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1.
Am J Sports Med ; 27(3): 304-7, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10352764

RESUMEN

Repair of patellar tendon ruptures has often relied on cerclage augmentation and prolonged immobilization in extension. We are reporting our experience with avulsion injuries as well as midsubstance ruptures, both treated with primary repair without augmentation, allowing early mobilization in the athlete less than 40 years of age. Repairs were performed to allow knee flexion to more than 60 degrees. Rehabilitation was performed with heel slides, allowing flexion to 45 degrees for the first 3 weeks, increasing to 90 degrees at 3 to 6 weeks, and thereafter without restriction. An accelerated weightbearing and muscle strengthening program was adopted. At a mean follow-up of 2.6 years (range, 20 to 61 months), 12 patients had returned to their previous levels of activity. No loss of extension or extensor lag was noted; mean flexion loss was 5 degrees. Patellofemoral symptoms and signs were present in five patients, but activity was limited in only two. Mean peak torque at 60 deg/sec was 92% (range, 73% to 105%). Mean Lysholm score was 94 +/- 2.5 points. Primary repair with immediate, protected range of motion resulted in uniformly excellent results and obviated the need for manipulation or subsequent hardware removal.


Asunto(s)
Rótula/lesiones , Traumatismos de los Tendones/cirugía , Tendones/cirugía , Adulto , Humanos , Masculino , Rotura , Traumatismos de los Tendones/rehabilitación , Resultado del Tratamiento
2.
Nature ; 392(6672): 182-6, 1998 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-9515963

RESUMEN

In lymphocytes, the expression of early immune response genes is regulated by NF-AT transcription factors which translocate to the nucleus after dephosphorylation by the Ca2+-dependent phosphatase, calcineurin. We report here that mice bearing a disruption in the NF-ATc gene fail to develop normal cardiac valves and septa and die of circulatory failure before day 14.5 of development. NF-ATc is first expressed in the heart at day 7.5, and is restricted to the endocardium, a specialized endothelium that gives rise to the valves and septum. Within the endocardium, specific inductive events appear to activate NF-ATc: it is localized to the nucleus only in endocardial cells that are adjacent to the interface with the cardiac jelly and myocardium, which are thought to give the inductive stimulus to the valve primordia. Treatment of wild-type embryos with FK506, a specific calcineurin inhibitor, prevents nuclear localization of NF-ATc. These data indicate that the Ca2+/calcineurin/NF-ATc signalling pathway is essential for normal cardiac valve and septum morphogenesis; hence, NF-ATc and its regulatory pathways are candidates for genetic defects underlying congenital human heart disease.


Asunto(s)
Proteínas de Unión al ADN/fisiología , Tabiques Cardíacos/embriología , Válvulas Cardíacas/embriología , Proteínas Nucleares , Factores de Transcripción/fisiología , Animales , Calcineurina/metabolismo , Inhibidores de la Calcineurina , Calcio/metabolismo , Línea Celular , Técnicas de Cultivo , Proteínas de Unión al ADN/genética , Endotelio/metabolismo , Muerte Fetal , Marcación de Gen , Defectos de los Tabiques Cardíacos/embriología , Válvulas Cardíacas/anomalías , Humanos , Ratones , Ratones Endogámicos C57BL , Morfogénesis/fisiología , Mutagénesis , Factores de Transcripción NFATC , Transducción de Señal , Tacrolimus/farmacología , Factores de Transcripción/genética
3.
J Immunol ; 159(6): 2735-40, 1997 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-9300694

RESUMEN

Nuclear factor of activated T cells (NF-AT) complexes regulate the induction of many early T cell activation molecules. Four related proteins can function as the cytoplasmic subunit of NF-AT, and their overlapping expression patterns and the mild phenotype of the NF-ATp null mice suggest that they may be functionally redundant. We characterized the distribution and activation of cytoplasmic NF-AT proteins in mature lymphocytes and found that NF-ATc, NF-ATp, and NF-AT4/x/c3 are co-expressed and co-regulated in mature T and B cells. Each protein forms independent DNA binding complexes, and at physiologic concentrations, NF-ATc and NF-ATp complexes out-compete NF-AT4/x/c3 for occupancy of NF-AT sites from the IL-2, IL-3/granulocyte-macrophage CSF, IL-4, and CD40 ligand genes. This predicts heavily redundant immune regulatory functions of NF-ATp and NF-ATc, but distinct activities for NF-AT4/x/c3. Additionally, Ab interaction with NF-ATp induces high affinity NF-kappaB site interaction, suggesting that nuclear partners may dramatically vary the specificity of the NF-AT family.


