Analytic Form of Planar Two-Loop Five-Gluon Scattering Amplitudes in QCD.

We present the analytic form of the planar two-loop five-gluon scattering amplitudes in QCD for a complete set of independent helicity configurations of external gluons. These include the first analytic results for five-point two-loop amplitudes relevant for the computation of next-to-next-to-leading-order QCD corrections at hadron colliders. The results were obtained by reconstructing analytic expressions from numerical evaluations. The complexity of the computation is reduced by exploiting physical and analytical properties of the amplitudes, employing a minimal basis of so-called pentagon functions that have recently been classified.

Skeletal muscle and plasma concentrations of cefazolin during complex paediatric spinal surgery.

BACKGROUND: Surgical site infections (SSIs) can have devastating consequences for children who undergo spinal instrumentation. Prospective evaluations of prophylactic cefazolin in this population are limited. The purpose of this study was to describe the pharmacokinetics and skeletal muscle disposition of prophylactic cefazolin in a paediatric population undergoing complex spinal surgery. METHODS: This prospective pharmacokinetic study included 17 children with adolescent idiopathic scoliosis undergoing posterior spinal fusion, with a median age of 13.8 [interquartile range (IQR) 13.4-15.4] yr and a median weight of 60.6 (IQR 50.8-66.0) kg. A dosing strategy consistent with published guidelines was used. Serial plasma and skeletal muscle microdialysis samples were obtained during the operative procedure and unbound cefazolin concentrations measured. Non-compartmental pharmacokinetic analyses were performed. The amount of time that the concentration of unbound cefazolin exceeded the minimal inhibitory concentration for bacterial growth for selected SSI pathogens was calculated. RESULTS: Skeletal muscle concentrations peaked at a median of 37.6 (IQR 26.8-40.0) µg ml(-1) within 30-60 min after the first cefazolin 30 mg kg(-1) dose. For patients who received a second 30 mg kg(-1) dose, the peak concentrations reached a median of 40.5 (IQR 30.8-45.7) µg ml(-1) within 30-60 min. The target cefazolin concentrations for SSI prophylaxis for meticillin-sensitive Staphylococcus aureus (MSSA) and Gram-negative pathogens were exceeded in skeletal muscle 98.9 and 58.3% of the intraoperative time, respectively. CONCLUSIONS: For children with adolescent idiopathic scoliosis undergoing posterior spinal fusion, the cefazolin dosing strategy used in this study resulted in skeletal muscle concentrations that were likely not to be effective for intraoperative SSI prophylaxis against Gram-negative pathogens.

Inflammation and tissue damage in mouse lung by single and repeated dosing of urban air coarse and fine particles collected from six European cities.

The authors have previously demonstrated heterogeneities in the inflammatory activities of urban air fine (PM(2.5-0.2)) and coarse (PM(10-2.5)) particulate samples collected from six European cities with contrasting air pollution situations. The same samples (10 mg/kg) were intratracheally instilled to healthy C57BL/6J mice either once or repeatedly on days 1, 3, and 6 of the study week. The lungs were lavaged 24 h after the single dose or after the last repeated dosing. In both size ranges, repeated dosing of particles increased the total cell number in bronchoalveolar lavage fluid (BALF) more than the respective single dose, whereas cytokine concentrations were lower after repeated dosing. The lactate dehydrogenase (LDH) responses increased up to 2-fold after repeated dosing of PM(2.5-0.2) samples and up to 6-fold after repeated dosing of PM(10-2.5) samples. PM(10-2.5) samples evoked a more extensive interstitial inflammation in the mouse lungs. The constituents with major contributions to the inflammatory responses were oxidized organic compounds and transition metals in PM(2.5-0.2) samples, Cu and soil minerals in PM(10-2.5) samples, and Zn in both size ranges. In contrast, poor biomass and coal combustion were associated with elevated levels of polycyclic aromatic hydrocarbons (PAHs) and a consistent inhibitory effect on the inflammatory activity of PM(2.5-0.2) samples. In conclusion, repeated intratracheal instillation of both fine and coarse particulate samples evoked enhanced pulmonary inflammation and cytotoxicity compared to single-dose administration. The sources and constituents of urban air particles responsible for these effects appear to be similar to those encountered in the authors' previous single-dose study.

Infection with the roundworm Toxocara canis leads to exacerbation of experimental allergic airway inflammation.

