[Late results after nerve transplantation on the upper extremities]

PURPOSE

The purpose of this retrospective study was to determine the influence of the type of injury, the time elapsed after the injury, the blood supply to the operation area, the size of the graft, and the applied treatment method on the late results.

METHOD AND MATERIAL

In the study period from 1985 through 2000, nerve transplantations had been performed in 281 patients. There were 204 men and 77 women. Reconstructions were applied on the median nerve in 59 patients, ulnar nerve in 48, median and ulnar nerves in 23, radial nerve in ten, and digital nerves in 141 patients. 188 patients presented for late follow-up (66.9%).

RESULTS

Evaluation was made according to the Highet scheme. In patients with median nerve transplantation M(3) or better results were seen in 69%, with M(3) being 45.2%. S(3) or better was observed in 64.3%, with S(3) being 47.6%. In patients after ulnar nerve transplantation M(3) or better result was achieved in 56.8%, M(3) being 19%. S(3) or better result was seen in 32.4%, S(3) being 27%. In patients who underwent median and ulnar nerve transplantations M(3) or better result was seen in 36.8%, M(3) being 26.3%. S(3) was in 42.1%, while S(4) did not occur. In patients after radial nerve transplantation M(3) or better effect resulted in 87.5%, M(3) being 12.5%. In patients with digital nerve transplantation S(3) or better result occurred in 57.4 %, S(3) being 47.6%.

CONCLUSION

The best result can be achieved with nerve suturing, performed as an optimum from all aspects. However, as far as the surgical technique is concerned, results of using interfascicular grafts are more advantageous than epineural nerve suture based on compromises. In ideal circumstances, transplantation of a nerve graft less than 2 cm is of the same value as a good primary suture. If a nerve graft is longer than 2 cm, and negative local factors are accumulating due to the type of injury, late results will gradually deteriorating. The final outcome definitely depends on the patient's age and the time elapsed from the injury to the operation.

Lipid hydroperoxides and free radical scavenging enzyme activities in preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: no evidence for circulating primary products of lipid peroxidation

OBJECTIVE

Preeclampsia is reportedly accompanied by increased plasma lipid peroxidation. However, to date the assays that have been applied to measure lipid peroxides have been relatively nonspecific. A highly specific high-performance lipid chromatographic-chemiluminescence technique was used here to measure lipid hydroperoxides in plasma and red blood cells of patients with preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.

STUDY DESIGN

Lipid peroxidation products, both lipid hydroperoxides and thiobarbituric acid reactive substances (TBARS), and free radical scavenging enzyme activities were measured in either plasma or erythrocytes of patients with normal pregnancies (n = 36), preeclampsia (n = 28), or HELLP syndrome (n = 10).

RESULTS

Whereas lipid hydroperoxides were undetectable (<0.02 micromol/L), plasma TBARS and glutathione peroxidase activity in plasma and erythrocytes were significantly increased in patients with HELLP syndrome. There were no differences in glutathione transferase and reductase activities or superoxide dismutase activity between the groups.

CONCLUSIONS

We were unable to corroborate results of studies that suggested that increased TBARS are representative of circulating plasma lipid hydroperoxides in preeclampsia. However, elevated glutathione peroxidase activity and TBARS are in line with increased oxidative stress in preeclampsia.

High-throughput functional annotation of novel gene products using document clustering

Gene products differentially expressed in healthy vs. diseased tissues may be considered drug targets since the change in their expression level can be related to the cause and progression of the disease studied. A significant portion of the proteins produced by these genes will be unknown and consequently their function must be characterised. The experimental elucidation of biochemical function must be supported by computational tools which can help predicting the possible function of a given protein from its amino acid sequence. We have designed a high-throughput system which automatically analyses amino acid sequences deduced from differentially represented cDNA clones. The system attempts to assign a biological function to protein sequences by carrying out searches in sequence databanks and by locating functionally relevant motifs in the query sequences. The results delivered by the various prediction methods consist of the annotations of matching sequences and/or motifs, which are free-format texts written by humans and therefore may describe the same concept with synonymous words. It is desirable to present the results in such a way that the annotations describing the same biological function are grouped together. To this end we devised an algorithm that enables the hierarchical clustering of free-format documents based on their contents. The system is capable of detecting and flagging conflicting annotations, and will speed up the interpretation of the function prediction results.