Asunto(s)
Linfocitos B/inmunología , Proteínas de Unión al ADN/inmunología , Activación de Linfocitos , Proteínas Nucleares , Linfocitos T/inmunología , Factores de Transcripción/inmunología , Animales , Anticuerpos , Proteínas de Unión al ADN/biosíntesis , Ratones , Datos de Secuencia Molecular , Factores de Transcripción NFATC , Factores de Transcripción/biosíntesis
4.
Immunity ; 6(4): 419-28, 1997 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-9133421

RESUMEN

It is not known how immunogenic versus tolerogenic cellular responses are signaled by receptors such as the B cell antigen receptor (BCR). Here we compare BCR signaling in naive cells that respond positively to foreign antigen and self-tolerant cells that respond negatively to self-antigen. In naive cells, foreign antigen triggered a large biphasic calcium response and activated nuclear signals through NF-AT, NF-kappa B, JNK, and ERK/pp90rsk. In tolerant B cells, self-antigen stimulated low calcium oscillations and activated NF-AT and ERK/pp90rsk but not NF-kappa B or JNK. Self-reactive B cells lacking the phosphatase CD45 did not exhibit calcium oscillations or ERK/pp90rsk activation, nor did they repond negatively to self-antigen. These data reveal striking biochemical differences in BCR signaling to the nucleus during positive selection by foreign antigens and negative selection by self-antigens.


Asunto(s)
Linfocitos B/metabolismo , Núcleo Celular/inmunología , Núcleo Celular/metabolismo , Proteínas Inmediatas-Precoces , Proteínas Nucleares , Receptores de Antígenos de Linfocitos B/fisiología , Transducción de Señal/inmunología , Animales , Linfocitos B/inmunología , Transporte Biológico/inmunología , Calcio/metabolismo , Calcio/fisiología , Proteínas Quinasas Dependientes de Calcio-Calmodulina/biosíntesis , Núcleo Celular/fisiología , Proteínas de Unión al ADN/genética , Proteínas de Unión al ADN/metabolismo , Proteína 1 de la Respuesta de Crecimiento Precoz , Regulación de la Expresión Génica/inmunología , Tolerancia Inmunológica , Antígenos Comunes de Leucocito/genética , Ratones , Ratones Transgénicos , Proteína Quinasa 1 Activada por Mitógenos , FN-kappa B/biosíntesis , Factores de Transcripción NFATC , Proteínas Serina-Treonina Quinasas/metabolismo , Proteínas Serina-Treonina Quinasas/fisiología , Proteínas Tirosina Quinasas/biosíntesis , Proteínas Quinasas S6 Ribosómicas , Transducción de Señal/genética , Factores de Transcripción/genética , Factores de Transcripción/metabolismo
5.
Immunity ; 6(3): 235-44, 1997 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-9075924

RESUMEN

Clinical deterioration in human immunodeficiency virus type 1 (HIV-1) infection is associated with increased levels of viral replication and burden in the peripheral blood and lymphoid organs. T cell activation and ensuing cellular gene activation can be critical for HIV-1 replication. The hypothesis that the nuclear factor of activated T cells (NF-AT) may influence HIV-1 replication is therefore compelling given the tight correlation of HIV-1 transcriptional induction to T cell activation. We report that certain NF-AT(Rel) family members productively bind the kappaB regulatory elements, synergize with NF-kappaB and Tat in transcriptional activation of HIV-1, and enhance HIV-1 replication in T cells. These results link regulatory factors critical to T cell commitment directly to HIV-1 replication.


Asunto(s)
Proteínas de Unión al ADN/farmacología , Regulación Viral de la Expresión Génica/efectos de los fármacos , VIH-1/genética , VIH-1/inmunología , Proteínas Nucleares , Linfocitos T/metabolismo , Linfocitos T/virología , Factores de Transcripción/farmacología , Replicación Viral/genética , Replicación Viral/inmunología , Células Cultivadas , Elementos de Facilitación Genéticos , VIH-1/efectos de los fármacos , Humanos , FN-kappa B/metabolismo , Factores de Transcripción NFATC , Linfocitos T/efectos de los fármacos , Activación Transcripcional , Replicación Viral/efectos de los fármacos
6.
Nature ; 383(6603): 837-40, 1996 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-8893011

