Vascular endothelial growth factor (VEGF) and VEGF receptor expression in biopsy samples of liver from dogs with congenital portosystemic shunts.

Surgical attenuation of a congenital portosystemic shunt (CPSS) results in increased liver mass, development of intrahepatic portal vasculature and improved liver function. Vascular endothelial growth factor (VEGF) is a key regulator of angiogenesis. The aim of this study was to investigate the role of VEGF and its receptor in the hepatic response to CPSS surgery. The study included 99 dogs with CPSS treated with either partial or complete suture attenuation. Forty-four dogs with partial attenuation underwent a second surgery for complete attenuation. The expression of VEGF and VEGF receptor 2 (VEGFR2) in biopsy samples of liver was assessed by immunohistochemistry with rabbit anti-human VEGF polyclonal antibody and mouse anti-human VEGFR2 monoclonal antibody. Expression of these molecules was graded. The proportion of samples expressing VEGF was significantly greater in samples from dogs with CPSS compared with control samples (P=0.04) and the proportion of samples expressing VEGFR2 was significantly greater in control samples compared with samples from dogs with CPSS (P=0.04). VEGF labelling grade decreased significantly (P=0.038) and VEGFR2 increased significantly (P=0.046) between first and second surgery. The decrease in VEGF may reflect transient expression, preferential expression of other factors, reperfusion of existing vessels and/or increased angiogenesis before surgery in the form of arterialization and subsequent reduction due to improved portal blood flow. Partial suture attenuation was associated with a degree of 'normalization' of VEGF and VEGFR2 expression when compared with the control samples. Further investigation is needed to provide more information on the hepatic response to CPSS surgery.

Prophylactic anti-infective activity of poly-[1-6]-beta-D-glucopyranosyl-[1-3]-beta-D-glucopryanose glucan in a guinea pig model of staphylococcal wound infection.

The judicious use of perioperative antibiotic prophylaxis reduces the infectious complications of surgery. However, increased bacterial resistance within hospitals may make antibiotic prophylaxis less effective in the future and alternative strategies are needed. New immunomodulatory agents might prevent wound infections by stimulation of the host immune system. To test this hypothesis, we administered poly-[1-6]-beta-D-glucopyranosyl- [1-3] -beta-D-glucopyranose glucan (PGG glucan), which enhances neutrophil microbicidal activity, intravenously to guinea pigs in doses ranging from 0.015 to 4 mg/kg of body weight on the day before, on the day of, and on the day after intermuscular inoculation with methicillin-resistant strains of Staphylococcus aureus and Staphylococcus epidermidis. Abscesses were identified at 72 h, and median infective doses (ID50) and statistical significance were determined by logistic regression. Guinea pigs receiving PGG glucan and inoculated with methicillin-resistant S. aureus and S. epidermidis exhibited ID50 of as much as 2.5- and 60-fold higher, respectively, than those of control guinea pigs not receiving PGG glucan. Maximal protection was observed with a dose of 1 mg of PGG glucan per kg, and efficacy was reduced at higher as well as at lower PGG glucan doses. Furthermore, a single dose of PGG glucan given 24 h following bacterial inoculation was found to be effective in preventing infection. We conclude that PGG glucan reduces the risk of staphylococcal abscess formation. Neutrophil-activating agents are a novel means of prophylaxis against surgical infection and may be less likely than antibiotics to be affected adversely by the increasing antibiotic resistance of nosocomial pathogens.

Severe open subtalar dislocations. Long-term results.

Fifteen adolescents and adults were assessed an average of eighteen years after a type-III open subtalar dislocation. There were ten lateral and five medial dislocations. Associated injuries included ten injuries of the tibial nerve, seven of which were complicated by causalgia; five ruptures of the posterior tibial tendon; five lacerations of the posterior tibial artery; twelve articular fractures involving the subtalar joint; three articular fractures of the talonavicular joint; three fractures of the talar dome; and three malleolar fractures. Osteonecrosis of the body of the talus was found in five of the fifteen patients. It was treated with a triple arthrodesis in all five patients, one of whom had a subsequent conversion to a pantalar arthrodesis. Subtalar arthrodesis was done, because of post-traumatic osteoarthrosis, in two other patients. On functional assessment at the long-term follow-up examination, all patients reported some pain in the ankle, nine had difficulty climbing stairs, fourteen had difficulty walking on uneven surfaces, and eleven wore modified shoes. The patients who had had a tarsal arthrodesis returned to their pre-injury occupation or to a less strenuous job. Four patients who had persistent causalgia did not return to work. We concluded that open subtalar dislocation is a distinctly severe injury and that only fair functional and poor anatomical results can be expected in most patients.

Spatial distribution of muscle fibers in a lumbrical muscle of the rat.

