Posterior cruciate avulsion fracture associated with a large inverted medial tibial osteochondral fragment

A case of traumatic avulsion fracture of the posterior cruciate ligament in association with a large osteochondral fracture of the medial tibial condyle is described. The osteochondral fragment was inverted 180 degrees. Many associated injuries of the posterior cruciate ligament have been described. This unusual combination of fractures to the best of our knowledge has not been reported before. The mechanism of injury and its clinical implications are discussed.

[Changes of HDL-receptor of hepatic cell membrane in rabbit model of calcium bilirubinate cholangiolithiasis]

HDL-receptor of the hepatic cell membrane and Fch level of the hepatic tissue in the rabbit model of calcium bilirubinate cholangiolithiasis were examined. The results showed: (1)the HDL-receptors' Bmax of the biliary obstruction and infection (BOI) and biliary obstruction (BO) groups decreased during the 1st week after operation (P < 0.01); they were only 69.09% and 49.09% of that in the control group respectively, and the lowered level continued until the 6th week; the Kd values of BOI and BO groups were not different from that of the control group during the 1st week, but they were significantly higher in the 6th week after operation (P < 0.01); (2)the Fch levels of the hepatic tissue were slightly decreased in all experimental groups (P < 0.05). We concluded that under the conditions of biliary obstruction and infection, there was a disorder of the HDL receptors of hepatic cell membrane. At the early stage of biliary obstruction and infection, the receptors decreased in number, and at the later stage, the affinity changed and less HDL entered into the hepatic cell. Then the precurser cholesterol pool for BA biosynthesis narrowed. Thus, BA secreted from the liver cells into genetic elements possibly promote the formation of the calcium bilirubinate gallstones.

Na,K-ATPase beta subunit isoform expression in the peripheral nervous system of the rat

Using the RNase protection assay (RPA) to study the distribution of isoforms of the non-catalytic (beta) subunit of Na,K-ATPase in the peripheral nervous system, we found both beta 1 and beta 2 isoform mRNAs in dorsal root ganglion (DRG), but only beta 2 mRNA in sciatic nerve. Using Western blot to measure accumulation of the polypeptides at a ligature on the nerve we found that beta 1 but not beta 2 polypeptide is carried by rapid axonal transport in the sciatic nerve. These results imply that beta 1 is the prominent isoform of Na,K-ATPase in neurons and beta 2 the prominent isoform in Schwann cells.

Computed tomographic osteometry of the Asian lumbar spine

The computed tomography (CT) scans of 100 adult Chinese patients 18-60 years of age were studied to provide osteometric data on the Asian lumbar spine. The study population was composed of 63 men and 37 women. A total of 29 parameters were measured from each vertebral level. All the data were statistically analyzed for differences between men and women and left and right sides for paired structures. The data then were compared with data for white individuals where available. The results show that for Asians there is a significant sex difference (p < 0.001) for vertebral body and disk dimensions but not for the posterior elements or spinal canal. Compared with white individuals, Asians have a smaller vertebral body and a different spinal canal shape, with the lower part of the canal in relation to the vertebral body being narrowest. Such findings are of significance to the radiologist, to the surgeon, and in the design of instruments and implants for the Asian lumbar spine.

Computed tomographic osteometry of Asian lumbar pedicles

STUDY DESIGN

The lumbar pedicles of 100 adult Chinese patients were studied with computed tomography to provide data on their dimensions and angular alignment. Data obtained were compared with published measurements of spines from white patients to determine similarities and differences between the lumbar spines.

SUMMARY OF BACKGROUND DATA

The age range of the patients was 18 to 60 years. There were 63 men and 37 women. There was no demonstrable sex difference for dimensions or angular alignment of the pedicles.

METHODS

The method of scanning and measurement was standardized. Levels considered abnormal by the radiologist were excluded from the study, and a single observer was used to avoid inter-observer errors. The data obtained were statistically analyzed using Student's t test to determine differences between men and women and left and right sides. Age differences were analyzed using the F statistic test. The pedicle inclination angle (transverse angle) and the pedicle dimensions were compared with published data of whites.

RESULTS

The pedicles of Asians, when compared with those of whites, showed a similar pattern of changes with vertebral level. However, Asian pedicles had a larger pedicle inclination angle (transverse angle) from L1 to L4 (L1 = 16 degrees, L2 = 16 degrees, L3 = 19 degrees, L4 = 23 degrees), whereas L5 (29 degrees) was similar to many series of whites.

