RESUMEN
Complete triceps tendon rupture is relatively rare, but more commonly seen in the athletic population. Loss of extension strength is the functional deficit for the elbow after rupture of the triceps tendon. Although partial tears may be treated conservatively, complete tears of the triceps tendon must be repaired to provide active extension at the elbow. Our preferred surgical technique for repair of the acute triceps tendon rupture is presented, as well as strategies for reconstruction of the triceps tendon with an Achilles tendon allograft.
Asunto(s)
Lesiones de Codo , Técnicas de Sutura , Traumatismos de los Tendones/cirugía , Tenodesis/métodos , Humanos , Traumatismos de los Tendones/diagnóstico , Traumatismos de los Tendones/etiologíaRESUMEN
The inclusion of magnetic nanoparticles into block copolymer micelles was studied towards the development of a targeted, magnetically triggered drug delivery system for cancer therapy. Herein, we report the synthesis of magnetic nanoparticles and poly(ethylene glycol-b-caprolactone) block copolymers, and experimental verification of magnetic heating of the nanoparticles, self-assembly of the block copolymers to form magnetic micelles, and thermally-enhanced drug release. The semicrystalline core of the micelles melted at temperatures just above physiological conditions, indicating that they could be used to release a chemotherapy agent from a thermo-responsive polymer system. The magnetic nanoparticles were shown to heat effectively in high frequency magnetic fields ranging from 30-70 kA/m. Magnetic micelles also showed heating properties, that when combined with a chemotherapeutic agent and a targeting ligand could be developed for localized, triggered drug delivery. During the magnetic heating experiments, a time lag was observed in the temperature profile for magnetic micelles, likely due to the heat of fusion of melting of polycaprolactone micelle cores before bulk solution temperatures increased. Doxorubicin, incorporated into the micelles, released faster when the micelles were heated above the core melting point.
RESUMEN
Arthrogryposis is a condition characterized by symmetric, nonprogressive joint contractures and weak or absent musculature that is present at birth. The amyoplasia form is the most common, and in this group, the elbow is frequently involved, typically in an extension contracture bilaterally. Active elbow flexion is weak or absent, but active extension is spared. This elbow dysfunction poses a significant disability for affected children. Sensation and cognitive development is normal in children with arthrogryposis, and as a group they demonstrate a remarkable degree of adaptability to their deformities. The goal of any treatment is to facilitate the child's functional independence. This article describes the surgical technique of transfer of the long head of the triceps into the proximal ulna to provide active elbow flexion in children with arthrogryposis. The goal of the procedure is to reliably achieve antigravity active flexion while preserving active extension. It has the advantages of technical simplicity and minimal donor site morbidity. By adding this procedure to the existing options for treating this challenging condition, a surgeon is better able to tailor intervention to an individual child's strength and available donor muscles.
Asunto(s)
Artrogriposis/cirugía , Articulación del Codo/cirugía , Músculo Esquelético/cirugía , Niño , Humanos , Selección de PacienteRESUMEN
Implant arthroplasty about the elbow using custom metal components for the distal humerus and proximal ulna was developed in the 1960s. Before this time, the only salvage procedures available for destructive joint disease about the elbow were resection arthroplasty, fascial interposition arthroplasty, or elbow arthrodesis. Today, many total elbow arthroplasty designs are available and used throughout the world. The Coonrad-Morrey total elbow prosthesis (Zimmer, Warsaw, IN) is the most widely used implant for elbow arthroplasty in the United States and has been chosen for discussion in this surgical technique article.
Asunto(s)
Artroplastia de Reemplazo/instrumentación , Articulación del Codo/cirugía , Prótesis Articulares , Artritis Reumatoide/cirugía , Humanos , Osteoartritis/cirugía , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/rehabilitación , Diseño de Prótesis , Rango del Movimiento Articular/fisiología , Instrumentos QuirúrgicosRESUMEN
BACKGROUND: The purpose of this study was to identify characteristics associated with bilateral ruptures of the distal biceps tendons. METHODS: We present a retrospective case series of 25 patients who sustained non-simultaneous bilateral distal biceps brachii tendon ruptures that were repaired surgically, with follow-up available on 10 patients. The average age of the patients was 50 years (range 28-76). All patients were male. The mean time from the first tendon rupture to the contralateral tendon rupture was 2.7 years (range 0.5 - 6.3). Follow-up averaged 45 months (range 24-85). RESULTS: Patients with bilateral ruptures tended to be middle-aged men, who commonly participated in weight lifting, manual labor, or sports, and who had higher rates of nicotine (50%) and anabolic steroid use (20%) than the general population. After surgical repair of 9 of 10 patients, patients with bilateral distal biceps tendon ruptures had good to excellent outcomes. With the numbers available, outcomes were not statistically associated with manual labor, past medical history, prescription medications, prior tendon injury, body mass index, current activity in sports, use of nutritional supplements, or anabolic steroid use, although worker's compensation claims approached statistical significance (p = 0.059). CONCLUSIONS: Patients who sustained bilateral distal biceps tendon ruptures tended to be middle-aged men with higher rates of nicotine and anabolic steroid use than the general population.