RESUMEN

Cells need to distinguish between transient Ca2+ signals that induce events such as muscle contraction, secretion, adhesion and synaptic transmission, and sustained Ca2+ signals that are involved in cell proliferation and differentiation. The latter class of events is blocked in lymphocytes by the immunosuppressive drugs cyclosporin A and FK506, which inhibit calcineurin, a Ca2+-activated serine/threonine phosphatase necessary for the nuclear import of NF-AT transcription factors. Here we report that sustained high concentrations of Ca2+, but not transient pulses, are required to maintain NF-AT transcription factors in the nucleus, where they participate in Ca2+-dependent induction of genes required for lymphocyte activation and proliferation. Furthermore, overexpression and constitutive nuclear localization of NF-AT, but not Jun, Fos, NF-kappaB, Oct or Ets family members, renders the interleukin-2 enhancer in Jurkat T lymphocytes resistant to FK506 and cyclosporin A. Thus a primary effect of these immunosuppressive reagents is to control the subcellular localization of the NF-AT family of transcription factors.


Asunto(s)
Calcio/metabolismo , Ciclosporina/farmacología , Proteínas de Unión al ADN/metabolismo , Inmunosupresores/farmacología , Proteínas Nucleares , Transducción de Señal , Linfocitos T/inmunología , Tacrolimus/farmacología , Factores de Transcripción/metabolismo , Animales , Transporte Biológico , Calcineurina , Proteínas de Unión a Calmodulina/metabolismo , Línea Celular , Núcleo Celular/metabolismo , Humanos , Interleucina-2/genética , Células Jurkat , Activación de Linfocitos , Ratones , Factores de Transcripción NFATC , Fosfoproteínas Fosfatasas/metabolismo , Linfocitos T/metabolismo , Transfección
7.
Mol Cell Biol ; 16(1): 228-35, 1996 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-8524300

RESUMEN

Interleukin 4 (IL-4), an immunoregulatory cytokine, is produced only by a subset of activated T cells and cells of the mast cell-basophil lineage. The production of IL-4 by mast cells likely represents a significant source of this protein in local immune-inflammatory responses in the skin, brain, gastrointestinal, and respiratory tracts, in which mast cells are prevalent. In the present study, the cis- and trans-acting elements that control inducible mast cell IL-4 gene transcription were examined and compared with those that function in T cells. We demonstrate that, as in T cells, sequences between bp -87 and -70 are critical for protein association and activation-dependent gene transcription and that this region (termed the activation-responsive element region) is the target of an inducible, cyclosporin A-sensitive, DNA-protein interaction. When assessed by electrophoretic mobility shift assays and UV cross-linking analyses, multiple proteins in both T- and mast cell nuclear extracts associate with the activation-responsive element in vitro, and some of these appear identical. However, distinct proteins are associated with each of the complexes as well. AP-1 family members are unique to the T-cell-stimulation-dependent complex, whereas mast cell complexes contain factors that are reactive with anti-nuclear factor of activated T cells p (NF-ATp) and anti-NF-ATc antibodies but have distinct molecular masses compared with those of T-cell-derived NF-AT. Furthermore, an anti-NF-ATp-reactive factor with a molecular mass of approximately 41 kDa is present in the nuclei of unstimulated cells and binds independently of cell activation, unlike the previously described NF-AT family members. These data support the idea that there are uniquely regulated, cell lineage-specific transcription factors related to T-cell-derived NF-AT that mediate inducible IL-4 transcription in mast cells. These differences likely reflect the distinct cell surface signaling requirements for IL-4 production in T and mast cells.


Asunto(s)
Proteínas de Unión al ADN/metabolismo , Interleucina-4/genética , Interleucina-4/metabolismo , Mastocitos/inmunología , Mastocitos/metabolismo , Proteínas Nucleares , Linfocitos T/inmunología , Linfocitos T/metabolismo , Factores de Transcripción/metabolismo , Animales , Secuencia de Bases , Cloranfenicol O-Acetiltransferasa/genética , Ciclosporina/farmacología , ADN/genética , Genes Reporteros , Mastocitos/efectos de los fármacos , Ratones , Datos de Secuencia Molecular , Mutación , Factores de Transcripción NFATC , Transcripción Genética/efectos de los fármacos
8.
Int J Sports Med ; 16(8): 563-7, 1995 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-8776213

RESUMEN

A 29 year old female recreational runner presented with two separate episodes of hip pain. The first, affecting the right hip was an uncommon cause of hip pain--an osteoid osteoma. The second, affecting the left hip was a more predictable cause of hip pain in a runner--a femoral stress fracture. Management of the subsequent stress fracture enabled more detailed and prolonged observation of the natural history and clinical course of the osteoid osteoma. The presentation and management of each of the conditions is discussed.