BACKGROUND: Epidemiological studies performed in developing as well as in western countries suggest that infection with Toxocara canis contributes to the development of atopic diseases. OBJECTIVES: To investigate the association between infection with this helminth and allergy, we examined the effect of T. canis infection on experimental allergic airway inflammation. METHODS: BALB/c mice were infected by oral administration with 500 embryonated T. canis eggs followed by ovalbumin (OVA) sensitization and challenge to induce allergic airway inflammation. RESULTS: Infection with T. canis in combination with OVA treatment leads to exacerbation of pulmonary inflammation, eosinophilia, airway hyperresponsiveness, OVA specific and total IgE. Relative quantification of cytokine expression in the lungs of these mice showed increased expression of IL-4 compared with mice that were only T. canis infected or OVA treated. Increased expression of IL-5 and IL-10 was measured in the lungs of T. canis-infected or OVA-treated mice compared with controls; however, combining infection and OVA treatment did not significantly change the expression of these cytokines. CONCLUSION: A previous infection with T. canis leads to exacerbation of experimental allergic airway inflammation. These results have important consequences for findings on the helminths-allergy association. Several factors, including parasite species, infection of definitive vs. accidental host, parasite load and timing of infection, may influence whether an infection with helminths protects one from or enhances allergic manifestations.

Subchronic inhalation of mixtures of cigarette smoke constituents in Xpa-/-p53+/- knock-out mice: a comparison of intermittent with semi-continuous exposure to acetaldehyde, formaldehyde, and acrolein.

We investigated whether inhaling peak concentrations of aldehydes several times daily is more damaging than semi-continuously inhaling low-dose aldehydes. We exposed Xpa-/-p53+/- knock-out mice either intermittently or semi-continuously to mixed acetaldehyde, formaldehyde, and acrolein. The intermittent regimen entailed exposure to the aldehydes 7 min every 45 min, 12 times/day, 5 days/week, corresponding to concentrations inhaled by smokers. Semi-continuously exposed animals received half the dose of aldehydes in 8h/day, 5 days/week. Some mice in each group were sacrificed after 13 weeks of exposure; the rest breathed clean air until the end of 1 year. Mice injected intratracheally with benzo[a]pyrene formed a positive control group. The nasal cavity, lungs, and any macroscopically abnormal organs of all mice were analysed histopathologically. After 13 weeks of exposure, the subacute, overall, histopathological changes induced by the inhalation differed noticeably between the intermittently and semi-continuously treated Xpa-/-p53+/- knock-out mice. After 13 weeks of mixed aldehyde exposure, atrophy of the olfactory epithelium generally appeared, but disappeared after 1 year (adaptation and/or recovery). Respiratory epithelial metaplasia of the olfactory epithelium occurred at a higher incidence at 1 year. Except for a significantly greater number of tumours observed in knock-out mice compared to wild mice (semi-continuous aldehyde exposure and controls), no differences between the semi-continuous and intermittent exposure groups were observed.

Antitumor effect, cardiotoxicity, and nephrotoxicity of doxorubicin in the IgM solid immunocytoma-bearing LOU/M/WSL rat.

Antitumor activity, cardiotoxicity, and nephrotoxicity induced by doxorubicin were studied in LOU/M/WSL inbred rats each bearing a transplantable solid IgM immunocytoma. Animals with a tumor (diameter, 15.8 +/- 3.3 mm) were treated with iv injections of doxorubicin on 5 consecutive days, followed by 1 weekly injection for 7 weeks (dose range, 0.015-4.0 mg/kg body wt). Tumor regression was observed with 0.5 mg doxorubicin/kg. Complete disappearance of the tumor was induced with 1.0 mg doxorubicin/kg. Histologic evidence of cardiotoxicity scored as grade III was only observed at a dose of 1.0 mg doxorubicin/kg. Light microscopic evidence of renal damage was seen above a dose of 0.5 mg doxorubicin/kg, which resulted in albuminuria and very low serum albumin levels. In the group that received 1.0 mg doxorubicin/kg, the serum albumin level decreased from 33.6 +/- 4.1 to 1.5 +/- 0.5 g/liter. Ascites and hydrothorax were observed simultaneously. The same experiments were performed with non-tumor-bearing rats, in which no major differences were observed. In conclusion, antitumor activity, cardiotoxicity, and nephrotoxicity were studied simultaneously in the same LOU/M/WSL rat. Albuminuria due to renal damage led to extremely low serum albumin levels, so ascites and hydrothorax were not necessarily a consequence of the observed cardiomyopathy.

