[Latarjet procedure for the treatment of inveterated shoulder dislocations]. / Pouzití operace podle Latarjeta pri inveterované luxaci ramene.

PURPOSE OF THE STUDY: Transfer of the tip of the coracoid process to the anterior margin of the glenoid is a procedure indicated in shoulder instability due to bone lesion. However, it is also used in inveterated shoulder dislocations refractory to conservative treatment that require open reduction of the joint. The bone block thus created allows for more effective and safer rehabilitation than does a temporary rigid Ki-wire fixation of the humeral head. The aim of this retrospective study was to evaluate the group of patients treated for irreducible inveterated shoulder dislocations by the Latarjet procedure. MATERIAL: Between 2005 and 2009, 16 patients with inveterated anterior shoulder dislocations were operated on. The group comprised 11 men and five women with an average age of 58 years. In all patients the duration of shoulder dislocation was longer than 3 days and reduction that would keep the humeral head in the glenoid socket was not possible even under general anaesthesia. The reasons for the late treatment included a delayed visit to the doctor's because the injury was not considered serious, the dislocation being missed in the presence of other more serious conditions, and even an overlooking by the attending physician. The longest time between the dislocation and its treatment was 23 days. Alcohol abuse was evident in some of the patients. METHODS: In the patients with irreducible inveterated shoulder dislocations who were referred to us, closed reduction was attempted in the first place.When this failed or when spontaneous dislocation subsequently occurred, open revision surgery was carried out. After coagula and synovia were removed from the glenoid socket, the head still had a tendency to dislocate spontaneously. Subsequently, the Latarjet procedure ;was performed this involved osteotomy of the coracoid process, retaining the attachment of the short head of the biceps brachii, and its transposition, through a split in the subscapularis ten- don, to the anterior lower margin of the glenoid. The process was fixed with two traction screws to create a firm bone barrier preventing dislocation. RESULTS: The functional outcome was assessed at 6 months after surgery, ;using the Constant score its average value was 60 points (35 to 85). From the evaluation of individual cases it appeared that the longer the time of shoulder dislocation, the worse the functional outcome of treatment. In comparison with the patients treated by open reduction with a temporary rigid Ki-wire fixation, the Latarjet procedure was clearly beneficial. DISCUSSION: Before the Latarjet procedure has been adopted, inveterated dislocations were treated by open reduction and a temporary fixation of the head in the socket by means of Ki-wires for three weeks. The functional outcomes following inveterated dislocation and rigid fixation were pitiable. Although the shoulder was articulated, its motion was restricted and painful. The procedure described here allows the patient to start early rehabilitation while maintaining shoulder stability. CONCLUSIONS: Inveterated irreducible shoulder dislocation is a rare diagnosis which is usually associated with the patient's personality disorder or is missed in patients with a disorder of consciousness. The treatment is difficult, but with the use of the procedure described here it is possible, with some limitation, to restore the shoulder function and its range of motion.

Significance of altered alpha-2-L-fucosyltransferase levels in serum of leukemic patients.

Serum alpha-2-L-fucosyltransferase levels were measured in 20 patients with leukemia. Lower than normal levels were found in patients with acute leukemia and higher than normal activity was demonstrated in patients with chronic granulocytic leukemia. alpha-2-L-Fucosyltransferase activity is expressed in platelets, and in both groups of leukemic patients this enzyme activity in serum was found to correlate directly with the platelet count. Assays on platelets from normal donors and from leukemic patients showed that the changes in level of the enzyme in serum result from changes in platelet numbers and not from alterations in the cellular expression of the transferase in leukemia. alpha-2-L-Fucosyltransferase levels in serum are therefore not per se diagnostic markers of leukemia.

Structure-based constitutive model can accurately predict planar biaxial properties of aortic wall tissue.

