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Transplacental effects of endotoxemia on fetal mouse brain, bone, and placental tissue.

Pregnant mice were given 0.005 mg endotoxin on day 10 of gestation or 0.0025 mg endotoxin on days 10 and 12. Pregnant mice treated with normal saline served as controls. On day 18 of pregnancy, fetuses and placentas were removed for microscopic and histological examination. The treated placentas had fibrin thrombi and hemorrhages in the labyrinth and spongiosa. Glycogen cells in the spongiosa were swollen. The long bones of experimental animals had few metaphyseal trabeculae, which also were disorganized, with an increase in the number of metaphyseal and diaphyseal osteoclasts. An increase in the number of necrotic neurons was observed in coronal sections of brains of experimental fetuses at the level of the trigeminal ganglion. To correlate the degree of neuronal necrosis with long-term behavioral effects, a behavioral test was performed on pups whose mothers were treated with endotoxin. The pups were tested at the age of 28 days and for the next 3 days for their audiogenic seizure response. The pups of the experimental groups were more sensitive to high sounds than the controls. Escherichia coli endotoxins seemed to have a significant teratogenic effect on mice, being more severe when endotoxin was given in divided doses to the pregnant animals. The widespread endothelial damage or the elevation of prostaglandin levels caused by endotoxins may have been responsible for these teratogenic effects.

Abnormalities, Drug-Induced↗

Observations on long bone medullary pressure in relation to mean arterial blood pressure in the anaesthetized dog.

To study the influence of variations in mean arterial pressures (MAP) on long bone medullary pressures, seven anaesthetized dogs were investigated. The medullary pressures were measured in the epiphyseal, the metaphyseal and the diaphyseal regions and remained rather constant when MAP was above 80 mmHg. Below this level of MAP a statistically significant (P less than 0.01) reduction of the medullary pressures was seen. Comparing the mean medullary pressures obtained with ranges of MAP of 81--100 mmHg (the control medullary pressures) and of 61--80 mmHg, the greatest decline was seen in the epiphyseal and the diaphyseal regions, from 25.2 mmHg to 8.1 mmHg and from 26.7 mmHg to 8.3 mmHg, respectively. The corresponding decrease in the metaphyseal region was from 18.9 mmHg to 10.9 mmHg. The mean values of intraosseous pressure measured by our technique were between 20--30 mmHg and this is in accordance with measurements in normal humans found by other authors.

Animals↗

Epidemiology of knee injuries in children.

We analyzed 91 consecutive metaphyseal fractures, physeal injuries, and ligament ruptures in children aged 0-14 years. In the younger children, metaphyseal fractures dominated, whereas teenager had ligament rupture associated with low-energy trauma and physeal injury with high-energy trauma.

Adolescent↗

Changes in bone-mass after tibial shaft fracture.

We studied 20 patients who had suffered tibial shaft fractures 30 months previously. The bone-mineral content in diaphyseal and metaphyseal bone of the femur and tibia was determined by photon absorptiometry. There was a moderate, but significant, deficit of bone-mineral in metaphyseal bone at the knee and distal tibia. This loss was, however, far smaller than that previously reported. Persisting bone-mineral changes in diaphyseal bone were insignificant except in the fracture area where there was a 28 per cent increase. This may indicate that bone may, under some circumstances, locally increase in strength after remodelling of the fracture.

Adolescent↗

Vascular changes following hip arthroplasty. The femur in goats studied with and without cementation.

We studied two groups of 6 adult female African pygmy goats, which received cemented or uncemented femoral endoprostheses in their right hip. One additional goat was used for in vivo angiography preoperatively and postoperatively. The blood supply to the proximal femur at a macroscopic level was not severed by the operation. Until the 6th postoperative week, the animals were killed at weekly intervals. Microangiography and fluorescence microscopy revealed that rapid revascularization of the metaphyseal trabecular bone in the vicinity of the implants occurred as early as the first postoperative week in both groups. However, in general, the revascularization of the bone around the uncemented prostheses occurred more rapidly, resulting in earlier bone remodeling when compared with the cemented group. Surprisingly, the apposition of periosteal bone was longer lasting and more intensive in the uncemented group, particularly at the metaphyseal level. We suggest that this phenomenon may be enhanced by mechanical stimuli; the restoration of function was delayed in the noncemented goats.

Angiography↗

Regeneration after physeal distraction of the radius in sheep.