Time-course study on doxorubicin-induced nephropathy and cardiomyopathy in male and female LOU/M/Wsl rats: lack of evidence for a causal relationship.

In a previous study on doxorubicin-induced cardiotoxicity in LOU/M/Wsl rats, severe nephropathy has been observed; therefore, the question was raised whether nephropathy adds to or even might be responsible for doxorubicin-induced cardiomyopathy in rats. For elucidation of this question, the temporal relationship between the onset of doxorubicin-induced cardiomyopathy and nephropathy was studied. In addition, examination was made of whether modifications of the treatment schedule could circumvent nephrotoxicity. Because preliminary studies had shown that female LOU/M/Wsl rats developed less doxorubicin-induced albuminuria, both male and female LOU/M/Wsl rats were treated with an iv dose of 1 mg doxorubicin/kg (body wt)/rat on five consecutive days and then weekly. Saline-treated animals served as controls. Albuminuria, serum albumin, and serum creatine levels were assessed weekly. For histologic examination, 5 male and 5 female rats were killed weekly. At day 14 and thereafter, doxorubicin-treated male rats showed albuminuria greater than or equal to 10 g/liter. Albuminuria of greater than or equal to 10 g/liter was not avoided by modifications of the treatment schedule. Female rats had on day 14 a urinary albumin level of 1.0-3.0 g/liter, yet reaching the level of greater than or equal to 10 g/liter at day 49. In male rats serum albumin levels decreased to levels below 10 g/liter (p less than .001 vs. finding for day 0); in contrast female rats maintained constant serum albumin levels till day 49. Serum creatine levels showed a tendency to rise, the values of male rats not being measured after day 28 due to hyperlipidemia; the levels of female rats increased from 37.8 +/- 3.0 mumol/liter to 53.7 +/- 2.5 mumol/liter on day 49 (P less than .001). At day 10 in male and female rats a grade 1-1.5 cardiomyopathy score, assessed according to the modified Billingham scoring system, was found, gradually increasing to grade 2.5-3 cardiomyopathy, both in males and females, on day 49. In male LOU/M rats the nephropathy developed steadily from day 14 and thereafter, whereas in females the rate of development of kidney damage was slower and at the end point of the study the severity of kidney lesions was less in comparison to that of the males. The onset of cardiomyopathy and nephropathy was simultaneous. It was concluded that cardiomyopathy observed in LOU/M rats is a phenomenon independent of nephropathy.

Failure of the antioxidant vitamin E to protect against adriamycin-induced cardiotoxicity in the rabbit.

Recently, vitamin E has been proposed to protect against Adriamycin-induced cardiotoxicity. We studied contractile decline and ultramicroscopic alterations of the heart of rabbits chronically treated with Adriamycin up to a cumulative dose of 400 mg/sq m. High doses of vitamin E did not protect against the Adriamycin-induced development of severe contractile decline as evaluated by means of measurement of the interval-force relationship curve. Light and electron microscopic analysis did not show any signs of protection against Adriamycin-induced morphological alterations. Biochemical and hematological alterations. Biochemical and hematological alterations caused by the antineoplastic agent were similar in both Adriamycin-treated animal groups. Coadministration of vitamin E did result in an increased life span. This study indicates that vitamin E does not protect against the development of cardiomyopathy and contractile decline after chronic exposure to Adriamycin.

Evidence for a diminished maturation of preosteoblasts into osteoblasts during aging in rats: an ultrastructural analysis.

