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Sample records for distal ostial collateral

  1. Activity-dependent differences in function between proximal and distal Schaffer collaterals.

    PubMed

    Owen, Benjamin; Grover, Lawrence M

    2015-06-01

    Axon conduction fidelity is important for signal transmission and has been studied in various axons, including the Schaffer collateral axons of the hippocampus. Previously, we reported that high-frequency stimulation (HFS) depresses Schaffer collateral excitability when assessed by whole-cell recordings from CA3 pyramidal cells but induces biphasic excitability changes (increase followed by decrease) in extracellular recordings of CA1 fiber volleys. Here, we examined responses from proximal (whole-cell or field-potential recordings from CA3 pyramidal cell somata) and distal (field-potential recordings from CA1 stratum radiatum) portions of the Schaffer collaterals during HFS and burst stimulation in hippocampal slices. Whole-cell and dual-field-potential recordings using 10-100-Hz HFS revealed frequency-dependent changes like those previously described, with higher frequencies producing more drastic changes. Dual-field-potential recordings revealed substantial differences in the response to HFS between proximal and distal regions of the Schaffer collaterals, with proximal axons depressing more strongly and only distal axons showing an initial excitability increase. Because CA3 pyramidal neurons normally fire in short bursts rather than long high-frequency trains, we repeated the dual recordings using 100-1,000-ms interval burst stimulation. Burst stimulation produced changes similar to those during HFS, with shorter intervals causing more drastic changes and substantial differences observed between proximal and distal axons. We suggest that functional differences between proximal and distal Schaffer collaterals may allow selective filtering of nonphysiological activity while maximizing successful conduction of physiological activity throughout an extensive axonal arbor.

  2. Novel side branch ostial stent.

    PubMed

    Chen, Shao-Liang; Lv, Shu-Zheng; Kwan, Tak W

    2009-04-01

    Bifurcation lesions are technically challenging and plagued by a high incidence of restenosis, especially at the side branch orifice, which results in a more frequent need for revascularization during the follow-up period. This report discusses two clinical experiences with a novel side branch ostial stent, the BIGUARD stent, designed for the treatment of bifurcation lesions; procedural success with no in-hospital complications was observed in types IVb and Ia lesions.

  3. Retrograde approach to an ostial left anterior descending chronic total occlusion through a left internal mammary artery graft.

    PubMed

    Hari, Pawan; Kirtane, Ajay J; Bangalore, Sripal

    2016-05-01

    Retrograde approach to chronic total occlusions (CTO) has been described via saphenous vein grafts, septal and epicardial collaterals. We report for the first time a successful retrograde approach to an ostial left anterior descending (LAD) artery CTO through a failed left internal mammary artery (LIMA) to LAD anastamosis. This case demonstrates the technical aspects of using a LIMA conduit as a retrograde approach to CTO. © 2015 Wiley Periodicals, Inc.

  4. Coronary Ostial Stenosis after Aortic Valve Replacement

    PubMed Central

    Ziakas, Antonios G.; Economou, Fotios I.; Charokopos, Nicholas A.; Pitsis, Antonios A.; Parharidou, Despina G.; Papadopoulos, Thomas I.; Parharidis, Georgios E.

    2010-01-01

    Coronary ostial stenosis is a rare but potentially serious sequela after aortic valve replacement. It occurs in the left main or right coronary artery after 1% to 5% of aortic valve replacement procedures. The clinical symptoms are usually severe and may appear from 1 to 6 months postoperatively. Although the typical treatment is coronary artery bypass grafting, patients have been successfully treated by means of percutaneous coronary intervention. Herein, we present the cases of 2 patients in whom coronary ostial stenosis developed after aortic valve replacement. In the 1st case, a 72-year-old man underwent aortic valve replacement and bypass grafting of the saphenous vein to the left anterior descending coronary artery. Six months later, he experienced a non-ST-segment-elevation myocardial infarction. Coronary angiography revealed a critical stenosis of the right coronary artery ostium. In the 2nd case, a 78-year-old woman underwent aortic valve replacement and grafting of the saphenous vein to an occluded right coronary artery. Four months later, she experienced unstable angina. Coronary angiography showed a critical left main coronary artery ostial stenosis and occlusion of the right coronary artery venous graft. In each patient, we performed percutaneous coronary intervention and deployed a drug-eluting stent. Both patients were asymptomatic on 6-to 12-month follow-up. We attribute the coronary ostial stenosis to the selective ostial administration of cardioplegic solution during surgery. We conclude that retrograde administration of cardioplegic solution through the coronary sinus may reduce the incidence of postoperative coronary ostial stenosis, and that stenting may be an efficient treatment option. PMID:20844624

  5. One-Year Outcomes After Everolimus-Eluting Stents Implantation in Ostial Lesions of Left Anterior Descending Coronary Arteries

    PubMed Central

    Golmohamadi, Zahra; Sokhanvar, Sepideh; Aslanabadi, Naser; Ghaffari, Samad; Sohrabi, Bahram

    2013-01-01

    Background In recent years, stents are increasingly used in variety of coronary lesions. Ostial lesion of left anterior descending coronary artery (LAD) however remains a challenge area because of the invariable involvement of distal left main coronary artery (LMCA). This study was designed to evaluate the clinical and angiographic outcomes of everolimus-eluting stent (EES) implantation for ostial LAD. Methods EESs were implanted in 45 consecutive patients with ostial LAD stenoses. For complete lesion coverage, stent positing was extended into the distal LMCA in 6 patients (13.3%) with intermediated LMCA narrowing. We assess MACE during one-year follow-up. Results In-hospital success rate was 100%; neither cardiac death nor stent thrombosis in our patients, but two patients had myocardial infarction in non-related coronary artery during follow-up. Two patients had angiographic restenosis and underwent TLR. The cumulative MACE-free survival rate was 95.6% at one year. Conclusion EES was in ostial LAD lesions with complete lesion coverage achieving high procedural success rate and acceptable clinical outcomes during one-year follow-up period.

  6. Coronary collaterals.

    PubMed

    Gorlin, R

    1976-01-01

    Coronary collaterals are probably enlargements of pre-existing channels which respond to local vasodilators and which function whenever pressure differences exist across them. Thus, in human coronary atherosclerosis collaterals are only seen when there is a severe intervening arterial obstruction (in excess of 75%). Coronary collaterals follow epicardial and intramycardial pathways, and the intermediary connections may be at vessels of highly varying caliber. The flow potential of most collateral pathways in man is possibly adequate for segmental myocardial function at lower than normal demands but clearly is inadequate for most, if not all, stressful interventions. In the last analysis, coronary collaterals in man are more an indication of severe regional ischemia (present or potential) than a sign of biological "compensation'' for a perfusion deficit.

  7. Transesophageal echocardiography assessment of severe ostial left main coronary stenosis

    NASA Technical Reports Server (NTRS)

    Firstenberg, M. S.; Greenberg, N. L.; Lin, S. S.; Garcia, M. J.; Alexander, L. A.; Thomas, J. D.

    2000-01-01

    Doppler echocardiography is commonly used in the assessment of stenotic valvular orifices. We describe the application of transesophageal echocardiography for the detection of a critical ostial left main coronary stenosis. Because preoperative coronary angiography often is not routinely performed in young patients undergoing valve surgery, application of Doppler echocardiography can potentially prevent catastrophic complications, particularly in atypical cases.

  8. Axonal degeneration, distal collateral branching and neuromuscular junction architecture alterations occur prior to symptom onset in the SOD1(G93A) mouse model of amyotrophic lateral sclerosis.

    PubMed

    Clark, Jayden A; Southam, Katherine A; Blizzard, Catherine A; King, Anna E; Dickson, Tracey C

    2016-10-01

    Degeneration of the distal axon and neuromuscular junction (NMJ) is considered a key and early feature of the pathology that accompanies motor neuron loss in people with amyotrophic lateral sclerosis (ALS). The mutant SOD1(G93A) mouse replicates many features of the disease, however the sequence of events resulting in degeneration of the neuromuscular circuitry remains unknown. Furthermore, despite widespread degenerative neuronal pathology throughout the spinal cord in this model, hindlimb motor function is lost before forelimb function. We investigated axons and NMJs in the hindlimb (gastrocnemius) and forelimb (extensor) muscles in the high copy number mutant SOD1(G93A)xYFP (yellow fluorescent protein) mouse. We found that distal axonal and NMJ alterations were present prior to previously reported functional symptom onset in this strain. Indeed, increased branch complexity as well as colocalisation between pre- and post-synaptic markers indicated widespread early axonal and NMJ alterations in the hindlimb. Immunohistochemical analysis demonstrated that the colocalisation of the scaffolding proteins nestin, LRP-4, dystrophin and rapsyn were diminished before post-synaptic receptors in the gastrocnemius, and the degree of loss differed between proteins. Analysis of the forelimb muscle revealed axonal and NMJ degeneration at a late, post symptomatic stage, as well as novel differences in NMJ morphology, with reduced complexity. Furthermore, post-synaptic scaffolding proteins were preserved in the forelimb compared with the hindlimb. Analysis of protein levels indicated an increase in LRP-4, dystrophin and rapsyn in post symptomatic skeletal muscle that may suggest ongoing attempts at repair. This study indicates that axonal and NMJ degeneration in the SOD1 model of ALS is a complex and evolving sequence of events. We provide evidence that YFP can detect morphological and plastic alterations in the SOD1(G93A) mouse, and that the pre- and post-synaptic integrity of

  9. Secondary syphilis presenting with aortitis and coronary ostial occlusion.

    PubMed

    Chadwick, John A; MacNab, Anita; Sarma, Jaydeep; Ray, Simon; Kadir, Isaac; Muldoon, Eavan G

    2016-03-01

    Aortitis is an established manifestation of tertiary syphilis. We report a rare case of aortitis with ostial occlusion and left ventricular failure in secondary syphilis. Her management required a true multidisciplinary approach from multiple specialities due to complications of concomitant psychosis and a history of anaphylaxis to penicillin. This case illustrates the complexities of diagnosing and managing a rare presentation of this increasingly prevalent infection.

  10. Collateral Circulation in Chronic Total Occlusions - an interventional perspective.

    PubMed

    Choo, Gim-Hooi

    2015-09-09

    Human coronary collaterals are inter-coronary communications that are believed to be present from birth. In the presence of chronic total occlusions, recruitment of flow via these collateral anastomoses to the arterial segment distal to occlusion provide an alternative source of blood flow to the myocardial segment at risk. This mitigates the ischemic injury. Clinical outcome of coronary occlusion ie. severity of myocardial infarction/ischemia, impairment of cardiac function and possibly survival depends not only on the acuity of the occlusion, extent of jeopardized myocardium, duration of ischemia but also to the adequacy of collateral circulation. Adequacy of collateral circulation can be assessed by various methods. These coronary collateral channels have been used successfully as a retrograde access route for percutaneous recanalization of chronic total occlusions. Factors that promote angiogenesis and further collateral remodeling ie. arteriogenesis have been identified. Promotion of collateral growth as a therapeutic target in patients with no suitable revascularization option is an exciting proposal.

  11. Collateral Circulation in Chronic Total Occlusions - An Interventional Perspective

    PubMed Central

    Choo, Gim-Hooi

    2015-01-01

    Human coronary collaterals are inter-coronary communications that are believed to be present from birth. In the presence of chronic total occlusions, recruitment of flow via these collateral anastomoses to the arterial segment distal to occlusion provide an alternative source of blood flow to the myocardial segment at risk. This mitigates the ischemic injury. Clinical outcome of coronary occlusion ie. severity of myocardial infarction/ischemia, impairment of cardiac function and possibly survival depends not only on the acuity of the occlusion, extent of jeopardized myocardium, duration of ischemia but also to the adequacy of collateral circulation. Adequacy of collateral circulation can be assessed by various methods. These coronary collateral channels have been used successfully as a retrograde access route for percutaneous recanalization of chronic total occlusions. Factors that promote angiogenesis and further collateral remodeling ie. arteriogenesis have been identified. Promotion of collateral growth as a therapeutic target in patients with no suitable revascularization option is an exciting proposal.

  12. Complications during renal artery stent placement for atherosclerotic ostial stenosis

    SciTech Connect

    Beek, Frederik J. A.; Kaatee, Robert; Beutler, Jaap J.; Ven, Peter J. van der; Mali, Willem P. T. M.

    1997-05-15

    Purpose. To describe short-term complications during stent placement for atherosclerotic renal artery ostial stenosis. Methods. Sixty-one arteries in 50 patients were treated with Palmaz stents. Nineteen patients had a single functioning kidney, 23 had a bilateral stenosis, which was stented bilaterally in 11, and 8 had a unilateral stenosis. The complications were grouped as those related to the catheterization procedure, those related to stent placement, and those possibly related to either category. The complications were divided into those with severe clinical significance (SCS), those with minor clinical significance (MCS), and radiological-technical complications (RTC). The stent placement procedures were ordered chronologically according to examination date and the complications were tabulated per group of 10 patients. Results. Five (10%) SCS, 5 (10%) MCS, and 8 (16%) RTC occurred in 50 patients. The catheterization procedure led to 2 SCS, 3 MCS, and 1 RTC. Stent placement gave rise to 7 RTC. Three SCS and 2 MCS could have been related to either catheterization or stent placement. More SCS occurred in the first group of 10 patients than in the following groups. Conclusion. Renal artery stent placement for atherosclerotic ostial stenosis has a considerable complication rate and a learning curve is present. The complications related to the actual stent placement were without clinical consequences.

  13. Pathophysiology of coronary collaterals.

    PubMed

    Stoller, Michael; Seiler, Christian

    2014-02-01

    While the existence of structural adaptation of coronary anastomoses is undisputed, the potential of coronary collaterals to be capable of functional adaptation has been questioned. For many years, collateral vessels were thought to be rigid tubes allowing only limited blood flow governed by the pressure gradient across them. This concept was consistent with the notion that although collaterals could provide adequate blood flow to maintain resting levels, they would be unable to increase blood flow sufficiently in situations of increased myocardial oxygen demand. However, more recent studies have demonstrated the capability of the collateral circulation to deliver sufficient blood flow even during exertion or pharmacologic stress. Moreover, it has been shown that increases in collateral flow could be attributed directly to collateral vasomotion. This review summarizes the pathophysiology of the coronary collateral circulation, ie the functional adapation of coronary collaterals to acute alterations in the coronary circulation.

  14. Pathophysiology of Coronary Collaterals#

    PubMed Central

    Stoller, Michael; Seiler, Christian

    2014-01-01

    While the existence of structural adaptation of coronary anastomoses is undisputed, the potential of coronary collaterals to be capable of functional adaptation has been questioned. For many years, collateral vessels were thought to be rigid tubes allowing only limited blood flow governed by the pressure gradient across them. This concept was consistent with the notion that although collaterals could provide adequate blood flow to maintain resting levels, they would be unable to increase blood flow sufficiently in situations of increased myocardial oxygen demand. However, more recent studies have demonstrated the capability of the collateral circulation to deliver sufficient blood flow even during exertion or pharmacologic stress. Moreover, it has been shown that increases in collateral flow could be attributed directly to collateral vasomotion. This review summarizes the pathophysiology of the coronary collateral circulation, ie the functional adapation of coronary collaterals to acute alterations in the coronary circulation. PMID:23701025

  15. Medial Collateral Ligament (MCL) Injuries

    MedlinePlus

    ... of Healthy Breakfasts Shyness Medial Collateral Ligament (MCL) Injuries KidsHealth > For Teens > Medial Collateral Ligament (MCL) Injuries ... Treatment Coping With an MCL Injury About MCL Injuries A torn medial collateral ligament (MCL) is a ...

  16. Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

    PubMed Central

    Nakazone, Marcelo A.; Machado, Maurício N.; Barbosa, Raphael B.; Santos, Márcio A.; Maia, Lilia N.

    2010-01-01

    Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case. PMID:21052501

  17. Flexible microsensor technology for real-time navigation tracking in balloon sinus ostial dilation

    PubMed Central

    Lam, Kent; Bigcas, Jo-Lawrence; Luong, Amber; Yao, William

    2017-01-01

    Background: Microsensor navigation has the potential to aid balloon sinus ostial dilation by providing real-time tracking of balloon devices within the complex anatomy of the sinonasal cavities. Objective: This feasibility study evaluated the incorporation of a new microsensor technology into a flexible guidewire for use with current instruments in balloon sinus ostial dilation. Methods: A retrospective study was conducted to include seven men and one woman (age range, 33–68 years), who underwent balloon sinus ostial dilation with flexible microsensor navigation in the operating room setting. All the procedures were performed at target sinuses with the patient under general anesthesia, in conjunction with subsequent endoscopic sinus surgery. Results: Balloon dilation was attempted at the maxillary (n = 3), frontal (n = 14), and sphenoid (n = 1) sinuses. In all the cases, the surgical navigation system displayed the flexible wire tip as it was advanced to the target sinus ostia; this visual feedback for wire position guided the balloon placement. Successful balloon dilation with assistance of flexible microsensor navigation was performed on most sinuses, except a single frontal sinus with adjacent type 2 frontal cells. Conclusion: Flexible navigation technology may be combined with balloon sinus technology to facilitate localization of instruments in the sinus anatomy. Additional optimization of both the device and software technology is warranted. PMID:28381323

  18. Ulnar Collateral Ligament Reconstruction

    PubMed Central

    Erickson, Brandon J.; Harris, Joshua D.; Chalmers, Peter N.; Bach, Bernard R.; Verma, Nikhil N.; Bush-Joseph, Charles A.; Romeo, Anthony A.

    2015-01-01

    Context: Ulnar collateral ligament (UCL) injuries lead to pain and loss of performance in the thrower’s elbow. Ulnar collateral ligament reconstruction (UCLR) is a reliable treatment option for the symptomatic, deficient UCL. Injury to the UCL usually occurs because of chronic accumulation of microtrauma, although acute ruptures occur and an acute-on-chronic presentation is also common. Evidence Acquisition: Computerized databases, references from pertinent articles, and research institutions were searched for all studies using the search terms ulnar collateral ligament from 1970 until 2015. Study Design: Clinical review. Level of Evidence: Level 5. Results: All studies reporting outcomes for UCLR are level 4. Most modern fixation methodologies appear to be biomechanically and clinically equivalent. Viable graft choices include ipsilateral palmaris longus tendon autograft, gracilis or semitendinosus autograft, and allograft. Clinical studies report excellent outcomes of UCLR for both recreational and elite level athletes with regard to return to sport and postoperative performance. Complications, although rare, include graft rerupture or attenuation, ulnar nerve symptoms, stiffness, pain, and/or weakness leading to decreased performance. Conclusion: Injuries to the UCL have become commonplace among pitchers. Nonoperative treatment should be attempted, but the limited studies have not shown promising results. Operative treatment can be performed with several techniques, with retrospective studies showing promising results. Complications include ulnar neuropathy as well as failure to return to sport. Detailed preoperative planning, meticulous surgical technique, and a comprehensive rehabilitation program are essential components to achieving a satisfactory result. PMID:26502444

  19. [Thinking of literature studies of collaterals].

    PubMed

    Li, Jie; Liang, Fan-Rong; Li, Ying

    2006-12-01

    Summarize recent 20 years' achievements in studying literature of channels and collaterals, analyze the problems in literature studies of collaterals and comment on literature studies of collaterals, and hold that systematical summarization and study of traditional theories of collaterals can explore collateral theory and its clinical application value, and summarization of literature should refine and raise theoretical structure and scientific connotation of the collateral theory, and serve for modern studies of collaterals and collateral diseases on the basis of systematical summarization and studies of traditional literature of collaterals.

  20. Measurements of pulmonary vein ostial diameter and distance to first bifurcation: a comparison of different measurement methods.

    PubMed

    Cronin, Paul; Saab, Ali; Kelly, Aine Marie; Gross, Barry H; Patel, Smita; Kazerooni, Ella A; Carlos, Ruth C

    2009-07-01

    The purpose of this study was to evaluate the agreement between axial, multiplanar reformatted (MPR) and semi-automated software measurements of pulmonary vein ostial diameters and distance to the first bifurcation. CT examinations of the thorax were retrospectively reviewed in 150 consecutive patients. The pulmonary vein ostial diameter and distance to the first bifurcation of the four main pulmonary veins were independently measured. The three measurement methods were compared using a Bland-Altman test. There was no significant variation between pulmonary vein ostial diameter measurements for the superior pulmonary veins across the three measurement methods. There was significant variation between the semi-automated program and both the axial (p=0.001) and MPR (p<0.001) measured diameters for the right inferior pulmonary vein ostial diameter and between the MPR and semi-automated program measurements (p=0.02) for the left inferior pulmonary vein ostial diameter. There was no significant variation between the pulmonary vein distance to first bifurcation measurements for any pulmonary vein across the three measurement methods. However, from a clinical perspective, differences were negligible; therefore, the clinician may confidently use any of the three measurement methods presented.

  1. DISTAL MYOPATHIES

    PubMed Central

    Dimachkie, Mazen M.; Barohn, Richard J.

    2014-01-01

    Over a century ago, Gowers described two young patients in whom distal muscles weakness involved the hand, foot, sternocleidomastoid, and facial muscles in the other case the shoulder and distal leg musculature. Soon after, , similar distal myopathy cases were reported whereby the absence of sensory symptoms and of pathologic changes in the peripheral nerves and spinal cord at postmortem examination allowed differentiation from Charcot-Marie-Tooth disease. In 1951, Welander described autosomal dominant (AD) distal arm myopathy in a large Scandanavian cohort. Since then the number of well-characterized distal myopathies has continued to grow such that the distal myopathies have formed a clinically and genetically heterogeneous group of disorders. Affected kindred commonly manifest weakness that is limited to foot and toe muscles even in advanced stages of the disease, with variable mild proximal leg, distal arm, neck and laryngeal muscle involvement in selected individuals. An interesting consequence of the molecular characterization of the distal myopathies has been the recognition that mutation in a single gene can lead to more than one clinical disorder. For example, Myoshi myopathy (MM) and limb girdle muscular dystrophy (LGMD) type 2B are allelic disorders due to defects in the gene that encodes dysferlin. The six well described distal myopathy syndromes are shown in Table 1. Table 2 lists advances in our understanding of the myofibrillar myopathy group and Table 3 includes more recently delineated and less common distal myopathies. In the same manner, the first section of this review pertains to the more traditional six distal myopathies followed by discussion of the myofibrillar myopathies. In the third section, we review other clinically and genetically distinctive distal myopathy syndromes usually based upon single or smaller family cohorts. The fourth section considers other neuromuscular disorders that are important to recognize as they display prominent

  2. Collateral circulation from the conus coronary artery to the anterior descending coronary artery: assessment using multislice coronary computed tomography.

    PubMed

    de Agustín, José A; Marcos-Alberca, Pedro; Hernández-Antolín, Rosana; Vilacosta, Isidre; Pérez de Isla, Leopoldo; Rodríguez, Enrique; Macaya, Carlos; Zamorano, José

    2010-03-01

    The prognosis of patients with coronary artery disease largely depends on the presence of a collateral circulation. The location and extent of the collateral circulation is highly variable and these parameters determine whether or not ischemic symptoms occur and whether left ventricular contractility is abnormal. The collateral circulation is generally established through small-caliber distal vessels, although many different forms have been described. We report on three patients with severe left coronary artery disease and collateral circulation through a large conus coronary artery that joined a proximal or medial segment of the left anterior descending coronary artery. In all three cases, left ventricular function was preserved.

