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  • 1
    Online Resource
    Online Resource
    Elevated levels of homocysteine compromise blood-brain barrier integrity in mice
    American Society of Hematology ; 2006
    In:  Blood Vol. 107, No. 2 ( 2006-01-15), p. 591-593
    Details
    In: Blood, American Society of Hematology, Vol. 107, No. 2 ( 2006-01-15), p. 591-593
    Abstract: Elevated levels of plasma homocysteine (Hcy) correlate with increased risk of cardiovascular and Alzheimer diseases. We studied the effect of elevated Hcy on the blood-brain barrier (BBB) to explore the possibility of a vascular link between the 2 diseases. On a hyperhomocysteinemic diet, cystathionine beta-synthase (Cbs)–heterozygous mice develop hyperhomocysteinemia. Intravital microscopy analysis of the mesenteric venules showed that leukocyte rolling velocity was markedly decreased and numbers of adherent cells were increased in the mutant mice. This was due at least in part to increased expression of P-selectin. BBB permeability was measured by Evans blue dye permeation and was found to be 25% greater in the Cbs+/– cortex compared with wild-type controls. Our study suggests an important toxic effect of elevated Hcy on brain microvessels and implicates Hcy in the disruption of the BBB.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood-2005-06-2506
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2006
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 2
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    Elevated Levels of Homocysteine Compromise Blood-Brain Barrier Integrity in Mice.
    American Society of Hematology ; 2005
    In:  Blood Vol. 106, No. 11 ( 2005-11-16), p. 3856-3856
    Details
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 3856-3856
    Abstract: Elevated levels of plasma homocysteine (Hcy) correlate with increased risks of cardiovascular and Alzheimer’s diseases. We studied the effect of elevated Hcy on the blood-brain barrier (BBB) to explore the possibility of a vascular link between the two diseases. On a methionine-enriched diet, cystathionine beta-synthase (CBS) heterozygous mice develop hyperhomocysteinemia (HHcy). To evaluate the extent of HHcy induced by an 8-week methionine-enriched diet (Diet), we determined plasma Hcy concentration. Concentrations were 23.5 ± 5 μM for wild type (WT) and 98.4 ± 22 μM for CBS+/− on Diet and 4.1 ± 0.20 μM for WT on normal chow. Inflammation can lead to BBB breakdown, therefore we first determined whether we could detect systemic endothelial activation/increased leukocyte adherence in the CBS+/− mice as an indicator of inflammation. We observed mesenteric venules (200–300 μm) in WT and CBS +/− mice fed Diet and compared them with WT on chow. Leukocyte rolling velocity was slower in CBS+/− than in WT mice indicating an increase in the density of adhesion molecules on the endothelium. In CBS+/− mice, 60% of leukocytes rolled at a velocity of & lt; 10 μm/s as compared with only 8% in WT mice on Diet (P & lt;0.002) and 3% WT on chow. The slower leukocyte velocity was due at least in part to higher expression of P-selectin on the endothelium. Infusion of fluorescent beads coated with antibody to P-selectin showed a several fold increase in their binding to venules of CBS +/− mice with HHcy as compared with WT on Diet (P & lt;0.05). We also observed increased leukocyte adherence in CBS +/− mice (P & lt;0.05). We then compared BBB function in mice after the 8-week Diet. We injected Evans blue (EB) dye intraperitoneally. EB binds to albumin and does not readily cross the BBB. The CBS+/− mice exhibited 25% greater EB in cortex compared with WT. EB leakage in WT mice was 3.19 ± 0.09, while CBS+/− leakage was 3.99 ± 0.29 (P & lt; 0.03). WT mice on Diet showed slightly higher plasma Hcy levels than on normal chow; but this increase was not sufficient to break the BBB, as the BBB leakage in the WT mice on Diet was similar to that of WT mice on normal chow. Our study suggests an important toxic effect of elevated Hcy on brain microvessels and implicates Hcy in the disruption of the BBB.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    URL: Article
    DOI: 10.1182/blood.V106.11.3856.3856
    RVK:
    XA 33000
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 3
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    Multi-axial correction system in the treatment of radial club hand
    SAGE Publications ; 2009
    In:  Journal of Children's Orthopaedics Vol. 3, No. 6 ( 2009-12), p. 493-498
    Details
    In: Journal of Children's Orthopaedics, SAGE Publications, Vol. 3, No. 6 ( 2009-12), p. 493-498
    Abstract: Radial club hand is a well-recognized congenital malformation characterized by hypoplasia of bone and soft tissue on the radial aspect of the forearm and hand. The modalities of treatment have traditionally varied from stretching casts with soft-tissue procedures to the use of multiple corrective osteotomies. These osteotomies can be stabilized by a variety of methods, including external fixators that allow the possibility of gradual distraction with neohistiogenesis. This current study outlines the usage of one such device (multi-axial correction system [MAC]) in the management of deformity associated with severe radial club hand. Methods Three consecutive cases of unilateral or bilateral severe (Bayne type IV) congenital radial club hand were corrected using MAC fixation in the last 5 years. This is a retrospective review of all three cases. Data parameters included: patient demographics, presentation findings, degree of deformity, amount of correction/lengthening, length of procedure, length of treatment, and associated complications. The surgical technique is described in detail for the benefit of the readership. Results The three patients with severe congenital radial club hand had a total of four limb involvements that underwent correction using osteotomies and usage of the MAC device for external fixation. All three patients underwent successful correction of deformity with the restoration of alignment, lengthening of forearm for improvement of function, and stabilization of the wrist (mean duration, mean lengthening, mean time to consolidation). The MAC system was well tolerated in all patients and associated complications were limited. Conclusion The MAC fixator seems to be a good alternative modality of stabilization and correction for severe congenital radial club hand deformities. Its usage is fairly simple and it provides the ease of application of a mono-lateral fixator with far superior three-dimensional control, like the circular external fixator. We recommend that clinicians should add this modality to their armamentarium for the deformity correction of severe radial club hand and others in general.
