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Assessment of spinal cord injury by counting corticospinal and rubrospinal neurons.

This paper describes an objective, quantifiable technique for assaying the degree of severity of spinal cord injury. Twenty-one rats underwent a C7-T1 laminectomy: 12 received a C8 spinal cord clip compression injury with forces of either 2.3, 16.9 or 53.0 g; 4 had cord transection at C8, and 5 had no cord lesion. Postoperative clinical neurological assessment was performed by the inclined plane method. At 4 weeks, the spinal cord-injured rats underwent a T10 transection and insertion of a Gelfoam pledget impregnated with horseradish peroxidase (HRP). HRP was similarly administered to 9 normal rats. Longitudinal sections of the spinal cord encompassing the injury site were stained with Luxol fast blue, and coronal sections from the cerebrum and midbrain were processed for HRP reactivity with tetramethylbenzidine. Labelled corticospinal and rubrospinal neurons were counted in every 6th section to derive a cortical score (CS) and a red nucleus score (RNS) for each animal. The CS reflected the extent of the pathological changes at the site of cord injury and the ln CS decreased linearly with increasing injury severity (P less than 0.0001). In contrast, the RNS was only reduced in animals with severe (53.0 g) cord injuries (P less than 0.0006). The degree of preservation of the dorsal columns including the corticospinal tracts at the injury site correlated with the CS, whereas the RNS was related to the degree of preservation of the lateral columns. Counts of rubrospinal neurons, but not corticospinal neurons, correlated closely (r = 0.96, P less than 0.001) with the inclined plane results, suggesting the importance of non-pyramidal tracts in controlling gross motor function. Thus, counting corticospinal and rubrospinal neurons is an objective, reliable test of the severity of experimental spinal cord injury.

Animals↗

Surgical damage stimulates proliferation of dopamine uptake sites in normal mouse brain.

To test the hypothesis that proliferation of host dopaminergic tissue in response to injury plays an important role in the response to intrastriatal grafting, we transplanted autologous adrenal medullary to striatum in normal C57-black mice and compared this procedure with transplantation of non-dopaminergic tissue (frontal cortex) or a non-cellular matrix (Gelfoam). [3H]Mazindol autoradiography revealed that all three protocols resulted in a marked proliferation of dopamine uptake sites 10 months after transplantation.

Adrenal Medulla↗

Neurotrophin-4/5 postpones the death of injured spinal motoneurons in newborn rats.

We have compared the short- and long-term effects of Neurotrophin-4/5 (NT-4/5) on the survival of spinal motoneurons in neonatal rats. To this aim, the sciatic nerve was cut in newborn rats and NT-4/5 or buffer were applied to the proximal nerve stem in a gelfoam as well as by daily local injection. The number of motoneurons or ventral root fibers was determined 4, 11, and 14 days later. Four days after received NT-4/5 lost only 19% + 2.7% (540 + 81). No systemic effect on the contralateral motoneurons was observed. Surprisingly, 11 and 14 days following the operation, the loss of motoneurons and of ventral root fibers was the same in buffer and NT-4/5 treated animal despite the daily treatment. Thus, although NT-4/5 is a potent survival factor for motoneurons in culture and can transiently prevent the death of motoneurons in vivo, it can not, under these experimental conditions, permanently rescue lesioned motoneurons. These results indicate that other trophic factors or combinations of factors may be required to permanently prevent the death of spinal motoneurons and that the short term survival promoting effects of neurotropic factors in motoneuron lesion models can not be used to predict their therapeutic potential in chronic neurodegenerative disorders.

Animals↗

The effects on extraction wound healing of a new drug combination introduced for use in the prevention of post-extraction complications. A preliminary report.

Fifteen extraction sockets packed with a new drug combination which includes a local anaesthetic (cincain chloride), a local antiseptic (tri-iodomethane) and two drugs with a potent antifibrinolytic activity (tranexamic acid and propyl-hydroxy-benzoic acid) in an absorbable gelatin sponge (Gelfoam) as a vehicle, were histologically assessed with special reference to the parameters related to wound healing. As a control, the same number of sockets were allowed to heal spontaneously and similarly assessed. Healing of the extraction wounds seemed to follow the normal sequence in both series, and no histological signs suggestive of a delay in the healing process could be found in any of the sockets studied. Also the mast cell count previously considered to be of importance in the connective tissue repair was found to be unaffected by the test substance. These results, together with the previously presented data on the clinical efficacy of the drug combination studied, suggest that a larger clinical study should be carried out to assess its value as a preventive measure against the development of the post-extraction symptoms, including dry socket.

Adolescent↗

Regeneration of central nervous system axons into an acellular tube in the absence of distal tissue.