  3. Effect of the Interaction between Recanalization and Collateral Circulation on Functional Outcome in Acute Ischaemic Stroke

    PubMed Central

    Mangiafico, Salvatore; Saia, Valentina; Nencini, Patrizia; Romani, Ilaria; Palumbo, Vanessa; Pracucci, Giovanni; Consoli, Arturo; Rosi, Andrea; Renieri, Leonardo; Nappini, Sergio; Limbucci, Nicola; Inzitari, Domenico; Gensini, Gian Franco

    2014-01-01

    Summary Identification of patients with acute ischaemic stroke who could most benefit from arterial recanalization after endovascular treatment remains an unsettled issue. Although several classifications of collateral circulation have been proposed, the clinical role of collaterals is still debated. We evaluated the effect of the collateral circulation in relation to recanalization as a predictor of clinical outcome. Data were prospectively collected from 102 patients consecutively treated for proximal middle cerebral or internal carotid artery occlusion. The collateral circulation was evaluated with a novel semiquantitative-qualitative score, the Careggi collateral score (CCS), in six grades. Both CCS and recanalization grades (TICI) were analysed in relation to clinical outcome. A statistical analysis was performed to evaluate the effect of interaction between recanalization and collateral circulation on clinical outcome. Out of the 102 patients, 37 (36.3%) had poor collaterals, and 65 (63.7%) had good collaterals. Patients with good collaterals had lower basal National Institute of Health Stroke Scale (NIHSS), more distal occlusion, smaller lesions at 24h CT scan and better functional outcome. After multivariate analysis, the interaction between recanalization and collateral grades was significantly stronger as a predictor of good outcome (OR 6.87, 95% CI 2.11 – 22.31) or death (OR 4.66, 95%CI 1.48 – 14.73) compared to the effect of the single variables. Collaterals showed an effect of interaction with the recanalization grade in determining a favourable clinical outcome. Assessment of the collateral circulation might help predict clinical results after recanalization in patients undergoing endovascular treatment for acute ischaemic stroke. PMID:25496680

  4. Pial Collateral Reactivity During Hypertension and Aging

    PubMed Central

    Chan, Siu-Lung; Sweet, Julie G.; Bishop, Nicole

    2016-01-01

    Background and Purpose— We investigated vasoactive properties of leptomeningeal arterioles (LMAs) under normotensive conditions and during hypertension and aging that are known to have poor collateral flow and little salvageable tissue. Methods— LMAs, identified as distal anastomotic arterioles connecting middle and anterior cerebral arteries, were studied isolated and pressurized from young (18 weeks) or aged (48 weeks) normotensive Wistar Kyoto (WKY18, n=14; WKY48, n=6) rats and spontaneously hypertensive rats (SHR18, n=16; SHR48, n=6). Myogenic tone and vasoactive responses to pressure as well as endothelial function and ion channel activity were measured. Results— LMAs from WKY18 had little myogenic tone at 40 mm Hg (8±3%) that increased in aged WKY48 (30±6%). However, LMAs from both WKY groups dilated to increased pressure and demonstrated little myogenic reactivity, a response that would be conducive to collateral flow. In contrast, LMAs from both SHR18 and SHR48 displayed considerable myogenic tone (56±8% and 43±7%; P<0.01 versus WKY) and constricted to increased pressure. LMAs from both WKY and SHR groups had similar basal endothelial nitric oxide and IK channel activity that opposed tone. However, dilation to sodium nitroprusside, diltiazem and 15 mmol/L KCl was impaired in LMAs from SHR18. Conclusions— This study shows for the first time that LMAs from young and aged SHR are vasoconstricted and have impaired vasodilatory responses that may contribute to greater perfusion deficit and little penumbral tissue. These results also suggest that therapeutic opening of pial collaterals is possible during middle cerebral artery occlusion to create penumbral tissue and prevent infarct expansion. PMID:27103017

  5. Characterization of intestinal collateral blood flow in the developing piglet.

    PubMed

    Crissinger, K D; Granger, D N

    1988-10-01

    Interest in the pathogenesis of neonatal necrotizing enterocolitis has prompted study of the intestinal circulation in developing animals. It is conceivable that poorly developed collateral channels may predispose the neonatal intestine to ischemic insults. We therefore characterized intestinal collateral blood flow in anesthetized and ventilated 1-day and 1-month-old piglets. Intestinal blood flow was measured with radioactive microspheres (15 micron diameter) before and after either 1) total occlusion of the superior mesenteric artery (SMA) or 2) occlusion of a distal (jejunoileal) branch of the SMA. After total SMA occlusion in 1-day and 1-month-old piglets, perfusion of the intestine via collaterals from the celiac and inferior mesenteric arteries was not evident. Jejunal, ileal, and colonic (except rectal) blood flows fell to zero 30 min after ligation of the SMA. Ligation of a distal branch of the SMA in 1-month-old animals significantly reduced total wall (by 25%) and mucosal/submucosal (by 25%) blood flows in the occluded segment. Similar experiments in 1-day-old piglets produced significantly greater reduction in total (70%) and mucosa/submucosa (70%) blood flows. Muscle/serosa blood flows in both groups were not significantly different from control values. In conclusion, collateral perfusion of the intestine via the celiac and inferior mesenteric arteries is insignificant during acute SMA occlusion in the developing piglet. Although there is significant collateral blood flow within the SMA vascular network, perfusion between adjacent gut segments is less effective in preventing intestinal ischemia after occlusion of a branch of the SMA in neonates than in 1-month-old piglets.

  6. Military Robotics and Collateral Damage

    DTIC Science & Technology

    2004-06-01

    Applications and Operations Military Robotics and Collateral Damage Robert Douglass (Primary POC) SET Associates 3811 N. Fairfax...2004 4. TITLE AND SUBTITLE Military Robotics and Collateral Damage 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S...Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Abstract We explore a concept of a combined force of air and ground combat robots

  7. Profunda Anchor Technique for Ipsilateral Antegrade Approach in Endovascular Treatment of Superficial Femoral Artery Ostial Occlusion

    SciTech Connect

    Pua, Uei

    2015-04-15

    Endovascular treatment of the superficial femoral artery (SFA) is challenging in the presence of flush ostial occlusion. One of the main challenges is the availability of access sites for intervention. Contralateral retrograde femoral access followed by cross-over and antegrade intervention while commonly used, may not be feasible in cases of altered iliac anatomy (e.g. kissing iliac stents). Ipsilateral antegrade intervention using common femoral artery (CFA) access in these instances while possible is typically challenging due to inadequate working length of the CFA for interrogation of the SFA ostium, compounded by the lack of sheath stability. The “profunda anchor” technique uses a buddy wire in the profunda femoris artery (PFA) to stabilize the sheath and allow catheter manipulation for antegrade intervention at the level of the SFA ostium. The PFA is further used as a conduit for deployment of closure device to avoid interference with the treated SFA.

  8. Ulnar Collateral Ligament Reconstruction

    PubMed Central

    Erickson, Brandon J.; Bach, Bernard R.; Cohen, Mark S.; Bush-Joseph, Charles A.; Cole, Brian J.; Verma, Nikhil N.; Nicholson, Gregory P.; Romeo, Anthony A.

    2016-01-01

    Background: Ulnar collateral ligament reconstruction (UCLR) is a common surgery performed in professional, collegiate, and high school athletes. Purpose: To report patient demographics, surgical techniques, and outcomes of all UCLRs performed at a single institution from 2004 to 2014. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent UCLR from January 1, 2004, through December 31, 2014, at a single institution were identified. Charts were reviewed to determine patient age, sex, date of surgery, sport played, athletic level, surgical technique, graft type, and complications. Data were collected prospectively, and patients were contacted via phone calls to obtain the return-to-sport rate, Conway-Jobe score, Andrews-Timmerman score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. Continuous variable data were reported as weighted means, and categorical variable data were reported as frequencies with percentages. Results: A total of 187 patients (188 elbows) underwent UCLR during the study period (92% male; mean age, 19.6 ± 4.7 years; 78.2% right elbows). There were 165 baseball players (87.8% of all patients), 155 of whom were pitchers (82.5% of all patients). Ninety-seven (51.6%) were college athletes, 68 (36.2%) high school athletes, and 7 (3.7%) professional athletes at the time of surgery. The docking technique was used in 110 (58.5%) patients while the double-docking technique was used in 78 (41.5%). An ipsilateral palmaris longus graft was used in 110 (58.5%) patients while a hamstring autograft was used in 48 (25.5%) patients. The ulnar nerve was subcutaneously transposed in 79 (42%) patients. Clinical follow-up data were available on 85 patients. Mean follow-up was 60 ± 30.8 months. Overall, 94.1% of patients were able to return to sport and had a Conway-Jobe score of good/excellent while 4.3% had a score of fair. The mean KJOC score was 90.4 ± 6.7 and mean Andrews-Timmerman score was 92.5 ± 7

  9. Coronary collateral circulation: its relevance.

    PubMed

    Karrowni, Wassef; El Accaoui, Ramzi N; Chatterjee, Kanu

    2013-11-15

    The interest in coronary collateral circulation (CCC) as "natural bypasses" is growing, especially in patients in whom the extent of coronary atherosclerosis is too severe to allow for conventional revascularization. The anatomic foundation of CCC has been recognized for long time. Recently, reliable methods have become available for the assessment of the adequacy of collateral flow. However, the debate regarding the importance of CCC in the different clinical settings continues. In this article, we present the recent progress in the understanding of anatomy and physiology of the CCC and focus on the studies addressing their functional significance in acute, subacute, and chronic coronary artery disease. In addition, we provide a focused update on the essential role of collateral circulation in the management of coronary chronic total occlusions.

  10. 31 CFR 202.6 - Collateral security.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Collateral security. 202.6 Section 202... GOVERNMENT 1 § 202.6 Collateral security. (a) Requirement. Prior to receiving deposits of public money, a depositary authorized to perform services under § 202.3(b) must pledge collateral security in the...

  11. 31 CFR 202.6 - Collateral security.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Collateral security. 202.6 Section... GOVERNMENT 1 § 202.6 Collateral security. (a) Requirement. Prior to receiving deposits of public money, a depositary authorized to perform services under § 202.3(b) must pledge collateral security in the...

  12. 31 CFR 202.6 - Collateral security.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Collateral security. 202.6 Section 202... GOVERNMENT 1 § 202.6 Collateral security. (a) Requirement. Prior to receiving deposits of public money, a depositary authorized to perform services under § 202.3(b) must pledge collateral security in the...

  13. 31 CFR 202.6 - Collateral security.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Collateral security. 202.6 Section 202... GOVERNMENT 1 § 202.6 Collateral security. (a) Requirement. Prior to receiving deposits of public money, a depositary authorized to perform services under § 202.3(b) must pledge collateral security in the...

  14. ST Segment Elevation Myocardial Infarction Due to Severe Ostial Left Main Stem Stenosis in a Patient with Syphilitic Aortitis.

    PubMed

    Predescu, L M; Zarma, L; Platon, P; Postu, M; Bucsa, A; Croitoru, M; Prodan, B; Chioncel, O; Deleanu, D

    2016-01-01

    Cardiovascular manifestations of tertiary syphilis infections are uncommon, but represent an important cause of mortality and morbidity. Syphilitic aortitis is characterized by aortic regurgitation, dilatation of ascending aorta and ostial coronary artery lesions. We report a case of 36 years old man admitted to our hospital for acute anterior ST segment elevation myocardial infarction complicated with cardiogenic shock (hypotension 75/50 mmHg). Transthoracic echocardiography revealed a dilated left ventricle with severe systolic dysfunction (ejection fraction = 25%), severe mitral regurgitation, moderate aortic regurgitation and mildly dilated ascending aorta. Coronary angiography showed a severe ostial lesion of left main coronary artery which was treated by urgent stent implantation and an intra-aortic contrapulsation balloon was implanted. Blood tests for syphilitic infection were positive. The patient was discharged with treatment including benzathine penicillin. In our case, we present an acute manifestation of a syphilitic ostial left main stenosis treated by primary percutaneous coronary intervention in acute myocardial infarction. Long term follow-up of the patient is crucial as a result of potential rapid in-stent restenosis caused by continuous infection of the ascending aorta. This case is particular because it shows that syphilitic aortitis can be diagnosed in acute settings, like ST segment elevation myocardial infarction.

  15. Hemodynamic role of ophthalmic artery collateral in internal carotid artery occlusion.

    PubMed

    Tatemichi, T K; Chamorro, A; Petty, G W; Khandji, A; Oropeza, L A; Duterte, D I; Mohr, J P

    1990-03-01

    We performed duplex and transcranial Doppler studies in 36 patients with angiographically documented internal carotid artery occlusion (ICAO) to determine the effect of ophthalmic artery collateral (OAC) on measures of vascular resistivity both proximal and distal to the occlusion. Resistance in the common carotid artery, measured by the resistivity index, was significantly lower in the group with OAC than in those without OAC, indicating a shunt to the low resistance intracranial circuit. The pulsatility index (PI) of the Doppler signal in the ipsilateral middle cerebral artery, a measure of both inflow pressure and distal vascular resistance, did not differ between those with and without OAC. However, the presence of circle of Willis collateral pathways (anterior communicating and/or posterior communicating artery) did appear to have a significant effect on pulsatility. When both were present angiographically, PI was higher than in the group with only 1 Willisian collateral. These findings suggest that OAC has a marginal effect on vascular resistance in arterial bed distal to an ICAO, while Willisian collaterals appear to have a more important role in cerebral perfusion, as measured indirectly by Doppler methods.

  16. Cyclooxygenase blockade limits blood flow to collateral-dependent myocardium during exercise.

    PubMed

    Altman, J D; Klassen, C L; Bache, R J

    1995-11-01

    Cyclooxygenase blockade has been found to cause vasoconstriction of coronary collateral vessels in open-chest animals. This study was carried out to determine whether cyclooxygenase blockade can limit blood flow to collateral-dependent myocardium during exercise. Studies were performed in 8 adult mongrel dogs in which intermittent followed by permanent occlusion of the left anterior descending coronary artery produced an area of collateral-dependent myocardium. Myocardial blood flow was measured with radioactive microspheres at rest and during treadmill exercise to produce heart rates of 215 +/-0 7 beats/min. At rest collateral zone blood flow (1.00 +/- 0.10 ml/min per g) was significantly less than normal zone flow (1.23 +/- 0.14) (P < 0.05). During control exercise blood flow increased 91 +/- 22% in the collateral zone and 102 +/- 28% in the normal zone (each P < 0.05). Thirty minutes after cyclooxygenase blockade with indomethacin (5 mg/kg i.v.) blood flow in the normal zone and the collateral zone was not different from control during resting conditions. Indomethacin did not change heart rate or arterial pressure during exercise, but significantly increased the aortic-to-distal coronary pressure gradient from 33 +/- 3 to 40 +/- 5 mmHg (P < 0.05). Indomethacin increased transcollateral resistance during exercise by 42 +/- 10% (P < 0.05); this was associated with a 27 +/- 11% decrease in subendocardial flow in the collateral zone (P < 0.05) with no significant change in subepicardial flow, and no change in normal zone blood flow. These findings demonstrate that in the intact awake animal cyclooxygenase blockade causes coronary collateral vasoconstriction which can impair blood flow to the dependent myocardium during exercise.

  17. Comparison of gradient echo with spin echo magnetic resonance imaging and echocardiography in the evaluation of major aortopulmonary collateral arteries.

    PubMed

    Vick, G W; Wendt, R E; Rokey, R

    1994-05-01

    This study compared gradient echo magnetic resonance imaging, spin echo magnetic resonance imaging, echocardiography, and echocardiography with x-ray cineangiography in the evaluation of major aortopulmonary collateral arteries. Twelve patients (ages 9 months to 35 years, mean 11 +/- 11 years) with known or suspected major aortopulmonary collateral arteries were studied. The aortic insertion and proximal course of 29 major aortopulmonary collateral arteries demonstrated by x-ray contrast angiography were shown in all 29 cases by gradient echo magnetic resonance imaging but in only 23 of the 29 cases by spin echo magnetic resonance imaging. Color Doppler-echocardiography detected aortopulmonary collateral arteries in four patients but did not define the proximal course or distal anatomy. Gradient echo images of distal aortopulmonary collateral anatomy were qualitatively superior to spin echo images. The contrast-to-noise ratio between the vessel lumen and adjacent lung was greater for gradient echo (6.06 +/- 2.91) than for spin echo (1.45 +/- 1.13)(p < 0.05). Gradient echo magnetic resonance imaging is a useful method for identification and characterization of aortopulmonary collateral arteries in patients of all ages and is superior to spin echo magnetic resonance imaging and echocardiography.

  18. "Cutting Balloon and the Three Burrs": treatment for ostial left anterior descending artery in-stent restenosis.

    PubMed

    Osula, Serge; Ramsdale, David R

    2002-02-01

    A 58-year-old man re-presented with symptoms of angina 3 months after percutaneous transluminal coronary angioplasty (PTCA) and stenting to his proximal left anterior descending artery (LAD). Angiography revealed ostial in-stent restenosis of the LAD, which was treated with rotational atherectomy and a cutting balloon PTCA. Combining two useful technologies for treating in-stent restenosis may prove to yield better results than using either technique alone. Long-term benefit will need to be assessed by randomized studies.

  19. Distal splenorenal shunt

    MedlinePlus

    ... shunt; Cirrhosis - distal splenorenal; Liver failure - distal splenorenal; Portal vein pressure - distal splenorenal shunt ... vein from your spleen is removed from the portal vein. The vein is then attached to the ...

  20. Intracranial Arteries - Anatomy and Collaterals.

    PubMed

    Liebeskind, David S; Caplan, Louis R

    2016-01-01

    Anatomy, physiology, and pathophysiology are inextricably linked in patients with intracranial atherosclerosis. Knowledge of abnormal or pathological conditions such as intracranial atherosclerosis stems from detailed recognition of the normal pattern of vascular anatomy. The vascular anatomy of the intracranial arteries, both at the level of the vessel wall and as a larger structure or conduit, is a reflection of physiology over time, from in utero stages through adult life. The unique characteristics of arteries at the base of the brain may help our understanding of atherosclerotic lesions that tend to afflict specific arterial segments. Although much of the knowledge regarding intracranial arteries originates from pathology and angiography series over several centuries, evolving noninvasive techniques have rapidly expanded our perspective. As each imaging modality provides a depiction that combines anatomy and flow physiology, it is important to interpret each image with a solid understanding of typical arterial anatomy and corresponding collateral routes. Compensatory collateral perfusion and downstream flow status have recently emerged as pivotal variables in the clinical management of patients with atherosclerosis. Ongoing studies that illustrate the anatomy and pathophysiology of these proximal arterial segments across modalities will help refine our knowledge of the interplay between vascular anatomy and cerebral blood flow. Future studies may help elucidate pivotal arterial factors far beyond the degree of stenosis, examining downstream influences on cerebral perfusion, artery-to-artery thromboembolic potential, amenability to endovascular therapies and stent conformation, and the propensity for restenosis due to biophysical factors.

  1. 7 CFR 2201.20 - Collateral.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Assets to be used in the delivery of the service for which the Loan is guaranteed. Such Assets may include, but are not limited to, the following: (1) Tangible Assets, including current Assets (such as... Collateral. Collateral required by paragraph (a) of this section shall consist solely of Assets of...

  2. 7 CFR 2201.20 - Collateral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Assets to be used in the delivery of the service for which the Loan is guaranteed. Such Assets may include, but are not limited to, the following: (1) Tangible Assets, including current Assets (such as... Collateral. Collateral required by paragraph (a) of this section shall consist solely of Assets of...

  3. 31 CFR 202.6 - Collateral security.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Service's web site at www.publicdebt.treas.gov. (c) Deposits of securities. Unless the Secretary of the... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Collateral security. 202.6 Section... GOVERNMENT 1 § 202.6 Collateral security. (a) Requirement. Prior to receiving deposits of public money,...

  4. 28 CFR 94.25 - Collateral sources.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Collateral sources. 94.25 Section 94.25 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Coverage § 94.25 Collateral sources. (a) The amount of...

  5. 28 CFR 94.25 - Collateral sources.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Collateral sources. 94.25 Section 94.25 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Coverage § 94.25 Collateral sources. (a) The amount of...

  6. 28 CFR 94.25 - Collateral sources.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Collateral sources. 94.25 Section 94.25 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Coverage § 94.25 Collateral sources. (a) The amount of...

  7. 28 CFR 94.25 - Collateral sources.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Collateral sources. 94.25 Section 94.25 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Coverage § 94.25 Collateral sources. (a) The amount of...

  8. 28 CFR 94.25 - Collateral sources.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Collateral sources. 94.25 Section 94.25 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIME VICTIM SERVICES International Terrorism Victim Expense Reimbursement Program Coverage § 94.25 Collateral sources. (a) The amount of...

  9. 7 CFR 2201.20 - Collateral.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 15 2013-01-01 2013-01-01 false Collateral. 2201.20 Section 2201.20 Agriculture Regulations of the Department of Agriculture (Continued) LOCAL TELEVISION LOAN GUARANTEE BOARD LOCAL TELEVISION LOAN GUARANTEE PROGRAM-PROGRAM REGULATIONS Loan Guarantees § 2201.20 Collateral. (a) Existence...

  10. 7 CFR 2201.20 - Collateral.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Collateral. 2201.20 Section 2201.20 Agriculture Regulations of the Department of Agriculture (Continued) LOCAL TELEVISION LOAN GUARANTEE BOARD LOCAL TELEVISION LOAN GUARANTEE PROGRAM-PROGRAM REGULATIONS Loan Guarantees § 2201.20 Collateral. (a) Existence...

  11. 12 CFR 725.19 - Collateral requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Collateral requirements. 725.19 Section 725.19 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS NATIONAL CREDIT UNION ADMINISTRATION CENTRAL LIQUIDITY FACILITY § 725.19 Collateral requirements. (a)...

  12. 45 CFR 160.532 - Collateral estoppel.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Collateral estoppel. 160.532 Section 160.532 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES ADMINISTRATIVE DATA STANDARDS AND RELATED REQUIREMENTS GENERAL ADMINISTRATIVE REQUIREMENTS Procedures for Hearings § 160.532 Collateral estoppel. When...

  13. [Simple analysis on collateral therapy in Huangdi's Internal Classic].

    PubMed

    Li, Jie; Liang, Fan-rong; Xia, Xiao-hong; Zhao, Zheng-yu

    2005-12-01

    Collateral therapy includes treatment of diseases of collaterals, and treatment of human other diseases with collaterals as treating subjects. In collateral therapy of Huangdi's Internal Classic, collaterals were used as treating subjects, and the treatment was directly given at the collaterals of lesion; for treatment methods, acupuncture and moxibustion were adopted as main method, including pricking blood therapy, moxibustion of collaterals, acupuncture; the diseases and syndromes of treatment included diseases and syndromes of channels and collaterals, and human other diseases and syndromes; the principles of reinforcing and reducing, and the principles of treatment varying from time to time were stressed, and it indicated contraindications for treatment.

  14. Anatomic study of the collateral blood supply of the sternum.

    PubMed

    de Jesus, R A; Acland, R D

    1995-01-01

    A microdissection study was carried out on ten injected, cleared human sternal specimens. Three types of vessel were identified that have the potential to carry blood to the sternum after mobilization of the internal thoracic artery (ITA): (1) branches of the ITA that supply both the sternum and the pectoralis major ("sternal/perforating branches"), (2) branches of the ITA that supply both the sternum and an adjoining intercostal space ("sternal/intercostal branches"), and (3) posterior intercostal arteries that do not anastomose with an ITA branch but continue past the ITA to reach the sternum. All three types of vessel were found more frequently in the proximal than in the distal half of the sternum. For sternal/perforating and sternal/intercostal vessels to function as collaterals after ITA bypass grafting, their short common trunks of origin must remain intact. The data support the recommendation that the branches of the ITA be ligated as close as possible to the ITA itself to preserve collateral blood flow to the sternum.

  15. Current Concepts in Rehabilitation Following Ulnar Collateral Ligament Reconstruction

    PubMed Central

    Ellenbecker, Todd S.; Wilk, Kevin E.; Altchek, David W.; Andrews, James R.

    2009-01-01

    Injuries to the ulnar collateral ligament (UCL) in throwing athletes frequently occurs from the repetitive valgus loading of the elbow during the throwing motion, which often results in surgical reconstruction of the UCL requiring a structured postoperative rehabilitation program. Several methods are currently used and recommended for UCL reconstruction using autogenous grafts in an attempt to reproduce the stabilizing function of the native UCL. Rehabilitation following surgical reconstruction of the UCL begins with range of motion and initial protection of the surgical reconstruction, along with resistive exercise for the entire upper extremity kinetic chain. Progressions for resistive exercise are followed that attempt to fully restore strength and local muscular endurance in the rotator cuff and scapular stabilizers, in addition to the distal upper extremity musculature, to allow for a return to throwing and overhead functional activities. Rehabilitation following UCL reconstruction has produced favorable outcomes, allowing for a return to throwing in competitive environments. PMID:23015887

  16. 12 CFR 950.10 - Collateral valuation; appraisals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Collateral valuation; appraisals. 950.10...-BALANCE SHEET ITEMS ADVANCES Advances to Members § 950.10 Collateral valuation; appraisals. (a) Collateral...) Appraisals. A Bank may require a member to obtain an appraisal of any item of collateral, and to perform...

  17. 12 CFR 615.5335 - Bank net collateral ratio.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Bank net collateral ratio. 615.5335 Section 615... collateral ratio. (a) Each bank shall achieve and at all times maintain a net collateral ratio of at least 103 percent. (b) At a minimum, a bank shall compute its net collateral ratio as of the end of...

  18. 12 CFR 615.5335 - Bank net collateral ratio.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Bank net collateral ratio. 615.5335 Section 615... collateral ratio. (a) Each bank shall achieve and at all times maintain a net collateral ratio of at least 103 percent. (b) At a minimum, a bank shall compute its net collateral ratio as of the end of...

  19. 12 CFR 615.5335 - Bank net collateral ratio.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false Bank net collateral ratio. 615.5335 Section 615... collateral ratio. (a) Each bank shall achieve and at all times maintain a net collateral ratio of at least 103 percent. (b) At a minimum, a bank shall compute its net collateral ratio as of the end of...

  20. 12 CFR 615.5335 - Bank net collateral ratio.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 7 2014-01-01 2014-01-01 false Bank net collateral ratio. 615.5335 Section 615... collateral ratio. (a) Each bank shall achieve and at all times maintain a net collateral ratio of at least 103 percent. (b) At a minimum, a bank shall compute its net collateral ratio as of the end of...

  1. 12 CFR 615.5335 - Bank net collateral ratio.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false Bank net collateral ratio. 615.5335 Section 615... collateral ratio. (a) Each bank shall achieve and at all times maintain a net collateral ratio of at least 103 percent. (b) At a minimum, a bank shall compute its net collateral ratio as of the end of...