Force field based conformational analysis of RNA structural motifs: GNRA tetraloops and their pyrimidine relatives

The protocol of conformational analysis applied here to ribonucleotide oligomers combines conformational search in the space of torsion angles and energy minimization using the AMBER4.1 force field with a continuum treatment of electrostatic solute-solvent interactions. RNA fragments with 5'-GGGCGNNAGCCU-3' sequences commonly fold into hairpins with four-membered loops. The combinatorial search for acceptable conformations using the MC-SYM program was restricted to loop nucleotides and yielded roughly 1500 structures being compatible with a double-stranded stem. After energy minimization by the JUMNA program (without applying any experimental constraints), these structures converged into an ensemble of 74 different conformers including 26 structures which contained the sheared G-A base pair observed in experimental studies of GNRA tetraloops. Energetic analysis shows that inclusion of solvent electrostatic effects is critically important for the selection of conformers that agree with experimentally determined structures. The continuum model accounts for solvent polarization by means of the electrostatic reaction field. In the case of GNRA loop sequences, the contributions of the reaction field shift relative stabilities towards conformations showing most of the structural features derived from NMR studies. The agreement of computed conformations with the experimental structures of GAAA, GCAA, and GAGA tetraloops suggests that the continuum treatment of the solvent represents a definitive improvement over methods using simple damping models in electrostatic energy calculations. Application of the procedure described here to the evaluation of the relative stabilities of conformers resulting from searching the conformational space of RNA structural motifs provides some progress in (non-homology based) RNA 3D-structure prediction.

Nurses on-line: career mobility for registered nurses

The demands of a dynamic health care environment have altered the roles and responsibilities of nurses, creating employment situations where distinctions across educational levels are becoming increasingly important. The 1995 Pew Foundation Report projected that, in the next decade, there would exist a shortage of registered nurses with baccalaureate and higher degree preparation. This deficit creates a unique opportunity to provide innovative approaches to career mobility for registered nurses. Constraints related to juggling the demands of home life, child rearing, and employment have been obstacles for diploma and associate degree nurses wishing to continue their education. Web-based instruction offers exciting possibilities for a new paradigm in nursing education that takes advantage of both the interactivity and substantial resources of the internet. On-line registered nurse completion programs offer flexible, cost-effective, and easily accessible alternatives to traditional education. This article describes the application of adult learning theory for use in re-engineering courses for on-line instruction. Hardware and software needs, technical support, development of an instructional model, teaching-learning considerations, and program evaluation also are discussed.

Unstable pelvic fractures in children

A total of 3561 freshly injured children received treatment at the paediatric trauma department of the National Institute of Traumatology between 1984 and 1994. Out of these 38 (approx. 1%) had pelvic fractures. Based on the classification of Tile and Laer, 15 pelvic fractures were diagnosed to be unstable, from which 8 were polytraumatised, 4 shocked and 1 was a casualty. Run downs could be considered as the main cause of these fractures. Conservative treatment was provided for 13 unstable cases (bed rest: 5, band suspension: 1, femur skeletal traction: 4, femur traction and band suspension: 3). Surgery was performed in 2 cases (symphysis cerclage: 1, acetabulum plate o.s.: 1). Eleven patients were called in for late controls (after 3 years). Subsequent complications were: pain: 3, limb shortening: 4, lumbal scoliosis: 1, minor pelvic deformations: 4, partial necrosis of caput femoris: 2. The subjective complaints of 3 adolescent cases seem to be small in number, however, it is a fair assumption that the control period of 3-6 years later is not enough to form a comprehensive conception on the nature of early degenerative deformations occurring later, e.g. during adulthood. Because of further surgeries and examinations, correct traction and suspensional treatment can only be carried out with great difficulties regarding children. Therefore, posterior stabilisation of the pelvic ring must be planned with percutaneous sacroiliac pinning or screwing in unstable cases.