Asunto(s)
Neoplasias Óseas , Fracturas del Fémur , Fracturas por Estrés , Cadera , Osteoma Osteoide , Dolor/etiología , Carrera , Adulto , Densidad Ósea , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/terapia , Femenino , Fracturas del Fémur/diagnóstico , Fracturas del Fémur/etiología , Fracturas del Fémur/terapia , Fracturas por Estrés/diagnóstico , Fracturas por Estrés/etiología , Fracturas por Estrés/terapia , Humanos , Osteoma Osteoide/diagnóstico , Osteoma Osteoide/terapia
9.
J Biol Chem ; 270(34): 19898-907, 1995 Aug 25.
Artículo en Inglés | MEDLINE | ID: mdl-7650004

RESUMEN

Signals transduced by the T cell antigen receptor (TCR) regulate developmental transitions in the thymus and also mediate the immunologic activation of mature, peripheral T cells. In both cases TCR stimulation leads to the assembly of the NFAT transcription complex as a result of the calcium-dependent nuclear translocation of cytosolic subunits, NFATc, and the Ras/protein kinase C-dependent induction of a nuclear subunit, NFATn. To further understand the diverse roles of antigen receptor signaling throughout T cell development, we have identified a new NFATc family member, NFATc3, that is expressed at highest levels in the thymus. NFATc3 is the product of a gene on murine chromosome 8 that is not linked to the other NFATc genes. NFATc3, like other NFATc family members, contains a conserved rel similarity domain, and also defines a region conserved among NFATc family members, the SP repeat region, characterized by the repeated motif SPxxSPxxSPrxsxx (D/E)(D/E)swl. NFATc3 activates NFAT site-dependent transcription when overexpressed, yet exhibits a pattern of DNA site specificity distinct from other NFATc proteins. Additionally, thymic NFATc3 undergoes modifications in response to agents that mimic T cell receptor signaling, including a decrease in apparent molecular mass upon elevation of intracellular calcium that is inhibited by the immunosuppressant FK506. Given the preferential expression of NFATc3 in the thymus, NFATc family members may regulate distinct subsets of genes during T cell development.


Asunto(s)
Calcio/metabolismo , Proteínas de Unión al ADN/metabolismo , ADN/metabolismo , Proteínas Nucleares , Linfocitos T/metabolismo , Factores de Transcripción/metabolismo , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Sitios de Unión , Mapeo Cromosómico , Clonación Molecular , Secuencia Conservada , Cricetinae , Citosol/metabolismo , ADN Complementario/genética , Proteínas de Unión al ADN/genética , Células Híbridas , Ratones , Datos de Secuencia Molecular , Factores de Transcripción NFATC , Proteína Quinasa C/metabolismo , Secuencias Repetitivas de Ácidos Nucleicos , Distribución Tisular , Factores de Transcripción/genética , Activación Transcripcional
10.
Am J Sports Med ; 23(4): 407-13, 1995.
Artículo en Inglés | MEDLINE | ID: mdl-7573648

RESUMEN

We reviewed the records of 72 professional baseball players who underwent arthroscopic or open elbow surgery. The most common diagnoses were posteromedial olecranon osteophyte (65%), ulnar collateral ligament injury (25%), and ulnar neuritis (15%). Intraarticular loose bodies were found in 39% of the patients. Fifty-nine patients (82%) were observed for a minimum of 24 months, with an average of 42 months' followup. Forty-seven players (80%) returned to play for a minimum of one season (73% at the same or higher level of play), and 17% of the players retired initially because of their elbow injury. One third of the players required two or more surgical procedures, with 25% of these patients requiring an ulnar collateral ligament reconstruction after removal of a posteromedial olecranon osteophyte. The patients with posteromedial olecranon osteophytes had the highest rate of reoperation, and patients who underwent ulnar collateral ligament reconstruction had a higher rate of return to play. The incidence of ulnar collateral ligament injuries was most likely underestimated in this group of athletes, with initial treatment directed at the secondary injuries instead of the primary ulnar collateral ligament injury.