CONCLUSIONS

There are differences between the lumbar pedicles of Asians and whites. Such differences need to be considered when posterior pedicle screw fixation of the spine is performed.

Pyogenic vertebral osteomyelitis: treatment by anterior spinal debridement and fusion

Forty-three patients with pathologically proven vertebral osteomyelitis were studied between 1957 and 1990. Thirty-nine underwent anterior debridement and fusion, and four underwent anterior debridement only. The indications for surgery were uncertain diagnosis, persistent pain, failed conservative treatment with uncontrolled sepsis, and neurological involvement. Thirty patients were followed-up for an average period of 5 years, with a minimum of 2 years and the longest for 15 years. All their symptoms improved after surgery; only one patient subsequently deteriorated due to multiple level recurrence. All patients with neurological deficit improved. Bony fusion occurred in 93% of cases (average time to fusion, 6.8 months), and 90% of the patients were able to return to their original work 4-20 months after surgery. We feel that anterior debridement and spinal fusion allow for reliable microbiological and histological diagnosis, and rapid relief of symptoms and return to work. Primary bone grafting is successful despite the presence of infection.

[Study of clearance and distribution of 125I-labeled apolipoprotein CIII in mice]

Using 125I-labeled human apoCIII, the clearance and distribution of 125I-apoCIII were investigated. Human apoCIII was purified from plasma VLDL. 125I-apoCIII was prepared by chloramine T method, The fraction clearance rate (FCR) value of 125I-apoCIII in mice plasma was 0.19/h with a plasma half life of 3 h. The radioactivity in different organs after the venous injection of 125I-apoCIII exhibited that the liver contained radioactivity 3-10 times as much as the reactivity in other organs, expressed by both the whole organ and 100 mg of tissues. Results show that there might occur some specific binding sites for apoCIII on liver cells.

Impacts of atmospherically deposited radionuclides on drinking water supply after a nuclear power plant accident

This paper analyzes the various possible situations in which a drinking water supply in China may be contaminated by the deposition of airborne radioactive effluent after reactor accidents occur. A model was utilized to calculate the impact of ingestion of contaminated drinking water from a reservoir after a design basic accident of a 900-MWe pressurized water reactor power station. It showed that the maximum individual effective dose caused by a contaminated drinking water supply was at most 0.02% of the total individual effective dose from a reactor design basic accident. This factor was not considered when evaluating the consequence of a reactor design basic accident since, under several unfavorable conditions, the contamination of a drinking water supply from airborne radioactive effluent after a reactor design basic accident is not a major contributor to the impact on individual effective dose. It may be necessary to consider surface water contamination by deposition of airborne radioactive effluent for an emergency plan after a serious accident.

Dependence of reaction rate of 5,5'-dithiobis-(2-nitrobenzoic acid) to free sulfhydryl groups of bovine serum albumin and ovalbumin on the protein conformations

The effect of protein conformations on the reaction rate of Ellman's reagent, 5,5'-dithiobis (2-nitrobenzoic acid) (DTNB) with sulfhydryl (SH) groups of proteins was examined. The stopped-flow method was applied to follow the reaction of DTNB with SH group of two proteins, bovine serum albumin (BSA) and ovalbumin (OVA), at various concentrations of guanidine hydrochloride and urea. The rates for both the proteins were faster in guanidine than in urea. The rate sharply depended on the protein conformations, which were monitored by changes of helix contents on the basis of the circular dichroism measurements. The reaction rate of DTNB with SH groups of BSA was maximal around 2 M guanidine and 5 M urea. On the other hand, the reaction rate of DTNB with OVA was maximal at 3.5 M guanidine, while it gradually increased with an increase in the urea concentration. The amount of reactive SH group participating in the reaction with DTNB was also estimated by the absorbance change at 412 nm. The magnitudes of absorbance change for the reaction with free SH groups of OVA at low concentrations of the denaturants were appreciably smaller than those for BSA with one free SH group. Most of the four SH groups of OVA might react with DTNB above 5 M guanidine, although only a part of them did even at 9 M urea.

