RESUMEN
We retrospectively studied the possibility that direct trauma to the biceps muscle might be the cause of poor elbow flexion and supination in 18 consecutive children with birth lesions of the brachial plexus who had delayed or impaired biceps recovery despite neurophysiological evidence of reinnervation. All had good shoulder and hand function at three months of age. Eight recovered a strong biceps after six months, but nine required a pectoralis minor to biceps transfer to augment elbow flexion and supination. One had a delayed but good recovery of the biceps after microsurgical reconstruction of the plexus. All had a clinical 'pseudotumour' in the biceps muscle, which was biopsied during pectoralis minor transfer in two patients and showed rupture and degeneration of muscle fibres with a fibro-fatty infiltrate, suggesting previous muscle trauma. Direct muscle trauma is an uncommon but important cause of delayed or impaired biceps recovery after brachial plexus birth injuries. Surgery to reinnervate the biceps muscle will not work if substantial muscle damage is present when a suitable muscle transfer should be considered.
Asunto(s)
Brazo/inervación , Traumatismos del Nacimiento/complicaciones , Neuropatías del Plexo Braquial/etiología , Plexo Braquial/lesiones , Codo/inervación , Músculo Esquelético/lesiones , Músculos/inervación , Brazo/fisiopatología , Brazo/cirugía , Traumatismos del Nacimiento/fisiopatología , Traumatismos del Nacimiento/cirugía , Plexo Braquial/fisiopatología , Plexo Braquial/cirugía , Neuropatías del Plexo Braquial/fisiopatología , Neuropatías del Plexo Braquial/cirugía , Preescolar , Codo/fisiopatología , Codo/cirugía , Femenino , Granuloma de Células Plasmáticas , Humanos , Lactante , Recién Nacido , Masculino , Microcirugia , Músculo Esquelético/fisiopatología , Recuperación de la Función/fisiología , Estudios Retrospectivos , SupinaciónAsunto(s)
Huesos/metabolismo , Osteoblastos/metabolismo , Isoformas de Proteínas/genética , ARN Mensajero/genética , Receptores de Progesterona/genética , Animales , Secuencia de Bases , Huesos/citología , Línea Celular , Cartilla de ADN , Humanos , Osteoblastos/citología , Reacción en Cadena de la Polimerasa , ARN Mensajero/metabolismoRESUMEN
Expression of progesterone receptors (PR) was studied in human osteoblast-like cell lines and primary human osteoblast cultures at the molecular level. Using the sensitive reverse transcriptase polymerase chain reaction (RT-PCR) and oligonucleotide primers which flank the progesterone-binding domain of human PR, progesterone receptor (PR) mRNA was detected in three osteoblast-like cell lines--HOS-TE85, MG-63, and SAOS-2. When compared with beta-actin gene expression, levels of PRmRNA transcripts varied between cell lines (PRmRNA in HOS-TE85 > MG-63 >> SAOS-2). In addition, RT-PCR confirmed the presence of PRmRNA transcripts in primary human osteoblast cells cultured from collagenase-treated bone. Immunostaining was used to visualize PR protein in cells. All osteoblast-like cell lines showed specific staining for PR. Immunoreactivity was distributed equally in the nucleus and cytoplasm. The level of staining was significantly lower than that detected in PR-positive MCF-7 breast cancer cells though well above background levels obtained for PR-negative HeLa cells. The finding that PR is expressed at both the level of mRNA and protein in several osteoblast-like cell lines as well as in human primary osteoblast cultures indicates that bone-forming osteoblast cells are direct targets for progesterone action.