The cervical spine of professional front-row rugby players: correlation between degenerative changes and symptoms.

BACKGROUND: Injuries to the cervical spine (C-spine) are among the most serious in rugby and are well documented. Front-row players are particularly at risk due to repetitive high-intensity collisions in the scrum. AIM: This study evaluates degenerative changes of the C-spine and associated symptomatology in front-row rugby players. MATERIALS AND METHODS: C-spine radiographs from 14 professional rugby players and controls were compared. Players averaged 23 years of playing competitive rugby. Two consultant radiologists performed a blind review of radiographs evaluating degeneration of disc spaces and apophyseal joints. Clinical status was assessed using a modified AAOS/NASS/COSS cervical spine outcomes questionnaire. RESULTS: Front-row rugby players exhibited significant radiographic evidence of C-spine degenerative changes compared to the non-rugby playing controls (P < 0.005). Despite these findings the rugby players did not exhibit increased symptoms. CONCLUSION: This highlights the radiologic degenerative changes of the C-spine of front-row rugby players. However, these changes do not manifest themselves clinically or affect activities of daily living.

Osteochondritis dissecans of the knee; long-term clinical outcome following arthroscopic debridement.

We reviewed 32 knees in 26 patients who had previously undergone arthroscopic debridement for symptomatic osteochondritis dissecans (OCD) of the knee. The patients were followed up at a minimum of 11 years following surgery and were evaluated clinically using the American Knee Society Clinical Rating Score. Additional evaluation was performed using the Hughston Scale to include radiographic assessment. The mean American Knee Society Score was 179 (out of 200), indicating good clinical function. Radiographically, however, only 29% scored excellent or good on the Hughston Scale. Younger patients with a small, stable (and therefore preserved), medial femoral condyle lesion had the best prognosis. Whilst more novel and complex options such as chondrocyte implantation are being assessed for the treatment of OCD, it is clear that within this study group careful debridement with removal of loose tissue can achieve good clinical results in the long term. There was however radiographic evidence of early degenerative joint disease in 17/24 (71%) of patients reviewed. Patients undergoing excision of OCD fragments did worse than those in whom the fragment was preserved, however the risk of further surgery is raised if a fragment is left in situ at initial surgery.

Enhancement of neutrophil chemotaxis and alteration of levels of cellular cyclic nucleotides by levamisole.

Levamisole, an antihelminthic agent reported to enhance nonspecifically various parameters of the immune response, was examined for its effect on chemotaxis of human neutrophils and on levels of cellular cyclic nucleotides. This agent was found, in most instances, to enhance chemotactic responses of neutrophils to a bacterial chemotactic factor derived from Escherichia coli. At similar concentrations, levamisole produced increases in levels of guanosine 3':5'-cyclic phosphate in neutrophils. In contrast, a decrease in concentrations of adenosine 3':5'-cyclic phosphate was observed when neutrophils were incubated with levamisole. Neutrophil chemotaxis, with and without the addition of levamisole, was assessed in 10 patients with recurrent infections. The illnesses of these patients included Job's syndrome, Wiskott-Aldrich syndrome, eczema with an increased level of IgE and recurrent abscesses, chronic mucocutaneous candidiasis, and diabetes mellitus. Levamisole significantly enhanced chemotaxis of polymorphonuclear leukocytes from these patients. Levamisole appears to have a profound effect on chemotactic responses of neutrophils which probably results from alterations in cellular cyclic nucleotide levels. Levamisole may prove to be useful therapeutically in certain patients with defective neutrophil chemotaxis.

Evaluation of nonspecific (alternative pathway) opsonic activity by neutrophil chemiluminescence.

