytes projecting into the spinal canal and associated with marked cervical myelopathy. CONCLUSION: In the group with pronounced hyperostosis, pseudoarthrosis or a variant can cause serious problems in the upper cervical spine that should not be overlooked.

Age Distribution↗

Intraosseous calcifying pseudotumor of the axis: a case report.

STUDY DESIGN: A case report and review of the literature. OBJECTIVE: To present the first case of intraosseous calcifying pseudotumor arising from the axis. SUMMARY OF BACKGROUND DATA: Calcifying pseudotumor is a very rare disease. Only 24 cases have been previously reported. METHODS: A case of calcifying pseudotumor involving the body, dens, and laminae of the axis in a 60-year-old male patient was managed with total laminectomy of the axis and instrumented occipitocervical fusion, followed by the curettage of the body and dens of the axis and autogenous iliac bone graft. Medical records, imaging studies, microscopic findings, and related literature are reviewed. RESULTS: Microscopic examination showed amorphous, basophilic, and chondroid calcifying masses surrounded with palisading histiocytes and foreign body-type giant cells. The findings were consistent with those of calcifying pseudotumors previously reported in other sites of the body. At 24 months after operation, a significant reduction of neck pain was achieved. But there was evidence of local recurrence of the lesion in the body and dens of the axis with a local progression of the preexisting lesion in the facet joints. CONCLUSION: This is the first report of intraosseous calcifying pseudotumor arising from the axis.

Axis, Cervical Vertebra↗

Double-Axis Maxillary Skeletal Expander Suggests Higher Expansion Efficiency in Early Activation: A Finite Element Analysis.

INTRODUCTION: Conventional single-axis maxillary skeletal expanders (MSE) have some drawbacks, such as limited control over maxillary expansion and possible asymmetric expansion between the anterior nasal spine (ANS) and posterior nasal spine (PNS). This report introduces a double-axis maxillary skeletal expander (DAMSE) concept to overcome these drawbacks and enhance the efficiency of maxillary skeletal expansion. MATERIALS AND METHODS: Five different DAMSE designs were compared with a conventional single-axis MSE. Finite element analysis was performed to analyse their expansion efficiency, stress magnitude and distribution occurring in a simplified bone model. RESULTS: DAMSE outperformed the single-axis MSE and provided better control over ANS and PNS expansion. During early activation, the highest expansion efficiency (31.7%) was achieved by DAMSE Model V, 13% more efficient than the single-axis MSE. This efficiency was increased to 100.8% by combining the DAMSE Model V with midpalatal suture surgery. However, with the simplified bone model, the current study could not demonstrate that DAMSE can resolve the issue of asymmetric expansion between ANS and PNS. CONCLUSIONS: An appropriately designed DAMSE can be a promising tool for maxillary expansion treatment. DAMSE offers more efficient treatment than the conventional single-axis MSE while maintaining similar levels of patient comfort and invasiveness.

Finite Element Analysis↗

[Anterior screw fixation combined with posterior interlaminar fusion for fracture of axis: report of two cases].

Two cases of axis fracture are reported. Traffic accidents were the cause of injury in both cases. The odontoid process was dislocated anterolaterally with fracture of the lateral mass of the axis in both cases. In Case 1 good alignment of the atlas and axis could not be maintained even with a Halo-vest. The case 2 patient with spinal cord compression caused by dislocation of the axis was referred to our hospital 8 weeks after the accident. Both cases were surgically treated in a similar fashion. Because of the lateral mass fracture and lateral displacement of the atlas relative to the axis, posterior screw fixation with interlaminar fixation (Magerl) was thought to carry a risk of causing damage to the vertebral artery. Because of this, anterior screw fixation combined with posterior wiring was conducted. First, the odontoid process was fixed anteriorly by a screw because it was able to be placed back in good alignment while the patient was in the supine position. Then, the posterior C1-2 interlaminar wiring with iliac bone graft was added. Rigid fixation was obtained without any complication. Various kinds of fixation, such as posterior interlaminar wiring, odontoid screw fixation and Magerl's fixation, have been reported for the treatment of unstable axis fracture. Among them Magerl's method has been regarded as the most stable. When it is not applicable, combination of the first two methods can be an alternative way of treatment for this odontoid process fracture.