    Type of Medium: Online Resource
    ISSN: 1863-2521 , 1863-2548
    URL: Article
    DOI: 10.1007/s11832-009-0196-3
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2268264-8
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  • 4
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    Online Resource
    Low-Profile Dorsal Plating for Dorsally Angulated Distal Radius Fractures: An Outcomes Study
    Elsevier BV ; 2006
    In:  The Journal of Hand Surgery Vol. 31, No. 7 ( 2006-09), p. 1061-1067
    Details
    In: The Journal of Hand Surgery, Elsevier BV, Vol. 31, No. 7 ( 2006-09), p. 1061-1067
    Type of Medium: Online Resource
    ISSN: 0363-5023
    URL: Article
    DOI: 10.1016/j.jhsa.2006.05.008
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2006
    detail.hit.zdb_id: 2023397-8
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  • 5
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    Hip Arthroscopy for Labral Tears : Review of Clinical Outcomes with 4.8-Year Mean Follow-Up
    SAGE Publications ; 2009
    In:  The American Journal of Sports Medicine Vol. 37, No. 9 ( 2009-09), p. 1721-1727
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 37, No. 9 ( 2009-09), p. 1721-1727
    Abstract: Arthroscopy of the hip joint is a relatively new diagnostic and therapeutic option for labral tears. Purpose More data are needed to characterize the utility and effectiveness of hip arthroscopy and identify patient-related factors that might predict functional outcome. Study Design Case series; Level of evidence, 4. Methods This retrospective study with prospective follow-up examined the clinical outcomes of 52 consecutive patients undergoing hip arthroscopy for labral tears. Outcomes measures included clinical outcome and the modified Harris hip score. Any complications associated with the procedure were recorded. Exclusion criteria included age younger than 18 years or prior ipsilateral hip surgery. Results Mean patient age was 42 years. Mean follow-up was 4.8 years. Twenty-one patients (40.4%) had a traumatic cause of the labral tears. Eight patients (15.4%) had possible secondary gain issues. Four (7.7%) patients suffered transient nerve palsies; in 1 case, the guide wire broke during initial cannulation. Three patients (5.8%) went on to total hip arthroplasty after hip arthroscopy. On multivariate analysis, left-sided surgery, a higher preoperative activity level, and duration of symptoms greater than 18 months were found to be positive predictors of good or excellent outcomes. Smoking and secondary gain issues were significant negative predictors of good or excellent outcomes. Only prior level of activity was a significant positive predictor of return to activity after surgery. A traumatic cause of the labral tear was a significant negative predictor of return to activity. Chondromalacia and osteoarthritis were not significant predictors of negative outcome. Postoperative modified Harris hip score improved 40% from 56.8 preoperatively to 80.4 (P 〈 .001). No cases of patients with secondary gain issues achieved good or excellent outcomes. Overall percentage of good or excellent outcomes was 56%, or 66% when those with secondary gain issues were excluded; 84% of patients were able to return to sports or equivalent level of preoperative recreational activity. Neither preoperative radiographic osteoarthritis nor grade of intraoperative chondromalacia predicted postoperative outcome. Conclusion This series supports the hypothesis that hip arthroscopy provides safe and reliable improvement of labral symptoms in the majority of patients.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546509333078
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 6
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    Open reduction of medial epicondyle fractures: Operative tips for technical ease
    SAGE Publications ; 2009
    In:  Journal of Children's Orthopaedics Vol. 3, No. 4 ( 2009-08), p. 331-336
    Details
    In: Journal of Children's Orthopaedics, SAGE Publications, Vol. 3, No. 4 ( 2009-08), p. 331-336
    Abstract: In the pediatric population, medial humeral epicondylar fractures account for nearly 12% of all elbow fractures. There is ongoing debate about the surgical management of medial epicondyle fracture cases. Our technique in the operative management of medial epicondyle fractures uses the external application of an Esmarch bandage, as well as provisional fixation with needle rather than K-wire fixation. This technique decreases the need for soft-tissue release and, therefore, theoretically, maintains soft-tissue vascularity of the small fracture fragments. Moreover, it preserves the soft-tissue tension medially. It involves the use of a bandage that is universally available in orthopedic operating rooms, including those in developing nations. It is easy to apply by either the principal or assisting surgeon. With practice, it cuts down operative time and can help substitute for an assistant. This relatively simple operative technique makes for a more seamless operative process, improved reduction, and key preservation of soft-tissue vascularity.