A study of function and residual joint stiffness after functional bracing of tibial shaft fractures

Ninety-eight diaphyseal tibial fractures were treated with custom made functional braces in 97 patients older than 14 years of age. The average follow-up period was 1.86 years, and 53 patients had more than two years' evaluation (average, 2.83 years). The majority of the patients did not have full range of movement in the ankle and subtalar joints when the brace was removed after fracture healing. Although the stiffness decreased with time, a significant number of patients were left with residual joint stiffness. At an average follow-up period of 1.86 years, 68.4% of the patients had normal ankle motion and 60% had normal inversion and eversion of the hindfoot. In patients with more than two years' evaluation, 75.5% had normal ankle movement and 71.1% had normal inversion and eversion of the foot. In the knee joint, the incidence of residual joint stiffness was small and the amount of stiffness was clinically insignificant. Patients with an abnormal walking pattern after fracture healing had a high incidence of ankle and subtalar joint stiffness.

[A study on the tumorigenic process of mesothelioma induced by intrapleural injection of crocidolite in rats]

90 Wistar strain rats were used in this experiment, 56 rats (Group A) were injected intrapleurally with crocidolite fibers suspended in physiological (NaCl) solution. Another 34 rats (Group B), serving as controls, were injected with the same volume of mere NaCl solution. The rats were killed 1, 3, 6, 9, 12, 14 and 16 months respectively after injection. The results showed that the rats of Group B only exhibited reactive proliferation of mesothelial cells caused by inflammation. In Group A, there appeared 9 cases of mesothelioma. The tumorigenic stages of mesothelioma include three processes: (1). reactive proliferation: the mesothelial cells became cuboid. (2). precancerous changes: the atypical proliferation of stratified, nodular or papillary mesothelial cells and of the cell elements around asbestos granulomas. (3). the occurrence of mesothelioma. Ultrastructural observation revealed that in mesothelioma tissue mesenchymal cells directly or indirectly (via transitional cells) differentiated cinto epithelioid cells. The mesenchymal cells may also become fibroblastoid cells. These findings suggest that mesothelioma originates from mesenchymal cells.

Post-traumatic oedema of the foot after tibial fracture

A total of 97 patients with diaphyseal tibial fractures treated with functional bracing were studied prospectively. Persistent ipsilateral foot swelling was present in 84.5 per cent of the patients. Most of the swellings subsided with time, but a small percentage of them persisted for a duration of 2 years or more after injury. The time for disappearance of the swelling in 50 per cent of the patients was 18.6 weeks. The development of oedema is not related to the age and sex of the patients, the configuration, type and level of the fractures, or the association of a fibular fracture. The bone healed quicker in those who did not have swelling of the foot. Once the swelling has developed, it seems to run its own course and its disappearance is not related to the age and sex, the configuration, type and level of fractures, the association of a fibular fracture, or the time for fracture healing. This complication does not have any adverse effect on the functional recovery of the patients.

Post-traumatic oedema of the foot after tibial fracture

A total of 97 patients with diaphyseal tibial fractures treated with functional bracing were studied prospectively. Persistent ipsilateral foot swelling was present in 84.5 per cent of the patients. Most of the swellings subsided with time, but a small percentage of them persisted for a duration of 2 years or more after injury. The time for disappearance of the swelling in 50 per cent of the patients was 18.6 weeks. The development of oedema is not related to the age and sex of the patients, the configuration, type and level of the fractures, or the association of a fibular fracture. The bone healed quicker in those who did not have swelling of the foot. Once the swelling has developed, it seems to run its own course and its disappearance is not related to the age and sex, the configuration, type and level of fractures, the association of a fibular fracture, or the time for fracture healing. This complication does not have any adverse effect on the functional recovery of the patients.

[Studies on the histology and essential oils of the adulterant sharen in Alpinia]

Morphological studies on eighteen adulterants of Sharen in Alpinia had been carried out previously. In this paper, a report on the histology and essential oil of their seeds is presented. According to our TLC analysis and microscopical examination, the differences between genuine Sharen and its adulterants are distinct in histological characters and constituents of the essential oil. A description of identification of these eighteen seeds is given together with line drawings, chromatograms and a table for comparison.

[Morphologic studies on the adulterant sharen in Alpinia]

In this paper, morphological studies on adulterant Sharen including eighteen fruits in Alpinia are reported. The morphological differences between genuine Sharen and its adulterants are distinct on their fruits, seeds and embryos. In addition, the distinguished characters for identification of the eighteen fruits and seeds are described with drawings and compared in a table.