Accidents, Traffic↗

Symptomatic anomalies and arthrotic formations of the axis vertebrae in eastern Anatolian people. A local investigation.

At the craniocervical junction, developmental anomalies of the axis may produce clinical symptoms by compressing the upper cervical cord during movements of the head and neck. The present study aimed at investigating several varieties and deformities of the axis on skeletal specimens of Eastern Anatolian origin. On 76 specimens, developmental anomalies and the variants of the second vertebrae (axis) were investigated. Hypoplasia of the dens axis in one specimen, the dens axis of a child with a bifid apex in another specimen and an arthrotic formation located on the apex of the dens in six axes were found. A bone protrusion narrowing the transverse foramen was also observed. The types of absence of the dens axis and clinical symptoms that may be caused by them are discussed. It was concluded that the frequency of arthrotic formations might reflect the possibility that the individuals suffered less commonly from neck pain due to arthrotic degeneration.

Axis, Cervical Vertebra↗

Postnatal ossification centers of the atlas and axis in miniature schnauzers.

Postnatal ossification of the atlas and axis was studied in Miniature Schnauzers by examining alizarin-stained bone clearings, cleaned dry bones, radiographs, histologic sections, and arterially perfused bone clearings. Sixty-two pups (1 day to 16 weeks old) and 4 adults were examined. In 1-day-old pups, the atlas consisted of 3 separate ossification centers: a left and right neural arch center and midventrally, the intercentrum 1, which formed the body of the atlas. The axis contained 4 separate ossification centers: a left and right neural arch center; centrum 2 in the main part of the axis body; and centrum 1, which formed the caudal part of the dens and the cranial part of the axis body. By 6 weeks of age, the epiphysis on the caudal end of the axis body had begun to ossify. At this time, the intercentrum 2, which developed as a cuboidal ossification center intercalated between centrum 1 and centrum 2 in the middle of the cranial half of the axis body, also began to ossify. The centrum of the proatlas, which formed the apex of the dens, was first seen ossified in a 9-week-old pup. These 10 ossification centers were seen as constant and separate elements. In all dogs, the dens developed from 2 separate ossification centers: the centrum of the proatlas formed the cranial one-quarter, and centrum 1 formed the caudal three-quarters. Dens dysplasia is unlikely to be a result of failure of development of one of the ossification centers for the dens.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Depression and axis II disorders: comorbidity and relationship to cooperativeness.

The diagnosis of depression and Axis II personality disorders have been found to co-occur in people, and the purpose of this paper is to examine the relationships between chronicity of depression and Axis II diagnosis. We assessed for the prevalence of two Axis II disorders, Antisocial Personality Disorder (APD) and Borderline Personality Disorder (BPD). Patients who were evaluated in a tertiary care center were diagnosed as having Chronic Major Depressive Disorder (CMDD), Dysthymic disorder (DD), or Acute Major Depressive Disorder (AMDD). We expected the prevalence of Axis II disorders to increase with increasing depression chronicity. Cloninger et al. (1993, Arch Gen Psychiatry 50:975-988; 1994) have proposed that temperament and character factors may be predictors of personality disorders. The instrument originally developed to measure these factors was the Tri-dimensional Personality Questionnaire (TPQ), which was later revised to produce the Temperament and Character Inventory (TCI). There is evidence that TCI scores help predict the presence of Axis II disorders. We hypothesized that one component of the TCI, cooperativeness, would be lower in CMDD than DD or AMDD, reflecting a relationship between Axis II disorders and chronicity of depression. From our sample, no patients had APD and there was not a significant difference between the number of patients with BPD in each of the depression groups. Furthermore, there was not a significant difference between cooperativeness scores among each of the groups. The implications of these findings are discussed.

Adolescent↗

Axis I and II comorbidities in subjects with and without nocturnal panic.