Bone is subject to continuous remodeling throughout life. The age-related loss of (trabecular) bone, leading to senile osteopenia, is mainly due to impaired bone formation. Osteoblasts (OB) and osteoclasts (OC) have been identified as playing a crucial role in the process of bone turnover, but the contribution made by their precursors is not well documented. We analyzed the cells of the osteoblast and osteoclast cell lineage along the trabecular bone of tibiae and the stromal cells in the marrow of aging BN/Bi Rij rats using electron microscopy. It appeared possible to distinguish preosteoblasts (pre-OB), OB, preosteoclasts (pre-OC), OC, and inactive bone-lining cells. Periods of increase, the maximal peak, and the decrease in trabecular bone volume were defined by means of morphometric measurements of trabecular bone volume. We found a decrease of more than 10-fold in the number of OB with age, but the numbers of pre-OB, pre-OC, and OC expressed per unit bone length, although variable, were age independent. The relative bone resorption and formation surface, expressed as a percentage of the total bone surface, decreased 2- and 15-fold, respectively. In 2-year-old animals the total volume of stromal cells, part of which constitutes the stem cell compartment of the osteogenic lineage, was a quarter of that found in 1-month-old animals and a third of that found in 6-month-old animals. The loss of trabecular bone is concomitant with a sharp increase in the ratio of pre-OB/OB, the ratio of OC/OB, and in the ratio of resorption to formation surfaces. There was no relation between the ratio of pre-OC/OC with age. These data lead to the conclusion that the main factor causing bone loss with age is a diminished maturation of pre-OB into OB.

A rat cytomegalovirus infection model as a tool for immunotoxicity testing.

A rat cytomegalovirus infection model for use in immunotoxicity testing has been developed. In resistance against viruses, natural killer cells and cytotoxic T-cells play an important role. Therefore, this model complements other rat host resistance models for immunotoxicity testing, i.e. existing bacterial and parasitic infection models in which cytotoxic T-cells and natural killer cells play a minor role. Host resistance against cytomegalovirus infections in the rat was determined by titrating infectious virus levels in organs after cytomegalovirus infection in an in vitro infectivity test denoted as the Plaque Forming Unit (PFU) Test. In this test, homogenates of different organs were investigated for infectious virus titers on rat embryonic cell monolayers. We demonstrated that in the salivary gland, the major target organ for rat cytomegalovirus, virus was detectable from 8 days onward after intraperitoneal infection. To show that this model is suitable for the detection of immunotoxicity four different methods for immunosuppression were investigated: 1. gamma-irradiation, 2. congenitally athymic rats, 3. chemically induced immunosuppression, 4. ultraviolet-B (UVB) irradiation. Rat cytomegalovirus titers in the salivary glands of irradiated (500 rad 1 day prior to infection) or congenitally athymic rats were significantly increased as compared to non-irradiated rats and euthymic control rats respectively. In TOX-Wistar rats, given 20 or 80 mg bis(tri-n-butyltin)oxide (TBTO) per kg food beginning 6 weeks before cytomegalovirus infection, a regimen known to have immunotoxic effects, cytomegalovirus titers in the salivary glands were significantly increased as compared to non-TBTO-treated cytomegalovirus infected rats.(ABSTRACT TRUNCATED AT 250 WORDS)

The orthopedists' perspective: bone tumors, scoliosis, and trauma.

Although a detailed, comprehensive look at pediatric orthopedists' use of imaging is beyond the scope of this article, we offer an orthopedist's perspective of the role imaging plays in the care of children with tumors, scoliosis, and trauma. Given the growing, dynamic state of a child's skeleton, the long-term consequences of injury must always be considered.

Changes in neuroreceptor function of tracheal smooth muscle following acute ozone exposure of guinea pigs.

We studied the effect of in vivo ozone inhalation (3 ppm, 2 h) on neuroreceptor function in guinea pig tracheal smooth muscle in vitro and the role of the epithelial layer in this process. Changes in smooth muscle tension after stimulation of the muscarinic- and beta-adrenergic receptor were recorded isometrically and stained tracheal tissue sections were histologically evaluated for changes in the epithelial and smooth muscle layer. Ozone exposure resulted in an increase in maximal contraction following stimulation of the muscarinic receptor, whereas pD2 values remained unchanged. After stimulation of the beta-adrenergic receptor no increase in maximal relaxation but only an increase in pD2 value was observed after correction for differences in precontraction level in control- and ozone-exposed situations. Mechanical removal of the epithelial layer resulted in a slight increase of the maximal contraction level after stimulation with methacholine in the control situation, whereas exposure to ozone resulted in a strong decrease of the maximal contraction level under these conditions. Histological stainings showed a slight and focal influx of neutrophilic granulocytes in the epithelial layer, submucosal layer and airway lumen after exposure to ozone. These data support the idea that ozone is able to increase the maximal degree of airway narrowing upon muscarinergic stimulation, i.e. a hyperreactivity response. The results also suggest that functionally altered epithelium plays an important role in the process of ozone-induced hyperreactivity, possibly linked with an early inflammatory response.

Ultrasonographic evaluation of the elbow in infants and young children after suspected trauma.