In 18 sheep, gradual physeal distraction of the distal radius was performed by external fixation. Separation of the physis from the metaphysis occurred in all the sheep. Prior to bone formation, collagen fibers were organized according to the direction of the distraction, and lamellar bone was formed if the collagen bundles were lineally organized. In the area where the collagen was disorganized, and also near the periosteum, woven bone was first formed, which was then remodeled into lamellar bone. In some sheep separate groups of chondrocytes were isolated in the metaphyseal area after the distraction. In 2 animals a double physis was formed in the metaphyseal area. This was obviously due to the separation of proliferative chondrocytes in the metaphysis as a result of distraction. After consolidation of the distraction area, this zone of chondrocytes, located in the metaphysis, was still producing new bone 20 weeks postoperatively.

Animals↗

Bone loss from the proximal femur after arthroplasty with an isoelastic femoral stem. BMD measurements in 25 patients after 9 years.

To quantify the bone loss from the proximal femur after total hip arthroplasty with an isoelastic femoral stem, the bone mineral densities (BMD) around 25 such stems were measured after an 8.5 (7.5-9.5)-year follow-up. The contralateral, healthy side was used as a control. The BMD on the prosthesis side was lower by a mean of 14 percent than on the control side. The difference was greatest in the calcar area and smallest in the cortex medially of the prosthesis stem. The decreases in BMD around the metaphyseal and diaphyseal areas of the stem were smaller than those reported for stiff stems. The marked bone loss in the calcar region is possibly due to stress bypass-i.e., the axial load is transmitted directly into the metaphyseal area of the femoral shaft, causing an increase in its stiffness and in the jamming of the prosthesis stem.

Adult↗

Alendronate did not inhibit instability-induced bone resorption. A study in rats.

Alendronate is a bisphosphonate that can decrease osteoclastic activity. It has been suggested as treatment for periprosthetic osteolysis. We used 48 rats, of which 32 had a plate implant on one tibia, to study the effect of alendronate on bone resorption at an unstable implant-bone interface. The plate has a handle on top, which can be grasped through the skin and turned, to create a sliding motion of a titanium surface against the underlying bone. This is known to result in bone resorption, which was studied by histomorphometry. Osmotic minipumps were used to administer alendronate at 0.063 mg/kg/day or saline. The systemic effect of the treatment was assessed by ashing the proximal metaphyses of the tibia of the contralateral unoperated leg. The ash-weight was increased in the alendronate-treated group by 43% (p = 0.0001), corresponding to histological changes in the metaphyseal bone. There was no inhibition of the instability-induced bone resorption at the test surface by alendronate: bone was being resorbed and replaced by a tissue similar to a loosening membrane.

Alendronate↗

Subacute pyogenic osteomyelitis.

Records of 110 cases of subacute osteomyelitis were reviewed. Twenty percent of the cases with a subacute clinical course had diffuse radiological changes more characteristic of an acute disease. Classic metaphyseal (Brodie) abscesses were most common. Diaphyseal lesions, of which over half were in adults, had a significantly higher rate of recurrence. The distribution by site and age of metaphyseal lesions resembled that of acute osteomyelitis. Staphylococcus aureus was the most common isolate, but 10% of lesions grew S. epidermidis. A modification of current classification is suggested which offers a basis for management and studies of outcome.

Acute Disease↗

The effects of bone resorption inhibitors on the growth plate and proximal tibial metaphysis of rats: clinical implications.

This study investigated the effects of diphosphonates at scalar doses in a high bone turnover structure, namely, the proximal tibial metaphysis of rats. Arrest of bone modeling was represented by cylindrical-shaped metaphyses, increased height of the perichondrial bone bark, and persistence of primary metaphyseal trabeculae; these changes were dose-related. Higher doses of the inhibitors produced extension of the growth plate and arrest of the mineralization process. The dose-related dissociation between the effects on bone resorption and mineralization allows the therapeutic use of this class of drugs.

Animals↗

The effect of an extended flexor carpi radialis approach on blood flow to the distal radius: a cadaveric study.