Our purpose in this study was to compare the prevalence and pattern of Axis I and II comorbidities between patients with and without nocturnal panic (NP) attacks. One hundred and sixteen subjects with panic disorder (PD; according to DSM-IV criteria) were included: We assessed Axis I and II comorbidities using the Structured Clinical Interview for DSM-IV Axis I and II disorders, respectively. Of the sample, 27.6% of subjects had recurrent nocturnal panic attacks (NP group). Subjects with NP did not differ from those without in any sociodemographic or clinical characteristics. In the sample (94 subjects), 81% had at least one lifetime comorbid Axis I disorder, without significant differences between subjects with and without nocturnal panic even when considering comorbidity rates for single disorders; a trend toward significance was found for anorexia nervosa and somatization disorder, which both were more frequent among subjects with NP. Concerning Axis II disorders, 49.1% of the sample (57 subjects) met the criteria for at least one personality disorder, without significant differences between patients with and without NP. No significant differences were detected in comorbidity rates for any single Axis II personality disorder. Personality might play a relevant role in influencing treatment approaches to PD, but it does not appear to be a differential focus of concern in patients with compared to those without NP.

Adult↗

Cine MRI using steady state free precession in the radial long axis orientation is a fast accurate method for obtaining volumetric data of the left ventricle.

In this study we assessed the use of a steady state free precession (SSFP) cine sequence in a series of radially orientated long axis slices for the measurement of left ventricular volumes and mass. We validated the radial long axis approach in phantoms and ex vivo porcine hearts and applied it to normal volunteers and patients using the SSFP and turbo gradient-echo (TGE) sequences. High quality images were obtained for analysis, and the measured volumes with radial long axis SSFP sequence correlated well with short axis TGE and SSFP volumes (r > 0.98). The best interobserver agreement for left ventricular volumes was obtained using SSFP in the long axis radial orientation (variability < 2.3%). We conclude that this combination of sequence and scan orientation has intrinsic advantages for image analysis due to the improved contrast and the avoidance of errors associated with the basal slice in the short axis orientation.

Animals↗

Regulation of the HPA axis by cytokines.

Cytokines are a group of polypeptide mediators, classically associated with the regulation of immunity and inflammation. However, these peptides regulate not only local immune/inflammatory responses, but also elicit many CNS-mediated responses which accompany such immune/inflammatory reactions. This article reviews the evidence that interleukin (IL)-1, IL-6, and tumor necrosis factor alpha (TNFalpha) produce hypothalamo-pituitary-adrenal (HPA) axis activation in response to various threats to homeostasis. To aid such an examination, and to gain insights into the potential mechanisms by which these cytokines influence the HPA axis, experimental findings are discussed within a framework of criteria. If a particular cytokine plays a significant role in the regulation of the HPA axis in response to a particular pathophysiology, then necessarily: (1) receptors for that cytokine should be present within tissues associated with the HPA axis; (2) administration of that cytokine should elicit HPA activation; (3) the HPA axis should be exposed to that cytokine; and (4) inhibition of the action of that cytokine should prevent HPA activation. The evidence discussed indicates that some, if not all, of these criteria are met for each of IL-1, IL-6, and TNFalpha. However, the extensive interactions between different cytokines, the broad spectrum of pathophysiologies associated with increased cytokine production (including inflammatory and non-inflammatory stresses), and the number of tissues/cells capable of either synthesizing or responding to cytokines, suggest that multiple mechanisms mediate the influence of cytokines on the HPA axis.

Animals↗

Chronic stimulation of the hypothalamus-pituitary-adrenal axis in rats by interleukin 1beta: central and peripheral mechanisms.