    Type of Medium: Online Resource
    ISSN: 1863-2521 , 1863-2548
    URL: Article
    DOI: 10.1007/s11832-009-0185-6
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2268264-8
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  • 7
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    Operative versus non-operative management of pediatric medial epicondyle fractures: A systematic review
    SAGE Publications ; 2009
    In:  Journal of Children's Orthopaedics Vol. 3, No. 5 ( 2009-10), p. 345-357
    Details
    In: Journal of Children's Orthopaedics, SAGE Publications, Vol. 3, No. 5 ( 2009-10), p. 345-357
    Abstract: There is ongoing debate about the management of medial epicondyle fractures in the pediatric population. This systematic review evaluated non-operative versus operative treatment of medial epicondyle fractures in pediatric and adolescent patients over the last six decades. Methods A systematic review of the available literature was performed. Frequency-weighted mean union times were used to compare union rates for closed versus open treatments. Moreover, functional outcomes and range-of-motion variables were correlated with varying treatment modalities. Any complications, including ulnar nerve symptoms, pain, instability, infection, and residual deformity, were cataloged. Results Fourteen studies, encompassing 498 patients, met the inclusion/exclusion criteria. There were 261 males and 132 female patients; the frequency-weighted average age was 11.93 years. The follow-up range was 6–216 months. Under the cumulative random effects model, the odds of union with operative fixation was 9.33 times the odds of union with non-operative treatment ( P 〈 0.0001). There was no significant difference between operative and non-operative treatments in terms of pain at final follow-up ( P = 0.73) or ulnar nerve symptoms ( P = 0.412). Conclusions Operative treatment affords a significantly higher union rate over the non-operative management of medial epicondyle fractures. There was no difference in pain at final follow-up between operative and non-operative treatments. As surgical indications evolve, and the functional demands of pediatric patients increase, surgical fixation should be strongly considered to achieve stable fixation and bony union.
    Type of Medium: Online Resource
    ISSN: 1863-2521 , 1863-2548
    URL: Article
    DOI: 10.1007/s11832-009-0192-7
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2009
    detail.hit.zdb_id: 2268264-8
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  • 8
    Online Resource
    Online Resource
    Surgical Technique for the Correction of Adult Spastic Equinovarus Foot
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Techniques in Foot & Ankle Surgery Vol. 8, No. 4 ( 2009-12), p. 160-167
    Details
    In: Techniques in Foot & Ankle Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 4 ( 2009-12), p. 160-167
    Type of Medium: Online Resource
    ISSN: 1536-0644
    URL: Article
    DOI: 10.1097/BTF.0b013e3181c24be9
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
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  • 9
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    “Sandwich” Plating for Intra-articular Distal Radius Fractures with Volar and Dorsal Metaphyseal Comminution
    SAGE Publications ; 2008
    In:  HAND Vol. 3, No. 1 ( 2008-03), p. 47-54
    Details
    In: HAND, SAGE Publications, Vol. 3, No. 1 ( 2008-03), p. 47-54
    Abstract: Introduction Intra-articular distal radius fractures with volar and dorsal comminution present a special challenge to the hand surgeon. Methods Ten patients formed the study cohort. All plates were low profile and stainless steel. Radiographic parameters, range of motion, and strength compared to the uninjured side were recorded. Functional outcome was evaluated by Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Gartland and Werley scoring system. Results Median age at surgery was 58 years (range, 24 to 86). Mean follow-up was 17 months (range, 12 to 28). According to the AO classification system, there were three type C2 and seven type C3 fractures. Median preoperative dorsal angulation was 24 deg; median postoperative dorsal angulation was 3 deg. Eighty percent (8) of the fractures also had an intra-articular step-off or gap, all of which were corrected to neutral by the procedure. Compared with the contralateral side, mean extension and flexion were 73 and 75%, respectively, pronation and supination were 95 and 88%, respectively, and grip strength and thumb pinch were 72 and 87%, respectively. Mean postoperative DASH score was 16 points, and 70% (7) of the patients had Gartland and Werley scores of good or excellent. None of the patients needed to have their plates removed, and no extensor tendon rupture was reported. Conclusions The “sandwich” plating technique is an effective method of regaining near-anatomic reconstruction of intra-articular, volarly and dorsally comminuted distal radius fractures. Results from this study demonstrate that patients can expect to regain about 80% of their range of motion and strength. Moreover, 70% of the patients will have good to excellent functional outcomes. This is the first study to examine range of motion and functional outcome of low-profile “sandwich” plating without plate removal.
    Type of Medium: Online Resource
    ISSN: 1558-9447 , 1558-9455
    URL: Article
    DOI: 10.1007/s11552-007-9061-3
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2008
    detail.hit.zdb_id: 2316440-2
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