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PubMed2000

Development of the innervation of long bones: expression of the growth-associated protein 43.

It has been known from clinical and experimental observations that the peripheral nervous system is involved in the development of long bones. Expression of growth-associated protein 43 (GAP-43/B-50) was found in axonal growth cones during embryonic and postnatal ontogeny as well as in regenerating axons after nerve injury. The aim of the present study was to examine the occurrence of growing nerve fibers in rat tibia from gestational day 16 (GD 16) to postnatal day 28 (PD28). An indirect immunoenzymatic reaction using antibodies raised against GAP-43 was applied to detect outgrowing nerve fibers penetrating into the developing bone. On GD 16 and GD 17 no GAP-43-immunoreactive (IR) fibers were observed in the close vicinity of bone rudiments. On GD19 GAP-43-IR fibers were scarcely present within the periosteum of the central portion of the diaphysis. In the perichondrium surrounding the proximal epiphysis, nerve fibers were first detected around birth. From PD1 onward, numerous fibers were seen in the fibrous buds of the perichondrium at the epi-metaphyseal junction (Ranvier's grooves), some of them being adjacent to the blood vessels. Nerve fibers penetrating into the bone and located in the bone marrow, predominantly associated with blood vessels, were first observed on GD21 and their number increased with further development. They were initially located in the central portion of the diaphysis and later extended towards the metaphyses. On PD4 an increased number of GAP-43-IR fibers appeared in the perichondrium of proximal and distal epiphyses. In the fibrous strands penetrating into the epiphyses and in the secondary ossification centers, nerve fibers were first observed on PD10. From PD14 onward the pattern of tibial innervation remained unchanged but the intensity of GAP-43 immunostaining visibly decreased. The present study demonstrates that developing long bones of rat hindlimbs are supplied by growing nerve fibers immunoreactive for GAP-43 from GD 19 onward. Time and location of their appearance were at least partially correlated with known events taking place during long bone development, e.g. formation of primary and secondary ossification centers. Decreased expression of GAP-43 immunoreactivity in later developmental stages is believed to reflect nerve fiber maturation.

Aging↗

PubMed2000

[Mini-invasive osteosynthesis in injuries of the metacarpal bones in children].

Injuries of the metacarpal bones in child and adolescent age are much less frequent than in adult age. Most frequently the IVth and Vth metacarpal bone are affected where paradoxically in the distal area metaphyseal fractures predominate over injuries of the physes. During the period between 1994-1998 on account of this injury in our department a total of 11 patients were treated by the method of miniinvasive osteosynthesis. In 7 instances treatment by means of a Kirschner wire was used in injuries of the base of the 1st metacarpal bone, incl. four cases where a physeal separation of the Salter-Harris II type was involved, once a physeal fracture of the Salter-Harris III type and twice a metaphyseal injury. In four patients the subcapital fracture of the metacarpal bone was transfixed. In all instances one implant was used. A total of 11 excellent results were recorded. In one injury of the 1st metacarpal bone slight restriction of movements in the metacarpophalangeal joint occurred. Miniinvasive osteosynthesis, if indicated, is a reliable and simple method with excellent results. A thin Kirschner wire which should be always inserted, avoiding adjacent joints, is a satisfactory implant.

Adolescent↗

PubMedDate not supplied

Radiographic evaluation of bowed legs in children.

Radiographic screening is widely used to distinguish between Blount disease (infantile tibia vara) and physiologic bowing. Thirteen children with Blount disease, evaluated before 3 years of age, with initial radiographs showing no sign of Langenskiold changes, were compared with 50 children with physiologic bowing, also evaluated before 3 years of age with similar radiographic studies. Screening test accuracy was determined retrospectively for measurement of the mechanical axis, the tibial metaphyseal-diaphyseal angle (TDMA), and the epiphyseal-metaphyseal angle (EMA). A radiographic screening method combining the TMDA and the EMA, using cutoff values of 10 degrees and 20 degrees respectively, exhibited the best combination of sensitivity, specificity, and positive predictive value, correctly identifying all cases of Blount disease and 40 of 50 cases of physiologic bowing. Our data suggest that children between 1 and 3 years of age with TMDA <10 degrees, or TMDA > or =10 degrees and EMA < or =20 degrees, are at less risk for development of Blount disease. Children with TMDA > or =10 degrees and EMA >20 degrees are at greater risk for development of Blount disease and should be followed closely.

