The effects of external mechanical stimulation on the healing of diaphyseal osteotomies fixed by flexible external fixation

OBJECTIVE: The purpose of this study was to investigate the effect of an externally applied mechanical stimulus on fracture healing under flexible fixation. DESIGN: Stimulation of fracture healing under various conditions of interfragmentary movement in an in vivo fracture model on 41 sheep. BACKGROUND: It is generally accepted that small interfragmentary movements (IFMs) yield better bone healing results than larger IFMs (> 1 mm). However, the optimal size of IFM within the 1-mm range remains undetermined. METHODS: Standardized transverse osteotomy of 3 mm gap size in the left ovine tibia was fixed with an unilateral external fixator. The sheep were divided into four IFM groups of 0.0, 0.2, 0.4 and 0.8 mm and stimulated with this amplitude for 1200 cycles per day at 1 Hz. After a healing period of 6 weeks, bone mineral density and biomechanical stability were evaluated to determine the quality of healing. RESULTS: The amount of callus formation increased significantly with increasing IFM (P <0.05). However, highest biomechanical stability of the healed bone and mineral density of the gap tissue was achieved with an IFM of 0.4 mm, although the differences were not significant. CONCLUSIONS: These results suggest that the optimal interfragmentary movement for acceleration of delayed fracture healing is in the range of 0.5 mm. However, the enhancement of the healing of flexibly-fixed fractures by external application of interfragmentary movement is limited. RELEVANCE: In this model the external application of a mechanical stimulus in addition to the stimulation caused by normal loading and the flexibility of the fixation did not enhance the healing process significantly. It appears that the external application of interfragmentary motion is promising perhaps only for patients unable to stimulate their fracture healing by weight-bearing.

[Disorders of gastric emptying in diabetes. II. Treatment]

The application of novel investigative techniques has contributed to an increased understanding of the prevalence, pathophysiology and treatment of disordered gastric motility in diabetes. Gastrokinetic drugs have improved therapeutic options for symptomatic patients with gastroparesis considerably. Future approaches to modulate gastric and small intestinal sensory responses may lead to significant advances in treatment.

The propeller flap: a one-stage procedure for nipple-areola reconstruction

The advantages of the propeller flap combined with tattooing for nipple-areola reconstruction include the fact that it is a simple one-stage procedure, a secondary procedure after creation of the nipple-areola complex is eliminated, and a skin graft and the possibility of a skin graft and second wound are eliminated. The propeller flap technique offers the ability to produce a nipple of adequate size, good color match, and satisfactory projection over an 18-month follow-up. The preliminary results of this flap operation are promising. A long-term evaluation of this operation has begun.

Esophageal blood flow in the rabbit: response to calcium channel blockers

Calcium channel blockers have recently been added to the therapeutic regimen for patients who have chest pain of esophageal origin. Although relief of symptoms has been reported, this has not always been associated with changes in esophageal contraction pressures or luminal pH. Myoischemia has been proposed as one possible mechanism for esophageal chest pain. We have investigated the effect of the calcium channel blockers verapamil, nifedipine, and diltiazem on esophageal blood flow in the rabbit model. Esophageal blood flow was measured three times in each rabbit with use of the radiolabeled microsphere technique after a 30-minute continuous infusion of (1) saline solution (baseline), (2) a low dose, and (3) a high dose of each agent. Esophageal mucosal blood flow significantly decreased with nifedipine but was unchanged with verapamil and diltiazem. Esophageal muscle blood flow significantly increased--approximately 100% after administration of each of the calcium channel blockers. Thus esophageal muscle blood flow is enhanced after administration of calcium channel blockers, and this may be one therapeutic mechanism of the calcium channel blockers in the relief of esophageal chest pain in some esophageal diseases.

Effects of prostaglandins on esophageal blood flow

The physiologic mediators of blood flow to the esophagus are poorly understood. We have investigated the effects of prostaglandins on esophageal blood flow as they are known to alter blood flow in other organs of the gastrointestinal tract. Esophageal mucosal and muscularis blood flow (Q) were measured in New Zealand white rabbits treated intravenously with the prostaglandin analogs misoprostol (PGE1), 16,16-dmPGE2 (PGE2), and iloprost (PGI2, prostacyclin). Esophageal blood flow was measured three times in each rabbit using the radiolabeled microsphere technique after a 30-min continuous infusion of (1) saline (baseline), (2) a low dose, and (3) a high dose of each agent. Iloprost significantly increased esophageal mucosal (fourfold) and muscularis (twofold) blood flow. The other two PG analogs, misoprostol and 16,16-dmPGE2, had no significant effect on esophageal blood flow. Iloprost also significantly increased blood flow to the other organs of the gastrointestinal tract; however, the response was not as dramatic as in the esophageal mucosa. Prostacyclin may have a physiologic role in blood flow regulation to the esophagus and may be involved in pathophysiologic processes in the esophagus, such as increasing mucosal blood flow in response to injury.

25-hydroxyvitamin D in patients with essential hypertension

Plasma 25-OH-D levels of normotensive and hypertensive subjects living in a highly industrial and in a nonindustrial area, were estimated. Significantly higher values were found in normotensive subjects than in hypertensive patients. Severity of arterial hypertension was not related to plasma 25-OH-D. Both groups of subjects (normotensive and hypertensive) living in the industrial area with high air pollution had lower 25-OH-D concentrations than those living in the nonindustrial region. Data presented in this paper suggest that antihypertensive treatment by pharmacologic agents exerts a depressive effect on plasma 25-OH-D level.