Anterior spinal fusion for spondylolysis and isthmic spondylolisthesis. Long term results in adults

We reviewed 20 adult patients with spondylolysis and isthmic spondylolisthesis an average of 10.5 years after treatment by anterior spinal fusion. Nineteen patients had excellent or satisfactory results. Ten of the patients were symptom-free at one year, and 15 were asymptomatic at final follow-up. Anterior spinal fusion can produce results comparable to those of posterior fusion with or without decompression. The results tend to improve with time in contrast to the known worsening of late results after posterior decompression without fusion.

[Studies on the histology and essential oil of the Chinese drug sharen and its adulterants in Amomum]

In this paper, fifteen seeds including Chinese drug Sharen and its adulterante in Amomum are studied. The histological characters of these seeds are described and compared in a table and illustrated with line drawings. The distribution of 2 constituents in essential oil of these seeds is determined by means of TLC with authentic samples.

Cervical myelopathy due to ossification of the posterior longitudinal ligament. A clinical, radiological and evoked potentials study in six Chinese patients

Six consecutive Chinese patients with cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL) who presented in a 4 yr period were studied. There were 5 males and 1 female whose mean age at presentation was 67 yrs. The common clinical features were spastic tetraparesis more marked in the lower limbs, spinothalamic and posterior column sensory deficits of varying degree and sphincter disturbance in advanced cases. OPLL was diagnosed on plain radiographs and cord compression ascertained by conventional and computer-assisted myelography. Somatosensory evoked potentials correlated with posterior column signs and appeared to reflect the clinical course following treatment. While the cord pathology in OPLL is similar to that of cervical spondylotic myelopathy (CSM), the pathogenetic mechanism probably differs in one aspect. Compression by OPLL is the determining factor in most cases whereas the combined presence of a congenitally narrow canal and spondylosis is essential for the development of CSM. Other contributory factors include coexisting spondylosis, a congenitally narrow canal, friction between cord and OPLL during neck movement and acute trauma. Cord damage is probably mediated by ischaemia which is due to disturbances of the microcirculation caused by the mechanical factors.

The pathogenesis of extensive discovertebral destruction in ankylosing spondylitis

The study of extensive discovertebral destructive lesions in ankylosing spondylitis has been largely limited to isolated case reports or clinicoroentgenologic reviews with little pathologic correlation. In eight specimens of the spine collected from 35 patients with ankylosing spondylitis showing extensive discovetebral destructive lesions, a detailed pathologic study revealed a consistent picture of complete or near-complete destruction of the disc-bone border and the intervertebral disc. The disc was replaced by fibrous tissue and/or fibrocartilage showing moderate to severe fibrinoid necrosis and cystic degeneration. Such changes are characteristic of pseudarthrosis, which may follow either fracture or degeneration of the disc perpetuated by abnormal stress and motion. The reparative process included fibrovascular tissue proliferation from the vertebral bone marrow. Fibrovascular tissue also perforated the vertebral end-plate and intervertebral spaces resulting in massive discovertebral destruction. Pathologic observations strongly implicate mechanical trauma and pseudarthrosis as initiating and perpetuating extensive discovertebral destruction in ankylosing spondylitis.

Spinal pseudarthrosis in ankylosing spondylitis. Clinicopathological correlation and the results of anterior spinal fusion

We reviewed 40 extensive destructive vertebral lesions in 35 patients with established ankylosing spondylitis. Of these, 31 had presented with localised pain while three had a neurological deficit. The radiographs suggested ununited fractures through either ankylosed discs (37) or vertebral bodies (3). Corresponding fractures were seen in the posterior column in 34 cases. Sixteen patients with 18 lesions underwent anterior spinal fusion, and pseudarthrosis was consistently proven by histopathology. Two pseudarthroses healed in conservatively treated patients. Thirteen of the operated patients were followed for an average of 7 years 7 months. There were two cases of non-union and one required an additional posterior fusion; in the remainder fusion was sound.

Spinal pseudarthrosis in ankylosing spondylitis

Spinal pseudarthrosis is an important mechanical complication in longstanding ankylosing spondylitis. Thirty-five patients with 40 lesions were studied. Three lesions through vertebral bodies resulted from complete fractures. The rest occurred at interspaces, more common at the lower thoracic and upper lumbar segments. Double pseudarthrotic lesions were observed in 5 patients. Progressive osteolysis of the anterior elements was prominent, with variable sclerosis, osteophytes, vacuum phenomenon, subluxation and fragmentation. A posterior element weak link, as a bony break or facet joint non-fusion, was an essential component in every lesion, playing an initiating or perpetuating role in its pathogenesis. Mechanical derangement from trauma, severe round kyphosis, spondylodiscitis, hip disease, spinal operation and unusual activities may be contributing factors. Initial treatment is conservative, but 16 patients required operative stabilisation.