Child, Preschool↗

PubMedDate not supplied

Early radiographic differentiation of infantile tibia vara from physiologic bowing using the femoral-tibial ratio.

SUMMARY: The authors hypothesized that the ratio of the femoral to tibial metaphyseal-diaphyseal angles (femoral-tibial ratio [FTR]) more accurately differentiates physiologic bowing from infantile tibial vara than the tibial metaphyseal-diaphyseal angle (TMDA). The purpose of this study was threefold: to determine the false-negative and false-positive error rate of the FTR and TMDA; to determine to the effect of rotation on the FTR and TMDA; and to determine the reliability of the FTR and TMDA measurements. An FTR < 1 resulted in a false-negative error rate of 10% and a false-positive error rate of 7%, whereas a TMDA > 13 degrees resulted in a false-negative error rate of 23% and a false-positive error rate of 10%. The difference between internal and external rotation was not significant for the FTR, whereas it was for the TMDA. The FTR was found to have good interobserver and intraobserver reliability (0.78 and 0.98, respectively).

Age Factors↗

PubMed1995

Theory of colors according to ancient Indians.

The theory of colors according to the ancient Indians was rooted clear and comprehensively in the Sankhya-Patanjali system. As was known then, the theory was essentially metaphysical in concept and based on then prevalent basics of natural philosophy. What appears striking is that there has been a total failure to understand the role of the eye in the different perceptions. The attempt cannot also be summarily dismissed as it runs parallel to information processing approach in the metaphysical plane.

Color Perception↗

PubMed1994

[Samuel Hahnemann: a mystical empiricist. A study of the origin and development of the homeopathic medical system].

Homeopathy is the product of the time of its birth and systematization and its founder's cultural background. From the beginning, homeopathy looked in two directions at the same time. On the one hand, it looked towards scientific enquiry and empirical proof and, on the other, towards religion, metaphysics and mysticism. The origin of this lies in the double orientation of Hahnemann's work: while affirming a rational system of therapeutics based on observation, he also developed a metaphysical theory of illness as well as of the action of medicines.

Germany↗

PubMed2000

Epigenesis of the monstrous form and preformistic 'genetics' (Lemery - Winslow - Haller).

The present essay analyzes an eighteenth-century phase of the querelle des monstres and highlights two main points. 1) As the cases of Lemery and Winslow demonstrate, in the period when preformation was the dominant view, the dispute over the origin of monsters carried into the very field of preformation the contrast which had originally opposed it to the now defeated model of epigenesis, namely the alternative between mechanical genesis and pre-existence of the monstrous form itself. 2) One of the most important episodes in the shift of teratology from a primarily theological or metaphysical issue to a purely natural one was due to Albrecht von Haller. Haller shifted the dispute from anatomy to embryology, and it is on an embryological base and not on metaphysics that he built his own demonstration of the original nature of the monster. He was furthermore the only scientist of authority who dealt with teratology from an epigenetic standpoint. His numerous changes of view in the field of embryology did in fact never affect his early adherence to the thesis of original monstrosity.

Congenital Abnormalities↗

PubMedDate not supplied

[Andreas Dudith's thoughts on medicine].

The author analyses the scientific, first of all medical conceptions of András Dudith, the Hungarian humanist of the 16th century. His attitude to medicine is reconstructed from his wide-ranging correspondence. It is pointed out that without taking into consideration the metaphysical notions of Dudith, his views on epidemiology cannot be discussed. His epistemological considerations and value orientation deduced from his metaphysical notions give the key to the author to explore the relation of Dudith to natural sciences and medicine, and to make statements concerning his religion as well. The author demonstrates that in Dudith's opinion the world could be described as a chain of causes conceived as one-direction influence. In order to avoid infinite regression, he separated three spheres of causes and effects, out of which it is the sphere of immediate causes where medicine has reason for existence. Dudith's epidemiological views are based on his causal conceptions and are free of any irrational element in spite of the fact that they took shape in a speculative way. He held the view that the cause of plague is infection, in opposition to the general belief attributing plague to the effect of infected air. Dudith considered the sporadic cases and the epidemic form of plague identical diseases. He possessed several empirical facts concerning the way of spreading from man to man, which solved the problem of two kinds of occurrence and made it possible for him to set up a chain of causation. The cause is the infection (rot), the effect is the disease, which is the cause of the epidemic. Dudith elucidated medical problems on a conceptual basis, consistently increasing the level of abstraction, then, after determining the gaps in knowledge, he raised new questions and tried to answer them on an empirical ground to be able to apply the same method again. ...