Asunto(s)
Béisbol/lesiones , Articulación del Codo/cirugía , Codo/cirugía , Adulto , Anciano , Artrografía , Artroscopía , Fenómenos Biomecánicos , Enfermedades Óseas/cirugía , Ligamentos Colaterales/cirugía , Codo/diagnóstico por imagen , Articulación del Codo/diagnóstico por imagen , Terapia por Ejercicio , Estudios de Seguimiento , Cuerpos Extraños/cirugía , Humanos , Inestabilidad de la Articulación/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Rango del Movimiento Articular , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento , Cúbito/fisiopatología , Nervio Cubital/cirugía , Lesiones de Codo
11.
Cytogenet Cell Genet ; 68(3-4): 185-91, 1995.
Artículo en Inglés | MEDLINE | ID: mdl-7842733

RESUMEN

The nuclear factor of activated T cells (NFAT) is a transcription factor complex involved in the activation of cytokines and cell surface molecules associated with coordinating the actions of different cells required for an immune response. Two different genes have recently been cloned that encode proteins capable of functioning as the pre-existing (p) and cytosolic (c) component of the NFAT transcription complex, NFATc of human and NFATp of murine origin (Northrop et al., 1994; McCaffrey et al., 1993b). We report here the partial cDNA cloning of the murine homolog of NFATc and the human homolog of NFATp, and the chromosomal localization of both genes in both species to conserved syntenic regions. Through the use of mapping panels of human x Chinese hamster and mouse x rodent cells hybrids, the NFATc genes were mapped to human and mouse chromosomes 18. By analyzing a chromosome 18 radiation hybrid panel, the human NFATc gene was localized to the q terminus, closely linked to STS marker D18S497. The murine Nfatc gene was sublocalized to chromosome band 18E4 by FISH. The NFATp genes were mapped by somatic cell hybrid analysis to human chromosome 20 and mouse chromosome 2. Human NFATp was assigned to chromosome region 20q13.2-->q13.3 by FISH. Based on the conserved syntenic region on human chromosome 20 and mouse chromosome 2, murine Nfatp is predicted to reside in the vicinity of a mutant locus wasted. Homozygous wst/wst mice display a phenotype reminiscent of severe combined immune deficiency or ataxia telangiectasia, disorders that could therefore be considered candidates for NFATp mutations.


Asunto(s)
Mapeo Cromosómico , Clonación Molecular , Proteínas de Unión al ADN/genética , Proteínas Nucleares , Factores de Transcripción/genética , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Cromosomas Humanos Par 18 , Ligamiento Genético , Humanos , Escala de Lod , Ratones , Datos de Secuencia Molecular , Factores de Transcripción NFATC , Linfocitos T/química
12.
J Orthop Trauma ; 9(6): 530-2, 1995.
Artículo en Inglés | MEDLINE | ID: mdl-8592269

RESUMEN

Isolated fracture of the humeral trochlea is rare. Recent fracture classification schemes do not specifically address this injury in regards to treatment. This case report describes an isolated fracture of the humeral trochlea treated with open reduction internal fixation. Radiographic union was present at 13 weeks, and at 20 weeks post-op, the patient had regained full elbow range of motion minus 5 degrees of terminal flexion. Open reduction and internal fixation can be performed with success if the trochlear fragment is large enough.


Asunto(s)
Accidentes de Tránsito , Fracturas del Húmero/cirugía , Adulto , Femenino , Fijación Interna de Fracturas , Humanos , Fracturas del Húmero/diagnóstico por imagen , Radiografía
13.
Am J Sports Med ; 22(5): 667-73, 1994.
Artículo en Inglés | MEDLINE | ID: mdl-7810791

RESUMEN

The histology and arthroscopic anatomy of the ulnar collateral ligament of the elbow were studied in cadaveric specimens. The capsule consists of two layers of collagen fibers, with two distinct ligamentous bundles corresponding to anterior and posterior portions of the ulnar collateral ligament. The posterior bundle consists of distinct collagen bundles within the layers of the capsule; the anterior bundle consists of a similar thickening within the capsular layers, with an additional ligament complex superficial to the capsular layers. With arthroscopy only the anterior 20% to 30% of the anterior bundle of the ulnar collateral ligament could be visualized via the anterior portal. Only the posterior 30% to 50% of the posterior bundle could be seen via the posterior portals. After sectioning of the anterior bundle, joint instability was noted arthroscopically by an increased opening in the ulnohumeral joint with application of valgus stress. At arthroscopy ulnar collateral ligament tears may be visualized in part or not at all. To diagnose a tear or laxity in the ulnar collateral ligament, a demonstration of an increase in the opening of the ulnohumeral joint in response to valgus stress is useful.