  2. 7 CFR 1779.48 - Collateral.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... (CONTINUED) WATER AND WASTE DISPOSAL PROGRAMS GUARANTEED LOANS § 1779.48 Collateral. (a) Lender... and ability of project management, soundness of the project, and the borrower's prospective earnings..., water rights, buildings, machinery, equipment, accounts receivable, contracts, cash, or other...

  3. Collateral vessel physiology and functional impact-in vivo assessment of collateral channels.

    PubMed

    Lim, M; Ziaee, A; Kern, Morten J

    2004-11-01

    The existence and recruitment of collateral vessels within the coronary circulation may account for the tremendous variability in presentation, symptoms and outcome in patients with coronary atherosclerosis. Multiple episodes of ischemia have been found to produce the stimuli necessary for the growth of new vessels which result in collateral blood flow. Furthermore, there is also a subset of patients with readily recruitable collateral vessels that function to limit myocardial necrosis during an acute ischemic event. Promising early studies have utilized angiogenic growth factors as a means to stimulate collateral growth, bringing a renewal interest in their assessment and significance. We review, in brief, the significance and understanding of the development of coronary collaterals as well as the available means to assess them.

  4. Pre-procedural combined coronary angiography and stress myocardial perfusion imaging using 320-detector CT in unprotected left main and ostial left anterior descending artery intervention.

    PubMed

    Ko, Brian S; Crossett, Marcus; Seneviratne, Sujith K

    2015-07-01

    Pre-procedural anatomic and functional coronary assessment plays a crucial role in selection of patients suitable for unprotected left main percutaneous coronary intervention. Combined coronary computed tomography angiography and adenosine stress computed tomography myocardial perfusion imaging is a non-invasive technique which may provide this information. This is the first report describing its use to assist patient selection and procedural planning prior to elective left main and ostial left anterior descending artery coronary intervention.

  5. Mechanical buckling of arterioles in collateral development.

    PubMed

    Liu, Qin; Han, Hai-Chao

    2013-01-07

    Collateral arterioles enlarge in both diameter and length, and develop corkscrew-like tortuous patterns during remodeling. Recent studies showed that artery buckling could lead to tortuosity. The objective of this study was to determine arteriole critical buckling pressure and buckling pattern during arteriole remodeling. Arterioles were modeled as elastic cylindrical vessels with an elastic matrix support and underwent axial and radial growth. Our results demonstrated that arteriole critical buckling pressure decreased with increasing axial growth ratio and radius growth ratio, but increased with increasing wall thickness. Arteriole buckling mode number increased (wavelength decreased) with increasing axial growth ratio, but decreased with increasing radius growth ratio and wall thickness. Our study suggests that axial growth in arterioles makes them prone to buckling and that buckling leads to tortuous collaterals. These results shed light on the mechanism of collateral arteriole tortuosity.

  6. Mechanical Buckling of Arterioles in Collateral Development

    PubMed Central

    Liu, Qin; Han, Hai-Chao

    2012-01-01

    Collateral arterioles enlarge in both diameter and length, and develop corkscrew-like tortuous patterns during remodeling. Recent studies showed that artery buckling could lead to tortuosity. The objective of this study was to determine arteriole critical buckling pressure and buckling pattern during arteriole remodeling. Arterioles were modeled as elastic cylindrical vessels with an elastic matrix support and underwent axial and radial growth. Our results demonstrated that arteriole critical buckling pressure decreased with increasing axial growth ratio and radius growth ratio, but increased with increasing wall thickness. Arteriole buckling mode number increased (wave length decreased) with increasing axial growth ratio, but decreased with increasing radius growth ratio and wall thickness. Our study suggests that axial growth in arterioles makes them prone to buckling and that buckling leads to tortuous collaterals. These results shed light on the mechanism of collateral arteriole tortuosity. PMID:23034307

  7. Impact of Slow Blood Filling via Collaterals on Infarct Growth: Comparison of Mismatch and Collateral Status

    PubMed Central

    Son, Jeong Pyo; Lee, Mi Ji; Kim, Suk Jae; Chung, Jong-Won; Cha, Jihoon; Kim, Gyeong-Moon; Chung, Chin-Sang; Lee, Kwang Ho; Bang, Oh Young

    2017-01-01

    Background and Purpose Perfusion-diffusion mismatch has been evaluated to determine whether the presence of a target mismatch helps to identify patients who respond favorably to recanalization therapies. We compared the impact on infarct growth of collateral status and the presence of a penumbra, using magnetic resonance perfusion (MRP) techniques. Methods Consecutive patients who were candidates for recanalization therapy and underwent serial diffusion-weighted imaging (DWI) and MRP were enrolled. A collateral flow map derived from MRP source data was generated by automatic post-processing. The impact of a target mismatch (Tmax>6 s/apparent diffusion coefficient (ADC) volume≥1.8, ADC volume<70 mL; and Tmax>10 s for ADC volume<100 mL) on infarct growth was compared with MR-based collateral grading on day 7 DWI, using multivariate linear regression analysis. Results Among 73 patients, 55 (75%) showed a target mismatch, whereas collaterals were poor in 14 (19.2%), intermediate in 36 (49.3%), and good in 23 (31.5%) patients. After adjusting for initial severity of stroke, early recanalization (P<0.001) and the MR-based collateral grading (P=0.001), but not the presence of a target mismatch, were independently associated with infarct growth. Even in patients with a target mismatch and successful recanalization, the degree of infarct growth depended on the collateral status. Perfusion status at later Tmax time points (beyond the arterial phase) was more closely correlated with collateral status. Conclusions Patients with good collaterals show a favorable outcome in terms of infarct growth, regardless of the presence of a target mismatch pattern. The presence of slow blood filling predicts collateral status and infarct growth. PMID:28030891

  8. 75 FR 64710 - Public Roundtable on Individual Customer Collateral Protection

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-20

    ... collateral protection in the context of the CFTC's rulemaking efforts pursuant to the Dodd-Frank Wall Street... addressed at the discussion, or on any other topics related to customer collateral protection in the...

  9. 30 CFR 800.21 - Collateral bonds.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR BONDING AND INSURANCE REQUIREMENTS FOR SURFACE COAL MINING AND RECLAMATION OPERATIONS BOND AND INSURANCE REQUIREMENTS FOR SURFACE COAL MINING AND RECLAMATION OPERATIONS UNDER REGULATORY PROGRAMS § 800.21 Collateral...

  10. 30 CFR 800.21 - Collateral bonds.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR BONDING AND INSURANCE REQUIREMENTS FOR SURFACE COAL MINING AND RECLAMATION OPERATIONS BOND AND INSURANCE REQUIREMENTS FOR SURFACE COAL MINING AND RECLAMATION OPERATIONS UNDER REGULATORY PROGRAMS § 800.21 Collateral...

  11. 30 CFR 800.21 - Collateral bonds.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR BONDING AND INSURANCE REQUIREMENTS FOR SURFACE COAL MINING AND RECLAMATION OPERATIONS BOND AND INSURANCE REQUIREMENTS FOR SURFACE COAL MINING AND RECLAMATION OPERATIONS UNDER REGULATORY PROGRAMS § 800.21 Collateral...

  12. 30 CFR 800.21 - Collateral bonds.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR BONDING AND INSURANCE REQUIREMENTS FOR SURFACE COAL MINING AND RECLAMATION OPERATIONS BOND AND INSURANCE REQUIREMENTS FOR SURFACE COAL MINING AND RECLAMATION OPERATIONS UNDER REGULATORY PROGRAMS § 800.21 Collateral...

  13. 30 CFR 800.21 - Collateral bonds.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR BONDING AND INSURANCE REQUIREMENTS FOR SURFACE COAL MINING AND RECLAMATION OPERATIONS BOND AND INSURANCE REQUIREMENTS FOR SURFACE COAL MINING AND RECLAMATION OPERATIONS UNDER REGULATORY PROGRAMS § 800.21 Collateral...

  14. Collateral Learning and Mathematical Education of Teachers

    ERIC Educational Resources Information Center

    Abramovich, Sergei

    2012-01-01

    This article explores the notion of collateral learning in the context of classic ideas about the summation of powers of the first "n" counting numbers. Proceeding from the well-known legend about young Gauss, this article demonstrates the value of reflection under the guidance of "the more knowledgeable other" as a pedagogical method of making…

  15. 13 CFR 120.934 - Collateral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Collateral. 120.934 Section 120.934 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Development Company... must be insured against such hazards and risks as SBA may require, with provisions for notice to...

  16. 12 CFR 614.4240 - Collateral definitions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... satisfied the requirements for and has been certified as a real estate appraiser by a State or territory... income and/or other collateral, absent the real estate, and the decision to extend credit was, in fact.... (o) Real estate means an identified parcel or tract of land, including improvements, if any. (p)...

  17. 12 CFR 614.4240 - Collateral definitions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... satisfied the requirements for and has been certified as a real estate appraiser by a State or territory... income and/or other collateral, absent the real estate, and the decision to extend credit was, in fact.... (o) Real estate means an identified parcel or tract of land, including improvements, if any. (p)...

  18. 12 CFR 614.4240 - Collateral definitions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... satisfied the requirements for and has been certified as a real estate appraiser by a State or territory... income and/or other collateral, absent the real estate, and the decision to extend credit was, in fact.... (o) Real estate means an identified parcel or tract of land, including improvements, if any. (p)...

  19. Using Collateral Material To Improve Writing Performance.

    ERIC Educational Resources Information Center

    Taylor, Monica E.

    2003-01-01

    Examines the extent to which the provision of selected collateral material can enhance students' enjoyment of their writing tasks, and their performance in a context where although English is the official language, it is little used and much resisted by students for whom the language of choice for social interaction is the local Creole.…

  20. 28 CFR 104.47 - Collateral sources.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... compensation, including life insurance, pension funds, death benefits programs, and payments by Federal, State... determining the appropriate collateral source offset for future benefit payments, the Special Master may employ an appropriate methodology for determining the present value of such future benefits....

  1. 28 CFR 104.47 - Collateral sources.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Collateral sources. 104.47 Section 104.47 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 2001..., or local governments related to the terrorist-related aircraft crashes of September 11, 2001....

  2. 12 CFR 950.7 - Collateral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... securities as the Finance Board in its discretion may determine. (2) Agency securities. Securities issued...: (i) Mortgage-backed securities issued or guaranteed by Freddie Mac, Fannie Mae, Ginnie Mae, or any... collateral has a readily ascertainable value, can be reliably discounted to account for liquidation and...

  3. Distal Biceps Tendon Rupture

    DTIC Science & Technology

    2010-06-01

    distal tendon. Although these findings overlap with those seen in tendinopathy , the presence of bone marrow edema at the radial tuberosity and fluid in...the bicipitoradial bursa suggests a partial tear rather than tendinopathy .3 When the distal biceps tendon tear is complete, MR imaging shows

  4. On the collateral sesamoidean (suspensory navicular) ligament of equines: topographic relations and sensitive innervation.

    PubMed

    Palmieri, G; Sanna, L; Asole, A; Farina, V; Bo Minelli, L

    1990-01-01

    The origin and course of the collateral sesamoidean (suspensory navicular) ligament of the horse and ass and its attachment to the distal sesamoid bone were studied by means of dissection. Particular attention was given to the topographic relations between this ligament and the deep digital flexor tendon. Numerous sensitive nerve endings are present in this anatomical district. The free and encapsulated nerve endings, displayed by impregnating techniques, are mostly concentrated in the ligament tract connected to the above-named tendon and close to its attachment to the distal sesamoid angle. The nerve endings are identified as typical Pacini, Pacini-like and Golgi-Mazzoni corpuscles on account of their morphological features and are found isolated, grouped to form flower-sprays, lined up along the course of a single nerve fibre or grouped to originate poikilomorphous fibres.

  5. Collateral response to activation of potassium channels in vivo.

    PubMed

    Lamping, K G

    1998-04-01

    Activation of ATP-sensitive K+ channels is involved in the coronary vascular response to decreases in perfusion pressure and ischemia. Since activation of ATP-sensitive K+ channels in collateral vessels may be important in determining flow to collateral-dependent myocardium, the ability of collaterals to respond to activation of the channel was tested. In the beating heart of dogs, we compared responses of non-collaterals less than 100 microns in diameter to collaterals of similar size using computer-controlled stroboscopic epi-illumination of the left ventricle coupled to a microscope-video system. Aprikalim, a selective activator of ATP-sensitive K+ channels (0.1-10 microM) produced similar dose-dependent dilation of non-collaterals and collaterals. Relaxation was decreased by inhibition of ATP-sensitive K+ channels with glibenclamide, but not by inhibition of nitric oxide synthase with nitro-L-arginine. Bradykinin (10-100 microM) produced similar dilation of non-collaterals and collaterals which was decreased by nitro-L-arginine but not glibenclamide. Thus, in microvascular collaterals, relaxation to both nitric oxide and activation of ATP-sensitive K+ channels is similar to non-collaterals.

  6. Collateral development and spinal motor reorganization after nerve injury and repair

    PubMed Central

    Yu, Youlai; Zhang, Peixun; Han, Na; Kou, Yuhui; Yin, Xiaofeng; Jiang, Baoguo

    2016-01-01

    Functional recovery is often unsatisfactory after severe extended nerve defects or proximal nerve trunks injuries repaired by traditional repair methods, as the long regeneration distance for the regenerated axons to reinnervate their original target end-organs. The proximal nerve stump can regenerate with many collaterals that reinnervate the distal stump after peripheral nerve injury, it may be possible to use nearby fewer nerve fibers to repair more nerve fibers at the distal end to shorten the regenerating distance. In this study, the proximal peroneal nerve was used to repair both the distal peroneal and tibial nerve. The number and location of motor neurons in spinal cord as well as functional and morphological recovery were assessed at 2 months, 4 months and 8 months after nerve repair, respectively. Projections from the intact peroneal and tibial nerves were also studied in normal animals. The changes of motor neurons were assessed using the retrograde neurotracers FG and DiI to backlabel motor neurons that regenerate axons into two different pathways. To evaluate the functional recovery, the muscle forces and sciatic function index were examined. The muscles and myelinated axons were assessed using electrophysiology and histology. The results showed that all labeled motor neurons after nerve repair were always confined within the normal peroneal nerve pool and nearly all the distribution of motor neurons labeled via distal different nerves was disorganized as compared to normal group. However, there was a significant decline in the number of double labeled motor neurons and an obvious improvement with respect to the functional and morphological recovery between 2 and 8 months. In addition, the tibial/peroneal motor neuron number ratio at different times was 2.11±0.05, 2.13±0.08, 2.09±0.12, respectively, and was close to normal group (2.21±0.09). Quantitative analysis showed no significant morphological differences between myelinated nerve fibers

  7. Collateral development and spinal motor reorganization after nerve injury and repair.

    PubMed

    Yu, Youlai; Zhang, Peixun; Han, Na; Kou, Yuhui; Yin, Xiaofeng; Jiang, Baoguo

    2016-01-01

    Functional recovery is often unsatisfactory after severe extended nerve defects or proximal nerve trunks injuries repaired by traditional repair methods, as the long regeneration distance for the regenerated axons to reinnervate their original target end-organs. The proximal nerve stump can regenerate with many collaterals that reinnervate the distal stump after peripheral nerve injury, it may be possible to use nearby fewer nerve fibers to repair more nerve fibers at the distal end to shorten the regenerating distance. In this study, the proximal peroneal nerve was used to repair both the distal peroneal and tibial nerve. The number and location of motor neurons in spinal cord as well as functional and morphological recovery were assessed at 2 months, 4 months and 8 months after nerve repair, respectively. Projections from the intact peroneal and tibial nerves were also studied in normal animals. The changes of motor neurons were assessed using the retrograde neurotracers FG and DiI to backlabel motor neurons that regenerate axons into two different pathways. To evaluate the functional recovery, the muscle forces and sciatic function index were examined. The muscles and myelinated axons were assessed using electrophysiology and histology. The results showed that all labeled motor neurons after nerve repair were always confined within the normal peroneal nerve pool and nearly all the distribution of motor neurons labeled via distal different nerves was disorganized as compared to normal group. However, there was a significant decline in the number of double labeled motor neurons and an obvious improvement with respect to the functional and morphological recovery between 2 and 8 months. In addition, the tibial/peroneal motor neuron number ratio at different times was 2.11±0.05, 2.13±0.08, 2.09±0.12, respectively, and was close to normal group (2.21±0.09). Quantitative analysis showed no significant morphological differences between myelinated nerve fibers

  8. Acquired portosystemic collaterals: anatomy and imaging.

    PubMed

    Leite, Andréa Farias de Melo; Mota, Américo; Chagas-Neto, Francisco Abaeté; Teixeira, Sara Reis; Elias Junior, Jorge; Muglia, Valdair Francisco

    2016-01-01

    Portosystemic shunts are enlarged vessels that form collateral pathological pathways between the splanchnic circulation and the systemic circulation. Although their causes are multifactorial, portosystemic shunts all have one mechanism in common-increased portal venous pressure, which diverts the blood flow from the gastrointestinal tract to the systemic circulation. Congenital and acquired collateral pathways have both been described in the literature. The aim of this pictorial essay was to discuss the distinct anatomic and imaging features of portosystemic shunts, as well as to provide a robust method of differentiating between acquired portosystemic shunts and similar pathologies, through the use of illustrations and schematic drawings. Imaging of portosystemic shunts provides subclinical markers of increased portal venous pressure. Therefore, radiologists play a crucial role in the identification of portosystemic shunts. Early detection of portosystemic shunts can allow ample time to perform endovascular shunt operations, which can relieve portal hypertension and prevent acute or chronic complications in at-risk patient populations.

  9. Acquired portosystemic collaterals: anatomy and imaging*

    PubMed Central

    Leite, Andréa Farias de Melo; Mota Jr., Américo; Chagas-Neto, Francisco Abaeté; Teixeira, Sara Reis; Elias Junior, Jorge; Muglia, Valdair Francisco

    2016-01-01

    Portosystemic shunts are enlarged vessels that form collateral pathological pathways between the splanchnic circulation and the systemic circulation. Although their causes are multifactorial, portosystemic shunts all have one mechanism in common-increased portal venous pressure, which diverts the blood flow from the gastrointestinal tract to the systemic circulation. Congenital and acquired collateral pathways have both been described in the literature. The aim of this pictorial essay was to discuss the distinct anatomic and imaging features of portosystemic shunts, as well as to provide a robust method of differentiating between acquired portosystemic shunts and similar pathologies, through the use of illustrations and schematic drawings. Imaging of portosystemic shunts provides subclinical markers of increased portal venous pressure. Therefore, radiologists play a crucial role in the identification of portosystemic shunts. Early detection of portosystemic shunts can allow ample time to perform endovascular shunt operations, which can relieve portal hypertension and prevent acute or chronic complications in at-risk patient populations. PMID:27777479

  10. Distal ulnar growth arrest.

    PubMed

    Nelson, O A; Buchanan, J R; Harrison, C S

    1984-03-01

    Four cases of arrest of distal ulnar physeal growth occurring in children ages 7 to 13 years had follow-up for 2 to 10 years. Each patient developed bowing of the radial diaphysis, ulnar translation of the distal radial epiphysis, and increased ulnar angulation of the distal radiocarpal joint surface. Growth discrepancies were documented in both the ulna (range 2.2 to 3.9 cm) and to a lesser extent the radius (range 0.2 to 1.6 cm) when compared to the opposite forearm in each patient. The progression of deformity appeared to be greatest during adolescence. Radial deviation and pronation were limited to varying degrees in each case. No patient had significant pain or functional impairment, but the cosmetic appearance was always displeasing. Indications for surgical treatment include increasing ulnar angulation of the distal radial articular surface, progressive loss of motion, and displeasing cosmetic appearance.

  11. Transphyseal Distal Humerus Fracture.

    PubMed

    Abzug, Joshua; Ho, Christine Ann; Ritzman, Todd F; Brighton, Brian

    2016-01-01

    Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed. Cubitus varus caused by a malunion, osteonecrosis of the medial condyle, or growth arrest is the most common complication encountered in the treatment of transphyseal distal humerus fractures. A corrective lateral closing wedge osteotomy can be performed to restore a nearly normal carrying angle.

  12. Distal renal tubular acidosis

    MedlinePlus

    ... get better with treatment. When to Contact a Medical Professional Call your health care provider if you have symptoms of distal renal tubular acidosis. Get medical help right away if you develop emergency symptoms ...

  13. α-Adrenergic and neuropeptide Y Y1 receptor control of collateral circuit conductance: influence of exercise training

    PubMed Central

    Taylor, Jessica C; Yang, H T; Laughlin, M Harold; Terjung, Ronald L

    2008-01-01

    This study evaluated the role of α-adrenergic receptor- and neuropeptide Y (NPY) Y1 receptor-mediated vasoconstriction in the collateral circuit of the hind limb. Animals were evaluated either the same day (Acute) or 3 weeks following occlusion of the femoral artery; the 3-week animals were in turn limited to cage activity (Sed) or given daily exercise (Trained). Collateral-dependent blood flows (BFs) were measured during exercise with microspheres before and after α-receptor inhibition (phentolamine) and then NPY Y1 receptor inhibition (BIBP 3226) at the same running speed. Blood pressures (BPs) were measured above (caudal artery) and below (distal femoral artery) the collateral circuit. Arterial BPs were reduced by α-inhibition (50–60 mmHg) to ∼75 mmHg, but not further by NPY Y1 receptor inhibition. Effective experimental sympatholysis was verified by 50–100% increases (P < 0.001) in conductance of active muscles not affected by femoral occlusion with receptor inhibition. In the absence of receptor inhibition, vascular conductance of the collateral circuit was minimal in the Acute group (0.13 ± 0.02), increased over time in the Sed group (0.41 ± 0.03; P < 0.001), and increased further in the Trained group (0.53 ± 0.03; P < 0.02). Combined receptor inhibition increased collateral circuit conductances (P < 0.005), most in the Acute group (116 ± 37%; P < 0.02), as compared to the Sed (41 ± 6.6%; P < 0.001) and Trained (31 ± 5.6%; P < 0.001) groups. Thus, while the sympathetic influence of the collateral circuit remained in the Sed and Trained animals, it became less influential with time post-occlusion. Collateral conductances were collectively greater (P < 0.01) in the Trained as compared to Sed group, irrespective of the presence or absence of receptor inhibition. Conductances of the active ischaemic calf muscle, with combined receptor inhibition, were suboptimal in the Acute group, but increased in Sed and Trained animals to exceptionally high

  14. Dynamics of collateral circulation in progressive asymptomatic carotid disease.

    PubMed

    Moll, F L; Eikelboom, B C; Vermeulen, F E; van Lier, H J; Schulte, B P

    1986-03-01

    Inadequacy of collateral arterial flow is the major risk factor for hemispheric infarction in association with spontaneous occlusion of the ipsilateral carotid artery. This prospective study was designed to measure the adaptation of collateral cerebral circulation through the circle of Willis in patients in whom a unilateral carotid stenosis of hemodynamic consequence develops asymptomatically. The collateral cerebral potential is assessed by ocular pneumoplethysmography (OPG) during proximal common carotid artery compression, measuring the collateral ophthalmic artery pressure (COAP). During an average follow-up of almost 3 years (maximum more than 7 years), 45 patients showed asymptomatic development of a unilateral hemodynamically significant carotid stenosis according to OPG evidence. In these patients the mean index COAP/brachial artery pressure did not change on the side of stenosis progression (p greater than 0.05). The developed carotid stenosis had only reduced collateral circulation to the contralateral hemisphere. The risk of inadequate collateral cerebral circulation remained during progression of asymptomatic extracranial arterial obstructive disease.

  15. The Erasme Study: A Multicenter Study on the Safety and Technical Results of the Palmaz Stent Used for the Treatment of Atherosclerotic Ostial Renal Artery Stenosis

    SciTech Connect

    Bakker, Jeannette; Goffette, Pierre P.; Henry, Michel; Mali, Willem P.T.M.; Melki, Jean-Pierre; Moss, Jon G.; Rabbia, Claudio; Therasse, Eric; Thomson, Kenneth R.; Thurnher, Siegfried; Vignali, Claudio

    1999-11-15

    Purpose: To assess, in a multicenter setting, safety, technical results, and restenosis rate of the Palmaz stent for treatment of atherosclerotic ostial renal artery stenosis. Methods: Ten centers enrolled 106 patients (120 treated renal artery stenoses) in the study. Patient selection was based on unsuccessful percutaneous transluminal renal angioplasty (residual stenosis {>=} 20%) performed for treatment of ostial stenosis {>=} 50%, in patients with hypertension and/or impaired renal function. Safety was assessed by means of the complication rate, and technical results by the number of successful stent placements and occurrence of restenosis (>50%) at intraarterial angiographic follow-up. Results: Stent placement was successful (n = 112) or partially successful (n = 5) in 117 (98%) arteries. Complications occurred in 19 procedures; seven were of serious clinical significance. Angiographic follow-up was performed in 89 of 117 (76%) cases, at a mean of 8 months (range 2.5-18 months). Fifteen stents (16.9%) showed restenosis (at a mean of 8.5 months), of which 10 were successfully redilated. Conclusion: Renal artery stenting has a high technical success rate, a complication rate comparable to percutaneous transluminal renal angioplasty, and a low rate of restenosis at 8 months angiographic follow-up.

  16. [IVUS-controlled aorto-ostial directional coronary atherectomy in higher grade stenosis of the central anastomosis of a sequential triple venous bypass].