The authors have studied mechanisms which could be involved in the sustained activation of the hypothalamus-pituitary-adrenal (HPA) axis during continuous infusion of rats with recombinant human interleukin-1beta (IL-1beta). First, the effects of 3 days of intracerebroventricular (i.c.v.) infusion of rats with IL-1 on plasma adrenocorticotropin (ACTH) and corticosterone (B) levels were investigated. Thereafter, changes in plasma ACTH and B levels were followed in rats intraperitoneally (i.p.) infused with IL-1beta after immunoneutralization of corticotropin-releasing hormone (CRH), hypophysectomy (HPX), macrophage depletion using dichloromethylene diphosphonate (Cl2MDP)-containing liposomes, adrenalectomy (ADX) and dexamethasone (DEX) administration, respectively. Infusion of IL-1beta i.c.v., even in doses as low as 0.1 microg/day, induced significant increases in plasma ACTH and B levels. HPX and ADX rats died within 18 h after starting the IL-1beta infusion (0.5 microg/day). Immunoneutralization of CRH significantly decreased and macrophage depletion significantly increased the stimulation of the HPA axis by IL-1 (4.0 microg/day). Administration of high doses of DEX completely abolished the stimulation of the HPA axis by IL-1beta (2.0 microg/day). The present study demonstrates that lower doses of IL-1beta were able to activate the HPA axis when infused i.c.v. compared with i.p. Regarding stimulation of the HPA axis by chronic i.p. infusion of IL-1beta the present study: (1) provides evidence that the CRH system is involved; (2) provides no evidence for a direct stimulatory effect of IL-1beta on the release of B by the adrenal gland which is of sufficient magnitude to resist the stress of chronic i.p. IL-1beta infusion; (3) shows that endogenous macrophage-derived mediators, induced by i.p. IL-1beta infusion, express an overall inhibitory rather than a stimulatory effect on the activity of the HPA axis; (4) demonstrates that exogenous administration of DEX blocks the effect of IL-1beta, which fits well in the concept of an immunoregulatory feedback between IL-1beta and glucocorticoids.

Adrenalectomy↗

Impact of node ablation on the morphogenesis of the body axis and the lateral asymmetry of the mouse embryo during early organogenesis.

The node of the mouse gastrula is the major source of the progenitor cells of the notochord, the floor plate, and the gut endoderm. The node may also play a morphogenetic role since it can induce a partial body axis following heterotopic transplantation. The impact of losing these progenitor cells and the morphogenetic activity on the development of the body axes was studied by the ablation of the node at late gastrulation. In the ablated embryo, an apparently intact anterior-posterior body axis with morphologically normal head folds, neural tube, and primitive streak developed during early organogenesis. Cell fate analysis revealed that the loss of the node elicits de novo recruitment of neural ectoderm and somitic mesoderm from the surrounding germ-layer tissues. This leads to the restoration of the neural tube and the paraxial mesoderm. However, the body axis of the embryo was foreshortened and somite formation was retarded. Histological and gene expression studies reveal that in most of the node-ablated embryos, the notochord in the trunk was either absent or interrupted, and the floor plate was absent in the ventral region of the reconstituted neural tube. The loss of the node did not affect the differentiation of the gut endoderm or the formation of the mid- and hindgut. In the node-ablated embryo, expression of the Pitx2 gene in the lateral plate mesoderm was no longer restricted to the left side but was found on both sides of the body or was completely absent from the lateral plate mesoderm. Therefore, the loss of the node results in the failure to delineate the laterality of the body axis. The node and its derivatives therefore play a critical role in the patterning of the ventral neural tube and lateral body axis but not of the anterior-posterior axis during early organogenesis.

Animals↗

Axis of preferred motion is a function of bar length in visual cortical receptive fields.