The spatial distributions of two different populations of muscle fibers were measured in cross-sections taken from the mid-belly of adult 4DL muscles. Muscle fibers belonging to a single motor unit (identified by glycogen depletion) were distributed randomly in most muscles. Muscle fibers which contained slow myosin (identified immunohistochemically) were distributed nonrandomly, being evenly distributed throughout most of the muscle cross-section, but excluded from the edge of the muscle. Interpreted from a developmental perspective, the results are consistent with the proposals that slow myosin-containing fibers in the adult represent the original population of primary myotubes, and that the adult pattern of motor unit fiber type is achieved by synapse elimination from mismatched fibers rather than by conversion of fiber type.

Anterior capsulotomy and continuous passive motion in the treatment of post-traumatic flexion contracture of the elbow. A prospective study.

Thirty-three patients who had a post-traumatic flexion contracture of the elbow were managed consecutively with anterior capsulotomy without tenotomy of the biceps tendon or myotomy of the brachialis muscle. The first fifteen patients (Group I) did not receive continuous passive motion postoperatively. Preoperative active extension for Group I was to an average of 48 degrees short of full extension, which improved to 19 degrees at a mean follow-up time of forty-five months. Subsequently, eighteen patients (Group II) received continuous passive motion postoperatively for a mean of six weeks. Preoperative active extension for Group II was to an average of 55 degrees short of full extension, which improved to 23 degrees at a mean duration of follow-up of thirty-five months. The mean preoperative arc of motion for Group I was 69 degrees, which improved to 94 degrees postoperatively. The mean preoperative arc of motion for Group II was 48 degrees, which improved to 95 degrees postoperatively. Five patients in Group I and six patients in Group II had severe preoperative heterotopic ossification. There was no correlation, however, between preoperative heterotopic ossification and the amount that extension of the elbow improved postoperatively. There was no postoperative increase in heterotopic ossification. Four patients in Group I and six patients in Group II had severe post-traumatic osteoarthrosis preoperatively. Anterior capsulotomy is an effective treatment of post-traumatic flexion contracture of the elbow. Although the postoperative use of continuous passive motion did not significantly improve mean active extension, it did improve active flexion and the total arc of motion.

Motor units of the fourth deep lumbrical muscle of the adult rat: isometric contractions and fibre type compositions.

1. Isometric twitch and tetanic tensions were recorded from whole muscles and single motor units in fourth deep lumbrical muscles isolated from young adult (60 days) rats. Muscles were superfused with oxygenated Ringer solution at 25 degrees C except where stated otherwise. 2. It was confirmed that the muscle is supplied most commonly by eleven motor axons, nine via the lateral plantar nerve (LPN), and two via the sural nerve (SN). Motor units whose axons were isolated from either LPN or SN were studied. There was no difference in mean motor unit size. 3. In their unfused tetani most units showed 'sag' and some 'no sag', with no segregation between LPN and SN. 'No sag' units were always small (unit tetanic tension less than 8% whole-muscle tetanic tension), tended to be relatively slowly contracting and relaxing during an isometric twitch, and tended to have relatively low twitch:tetanus ratios. Units showing sag ranged from large to small. 4. In some motor units muscle fibres were depleted of their glycogen by repetitive stimulation at 30 degrees C in glucose-free Ringer solution, and the muscle and its unstimulated control frozen and sectioned. Neighbouring sections were stained for glycogen and for binding of two myosin-specific antibodies, one specific for slow myosin and the other for type IIA myosin. Myosin ATPase and succinic dehydrogenase histochemistry were also carried out in some muscles. 5. Serial reconstructions showed that all or virtually all extrafusal fibres in the muscle were present in a midbelly section, and that the myosin type of individual fibres did not change significantly along their length. Spindle profiles were seen frequently and in two muscles eight and twelve spindles were identified. 6. Of twenty-six motor units examined twenty contained almost exclusively muscle fibres of the recently described type IIX. All these units showed sag in their isometric tetani. 7. Six units each contained 50% or more of slow myosin-containing fibres (IIC and a few type I). The remaining fibres in these units were IIA. All these units were therefore of mixed fibre composition, and are discussed as IIC/IIA units. In whole muscles slow-myosin-containing fibres were generally distributed evenly (non-randomly) throughout the muscle cross-section. 8. Whole muscles contained on average 970 fibres (S.D. +/- 70) of which 82 (+/- 9) were slow-myosin-containing. A few muscles from older rats (3-24 months) contained very few such fibres.(ABSTRACT TRUNCATED AT 400 WORDS)

An improved invertebrate synaptosomal preparation with cholinergic properties.

Our laboratory has previously characterized a high affinity choline uptake system (HAChUS) in Limulus tissues and synaptosomes. We report here on the characterization of the HAChUS in synaptosomes prepared selectively from central nervous system tissues shown to be enriched for presumed cholinergic functions; namely the protocerebrum, corpora pedunculata and abdominal ganglia. Synaptosomes were prepared from these tissues by means of a modification of the subfractionation procedure developed by Dowdall and Whittaker. In our modification, we harvested a PP2L fraction exclusively from the S2 fraction. Compared to the P2L fraction, the PP2L was greater than three times more efficient in [3H]choline uptake and was significantly more sensitive to inhibition with micromolar concentrations of hemicholinium-3. The PP2L fraction HAChUS was shown to have characteristics common to the HAChUS of identified cholinergic tissues.