    PubMed

    Schiele, T M; Beauport, J; Niehues, R; Jacksch, R

    1998-12-01

    Following coronary artery bypass grafting repeat ischemia mandatory for reintervention occurs in 2 to 30% of cases, depending mainly on graft age. Selection of a suitable strategy for revascularisation--transcatheter angioplasty or reoperation--depends on various parameters including coronary morphology, left ventricular performance, comorbidity and availability of graft material. Catheter-based interventions on saphenous vein bypass grafts are feasible, but lower primary success rates and a higher incidence of restenosis--compared with native coronary arteries--have to be expected. Repeat coronary artery bypass graft operations are associated with a significantly higher perioperative morbidity and mortality, patency rates are lower and late clinical outcome is worse than in primary surgery. We report on a patient who underwent coronary artery bypass grafting 4 years ago revealing a high grade ostial stenosis in a jump-graft supplying RCA, LAD and Cx sequentially, making reintervention necessary. As a prerequisite serial balloon angioplasty of two native vessels was performed prior to ostial intervention. Intravascular-ultrasound guided directional coronary atherectomy was performed with good primary and long-term result. Our case demonstrates that, if all relevant clinical parameters and different therapeutic options are taken into account, complex transcatheter angioplasty procedures are feasible and associated with a reasonable amount of risk, thus avoiding repeat coronary artery bypass graft operations.

  17. MRI Predictors of Failure in Non-operative Management of Ulnar Collateral Ligament Injuries in Professional Baseball Pitchers

    PubMed Central

    Lynch, Thomas Sean; Frangiamore, Salvatore; Vaughn, Michael Derek; Soloff, Lonnie; Schickendantz, Mark S.

    2016-01-01

    Objectives: Ulnar collateral injuries (UCL) of the elbow are prevalent among professional baseball pitchers. The decision on initial operative versus nonoperative management of these injuries remains subjective in many cases, with reported success rates with nonoperative management ranging from 42 to 93% in professional throwing athletes. No studies to date have identified objective characteristics specific to success or failure of nonoperative intervention. The purpose of this study was to identify radiologic predictors for success or failure in nonoperative management of ulnar collateral ligament injuries in professional pitchers. Methods: A retrospective review of pitchers sustaining UCL injuries between 2006 and 2015 from one professional baseball organization (one major league team and all minor league teams included) was performed. UCL injuries were identified in 38 players based on clinical and radiographic findings. Six players underwent initial surgical intervention without attempted nonoperative intervention and were excluded from analysis. This left 32 (84%) professional pitchers who underwent an initial trail of nonoperative treatment for partial UCL tears. Success was defined as return to same level of play (RTSP) or higher for >1 year. Failure was defined as recurrent pain or weakness requiring surgical intervention after a minimum of 3 months’ rest when attempting a return to throw rehabilitation program. MRI findings were classified as high or low grade sprains, proximal or distal location of injury, and with or without the presence of concomitant chronic findings. Results: Of the 32 patients who underwent nonoperative management, 10 (36%) failed and required subsequent ligament reconstruction. Between the success and failure groups, there was no significant difference seen in total shoulder arc of motion (P=.7776), shoulder internal rotation deficit (P=.3846) or loss in elbow extension (P=.0644) at the time of injury. When comparing MRI findings

  18. Collateral sensitivity of antibiotic-resistant microbes.

    PubMed

    Pál, Csaba; Papp, Balázs; Lázár, Viktória

    2015-07-01

    Understanding how evolution of microbial resistance towards a given antibiotic influences susceptibility to other drugs is a challenge of profound importance. By combining laboratory evolution, genome sequencing, and functional analyses, recent works have charted the map of evolutionary trade-offs between antibiotics and have explored the underlying molecular mechanisms. Strikingly, mutations that caused multidrug resistance in bacteria simultaneously enhanced sensitivity to many other unrelated drugs (collateral sensitivity). Here, we explore how this emerging research sheds new light on resistance mechanisms and the way it could be exploited for the development of alternative antimicrobial strategies.

  19. Intravascular ultrasound guidance of percutaneous coronary intervention in ostial chronic total occlusions: a description of the technique and procedural results.

    PubMed

    Ryan, Nicola; Gonzalo, Nieves; Dingli, Philip; Cruz, Oscar Vedia; Jiménez-Quevedo, Pilar; Nombela-Franco, Luis; Nuñez-Gil, Ivan; Trigo, María Del; Salinas, Pablo; Macaya, Carlos; Fernandez-Ortiz, Antonio; Escaned, Javier

    2017-02-14

    Inability to cross the lesion with a guidewire is the most common reason for failure in percutaneous revascularization (PCI) of chronic total occlusions (CTOs). An ostial or stumpless CTO is an acknowledged challenge for CTO recanalization due to difficulty in successful wiring. IVUS imaging provides the opportunity to visualize the occluded vessel and to aid guidewire advancement. We review the value of this technique in a single-centre experience of CTO PCI. This series involves 22 patients who underwent CTO-PCI using IVUS guidance for stumpless CTO wiring at our institution. CTO operators with extensive IVUS experience in non-CTO cases carried out all procedures. Procedural and outcome data was prospectively entered into the institutional database and a retrospective analysis of clinical, angiographic and technical data performed. 17 (77%) of the 22 procedures were successful. The mean age was 59.8 ± 11.5 years, and 90.9% were male. The most commonly attempted lesions were located in the left anterior descending 36.4% (Soon et al. in J Intervent Cardiol 20(5):359-366, 2007) and Circumflex artery (LCx) 31.8% (Mollet et al. in Am J Cardiol 95(2):240-243, 2005). Mean JCTO score was 3.09 ± 0.75 (3.06 ± 0.68, 3.17 ± 0.98 in the successful and failed groups respectively p = 0.35). The mean contrast volume was 378.7 ml ± 114.7 (389.9 ml ± 130.5, 349.2 ml ± 52.2 p = 0.3 in the successful and failed groups respectively). There was no death, coronary artery bypass grafting or myocardial infarction requiring intervention in this series. When the success rates were analyzed taking into account the date of adoption of this technique, the learning curve had no significant impact on CTO-PCI success. This series describes a good success rate in IVUS guided stumpless wiring of CTOs in consecutive patients with this complex anatomical scenario.

  20. Calcium-dependent signalling is essential during collateral growth in the pig hind limb-ischemia model.

    PubMed

    Troidl, C; Nef, H; Voss, S; Schilp, A; Kostin, S; Troidl, K; Szardien, S; Rolf, A; Schmitz-Rixen, T; Schaper, W; Hamm, C W; Elsässer, A; Möllmann, H

    2010-07-01

    We investigated the effect of pharmacological activation of the Ca(2+)-channel transient receptor potential cation channel, subfamily V, member 4 (TRPV4) on collateral growth in a pig hind limb-ischemia model thereby identifying subcellular mechanisms. Domestic pigs received femoral artery ligature and were randomly assigned to one of the following groups (each n=6): (1) 4alpha-phorbol 12,13-didecanoate (4alphaPDD) treatment; (2) treatment with an arterio-venous shunt (AV-shunt) distal to the occlusion; or (3) implantation of NaCl-filled minipump. Six sham-operated pigs acted as controls. Aortic and peripheral mean arterial pressure (MAP) measurements were performed to assess the collateral flow index (CFI). Tissue was isolated from M. quadriceps for immunohistochemistry and from isolated collateral arteries for quantitative real time PCR (qRT-PCR). Shortly after ligature the CFI dropped from 0.96+/-0.02 to 0.21+/-0.02 in all ligature-treated groups. In ligature-only-treated pigs CFI increased to 0.56+/-0.03 after 7days. Treatment with 4alphaPDD led to an enhancement of CFI compared with ligature alone (0.73+/-0.03). CD31-staining showed improved arteriolar density. Increased Ki67 staining in collaterals indicated proliferation. qRT-PCR and Western blot analysis showed upregulation or modulation of Ca(2+)-dependent transcription factors nuclear factor of activated T-cells, cytoplasmic, calcineurin-dependent 1 (NFATc1), Kv channel interacting protein 3, calsenilin (KCNIP3/CSEN/DREAM), and myocyte enhancer factor 2C (MEF2C) in 4alphaPDD- and AV-shunt-treated pigs compared with controls. Improved CFI after 4alphaPDD treatment identifies TRPV4 as an initial fluid shear-stress sensor and collateral remodelling and growth trigger. Subcellularly, modulation of Ca(2+)-dependent transcription factors indicates a pivotal role for Ca(2+)-signalling during arteriogenesis.

  1. Laparoscopic Distal Pancreatectomy

    PubMed Central

    Melotti, Gianluigi; Butturini, Giovanni; Piccoli, Micaela; Casetti, Luca; Bassi, Claudio; Mullineris, Barbara; Lazzaretti, Maria Grazia; Pederzoli, Paolo

    2007-01-01

    Objective: To describe the clinical characteristics, indications, technical procedures, and outcome of a consecutive series of laparoscopic distal pancreatic resections performed by the same surgical team. Summary Background Data: Laparoscopic distal pancreatic resection has increasingly been described as a feasible and safe procedure, although accompanied by a high rate of conversion and morbidity. Methods: A consecutive series of patients affected by solid and cystic tumors were selected prospectively to undergo laparoscopic distal pancreatectomy performed by the same surgical team. Clinical characteristics as well as diagnostic preoperative assessment and intra- and postoperative data were prospectively recorded. A follow-up of at least 3 months was available for all patients. Results: Fifty-eight patients underwent laparoscopic resection between May 1999 and November 2005. All procedures were successfully performed laparoscopically, and no patient required intraoperative blood transfusion. Splenic vessel preservation was possible in 84.4% of spleen-preserving procedures. There were no mortalities. The overall median hospital stay was 9 days, while it was 10.5 days for patients with postoperative pancreatic fistulae (27.5% of all cases). Follow-up was available for all patients. Conclusions: Our experience in 58 consecutive patients was characterized by the lack of conversions and by acceptable rates of postoperative pancreatic fistulae and morbidity. Laparoscopy proved especially beneficial in patients with postoperative complications as they had a relatively short hospital stay. Solid and cystic tumors of the distal pancreas represent a good indication for laparoscopic resection whenever possible. PMID:17592294

  2. 48 CFR 48.104-3 - Sharing collateral savings.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Sharing collateral savings. 48.104-3 Section 48.104-3 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT VALUE ENGINEERING Policies and Procedures 48.104-3 Sharing collateral savings. (a)...

  3. 48 CFR 2448.104-3 - Sharing collateral savings.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Sharing collateral savings. 2448.104-3 Section 2448.104-3 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CONTRACT MANAGEMENT VALUE ENGINEERING 2448.104-3 Sharing collateral savings. (a) The authority...

  4. 48 CFR 2448.104-3 - Sharing collateral savings.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 6 2014-10-01 2014-10-01 false Sharing collateral savings. 2448.104-3 Section 2448.104-3 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CONTRACT MANAGEMENT VALUE ENGINEERING 2448.104-3 Sharing collateral savings. (a) The authority...

  5. Collateral Informant Assessment in Alcohol Use Research Involving College Students

    ERIC Educational Resources Information Center

    Hagman, Brett T.; Cohn, Amy M.; Noel, Nora E.; Clifford, Patrick R.

    2010-01-01

    Objective: This study examined the associations between college students' self-reported alcohol use and corresponding collateral reports and identified factors that influence agreement between both sets of reports. Participants/Methods: Subject-collateral pairs (N = 300) were recruited from undergraduate psychology courses. Results: Data yielded…

  6. 46 CFR 308.509 - Collateral deposit fund.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false Collateral deposit fund. 308.509 Section 308.509 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.509 Collateral deposit fund....

  7. Endothelial function in well-developed canine coronary collateral vessels.

    PubMed

    Altman, J; Dulas, D; Pavek, T; Laxson, D D; Homans, D C; Bache, R J

    1993-02-01

    This study examined responses of coronary collateral blood flow to endothelial-dependent vasodilators. Studies were performed in 13 dogs 4-6 mo after embolic occlusion of the left anterior descending coronary artery (LAD). Collateral flow was determined as the sum of retrograde flow from the cannulated LAD, and continuing tissue flow was measured with microspheres administered during the retrograde flow collection. Agonists were introduced into the left main coronary artery to reach collaterals arising from the left coronary arterial system. The endothelial-dependent vasodilators acetylcholine and bradykinin caused 21 +/- 7 and 25 +/- 8% increases of collateral flow, respectively (each P < 0.05). This was not different from the 28 +/- 8% increase in collateral flow produced by nitroglycerin. To determine whether vasodilator prostaglandins contributed to the increased collateral flow, studies were performed after cyclooxygenase blockade with indomethacin (5 mg/kg iv). Indomethacin caused a 30 +/- 9% decrease of retrograde flow during basal conditions but did not blunt the maximum collateral flow rates produced by acetylcholine, bradykinin, or nitroglycerin. These data demonstrate intact endothelial-dependent vasodilator mechanisms in the well-developed coronary collateral circulation.

  8. 12 CFR 614.4250 - Collateral evaluation standards.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... and procedures. Such a collateral evaluation shall be identified as either a collateral valuation or a...) Potential liabilities, including those associated with any hazardous waste or other environmental concerns... requested minimum valuation or specific valuation or approval of a loan. (b) For purposes of...

  9. 48 CFR 48.104-3 - Sharing collateral savings.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 1 2013-10-01 2013-10-01 false Sharing collateral savings. 48.104-3 Section 48.104-3 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT VALUE ENGINEERING Policies and Procedures 48.104-3 Sharing collateral savings. (a)...

  10. 48 CFR 48.104-3 - Sharing collateral savings.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Sharing collateral savings. 48.104-3 Section 48.104-3 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT VALUE ENGINEERING Policies and Procedures 48.104-3 Sharing collateral savings. (a)...

  11. 48 CFR 48.104-3 - Sharing collateral savings.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Sharing collateral savings. 48.104-3 Section 48.104-3 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT VALUE ENGINEERING Policies and Procedures 48.104-3 Sharing collateral savings. (a)...

  12. 48 CFR 48.104-3 - Sharing collateral savings.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Sharing collateral savings. 48.104-3 Section 48.104-3 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION CONTRACT MANAGEMENT VALUE ENGINEERING Policies and Procedures 48.104-3 Sharing collateral savings. (a)...

  13. 48 CFR 2448.104-3 - Sharing collateral savings.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Sharing collateral savings. 2448.104-3 Section 2448.104-3 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CONTRACT MANAGEMENT VALUE ENGINEERING 2448.104-3 Sharing collateral savings. (a) The authority...

  14. 48 CFR 2448.104-3 - Sharing collateral savings.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 6 2012-10-01 2012-10-01 false Sharing collateral savings. 2448.104-3 Section 2448.104-3 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CONTRACT MANAGEMENT VALUE ENGINEERING 2448.104-3 Sharing collateral savings. (a) The authority...

  15. 48 CFR 2448.104-3 - Sharing collateral savings.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Sharing collateral savings. 2448.104-3 Section 2448.104-3 Federal Acquisition Regulations System DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT CONTRACT MANAGEMENT VALUE ENGINEERING 2448.104-3 Sharing collateral savings. (a) The authority...

  16. 46 CFR 308.509 - Collateral deposit fund.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 8 2013-10-01 2013-10-01 false Collateral deposit fund. 308.509 Section 308.509 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.509 Collateral deposit fund....

  17. 46 CFR 308.509 - Collateral deposit fund.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 8 2011-10-01 2011-10-01 false Collateral deposit fund. 308.509 Section 308.509 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.509 Collateral deposit fund....

  18. 46 CFR 308.509 - Collateral deposit fund.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 8 2012-10-01 2012-10-01 false Collateral deposit fund. 308.509 Section 308.509 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.509 Collateral deposit fund....

  19. 46 CFR 308.509 - Collateral deposit fund.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Collateral deposit fund. 308.509 Section 308.509 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Open Policy War Risk Cargo Insurance § 308.509 Collateral deposit fund....

  20. Assessment of collateral flow in patients with cerebrovascular disorders.

    PubMed

    Donahue, Joseph; Sumer, Suna; Wintermark, Max

    2014-10-01

    The ability to maintain cerebral parenchymal perfusion during states of acute or chronic ischemic insult depends largely on the capacity of the cerebral collateral circulation. Perfusion techniques, including perfusion-CT and arterial spin labeling, may not only describe the overall status of the collateral network, but can also quantify the pathophysiologic collateral reserve, which is occult to conventional imaging techniques. The following review details advanced imaging modalities capable of resolving pathophysiologic collateral circulation in a functional and dynamic manner, with regards to the evaluation of both acute ischemic penumbra and chronic cerebral vascular reserve. Specifically, the applications of perfusion-CT, arterial spin labeling MRI techniques, and transcranial Doppler are reviewed in the context of collateral circulation with emphasis on perfusion techniques and proposed clinical utility.

  1. Collateral learning and mathematical education of teachers

    NASA Astrophysics Data System (ADS)

    Abramovich, Sergei

    2012-04-01

    This article explores the notion of collateral learning in the context of classic ideas about the summation of powers of the first n counting numbers. Proceeding from the well-known legend about young Gauss, this article demonstrates the value of reflection under the guidance of 'the more knowledgeable other' as a pedagogical method of making one's mathematics learning experience educative. This includes learning about the efficacy of generalizing by induction and the perils of overgeneralization. Recourse to geometry and computing as support system in understanding concepts of algebra is emphasized towards the end of promoting an experiential approach to mathematics. This article stems from the author's work with prospective teachers of secondary mathematics in a capstone course. Their reflections on the course are shared and analysed.

  2. Distal Radioulnar Joint Instability

    PubMed Central

    Mirghasemi, Ali R.; Lee, Daniel J.; Rahimi, Narges; Rashidinia, Shervin

    2015-01-01

    Distal radioulnar joint (DRUJ) instability is a common clinical condition but a frequently missed diagnosis. Both surgical and nonsurgical treatments are possible for chronic cases of DRUJ instability. Nonsurgical treatment can be considered as the primary therapy in less active patients, while surgery should be considered to recover bone and ligament injuries if nonsurgical treatment fails to restore forearm stability and function. The appropriate choice of treatment depends on the individual patient and specific derangement of the DRUJ PMID:26328241

  3. Distal radioulnar joint injuries

    PubMed Central

    Thomas, Binu P; Sreekanth, Raveendran

    2012-01-01

    Distal radioulnar joint is a trochoid joint relatively new in evolution. Along with proximal radioulnar joint, forearm bones and interosseous membrane, it allows pronosupination and load transmission across the wrist. Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures. The injury can be purely involving the soft tissue especially the triangular fibrocartilage or the radioulnar ligaments. The patients usually present with ulnar sided wrist pain, features of instability, or restriction of rotation. Difficulty in carrying loads in the hand is a major constraint for these patients. Thorough clinical examination to localize point of tenderness and appropriate provocative tests help in diagnosis. Radiology and MRI are extremely useful, while arthroscopy is the gold standard for evaluation. The treatment protocols are continuously evolving and range from conservative, arthroscopic to open surgical methods. Isolated dislocation are uncommon. Basal fractures of the ulnar styloid tend to make the joint unstable and may require operative intervention. Chronic instability requires reconstruction of the stabilizing ligaments to avoid onset of arthritis. Prosthetic replacement in arthritis is gaining acceptance in the management of arthritis. PMID:23162140

  4. [Use of laser technologies in treatment of chronic venous insufficiency in patients with a wide ostial segment of the main trunks of subcutaneous veins].

    PubMed

    Luk'ianenko, M Iu; Starodubtsev, V B; Karpenko, A A; Sergeevichev, D S

    2014-01-01

    Presented herein is the authors' experience in endovascular laser obliteration of the major trunks of the grate saphenous vein (GSV) with a wide ostial segment (measuring from 15 to 34 mm) in patients presenting with chronic venous insufficiency. Group One patients (n=32) underwent crossectomy followed by endovasal laser obliteration (EVLO) of the GSV's trunk on the femur. Group Two patients (n=46) were not subjected to crossectomy, whereas obliteration of the GSV's trunk was carried out immediately from the ostium. In Group One we managed to achieve obliteration of the GSV's trunk in 32 patients (100%) with no additional interventions, and in Group Two this was achieved in 42 (91.3%) patients. Four patients (8.7%) required performing a secondary procedure of EVLO after which obliteration of the trunk was achieved in all patients of Group Two. There was no evidence of deep-vein thrombosis.

  5. Inhibition of collateral artery growth by mibefradil: possible role of volume-regulated chloride channels.

    PubMed

    Ziegelhoeffer, Tibor; Scholz, Dimitri; Friedrich, Christian; Helisch, Armin; Wagner, Shawn; Fernandez, Borja; Schaper, Wolfgang

    2003-01-01

    Endothelial cell swelling is one of the earliest hallmarks of arteriogenesis, the growth and maturation of collaterals. Mibefradil was found to block endothelial Cl(-) channels that control the volume of endothelial cells. Thus the authors investigated whether the blockade of volume-controlling endothelial cell channels would translate into an inhibition of arteriogenesis. In BALB/c mice, the right femoral artery was ligated and the animals received either mibefradil or solvent (phosphate-buffered saline [PBS]) via osmotic minipumps. Laser Doppler perfusion ratio (R/L) of ligated versus nonligated distal hindlimb increased from 0.06 +/- 0.01 (immediately after ligation) to 0.25 +/- 0.02 (day 7) in the PBS group and only from 0.07 +/- 0.02 to 0.13 +/- 0.02 in the mibefradil group (p <.01). Collateral artery diameters were significantly smaller in the mibefradil group (61 +/- 4.7 microm) versus controls (77.3 +/- 0.9 microm) (p <.05). Relative hemoglobin oxygen saturation measurements confirmed these findings (p <.02). The inhibition of arteriogenesis in the mibefradil group suggests that endothelial Cl(-) channels are involved in the initiation of arteriogenesis.

  6. Rotational stability test for the diagnosis of radial collateral ligament rupture in the fingers: Anatomical study.

    PubMed

    Lazarus, P; Hidalgo Diaz, J J; Prunières, G; Pire, E; Taleb, C; Honecker, S; Bellemère, P; Fontaine, C; Liverneaux, P A

    2017-04-01

    Diagnosing rupture of the radial collateral ligament (RCL) of the finger metacarpophalangeal (MCP) joints is difficult. The aim of this cadaver study was to validate a rotational test for the MCP after RCL transection. With the MCP and proximal interphalangeal joints in flexion, rotation along the axis of the proximal phalanx was applied through an extended distal interphalangeal joint to 36 cadaver fingers. Each finger's pulp described an arc of pronation and supination that was noted on the palm. The test was repeated three times: before transection, after transection of the proper collateral ligament (CL) and after transection of both the proper and accessory CLs. Rotational arcs were measured in pronation and supination. Mean length of the pronation arc after transection of the main RCL was 17.53mm, while it was only 12.41mm before transection for the supination arc. Mean length of the pronation arc after transection of both CLs was 22.83mm compared to only 11.93mm before transection. Our results show a significant difference in pronation stability of the MCP joint after transection of the RCL proper. We can conclude that this rotational stability test is a valid test for diagnosing RCL rupture in MCP joints.

  7. Use of collateral information to improve LANDSAT classification accuracies

    NASA Technical Reports Server (NTRS)

    Strahler, A. H. (Principal Investigator)

    1981-01-01

    Methods to improve LANDSAT classification accuracies were investigated including: (1) the use of prior probabilities in maximum likelihood classification as a methodology to integrate discrete collateral data with continuously measured image density variables; (2) the use of the logit classifier as an alternative to multivariate normal classification that permits mixing both continuous and categorical variables in a single model and fits empirical distributions of observations more closely than the multivariate normal density function; and (3) the use of collateral data in a geographic information system as exercised to model a desired output information layer as a function of input layers of raster format collateral and image data base layers.

  8. Pulmonary artery agenesis associated with coronary collaterals among adults.

    PubMed

    Darwazah, Ahmad K; Alhaddad, Imad A

    2016-07-16

    Unilateral agenesis of the pulmonary artery is a rare congenital anomaly, which commonly involves the right side. Cases are associated with systemic collaterals, that may also rarely arise from the coronary arteries.Two adult patients are presented with a right pulmonary artery agenesis associated with collaterals from the right coronary artery. The implications of such an anomaly on pulmonary artery pressure and lung pathology differs among both cases. The association of coronary collaterals is rare and its implication is variable among various patients.

  9. 13 CFR 120.1850 - Will the Collateral be held by SBA?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Will the Collateral be held by SBA... Loan Program) § 120.1850 Will the Collateral be held by SBA? Yes, SBA or its expressly authorized agent... all Collateral for SISMBD Loans in a custodial account. Certificates held as Collateral must be...