[Possibilities for revascularization in early and late stage lunate malacia]

There are various biomechanical procedures for the treatment of lunate necrosis in the literature, but only a few deal with the possible revascularisation of the bone. We used the second dorsal metacarpal vascular bundle implantation technique in different stages of Kienböck's disease. Since 1990, twelve patients were treated by this method. In stage I-II according to Lichtman, we implanted the vessels in the lunate after excochleation and cancellous bone grafting, in stage III we used a modified form of the Graner operation and revascularised the proximalised part of the capitate. In the first group, six patients, we observed significant improvement in five cases clinically, radiologically confirmed stagnation of the process in four cases. In the second group of six patients, the clinical symptoms improved in four cases, three patients had to change work and one patient developed a pseudarthrosis between the capitate and corticocancellous block, but the proximalised part of capitate survived in all cases. Vascular bundle implantation can be a helpful method in early stages of lunate necrosis, helping to slow or to stop the progression of the disease.

Exploring the fitness landscapes of lattice proteins

We present methods to investigate the sequence to structure relation for proteins. We use random structures of HP-type lattice models as a coarse grained model to study generic properties of biopolymers. To circumvent the computational limitations imposed by most lattice protein folding algorithms we apply a simple and fast deterministic approximation algorithm with a tunable accuracy. We investigate ensemble properties such as the conditional probability to find structures with a certain similarity at a given distance of the underlying sequence for various alphabets. Our results suggest that the structure landscapes for lattice proteins are generally very rugged, while larger alphabets fine tune the folding process and smoothen the map. This implies a simplification for evolutionary strategies. The applied methods appear to be helpful in the study of the complex interplay between folding strategies, energy functions and alphabets. Possible implications to the investigation of evolutionary strategies or the optimization of biopolymers are discussed.

Density of states, metastable states, and saddle points exploring the energy landscape of an RNA molecule

Detailed knowledge of the energy landscape of a biopolymer molecule is a prerequisite for understanding its folding kinetics and its final spatial structure. In the case of RNA we consider the energy landscape defined on the set of all secondary structures that can be formed by a given sequence. We show that the exploration of this energy landscapes is computationally feasible. For this purpose we present a recursive algorithm for computing the complete density of states and discuss its application to tRNA sequences. For shorter sequences a more detailed analysis of the energy surface is possible using a complete list of all secondary structures. In this case we identify metastable states and the saddle points that connect them.

[Special epiphyseal injuries. 5 case examples]

In daily practice, the well-proved Salter-Harris-Rang epiphyseal injuries classification is used worldwide and in Hungary as well. Occasionally there are to be seen epiphyseal injuries which cannot be typed by this classification. The Ogden classification of epiphyseal injuries which enlarges the Salter-Harris-Rang classification with 6 subdivisions and 3 more subdivisions is very useful for the classification of such rare epiphyseal injuries. The authors focus one's attention on Ogden IIB type and Ogden VI type injuries on the basis of their own experience. Ogden IIB is often unstable and susceptible to shortening. In Ogden VI type ligamentous instability beside growing disturbance, caused by meta-epiphyseal bone bridge formation, can be seen. The comminuted growing plate injury caused by high energy direct trauma and healed without growing disturbance in their case, is missed in the Ogden classification. The proper classification is a necessary condition of adequate treatment. We recommend the Ogden classification of rare epiphyseal injuries.

[Microsurgical methods of bone replacement]

Vascularized bone grafting techniques are ideal for long bone defects in the extremities. The authors report on their experience in this field. From January 1991 to 2nd November 1995, 17 patients were treated by vascularized bone grafts. In ten cases iliac crest, in six cases fibula, and in one case a radial forearm composite flap was used. All patients have shown optimal healing and good bony consolidation, except for one case of circulatory disorder of the fibula graft.