The responses of 82 simple cells and 41 complex cells in area 17 of anesthetized and paralysed cats were examined with light bars of different length. For 84% of the simple cells and 66% of the complex cells the preferred axis of orientation of a stationary flashing long bar (orientational selectivity) and the preferred axis of movement of a small spot were parallel. As a consequence, the axis of maximal response to a moving light spot was mostly orthogonal to the optimal axis of a moving bar. Thus, a single cell responds to two perpendicular axes of preferred movement one for a long bar and one for a light spot, respectively. For both axes independent direction preferences could be distinguished. Additional preferred axes of movement between the two orthogonal extremes could be found with moving bars of intermediate lengths. This can be explained by the fact that cells with a pronounced response to a moving spot showed a strong tendency for intermediate bar length to elicit responses consisting of a superposition of both components. Therefore, decreasing bar length resulted in a gradual rotation of the preferred direction of movement from orthogonal to parallel with respect to the orientational axis, rather than to a mere widening of the tuning curve. Accordingly, the change in orientation selectivity with decreasing bar length is a regular transition from the orientation dependent response to a response type that depends only on the movement axis of the spot. Thus, in a simple model, the resulting response characteristic can be interpreted as an average of both components weighted according to the length of the stimulus.

Animals↗

Racial differences in hip axis lengths might explain racial differences in rates of hip fracture. Study of Osteoporotic Fractures Research Group.

Compared with white women, Asian women have about a 40%-50% and blacks a 50%-60% lower risk of hip fracture, but the reason for this racial difference is not known. Women with a shorter hip axis have a lower risk of hip fracture. To test the hypothesis that a shorter hip axis length could account for the lower risk of hip fracture among Asian and black women, we measured hip axis length in 135 Caucasian, 74 Asian and 50 black women. The mean hip axis lengths of Asian and black women were significantly shorter (1.2 and 0.7 standard deviations, respectively) than that of the whites (p < 0.0001). We estimate that, compared with white women, Asians would have a 47% lower risk (95% confidence interval: 32%-63%) and blacks would have a 32% (15%-45%) lower risk of hip fracture because of their shorter hip axis. We conclude that a shorter hip axis length might be a major factor accounting for Asian women's lower risk of hip fracture and might contribute to the lower risk in black women.

Aged↗

Axis II diagnoses and treatment refractoriness in schizophrenia.

In a previous medical record review study we identified a subset of chronic schizophrenic patients with comorbid Axis II personality disorder diagnoses, who had significantly longer lengths of inpatient stay as compared to schizophrenic patients without Axis II diagnoses. This study describes a detailed review of a subset of these records. Eighteen records of schizophrenic patients with comorbid Axis II diagnoses were matched with records of patients without comorbid diagnoses. Demographic and premorbid data revealed no differences between the groups, indicating that the Axis II diagnoses were markers for current as opposed to past psychopathology. Negative symptoms were lower in the cohort with comorbid Axis II personality disorder diagnoses on admission only, while affective symptomatology was increased in this group throughout treatment. Ratings of personality pathology showed a trend towards significance, with the comorbid group demonstrating greater amounts of maladaptive personality traits. These data support the notion that personality traits may be independent of Axis I symptomatology in chronic schizophrenia, and can influence the course of treatment.

Adult↗

[Calculation of the true angle in malposition of the skeletal system using electronic data processing. Retrospective study of 53 axis deviations in healed femoral fractures].

Under standard conditions deformations in the skeletal system are diagnosed by two X-ray photographs whose planes of projection form a right angle. The degree of deviation from the axis is measured directly on the X-ray photograph with a protractor. The analysis of the position of the axis of a tabular bone is carried out by determining the varus/valgus or ante/recurvation deformities resp. in the a.-p. and lateral rays. The degree of deformation is expressed through the supplementary angle. We asked ourselves whether a diagnostic procedure using X-rays taken in two planes is suitable for substantiating the evidence of a deformation of the axis. Example: If a fracture of the lower leg shows a varus deformity of 20 degrees in the a.-p. and a normal position of the axis in the lateral photograph, the actual angle is 20 degrees. This situation is an expection in that most cases the defect of the axis is a so-called combined defect (dislocation from the axis in both planes). In this case it can maintained that the measurable angle of deviation in the a. -p. and lateral X-ray photographs is smaller than the angle that is actually included by both fragments. We call this angle true angle. If you think of a fractured tubular bone as a cylinder it can be shown in a diagram that its deformation can only occur in one plane (Figure 1). Only from the perspective of a ray falling vertically on the curve k we would be able to determine the true angle directly from the photograph with a protractor.(ABSTRACT TRUNCATED AT 250 WORDS)

Casts, Surgical↗

Response of the hypothalamic-pituitary-adrenal axis to small dose arginine-vasopressin and daily urinary free cortisol before and after alprazolam pre-treatment differs in obesity.

