Plasma profile of follicle-stimulating hormone and sex steroid hormones after a single epidural administration of follicle-stimulating hormone via caudal vertebrae in Holstein dry cows.

The conventional follicle-stimulating hormone (FSH) treatment for bovine superstimulation involves multiple intramuscular injections, which is stressful for animals and onerous. We herein investigated whether a single epidural injection of porcine FSH (pFSH) can induce superovulation and peripheral concentrations of pFSH and steroid hormones after the treatment in Holstein dry cows. We intramuscularly administered pFSH twice daily to three cows for 3 days (control) or a single epidural pFSH administration (epidural). Numbers of follicles (≥10 mm in diameter) at estrus and corpora lutea at luteal phase were counted by ultrasonography. Blood was sampled from 0 to 104 h after the first pFSH administration and plasma pFSH, progesterone, androstenedione, testosterone, and estradiol-17ß concentrations were measured. Numbers of follicles (control: 18.3 ± 7.5, epidural: 15.7 ± 4.0; mean ± SD) and corpora lutea (control: 7.3 ± 4.2, epidural: 8.0 ± 2.6) were similar between both treatments. Plasma pFSH concentrations were higher in epidural than in control (p < 0.01). Although no significant differences were observed in progesterone, androstenedione, or estradiol-17ß concentrations between the groups, testosterone concentrations were slightly lower with the epidural treatment than with the control treatment (p = 0.08). In conclusion, superovulation was induced by a single epidural injection of pFSH, which achieved higher pFSH level than the multiple injections in Holstein dry cows.

Polymethylmetacrylate Cement Augmentation of the Coccyx (Coccygeoplasty) for Fracture: A Case Report

Background: Coccydynia is a painful condition of the sacrococcygeal region, with symptoms associated with sitting and rising from a seated position. It is frequently related to trauma and idiopathic causes, and the pain is mostly chronic. Percutaneous vertebroplasty and sacroplasty are the methods that are widely used for treating compression fractures and sacral insufficiency fractures, respectively. However, the success of polymethylmethacrylate injection in the treatment of osteoporotic coccyx fractures and coccydynia is still unknown. Case Report: A 68-year-old man was admitted to our clinic with complaints of pain in the sacrococcygeal and perianal regions. In the imaging studies, a fracture line in the fifth sacral and first coccygeal segments was observed as evidenced by a bony edema. Since the patient's pain did not improve with conservative methods, we treated him with coccygeoplasty. No complication was encountered. The day after the operation, he was discharged from the hospital with complete pain relief. The patient confirmed having no pain on the third postoperative month and so did not need any analgesics. Conclusion: Coccyceoplasty may be a good treatment option for retractable pain in patients with acute or subacute osteoporotic coccygeal fractures and coccydinia with edema.

Conus infarction after non-guided transcoccygeal ganglion impar block using particulate steroid for chronic coccydynia.

Introduction: Ganglion impar block (GIB) is a well-recognised treatment for chronic coccydynia. Several side effects have previously been described with this procedure, including transient motor dysfunction, bowel, bladder, and sexual dysfunction, neuritis, rectal perforation, impingement of the sciatic nerve, cauda equina syndrome, and infection. Case presentation: We describe the first report of imaging-documented conus infarction after an unguided-GIB performed in theatre using particulate steroids for a 17-year-old patient with coccydynia. Immediately post-GIB, patient developed transient neurological deficits in her lower limbs of inability to mobilise her legs that lasted for 24 h. These include back and leg pain, decreased power and movement, increased tone, brisk reflexes, reduced light touch sensation and proprioception of legs up to the T10 level. Urgent MRI spine showed intramedullary hyperintense signal within the conus and mild restricted diffusion on the distal cord and conus, suggestive of an acute conus infarction. On follow-up, the GIB did not result in symptom improvement of coccydynia and there was persistent altered sensation of her legs. Discussion: Various approaches of ganglion impar block have been described and performed in the past with different imaging techniques and injectants. A few cases of unusual neurological complications have been reported with the use of epidural steroid injections and ganglion impar block. Clinicians should be aware of the possible neurological complications following ganglion impar blocks and the risk of inadvertent intravascular injection of particulate steroids can potentially to be minimised by using imaging guidance.

Angiopoietin-1 receptor Tie2 distinguishes multipotent differentiation capability in bovine coccygeal nucleus pulposus cells.

