[Proliferative activity of paravasal connective tissue cells in the age aspect.]

The aim of the study was to investigate the age-related variability of the proliferative activity of fibroblasts of the paravasal connective tissue of the hollow and parenchymal organs of men corpses of the first period of mature age, elderly and senile age by detecting the expression of the Ki-67 protein (MIB-1 clone) and calculating the proliferation index. The results showed that in the first period of mature age, the proliferation index is almost at the same level in the paravasal tissue cells of the parenchymal and hollow organs of the digestive tract, while the fibroblasts of the paravasal tissue of the heart have the lowest proliferation activity among all the organs studied. With age, the intensity of cell proliferation decreases, moreover, at the age of more than 75 years, a distinct organ specificity is revealed. In cells of the paravasal tissue of parenchymal organs, proliferation index is characterized by minimal values among all studied organs. The cells of the paravasal tissue of hollow organs retain significantly greater proliferative activity in the senile, which is almost twice as large as the same parameter of the parenchymatous organs in this age group.

[Age changes in connective tissue structures of the stomach.]

The study of paravasal connective tissue of the stomach was carried out on the preparations of 80 men corpses of three age groups: the first period of adulthood (n=20), the elderly (n=30) and senile (n=30) ages. With the help of standard histological and histochemical methods, the features of the age-related variability of the fiber composition were established; the level of apoptosis and proliferation in fibroblasts has been investigated with the help of immunohistochemical methods. The regularities of the structural organization of the paravasal connective tissue of the stomach during the period of biological stability (the first period of adulthood), as well as its age transformations at the stages of postnatal ontogeny (in the older age groups), were revealed.

[Age-related changes Kernogan`s index of venous vessels hollow and parenchymatous organs at stages of a postnatal ontogenesis].

Kernogan`s index determination of hollow and parenchymatous organs' venous vessels was conducted on 80 men corpses of the three age groups. Average age of the investigated men corpses of the mature period is 27,8±4,2 years, elderly - 67,8±3,7 years, senile - 81,9±4,5 years. The age variability transformation of venous vessels bandwidth of lungs, kidneys, heart, stomach and ileum were obligate. It was revealed that the Kernogan`s index of venous vessels changes can be equally detected at different age periods. While, with the obsolence, there is a gradual indicator's decline, which is mostly discerned in parenchymatous organs, while for the hollow organs transformations are less essentic.

Reliability after repeated use of a torque screwdriver employed for halo pin fixation.

It has been recommended that halo torque screwdrivers be used only once. To determine if this advice is justified on biomechanical grounds, five commercially available torque screwdrivers were cycled 1,600 times each in an Instron testing machine over a 7-day period. The screwdrivers displayed an initial error from the dial reading at both 6 and 10 in-lb of only +/- 0.3 in-lb. After cyclic loading and retesting, the percent deviation from original calibration was 8% at both 6 and 10 in-lb. These data demonstrate the accuracy and dependability of the torque screwdrivers and imply that repeated use of these devices should be safe.

Complications with use of the Stryker frame.

Roentgenograms were made of two patients with acute dislocations of the cervical spine who were undergoing treatment on Stryker frames with cervical traction. Losses of reduction were evident when the patients were turned from the supine to the prone position. The pulmonary vital capacity of patients with complete traumatic quadriplegia consistently decreased when they were turned to the prone position. Prolonged supine positioning of patients on the Stryker frame also caused occipital decubitus ulcers.

Heterotopic ossification around the hip in spinal cord-injured patients. A long-term follow-up study.

Twenty patients with spinal cord injury complicated by ossification around the hip were followed for eighteen months or more. The bone scan, roentgenogram, level of alkaline phosphatase, and range of hip motion of each patient were analyzed. The average follow-up was forty months. The heterotopic ossification usually did not mature until after one and one-half years. The roentgenograms were of no value in judging its maturity. The bone scan correlated well with the results of the alkaline phosphatase testing in judging maturity of the ossification. We concluded that before operative resection, a patient should have a normal level of alkaline phosphatase, decreasing activity on the bone scans, and a restriction of motion to less than 50 degrees of hip flexion.

Subdural abscess associated with halo-pin traction.

Osteomyelitis and intracranial abscess are among the most serious complications that have been reported in association with the use of the halo device. The cases of five patients who had formation of an intracranial abscess related to the use of a halo cervical immobilizer are described. All of the infections resolved after drainage of the abscess, débridement, and parenteral administration of antibiotics. Meticulous care of the pin sites is essential to avoid this serious complication. Additionally, since all of the infections were associated with prolonged halo-skeletal traction, this technique should be used with caution and with an awareness of the possible increased risks of pin-site infection and of formation of a subdural abscess.

Treatment of unreduced traumatic posterior dislocations of the hip.

A study was made of thirty-nine traumatic posterior dislocations of the hip that had remained unreduced for from three days to nine years. The purpose of the review was to compare the results of closed and open reduction with those of primary reconstructive surgery. Three of the twenty hips that had closed or open reduction had good results as compared with ten of the thirteen hips that had primary reconstructive surgery. Six hips that were left dislocated had uniformly poor results.

Complications in the use of the halo fixation device.