RNA structures and folding: from conventional to new issues in structure predictions

Prediction and modeling of RNA structures has become an indispensable tool of biological research disciplines. Currently, reliable predictions require massive input of experimental data. Structure-forming elements are conventional base pairs, as well as a rapidly increasing repertoire of novel structural motifs. New developments extend structural analysis beyond the one-sequence/one-structure paradigm and allow questions that are relevant to molecular evolution to be answered.

Orthodromic activation of peptidergic cells in the medial amygdala

Electrical recordings from vasopressin-containing cells in the medial amygdala were obtained. Electrical stimulation of one major afferent structure, the accessory olfactory bulb, invariably elicited single unit discharge in the peptidergic cells and set up a field potential indicating widespread excitation in the structure. Pheromonal stimuli, normally borne into the brain by the accessory olfactory bulb, were ineffective in activating the medial amygdala. These results in combination with preexisting research suggest that the accessory olfactory bulb is an important influence, but not the only influence, on the activity of the peptidergic cells.

[Comparison between various treatment methods in scaphoid pseudarthrosis]

In this study we compare the results of various methods of treatment in 159 patients who were operated on between 1980 and 1990 for scaphoid pseudarthrosis at the Budapest Central Institute for Traumatology. Rated subjectively, 84% of the results of the Russe-I plasty were regarded as good, as were 75% of the spongiosaplasty, 88% of the Ender plate synthesis, and 75% of the AO navicular screw. Of the palliative methods retaining movement, denervation with styloidectomy yielded good results. Silicon prosthesis and proximal pole resection only led to temporary improvement. In patients with severe radiocarpal arthrosis who do heavy work, even today radiocarpal stiffening is regarded as the procedure of choice. In our experience, the best functional results can be expected when immobilization is as short as possible and fixation as stable as possible - which corresponds to Ender plate synthesis according to our results.

Occult distal radial fractures

The radiological diagnosis of distal radial fractures is usually easy, but some fractures without displacement cannot be detected at the first examination. In this retrospective study of 626 wrist injuries diagnosed as "wrist sprain" we found 39 distal radial fractures which were discovered only after repeated examinations. The incidence of distal radial fractures was much higher than other wrist fractures that were diagnosed after repeated examinations. Repeat standard four-view X-ray examination, as well as other imaging methods, are necessary to diagnose these fractures.

Epidemiology of distal radius fractures in Budapest. A retrospective study of 2,241 cases in 1989

Retrospective data concerning 2,223 patients with fracture of the distal radius were related to the age- and sex-profiles of the population. Compared with observations from other countries, we found a similar sex ratio with a steep rise in fracture incidence in women after age 30-40. Our data did not permit calculation of absolute fracture incidence rates.

Silicone-induced synovial and osseal granuloma following metacarpophalangeal and carpal arthroplasty

Intraarticular particulate silicone rubber created by abrasion of silicone arthroplasty of the hand may be responsible for the development of an iatrogenic granulomatous synovitis and ostitis. Histological and ultrastructural appearances of the involved tissues are presented, together with a discussion of the possible mechanism and methods of pathological diagnosis.

Tumors and tumor-like lesions arising in tendons. A clinicopathological study of 75 cases

Eight cases of malignant tumors, 38 cases of benign tumors, 15 cases of metastatic tumors, and 14 cases of tumor-like lesions arising in tendons seen over a period of 22 years (1967-1988) are surveyed. Benign tumors of tendon occur relatively frequently - in 38 (1.7%) of 2143 tendon biopsies - but malignant tumors (0.37%) and metastases (0.70%) are extremely rare. Malignant tumors occurred most frequently in lower limb tendons, while benign tumors were most often found in the tendons of the hand.