Epidemiology↗

PubMed1999

Thomas Henry Huxley and neuroscience.

In the latter decades of the nineteenth century Thomas Henry Huxley was at the heart of British Science: President of the British Association for the Advancement of Science (1870), President of the Royal Society (1883-86), Chairman of innumerable committees. His thought in many ways characterises the spirit of the 'high' Victorian age in Britain. He was not only the most eminent academic biologist of his time but also deeply interested in philosophical issues. His re-examination of the evolution of the brain in response to Richard Owen's 'telenomic' views formed the kernel of the notorious debate at the 1860 meeting of the British Association in Oxford. From his early youth until old age he thought long and hard about the mind/body problem. This paper follows the development of his ideas and shows how in debate with many of the leading thinkers of his age, in the X-club and the Metaphysical Society, he struggled to develop a biologically-based account of the relationship between mind and brain. However, at the end, he seems to have recognized that his position was not entirely satisfactory and ultimately famously confessing himself 'agnostic' turned from metaphysics to devote himself to more practical issues. The unresolved problems of mind and brain which perplexed Huxley remain to torment his epigoni.

History, 19th Century↗

PubMedDate not supplied

Partial sleeve fractures of the tibia in children: an unusual fracture pattern.

Sleeve avulsion fractures of the patella are a well-recognized fracture pattern in children. Less appreciated is a similar fracture pattern involving the anterior metaphyseal area of the tibia. These metaphyseal sleeve fractures represent a fracture pattern characterized by the avulsion of a large area of periosteal attachment of the patellar tendon associated with small subchondral fragments of bone, encountered in skeletally immature children secondary to contraction of the quadriceps associated with forced knee flexion. Although an avulsion fracture of the tibial tubercle is the usual result of this type of trauma, partial sleeve avulsion fractures of the tibial apophysis and adjacent metaphysis occasionally occur and have not been adequately described. It was the authors' purpose to describe their experience with this fracture pattern. Since 1998, three boys have presented to a major pediatric trauma center with a partial sleeve fracture of the tibia. The average age was 13 years 6 months (range 10 years 3 months to 15 years 3 months). Follow-up ranged from 1 year 5 months to 2 years 3 months, with an average of 1 year 9 months. All three boys were treated with open reduction and internal fixation with small cancellous screws and postoperative plaster immobilization. At the time of most recent follow-up, each child showed full range of knee motion and had returned to all sports activities.

Adolescent↗

PubMed2002

Refracture rate after plate removal from the radial metaphysis.

OBJECTIVES: To document the refracture rate after removal of internal fixation at the metaphyseal region of the distal radius and to compare this rate to that associated with diaphyseal plate removal reported in the literature. DESIGN: A chart review with telephone follow-up. SETTING: Three tertiary care hospitals (in Ottawa, Burlington, Vt., and London, Ont.). PATIENTS: Fifty-three patients (54 radii) underwent elective removal of internal fixation of the distal radius after distal metaphyseal procedures. The mean follow-up was 46.8 months. MAIN OUTCOME MEASURE: The refracture rate. RESULTS: No refractures were reported after plate removal, and the overall complication rate was minimal. CONCLUSIONS: The refracture rate at the metaphvsis of the radius after plate removal is lower than the rate after diaphyseal plate removal reported in the literature.

Adult↗

PubMed2001

[Complex fractures of the proximal end of the radius and ulna in adults: a retrospective study of 38 cases].