The medical records of 179 patients were reviewed to identify complications related to the use of the halo external skeletal-fixation device. The complications that were identified included pin-loosening in 36 per cent of the patients, pin-site infection in 20 per cent, pressure sores under either a plastic vest or a plaster cast in 11 per cent, nerve injury in 2 per cent, dural penetration in 1 per cent, dysphagia in 2 per cent, cosmetically disfiguring scars in 9 per cent, and severe pin discomfort in 18 per cent. One hundred and eighty (25 per cent) of the 716 pins used had become loose at least once, and an infection had developed at sixty-seven pin sites (9 per cent). Two-thirds of the pins that were loose or associated with infection required change or removal. These complication rates, particularly of pin-loosening and infection, are exceedingly high. Attention to details in pin application, pin maintenance, and proper pin-site care may minimize the number of complications.

Evolution of treatment of paralytic scoliosis at Rancho Los Amigos Hospital.

Between 1954 and 1970, 351 patients with severe paralytic scoliosis were treated at Rancho Los Amigos Hospital. During this time the treatment evolved through five stages: body cast alone, halo cast, halo cast with buttons and traction wires, Harrington instrumentation, and finally preoperative halo-femoral traction and Harrington instrumentation. Coincident with this evolution, correction improved from 20 to 57 per cent, the incidence of curve progression dropped from 38 to 0 per cent, and curve extension decreased from 25 to 0 per cent, while postoperative recumbency was reduced from one year to about three weeks. In addition, complications changed, in general decreasing except for the rate of pseudarthrosis, which remained essentially the same. Clinically significant hyperlordosis involving the thoracic and lumbar spine was seen in sixteen patients who had long fusions from the fourth cervical vertebra and above to the fourth lumbar vertebra or the sacrum.

The halo vest: an evaluation of motion and forces across the neck.

Flexion-extension motion and compression-distraction forces across the cervical spine were evaluated in 6 patients in halo vests and in 1 patient in a halo cast. Motion in the vest was evaluated in supine and upright positions and averaged 31% of normal motion at the levels tested. Compression-distraction forces showed great individual variation and frequent compression. The average distraction force varied in different positions by nearly 20 pounds in the vest and over 30 pounds in the cast. Methods of improving cervical spine stability in halo orthoses are discussed.

Cervical spine injuries resulting from water sports.

A retrospective review of 152 cases of cervical spine injury suffered in water sport-related accidents is presented. Water sport accidents were the second most common cause of traumatic quadriplegia among patients treated on the Spinal Injury Service at Rancho Los Amigos Hospital. The mechanics of injury in 80% of the cases involved flexion and/or axial loading forces. A fracture of the body of C5 was seen in two thirds of the cases. The ratio of complete to incomplete cord lesions was approximately 1:1, with anterior cord syndrome being the most commonly observed. Various risk factors are identified.

Clinical review of the early stability of spine injuries.

One hundred fifteen cervical fractures, 51 thoracic and lumbar major fractures, 214 compression fractures, and 34 transverse process fractures from Los Angeles County-University of Southern California Medical Center and Rancho Los Amigos Hospital were reviewed. Epidemiology, fracture type, and early results of treatment in terms of musculoskeletal and neurologic stability were studied. Flexion-rotation fractures of the cervical, thoracic, and lumbar spine showed significant loss of reduction when not treated with operative internal fixation. Operative intervention did not influence the neurologic outcome. Laminectomy resulted in progressive deformity and a significantly increased incidence of second operations. Epidemiology indicated changing patterns of fracture.

Osteology of the skull as it affects halo pin placement.

Twenty-seven cadaver skulls and 20 CT scans of skulls were measured above the orbital rim and ear but below the greatest diameter to determine optimal placement of halo pin sites. At the antero- and posterolateral portions of the calvaria, the outer table averaged 2 mm, the diploe 3 mm, and the inner table 2 mm. At the temporal fossa, the outer cortex averaged 1.7 mm, the diploe 2.0 mm, and the inner table 1.6 mm. Average distance between the anterior edge of the temporal fossa and the frontal sinus approximated 3 cm. These data confirm previously recommended halo pin insertion sites, anterolaterally and posterolaterally, where the bone is thickest and the thinner frontal sinus and temporal fossae are avoided.

Gait parameters following stroke: a practical assessment.

Mechanical methods of quantifying gait are more sensitive to change than is direct clinical inspection. To assess gait parameters and patterns of patients with stroke, and the temporal changes of these parameters, a foot-switch gait analyzer was used to test 49 ambulatory patients with stroke and 24 controls. Patients walked significantly slower than controls, with decreased cadence, increased gait cycle, and increased time in double limb support. Patients' hemiplegic limbs spent more time in swing and stance when compared to controls; their unaffected limbs spent significantly more time in stance and single limb support compared to controls. Patients' hemiplegic side, when compared with the unaffected side, spent less time in stance and more time in swing. A flatfoot pattern was typically noted on the affected side. General gait parameters improved over time, with the largest changes occurring in the first 12 months. However, the percentage of time spent in double and single limb support, stance and swing, parameters which describe the asymmetrical pattern of gait, did not change over time. Abnormal gait was due to difficulty in moving the body over an unstable limb. Gait analysis can be of importance in documenting abnormalities and determining the effects of therapeutic modalities.

Rancho flotation bed.

The Rancho Flotation Bed provides hydrostatic support with maximum pressures over bony prominences of 15 to 25 mm Hg (measured with a pneumatic pressure transducer). This is generally below the levels normally quoted as conducive to the development of ischaemia. Clinical experience has shown the bed to be a successful aid to nursing by eliminating the need to turn the patients for pressure reasons, allowing patients with pressure sores to remain in a position which is more comfortable and more suitable for other nursing care. It also makes it easier for nurses to handle patients in order to care for the pressure sores.