The effect of an extended flexor carpi radialis approach on the blood supply of the radius was examined in six (3 paired) fresh frozen cadaver limbs after injection with India ink and clearing using a modified Spalteholz technique. An extended flexor carpi radialis approach to the distal radius was made in the left limb in each of the three-paired limbs. The right limb served as a nonoperative control. Following perfusion of the arterial vasculature of each limb with India ink, serial transverse sections were cut and the intraosseous blood supply evaluated using a modified Spalteholz technique. Both controls and surgical specimens demonstrated complete cortical penetration from endosteal vessels in the proximal and midsections of the radius. In the distal radius, surgical specimens demonstrated reduced perfusion volarly, however there continued to be perfusion of ink through intact dorsal and ulnar metaphyseal perforating arteries. Persistent vascular perfusion to the distal radius remains through intact endosteal vessels and metaphyseal perforators of extensive surgical soft-tissue stripping.

Aged, 80 and over↗

Complex Articular Fractures of the Distal Radius: Classification and Management.

Articular fractures of the distal radius require an anatomic reduction, as even minimal step-offs are associated with the development of osteoarthritis. Such fractures are classified on the basis of both the mechanism and the pattern of injury. The comprehensive classification of fractures established by Muller et al defines those occurring from a shearing mechanism and involving part of the articular surface as type B fractures. These are in turn subdivided into group B1 fractures, which involve the radial styloid (chauffeur's fracture); group B2, which involve the dorsal margin of the radius; and group B3, which involve the volar margin of the distal radius (Barton's fracture). Type B fractures are unstable and often require operative intervention. Articular fractures resulting from a compression force on the end of the radius are classified as type C. A group C1 fracture is a two-part fracture without metaphyseal comminution; group C2, a two-part fracture with metaphyseal comminution; group C3, a fracture with more than two pieces, with or without comminution. The operative tactic for compression fractures involves restoration of the four common fragments in sequence. This can often be accomplished by manipulative means alone or with limited exposure of the fracture fragments and stabilization with percutaneous Kirschner wires. Neutralization with an external fixator and use of an autogenous bone graft are often required.

Journal Article↗

Surgical treatment of nonarticular distal tibia fractures.

Distal tibia metaphyseal fractures can be difficult to manage. Treatment selection is influenced by the proximity of the fracture to the plafond, fracture displacement, comminution, and injury to the soft-tissue envelope. Nonsurgical management is possible for stable fractures with minimal shortening. Indications for intramedullary nailing have expanded to include distal metaphyseal tibia fractures. Intramedullary nailing allows atraumatic, closed stabilization while preserving the vascularity of the fracture site and integrity of the soft-tissue envelope. Intramedullary canal anatomy at this level prevents intimate contact between the nail and endosteum, however, and concerns have been raised regarding the biomechanical stability of fixation and risk of malunion. Plate fixation is effective in stabilizing distal tibia fractures. Conventional techniques involve extensive dissection and periosteal stripping, which increase the risk of soft-tissue complications. Percutaneous plating techniques use indirect reduction methods and allow stabilization of distal tibia fractures while preserving vascularity of the soft-tissue envelope. External fixation is effective in the setting of contaminated wounds or extensive soft-tissue injury. Careful preoperative planning with consideration for fracture pattern and soft-tissue condition helps guide implant selection and minimize postoperative complications.

Bone Nails↗

Juvenile rickets and hyperparathyroidism in the Arctic fox.

Three of seven Arctic fox kits, Alopex lagopus, trapped on St. Paul Island, Alaska, had evidence of rickets and hyperparathyroidism. Radiographic, morphologic and histologic examination confirmed the diagnosis. The disease was presumed to be a juvenile-onset disease due to calcium-deficient intake following weaning. The possibility of insufficient exposure to sunlight could not be determined. No other abnormalities (e.g., genitourinary) were found. Skeletal involvement was quite varied. All growth plates exhibited columnar hyperplasia compatible with rickets, while the metaphyses showed decreased trabeculation and cortical thinning compatible with osteodystrophia fibrosa. One fox had bilateral metaphyseal fractures through this osteodystrophic bone.

Alaska↗

[Differential diagnosis of giant cell tumor of bone].