Fractures and epiphyseal injuries in the region of the elbow are uncommon in infants and young children, but they can be very difficult to diagnose and delineate accurately. In addition to plain radiography, invasive or costly procedures such as arthrography and magnetic resonance imaging traditionally have been used to evaluate these injuries. We used high-resolution real-time ultrasonography to evaluate a suspected injury of the elbow in seven infants and one ten-year-old child. Three of the infants had a physeal separation, two had a supracondylar fracture, and two had no skeletal injury. The child had an avulsion fracture of the lateral epicondyle of the humerus and an effusion in the joint. The ultrasonographic findings were confirmed by arthrography in three patients, by open reduction in one, and by follow-up radiographs in all. None of the ultrasonographic studies were performed with the patient under general anesthesia. Ultrasonography, a readily available, non-invasive technique, can be used to evaluate the unossified epiphysis about the elbow of infants and young children; to demonstrate dislocations, fractures, and physeal separations; to identify a hinge of soft tissue at the site of a fracture; to identify interposition of soft tissue between fracture fragments; and to aid in the planning of closed and open reductions.

Complications in children managed with immobilization in a halo vest.

Thirty-seven patients who were three to sixteen years old were managed with immobilization in a halo vest between 1987 and 1993. Twenty-four patients (65 per cent) had the halo vest applied in conjunction with operative arthrodesis of the cervical spine; the remaining thirteen patients (35 per cent) had the halo vest applied to immobilize the cervical spine after trauma. Complications occurred in twenty-five patients (68 per cent). Pin-site infections were the most common complications, developing in twenty-two patients. Grade-II infections (purulent drainage) developed more frequently in children who were eleven years old or more: they were identified in five of fourteen such patients, compared with two of twenty-three patients who were ten years old or less. There was a tendency toward more grade-I infections (non-purulent drainage, with or without erythema) and loosening of the pins in the children who were ten years old or less: eleven of twenty-three such patients had each of those complications, compared with four of fourteen children who were eleven years old or more. Both loosening and infection occurred more frequently at the anterior pin sites. Other complications included one dural penetration, one transient injury of the supraorbital nerve, and three pin-site scars that were considered by the family to be objectionable. There were no complications related to the vest part of the halo vest. Younger patients who had a halo construct with more than four pins (multiple-pin constructs) had a similar rate of complications compared with patients who were managed with a standard four-pin halo construct.(ABSTRACT TRUNCATED AT 250 WORDS)

Occipitocervical arthrodesis in children. A new technique and analysis of results.

A new wiring technique for occipitocervical arthrodesis was used in sixteen consecutive children between 1985 and 1992. The twelve boys and four girls had an average age of nine years and six months (range, two years and five months to nineteen years and three months) at the operation. The arthrodesis was performed between the occiput and the second cervical vertebra in ten patients and between the occiput and the third cervical vertebra in six. The instability was related to congenital anomalies (six patients), decompression for cervical stenosis (four patients), Down syndrome (three patients), trauma (one patient), resection of a tumor (one patient), and neurofibromatosis (one patient). Six patients needed a laminectomy for decompression because of cervical stenosis or for removal of a tumor. All of the patients were managed with an autogenous bone graft from the iliac crest and postoperative immobilization with a halo device. Fusion was achieved in fifteen of the sixteen patients. Complications developed in seven patients. The use of wire fixation, combined with the inherent stability of the bone-graft construct, allowed for removal of the halo device relatively early (range, six to twelve weeks), before the fusion was fully mature. No graft was displaced. All of the patients were followed at least until there was radiographic evidence of fusion (fifteen patients) or until a reoperation was performed (one patient). The average duration of follow-up was thirty-seven months (range, twelve to 108 months).

Intraoperative anaphylaxis due to exposure to latex (natural rubber) in children.