[Recurrent infantile digital fibromatosis]

In connection with a boy's case, receiving treatment in their institute several times, authors sum up our knowledge on infantile relapsing digital fibromatosis, first time in Hungary. Results of histological and electronmicroscopic examination are reported compared to results of foreign authors' studies of similar subject.

[Reconstruction of metacarpophalangeal and interphalangeal joints with endoprostheses following injuries]

Implants have been used since 1969 by the authors for the replacement of damaged finger joints following trauma. In several cases reconstruction of other damaged tissues in the same finger was also performed. A method is described for replacement of the central slip of the extensor tendon over the PIP joint. Analysis of twenty-one MP and sixty-eight PIP endoprostheses placed in eighty-three patients until 1979 is given. Significant improvement in the range of movement is seen. Preoperative pain was relieved in all cases. There was a need to change occupation in ten percent of patients. Careful analysis of early and late complications calls attention to the proper selection of patients for surgery.

Diurnal variations in unconjugated oestriol levels during early pregnancy and their relation to maternal cortisol levels

We studied maternal plasma levels of oestriol (measured by radioimmunoassay) and total cortisol (measured by a protein binding method) in 11 women from 8 to 22 weeks gestation. Blood specimens (5 ml) were drawn over a 24-h period at 60 and 30 min intervals. The diurnal rhythm of cortisol with higher values in the morning than in the afternoon and evening was present at all gestational ages studied. Unconjugated plasma oestriol showed a similar circadian rhythm to maternal cortisol (r = 0.576, P less than 0.01) in the 8th week. From the 9th to the 11th week oestriol values rose and there was no evidence of a circadian rhythm. In the 12th week plasma oestriol again showed a circadian rhythm, with higher values at night (117.3 +/- 9.5 pg/ml) than during day-time (104 +/- 7.5 pg/ml, P less than 0.001). This pattern remained until the 22nd week, when plasma oestriol levels at night (3.78 +/- 0.49 ng/ml) were markedly higher than in the day-time (3.16 +/- 0.3 ng/ml, P less than 0.001). An inverse relation between oestriol and cortisol levels as shown in late human pregnancy could not be demonstrated for the early stages we studied. The interval between rising cortisol and falling oestriol levels decreased from 6 h in the 12th week to 3.5 h in the 22nd week of gestation. This suggests an increasing sensitivity of the fetal hypothalamus to the feedback effect of maternal cortisol.

Immunopathological study on palmar aponeurosis in Dupuytren's disease

The authors examined the immunological and immunohistochemical alterations of palmar aponeurosis in Dupuytren's contracture. In the IgG-content no difference were found between the intact and diseased aponeurosis. The mean of IgA content was 2 fold, the IgM content 3 fold higher in Dupuytren's aponeurosis than in normal ones. The immunoglobulin containing cells localised around the Dupuytren's nodules and in fibrotic, but not nodular parts of aponeurosis. Extracellular immunoglobulin deposits were not found.

[Extensive cavernous lymphangioma of the hand (case report)]

In two cases the authors show that cavernous lymphangioma of the hand can only be treated by radical removal of the tumor and replacement of the overlying skin. In one case the large skin defect caused by tumor removal was replaced by a radial artery forearm flap in one sitting.

Measuring eye movements with a search coil: non-linear filter allows simultaneous recording of horizontal and vertical eye position by means of the phase modulation method

Measuring eye position from the phase angle of the signal induced by a rotating magnetic field in a search coil presents a number of advantages. So far, however, existing schemes using this principle either record eye position in one dimension only or require two search coils. We describe here a simple analog circuit which singles out a signal of given frequency from a frequency composite without changing the signal's phase. This makes it feasible to measure horizontal and vertical eye position with a single search coil by using two orthogonal rotating fields of different frequency.