  10. Chronic stress impairs collateral blood flow recovery in aged mice.

    PubMed

    Lassance-Soares, Roberta M; Sood, Subeena; Chakraborty, Nabarun; Jhamnani, Sunny; Aghili, Nima; Nashin, Hajra; Hammamieh, Rasha; Jett, Marti; Epstein, Stephen E; Burnett, Mary Susan

    2014-11-01

    Chronic stress is associated with increased risk of cardiovascular diseases. Aging is also associated with vascular dysfunction. We hypothesize that chronic stress accelerates collateral dysfunction in old mice. Mice were subjected to either chronic social defeat (CSD) or chronic cold stress (CCS). The CSD mice were housed in a box inside an aggressor's cage and exposed to the aggressor. The CCS group was placed in iced water. After chronic stress, mice underwent femoral artery ligation (FAL) and flow recovery was measured. For the CSD group, appearance and use scores of the foot and a behavioral test were performed. CSD impaired collateral flow recovery after FAL. Further, stressed mice had greater ischemic damage, impaired foot function, and altered behavior. The CCS mice also showed impaired collateral flow recovery. Chronic stress causes hind limb collateral dysfunction in old mice, a conclusion reinforced by the fact that two types of stress produced similar changes.

  11. 7 CFR 4287.113 - Release of collateral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... used to reduce the guaranteed loan or to buy replacement collateral must be requested in writing by the lender and concurred in by the Agency in writing in advance of the release. A written evaluation will...

  12. Vasomotor responses of newly developed coronary collateral vessels.

    PubMed

    Kinn, J W; Altman, J D; Chang, M W; Bache, R J

    1996-08-01

    Well-developed coronary collateral vessels contain an abundant muscular media and can undergo active vasomotion. However, early after coronary occlusion, coronary collateral vessels are thin walled with little smooth muscle, suggesting that vasomotor capability might be limited. Consequently, this study determined whether newly developed coronary collateral vessels have active vasomotor activity and whether endothelial function in these newly developed vessels is impaired. Retrograde blood flow was measured as an index of coronary collateral blood flow approximately 2 wk after embolic occlusion of the anterior descending coronary artery of dogs. Agonists were administered into the left main coronary artery to reach collaterals originating from the left coronary system. Baseline retrograde blood flow was 25.1 +/- 2.7 ml/min and increased to 36.7 +/- 3.7 ml/min after nitroglycerin (6 micrograms.kg-1.min-1, P < 0.05). Cyclooxygenase blockade with indomethacin (5 mg/kg i.v.) decreased retrograde collateral blood flow to 16.8 +/- 2.3 ml/min (P < 0.05). Subsequent administration of acetylcholine increased retrograde flow to 29.4 +/- 3.7 ml/min (P < 0.05), indicating intact endothelium-mediated vasodilation. Inhibition of nitric oxide synthase with NG-nitro-L-arginine further decreased coronary collateral retrograde flow to 12.0 +/- 2.8 ml/min (P < 0.05) and markedly blunted the response to acetylcholine. These findings demonstrate substantial vasomotor capability even early during coronary collateral development and indicate that both nitric oxide and cyclooxygenase-dependent endothelial mechanisms are intact.

  13. Distal tibiofibular radiological overlap

    PubMed Central

    Sowman, B.; Radic, R.; Kuster, M.; Yates, P.; Breidiel, B.; Karamfilef, S.

    2012-01-01

    Objectives Overlap between the distal tibia and fibula has always been quoted to be positive. If the value is not positive then an injury to the syndesmosis is thought to exist. Our null hypothesis is that it is a normal variant in the adult population. Methods We looked at axial CT scans of the ankle in 325 patients for the presence of overlap between the distal tibia and fibula. Where we thought this was possible we reconstructed the images to represent a plain film radiograph which we were able to rotate and view in multiple planes to confirm the assessment. Results The scans were taken for reasons other than pathology of the ankle. We found there was no overlap in four patients. These patients were then questioned about previous injury, trauma, surgery or pain, in order to exclude underlying pathology. Conclusion We concluded that no overlap between the tibia and fibula may exist in the population, albeit in a very small proportion. PMID:23610666

  14. Serotonin, atherosclerosis, and collateral vessel spasm

    NASA Technical Reports Server (NTRS)

    Hollenberg, N.

    1988-01-01

    Studies on animal models demonstrate that platelet products contribute to vascular spasm in ischemic syndromes and that this is reversible with administration of ketanserin and thromboxane synthesis inhibitors. Laboratory animals (dogs, rabbits, and rats) that had femoral artery ligations exhibited supersensitivity to serotonin within days in their collateral blood vessels. This supersensitivity lasted at least 6 months. The response to serotonin was reversed by ketanserin, but not by 5HT-1 antagonists. Supersensitivity does not extend to norepinephrine, and alpha blockers do not influence the response to serotonin. It appears that platelet activation by endothelial injury contributes to ischemia through blood vessel occlusion and vascular spasm. When platelet activation occurs in vivo, blood vessel occlusion and vascular spasm are reversible in part by using ketanserin or agents that block thromboxane synthesis or its action. Combining both classes of agents reverses spasm completely. These findings support existing evidence that platelet products contribute to vascular disease, and provide an approach to improved management with currently available pharmacologic agents.

  15. "Spiral stenting"-creating a subintimal neo-luminal helix around a massively calcified ostial chronic total occlusion of the right coronary artery in a patient with recurrent ventricular tachycardia.

    PubMed

    Mashayekhi, Kambis; Valuckiene, Zivile; Neuser, Hans; Walter, Marlon; Gappmaier, Wolfgang; Kaiser, Thomas; Neumann, Franz-Josef; Akin, Ibrahim; Behnes, Michael

    2016-11-01

    This case report describes a successful percutaneous coronary intervention (PCI) of a severely calcified aorto-ostial chronic total occlusion (CTO) of the right coronary artery (RCA). The lesion was treated by a retrograde approach implementing long spiral subintimal wire tracking and final coronary stenting creating a subintimal neo-luminal helix around the natively occluded RCA. After 6 months of follow-up valuable angiographic results were proven.

  16. “Spiral stenting”—creating a subintimal neo-luminal helix around a massively calcified ostial chronic total occlusion of the right coronary artery in a patient with recurrent ventricular tachycardia

    PubMed Central

    Valuckiene, Zivile; Neuser, Hans; Walter, Marlon; Gappmaier, Wolfgang; Kaiser, Thomas; Neumann, Franz-Josef; Akin, Ibrahim; Behnes, Michael

    2016-01-01

    This case report describes a successful percutaneous coronary intervention (PCI) of a severely calcified aorto-ostial chronic total occlusion (CTO) of the right coronary artery (RCA). The lesion was treated by a retrograde approach implementing long spiral subintimal wire tracking and final coronary stenting creating a subintimal neo-luminal helix around the natively occluded RCA. After 6 months of follow-up valuable angiographic results were proven. PMID:28066662

  17. Distal arthrogryposis syndrome

    PubMed Central

    Kulkarni, K. P.; Panigrahi, I.; Ray, M.; Marwaha, R. K.

    2008-01-01

    A 5-month-old male infant presented with weak cry, decreased body movements, tightness of whole body since birth, and one episode of generalized seizure on day 4 of life. He was born at term by elective caesarian section performed for breech presentation. The child had failure to thrive, contractures at elbow and knee joints, hypertonia, microcephaly, small mouth, retrognathia, and camptodactyly. There was global developmental delay. Abdominal examination revealed umbilical and bilateral inguinal hernia. Visual evoked response and brainstem evoked response audiometry were abnormal. Nerve conduction velocity was normal. Magnetic resonance imaging of brain revealed paucity of white matter in bilateral cerebral hemispheres with cerebellar and brain stem atrophy. The differential diagnoses considered in the index patient were distal arthrogryposis (DA) syndrome, cerebroculofacioskeletal syndrome, and Pena Shokier syndrome. The index patient most likely represents a variant of DA: Sheldon Hall syndrome. PMID:20300297

  18. Dorsal Capsuloplasty for Dorsal Instability of the Distal Ulna

    PubMed Central

    Kouwenhoven, S.T.P.; de Jong, T.; Koch, A.R.

    2013-01-01

    Background Dorsal instability of the distal ulna can lead to chronic wrist pain and loss of function. Structural changes to the dorsal radioulnar ligaments (DRUL) of the triangular fibrocartilage complex (TFCC) and the dorsal capsule around the ulnar head with or without foveal detachment can lead to volar subluxation of the distal radius e.g., dorsal instability of the distal ulna. Purpose Is to evaluate the post-operative results of reinstituting distal radioulnar joint (DRUJ) stability through reefing of the dorsal capsule and dorsal radioulnar ligaments, with and without a foveal reattachment of the TFCC. Methods A total of 37 patients were included in this retrospective study. Diagnosis and treatment was based strictly on dry wrist arthroscopy. In 17 patients isolated reefing of the DRUL and their collateral tissue extension was performed. In 20 patients an additional foveal reinsertion was performed. Postoperative results were evaluated with the DASH questionnaire, VAS scores, grip strength and range of motion. These findings were extrapolated in the Mayo wrist score. The two subgroups were compared. Results Mayo wrist scores of the whole population had a mean of 73. There was no difference between the group that was treated with reefing of the DRUL only and the group that was treated with a combined foveal reinsertion. Conclusion This relatively simple 'dorsal reefing' procedure, with foveal reinsertion when indicated, is a reliable method to restore volar-dorsal DRUJ stability with a significant decrease in pain sensation, good DASH scores and restoration of functional grip strength and ROM. Type of Study/Level of Evidence Therapeutic, Level IV. PMID:24436811

  19. Ulnar Collateral Ligament Reconstruction of the Elbow

    PubMed Central

    Erickson, Brandon J.; Chalmers, Peter N.; Bush-Joseph, Charles A.; Verma, Nikhil N.; Romeo, Anthony A.

    2015-01-01

    Background: Ulnar collateral ligament reconstruction (UCLR) is a common procedure in both professional and high-level athletes. Purpose: To determine the effect of technique and level of play with UCLR on return to sport (RTS). Hypothesis: When comparing different surgical techniques or preoperative level of sports participation, there is no difference in rate of RTS after UCLR. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was registered with PROSPERO and performed following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting UCLR outcomes with level of evidence 1 through 4 were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Descriptive statistics were calculated, and 2-proportion 2-sample z-test calculators with α = .05 were used to compare RTS between level of play and technique. Results: Twenty studies (2019 patients/elbows; mean age, 22.13 ± 4 years; 97% male; mean follow-up, 39.9 ± 16.2 months) were included. The majority of patients were baseball players (94.5%), specifically pitchers (80%). The most common level of play was collegiate (44.6%). Palmaris longus (71.2%) and the American Sports Medicine Institute (ASMI) technique (65.6%) were the most common graft choice and surgical technique, respectively. There was a pooled 86.2% RTS rate, and 90% of players scored excellent/good on the Conway-Jobe scale. RTS rates were higher among collegiate athletes (95.5%) than either high school (89.4%, P = .023) or professional athletes (86.4%, P < .0001). RTS rates were higher for the docking technique (97.0%, P = .001) and the ASMI technique (93.3%, P = .0034) than the Jobe technique (66.7%). Conclusion: UCLR is performed most commonly in collegiate athletes. Collegiate athletes have the highest RTS rate

  20. Impaired compensation to femoral artery ligation in diet-induced obese mice is primarily mediated via suppression of collateral growth by Nox2 and p47phox

    PubMed Central

    DiStasi, Matthew R.; Mund, Julie A.; Bohlen, H. Glenn; Miller, Steven J.; Ingram, David A.; Dalsing, Michael C.

    2015-01-01

    The present study was undertaken to establish the role of NADPH oxidase (Nox) in impaired vascular compensation to arterial occlusion that occurs in the presence of risk factors associated with oxidative stress. Diet-induced obese (DIO) mice characterized by multiple comorbidities including diabetes and hyperlipidemia were used as a preclinical model. Arterial occlusion was induced by distal femoral artery ligation in lean and DIO mice. Proximal collateral arteries were identified as the site of major (∼70%) vascular resistance to calf perfusion by distal arterial pressures, which decreased from ∼80 to ∼30 mmHg with ligation in both lean and DIO mice. Two weeks after ligation, significant vascular compensation occurred in lean but not DIO mice as evidenced by increased perfusion (147 ± 48% vs. 49 ± 29%) and collateral diameter (151 ± 30% vs. 44 ± 17%). Vascular mRNA expression of p22phox, Nox2, Nox4, and p47phox were all increased in DIO mice. Treatment of DIO mice with either apocynin or Nox2ds-tat or with whole body ablation of either Nox2 or p47phox ameliorated the impairment in both collateral growth and hindlimb perfusion. Multiparametric flow cytometry analysis demonstrated elevated levels of circulating monocytes in DIO mice without impaired mobilization and demargination after femoral artery ligation. These results establish collateral resistance as the major limitation to calf perfusion in this preclinical model, demonstrate than monocyte mobilization and demarginatin is not suppressed, implicate Nox2-p47phox interactions in the impairment of vascular compensation to arterial occlusion in DIO mice, and suggest that selective Nox component suppression/inhibition may be effective as either primary or adjuvant therapy for claudicants. PMID:26297224

  1. Collateral branching of long-distance cortical projections in monkey.

    PubMed

    Rockland, Kathleen S

    2013-12-15

    Collateralization of individual cortical axons is well documented for rodents but less so for monkeys, where double retrograde tracer experiments have tended to find only small numbers of neurons projecting to two different injection sites. Evidence from both double label and single axon studies, however, suggests that in specific projection systems the number of neurons with collateralized axons can be 10% or greater. These include feedback projections from temporal areas (but less so those from V4 and MT/V5). Single-axon analyses show that many parietal neurons branch to multiple targets. Except for giant Meynert cells in area V1, feedforward projections from early visual areas have only a small number of neurons with branching axons. Why only some neurons collateralize, what determines branch points and projection foci, and how this impacts network organization are largely unknown. Deciphering the branching code might offer new perspectives on space-time organization at the network level.

  2. How temporal evolution of intracranial collaterals in acute stroke affects clinical outcomes

    PubMed Central

    Paliwal, Prakash; Low, Adrian F.; Tay, Edgar L.W.; Gopinathan, Anil; Nadarajah, Mahendran; Ting, Eric; Venketasubramanian, Narayanaswamy; Seet, Raymond C.S.; Ahmad, Aftab; Chan, Bernard P.L.; Teoh, Hock L.; Soon, Derek; Rathakrishnan, Rahul; Sharma, Vijay K.

    2016-01-01

    Objective: We compared intracranial collaterals on pretreatment and day 2 brain CT angiograms (CTA) to assess their evolution and relationship with functional outcomes in acute ischemic stroke (AIS) patients treated with IV tissue plasminogen activator (tPA). Methods: Consecutive AIS patients who underwent pretreatment and day 2 CTA and received IV tPA during 2010–2013 were included. Collaterals were evaluated by 2 independent neuroradiologists using 3 predefined criteria: the Miteff system, the Maas system, and 20-point collateral scale by the Alberta Stroke Program Early CT Score methodology. We stratified our cohort by baseline pre-tPA state of their collaterals and by recanalization status of the primary vessel for analysis. Good outcomes at 3 months were defined by a modified Rankin Scale score of 0–1. Results: This study included 209 patients. Delayed collateral recruitment by any grading system was not associated with good outcomes. All 3 scoring systems showed that collateral recruitment on the follow-up CTA from a baseline poor collateral state was significantly associated with poor outcome and increased bleeding risk. When the primary vessel remained persistently occluded, collateral recruitment was significantly associated with worse outcomes. Interestingly, collateral recruitment was significantly associated with increased mortality in 2 of the 3 grading systems. Conclusions: Not all collateral recruitment is beneficial; delayed collateral recruitment may be different from early recruitment and can result in worse outcomes and higher mortality. Prethrombolysis collateral status and recanalization are determinants of how intracranial collateral evolution affects functional outcomes. PMID:26740681

  3. [On structure characteristics and mechanisms of channels and collaterals].

    PubMed

    Chen, Jun-De

    2009-04-01

    Recognition of traditional Chinese medicine for the structures of channels and collaterals is possibly related with the tactics of human early general medical study, characterized by "inner", sub-micro, entirety, etc. The mechanisms are possibly involved in direct communication pathway of the cell junction (specially keeping the relevant cellular direct communication relation in individual development), the extra-cellular matrix stress network system and its biophysical message transmission--force--meridian signs transformation--inter-cellular massage integration, and "generalization" of the structures and activities of channels and collaterals in acupuncture serum phenomenon, etc. Thus, the hypothesis of multi-factors about channel structures-mechanisms is proposed.

  4. Optimal management of ulnar collateral ligament injury in baseball pitchers

    PubMed Central

    Hibberd, Elizabeth E; Brown, J Rodney; Hoffer, Joseph T

    2015-01-01

    The ulnar collateral ligament stabilizes the elbow joint from valgus stress associated with the throwing motion. During baseball pitching, this ligament is subjected to tremendous stress and injury if the force on the ulnar collateral ligament during pitching exceeds the physiological limits of the ligament. Injuries to the throwing elbow in baseball pitchers result in significant time loss and typically surgical intervention. The purpose of this paper is to provide a review of current information to sports medicine clinicians on injury epidemiology, injury mechanics, injury risk factors, injury prevention, surgical interventions, nonsurgical interventions, rehabilitation, and return to play outcomes in baseball pitchers of all levels. PMID:26635490

  5. Vascular collateralization along ventriculoperitoneal shunt catheters in moyamoya disease.

    PubMed

    Singla, Amit; Lin, Ning; Ho, Allen L; Scott, R Michael; Smith, Edward R

    2013-06-01

    Surgically created openings such as bur holes can serve as avenues for the development of collateral blood supply to the brain in patients with moyamoya disease. When such collateralization occurs through preexisting shunt catheter sites, the potential exists for perioperative stroke if these vessels are damaged during revision of a ventricular catheter for shunt malfunction. In this paper the authors report on a series of patients with a history of ventriculoperitoneal (VP) shunts who later developed moyamoya disease and were found to have spontaneous transdural collateral vessels at ventricular catheter sites readily visualized on diagnostic angiography. A consecutive surgical series of 412 patients with moyamoya disease treated at Boston Children's Hospital from 1990 to 2010 were reviewed to identify patients with concomitant moyamoya and a VP shunt. The clinical records and angiograms of these patients were reviewed to determine the extent of bur hole collaterals through the shunt site. Three patients were identified who had VP shunts placed for hydrocephalus and subsequently developed moyamoya disease. All 3 patients demonstrated spontaneous transdural collaterals at the ventricular catheter bur hole, as confirmed by angiography during the workup for moyamoya disease. No patients required subsequent revision of their ventricular catheters following the diagnosis of moyamoya. All patients have remained stroke free and clinically stable following pial synangiosis. Although the association of moyamoya and shunted hydrocephalus is rare, it may present a significant potential problem for the neurosurgeon treating a shunt malfunction in this patient population, because shunt bur holes may become entry sites for the ingrowth of significant cortical transdural collateral blood supply to the underlying brain. Shunt revision might therefore be associated with an increased risk of postoperative stroke or operative-site hemorrhage in this population if this

  6. Progressive Deconstruction of a Distal Posterior Cerebral Artery Aneurysm Using Competitive Flow Diversion

    PubMed Central

    Johnson, Andrew K.; Lopes, Demetrius K.; Moftakhar, Roham

    2016-01-01

    Progressive deconstruction is an endovascular technique for aneurysm treatment that utilizes flow diverting stents to promote progressive thrombosis by diverting blood flow away from the aneurysm's parent vessel. While the aneurysm thromboses, collateral blood vessels develop over time to avoid infarction that can often accompany acute parent vessel occlusion. We report a 37-year-old woman with a left distal posterior cerebral artery aneurysm that was successfully treated with this strategy. The concept and rationale of progressive deconstruction are discussed in detail. PMID:26958413

  7. Ultrasound imaging versus morphopathology in cardiovascular diseases. Coronary collateral circulation and atherosclerotic plaque

    PubMed Central

    Baroldi, Giorgio; Bigi, Riccardo; Cortigiani, Lauro

    2005-01-01

    This review article is aimed at comparing the results of histopathological and clinical imaging studies to assess coronary collateral circulation in humans. The role of collaterals, as emerging from morphological studies in both normal and atherosclerotic coronary vessels, is described; in addition, present role and future perpectives of echocardiographic techniques in assessing collateral circulation are briefly summarized. PMID:15740620

  8. 45 CFR 1336.67 - Security and collateral: Responsibilities of the Loan Administrator.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...) As a Credit Factor. The availability of collateral security normally is considered an important factor in making loans. The types and amount of collateral security required should be governed by the relative strengths and weaknesses of other credit factors. The taking of collateral as security should...

  9. 7 CFR 1434.16 - Release of the honey pledged as collateral for a loan.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Release of the honey pledged as collateral for a loan... MARKETING ASSISTANCE LOAN AND LDP REGULATIONS FOR HONEY § 1434.16 Release of the honey pledged as collateral for a loan. (a)(1) A producer shall not move or dispose of any honey pledged as collateral for a...

  10. 7 CFR 1434.16 - Release of the honey pledged as collateral for a loan.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false Release of the honey pledged as collateral for a loan... MARKETING ASSISTANCE LOAN AND LDP REGULATIONS FOR HONEY § 1434.16 Release of the honey pledged as collateral for a loan. (a)(1) A producer shall not move or dispose of any honey pledged as collateral for a...

  11. 7 CFR 1421.106 - Warehouse-stored marketing assistance loan collateral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false Warehouse-stored marketing assistance loan collateral... Marketing Assistance Loans § 1421.106 Warehouse-stored marketing assistance loan collateral. (a) A commodity may be pledged as collateral for a warehouse-stored marketing assistance loan in the...

  12. 7 CFR 1434.16 - Release of the honey pledged as collateral for a loan.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 10 2013-01-01 2013-01-01 false Release of the honey pledged as collateral for a loan... MARKETING ASSISTANCE LOAN AND LDP REGULATIONS FOR HONEY § 1434.16 Release of the honey pledged as collateral for a loan. (a)(1) A producer shall not move or dispose of any honey pledged as collateral for a...

  13. 7 CFR 1434.16 - Release of the honey pledged as collateral for a loan.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 10 2012-01-01 2012-01-01 false Release of the honey pledged as collateral for a loan... MARKETING ASSISTANCE LOAN AND LDP REGULATIONS FOR HONEY § 1434.16 Release of the honey pledged as collateral for a loan. (a)(1) A producer shall not move or dispose of any honey pledged as collateral for a...

  14. 76 FR 31518 - Public Roundtable on the Protection of Cleared Swaps Customer Collateral

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-01

    ... COMMISSION 17 CFR Parts 22 and 190 Public Roundtable on the Protection of Cleared Swaps Customer Collateral... related to the protection of cleared swaps customer collateral described in the CFTC's notice of proposed rulemaking regarding the Protection of Cleared Swaps Customer Contracts and Collateral and...

  15. 7 CFR 762.142 - Servicing related to collateral.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 7 2014-01-01 2014-01-01 false Servicing related to collateral. 762.142 Section 762.142 Agriculture Regulations of the Department of Agriculture (Continued) FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE SPECIAL PROGRAMS GUARANTEED FARM LOANS § 762.142 Servicing related to...

  16. Embolization of nonvariceal portosystemic collaterals in transjugular intrahepatic portosystemic shunts

    SciTech Connect

    Bilbao, Jose Ignacio; Arias, Mercedes; Longo, Jesus Maria; Alejandre, Pedro Luis; Betes, Maria Teresa; Elizalde, Arlette Maria

    1997-03-15

    Percutaneous embolization of large portosystemic collaterals was performed in three patients following placement of a transjugular intrahepatic portosystemic shunt in order to improve hepatopetal portal flow. Improved hepatic portal perfusion was achieved in these cases, thereby theoretically reducing the risk of chronic hepatic encephalopathy.

  17. 41 CFR 105-55.014 - Liquidation of collateral.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Liquidation of collateral. 105-55.014 Section 105-55.014 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General...

  18. Collateral effects of antibiotics on mammalian gut microbiomes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Antibiotics are an essential component of the modern lifestyle. They improve our lives by treating disease, preventing disease, and in the case of agricultural animals by improving feed efficiency. However, antibiotic usage is not without collateral effects. The development and spread of antibiot...

  19. 41 CFR 105-55.014 - Liquidation of collateral.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false Liquidation of collateral. 105-55.014 Section 105-55.014 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General...

  20. 7 CFR 3.15 - Liquidation of collateral.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 1 2013-01-01 2013-01-01 false Liquidation of collateral. 3.15 Section 3.15 Agriculture Office of the Secretary of Agriculture DEBT MANAGEMENT Standards for the Administrative Collection.... (b) When an agency learns that a bankruptcy petition has been filed with respect to a debtor,...

  1. 41 CFR 105-55.014 - Liquidation of collateral.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false Liquidation of collateral. 105-55.014 Section 105-55.014 Public Contracts and Property Management Federal Property Management Regulations System (Continued) GENERAL SERVICES ADMINISTRATION Regional Offices-General...

  2. 7 CFR 3.15 - Liquidation of collateral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 1 2010-01-01 2010-01-01 false Liquidation of collateral. 3.15 Section 3.15 Agriculture Office of the Secretary of Agriculture DEBT MANAGEMENT Standards for the Administrative Collection.... (b) When an agency learns that a bankruptcy petition has been filed with respect to a debtor,...

  3. 22 CFR 213.17 - Liquidation of collateral.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Liquidation of collateral. 213.17 Section 213.17 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT CLAIMS COLLECTION Collection § 213.17... circumstances require judicial foreclosure. However, collection from other businesses, including liquidation...