The use of magnetic resonance imaging in the diagnosis of pigmented villonodular synovitis.

Although the clinical and radiographic features of pigmented villonodular synovitis (PVS) have been well described, diagnosis is often delayed and high rates of recurrence after synovectomy are reported. Magnetic resonance imaging (MRI) has been shown to be useful in the diagnosis of soft tissue masses. Three patients with biopsy-proven PVS and radiographs showing only effusion underwent MRI in the axial, coronal, and sagittal planes. The margins of the diseased synovium were best demonstrated on long TR/TE (T2-weighted) images. The synovium contained areas of void signal intensity felt to be due to hemosiderin, interspersed with increased signal from both inflammation and fat. In all cases, the margins of the diseased synovium were clearly delineated, allowing classification as nodular or diffuse. No appreciable change in signal intensity was seen when comparing nodular and diffuse forms. MRI is useful but not specific for PVS, since rheumatoid synovitis may show a similar signal pattern. However, MRI in patients with suspected PVS may decrease the time until diagnosis, aid in preoperative planning and obtaining adequate margins of resection, and may be a non-invasive method of long-term follow up for possible recurrence.

Bone-grafting in total hip arthroplasty for protrusio acetabuli. A follow-up note.

The results of total hip arthroplasty with the use of medial and superior bone-graft augmentation in thirty-nine hips (thirty-two patients) that had protrusio acetabuli were previously reported after two to eight years (mean, 4.7 years) of follow-up. We followed the surviving patients for 10.9 to 17.4 years (mean, 12.8 years). The average Harris hip-rating was 72 points--an average drop of 17 points since the previous report. The average was 64 points for patients who had rheumatoid arthritis and 83 points for those who had another diagnosis. Radiographic evaluation demonstrated definite, probable, and possible loosening in about 20, 10, and 60 per cent of the hips, respectively. Of the six hips that had definite loosening, four (10 per cent of the total series) had progression of the protrusion (acetabular migration); operative revision was performed on two of those four hips and on two other hips, in which progression had ceased. Hips that had progressive protrusion demonstrated superior migration more often than medial migration. The rates of loosening and revision were similar to those in hips that did not have protrusio acetabuli. We concluded that augmentation of total hip arthroplasty with bone-grafting is effective in arresting the progression of protrusio acetabuli in most hips (90 per cent in our series).

Talar impingement by the anteroinferior tibiofibular ligament. A cause of chronic pain in the ankle after inversion sprain.

Seven patients who had pain in the anterior aspect of the ankle were found to have a thickened distal fascicle of the anteroinferior tibiofibular ligament. Each patient had a history of an inversion sprain of the ankle followed by chronic pain in the anterior aspect of the ankle. The thickened distal fascicle was resected without loss of stability of the ankle. Five patients needed débridement of an area of abraded hyaline cartilage on the anterolateral aspect of the talus. Six patients were followed for a mean of thirty-nine months (range, twenty-four to fifty-nine months). Four of them had no pain in the ankle or limitation in activities, and two reported marked improvement, with only occasional pain in the ankle related to overuse. A separate distal fascicle of the anteroinferior tibiofibular ligament is present in most human ankles and can be a cause of talar impingement, abrasion of the articular cartilage, and pain in the anterior aspect of the ankle. Resection of this ligament usually will alleviate the pain caused by the impingement.

Clear cell ("mesonephroid") adenocarcinoma of the vulva arising in endometriosis: a case report.

A very unusual case of an apparent primary clear cell adenocarcinoma of the vulva in a 57-year-old female is presented. The carcinoma arose in an area of endometriosis within the canal of Nuck in the superior aspect of the right labium majus. Smooth muscle fibers presumably representing remnants of the extrapelvic round ligament were found associated with the endometriosis. Of interest is the fact that the patient underwent right herniorrhaphy 9 years earlier. Although several cases of primary adenocarcinoma arising within the vulva have been reported, none has arisen in areas of endometriosis within the canal of Nuck. No case in the literature of a primary clear cell adenocarcinoma arising from endometriosis in the canal of Nuck and in association with the extrapelvic portion of the round ligament could be found.

Uterine cancer screening by the family physician.

Endometrial diagnostic techniques available to the family physician for office use have a high degree of accuracy in identifying intrauterine pathology. Recent refinements in endometrial sampling devices have made their use cost-effective and complication rates minimal. These methods can be utilized annually for screening asymptomatic women at high risk of developing uterine cancer. Detection of endometrial hyperplasia has improved with the newer samplers. Patient acceptance is excellent, especially with the cytologic devices.