PURPOSE OF THE STUDY: Complex lesions of the proximal end of the radius and ulna are uncommon and generally associate a fracture of the proximal ulna and a dislocation of the radial head, which also may be fractured. We assessed the effect of the type of fracture and treatment on functional outcome and complications. MATERIAL AND METHODS: Thirty-eight adults (25 men and 13 women) were treated for complex fractures of the proximal end of the radius and ulna. For 25 of them, mean follow-up was 2.4 years. For the ulna, there was an epiphyseal fracture in 10 cases, a metaphyseal-epiphyseal fracture in 16 and a diaphyseal fracture in 12. The coronoid process was fractured in 20 cases and the proximal radius in 19. There was an anterior displacement in 24 cases. There were 9 open fractures and 13 patients had another injury of the upper limb. Functional outcome was assessed with a 100 point scale using subjective (pain) and objective (active motion, muscle force, stability) criteria. RESULTS: For the 25 fractures with more than 1 year follow-up, outcome was very good in 8, good in 6, fair in 8 and poor in 3. The pain and muscle force scores followed a similar pattern. Motion appeared as the determining factor for good outcome. Seven early revisions (2 for deep infections, 2 for disassembly of the fixation system, 3 for insufficient fixation) were required among the 38 patients. Among the late complications, there were 3 nonunions, 5 misalignments, and 4 proximal radio-ulnar synostoses. Six elbows required revision to restore motion. DISCUSSION: Certain characteristics of the fractures were predictive of poor outcome: skin opening, association with a lesion of the homolateral upper limb, mirror lesion of the lateral condyle, metaphyseal-epiphyseal fractures, communitive fractures, presence of a fracture of the radial head or the coronoid process. CONCLUSION: Complex proximal fractures of both bones of the forearm threaten the functional prognosis of the upper limb due to the risk of stiffness. Successful treatment depends on three factors: stable anatomic reconstruction of the ulnar articulation, and reconstruction of the lateral column and the coronoid process, necessary for a stable elbow. In addition, early mobilization, possible with a stable osteosynthesis, is indispensable for recovering useful joint movement.

Adolescent↗

PubMed1975

[Formation of the skeleton. VIII. Growth of a long bone: periostealization of the metaphysial bone].

The growth of the diaphysis of a long bone is manifested in three distinct constituent parts: the bone periosteal collar and, at both ends, the two metaphyses. These grow on the epiphyseal plate side and at the other end, they are integrated into the periosteal bone collar. This integration involves changes in the periosteal bone as well as in the fibro-cellular-layer which surrounds it. All these modifications have been described as constitutuing "the periostealisation of metaphyseal bone".

Animals↗

PubMed2002

[Internal fixation of proximal humerus fracture by "palm tree" pinning].

PURPOSE OF THE STUDY: Fractures of the proximal humerus are increasingly frequent. Conservative treatment is most often proposed, but surgery must be performed when the displacement is significant and/or when the fracture is unstable. Osteoporosois and comminution are two essential elements for deciding on the surgical technique. MATERIAL AND METHODS: This retrospective study included 31 patients who underwent pinning from the deltoid V according to the Kapandji procedure. There were 19 females and 12 males. Mean age was 61 years. There was a fracture of one of the tuberosities in 12 cases and significant metaphyseal comminution in 8. RESULTS: Mean follow-up was 26 months. Outcome was excellent or good in 22 cases (70.9%), fair in 4 (12.9%), and poor in 5 (16.2%). Fifteen complications were noted (48.4%): material displacement 8 cases, reflex sympathic dystrophy 3 cases, radial nerve palsy 2 cases, head osteonecrosis 1 case, and humeral fracture at the site of insertion of the K wires 1 case. DISCUSSION: At the present time, there is no consensus for the surgical management of fractures of the proximal humerus, including proximal metaphyseal fracture with or without fracture of one of the tuberosities. Closed reduction and pinning is not really an invasive procedure, and does not injure the rotator cuff. Surgical approach at the level of the deltoid V according to the Kapandji technique avoids elbow pain and stiffness. The procedure requires a fluoroscan and experience to obtain satisfactory divergence of the K wires in the humeral head, an essential technical point. This procedure cannot be recommended for elderly patients whose bone quality is too poor to obtain good fixation of the K wires.

Adolescent↗

PubMed1976

Bone lesions in early congenital syphilis.