Structure-based constitutive models might help in exploring mechanisms by which arterial wall histology is linked to wall mechanics. This study aims to validate a recently proposed structure-based constitutive model. Specifically, the model's ability to predict mechanical biaxial response of porcine aortic tissue with predefined collagen structure was tested. Histological slices from porcine thoracic aorta wall (n=9) were automatically processed to quantify the collagen fiber organization, and mechanical testing identified the non-linear properties of the wall samples (n=18) over a wide range of biaxial stretches. Histological and mechanical experimental data were used to identify the model parameters of a recently proposed multi-scale constitutive description for arterial layers. The model predictive capability was tested with respect to interpolation and extrapolation. Collagen in the media was predominantly aligned in circumferential direction (planar von Mises distribution with concentration parameter bM=1.03 ± 0.23), and its coherence decreased gradually from the luminal to the abluminal tissue layers (inner media, b=1.54 ± 0.40; outer media, b=0.72 ± 0.20). In contrast, the collagen in the adventitia was aligned almost isotropically (bA=0.27 ± 0.11), and no features, such as families of coherent fibers, were identified. The applied constitutive model captured the aorta biaxial properties accurately (coefficient of determination R(2)=0.95 ± 0.03) over the entire range of biaxial deformations and with physically meaningful model parameters. Good predictive properties, well outside the parameter identification space, were observed (R(2)=0.92 ± 0.04). Multi-scale constitutive models equipped with realistic micro-histological data can predict macroscopic non-linear aorta wall properties. Collagen largely defines already low strain properties of media, which explains the origin of wall anisotropy seen at this strain level. The structure and mechanical properties of adventitia are well designed to protect the media from axial and circumferential overloads.

Neonatal alloimmune thrombocytopenia.

Neonatal alloimmune thrombocytopenia (NAIT) occurs when maternal alloantibodies to antigens present on fetal platelets cause their immune destruction resulting in thrombocytopenia in the newborn infant or fetus. Bleeding may be severe; intracranial haemorrhage and permanent neurological damage are the most serious complications. Despite the severity of the disease, there is often a delay in making the correct diagnosis and instigating appropriate treatment. Recent evidence that NAIT is more common than has previously been recognised, a better understanding of the molecular basis of platelet serology and advances in technology, which have made it possible to take blood samples from fetuses and transfuse them in utero, have all contributed to a growing interest in this condition. In addition, it is exciting to realise that an aggressive approach to the management of established cases and 'at risk' pregnancies can prevent serious neurological sequelae and dramatically improve the outcome for affected infants.

Reducing donor exposure in preterm infants requiring multiple blood transfusions.

Preterm infants frequently require multiple blood transfusions. Traditionally, 'fresh' (less than seven days old) blood has been used but this often results in transfusions from multiple donors. To reduce donor exposure the policy for top-up transfusions was changed. A unit of blood under five days old with additional satellite packs was ordered for each infant and used up to its expiry date, allowing up to eight transfusions from a single donation to be given. The mean (SD) number of transfusions per infant in 43 infants transfused according to previous policy and in 29 transfused according to the new policy was similar at 5.6 (4.0) and 5.3 (3.1), respectively. However, donor exposure fell following the change in policy from 4.9 (3.5) to only 2.0 (0.9). Only one infant was exposed to more than three donors compared with 24 infants in the control group. Plasma potassium concentrations were not significantly different following transfusion of blood stored for up to 33 days. This simple change in policy has reduced donor exposure in infants requiring multiple top-up transfusions.

Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports.