OBJECTIVE: Arginine vasopressin (AVP) has a central role in the response of the hypothalamic-pituitary-adrenal (HPA) axis to stress conditions. A low dose of AVP has been shown to have a modest, but significant effect on ACTH response in normal weight subjects. The aim of this study was to test the response of the HPA axis in obese subjects in order to assess eventual primary neuroendocrine alterations, previously demonstrated by using AVP combined with corticotropin releasing hormone (CRH). In addition, given its central inhibitory action on the HPA axis, we investigated whether the suppressive capacity of alprazolam (APZ) pretreatment on the hormone response to low-dose AVP challenge and daily urinary free cortisol (UFC) excretion rate may be altered in the presence of obesity. DESIGN: Fifteen overweight or obese women and eight normal-weight controls randomly underwent two low-dose AVP tests (0.3 UI iv bolus), one without (AVP test) and the other preceded by APZ administration (0.5 mg at midnight and 0.5 mg 90 min before the test in the morning at 08:30 h) (APZ/AVP test). Blood samples for ACTH and cortisol assay were obtained at baseline and throughout each test. The day before each test, 24h-UFC/ creatinine was also mea-sured. RESULTS: Basal ACTH levels were similar in the two groups, whereas cortisol concentrations were significantly lower in the overweight/obese group. Overweight/obese women had higher ACTH and cortisol responses to the AVP tests and significantly greater hormone inhibition after APZ than controls. In both groups, AVP-induced delta-peak cortisol values before and after APZ pre-treatment were significantly correlated. Body fat distribution had no effect on the HPA axis response to AVP either before or after APZ. Moreover, APZ decreased 24h-UFC/creatinine values unsignificantly in controls and by approximately 50% in the overweight/obese subjects. These changes were unrelated to the cortisol response to the AVP test before and after APZ pretreatment. On the other hand, percent changes of 24h-UFC/creatinine after APZ were negatively related to the body mass index (BMI) but positively with waist circumference values, which indicates that the abdominal obesity phenotype may counteract the 24 h-UFC/creatinine that would be expected on the basis of BMI values. CONCLUSIONS: Our data further support the concept that in women obesity may represent a condition of hyperresponsiveness or hypersensitivity of the HPA axis to neuroendocrine stimuli, which appear to be independent of feedback control. In addition, the data on the inhibiting capacity of APZ on UFC excretion confirm that the alterations of the HPA axis in obesity is particularly evident in the abdominal phenotype.

Adult↗

[Correction of leg deformities. Definition, estimation and realignment of axis deviation and misalignment].

The operative realignment of mechanical axis deviations (MAD) is necessary to prevent early joint degeneration and to reach normal load-bearing. Modern types of external fixation systems allow an alignment of the mechanical axis to exact degrees. Predominantly this are corrections of angular deformities. In some cases the analysis of the MAD does not show any angular deformity, but a parallel staggering of the mechanical axis lines of a bone. Such parallel staggering of the mechanical axis lines is defined as a translation deformity of the bone. In combined deformities with angulation and translation the centre of deformity can be established proximal or distal out of the limit of the bone. In translation deformities the realignment of the mechanical axis requires a parallel re-staggering made by a translation-osteotomy or by a counter-angulated double osteotomy. In complex deformities with angulation and translation, the translation requires a separate corrective planning. By using external fixator systems to perform acute or progressive corrective osteotomies the position of the Axis of Correction of Angulation (ACA) in relation to the n-CORA of the deformity has to be considered. If ACA position is not conform with the n-CORA position relevant geometric effects in relation of length and translation occur. These geometric effects to corrective osteotomies can be calculated by using simple trigonometric formulas or graphical methods. Possibilities to compensate translation and length effects are shown by using unilateral external fixator systems.

Bone Lengthening↗