The role of alternative complement pathway activation in protection against infection is not well understood. We have investigated nonspecific opsonic activity in human adult, term neonatal and premature serum using the technique of neutrophil chemiluminescence (cl) to measure particle uptake. Following phagocytosis, neutrophils become metabolically active, produce excited molecular oxygen and emit a burst of light which can be detected and quantitated in a liquid scintillation counter. In the present study, zymosan particles were preopsonized in human serum and added to control neutrophils. Particles opsonized in adult serum produced a marked peak in CL. Serial dilutions of the serum prior to opsonization yielded proportionally lower peaks in CL. Opsonic activity as measured by the CL procedure was completely blocked by the addition of chelating agents which remove calcium and magnesium ions and block both classic and alternative complement pathway activation. Addition of an excess of magnesium ions (needed for alternative pathway activation) to the reaction mixture partially restored the opsonic activity. Opsonic activity as measured by the CL procedure was significantly depressed in approximately two-thirds of term and premature infant sera tested. Deficient nonspecific opsonic activity was closely correlated with serum levels of C3PA. These studies suggest that the CL procedure may be of value in the investigation of nonspecific opsonins in human serum.

Severe staphylococcal disease associated with allergic manifestations, hyperimmunoglobulinemia E, and defective neutrophil chemotaxis.

Neutrophil granulocyte function was determined in three patients with systemic staphylococcal infection, clinical manifestations of generalized allergic disease, and hyperimmunoglobulinemia E. Each of the patients had urticarial skin rashes before or at the time of development of staphylococcal suppurative lymphadenitis, pneumonia, or sepsis. Neutrophil chemotaxis, random migration, phagocytosis, and bactericidal capacity were assessed to determine if an abnormality in these functions might have contributed to the development of severe staphylococcal infections. Each of the three patients with generalized urticaria was found to have a marked defect in neutrophil chemotaxis. The mean chemotactic index of the patients was 12 +/- 4, whereas that of 20 controls was 72 +/- 11. Neutrophil random migration, phagocytosis, and bactericidal capacity were normal in each patient. The serum or plasma of the patients did not inhibit chemotaxis of control neutrophils and did not contain an increased concentration of the chemotactic-factor inactivator found in normal serum. Treatment of the neutrophils of these three patients with the competitive histamine H2 receptor blocking agent, burimamide, produced a significant increase in chemotactic responsiveness. These studies suggest the possibility of pharmacologic modification of neutrophil granulocyte function.

Neutrophil chemotaxis during and after general anesthesia and operation.

The neutrophil granulocytes of 43 patients undergoing general anesthesia and operation were examined to determine if altered function occurs during these procedures. Neutrophil chemotaxis, random migration, and total and differential leukocyte counts were determined immediately before anesthesia; after 35 to 60 minutes of anesthesia but before operation; 60 minutes after initiation of operation; and 60 minutes after operation. Anesthetic agents included 1 to 3.5% enflurane, 0.5 to 2% halothane, or 0.5 to 1.1 mg/kg of morphine plus N2O-O2 (60:40). Neutrophil and total white blood cell counts were uninfluenced by any of the anesthetics; however, marked rises in both occurred during operation and persisted postoperatively after each of the anesthetic technics. Neutrophil chemotaxis was reduced an average of 36, 32, and 21%, respectively, by halothane, enflurane, and morphine before operation and 20, 10, and 5% intraoperatively. Preoperative reductions in chemotaxis were statistically significant after all anesthetics. However, only halothane produced a significant intraoperative reduction in chemotaxis. Postoperative neutrophil chemotaxis did not differ from control (preanesthesia) values after any of the anesthetics. Halothane and enflurane reduced leukocytic random migration before but not after operation. Morphine had no effect on random migration at any time. These data demonstrate that anesthesia impairs neutrophil function in man but that operation appears to reverse this depression.

Rapid specific identification of group D streptococci by counterimmunoelectrophoresis.