Varus deformity following lateral humeral condylar fractures in children

Lateral humeral condylar fractures are quite common in children. This article shows that varus deformity is a common sequela following such injuries. Twenty-four patients were studied, with a mean follow-up of 4.8 years. A loss of carrying angle, seen in 10 cases, occurred with comparable frequency in undisplaced (50%) and displaced (39%) fractures. The deformity was usually mild, averaging 10 degrees in the undisplaced fractures and 9.6 degrees in the displaced fractures treated with open reduction. We conclude that varus deformity is common in this injury, and occurs whether or not the fracture is displaced.

Gap-junctional communication in a communication-defective and in a communication-competent teratocarcinoma cell line

We examined the gap-junctional communication properties of a communication-defective cell line R5/3 and its communication-competent revertant H2T12. For these studies, we carried out microelectrode impalements to monitor ionic coupling and dye coupling. Our dye-injection experiments revealed that the H2T12 cells are much more efficient in dye coupling than the R5/3 cells. This latter observation is in agreement with the previous finding that the H2T12 cells are much better metabolically coupled than the R5/3 cells. With ionic coupling measurements, however, both cell lines exhibited similar levels of cell-cell coupling. The R5/3 cells demonstrated an ionic coupling coefficient of 0.19 +/− 0.011 (S.E.M.) and H2T12 a coupling coefficient of 0.25 +/− 0.009 (S.E.M.). These results in conjunction with observations from other studies indicate that the different experimental approaches for monitoring gap-junctional communication may have different levels of sensitivity for detecting as opposed to measuring the level of cell-cell coupling.

Long-term results of lumbar intervertebral disc prolapse

A series of 40 patients is presented at least ten years following anterior spinal fusion for intervertebral disc prolapse. The proportion of patients who had complete relief or only isolated transient symptoms at the five-year review (67.5%) showed only a very slight fall over the years (65.0%). The union rate was shown to improve with time. There was no clear evidence that anterior spinal fusion led to accelerated degeneration of adjacent intervertebral discs. The significance of posterior extension of the fusion is discussed.

Tuberculosis of the upper cervical spine

Six patients, aged between 3 and 51 years, with tuberculosis of the upper cervical spine were studied. Prominent features of the disease included pain and stiffness, paralysis, swelling of the retropharyngeal soft tissue, osteolytic erosions, and atlanto-axial subluxation. Cure was obtained with antibiotics, transoral decompression and C1-2 fusion.

Disc excision and anterior spinal fusion for lumbar disc protrusion in the adolescent

Twenty patients who had undergone disc excision and anterior spinal fusion during adolescence for lumbar intervertebral disc protrusion were reviewed at an average of four years and four months after surgery. Excellent or good results were found in 95% of patients.

The treatment of thoracolumbar spinal injuries with paresis by conservative versus surgical methods

18 patients with cord or root involvement in thoracolumbar injuries underwent posterior spinal surgery, including 11 Harrington instrumentations. 11 similar patients were treated conservatively. Surgery offered no definite advantage for neural recovery, nor did it curtail the duration of hospitalisation. However, it significantly decreased post-traumatic kyphotic deformity and improved the vertebral alignment. Morbidity and implant failure were noted in 27% of the operated cases. It would appear that operative stabilisation of the thoracolumbar injuries of the spine is indicated in selected cases where there is a risk of significant post-traumatic kyphotic deformity with gross vertebral body displacement.

The treatment of unstable intertrochanteric fractures of the hip: a prospective trial of 150 cases

We report a prospective clinical trial of 150 cases for the treatment of unstable intertrochanteric fracture of the neck of the femur. Three methods were tested in our series--skeletal traction with a tibial pin, medial displacement osteotomy and valgus osteotomy--with 50 patients in each group. Our results showed no significant difference between those treated with the Dimon and Hughston osteotomy and those treated by the Sarmiento osteotomy. Conservative treatment of skeletal traction for unstable fracture was found to be well tolerated by the Chinese patient. A low mortality and morbidity rate was found in this series with an overall infection rate of 4 per cent.