  4. Chloride intracellular channel 4 is required for maturation of the cerebral collateral circulation.

    PubMed

    Lucitti, Jennifer L; Tarte, Natalie J; Faber, James E

    2015-10-01

    The number and diameter of native collaterals in tissues of healthy mice vary widely, resulting in large differences in tissue injury in occlusive diseases. Recent studies suggest similar variation may exist in humans. Collateral variation in mice is determined by genetic background-dependent differences in embryonic collateral formation, by variation in maturation of the nascent collaterals, and by environmental factors such as aging that cause collateral rarefaction in the adult. Recently, formation of the collateral circulation in the brain was found to involve a unique VEGF-A-dependent "arteriolar" angiogenic sprouting-like mechanism. Elsewhere, chloride intracellular protein 4 (CLIC4) was implicated but not investigated directly, prompting the present study. Deletion of Clic4 had no effect on embryonic collaterogenesis. However, during collateral maturation from embryonic day 18.5 to postnatal day 7, reduced mural cell investment was observed and excessive pruning of collaterals occurred. Growth in collateral diameter was reduced. This resulted in 50% fewer collaterals of smaller diameter in the adult and thus larger infarct volume after middle cerebral artery occlusion. During collateral maturation, CLIC4 deficiency resulted in reduced expression of Vegfr2, Vegfr1, Vegfc, and mural cell markers, but not notch-pathway genes. Overexpression of VEGF-A in Clic4(-/-) mice had no effect on collaterogenesis, but rescued the above defects in collateral maturation by preventing mural cell loss and collateral pruning, thus restoring collateral number and diameter and reducing stroke severity in the adult. CLIC4 is not required for collaterogenesis but is essential for perinatal maturation of nascent collaterals through a mechanism that supports VEGF signaling.

  5. Chloride intracellular channel 4 is required for maturation of the cerebral collateral circulation

    PubMed Central

    Lucitti, Jennifer L.; Tarte, Natalie J.

    2015-01-01

    The number and diameter of native collaterals in tissues of healthy mice vary widely, resulting in large differences in tissue injury in occlusive diseases. Recent studies suggest similar variation may exist in humans. Collateral variation in mice is determined by genetic background-dependent differences in embryonic collateral formation, by variation in maturation of the nascent collaterals, and by environmental factors such as aging that cause collateral rarefaction in the adult. Recently, formation of the collateral circulation in the brain was found to involve a unique VEGF-A-dependent “arteriolar” angiogenic sprouting-like mechanism. Elsewhere, chloride intracellular protein 4 (CLIC4) was implicated but not investigated directly, prompting the present study. Deletion of Clic4 had no effect on embryonic collaterogenesis. However, during collateral maturation from embryonic day 18.5 to postnatal day 7, reduced mural cell investment was observed and excessive pruning of collaterals occurred. Growth in collateral diameter was reduced. This resulted in 50% fewer collaterals of smaller diameter in the adult and thus larger infarct volume after middle cerebral artery occlusion. During collateral maturation, CLIC4 deficiency resulted in reduced expression of Vegfr2, Vegfr1, Vegfc, and mural cell markers, but not notch-pathway genes. Overexpression of VEGF-A in Clic4−/− mice had no effect on collaterogenesis, but rescued the above defects in collateral maturation by preventing mural cell loss and collateral pruning, thus restoring collateral number and diameter and reducing stroke severity in the adult. CLIC4 is not required for collaterogenesis but is essential for perinatal maturation of nascent collaterals through a mechanism that supports VEGF signaling. PMID:26276819

  6. Distal gastrectomy versus total gastrectomy for distal gastric cancer

    PubMed Central

    Liu, Zhen; Feng, Fan; Guo, Man; Liu, Shushang; Zheng, Gaozan; Xu, Guanghui; Lian, Xiao; Fan, Daiming; Zhang, Hongwei

    2017-01-01

    Abstract Even though more than a century later, after the first case of gastrectomy has been successfully performed, the best surgical treatment for distal gastric cancer still remains controversial. Thus, the present study was designed to compare the survival impact of distal (DG) or total gastrectomy (TG) for distal gastric cancer. A total of 1262 distal gastric cancer patients were enrolled in current study including 1157 patients who underwent DG and 157 patients who underwent TG. The postoperative complications and 5-year overall survival were compared between the 2 groups. TG group presented a longer surgical time, a higher volume of intraoperative bleeding, and a larger number of excised lymph nodes (all P < 0.05) compared with the DG group. The postoperative complications were comparable (all P >0.05). The 5-year overall survival rate of DG group was significantly higher than that of TG group (67.6% vs 44.3%, P < 0.001). However, multivariate analysis showed that type of resection was not an independent prognostic factor for distal gastric cancer (P > 0.05). The factor-stratified multivariate analysis showed that only in the subgroup of Tumor-node-metastasis staging system (TNM) stage III (P = 0.049), TG was the independent prognostic factor for poor survival. In conclusion, DG was as feasible as TG; however, TG did not increase the survival rate. DG brought better long-term survival than TG in patients with TNM stage III tumor. We recommended that DG should be the optimal surgical procedure for distal gastric cancer under the premise of negative resection margin. PMID:28151896

  7. Traumatic Distal Ulnar Artery Thrombosis

    PubMed Central

    Karaarslan, Ahmet A.; Karakaşlı, Ahmet; Mayda, Aslan; Karcı, Tolga; Aycan, Hakan; Kobak, Şenol

    2014-01-01

    This paper is about a posttraumatic distal ulnar artery thrombosis case that has occurred after a single blunt trauma. The ulnar artery thrombosis because of chronic trauma is a frequent condition (hypothenar hammer syndrome) but an ulnar artery thrombosis because of a single direct blunt trauma is rare. Our patient who has been affected by a single blunt trauma to his hand and developed ulnar artery thrombosis has been treated by resection of the thrombosed ulnar artery segment. This report shows that a single blunt trauma can cause distal ulnar artery thrombosis in the hand and it can be treated merely by thrombosed segment resection in suitable cases. PMID:25276455

  8. Collateral Lethality: A new therapeutic strategy in oncology

    PubMed Central

    Muller, Florian L.; Aquilanti, Elisa A.; DePinho, Ronald A.

    2016-01-01

    Genomic deletion of tumor suppressor genes (TSG) is a rite of passage for virtually all human cancers. The synthetic lethal paradigm has provided a framework for the development of molecular targeted therapeutics that are functionally linked to the loss of specific TSG functions. In the course of genomic events that delete TSGs, a large number of genes with no apparent direct role in tumor promotion also sustain deletion as a result of chromosomal proximity to the target TSG. In this perspective, we review the novel concept of “collateral lethality”, which has served to identify cancer-specific therapeutic vulnerabilities resulting from co-deletion of passenger genes neighboring TSG. The large number of collaterally deleted genes, playing diverse functions in cell homeostasis, offers a rich repertoire of pharmacologically targetable vulnerabilities presenting novel opportunities for the development of personalized anti-neoplastic therapies. PMID:26870836

  9. Intracoronary demonstration of adenosine-induced coronary collateral steal.

    PubMed Central

    Seiler, C.; Kaufmann, U.; Meier, B.

    1997-01-01

    A steal phenomenon was detected by intravascular Doppler guidewire in a patient with a well collateralised coronary vascular area supplied by a reopened left circumflex coronary artery. This phenomenon accounted for the fall in blood flow velocity reserve during hyperaemic conditions to 50% of the baseline value. The collaterals must have been the cause of the steal phenomenon because complete revascularisation of the lesion barely reversed it. Images PMID:9038700

  10. Collateral Damage and the United States Air Force

    DTIC Science & Technology

    2007-11-02

    when a resource rich coalition conducts an air campaign against an inferior adversary, that coalition can discriminate in its application of...resource rich coalition conducts an air campaign against an inferior adversary, that coalition can discriminate in its application of airpower by... campaign .8 For that reason, it is logical for the strategist to possess a thorough awareness of the effects of potential and actual collateral

  11. Embryologicalic collateral venous channel on radionuclide liver/spleen study

    SciTech Connect

    Wilkinson, R.H. Jr.; Johnson, D.G.

    1983-07-01

    Obstruction of normal venous portal blood flow generally results in collateral circulation. The obstruction may be intrinsic t the vasculature (e.g., hepatic vein thrombosis, vascular anomalies) or it may be extravascular (e.g., cirrhosis, hepatic masses) and may effect blood flow by deforming and compressing the intrahepatic or splenoportal axis vessels. A technetium-99m sulfur colloid liver/spleen study demonstrates what is thought to be a functional paraumbilical or umbilical vein in a cirrhotic patient with portal hypertension.

  12. Distal Insertions of the Biceps Femoris

    PubMed Central

    Branch, Eric A.; Anz, Adam W.

    2015-01-01

    Background: Avulsion of the biceps femoris from the fibula and proximal tibia is encountered in clinical practice. While the anatomy of the primary posterolateral corner structures has been qualitatively and quantitatively described, a quantitative analysis regarding the insertions of the biceps femoris on the fibula and proximal tibia is lacking. Purpose: To quantitatively assess the insertions of the biceps femoris, fibular collateral ligament (FCL), and anterolateral ligament (ALL) on the fibula and proximal tibia as well as establish relationships among these structures and to pertinent surgical anatomy. Study Design: Descriptive laboratory study. Methods: Dissections were performed on 12 nonpaired, fresh-frozen cadaveric specimens identifying the biceps femoris, FCL, and ALL, and their insertions on the proximal tibia and fibula. The footprint areas, orientations, and distances from relevant osseous landmarks were measured using a 3-dimensional coordinate measurement device. Results: Dissection produced 6 easily identifiable and reproducible anatomic footprints. Tibial footprints included the insertion of the ALL and an insertion of the biceps femoris (TBF). Fibular footprints included the insertion of the FCL, a distal insertion of the biceps femoris (DBF), a medial footprint of the biceps femoris (MBF), and a proximal footprint of the biceps femoris (PBF). The mean area of these footprints (95% CI) was as follows: ALL, 53.0 mm2 (38.4-67.6); TBF, 93.9 mm2 (72.0-115.8); FCL, 86.8 mm2 (72.3-101.2); DBF, 119 mm2 (91.1-146.9); MBF, 46.8 mm2 (29.0-64.5); and PBF, 215 mm2 (192.4-237.5). The mean distance (95% CI) from the Gerdy tubercle to the center of the ALL footprint was 24.3 mm (21.6-27.0) and to the center of the TBF was 22.5 mm (21.0-24.0). The center of the DBF was 8.68 mm (7.0-10.3) from the anterior border of the fibula, the center of the FCL was 14.6 mm (12.5-16.7) from the anterior border of the fibula and 20.7 mm (19.0-22.4) from the tip of the fibular

  13. [Fractures of the distal radius].

    PubMed

    Rueger, J M; Hartel, M J; Ruecker, A H; Hoffmann, M

    2014-11-01

    The most prevalent fractures managed by trauma surgeons are those involving the distal radius. The injury occurs in two peaks of prevalence: the first peak around the age of 10 years and the second peak around the age of 60 years. Distal radius fracture management requires sensitive diagnostics and classification. The objectives of treatment are the reconstruction of a pain-free unlimited durable functioning of the wrist and avoidance of typical fracture complications. Non-operative conservative management is generally employed for stable non-displaced fractures of the distal radius with the expectation of a good functional outcome. Unstable comminuted fractures with intra-articular and extra-articular fragment zones are initially set in a closed operation and finally by osteosynthesis. An armament of surgical implants is available for instable fractures requiring fixation. Palmar locked plate osteosynthesis has been established in recent years as the gold standard for operative management of distal radius fractures. Complex Working Group on Osteosynthesis (AO) classification type 3 fractures require extensive preoperative diagnostics to identify and treat typical associated injuries around the wrist.

  14. [The significance of cervical collaterals in the subclavian steal phenomenon].

    PubMed

    Yamaguchi, K; Uchiyama, S

    1993-09-01

    The subclavian steal syndrome (SSS) is often associated with occlusive disease involving the subclavian or innominate arteries, but an asymptomatic subclavian steal, called the "subclavian steal phenomenon" (SSP), is not uncommon. Though intracranial collaterals had been postulated as one of the etiologies for the SSP's being asymptomatic, little has been accomplished in the investigation of extracranial channels. To study the hemodynamic role of cervical collateral channels, an angiographical study was done in three cases with SSP. The three cases were admitted to the hospital because of carotid ischemic symptoms, such as right hemiplegia or sensory aphasia. Each case had a blood pressure difference between the two arms, but in all of them the past history or the exercise test was negative for vertebrobasilar or arm ischemia. On angiography, occlusions of the unilateral proximal subclavian artery, the left in case 1 and the right in case 2, or a tight stenosis of the innominate artery was found in case 3. In each case, the vertebral artery flow in the affected side was inverted, siphoning off from the opposite vertebral artery into the affected subclavian artery. In addition to the vertebral siphoning; muscular branches of ipsilateral external carotid origin in cases 1 and 2, or the thyrocervical trunk via the inferior thyroid artery in case 3 was also found to function as a collateral channel to the vertebral artery on the affected side.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Regulation of native collateral vessel dilation after coronary occlusion in the dog.

    PubMed

    Lamping, K G; Bloom, E N; Harrison, D G

    1994-02-01

    The purpose of this study was to examine mechanisms involved in the response of native collaterals to coronary occlusion. In anesthetized dogs native collaterals were identified as vessels coursing between the left anterior descending and left circumflex arteries using fluorescence angiography. After a left anterior descending occlusion in 12 dogs, collaterals < 100 microns in diameter progressively dilated by 21 +/- 4% (n = 12) 1 min after occlusion and by 39 +/- 6% 15 min after occlusion. Collaterals > 100 microns in diameter did not dilate after coronary occlusion. NG-nitro-L-arginine (1 mg/min intracoronary) caused constriction under basal conditions in collaterals < 100 microns but did not prevent the dilation of collaterals after occlusion. In contrast, glibenclamide (10(-5) M), an inhibitor of ATP-sensitive potassium channels, had no effect on baseline diameter of collaterals < 100 microns diameter but completely prevented dilation of collaterals after occlusion. We conclude that collaterals are not maximally dilated immediately after a coronary occlusion but rather progressively dilate for at least 15 min after an occlusion. This dilation of native collaterals after an occlusion is not mediated by release of an endothelium-derived relaxing factor derived from L-arginine but is mediated by activation of ATP-sensitive K+ channels.

  16. The mechanism of coronary collateral vasoconstriction in response to cyclooxygenase blockade.

    PubMed

    Altman, J D; Bache, R J

    1994-02-01

    The present study was performed to examine the mechanism by which cyclooxygenase blockade produces vasoconstriction in well-developed coronary collateral vessels. Eight dogs were studied 4 to 6 months after occlusion of the left anterior descending coronary artery (LAD) had been performed to stimulate collateral vessel growth. At the time of study, the LAD was cannulated at the site of occlusion for measurement of retrograde blood flow as an index of collateral blood flow. Levels of 6-ketoprostaglandin F1 alpha were 32 +/- 13% higher in blood diverted from the collateral-dependent LAD than in aortic blood (P < .05); the increase in this stable product of prostacyclin metabolism indicated production of prostacyclin across the coronary collateral system. Administration of arachidonic acid into the left main coronary artery to reach collateral vessels entering the LAD resulted in a 21 +/- 6% increase in retrograde flow (P < .01), demonstrating cyclooxygenase activity with production of vasodilator prostaglandins in the collateral system. Ibuprofen (10 mg/kg IV) caused a 55 +/- 7% decrease in retrograde flow (P < .03), suggesting that cyclooxygenase blockade inhibited tonic production of vasodilator prostaglandins in the collateral system. In contrast, neither thromboxane synthase inhibition with dazmegrel nor thromboxane receptor blockade with SQ 30741 caused a significant change in collateral flow, thus failing to support thromboxane-induced collateral constriction. After cyclooxygenase blockade, prostacyclin infused into the left main coronary artery was able to restore retrograde flow to the preibuprofen level.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. FGF-4 gene therapy GENERX--Collateral Therapeutics.

    PubMed

    2002-01-01

    Collateral Therapeutics and Schering AG in Germany are developing a gene therapy product, GENERX for coronary artery disease. Based on the terms of the agreement, Schering or its affliates will be responsible for conducting and financing phase II/III clinical trials which are currently underway in the US and Europe. In particular, Berlex Labs (the US subsidiary of Schering AG), is involved in developing the gene therapy in the US. GENERX is an angiogenic gene therapy which triggers the production of a protein that stimulates new blood vessel growth providing an alternative route for blood to bypass clogged and blocked arteries in the heart. GENERX involves a one-time, non-surgical delivery of an adenovirus vector containing the human fibroblast growth factor-4 (FGF-4) into coronary arteries via a standard catheter. The FGF-4 gene was licensed from New York University. Collateral Therapeutics has been granted a US patent for "gene transfer-mediated angiogenesis therapy" for the nonsurgical administration of angiogenic genes for coronary and peripheral vascular disease. The patented technology has been licensed from the University of California. Collateral and Berlex have initiated pivotal phase IIb/III trials with GENERX in the US and Europe. The US-based study will evaluate the safety and efficacy of GENERX in patients with stable exertional angina due to coronary artery disease. The European-based study will evaluate patients with advanced coronary artery disease who are not considered candidates for interventions such as angioplasty and bypass surgery and/or patients who are unlikely to have positive outcomes from such interventions. Both studies, of a multicentre, randomised, double-blind and placebo-controlled design, will evaluate 2 dose levels of GENERX which will be non-surgically administered to the heart via intracoronary infusion through a standard cardiac catheter. Collateral also plans to develop a non-surgical gene therapy product using the FGF-4 gene

  18. [Distal radius fractures in children].

    PubMed

    Otayek, S; Ramanoudjame, M; Fitoussi, F

    2016-12-01

    Metaphyseal and physeal fractures of the distal radius are common in children. Most cases are best treated with closed reduction and cast immobilization. Long-term outcomes of these injuries are excellent when specific treatment principles of reduction and casting are followed. Surgical indications are limited and include open fractures, intra-articular fractures, non-reducible fractures, unstable fractures, and the presence of associated nerve injury. Closed reduction and percutaneous pin fixation is the most commonly used surgical option. The clinician should be aware of delayed complications such as growth disturbance of the distal radius, and understand how to manage these problems to ensure successful long-term outcomes. Epiphysiodesis is uncommon but growth plate injuries need to be followed for one year.

  19. Distal clavicle fractures in children☆

    PubMed Central

    Labronici, Pedro José; da Silva, Ricardo Rodrigues; Franco, Marcos Vinícius Viana; Labronici, Gustavo José; Pires, Robinson Esteves Santos; Franco, José Sergio

    2015-01-01

    Objective To analyze fractures of the distal clavicle region in pediatric patients. Methods Ten patients between the ages of five to eleven years (mean of 7.3 years) were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. Results All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. Conclusion The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments. PMID:26962489

  20. Distal esophageal spasm: an update.

    PubMed

    Achem, Sami R; Gerson, Lauren B

    2013-09-01

    Distal esophageal spasm (DES) is an esophageal motility disorder that presents clinically with chest pain and/or dysphagia and is defined manometrically as simultaneous contractions in the distal (smooth muscle) esophagus in ≥20% of wet swallows (and amplitude contraction of ≥30 mmHg) alternating with normal peristalsis. With the introduction of high resolution esophageal pressure topography (EPT) in 2000, the definition of DES was modified. The Chicago classification proposed that the defining criteria for DES using EPT should be the presence of at least two premature contractions (distal latency<4.5 s) in a context of normal EGJ relaxation. The etiology of DES remains insufficiently understood, but evidence links nitric oxide (NO) deficiency as a culprit resulting in a disordered neural inhibition. GERD frequently coexists in DES, and its role in the pathogenesis of symptoms needs further evaluation. There is some evidence from small series that DES can progress to achalasia. Treatment remains challenging due in part to lack of randomized placebo-controlled trials. Current treatment agents include nitrates (both short and long acting), calcium-channel blockers, anticholinergic agents, 5-phosphodiesterase inhibitors, visceral analgesics (tricyclic agents or SSRI), and esophageal dilation. Acid suppression therapy is frequently used, but clinical outcome trials to support this approach are not available. Injection of botulinum toxin in the distal esophagus may be effective, but further data regarding the development of post-injection gastroesophageal reflux need to be assessed. Heller myotomy combined with fundoplication remains an alternative for the rare refractory patient. Preliminary studies suggest that the newly developed endoscopic technique of per oral endoscopic myotomy (POEM) may also be an alternative treatment modality.

  1. Endoscopic Distal Tibiofibular Syndesmosis Arthrodesis.

    PubMed

    Lui, Tun Hing

    2016-04-01

    Chronic distal tibiofibular syndesmosis disruption can be managed by endoscopic arthrodesis of the syndesmosis. This is performed through the proximal anterolateral and posterolateral portals. The scar tissue and bone block are resected to facilitate the subsequent reduction of the syndesmosis. The reduction of the syndesmosis can be guided either arthroscopically or endoscopically. The tibial and fibular surfaces of the tibiofibular overlap can be microfractured to facilitate subsequent fusion.

  2. Development of a NO biosensor and its application in research on channels and collaterals

    NASA Astrophysics Data System (ADS)

    Zhou, Yikai; Ren, Shu

    2001-09-01

    There are three parts in this paper. In the part 1 nitric oxide chemistry and the measurements of nitric oxide in biological models have been reviewed. In the part 2 the channels and collateral sand modern studies of the channels and collaterals have also ben reviewed and in part 3 a NO biosensor has been developed and it has been applied in the research of the channels and collaterals. Research results have confirmed that NO plays an important role in channel transmission.

  3. The Strategic and Political Impacts of Collateral Damage from Strike Warfare

    DTIC Science & Technology

    2015-03-01

    guided munitions. As the effects of collateral damage became much more visible because of mass media during the latter part of the twentieth century...Vietnamese’s ability to exploit collateral damage incidents in the media . Air commanders were not afforded the same freedoms they were in Korea because of...industrial capacity and population centers. With the growth of mass media after the Korean War, the effects of collateral damage started to become more

  4. Fate of coronary collateral circulation after aorto-coronary saphenous vein bypass grafts.

    PubMed Central

    Di Luzio, V; Roy, P R; Sowton, E; Dow, J

    1975-01-01

    The pre- and postoperative patterns of coronary artery collateral circulation have been studied in 34 patients who had saphenous vein bypass grafting. When the graft remained patent homocoronary collaterals could not be visualized after operation, but new intercoronary anastomoses frequently developed to other diseased arteries. When the graft and the bypassed artery were both obstructed there was a high incidence (5 out of 11) of myocardial infarction despite good preoperative collaterals. Images PMID:1079134

  5. A Comprehensive Review of Portosystemic Collaterals in Cirrhosis: Historical Aspects, Anatomy, and Classifications

    PubMed Central

    Shetty, Rajesh; Kasana, Vivek

    2016-01-01

    Portosystemic collateral formation in cirrhosis plays an important part in events that define the natural history in affected patients. A detailed understanding of collateral anatomy and hemodynamics in cirrhotics is essential to envisage diagnosis, management, and outcomes of portal hypertension. In this review, we provide detailed insights into the historical, anatomical, and hemodynamic aspects to portal hypertension and collateral pathways in cirrhosis with emphasis on the various classification systems. PMID:28074159

  6. A Comprehensive Review of Portosystemic Collaterals in Cirrhosis: Historical Aspects, Anatomy, and Classifications.

    PubMed

    Philips, Cyriac Abby; Arora, Ankur; Shetty, Rajesh; Kasana, Vivek

    2016-01-01

    Portosystemic collateral formation in cirrhosis plays an important part in events that define the natural history in affected patients. A detailed understanding of collateral anatomy and hemodynamics in cirrhotics is essential to envisage diagnosis, management, and outcomes of portal hypertension. In this review, we provide detailed insights into the historical, anatomical, and hemodynamic aspects to portal hypertension and collateral pathways in cirrhosis with emphasis on the various classification systems.

  7. Infarction Distribution Pattern in Acute Stroke May Predict the Extent of Leptomeningeal Collaterals

    PubMed Central

    Verma, Rajeev Kumar; Gralla, Jan; Klinger-Gratz, Pascal Pedro; Schankath, Adrian; Jung, Simon; Mordasini, Pasquale; Zubler, Christoph; Arnold, Marcel; Buehlmann, Monika; Lang, Matthias F.