Intraoperative anaphylaxis secondary to exposure to latex is a serious and potentially life-threatening phenomenon that has been recognized more frequently in recent years. Between 1989 and 1992, twenty-one patients had a Type-I (anaphylactic) reaction to latex intraoperatively at The Children's Hospital of Philadelphia. Twelve (57 per cent) of these patients had spina bifida. Six patients (29 per cent) had cerebral palsy, and five of them had a ventriculoperitoneal shunt. Of the remaining three patients, one (5 per cent) had exstrophy of the bladder, one had VATER syndrome, and one had Duchenne muscular dystrophy. All of the patients had had at least two previous operative procedures. Overall, sixteen patients (76 per cent) had a ventriculoperitoneal shunt. The manifestations of the allergic reaction included a rash in fifteen patients (71 per cent), hypotension in fifteen, tachycardia in eleven (52 per cent), bronchospasm in ten (48 per cent), bradycardia in two (10 per ent), and cardiac arrest in two. The symptoms occurred within minutes after the induction of the anesthesia in all but one patient, in whom hypotension and cardiovascular arrest developed approximately one hour after the beginning of the operation. Two patients had a full cardiopulmonary arrest while under the anesthesia. All twenty-one patients responded to management; there were no deaths. Of the six patients who had cerebral palsy, five had been managed with a ventriculoperitoneal shunt because of hydrocephalus following a previous intraventricular hemorrhage that was related to prematurity.(ABSTRACT TRUNCATED AT 250 WORDS)

Results of brace treatment of scoliosis in Marfan syndrome.

STUDY DESIGN: Retrospective review of a defined Marfan population with traditional indications for bracing. OBJECTIVES: To determine the success rate of brace treatment in keeping curves from progressing by more than 5 degrees or exceeding 45 degrees. SUMMARY OF BACKGROUND DATA: Few studies exist regarding brace treatment of Marfan syndrome, and they include many patients with curves of more than 45 degrees, as well as some who are near maturity. All of the prior studies risk the possibility of some selection bias. METHODS: Patients were selected from support groups and several institutions. Inclusion criteria were: Definite diagnosis of Marfan syndrome, curve of 45 degrees or less, Risser sign 2, 1, or 0 at inception of bracing, recommended wear of 18 hours or more per day, and follow-up until maturity or surgery (minimum, 2 years). Success was defined as curve progression of 5 degrees or less and final curve remaining 45 degrees or less. Failure was a final curve of more than 45 degrees. Twenty-four patients met the criteria. There were 15 girls and 9 boys. Twenty-two patients wore a brace as recommended. Two additional patients were unable to tolerate it. RESULTS: Mean age at inception of bracing was 8.7 years (range, 4-12 years). There were 14 double major, 6 thoracic, and 4 thoracolumbar curves with a mean size of 29 degrees at the beginning of bracing. The stated wearing time averaged 21 hours per day. Five patients had significant pain over bony prominences. Although correction of the curve in brace was good (45%), only 4 of the patients had success, and in 20 of the 24 treatment was considered a failure. Mean progression was 6 degrees +/- 8 degrees per year, for a final mean curve of 49 degrees. Sixteen of the patients had, or were advised to have, surgical correction. The difference in age and degree of curvature were not statistically significant between the success and nonsuccess groups. CONCLUSIONS: The success rate for brace treatment of Marfan scoliosis is 17%, which is lower than that reported for idiopathic scoliosis. Possible reasons include increased progressive forces, altered transmission of corrective pressure to the spine, and younger age at inception of bracing. Because there was no control group, it is unknown whether bracing slowed curve progression. Physicians should understand that most patients with Marfan syndrome who have a curve of more than 25 degrees and a Risser sign of 2 or less will reach the surgical range, even with brace treatment.

A comparison of various angles of halo pin insertion in an immature skull model.

STUDY DESIGN: A basic science biomechanical study involving an animal model. OBJECTIVES: To evaluate the effect of varying angles of halo pin insertion on the force generated at the pin-bone interface, and thereby the stability of the halo pin-bone interaction during insertion. BACKGROUND DATA: Because of variations in the shape and size of the pediatric skull, halo pins often are inserted at various angles rather than perpendicular to the skull. Concern exists that the high complication rate associated with pediatric halo use may result in part from less than ideal structural properties at the halo pin-bone interface. METHODS: The authors used a fetal calf skull model to simulate the thickness and structural properties of the pediatric skull. Halo pins were inserted at angles of 0 degree (perpendicular), 10 degrees, 15 degrees, and 30 degrees into skull segments via a halo ring. Load generated at the pin-bone interface was measured using a modified mechanical testing device. Twenty trials were conducted per angle, with the endpoint being specimen failure, pin penetration, or maximum load. RESULTS: Mean maximum loads per unit thickness were 82.15 +/- 7.54 N/mm at 0 degree, 68.80 +/- 4.79 N/mm at 10 degrees, 51.49 +/- 5.08 N/mm at 15 degrees, and 42.38 +/- 3.51 N/mm at 30 degrees, There was a significant difference between perpendicular insertion (0 degree) and 15 degrees angles of insertion. There was also a significant difference between the 10 degrees and 30 degrees angles of insertion. CONCLUSIONS: Perpendicular halo pin insertion in an immature skull model was shown to result in increased load at the pin-bone interface. This improved structural behavior may help to reduce the incidence of complications of halo application in children.