OBJECTIVE: To receive and collate reports of death or major complications of transfusion of blood or components. DESIGN: Haematologists were invited confidentially to report deaths and major complications after blood transfusion during October 1996 to September 1998. SETTING: Hospitals in United Kingdom and Ireland. SUBJECTS: Patients who died or experienced serious complications, as defined below, associated with transfusion of red cells, platelets, fresh frozen plasma, or cryoprecipitate. MAIN OUTCOME MEASURES: Death, "wrong" blood transfused to patient, acute and delayed transfusion reactions, transfusion related acute lung injury, transfusion associated graft versus host disease, post-transfusion purpura, and infection transmitted by transfusion. Circumstances relating to these cases and relative frequency of complications. RESULTS: Over 24 months, 366 cases were reported, of which 191 (52%) were "wrong blood to patient" episodes. Analysis of these revealed multiple errors of identification, often beginning when blood was collected from the blood bank. There were 22 deaths from all causes, including three from ABO incompatibility. There were 12 infections: four bacterial (one fatal), seven viral, and one fatal case of malaria. During the second 12 months, 164/424 hospitals (39%) submitted a "nil to report" return. CONCLUSIONS: Transfusion is now extremely safe, but vigilance is needed to ensure correct identification of blood and patient. Staff education should include awareness of ABO incompatibility and bacterial contamination as causes of life threatening reactions to blood.

Impaired chemiluminescence and bactericidal killing by neutrophils from patients with severe cobalamin deficiency.

Neutrophil function was examined in 24 patients with megaloblastic haemopoiesis due to vitamin B12-or folate deficiency. Defective bactericidal activity was demonstrated in the B12-deficient group only and was associated with normal phagocytic activity but impaired intracellular killing. Luminol amplified luminescence was consistently low in B12-deficient subjects with RBC counts of less than 2 X 10(12)/l. These defects were not seen in the folate-deficient cases although isolated abnormalities were present in those who were also alcoholic.

Up-regulation of alpha2,6 sialylation during myeloid maturation: a potential role in myeloid cell release from the bone marrow.

The mechanisms by which mature myeloid cells are released from the bone marrow into the peripheral blood are not clearly understood. Glycosylation is likely to play an important role, as has been shown in the homing of lymphocytes to lymph nodes and of neutrophils to inflamed endothelia. Cell surface sialylation is an important component of many cellular adhesive interactions, both as ligand-promoting interactions, as occurs in selectin and sialoadhesin-mediated adhesion, and for reducing cell adhesion as in some cancer cells. We have studied the expression of cell surface alpha2,6-linked sialic acid in the maturation of normal bone marrow myeloid cells, the expression of alpha2,6-sialyltransferase mRNA, and the role of sialylation in the adherence of myeloid cells to bone marrow stroma. Our data show that there is a dramatic increase in cell surface alpha2,6-sialylation during the late stage of maturation. This up-regulation is restricted to specific glycoproteins including CD11b and CD18. It is associated with a relative increase in the level of alpha2,6-sialyltransferase mRNA compared with alpha2,3-sialyltransferase mRNA. The changes in mature bone marrow myeloid cells are associated with reduced cell binding to fibronectin and cultured bone marrow stroma. Our data strongly suggest that alpha2,6-sialylation may be important in the interaction between maturing myeloid cells and bone marrow stroma and may govern the release of cells from the bone marrow into the peripheral blood.

Expression of alpha-1,3-galactose and other type 2 oligosaccharide structures in a porcine endothelial cell line transfected with human alpha-1,2-fucosyltransferase cDNA.

The binding of xenoreactive natural antibodies to the Galalpha1-3Galbeta1-4GlcNAc (alpha-galactose) oligosaccharide epitope on pig cells activates the recipient's complement system in pig to primate xenotransplantation. Expression of human alpha-1, 2-fucosyltransferase in pigs has been proposed as a strategy for reducing the expression level of the alpha-galactose epitope, thereby rendering the pig organs more suitable for transplantation into humans. The aim of this study was to examine how the cell surface expression of alpha-galactose, H, and related fucosylated and sialylated structures on a pig liver endothelial cell line is affected by transfection of human alpha-1,2-fucosyltransferase cDNA. Nontransfected and mock-transfected cells expressed alpha-galactose, alpha-2,3-sialylated, and alpha-2,6-sialylated epitopes strongly, with low level expression of type 2 H and LewisX. By contrast, expression of the H epitope was increased 5-8-fold in transfected cells with a 40% reduction in the expression of alpha-galactose epitope and a 50% decrease in sialylation, as measured by binding of Maackia amurensis and Sambuccus nigra agglutinins. LewisX expression was reduced to background levels, while the LewisY neoepitope was induced in human alpha-1,2-fucosyltransferase-expressing pig cells. The activities of endogenous alpha-1,3-galactosyltransferase, alpha-1,3-fucosyltransferases, and alpha-2,3- and alpha-2, 6-sialyltransferases acting on lactosamine were unaffected. Our results show that a reduction in alpha-galactose epitope expression in porcine endothelial cells transfected with human alpha-1, 2-fucosyltransferase cDNA may be achieved but at the expense of considerable distortion of the overall cell surface glycosylation profile, including the appearance of carbohydrate epitopes that are absent from the parent cells.