A radiological study of bone changes in 112 children with congenital syphilis was undertaken. A similar number of normal children acted as a control group. Radiological examination of 5 syphilitic children showed that their bones were normal. Combined metaphyseal and periosteal lesions were the commonest bone disorders seen and are thus the most convincing radiological evidence of congenital syphilis. Transverse metaphyseal lucencies occur early in the disease, and with Wimburger's sign they are the prime evidence of pathology in syphilitic bone. Other radiographic changes are probably owing to minimal trauma in fragile disorganized bone. The occurrence of periosteal lesions alone has also been evaluated.

Bone Diseases↗

PubMed1975

The effects of small-bowel resection or bypass on the rat skeleton.

The bones of adult rats became progressively osteopenic 1 to 5 weeks following jejunoileal bypass or resection. These changes were accompanied by increased levels of metaphyseal enzyme activities as well as by loss of histochemically identifiable osteoid. Osteoid tissue and the ability to mineralize skeletal collagen were recovered more rapidly and fully in the resection group than in the bypass group. Metaphyseal alkaline phosphatase concentrations increased in both groups coincident with the elevated lysosomal enzymes levels, and the skeletons showed a calcium deficit (low Ca/HOPr ratio) within the first 3 weeks. In resected rats the osteopenia and bone blood chemistry were consistent with hyperparathyroidism secondary to impared Ca absorption. In bypassed rats the results suggest that the osteopenia might be related to the release of a "resorptive factor" from the excluded intestinal segment.

Acid Phosphatase↗

PubMed2003

The effects of osteoporosis on distraction osteogenesis: an experimental study in an ovariectomised rabbit model.

The effects of oestrogen deficiency-associated osteoporosis on callus distraction were investigated in rabbits. Twenty-four female New Zealand rabbits 5 to 6 months old were used. Ovariectomy was performed on 12 rabbits, which composed the osteoporotic model group. Six weeks later, osteotomy was carried out and Ilizarov external fixators were applied to the right proximal tibial metaphyses in both the osteoporotic model group and the control group. Beginning one week postosteotomy, the metaphyses were distracted 0.35 mm twice daily for 3 weeks, and the average length increase obtained for both groups was 17.2 mm (minimum: 16.8, maximum: 19 mm). Following a postdistraction waiting period of 6 weeks for newbone formation, the subjects were sacrified and specimens were examined histopathologically. Radiography was carried out at one-week intervals during the distraction period and at 2-week intervals during the waiting period, and scintigraphy was performed at the end of each period. On histopathologic examination, a significant difference in callus remodeling was observed between the control and osteoporotic model groups. On radiologic evaluation it was observed that, while both groups had inadequate callus tissue at the end of the waiting period, callus formation and remodeling occurred later in the model group than in the control group, and the new bone was more osteoporotic. Osteoporosis associated with estrogen deficiency adversely affects the outcome of callus distraction. Nonetheless, radiographic findings in rabbits indicate that the effects may not be so great as to preclude clinical procedures. It was concluded that these results should be supported with clinical studies.

Animals↗

PubMed2003

Hyena disease (premature physeal closure) in calves due to overdose of vitamins A, D3, E.

Holstein suckling calves on a farm manifested severe emaciation, generalized alopecia, dome-like cranial deformation, and high mortality (Case 1). Metaphyseal growth plates of the femur were achondroplastic; segmented, partially resorped, and replaced with immature bony trabeculae containing degenerated chondrocytes. The skull was thin and partially replaced with connective tissue. Diffuse and severe fatty degeneration was observed in the hepatic stellate (Ito') cells. After 6 mo, surviving calves manifested unthrifty with short and irregular hindquarters (Case 2). The metaphyseal growth plates were poorly formed, irregular, partially disappeared centrally, and often sealed with thin bony trabeculae. The cartilage matrix was not homogeneous but was finely fibrous, and chondrocytes were flat and degenerated. The bone lesion was diagnosed as chondrodysplasia due to premature physeal closure. These calves had been administered excessive amounts of vitamins A, D3 and E, and blood chemistry of acute case showed hypervitaminosis A and E. Case I demonstrated acute disease, while Case 2 demonstrated chronic sequelae. Hypervitaminosis A was the suspected cause.

Animals↗