A technique of occipitocervical arthrodesis in children using autologous rib grafts.

STUDY DESIGN: Description of an operative technique with an illustrative case report. OBJECTIVES: The technique is presented to provide an alternative to iliac crest graft procedures for achieving occipitocervical fusion in children. This technique is particularly useful in children with instability after extensive decompression or laminectomy and in children with a large protuberant occiput. SUMMARY OF BACKGROUND DATA: The majority of techniques previously described for occipitocervical fusion in children rely on corticocancellous iliac crest autograft. Results generally have been promising; however, it can be difficult to harvest enough graft to span large defects after extensive decompression or to contour an iliac crest graft to a protuberant occiput. Structural rib autograft is superior in terms of availability and its unique and modifiable contour. Theoretical benefits of rib graft include superior strength and lower donor site morbidity. METHODS: The surgical technique is described. A case of a 2-year-old boy with Down's syndrome and myelopathy secondary to cervical instability is reviewed. RESULTS: The patient underwent occipitocervical arthrodesis using the technique described. The child made a full neurologic recovery, and at the 2-years follow-up evaluation, the graft had incorporated and the spine was stable. CONCLUSION: A technique of occipitocervical arthrodesis in children is described using autologous rib graft. This procedure was designed to span large defects or to deal with a large protuberant occiput; however, it is also useful for less demanding cases and may offer several advantages compared with procedures relying on iliac crest graft.

Anterior vertebral screw strain with and without solid interspace support.

STUDY DESIGN: This in vitro biomechanical study examines segmental anterior vertebral screw strain and solid rod construct stiffness with and without the addition of multilevel, threaded cortical bone dowels in a bovine model. OBJECTIVE: To determine whether strain at the bone-screw interface is higher at the end levels during physiologic range loading, and whether solid interspace support decreases segmental strain on the implant. SUMMARY OF BACKGROUND DATA: Anterior instrumentation provides greater correction and preserves distal motion segments. However, nonunion and implant failure are observed more frequently than with posterior segmental instrumentation, and when observed, loss of fixation occurs at the end levels. METHODS: Eight calf spines underwent mechanical testing in the following sequence: 1) intact condition, 2) anterior release with anterior solid rod and bicortical rib grafts, and 3) anterior release with anterior solid rod and threaded cortical bone dowels (L2-L5). Instrumented vertebral screws were used to assess strain within the vertebral body by the near cortex, whereas an anterior extensometer spanning the instrumented segments was used to measure segmental displacements to calculate construct stiffness. The protocol included axial compression (-400 N), right lateral bending (4 Nm (Newton-meter), away from the implant), and left lateral bending (4 Nm, toward the implant). Statistical analysis included a one-way analysis of variance and a Student-Newman-Keuls post hoc test. A pilot study was performed using four additional specimens loaded for 4000 cycles to investigate macroscopic loosening after fatigue loading. RESULTS: In lateral bending toward the implant, the strain was higher at both end levels, with no differences between the rib and dowel reconstructions. The stiffness values were greater than the intact values for both groups. In lateral bending away from the implant, the strain also was higher at both end screws, and the dowel group had less strain at these levels than the rib group. Both groups were stiffer than the intact condition, and the dowel group was stiffer than the rib group. Axial compressive strain also was higher at the end levels, but this difference did not reach statistical significance. The rib group did not reach intact stiffness values, whereas the dowel group was stiffer than the intact condition. The fatigue study showed gross loosening at one or both end levels in all cases. CONCLUSIONS: Higher strain was observed at the bone-screw interface in both end screws of an anterior solid rod construct during lateral bending, which correlates with the clinically observed failure location. This suggests that physiologic range loading may predispose to failure at the end levels. Disc space augmentation with solid implants increased construct stiffness in all three load paths and decreased strain at the end levels in lateral bending away from the implant. Future implant modifications should achieve better fixation at the end screws, and the current model provides a means to compare different strategies to decrease strain at these levels.