Significance of lymphocytosis in adults.

11/19 adults with a persistent increase in the total lymphocyte count, but with neither lymphodenopathy, hepatomegaly, nor splenomegaly, proved to have a monoclonal increase in B lymphocytes indicative of chronic lymphatic leukaemia (CLL). All remaining 8 patients had increased numbers of T-lymphocytes, more often of the helper than of the suppressor subsets. All the patients with a lymphocyte count in excess of 10 000/microliter, but only 5/13 patients with a lymphocyte count below 10 000/microliter had CLL. In adults a sustained lymphocytosis is thus not an adequate basis for the diagnosis of early CLL, which requires the demonstration of a monoclonal population. The T-lymphocytosis is likely to be reactive rather than neoplastic in nature.

Enzymic control of the expression of the X determinant (CD15) in human myeloid cells during maturation: the regulatory role of 6-sialytransferase.

To establish the basis for the reduced expression of the X determinant on leukemic blasts and the changes in antigenic expression that occur during myeloid maturation, the presence on myeloid cells of X and related structures was examined in conjunction with studies on the activities of the glycosyltransferases involved in their biosynthesis. Expression of X and sialyl-X was weak on blasts in comparison with neutrophils despite the presence of the requisite precursor structures. Much higher levels of 3-fucosyltransferase activity were found in blasts than in neutrophils when nonsialylated substrates were used, but, whereas the enzyme in neutrophils reacted equally well with 3'-sialylated and nonsialylated acceptors, the enzyme in blasts showed a marked preference for nonsialylated substrates. 6'-Sialyltransferase activity was strong in blasts but was not detectable in neutrophils, whereas a much lower level of 3'-sialyltransferase activity was present in both blasts and neutrophils. Dimethyl sulfoxide-induced maturation of HL60 cells was associated with (1) a decrease in both 6'-sialyltransferase and 3-fucosyltransferase activities, (2) a change in the substrate specificity of 3-fucosyltransferase towards that found in mature cells, and (3) increased cell surface expression of sialyl-X. These results suggest that the reduced expression of X in myeloblasts is related to the presence of the strong 6'-sialyltransferase, which uses the precursor substrate at the expense of the 3-fucosyltransferase and prevents the synthesis of X and sialyl-X. The developmental regulation of the levels of 3'- and 6'-sialyltransferases, and the level and specificity of the 3-fucosyltransferases, therefore controls the expression of X and its degree of sialylation.

Maternal alloimmunization to HLA, platelet and granulocyte-specific antigens during pregnancy: its influence on cord blood granulocyte and platelet counts.

In order to obtain an estimate of the frequency of platelet-specific and granulocyte-specific antibodies and of the effect of such antibodies on the platelet count and granulocyte count of the newborn infant, serum from 147 women in their second or subsequent pregnancies was tested. No platelet-specific antibodies were found but 29 of the women had granulocyte-specific antibodies and the corresponding infants had granulocyte counts which were significantly lower than those of infants without antibodies. HLA antibodies were found in the sera of 57 women but were not associated with diminished platelet or granulocyte counts in the corresponding infants. Maternal granulocyte antibodies may be an underestimated contributory factor in the pathogenesis of neonatal neutropenia.