Asunto(s)
Artroscopía , Ligamentos Colaterales/anatomía & histología , Articulación del Codo/anatomía & histología , Artroscopía/métodos , Cadáver , Ligamentos Colaterales/lesiones , Ligamentos Colaterales/patología , Humanos , Inestabilidad de la Articulación/patología
14.
Nature ; 369(6480): 497-502, 1994 Jun 09.
Artículo en Inglés | MEDLINE | ID: mdl-8202141

RESUMEN

The NF-AT transcription complex is required for the expression of a group of proteins that collectively coordinate the immune response. Here we purify two proteins encoded by separate genes that represent the pre-existing (p) and cytosolic (c) components of NF-AT. Expression of the full-length complementary DNA encoding NF-ATc activates the interleukin (IL-2) promoter in non-T lymphocytes, whereas a dominant negative of NF-ATc specifically blocks activation of the IL-2 promoter in T lymphocytes, indicating that NF-ATc is required for IL-2 gene expression. NF-ATc RNA expression is largely restricted to lymphoid tissues and is induced upon T-cell activation. The other protein, NF-ATp, is highly homologous to NF-ATc over a limited domain which shows similarity to the Dorsal/Rel family, but has a wider tissue distribution. Agents that increase intracellular Ca2+ or activate protein kinase C independently modify NF-ATc, indicating that distinct signalling pathways converge on NF-ATc to regulate its function.


Asunto(s)
Proteínas de Unión al ADN/metabolismo , Activación de Linfocitos , Proteínas Nucleares , Linfocitos T/inmunología , Factores de Transcripción/metabolismo , Secuencia de Aminoácidos , Animales , Secuencia de Bases , Calcio/metabolismo , Bovinos , Línea Celular , Núcleo Celular/metabolismo , Citosol/metabolismo , ADN Complementario , Proteínas de Unión al ADN/química , Proteínas de Unión al ADN/genética , Proteínas de Unión al ADN/aislamiento & purificación , Regulación de la Expresión Génica , Células HeLa , Humanos , Interleucina-2/genética , Activación de Linfocitos/genética , Ratones , Datos de Secuencia Molecular , Factores de Transcripción NFATC , Proteína Quinasa C/metabolismo , Procesamiento Proteico-Postraduccional , ARN Mensajero/biosíntesis , Transducción de Señal , Linfocitos T/metabolismo , Timo/citología , Timo/metabolismo , Factores de Transcripción/química , Factores de Transcripción/genética , Factores de Transcripción/aislamiento & purificación
15.
Am J Sports Med ; 22(2): 230-5, 1994.
Artículo en Inglés | MEDLINE | ID: mdl-8198192

RESUMEN

Nineteen consecutive cases of posttraumatic arthrofibrosis of the elbow secondary to a fracture or fracture-dislocation and treated with arthroscopic debridement and manipulation were retrospectively reviewed. All of the patients had pain and stiffness in their elbows, and all had failed a conservative therapy program. All 19 patients were followed postoperatively for an average of 29 months (range, 12 to 51). One hundred-point scoring systems were used to evaluate subjective (pain, swelling, locking, and activities) and objective (range of motion) results. The average preoperative subjective score of 39 improved to 91 postoperatively (P = 0.0001); the objective score improved from 46 preoperatively to 81 postoperatively (P = 0.0001). Extension improved from a mean of 29 degrees to 11 degrees; flexion improved from an average of 123 degrees to 134 degrees. Fourteen patients had limitations in their sports activity preoperatively; 11 were able to return to their preinjury levels of activity after surgery. This study demonstrated good-to-excellent overall results in 79% of the patients treated with arthroscopic debridement for posttraumatic elbow arthrofibrosis. Although complete return of preinjury motion was not obtained, each patient showed a significant improvement in motion and subjective symptoms.