Clinical isolates of group D streptococci have been examined by counterimmunoelectrophoresis (CIE) to determine if this method might be of value in the rapid identification of the members of this group. Group D organisms identified by classical biochemical and serologic procedures were inoculated into Todd Hewitt broth and incubated at 37 degrees C. After 4 hours of incubation, free group D streptococcal antigen was detected in broth cultures from 70 of 70 group D enterococcal strains. Precipitin lines were readily visible immediately after electrophoresis in each case. In contrast, 10 nonenterococcal group D strains failed to produce detectable free group D antigen in the Todd Hewitt broth after 4, 24, or 48 hours incubation. Such antigen was detectable, however, after 48 hours incubation in Mueller Hinton broth containing 10 grams of glucose per liter. Representative strains of group A, C, G, and B streptococi, Streptococcus viridans and Streptococcus pneumoniae grown in Todd-Hewitt broth for 4 hours gave no precipitin lines when reacted against adsorbed monospecific group D antiserum. Group D antigen was also detected in broth cultures of direct swabs and in 18-hour blood culture broths. CIE appears to be a rapid and sensitive procedure for identification of the enterococcal strains of group D streptococci from clinical isolates.

Evaluation of a cytocentrifuge method for measuring neutrophil granulocyte chemotaxis.

An in vitro method for the assessment of neutrophil granulocyte chemotaxis employing a cytocentrifuge has been evaluated. The cytocentrifuge is used to directly sediment leukocytes on a Millipore filter, and thus (1) eliminates errors due to abnormal or unequal settling of the cells and (2) eliminates the need for serum, plasma, or albumin on the cell side of the chemotactic chamber to obtain optimal chemotaxis. In addition, other advantages of the method are that it requires smaller volumes of blood, less handling of the cells, and less time is required for visual counting of the neutrophils. The method has been utilized to assess chemotactic activity of neutrophils from 80 control subjects and over 100 patients with various diseases and to study the effects of various pharmacologic agents on neutrophil chemotactic responsiveness.

Modulation of human neutrophil chemotactic responses by cyclic 3',5'-guanosine monophosphate and cyclic 3',5'-adenosine monophosphate.

Cyclic 3',5'-guanosine monophosphate (cGMP) and cyclic 3',5'-adenosine monophosphate (cAMP) and compounds known to effect the intracellular concentrations of these nucleotides were examined for their ability to effect human neutrophil (PMN) responsiveness to chemotactic stimulation. Incubation of neutrophils with agents recognized to promote increases in intracellular cAMP in a variety of tissues (i.e., epinephrine, norepinephrine, isoproterenol, histamine, cholera toxin, and prostaglandin E-1 and E-2) or with cAMP inhibited the leukotactic response to a bacterial chemotactic factor. In contrast, cGMP and compounds which have been shown to promote increases in intracellular cGMP concentration (i.e., acetylcholine, carbamylcholine, phorbol myristate acetate, and prostaglindin F-2-alpha) markedly enhanced the neutrophil chemotactic response. The inhibitory or stimulatory influences on chemotactic responsiveness promoted by several of the agents could be shown to be blocked by a specific pharmacologic antagonist of the particular compound tested. These data support the hypothesis that cGMP and cAMP can provide opposing regulatory influences on certain cellular functions; in this case, directed motility of leukocytes.

Hyperactivity of neutrophil leukotactic responses during active bacterial infection.

To determine if changes in neutrophil leukocyte function occur during active bacterial infection, the neutrophils of 25 patients with active bacterial infection and 25 age-matched controls were compared for leukotactic activity, random mobility, and nitroblue tetrazolium reduction. The neutrophil leukocytes of patients with bacterial infection were hyperactive in unidirectional movement toward a chemotactic stimulus as measured in the leukotactic assay and usually had increased nitroblue tetrazolium reduction. The mean leukotactic index was 165+/-56 in patients with bacterial infection and 70+/-11 in controls (P < 0.001). After 7-10 days of appropriate therapy with clinical and bacteriological response, leukotactic activity returned to normal values. A hyperactive leukotactic response continued, however, in patients with persisting bacterial infection. The hyperactive leukotactic response of circulating neutrophils appears to be an early and sensitive event in the inflammatory cycle stimulated by bacterial infection and may aid in the localization of invading bacteria.