Asunto(s)
Procedimientos Ortopédicos/métodos , Traumatismos de los Tendones/patología , Traumatismos de los Tendones/cirugía , Adulto , Anciano , Traumatismos del Brazo/diagnóstico por imagen , Traumatismos del Brazo/epidemiología , Traumatismos del Brazo/cirugía , Estudios de Cohortes , Articulación del Codo/cirugía , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Fuerza Muscular/fisiología , Músculo Esquelético/fisiopatología , Músculo Esquelético/cirugía , Cuidados Posoperatorios/métodos , Pronóstico , Radiografía , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Rotura/epidemiología , Rotura/cirugía , Traumatismos de los Tendones/diagnóstico por imagen , Traumatismos de los Tendones/epidemiología , Resultado del Tratamiento , Lesiones de CodoRESUMEN
OBJECTIVE: To report the functional outcomes of Ilizarov treatment of infected nonunion of the distal humerus. DESIGN: Prospective case series. SETTING: Tertiary referral center. PATIENTS: Between July 1998 and August 2003, 6 consecutive patients (age 33 to 73 years) were referred to us with an infected nonunion of the distal humerus following failure of open reduction and internal fixation. The average time from initial injury to presentation with the nonunion was 27 months (range, 6 to 99 months). The average number of prior surgeries was 2.8 (range, 1 to 4). INTERVENTION: Hardware removal, ulnar nerve neurolysis, 1 stage debridement, autogenous bone grafting, and application of an Ilizarov external fixator with acute compression in the operating room followed by slow gradual compression (0.25-0.50 mm per day) for several weeks postoperatively. MEASUREMENTS: Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire; SF-12 Physical Component Scale (PCS); Brief Pain Inventory; quality-adjusted life years. RESULTS: All patients attained bony union. One patient refractured 3 weeks after removal of the external fixator following a fall and ultimately underwent total elbow arthroplasty. At an average follow-up of 4.1 years (range, 2 to 7 years), none of the remaining 5 patients had undergone any additional surgery on their arm and all were free of infection. For these 5 patients, significant improvements were seen in standardized DASH scores (42% initially to 78% at follow-up, P = 0.017), worst pain intensity ratings (5.4 initially to 0.8 at follow-up, P = 0.007), and SF-12 PCS scores (37 initially to 44 at follow-up, P = 0.041). On average, the pretreatment to posttreatment improvement was equivalent to 3.8 quality-adjusted life years. CONCLUSIONS: Ilizarov treatment of infected distal humeral nonunions that have failed internal fixation restores function, decreases pain, and improves quality of life. The Ilizarov method should be considered a primary treatment option for this disabling and difficult clinical problem.
Asunto(s)
Curación de Fractura , Fracturas no Consolidadas/cirugía , Fracturas del Húmero/cirugía , Técnica de Ilizarov , Dolor/clasificación , Infección de Heridas/microbiología , Adulto , Anciano , Comorbilidad , Femenino , Humanos , Fracturas del Húmero/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Prospectivos , RadiografíaRESUMEN
The parkinsonian neurotoxin methylpyridinium (MPP(+)) mimics the neuropathology of Parkinson's disease (PD) and likely kills neurons by inhibiting complex I of the electron transport chain and increasing oxidative stress. We examined the time course of activation/inactivation of multiple pro- and anti-apoptotic signaling pathways in MPP(+)-induced apoptotic death of SH-SY5Y neuroblastoma cells. We found an early increase and later decrease of transcriptional activity of the generally anti-apoptotic nuclear factor kappa-beta (NF-kappa B) and early increases in activating phosphorylation of the anti-apoptotic upstream kinase protein kinase B (PKB, also known as AKT). Sequestration-inducing phosphorylation of pro-apoptotic BAD protein increased early then declined. A small biphasic increase in the generally pro-apoptotic p38 kinase activity paralleled the biphasic rise in NF-kappa B-mediated transcription. Inhibition of p38 kinase with 5 micro M SB203540, inhibition of MEK-ERK with 50 micro M U0126, or inhibition of phosphatidylinositol-3-kinase (PI3K) with 10 micro M LY294002 reduced cell viability by 4, 18 or 37%, respectively, after 24 h. All three kinase inhibitors increased cell death in response to 24 h of MPP(+), with the greatest effect shown by LY294002. Nerve growth factor (NGF) caused an early increase in activating phosphorylation of PKB/AKT and MEK-ERK and increased cell survival during MPP(+) exposure. We found that acute MPP(+) exposure activates multiple interacting death- and survival-promoting pathways. Survival-promoting MEK-ERK and PI3K pathways contribute to viability during MPP(+) exposure, both are activated by NGF, and loss of PI3K-mediated signaling and NF-kappa B-mediated transcription may commit cells irreversibly to apoptosis in this model. It remains unknown to what extent these signaling pathways modulate dopamine neuronal death in PD.