To differentiate between local and distant influences on central nerve regeneration, an impervious, stainless-steel cannula, 12 mm long, was placed in the path of severed axons within the corpus callosum of adult rats. The cannula was occluded for 1 week after implantation to prevent herniation of tissue into its lumen. The extracranial end of the tube was plugged with Gelfoam rather than tissue. Inflammatory cells within the tube decreased in number with time and all animals survived for the experiment's duration of 4 to 16 weeks. Some callosal axons grew into the cannula and eventually extended about 1.3 mm. After 8 to 16 weeks, the lumen of the cannula contained many unmyelinated axons, some of which formed fascicles, myelinated axons, demyelinating axons, a few oligodendrocytes, and many astrocytic processes, macrophages, and blood vessels. A striking feature was the linear orientation of cells and their processes. The distal tip of the core resembled a central nervous system explant: it included an appreciable number of growth cones, synaptic terminals embedded in a generous extracellular space, and occasional remyelinating axons. Thus, within an impervious, acellular conduit and in the absence of distal tissue, intrinsic, neuronal processes can be redirected, fasciculate, myelinate, and can regrow alongside glia and endothelium. An indwelling tube, isolating the growth from surrounding brain fluid, may permit assessment of glial, neuronal, and extracellular contributions to the directed regeneration of adult, central axons.

Animals↗

On the diffusion of horseradish peroxidase into muscles and the "spurious" labeling of motoneurons.

There is some evidence to suggest that the fascial sheaths of muscles are important in preventing the labeling of motoneurons that occurs, apparently, as a result of the diffusion of horseradish peroxidase (HRP) into the muscles. To test this possibility, Gelfoam soaked in HRP was implanted over flexor and extensor muscles in the proximal forelimb of the rat. When the fascial sheaths were damaged, labeled neurons were found in the motoneuronal pools of the exposed muscles; if intact, virtually no labeling of motoneurons was observed. These results suggest that, if intramuscular injections are to be used as a method for identifying motoneuronal pools, care should be taken when exposing the muscle to be injected, to ensure that surrounding muscles and their fascial sheaths are not damaged.

Animals↗

Fine structural correlates of vascular permeability of chromaffin cell transplants in CNS pain modulatory regions.

Adrenal medullary tissue, bovine chromaffin cells, and PC12 cells were transplanted into the pain modulatory regions of the rat midbrain periaqueductal gray (PAG) or dorsal spinal cord. Fine structural studies of vascular permeability of these grafts revealed that in all three cases, the capillary endothelium of the graft vasculature was attenuated and fenestrated, unlike that of the surrounding host CNS tissue. The intravascular injection of the protein marker, horseradish peroxidase (HRP), enters the grafted tissue parenchyma and is found in the extracellular space of the surrounding host CNS. In contrast, control gelfoam transplants, which become vascularized, do not contain vessels with fenestrated endothelium and do not leak HRP. Since cell suspension implants do not contain endothelial cells, the vasculature of the grafts must be derived from the host. However, as their morphological characteristics are similar to those of the in situ adrenal medulla, it appears that the tissue environment of the graft influences the permeability properties of the vascular bed. The increased permeability to HRP is apparently permanent and most likely is due to the passage through endothelial cell fenestrae.

Adrenal Medulla↗

Pharmacologic consequences of the vascular permeability of chromaffin cell transplants in CNS pain modulatory regions.

The transplantation of peripheral neural tissue into the CNS has been shown to alter blood-brain barrier (BBB) permeability to intravascularly injected proteins such as horseradish peroxidase. The pharmacological consequences of such BBB alterations following the transplantation of adrenal medullary tissue, isolated bovine chromaffin cell suspensions, or PC12 cell suspensions into the pain modulatory regions of the periaqueductal gray (PAG) or subarachnoid space of the lumbar spinal cord were studied using agents that normally do or do not readily pass the BBB. The injection of nicotine in animals with adrenal medullary or chromaffin cell transplants produces potent analgesia, most likely due to the stimulated release of opioid peptides and catecholamines from the transplanted cells. This analgesia could be blocked by nicotinic antagonist mecamylamine, which normally passes the BBB, but not by nicotinic antagonist hexamethonium, which normally does not readily pass the BBB. Furthermore, quaternary nicotinic agonists tetramethylammonium and 1,1-dimethyl-phenyl-piperazinium had no effect on pain sensitivity in animals with adrenal medullary implants. The Met-enkephalin peptide analog, D-Ala-Met-enkephalinamide, which normally does not alter pain sensitivity when injected systemically due to limited penetration to the CNS, produced analgesia in animals with adrenal medullary, bovine chromaffin cell, and PC12 cell implants in the PAG, but not in control gelfoam-implanted animals. This analgesia, as well as analgesia induced by nicotine, was completely blocked by naloxone pretreatment, but not by naloxone methobromide, a quaternary derivative of naloxone that does not normally pass the BBB.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Medulla↗

Cultivation of murine bone marrow macrophages in sponges: a method that permits recovery of viable cultured cells.