Osteoclast-like giant cells (GC) may dominate the histologic pattern not only in conventional giant-cell tumor (GCT)--originating as a radiologically pure lytic, possibly trabeculated lesion especially within the epiphyses of long tubular bones (LB) and pelvic bones of adults--but also in many tumor-like lesions as well as in various benign and malignant bone tumors which may simulate each other. Although the mononuclear cells as well as the amount of collagene fibres don't differ significantly, these lesions can be distinguished by substantial differences concerning their site, radiomorphology and the patients age. The unique lesion which can be recognized by histology only is chondroblastoma--centered in epiphyseal regions as GCT, mostly in the 2nd decade--by its typical mononuclear cells independently of the typical chondroid matrix and calcifications. The brown tumor of hyperparathyreoidism is associated with elevated serum Ca and parathormon, which is not altered in the histologically identical giant cell granuloma. In contrast to GCT aneurysmal bone cyst prefers the metaphyseal area of LB and the posterior parts of vertebras in the 2nd decade. Metaphyseal fibrous defects occurring during growth period leave the epiphyses unaffected and display typical x-rays. Villondoular synovitis sometimes can produce osteolytic defects. GC-rich malignant tumors which present with clear cut atypia except some cases of GC-variants of osteosarcoma, are: Giant-cell rich osteosarcoma, the rare malignant GCT, giant-cell ("osteoclastic") sarcoma, MFH and GC-rich metastases of carcinomas. All of them occur in middle aged and older patients except osteosarcoma and don't affect the epiphyses primarily except malignant GCT. To avoid confusion in GC-lesions it is conditio sine qua non to take into account for diagnosis not only histology but especially radiomorphology as well as site of the lesion and patients age.

Bone Diseases↗

Why we should not legalize euthanasia. The foundational ethical principle obliging us to protect life must be translated into a concrete norm.

The euthanasia debate is really the backdrop for a discussion within our society about the very nature of human life and meaning. Because the origin of life is in God, human beings do not have dominion over life but are stewards of life. The powerful combination of sanctity and stewardship is expressed in the foundational ethical principle. This principle says that no person has the right to directly take innocent human life and in fact there is a positive obligation to nurture and protect life. In our secular society there is a need to develop a "natural" metaphysic of sacredness. Such a metaphysic can serve as bedrock from which a foundational principle can be developed and then applied in concrete moral norms. It can show that life contributes to the full dignity of the human person. For this perspective to be effective in countering the movement to legalize euthanasia, this sense of integral wholeness of human personhood must be demonstrated in a convincing manner. It can be because a dualistic philosophical bias has been found wanting by Western culture. We must arrive at what ethicists would call concrete norms that guide individual choices. At issue is how we translate our foundational principle--Do not directly attack innocent human life--into a concrete norm when confronted with the possibility of death. Some persons question whether the concrete norm opposing euthanasia should be a matter of public morality. To answer this question, we must turn to our foundational principle.(ABSTRACT TRUNCATED AT 250 WORDS)

Catholicism↗

Effect of intermittent three-month treatment with different doses of Ukrain on subregional femoral bone mineral density of sexually mature female rats.

Sexually mature but still growing female Wistar rats received i.p. injections of Ukrain (7, 14 or 28 mg/kg in a volume of 0.5 ml/100g) every other day for 10 days, followed by a 10-day break, and this procedure was performed five times. The control animals received the same volume of injected water. At the end of the experiment the rat right femora were harvested and the bone densitometric parameters of the entire bone, distal metaphyseal and basicervical subregions were assessed using the dual-energy X-ray absorptiometry (DXA) densitometric method. No significant changes were observed in the bone mineral density in experimental groups in comparison with control animals that received the vehicle. A slight decrease in the bone mineral content value was observed in the distal metaphyseal region in animals that were treated with the highest dose of Ukrain.

Alkaloids↗

Fracture separation of the distal humeral epiphysis in children younger than three years old.

This study evaluated the change of carrying angle and the causes of cubitus varus after the fracture separation of the distal humeral epiphysis in young children. Twelve cases of fracture separation of distal humeral epiphysis were treated from January 1995 to July 1997. The age of all patients was younger than 3 years old. A metaphyseal fragment was seen in all cases (Salter-Harris type II), but the size of the metaphyseal fragment was either a very small flake or a large Thurston-Holland fragment. Posteromedial displacement was seen in all cases. There were three treatment groups: closed reduction with percutaneous pinning, closed reduction with cast, and cast without reduction. Follow-up period averaged 23.5 months (range, 12-40). Cubitus varus deformity was seen in seven cases, and six of them had a partial defect of the medial condyle that was avascular necrosis. The methods of treatment, age of injury, and the type of epiphyseal injury had no influence on the development of cubitus varus, but avascular necrosis of the medial condyle was related to the cubitus varus deformity (p<0.05). The results of this study suggest that fracture separation of distal humeral epiphysis in young children is likely to produce cubitus varus deformity with the development of avascular necrosis of the medial humeral condyle.

Casts, Surgical↗