Asunto(s)
Desbridamiento/métodos , Lesiones de Codo , Articulación del Codo/cirugía , Fracturas Óseas/complicaciones , Luxaciones Articulares/complicaciones , Rango del Movimiento Articular , Adolescente , Adulto , Artroscopía , Niño , Articulación del Codo/patología , Femenino , Fibrosis , Humanos , Masculino , Manipulación Ortopédica , Persona de Mediana Edad , Dolor/etiología , Manejo del Dolor , Estudios Retrospectivos
16.
Am J Sports Med ; 22(1): 26-31; discussion 32, 1994.
Artículo en Inglés | MEDLINE | ID: mdl-8129106

RESUMEN

A prospective study was completed on 25 baseball players with medial side elbow pain. They were evaluated preoperatively with both computed tomography arthrogram and magnetic resonance imaging examinations of the elbow to assess the ulnar collateral ligament. At surgery, 16 of 25 patients had an abnormal ulnar collateral ligament and 9 patients had a normal ulnar collateral ligament. The computed tomography arthrogram detected abnormalities in 12 of the 14 patients with ulnar collateral ligament tearing (sensitivity, 86%). The magnetic resonance imaging scan indicated abnormalities in 8 of 14 patients (sensitivity, 57%). The specificity of the computed tomography arthrogram was 91% and the magnetic resonance imaging was 100%. A newly described "T-sign" was seen on the computed tomography arthrogram in the patients with an undersurface tear of the ulnar collateral ligament. This represented the dye leaking around the detachment of the ulnar collateral ligament from its bony insertion but remaining contained within the intact superficial layer of the ulnar collateral ligament and capsule. Both the computed tomography arthrogram and the magnetic resonance imaging scan were accurate in diagnosing a complete tear of the ulnar collateral ligament preoperatively in all cases. The main advantage of the computed tomography arthrogram was in evaluating the partial undersurface tear.


Asunto(s)
Artrografía , Béisbol/lesiones , Ligamentos Colaterales/lesiones , Lesiones de Codo , Imagen por Resonancia Magnética , Cuidados Preoperatorios , Tomografía Computarizada por Rayos X , Cúbito , Adolescente , Adulto , Artrografía/métodos , Artroscopía , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/diagnóstico por imagen , Traumatismos en Atletas/patología , Traumatismos en Atletas/cirugía , Ligamentos Colaterales/diagnóstico por imagen , Ligamentos Colaterales/patología , Ligamentos Colaterales/cirugía , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/patología , Articulación del Codo/cirugía , Estudios de Evaluación como Asunto , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/patología , Inestabilidad de la Articulación/cirugía , Imagen por Resonancia Magnética/métodos , Masculino , Estudios Prospectivos , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/métodos , Cúbito/diagnóstico por imagen , Cúbito/patología , Cúbito/cirugía
17.
Am J Sports Med ; 22(1): 33-6, 1994.
Artículo en Inglés | MEDLINE | ID: mdl-8129107

RESUMEN

Seven patients were diagnosed with an undersurface tear of the deep capsular layer of the anterior bundle of the ulnar collateral ligament. Preoperatively, all of the patients had tenderness over the anterior bundle of the ulnar collateral ligament and pain with valgus stressing of the elbow. Six of the seven patients had a normal magnetic resonance imaging scan, with one magnetic resonance imaging scan showing degeneration within the ligament. All of the patients had a negative computed tomography arthrogram for extracapsular contrast extravasation. A consistent finding in five of the seven patients was a leak of contrast around the edge of the humerus or ulna, although the contrast was contained within the joint. At arthroscopic evaluation, all of the patients demonstrated medial elbow instability as valgus stress was applied across the elbow joint in 70 degrees of flexion. All of the patients underwent open medial elbow surgery, where the ulnar collateral ligament was visualized and found to be intact externally. But when the anterior bundle was incised, there was a detachment of the undersurface of the ligament at the ulna or the humerus. Cadaveric dissections were performed to define the anatomy of the insertion sites and to confirm that this lesion was not an anatomic variant. A tear of the deep layer of the ulnar collateral ligament can result in symptomatic instability that is difficult to diagnose with conventional preoperative testing. This lesion of the anterior bundle of the ulnar collateral ligament has not been previously reported, and in our series it was associated with persistent medial elbow pain in throwing athletes.