[Measurement of residual urine in outpatient clinics with a small ultrasound device]

Serial controls of residual urine are necessary in the case of patients with such chronic diseases as multiple sclerosis, in which there are neurogenic bladder disorders. They can be done free of risk by ultrasound technique. A special, relatively cheap and battery-powered ultrasound scanner (Uroson) has been developed. Transducer, electronic circuitry and videoscreen together are the size of a book. Bladder volumes were measured with Uroson in 30 healthy persons with control of micturition and in 78 patients with residual urine due to neurogenic bladder disorders, with subsequent bladder catheterization. A total of 58 measurements in the range of 20-200 ml residual volume gave a correlation coefficient of 0.87 for the normal controls and 0.86 for patients, with a scatter of +/- 20%. These results agree with those reported earlier with the customary abdominal ultrasound apparatus. In 24 patients with residual volumes of less than 20 ml the Uroson gave correct result. Because of its simplified construction and single-button control Uroson does not require any special knowledge and, after instruction, can be used by non-medical personnel.

Muscle capillaries in tenotomized human muscles

The capillaries were studied in tenotonized human muscles after tenotomy or spontaneous rupture of the tendon. The mean capillary area was not significantly different in the patients with tenotomy, or with spontaneous rupture of the tendon, as compared to intact muscles. The mean basement membrane area as a percentage of total capillary area was significantly larger and the size capillary lumen significantly smaller in the injured than in the intact muscles. The alterations of the capillaries were time-dependent.

The effect of tourniquet ischaemia on intact, tenotomized and motor nerve injured human hand muscles

Ultrastructural examination of the intrinsic hand muscles was performed on young healthy patients undergoing reconstructive operation following tendon or nerve lesions. The muscle specimens were taken at the start and then every fifteen to twenty minutes until the end of the tourniquet ischaemia. The authors have not found any morphological alterations following the use of a tourniquet up to two hours in either the intact or previously injured muscles.

Correlation of plasma non-conjugated oestriol and plasma cortisol in late human pregnancy

The present study concerns the diurnal variations of free plasma oestriol and their relationship to maternal plasma cortisol in late human pregnancy. Four pregnant women volunteered for the study. According to the half-life time of oestriol blood was drawn at intervals of 30 and 60 minutes, respectively, over a period of 24 hours. Free oestriol was measured by radioimmunoassay and cortisol was quantitated by a protein binding method. All patients exhibited a circadian rhythm for free oestriol with higher values in the evening and early night (14.4 +/- 3.7 ng/ml) than in the morning (11.3 +/- 2.3 ng/ml, P less than 0.001). The course of oestriol followed plasma cortisol in a significant negative correlation (r = -0.566, P less than 0.001). During the period of low cortisol concentration oestriol levels demonstrated the phenomenon of episodic secretion. The results suggest that the maternal adrenals predominantly regulate the circadian rhythm of free oestriol by a negative feed-back action on the foetal hypothalamus.

[Ultrastructural changes of human skeletal muscle after tendon and nerve injuries. I. Fine-structural changes of the hand muscles after tendor injuries (author's transl)]

During reconstructive procedures performed 4--16 weeks after the tendon lesion the specimens obtained from the injured muscle have been examined by the authors. It was found that after the tendon injury inactivity atrophy develops and a condition of equilibrum could be observed at this time. The most important changes in the fine structure were seen in the contractile elements: there were atrophied, homogenized, fragmentated and ragged independently from the functional unities. The number of the mitochondria was considerably decreased, the sarcoplasmatic reticulum was increased, and the difference between the originally red and white muscular fibres was indistinct. The glycogen content of the musculature was decreased, or it disappeared completely. No pathological changes have been observed in the sarcolemme, the cell nuclei and the motor nerve end-plates.

[Ultrastructural changes of human skeletal muscle after tendon and nerve injuries. II. Fine-structural alterations of the hand muscles after injuries of the motor nerve (author's transl)]

The authors examined the fine structural alterations of the muscles after traumatic neurotomy. The most important changes were forro found on the contractile elements, especially atrophy, and fragmentation. The number of mitochondria and sarcoplasmatic reticulum decreased both the glycogen content of sarcoplasma increased. The motor end plates were complete destroyed. On the motor motor-neurons typical Wallerian degeneration could be seen.