Various investigators have cultured murine bone marrow or peritoneal cells in vitro on glass or plastic surfaces with the ultimate aim of retrieving adherent macrophages for morphologic and functional evaluation. The removal of these adherent macrophages by conventional techniques has been consistently accompanied by low yield and significant cell damage. We report here a simple technique for culturing murine bone marrow cells in gelatin sponges (Spongostan and Gelfoam) in growth medium containing 10% fetal bovine serum and 10% L-cell conditioned medium. Viable cells were retrieved from the sponges in 10 min by digestion with collagenase. The in situ growth kinetics were similar to those found for cells cultured on plastic dishes. The recovered cells were adherent, phagocytic, positive for Fc gamma receptors, and had esterase activity.

Animals↗

A modern approach to prevention and treatment of oral bleeding in patients with hepatocellular disease.

Dental treatment for patients with hepatocellular disease constitutes a very complex problem because of their severe bleeding tendency. It seems that bleeding from the oral structures follows organ-specific patterns. The use of systemically administered antifibrinolytic agents, together with the local use of Gelfoam, cyanoacrylate spray, and intraligamentary anesthesia make possible bleeding-inducing procedures without exaggerated hemorrhage. This approach avoids the need for transfusion and hospitalization for dental treatment, making such treatment cheaper and more accessible.

Adult↗

An evaluation of 9-aminoacridine/Gelfoam to reduce dry socket formation.

This clinical study was undertaken to evaluate the effectiveness of locally applied 9-aminoacridine in Gelfoam in reducing the incidence of dry socket formation after third molar extractions. Results indicated that this technique was not effective. The incidence of dry socket formation in smokers and nonsmokers was compared. Also, the influence of surgical trauma on dry socket formation was examined.

Aminacrine↗

Postoperative radiographic appearance of intracranial hemostatic gelatin sponge.

Hemostatic gelatin sponges were placed in hemispheric defects created in four dogs which were then periodically scanned by computed tomography to determine the postoperative appearance of the sponges. The hemostatic sponges appeared as low attenuation regions for 7-10 days. The attenuation value of these Gelfoam cavities was intermediate between fat and air. Subsequently, clinical cases were selected in which the location of gelatin sponges were known to demonstrate the appearance of the material in patients. In addition to enhancing the accuracy of computed tomographic interpretation, we have found that the gelatin sponge can be useful as a transient computed tomography marker for localization of surgical activity.

Adolescent↗

Transcatheter embolization of renal arteriovenous fistula.

A patient with malignant hypertension and acute renal failure underwent percutaneous renal biopsy which resulted in the creation of an arteriovenous fistula that communicated with the renal pelvis. Successful segmental embolization with gelatin sponge (Gelfoam) was achieved via a transcatheter approach.

Adult↗

Treatment of uncontrolled hypertension by therapeutic renal infarction.

Certain hemodialysis patients need to be made anephric, either surgically or physiologically. Bilateral renal infarction with shredded absorbable gelatin sponge (Gelfoam) was performed on a woman with malignant hypertension being maintained on chronic center dialysis who was too great a surgical risk for bilateral nephrectomy. Peripheral embolization complicated the procedure resulting in a forefoot amputation for dry gangrene two months later. Her postinfarction peripheral plasma renins remained elevated, and she remained hypertensive but was more easily managed with fewer drugs. This technique has been successfully used by others in 1 patient with chronic renal failure and heavy proteinuria and another with hypertension and a solitary kidney. If, as in our case, postinfarction plasma renins remain elevated and hypertension persists, bilateral nephrectomy could be performed at a later date or infarction could be repeated.

Adult↗

In vitro growth of renal cell carcinoma after preoperative renal infarction.

Renal cell carcinoma tissue was cultured from 2 patients who underwent embolization of the tumor before surgery and from 2 patients who did not have the tumor embolized. A combination of small Gelfoam particles and polyvinyl alcohol foam particles (250-590 mu diameter) was used to devascularize maximally the tumors that were embolized. The tumor cells from all 4 patients grew in short-term tissue cultures and demonstrated histology and growth properties characteristic of tumor cells. Successful embolization of renal cell carcinomas may not completely infarct the primary tumor, and local tumor growth may continue.

Adenocarcinoma↗

Hypogastric arterial-vaginal fistula following multiple surgeries and pelvic radiotherapy.

A patient with recurrent sigmoid colon cancer developed an arterial-vaginal fistula after multiple surgeries and postoperative radiotherapy. Angiography revealed a fistula between the hypogastric artery and vaginal wall. Gelfoam and coil embolization controlled the hemorrhage and she recovered without incident. This case illustrates development of malignant fistula and intervention with embolization in a patient with multiple surgeries and postoperative irradiation in the pelvis.

Adenocarcinoma↗