BACKGROUND: The intervertebral disc (IVD) has limited self-healing potential and disc repair strategies require an appropriate cell source such as progenitor cells that could regenerate the damaged cells and tissues. The objective of this study was to identify nucleus pulposus-derived progenitor cells (NPPC) and examine their potential in regenerative medicine in vitro. METHODS: Nucleus pulposus cells (NPC) were obtained from 1-year-old bovine coccygeal discs by enzymatic digestion and were sorted for the angiopoietin-1 receptor Tie2. The obtained Tie2- and Tie2+ fractions of cells were differentiated into osteogenic, adipogenic, and chondrogenic lineages in vitro. Colony-forming units were prepared from both cell populations and the colonies formed were analyzed and quantified after 8 days of culture. In order to improve the preservation of the Tie2+ phenotype of NPPC in monolayer cultures, we tested a selection of growth factors known to have stimulating effects, cocultured NPPC with IVD tissue, and exposed them to hypoxic conditions (2 % O2). RESULTS: After 3 weeks of differentiation culture, only the NPC that were positive for Tie2 were able to differentiate into osteocytes, adipocytes, and chondrocytes as characterized by calcium deposition (p < 0.0001), fat droplet formation (p < 0.0001), and glycosaminoglycan content (p = 0.0095 vs. Tie2- NPC), respectively. Sorted Tie2- and Tie2+ subpopulations of cells both formed colonies; however, the colonies formed from Tie2+ cells were spheroid in shape, whereas those from Tie2- cells were spread and fibroblastic. In addition, Tie2+ cells formed more colonies in 3D culture (p = 0.011) than Tie2- cells. During expansion, a fast decline in the fraction of Tie2+ cells was observed (p < 0.0001), which was partially reversed by low oxygen concentration (p = 0.0068) and supplementation of the culture with fibroblast growth factor 2 (FGF2) (p < 0.0001). CONCLUSIONS: Our results showed that the bovine nucleus pulposus contains NPPC that are Tie2+. These cells fulfilled formally progenitor criteria that were maintained in subsequent monolayer culture for up to 7 days by addition of FGF2 or hypoxic conditions. We propose that the nucleus pulposus represents a niche of precursor cells for regeneration of the IVD.

Efficacy of fluoroscopically guided steroid injections in the management of coccydynia.

BACKGROUND: Coccydynia is a rare but painful disorder characterized by axial coccygeal pain which is typically exacerbated by pressure. Management includes physical therapy/rectal manipulation, use of anti-inflammatory medications, modality use, coccygectomy, and fluoroscopically guided steroid injections. There are no studies documenting the efficacy of fluoroscopically guided coccygeal steroid injections in patients with coccydynia. METHODS: Retrospective chart review was used to collect data on 14 consecutive patients diagnosed with coccydynia who underwent a fluoroscopically guided coccygeal injection of 80 mg triamcinolone acetate and 2mg of 1% lidocaine over a 3-year period at a tertiary care academic medical center. RESULTS: Using stepwise logistic regression, acute pain was determined to be the best predictor of relief. Fisher's exact test showed that those patients with pain lasting less then 6 months were significantly more likely to have greater than 50% relief (P=0.055). Patients with chronic pain longer than 6 months were not found to have pain relief of >50% to any statistical significance, but every patient with acute pain showed improvement. CONCLUSION: Patients with acute pain (less then 6 months) are more likely to respond to fluoroscopically guided coccygeal steroid injections.

[Corticosteroid injection for coccygodynia]. / Injeksjonsbehandling ved halebeinssmerter.

BACKGROUND: Severe coccygodynia is often treated with coccygectomy. In Norway, conservative treatment is usually restricted to avoiding pressure on the painful area. We have used local injection with a mixture of corticosteroid and lidocaine in this condition. MATERIAL AND METHODS: We present 11 patients with coccygodynia treated with local injection. All patients were contacted by telephone three or more years later. RESULTS: At follow-up, one patient was asymptomatic, five patients had improved so much that further treatment was unnecessary, and in one patient the condition was unchanged. Four patients had been operated during the follow-up period. INTERPRETATION: Local injection of corticosteroid and lidocaine is a simple therapeutic option that should be tried before operation.

Role of nitric oxide and prostaglandins in mechanically induced bone formation.

We have previously shown that prostaglandins (PG) and nitric oxide (NO) are required in the induction of bone formation by mechanical stimulation. We therefore tested the ability of NO donors, S-nitroso-N-acetyl-D,L-penicillamine (SNAP), and S-nitroso-glutathione (GSNO) to mimic or augment the osteogenic response of bone to a minimal mechanical stimulus. In rats administered vehicle or the vasodilator hydralazine, stimulation of the 8th caudal vertebra increased bone formation. In animals treated with SNAP or GSNO, there was significant potentiation of this osteogenic response. The bone formation rate in nonloaded vertebrae was unaffected by administration of the NO donors. We also found that while inhibition of either PG or NO production at the time of loading caused a partial suppression of c-fos mRNA expression in the loaded vertebrae, administration of indomethacin and NG-monomethyl-L-arginine together markedly suppressed c-fos expression. This suggests that although both PG and NO are required in mechanically induced osteogenesis, they appear to be generated largely independently of each other. Moreover, while exogenous NO potentiates the stimulatory effect of mechanical loading on bone formation, the lack of effect in nonloaded vertebrae suggests that NO is necessary but not sufficient for induction of bone formation.

The effect of immunosympathectomy and of 6-hydroxydopamine on the responses of the rat anococcygeus to nerve stimulation and to some drugs.

1. The rat anococcygeus muscle possesses a dense motor adrenergic innervation and also a powerful inhibitory innervation whose transmitter is unknown. The possibility that the adrenergic nerves released both noradrenaline and the unknown inhibitory transmitter was investigated by destroying the adrenergic nerves either by immunosympathectomy or by 6-hydroxydopamine.2. Immunosympathectomy was only partially effective in destroying the adrenergic neurones to the anococcygeus. 6-Hydroxydopamine destroyed the terminal adrenergic varicosities abolishing almost completely the motor response. Neither treatment affected the inhibitory response.3. 6-Hydroxydopamine induced a specific hypersensitivity of the muscle to noradrenaline which was not shared with carbachol.4. The maximum tension response of the anococcygeus muscle was greater in the male than in the female probably because the muscle is bigger.