    2015-01-01

    Objective The aim of this study was to evaluate whether the distribution pattern of early ischemic changes in the initial MRI allows a practical method for estimating leptomeningeal collateralization in acute ischemic stroke (AIS). Methods Seventy-four patients with AIS underwent MRI followed by conventional angiogram and mechanical thrombectomy. Diffusion restriction in Diffusion weighted imaging (DWI) and correlated T2-hyperintensity of the infarct were retrospectively analyzed and subdivided in accordance with Alberta Stroke Program Early CT score (ASPECTS). Patients were angiographically graded in collateralization groups according to the method of Higashida, and dichotomized in 2 groups: 29 subjects with collateralization grade 3 or 4 (well-collateralized group) and 45 subjects with grade 1 or 2 (poorly-collateralized group). Individual ASPECTS areas were compared among the groups. Results Means for overall DWI-ASPECTS were 6.34 vs. 4.51 (well vs. poorly collateralized groups respectively), and for T2-ASPECTS 9.34 vs 8.96. A significant difference between groups was found for DWI-ASPECTS (p<0.001), but not for T2-ASPECTS (p = 0.088). Regarding the individual areas, only insula, M1-M4 and M6 showed significantly fewer infarctions in the well-collateralized group (p-values <0.001 to 0.015). 89% of patients in the well-collateralized group showed 0–2 infarctions in these six areas (44.8% with 0 infarctions), while 59.9% patients of the poor-collateralized group showed 3–6 infarctions. Conclusion Patients with poor leptomeningeal collateralization show more infarcts on the initial MRI, particularly in the ASPECTS areas M1 to M4, M6 and insula. Therefore DWI abnormalities in these areas may be a surrogate marker for poor leptomeningeal collaterals and may be useful for estimation of the collateral status in routine clinical evaluation. PMID:26327519

  8. Detection of human collateral circulation by vasodilation-thallium-201 tomography

    SciTech Connect

    Nienaber, C.A.; Salge, D.; Spielmann, R.P.; Montz, R.; Bleifeld, W. )

    1990-04-15

    Coronary arteriolar vasodilation may provoke redistribution of flow to collateral-dependent jeopardized myocardium. To assess the physiologic significance of collaterals, 80 consecutive post-infarction patients (age 58 +/- 8 years) underwent vasodilation-redistribution thallium-201 tomographic imaging after administration of 0.56 mg of intravenous dipyridamole/kg body weight. Circumferential profile analysis of thallium-201 uptake and redistribution in representative left ventricular tomograms provided quantitative assessment of transient and fixed defects and separation between periinfarctional and distant inducible hypoperfusion. Tomographic perfusion data were correlated to wall motion and collateral circulation between distinct anatomic perfusion territories. Patients were grouped according to presence (59%) or absence (41%) of angiographically visible collateral channels to jeopardized myocardium. In the presence of collaterals, distant reversible defects were larger than in absence of collaterals (p less than 0.05); the extent of combined periinfarctional and distant redistribution was also larger in collateralized patients (p less than 0.025), whereas the size of the persistent perfusion defect was similar in both groups. By prospective analysis the tomographic perfusion pattern of combined periinfarctional and distant redistribution revealed a sensitivity of 85% and a specificity of 78% for the detection of significant collateral circulation in this group of patients. Thus, using the exhausted flow reserve as a diagnostic tool, vasodilation-thallium-201 tomography has the potential to identify and quantitate collateralized myocardium in post-infarction patients and may guide diagnostic and therapeutic decision-making.

  9. [A hypothesis about component model of substances of channels and collaterals].

    PubMed

    Lu, Liu-Sha

    2008-10-01

    The theory of channels and collaterals is a very important "substance" prop for the basic theories of TCM. After component model of substances of channels and collaterals is raised, according to the principle, structure and function are dialectical unity, the author finds in deeply research on a great number of completed experimental investigations of corresponding anatomic position of channels and collaterals and similar physiology at home and abroad that the difficult to understand TCM concepts such as "interdependence between yin and yang", "defensive energy" all could be displayed by the substance of body liquid showing liquid crystalline state during living of channels and collaterals.

  10. Sprouting of axonal collaterals after spinal cord injury is prevented by delayed axonal degeneration.

    PubMed

    Collyer, E; Catenaccio, A; Lemaitre, D; Diaz, P; Valenzuela, V; Bronfman, F; Court, F A

    2014-11-01

    After an incomplete spinal cord injury (SCI), partial recovery of locomotion is accomplished with time. Previous studies have established a functional link between extension of axon collaterals from spared spinal tracts and locomotor recovery after SCI, but the tissular signals triggering collateral sprouting have not been identified. Here, we investigated whether axonal degeneration after SCI contributes to the sprouting of collaterals from axons spared after injury. To this end, we evaluated collateral sprouting from BDA-labeled uninjured corticospinal axons after spinal cord hemisection (SCI(H)) in wild type (WT) mouse and Wld(S) mouse strains, which shows a significant delay in Wallerian degeneration after injury. After SCI(H), spared fibers of WT mice extend collateral sprouts to both intact and denervated sides of the spinal cord distant from the injury site. On the contrary, in the Wld(S) mice collateral sprouting from spared fibers was greatly reduced after SCI(H). Consistent with a role for collateral sprouting in functional recovery after SCI, locomotor recovery after SCI(H) was impaired in Wld(S) mice compared to WT animals. In conclusion, our results identify axonal degeneration as one of the triggers for collateral sprouting from the contralesional uninjured fibers after an SCI(H). These results open the path for identifying molecular signals associated with tissular changes after SCI that promotes collateral sprouting and functional recovery.

  11. Enhancement of canine coronary collateral flow by nafazatrom.

    PubMed

    Fiedler, V B; Mardin, M

    1986-11-04

    The ability of oral nafazatrom treatment (10 mg/kg) 2 h preceding occlusion of the left anterior descending coronary artery for 6 h to limit expansion of myocardial injury was studied in anaesthetized canine hearts. Collateral blood flow was obtained with a load line analysis, employing aortic pressure, post-stenotic coronary pressure, and retrograde coronary flow from the occluded vessel. Contractile changes in the subendocardial ischemic perfused muscles were measured with ultrasonic techniques. Infarct size was determined post-mortem by a biochemical staining method and excision of necrosis. Post-stenotic coronary pressure was slightly below aortic pressure in both groups before coronary occlusion, and fell to 29 and 27% of aortic pressure in vehicle- and drug-treated hearts, respectively, after the insult. Retrograde flow was 2.4 +/- 0.6 vs. 4.1 +/- 0.7 ml/min in tylose- or nafazatrom-treated hearts. Collateral flow amounted to 1.5 +/- 0.06 vs. 2.5 +/- 0.04 ml/min in controls and drug-protected hearts. Contractility (dP/dtmax) and the %-segment shortening were greater in the ischaemic myocardium after nafazatrom treatment. Infarct size was 38 +/- 5.2 vs. 17 +/- 3.4 g/100 g left ventricle in the vehicle controls and nafazatrom group, respectively. Nafazatrom reduced infarct size by 46%. Besides other mechanisms, this was due to improved %-segment shortening and increased periinfarction collateral blood supply to jeopardized but viable myocardium. The drug may be of value in ischaemic heart disease as shown by the enhanced regional myocardial perfusion and improved contractility.

  12. Investigation of cerebral hemodynamics and collateralization in asymptomatic carotid stenoses.

    PubMed

    AlMuhanna, Khalid; Zhao, Limin; Kowalewski, Gregory; Beach, Kirk W; Lal, Brajesh K; Sikdar, Siddhartha

    2012-01-01

    Stroke is the second leading cause of death in the world, and one of the major causes of disability. Approximately 30% of ischemic strokes are due to plaque rupture in the carotid arteries. The most popular diagnostic method uses Doppler ultrasound to find the percent stenosis. However, other factors, such as the hemodynamics around the plaque may play a larger role in identifying the risk of plaque rupture. It has been shown previously in simulations that non-collateral flow in the circle of Willis (COW) could cause an increase of the intraluminal velocity around carotid plaque. This added strain may increase the vulnerability of the plaque to rupture. We investigated asymmetries in flow waveforms in the middle cerebral artery (MCA) in asymptomatic patients with carotid artery stenosis. We compared clinical results of velocity waveforms in the MCA, acquired using transcranial Doppler (TCD), with a simple linear simulation model of the intra- and extracranial arterial network to investigate the relationship between contralateral and ipsilateral flow profiles in the MCA for patients with asymptomatic carotid stenosis. In 17 out of 23 patients we found waveforms consistent with those predicted for a collateralized COW, with minimal differences in delay, velocity magnitude and resistivity index. In 6 cases, some unexpected findings were noted, such as large delays for 2 patients ≤ 50% stenosis, and a large velocity difference with low delay for 4 patients. More studies are needed to elucidate the role of incomplete intracranial collateralization on the hemodynamics around carotid plaque and to use imaging of the COW to corroborate our results.

  13. Nox2 and p47(phox) modulate compensatory growth of primary collateral arteries.

    PubMed

    DiStasi, Matthew R; Unthank, Joseph L; Miller, Steven J

    2014-05-15

    The role of NADPH oxidase (Nox) in both the promotion and impairment of compensatory collateral growth remains controversial because the specific Nox and reactive oxygen species involved are unclear. The aim of this study was to identify the primary Nox and reactive oxygen species associated with early stage compensatory collateral growth in young, healthy animals. Ligation of the feed arteries that form primary collateral pathways in rat mesentery and mouse hindlimb was used to assess the role of Nox during collateral growth. Changes in mesenteric collateral artery Nox mRNA expression determined by real-time PCR at 1, 3, and 7 days relative to same-animal control arteries suggested a role for Nox subunits Nox2 and p47(phox). Administration of apocynin or Nox2ds-tat suppressed collateral growth in both rat and mouse models, suggesting the Nox2/p47(phox) interaction was involved. Functional significance of p47(phox) expression was assessed by evaluation of collateral growth in rats administered p47(phox) small interfering RNA and in p47(phox-/-) mice. Diameter measurements of collateral mesenteric and gracilis arteries at 7 and 14 days, respectively, indicated no significant collateral growth compared with control rats or C57BL/6 mice. Chronic polyethylene glycol-conjugated catalase administration significantly suppressed collateral development in rats and mice, implying a requirement for H2O2. Taken together, these results suggest that Nox2, modulated at least in part by p47(phox), mediates early stage compensatory collateral development via a process dependent upon peroxide generation. These results have important implications for the use of antioxidants and the development of therapies for peripheral arterial disease.

  14. Plasma Catestatin: A Useful Biomarker for Coronary Collateral Development with Chronic Myocardial Ischemia

    PubMed Central

    Xu, Weixian; Yu, Haiyi; Li, Weihong; Gao, Wei; Guo, Lijun; Wang, Guisong

    2016-01-01

    Backgrounds Catestatin is an endogenous multifunctional neuroendocrinepeptide. Recently, catestatin was discovered as a novel angiogenic cytokine. The study was to investigate the associations between endogenous catestatin and coronary collateral development among the patients with chronic myocardial ischemia. Methods Thirty-eight patients with coronary artery chronic total occlusions (CTO) (CTO group) and 38 patients with normal coronary arteries (normal group) were enrolled in the series. Among the patients with CTO, coronary collateral development was graded according to the Rentrop score method. Rentrop score 0–1 collateral development was regarded as poor collateral group and 2–3 collateral development was regarded as good collateral group. Plasma catestatin level and vascular endothelial growth factor (VEGF) were measured by ELISA kits. Results The plasma catestatin levels in CTO group were significantly higher than that in normal group (1.97±1.01 vs 1.36±0.97ng/ml, p = 0.009). In the CTO group, the patients with good collateral development had significantly higher catestatin and VEGF levels than those with poor collateral development (2.36±0.73 vs 1.61±1.12 ng/ml, p = 0.018; 425.23±140.10 vs 238.48±101.00pg/mL, p<0.001). There is a positive correlation between plasma catestatin levels and Rentrop scores (r = 0.40, p = 0.013) among the patients with CTO. However, there is no correlations between plasma catestatin levels and VEGF (r = -0.06, p = 0.744). In the multiple linear regression models, plasma catestatin level was one of the independent factors of coronary collateral development after adjustment for confounders. Conclusions Plasma catestatin was associated with coronary collateral developments. It may be a useful biomarker for coronary collateral development and potential target for therapeutic angiogenesis in patients with CTO. PMID:27304618

  15. Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies.

    PubMed

    Donaldson, Oliver; Vannet, Nicola; Gosens, Taco; Kulkarni, Rohit

    2014-01-01

    In the second part of this review article the management of medial elbow tendinopathy, distal biceps and distal triceps tendinopathy will be discussed. There is a scarcity of publications concerning any of these tendinopathies. This review will summarise the current best available evidence in their management. Medial elbow tendinopathy, also known as Golfer's elbow, is up to 6 times less common than lateral elbow tendinopathy. The tendinopathy occurs in the insertion of pronator teres and flexor carpi radialis. Diagnosis is usually apparent through a detailed history and examination but care must be made to exclude other conditions affecting the ulnar nerve or less commonly the ulnar collateral ligament complex. If doubt exists then MRI/US and electrophysiology can be used. Treatment follows a similar pattern to that of lateral elbow tendinopathy. Acute management is with activity modification and topical NSAIDs. Injection therapy and surgical excision are utilised for recalcitrant cases. Distal biceps and triceps tendinopathies are very rare and there is limited evidence published. Sequelae of tendinopathy include tendon rupture and so it is vital to manage these tendinopathies appropriately in order to minimise this significant complication. Their management and that of partial tears will be considered.

  16. 10 CFR 609.16 - Perfection of liens and preservation of collateral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Perfection of liens and preservation of collateral. 609.16 Section 609.16 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS LOAN GUARANTEES FOR PROJECTS THAT EMPLOY INNOVATIVE TECHNOLOGIES § 609.16 Perfection of liens and preservation of collateral....

  17. 10 CFR 609.15 - Default, demand, payment, and collateral liquidation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Default, demand, payment, and collateral liquidation. 609.15 Section 609.15 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS LOAN GUARANTEES FOR PROJECTS THAT EMPLOY INNOVATIVE TECHNOLOGIES § 609.15 Default, demand, payment, and collateral...

  18. 12 CFR 723.7 - What are the collateral and security requirements?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 7 2013-01-01 2013-01-01 false What are the collateral and security requirements? 723.7 Section 723.7 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS MEMBER BUSINESS LOANS § 723.7 What are the collateral and security requirements? (a)...

  19. 12 CFR 723.7 - What are the collateral and security requirements?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false What are the collateral and security requirements? 723.7 Section 723.7 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS MEMBER BUSINESS LOANS § 723.7 What are the collateral and security requirements? (a)...

  20. 12 CFR 723.7 - What are the collateral and security requirements?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false What are the collateral and security requirements? 723.7 Section 723.7 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS MEMBER BUSINESS LOANS § 723.7 What are the collateral and security requirements? (a)...

  1. 12 CFR 723.7 - What are the collateral and security requirements?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 7 2014-01-01 2014-01-01 false What are the collateral and security requirements? 723.7 Section 723.7 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS MEMBER BUSINESS LOANS § 723.7 What are the collateral and security requirements? (a)...

  2. 12 CFR 723.7 - What are the collateral and security requirements?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 7 2012-01-01 2012-01-01 false What are the collateral and security requirements? 723.7 Section 723.7 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS MEMBER BUSINESS LOANS § 723.7 What are the collateral and security requirements? (a)...

  3. Comparison of Alcoholics' Self-Reports of Drinking Behavior with Reports of Collateral Informants.

    ERIC Educational Resources Information Center

    Maisto, Stephen A.; And Others

    1979-01-01

    Posthospitalization follow-up data were collected from 52 alcoholic subjects and their collateral informants. Findings suggest that alcoholics who have been hospitalized for detoxification generally provide reliable self-reports of their posttreatment drinking behavior, and that gathering data from collateral informants is an effective method for…

  4. 7 CFR 1980.334 - Appraisal of property serving as collateral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 14 2010-01-01 2009-01-01 true Appraisal of property serving as collateral. 1980.334... Appraisal of property serving as collateral. An appraisal of all property serving as security for the... Lender may pass the cost of the appraisal on to the borrower. The appraisal must have been...

  5. 7 CFR 1980.444 - Appraisal of property serving as collateral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 14 2010-01-01 2009-01-01 true Appraisal of property serving as collateral. 1980.444... Program § 1980.444 Appraisal of property serving as collateral. (a) Appraisal reports prepared by... the appraisal to be made by a qualified appraiser on the lender's staff with experience appraising...

  6. 10 CFR 611.108 - Perfection of liens and preservation of collateral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Perfection of liens and preservation of collateral. 611.108 Section 611.108 Energy DEPARTMENT OF ENERGY (CONTINUED) ASSISTANCE REGULATIONS ADVANCED TECHNOLOGY... determines are required to preserve the collateral. The cost of such contracts may be charged to the Borrower....

  7. Noninvasive assessment of coronary collaterals in man by PET perfusion imaging

    SciTech Connect

    Demer, L.L.; Gould, K.L.; Goldstein, R.A.; Kirkeeide, R.L. )

    1990-03-01

    At present, coronary collateralization cannot be identified or assessed noninvasively in patients. In animal studies, coronary collaterals are associated with coronary steal, defined as a regional fall in perfusion during coronary arteriolar vasodilation. To determine the effect of coronary arteriolar vasodilation on collateral bed perfusion in man, myocardial perfusion imaging was performed before and after pharmacologic coronary vasodilation in patients with coronary artery disease (CAD). Regional myocardial activity of {sup 82}Rb or {sup 13}N ammonia was measured by positron emission tomography (PET) at rest and with intravenous dipyridamole/handgrip stress in 28 patients with angiographic collaterals and in 25 control patients with similar CAD severity by quantitative arteriography. Regional myocardial activity decreased after dipyridamole, indicating coronary steal, in 25 of 28 patients with angiographic collaterals and in only 4 of 25 control patients without angiographic collaterals. These findings suggest that developed collaterals are associated with myocardial steal in patients with CAD, allowing potential use of PET for non-invasive identification of coronary collateralization.

  8. Excimer laser coronary atherectomy in septal collaterals during retrograde recanalization of a chronic total occlusion

    PubMed Central

    Ohlow, Marc-Alexander; Lotze, Ullrich; Lauer, Bernward

    2011-01-01

    Management of chronic total occlusions has been refined through the development of a retrograde approach via collateral pathways. We describe here the use of excimer laser coronary atherectomy in the septal collaterals. This appraoch was not yet described in the literature. PMID:22355487

  9. Factors associated with client-collateral agreement in substance abuse post-treatment self-reports.

    PubMed

    Kedia, Satish; Perry, Stephanie W

    2005-07-01

    This study examined levels of agreement and directionality of disagreement between the post-treatment self-reports of substance abuse clients and their collaterals. The study population comprised 1252 clients with a primary or secondary diagnosis of substance abuse or dependence whose treatment was publicly funded in Tennessee. Client and collateral responses to 13 questions were analyzed for levels of agreement, revealing the following: (a) levels of client-collateral agreement were high, at least 75% agreement on all 13 questions and at least 88% agreement on 10 variables; (b) a Simple Kappa Test confirmed that 11 out of 13 items had moderate to excellent nonchance agreement; (c) there was no consistent trend in directionality, that is, clients neither reported information more positively nor more negatively than their collaterals did; (d) on average, those collaterals who were spouses, parents, and children agreed more with clients compared to other types of collaterals; and (e) those collaterals who saw the clients more frequently and more recently had higher agreement than those who saw the clients less frequently. This research reaffirms that collaterals are a valuable source for verifying the accuracy of clients' self-reports and that this approach continues to hold considerable promise for substance abuse post-treatment assessment.

  10. Loss of distal femur combined with popliteal artery occlusion: reconstructive arthroplasty using modular segmental endoprosthesis: a case report.

    PubMed

    Kang, Shin-Taeg; Hwang, Chan-Ha; Kim, Bo-Hyeon; Sung, Byung-Yoon

    2009-04-01

    Severe injury to the knee and the surrounding area is frequently associated with injury to ligaments of the knee joint and structures in the popliteal fossa. This case involved a popliteal artery occlusion, severe bone loss of distal femur, loss of collateral ligaments, and extensor mechanism destruction of the knee. Initially, prompt recognition and correction of associated popliteal artery injury are important for good results after treatment. After successful revascularization, treatment for severe bone loss of distal femur and injury of the knee joint must be followed. We treated this case by delayed reconstruction using modular segmental endoprosthesis after revascularization of the popliteal artery. This allowed early ambulation. At 36 months after surgery, the patient had good circulation of the lower limb and was ambulating independently.

  11. Influence on collateral flow of recanalising chronic total coronary occlusions: a case-control study

    PubMed Central

    Pohl, T; Hochstrasser, P; Billinger, M; Fleisch, M; Meier, B; Seiler, C

    2001-01-01

    OBJECTIVE—To assess the effect of recanalisation on collateral flow in a case-control study in patients with and without chronic total coronary occlusions.
DESIGN—In 54 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) (mean (SD) age 61 (6) years), coronary collateral flow was measured by intracoronary pressure or Doppler guide wires at the end of repeated balloon occlusions. Coronary collateral flow index (collateral flow relative to normal antegrade flow) during the first two balloon inflations in 27 patients with a chronic total occlusion (occlusion group) was compared with that of 27 patients matched for age, sex, and collateral flow index at the first occlusion and with a coronary artery diameter stenosis ⩽ 80% (stenosis group).
RESULTS—Following revascularisation, collateral flow index decreased in 17 of the patients in the occlusion group (63%) and in eight of the patients in the stenosis group (30%) (p = 0.03 between groups). The overall change of collateral flow index between the first and the second balloon occlusion was −0.04 (0.01) in the occlusion group (p = 0.07 for paired comparison; from 0.29 (0.17) to 0.25 (0.14)), and +0.02 (0.06) in the stenosis group (p = 0.06 for paired comparison; from 0.27 (0.13) to 0.30 (0.15)). The trend to collateral enhancement in the stenosis group differed significantly from the occlusion group (p = 0.01).
CONCLUSIONS—While repeated coronary balloon occlusions induce collateral recruitment in the majority of patients with moderate stenoses, recanalisation of chronic total coronary occlusions is more often associated with collateral flow reduction. A later decrease in collateral flow by involution of collateral channels cannot be excluded by this study but has not been reported so far.


Keywords: coronary collateral circulation; coronary occlusion; revascularisation; collateral damage PMID:11559686

  12. Clinicopathologic correlation of retinal to choroidal venous collaterals of the optic nerve head.

    PubMed

    Schatz, H; Green, W R; Talamo, J H; Hoyt, W F; Johnson, R N; McDonald, H R

    1991-08-01

    An optic nerve meningioma developed in an elderly woman and was followed for 13 years until her death. The optic nerve was initially normal. Over time it became swollen and then atrophic and developed retinal venous to choroidal venous collaterals. Five hundred serial sections were prepared through the optic nerve and for approximately 1.5 mm superiorly and inferiorly to the optic nerve to trace the course of the collaterals that were seen ophthalmoscopically and angiographically in the optic nerve head. This clinicopathologic study shows clearly that the abnormal channels are, in fact, retinal venous to choroidal venous collaterals (bypass channels). Four collaterals extended around the end of Bruch's membrane at the optic nerve head. Two more collaterals extended through the retinal pigment epithelium to become continuous with a subretinal pigment epithelial neovascular membrane, the vessels of which connected with the choroidal vessels through a defect in Bruch's membrane.

  13. Chloride intracellular channel-4 is a determinant of native collateral formation in skeletal muscle and brain.

    PubMed

    Chalothorn, Dan; Zhang, Hua; Smith, Jennifer E; Edwards, John C; Faber, James E

    2009-07-02

    The capacity of the collateral circulation to lessen injury in occlusive vascular disease depends on the density and caliber of native (preexisting) collaterals, as well as their ability to outwardly remodel in ischemia. Native collateral conductance varies widely among healthy individuals, yet little is known about what specifies collateral formation. Chloride intracellular channel (CLIC)4 protein is required for endothelial cell hollowing, a process necessary for vessel formation during embryogenesis and ischemia. Whether CLIC4 has other physiological roles in vascular biology is uncertain. We studied collateral formation and remodeling in mice deficient in CLIC1 and CLIC4. Vascular responses to femoral artery ligation were similar in Clic1(-/-) and wild-type mice. In contrast, immediately after ligation perfusion dropped more in Clic4(-/-) than wild-type mice, suggesting fewer preexisting collaterals, a finding confirmed by angiography, greater ischemia, and worse recovery of perfusion; however, collateral remodeling was unaffected. Likewise, native cerebral collateral density in Clic4(-/-) (but not Clic1(-/-)) mice was reduced, resulting in severe infarctions. This was associated with impaired perinatal formation and stabilization of nascent collaterals. Clic4 hemizygous mice had intermediate deficits in the above parameters, suggesting a gene-dose effect. Ischemia augmented CLIC1 and CLIC4 expression similarly in wild-type mice. However, CLIC1 increased 3-fold more in Clic4(-/-) mice, suggesting compensation. Despite greater ischemia in Clic4(-/-) mice, hypoxia-inducible factor-1alpha, vascular endothelial growth factor (VEGF) and angiopoietin-2 increased less compared to wild-type, suggesting CLIC4 exerts influences upstream of hypoxia-inducible factor-1alpha-VEGF signaling. Hence, CLIC4 represents the second gene that, along with VEGF shown by us previously, specifies native collateral formation.