Asunto(s)
Béisbol/lesiones , Ligamentos Colaterales/lesiones , Lesiones de Codo , Cúbito , Adulto , Artrografía , Artroscopía , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/diagnóstico por imagen , Traumatismos en Atletas/patología , Ligamentos Colaterales/diagnóstico por imagen , Ligamentos Colaterales/patología , Medios de Contraste , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/patología , Humanos , Húmero/patología , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/patología , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos X , Cúbito/patología
18.
J Orthop Trauma ; 7(4): 331-7, 1993.
Artículo en Inglés | MEDLINE | ID: mdl-8377042

RESUMEN

Twenty-two femoral shaft fractures in 20 patients aged 10-14 years with open physes treated with closed reamed intramedullary nailing were studied retrospectively. Follow-up averaged 26.7 months in 18 of 20 patients. Eleven additional patients with 11 femoral shaft fractures treated with casting and traction were included for comparison of hospitalization time, cost, and time to mobilization. All of the fractures treated with an intramedullary nail healed without malunion or leg length inequality, and there was no evidence of growth plate arrest. The patients treated with an intramedullary nail had statistically significant shorter hospitalizations and shorter times to mobilization, and treatment had an estimated cost of less than half of traction treatment. Results of this study suggest that closed intramedullary nailing of femur fractures in adolescents is an effective treatment option.


Asunto(s)
Moldes Quirúrgicos/normas , Fracturas del Fémur/terapia , Fijación Intramedular de Fracturas/normas , Tracción/normas , Adolescente , Moldes Quirúrgicos/economía , Niño , Ambulación Precoz , Fracturas del Fémur/clasificación , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/fisiopatología , Estudios de Seguimiento , Fijación Intramedular de Fracturas/economía , Curación de Fractura , Costos de la Atención en Salud , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Radiografía , Rango del Movimiento Articular , Estudios Retrospectivos , Tracción/economía , Resultado del Tratamiento
19.
Hum Immunol ; 30(2): 77-84, 1991 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-2022497

RESUMEN

Most autoimmune disorders are associated with particular alleles of the major histocompatibility complex (MHC) class II genes. However, only a minority of individuals with these alleles develop autoimmunity. The identification of alleles more closely associated with an autoimmune disorder such as lupus would facilitate screening and diagnosis and perhaps the understanding of mechanisms of disease. Analysis of sequence variation in the polymorphic first domain of the MHC genes HLA DQ beta and DQ alpha has revealed a novel DQ beta allele in two Caucasian lupus patients and no Caucasian controls. The novel DQ beta allele shares polymorphic amino acids at positions 26 to 30 and 57 with other lupus-associated DQ beta alleles. These hypervariable regions may play a role in lupus susceptibility and may provide insights into the molecular mechanism for this susceptibility.


Asunto(s)
Alelos , Antígenos HLA-DQ/genética , Lupus Eritematoso Sistémico/genética , Secuencia de Aminoácidos , Secuencia de Bases , Cadenas beta de HLA-DQ , Humanos , Datos de Secuencia Molecular
20.
Arthritis Rheum ; 33(10): 1542-53, 1990 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-1977392

RESUMEN

Susceptibility to systemic lupus erythematosus is associated with major histocompatibility complex (MHC)--encoded genes. We have used nucleotide sequence analysis to better define the disease-associated MHC alleles. HLA-DR2, DQw1, and especially the rare allele DQ beta 1. AZH confer high relative risk (RR = 14) for lupus nephritis in a Caucasian population of patients. Pilot studies using historical controls suggest that these genes also confer a high risk in non-Caucasian ethnic groups (RR = 24-78). We have found that DR4 is significantly decreased in patients with lupus nephritis. Fifty percent of the patients with lupus nephritis had either the DQ beta 1.1, the DQ beta 1.AZH, or the DQ beta 1.9 alleles. These alleles share amino acid residues that have been predicted to be the contact points for antigen and the T cell receptor. These HLA alleles appear to have a direct role in the predisposition to lupus nephritis, whereas DR4 may have a "protective" effect.


Asunto(s)
Lupus Eritematoso Sistémico/genética , Complejo Mayor de Histocompatibilidad/genética , Alelos , Proteínas del Sistema Complemento/genética , Susceptibilidad a Enfermedades , Genes Reguladores/genética , Antígenos HLA-DQ/genética , Cadenas beta de HLA-DQ , Antígeno HLA-DR4/genética , Antígenos de Histocompatibilidad Clase II/genética , Humanos , Lupus Eritematoso Sistémico/epidemiología , Lupus Eritematoso Sistémico/etiología , Proyectos Piloto , Polimorfismo Genético/genética , Polimorfismo de Longitud del Fragmento de Restricción , Factores de Riesgo
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