Developmental regulation of alpha 1,3-fucosyltransferase expression in CD34 positive progenitors and maturing myeloid cells isolated from normal human bone marrow.

The adhesive interactions of hemopoietic cells within the bone marrow regulate their distribution, growth, and development. Fucosylated structures, of which sialyl Lewis x has been most extensively studied, are important ligands for selectins, but little is known about their function or regulation during normal hemopoietic development. We have studied alpha 1,3-fucosyltransferase activity in CD34 positive progenitors and myeloid cells at different stages of maturation isolated form normal human bone marrow, together with mRNA levels of Fuc-TIV and Fuc-TVII. Enzyme activity measured with H type 2 acceptor was present at all stages but was markedly elevated in fractions of early myeloid cells enriched for promyelocytes, correlating with the appearance of Lewis x on these cells, and thereafter fell progressively as cells matured. Activity measured with 3'sialyllactosamine was present in CD34+ cells and at all stages of maturation. Levels were low in promyelocyte/myelocyte transitional cells and increased, relative to those measured with H type 2, during the later stages of maturation; these changes correlate directly with a maturation-related increase in sialyl Lewis x expression. Using competitive quantitative RT-PCR, mRNA levels of Fuc-TIV and Fuc-TVII were similar in CD34+ cells, early myeloid and late myeloid cells. The significance of these findings in relation to fucosyltransferase activity, the synthesis of selectin ligands and differences between normal cells and leukemic cell lines is discussed.

Granulocytic cryopreservation: further studies on the pathogenesis of impaired cellular function.

The effects of different methods of purifying peripheral blood granulocytes on their functional capacity after cryopreservation have been studied. The standard method of isolating granulocytes by centrifugation through Lymphoprep sensitizes cells to damage induced by subsequent cryopreservation. Some of this damage occurs during addition of cryoprotectant and we describe how to add and remove dimethyl sulphoxide without impairing cell function. The granulocytic function that suffers most during cryopreservation is granulocyte migration. This impairment may be partially due to uncontrolled entry into the cell of calcium. In contrast the bactericidal capacity in vitro is not so greatly reduced and ability to reduce nitroblue tetrazolium redox dye even less so.

Studies on the haemopoietic toxicity of nitrous oxide in man.

Nitrous oxide inactivates vitamin B12 and in man can produce a megaloblastic anaemia. Haematological and biochemical changes were studied in nine surgical patients ventilated with 70% N2O for up to 24 h and in three control patients. There was a rise in the numbers of hypersegmented neutrophils in peripheral blood following N2O. Serial bone marrow aspirates showed gross megaloblastic change after 24 h of N2O which had reverted to normoblastic but dyserythropoietic haemopoiesis by 1 week. Giant forms of early myeloid precursors were also seen after 24 h ventilation with N2O but by 1 week abnormalities were evident in more mature cells, metamyelocytes and segmented neutrophils. Megaloblastosis was associated with abnormal dU suppression which showed a correction pattern similar to that seen in vitamin B12 deficiency. Administration of N2O was also associated with a progressive rise in serum folate and fall in serum methionine levels. No similar patterns were seen in the three control patients.

Effects of colchicine and vinblastine on axonal transport of choline acetyltransferase in rat sciatic nerve.

The effects of colchicine (0.5-10(-2) M) and vinblastine (10(-2)-10(-5) M) Upon axonal transport of choline acetyltranserase (CAT) and on nerve impulse conduction have been investigated in the rat sciatic nerve. High concentrations of colchicine (0.5 M) and vinblastine (10(-2) M) blocked completely both axonal transport of CAT and impulse conduction. 10(-3) M vinblastine did not affect impulse conduction until 20-22 h after injection, but this concentration of vinblastine did block CAT transport but not impulse conduction. 10(-2) M and 10(-1) M colchicine were without effect on impulse conduction, but did produce substantial, although incomplete, block of CAT transport. The results are discussed in relation to the possible involvement of microtubules in transport of CAT.