  14. Collateral vessel number, plaque burden, and functional decline in peripheral artery disease.

    PubMed

    McDermott, Mary M; Carr, James; Liu, Kiang; Kramer, Christopher M; Yuan, Chun; Tian, Lu; Criqui, Michael H; Guralnik, Jack M; Ferrucci, Luigi; Zhao, Lihui; Xu, Dongxiang; Kibbe, Melina; Berry, Jarett; Carroll, Timothy J

    2014-08-01

    Associations of collateral vessels and lower extremity plaque with functional decline are unknown. Among people with peripheral artery disease (PAD), we determined whether greater superficial femoral artery (SFA) plaque burden combined with fewer lower extremity collateral vessels was associated with faster functional decline, compared to less plaque and/or more numerous collateral vessels. A total of 226 participants with ankle-brachial index (ABI) <1.00 underwent magnetic resonance imaging of lower extremity collateral vessels and cross-sectional imaging of the proximal SFA. Participants were categorized as follows: Group 1 (best), maximum plaque area < median and collateral vessel number ≥6 (median); Group 2, maximum plaque area < median and collateral vessel number <6; Group 3, maximum plaque area > median and collateral vessel number ≥6; Group 4 (worst), maximum plaque area > median and collateral vessel number <6. Functional measures were performed at baseline and annually for 2 years. Analyses adjust for age, sex, race, comorbidities, and other confounders. Annual changes in usual-paced walking velocity were: Group 1, +0.01 m/s; Group 2, -0.02 m/s; Group 3, -0.01 m/s; Group 4, -0.05 m/s (p-trend=0.008). Group 4 had greater decline than Group 1 (p<0.001), Group 2 (p=0.029), and Group 3 (p=0.010). Similar trends were observed for fastest-paced 4-meter walking velocity (p-trend=0.018). Results were not substantially changed when analyses were repeated with additional adjustment for ABI. However, there were no associations of SFA plaque burden and collateral vessel number with decline in 6-minute walk. In summary, a larger SFA plaque burden combined with fewer collateral vessels is associated with a faster decline in usual and fastest-paced walking velocity in PAD.

  15. The association of circulating monocyte count with coronary collateral growth in patients with diabetes mellitus.

    PubMed

    Kocaman, Sinan Altan; Sahinarslan, Asife; Akyel, Ahmet; Timurkaynak, Timur; Boyaci, Bulent; Cengel, Atiye

    2010-03-01

    The status of inflammation may affect the collateral development in patients with diabetes mellitus (DM). Monocytes were found to have an important role in collateral growth in animal studies. We aimed to investigate the possible association of circulating monocyte count with collateral development in patients with DM and severe coronary artery disease (CAD). We enrolled 134 consecutive patients with DM who had > or =95 stenosis in at least one major coronary artery and investigated the relationship between circulating monocyte count and collateral growth. When we analyzed the coronary angiograms of eligible patients, we found that 64 of them had good collateral growth and 70 had poor collateral growth according to the Cohen-Rentrop method. The monocyte count was significantly different between good and poor collateral growth groups (643 +/- 184 vs. 479 +/- 143 per mm(3), P < 0.001). In the analysis comparing the Rentrop score with the Gensini score and circulating monocyte count, we found significant correlations (r = 0.293, P = 0.001 and r = 0.455, P < 0.001, respectively). The duration of ischemic symptoms tended to be longer in the good collateral group (1.9 +/- 4.1 vs. 0.8 +/- 1.3 years, P = 0.079). The Gensini score was also correlated with the duration of myocardial ischemic symptoms (r = 0.299, P = 0.004). Multivariate analysis revealed an increased monocyte count in the good collateral group [odds ratio (OR), 5.726; 95% confidence interval (CI), 1.817-18.040, P = 0.003, the cut-off value for monocyte was defined as 550 cell/mm(3)]. The increased circulating monocyte count in diabetic patients was evidently related to good coronary collateral growth. This finding may be potentially important in clinical and basic cardiovascular medicine.

  16. [Synopsis about the hypothesis of "information channel" of channel-collateral system].

    PubMed

    Chang, Xi-Lang

    2008-10-01

    The author of the present paper founded a theorem about the "incompleteness of single channel structure" (nerve, blood vessel, lymphatic, interspace, aperture, etc.) through quantitative and qualitative analysis about the economic information channel in the human body, which eliminates the probability of single channel structure in the information channel of channel (meridian)-collateral system. After comprehensive analysis on the current researches, the author puts forward a neodoxy, i.e., the body "information channel" structure of the channel-collateral system, mainly follows the distribution regularity of systemic statistics, and is not a single specific entity; various layers of the information channel in the main stems of the channel-collaterals are composed of optimized structure tissues. Hence, the structure of this information channel of channel-collateral system is an overall-optimized, sequential and compatible systemic structure. From this neodoxy, the author brings forward a working principle of channel-collaterals, which is supported theoretically by bio-auxology. The longitudinal distribution of the main stems of meridian-collaterals is considered to result from that in the process of the animal evolution, in the animals moving forward, the microscopic complicated movement of intracorporeal information and energy molecules is related to the forward macroscopic and non-uniform movement of organism in trans-measure. Its impulse and kinetic momentum forms a main vector in the longitudinal direction of the body (the direction of the main stem of channel-collaterals). In order to adapt to and utilize natural regularities, the main stems of the channel-collaterals gradually differentiate and evolve in the living organism, forming a whole system. The "hypothesis of biological origin of channel-collateral system" and "that of information channel of the channel-collaterals in the body" constitute a relatively complete theoretical system framework.

  17. 12 CFR 223.41 - What covered transactions are exempt from the quantitative limits and collateral requirements?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... quantitative limits and collateral requirements? 223.41 Section 223.41 Banks and Banking FEDERAL RESERVE SYSTEM... are exempt from the quantitative limits and collateral requirements? The following transactions are not subject to the quantitative limits of §§ 223.11 and 223.12 or the collateral requirements of §...

  18. 26 CFR 1.6049-7 - Returns of information with respect to REMIC regular interests and collateralized debt obligations.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... regular interests and collateralized debt obligations. 1.6049-7 Section 1.6049-7 Internal Revenue INTERNAL... collateralized debt obligations. (a) Definition of interest—(1) In general. For purposes of section 6049(a), for... with respect to a collateralized debt obligation (as defined in paragraph (d)(2) of this section),...

  19. 26 CFR 1.6049-7 - Returns of information with respect to REMIC regular interests and collateralized debt obligations.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... regular interests and collateralized debt obligations. 1.6049-7 Section 1.6049-7 Internal Revenue INTERNAL... collateralized debt obligations. (a) Definition of interest—(1) In general. For purposes of section 6049(a), for... with respect to a collateralized debt obligation (as defined in paragraph (d)(2) of this section),...

  20. Distal realignment (tibial tuberosity transfer).

    PubMed

    Feller, Julian Ashley

    2012-09-01

    Although tibial tuberosity (TT) transfer has for many years been the basis of many protocols for the management of patellar instability, the role of pure medial transfer in particular appears to be declining. In contrast, the greater recognition of the importance of patella alta as a predisposing factor to recurrent patellar dislocation has resulted in a resurgence in the popularity of distal TT transfer. When TT transfer is performed, the direction and amount of transfer is based on the patellar height and the lateralization of the TT relative to the trochlear groove. Patellar height is best assessed on a lateral radiograph with the knee in flexion using a ratio that uses the articular surface of the patella in relation to the height above the tibia. Assessment of lateralization of the TT relative to the trochlear groove can be made using either computed tomography or magnetic resonance imaging scans.

  1. Photoionization of Endohedral Atoms: Collective, Reflective and Collateral Emissions

    NASA Astrophysics Data System (ADS)

    Chakraborty, Himadri S.; McCune, Matthew A.; Madjet, Mohamed E.; Hopper, Dale E.; Manson, Steven T.

    2009-12-01

    The photoionization properties of a fullerene-confined atom differ dramatically from that of an isolated atom. In the low energy region, where the fullerene plasmons are active, the electrons of the confined atom emerge through a collective channel carrying a significant chunk of plasmon with it. The photoelectron angular distribution of the confined atom however shows far lesser impact of the effect. At higher energies, the interference between two single-electron ionization channels, one directly from the atom and another reflected off the fullerene cage, producuces oscillatory cross sections. But for the outermost atomic level, which transfers some electrons to the cage, oscillations are further modulated by the collateral emission from the part of the atomic charge density transferred to the cage. These various modes of emissions are studied for the photoionization of Ar endohedrally confined in C60.

  2. Medial collateral ligament reconstruction in the baseball Pitcher's elbow.

    PubMed

    Erne, Holger C; Zouzias, Ioannis C; Rosenwasser, Melvin P

    2009-08-01

    Pitchers are prone to elbow injuries because of high and repetitive valgus stresses on the elbow. The anterior bundle of the medial ulnar collateral ligament (MCL) of the elbow is the primary restraint and is often attenuated with time, leading to functional incompetence and ultimate failure. Pitchers with a history of medial elbow pain, reduced velocity, and loss of command may have an MCL injury in evolution. Physical examination and imaging can confirm the diagnosis. Treatment begins with rest and activity modification. All medial elbow pain is not MCL injury. Surgery is considered only for talented athletes who wish to return to competitive play and may include elite scholastic and other collegiates and professionals. The technique for MCL reconstruction was first described in 1986. Many variations have been offered since then, which can result in predictable outcomes, allowing many to return to the same level of competitive play.

  3. Photoionization of Endohedral Atoms: Collective, Reflective and Collateral Emissions

    SciTech Connect

    Chakraborty, Himadri S.; McCune, Matthew A.; Hopper, Dale E.; Madjet, Mohamed E.; Manson, Steven T.

    2009-12-03

    The photoionization properties of a fullerene-confined atom differ dramatically from that of an isolated atom. In the low energy region, where the fullerene plasmons are active, the electrons of the confined atom emerge through a collective channel carrying a significant chunk of plasmon with it. The photoelectron angular distribution of the confined atom however shows far lesser impact of the effect. At higher energies, the interference between two single-electron ionization channels, one directly from the atom and another reflected off the fullerene cage, producuces oscillatory cross sections. But for the outermost atomic level, which transfers some electrons to the cage, oscillations are further modulated by the collateral emission from the part of the atomic charge density transferred to the cage. These various modes of emissions are studied for the photoionization of Ar endohedrally confined in C{sub 60}.

  4. Modeling and simulation for collateral damage estimation in combat

    NASA Astrophysics Data System (ADS)

    Gordon, Steven C.; Martin, Douglas D.

    2005-05-01

    Modeling and simulation (M&S) is increasingly used for decision support during combat operations: M&S is going to war! One of the key operational uses of M&S in combat is collateral damage estimation (CDE). Reducing undesired collateral damage (CD) in war and in operations other than war is important to the United States of America. Injuries to noncombatants and damage to protected sites are uniformly avoided by our forces whenever possible in planning and executing combat operations. This desire to limit unwanted CD presents unique challenges to command and control (C2), especially for time-sensitive targeting (TST). The challenges begin the moment a target is identified because CD estimates must meet specified criteria before target approval is granted. Therefore, CDE tools must be accurate, responsive, and human-factored, with graphics that aid C2 decisions. This paper will describe how CDE tools are used to build three-dimensional models of potential target areas and select appropriate munitions, fusing, and delivery in order to minimize predicted CD. The paper will cover the evolution of CDE from using only range rings around the target to improvements through Operation Allied Force, Operation Enduring Freedom, and Operation Iraqi Freedom. Positive CDE feedback from various sources, including the Secretary of Defense, lessons learned, and warfighters will be presented. Current CDE tools in the field and CDE tools used in reachback are being improved, and short-term and long-term improvements in those tools and in the CDE methodology will be described in this paper.

  5. The fissure: interlobar collateral ventilation and implications for endoscopic therapy in emphysema.

    PubMed

    Koster, Theodoor David; Slebos, Dirk-Jan

    2016-01-01

    In patients with severe emphysema, bronchoscopic lung volume reduction using one-way valves is a promising therapeutic option to improve lung function and quality of life. The goal of this treatment is to achieve a complete lobar atelectasis. In a significant proportion of patients, this atelectasis cannot be achieved due to interlobar collateral ventilation. This collateral ventilation is generated through incomplete lobar fissures. Therefore, only patients with complete fissures and no collateral ventilation can be selected for endobronchial therapy with one-way valves. Incomplete fissures are very common and exhibit a great variation in anatomy. The reported prevalence is 17%-85% for the right major fissure, 19%-74% for the left major fissure, and 20%-90% for the minor fissure. There are several methods of measuring or predicting the presence of collateral ventilation, with computed tomography (CT)-fissure analysis and the Chartis measurement being the most important. CT-fissure analysis is an indirect method to measure the completeness of fissures as a surrogate for collateral ventilation. The Chartis system is an endobronchial method to directly measure the presence of collateral ventilation. Both methods have unique value, and the combination of both can accurately predict the treatment response to the bronchoscopic placement of endobronchial valves. This review provides an in-depth view of lung fissure and collateral ventilation to help understand its importance in selecting the appropriate patients for new emphysema treatments and thus avoid useless treatment in unsuitable patients.

  6. Effect of cyclooxygenase blockade on blood flow through well-developed coronary collateral vessels.

    PubMed

    Altman, J; Dulas, D; Bache, R J

    1992-06-01

    Collateral vessels that develop after coronary artery occlusion demonstrate perivascular inflammation, subintimal hyperplasia, and endothelial proliferation. This study was performed to test the hypothesis that these abnormalities are associated with evidence for increased production of vasodilator prostaglandins. Eight dogs were studied 4-6 months after occlusion of the anterior descending coronary artery had been performed to stimulate collateral vessel growth. At the time of study, the anterior descending coronary artery was cannulated at the site of occlusion to allow measurement of retrograde blood flow as an index of interarterial collateral flow. Injection of radioactive microspheres during the retrograde flow collection allowed determination of continuing tissue flow in the collateral-dependent zone as an index of intramural microvascular collateral flow. Retrograde and tissue flows were measured before and 20 minutes after 5 mg/kg i.v. indomethacin, a dose that caused 95 +/- 3% inhibition of the coronary vasodilation in response to a 500 micrograms intracoronary bolus of arachidonic acid. Heart rate and mean aortic pressure were not significantly altered by indomethacin, and blood flow to the normally perfused myocardial region was not changed by administration of indomethacin. However, indomethacin caused a 40 +/- 7% decrease in retrograde flow (p less than 0.01), and microvascular collateral flow to the dependent myocardium decreased by 20 +/- 10% (p less than 0.05). These data indicate that, unlike the normal coronary circulation, well-developed coronary collateral vessels are under the tonic influence of vasodilator prostaglandins.

  7. Giant-Cell Tumor of the Distal Ulna Treated by Wide Resection and Ulnar Support Reconstruction: A Case Report

    PubMed Central

    Minami, Akio; Iwasaki, Norimasa; Nishida, Kinya; Motomiya, Makoto; Yamada, Katsuhisa; Momma, Daisuke

    2010-01-01

    Giant-cell tumor of bone occurred in the distal end of the ulna is extremely uncommon. A 23-year-old male had a giant-cell tumor occurred in the distal end of the ulna. After wide resection of the distal segment of the ulna including giant-cell tumor, ulnar components of the wrist joint were reconstructed with modified Sauvé-Kapandji procedure using the iliac bone graft, preserving the triangular fibrocartilage complex and ulnar collateral ligament in order to maintain ulnar support of the wrist, and the proximal stump of the resected ulna was stabilized by tenodesis using the extensor carpi ulnaris tendon. One year after operation, the patient's wrist was pain-free and had a full range of motion. Postoperative X-rays showed no abnormal findings including recurrence of the giant-cell tumor and ulnar translation of the entire carpus. The stability of the proximal stump of the distal ulna was also maintained. PMID:20592994

  8. Collateral blood flow in different cerebrovascular hierarchy provides endogenous protection in cerebral ischemia.

    PubMed

    Luo, Chuanming; Liang, Fengyin; Ren, Huixia; Yao, Xiaoli; Liu, Qiang; Li, Mingyue; Qin, Dajiang; Yuan, Ti-Fei; Pei, Zhong; Su, Huanxing

    2016-11-15

    Collateral blood flow as vascular adaptions to focal cerebral ischemia is well recognized. However, few studies directly investigate the dynamics of collateral vessel recruitment in vivo and little is known about the effect of collateral blood flow in different cerebrovascular hierarchy on the neuropathology after focal ischemic stroke. Here, we report that collateral blood flow is critically involved in blood vessel compensations following regional ischemia. We occluded a pial arteriole using femtosecond laser ablating under the intact thinned skull and documented the changes of collateral flow around the surface communication network and between the surface communication network and subsurface microcirculation network using in vivo two photon microscopy imaging. Occlusion of the pial arteriole apparently increased the diameter and collateral blood flow of its leptomeningeal anastomoses, which significantly reduced the cortical infarction size. This result suggests that the collateral flow via surface communicating network connected with leptomeningeal anastomoses could greatly impact on the extent of infarction. We then further occluded the target pial arteriole and all of its leptomeningeal anastomoses. Notably, this type of occlusion led to reversals of blood flow in the penetrating arterioles mainly proximal to the occluded pial arteriole in a direction from the subsurface microcirculation network to surface arterioles. Interesting, the cell death in the area of ischemic penumbra was accelerated when we performed occlusion to cease the reversed blood flow in those penetrating arterioles, suggesting that the collateral blood flow from subsurface microcirculation network exerts protective roles in delaying cell death in the ischemic penumbra. In conclusion, we provide the first experimental evidence that collateral blood vessels at different cerebrovascular hierarchy are endogenously compensatory mechanisms in brain ischemia. This article is protected by

  9. The Collateral Consequences of Sex Offender Management Policies: Views From Professionals.

    PubMed

    Call, Corey

    2016-06-13

    In this study, the perceptions of community corrections professionals and clinical specialists toward the collateral consequences of current sex offender management policies were explored and contrasted. In addition, potential influencing factors of these perceptions were examined. Results indicate high levels of belief that sex offenders experience a variety of collateral consequences upon reentry; however, community corrections professionals are significantly less likely to believe that sex offenders experience collateral consequences than clinical specialists. Furthermore, few demographic variables were found to significantly influence the perceptions of the sample. Implications for the management of sex offenders are discussed.

  10. Spectrum of hepatofugal collateral pathways in portal hypertension: an illustrated radiological review.

    PubMed

    Arora, Ankur; Rajesh, S; Meenakshi, Yamini S; Sureka, Binit; Bansal, Kalpana; Sarin, Shiv Kumar

    2015-10-01

    The purpose of this article is to describe the various portosystemic collateral pathways pertinent to portal hypertension on multi-detector row computed tomography (MDCT) and their clinical relevance, with special emphasis on the uncommon ones. The knowledge and understanding of the various patterns of portosystemic collateral channels has important implications both for the clinician and the interventionist. MDCT with its advanced post processing capabilities can exquisitely demonstrate these vascular pathways to help in therapeutic decision making. Teaching points • Portosystemic collaterals are an important cause of bleeding and hepatic encephalopathy. • Radiologists should be familiar with the imaging findings to effectively identify them. • Pre-operative knowledge of portosystemic collaterals is essential to avoid inadvertent vascular injury.

  11. 46 CFR 308.522 - Collateral deposit fund, letter of transmittal, Form MA-302.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.522... use in establishing a collateral deposit fund, may be obtained from the American War Risk Agency...

  12. 13 CFR 123.513 - Does SBA require collateral on its Military Reservist EIDL?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... ADMINISTRATION DISASTER LOAN PROGRAM Military Reservist Economic Injury Disaster Loans § 123.513 Does SBA require... provide available collateral such as a lien on business property, a security interest in personal...

  13. Fatal derecruitment of occluded left anterior descending collaterals after left circumflex revascularization

    PubMed Central

    Boukhris, Marouane; Tomasello, Salvatore D.; Galassi, Alfredo R.

    2015-01-01

    Coronary arteries are not definitely functionally terminal arteries, as previously thought; indeed, they are linked and interconnected by a rich network of collaterals. Chronic total occlusions (CTOs) represent a subset of frequent lesions encountered in everyday catheterization laboratory practice, generally associated with a developed system of collateral connections. These latter have the capacity to prevent myocardial necrosis and may even uphold metabolic supply to the ischemic territory to maintain its contractile capacity. Authors have reported a rapid and progressive reduction of collateral function and their decline after antegrade flow restoration, resulting in higher myocardial susceptibility to ischemia in the CTO territory. Here, we report the case of a fatal derecruitment of collaterals for a left anterior descending CTO not reopened, after left circumflex subocclusion revascularization. PMID:26778906

  14. 7 CFR 1980.443 - Collateral, personal and corporate guarantees and other requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... loan is reasonably assured when considered with the integrity and ability of project management... to the following: Land, buildings, machinery, equipment, furniture, fixtures, inventory, accounts receivable, cash or special cash collateral accounts, marketable securities and cash surrender value of...

  15. Resolution of bilateral moyamoya associated collateral vessel aneurysms: Rationale for endovascular versus surgical intervention

    PubMed Central

    Amin-Hanjani, Sepideh; Goodin, Sean; Charbel, Fady T.; Alaraj, Ali

    2014-01-01

    Background: Management of aneurysms associated with deep collateral vessels in moyamoya disease is challenging both from an endovascular and a surgical standpoint. Difficulties with access or localization, and compromise of the collateral circulation with subsequent ischemia are the primary concerns, making direct obliteration potentially unfeasible or risky. Alternatively, superficial temporal artery–middle cerebral artery bypass is another potential strategy for resolution of these aneurysms. Case Description: Presented are the findings and management for a patient with moyamoya disease and bilateral deep collateral vessel aneurysms, successfully treated with endovascular obliteration following a right-sided hemorrhage and subsequently with bypass for an unruptured but growing contralateral aneurysm. Conclusions: A rationale and approach to management is outlined, as derived from review of the current literature and the illustrative case with bilateral collateral vessel aneurysms. PMID:25071939

  16. 46 CFR 308.522 - Collateral deposit fund, letter of transmittal, Form MA-302.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.522... use in establishing a collateral deposit fund, may be obtained from the American War Risk Agency...

  17. 46 CFR 308.522 - Collateral deposit fund, letter of transmittal, Form MA-302.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.522... use in establishing a collateral deposit fund, may be obtained from the American War Risk Agency...

  18. 46 CFR 308.522 - Collateral deposit fund, letter of transmittal, Form MA-302.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Ii-Open Policy War Risk Cargo Insurance § 308.522... use in establishing a collateral deposit fund, may be obtained from the American War Risk Agency...

  19. Incidentally detected right pulmonary artery agenesis with right coronary artery collateralization.

    PubMed

    Mikaberidze, Nino; Goldberg, Ythan; Khosraviani, Khashayar; Taub, Cynthia

    2014-01-01

    Unilateral pulmonary artery agenesis (UPAA) with pulmonary hypoplasia is a rare congenital anomaly. We describe a 71-year old male who was incidentally diagnosed with the right UPAA and a hypoplastic right lung supplied by collateralized right coronary.

  20. Genetics Home Reference: distal hereditary motor neuropathy, type II

    MedlinePlus

    ... distal hereditary motor neuropathy, type II distal hereditary motor neuropathy, type II Enable Javascript to view the ... PDF Open All Close All Description Distal hereditary motor neuropathy, type II is a progressive disorder that ...

  1. Elbow dislocation with ipsilateral distal radius fracture

    PubMed Central

    Meena, Sanjay; Trikha, Vivek; Kumar, Rakesh; Saini, Pramod; Sambharia, Abhishek Kumar

    2013-01-01

    Elbow dislocation associated with ipsilateral distal radius fracture is a rare pattern of injury, although it is common for elbow dislocation and forearm fractures to occur separately. We report a rare case of a 20-year-old male who had a posterior elbow dislocation and ipsilateral distal radius fracture. Elbow dislocation was first reduced in extension and distal radius fracture was then reduced in flexion. Both the injuries were conservatively managed. At 6 months follow-up, the patient had no pain in his elbow and minimal pain in his wrist on heavy lifting and had resumed his work as a laborer. PMID:24082758

  2. Elbow dislocation with ipsilateral distal radius fracture.

    PubMed

    Meena, Sanjay; Trikha, Vivek; Kumar, Rakesh; Saini, Pramod; Sambharia, Abhishek Kumar

    2013-07-01

    Elbow dislocation associated with ipsilateral distal radius fracture is a rare pattern of injury, although it is common for elbow dislocation and forearm fractures to occur separately. We report a rare case of a 20-year-old male who had a posterior elbow dislocation and ipsilateral distal radius fracture. Elbow dislocation was first reduced in extension and distal radius fracture was then reduced in flexion. Both the injuries were conservatively managed. At 6 months follow-up, the patient had no pain in his elbow and minimal pain in his wrist on heavy lifting and had resumed his work as a laborer.

  3. Management of Complications of Distal Radius Fractures

    PubMed Central

    Chung, Kevin C.; Mathews, Alexandra L.

    2015-01-01

    Synopsis Treating a fracture of the distal radius may require the surgeon to make a difficult decision between surgical treatment and nonsurgical management. The use of surgical fixation has recently increased owing to complications associated with conservative treatment. However, conservative action may be necessary depending on certain patient factors. The treating surgeon must be aware of the possible complications associated with distal radius fracture treatments to prevent their occurrence. Prevention can be achieved with a proper understanding of the mechanism of these complications. This article discusses the most recent evidence on how to manage and prevent complications following a fracture of the distal radius. PMID:25934197

  4. Nettleship collaterals: circumpapillary cilioretinal anastomoses after occlusion of the central retinal artery.

    PubMed

    Ragge, N K; Hoyt, W F

    1992-03-01

    In extremely rare cases, after occlusion of the central retinal artery, a complete ring of peripapillary anastomotic channels develops. One such case is described and a proposed term given to these channels--'Nettleship collaterals'--after the man who first described them. These collaterals are dilated pathways within the terminal capillary networks of the posterior ciliary arteries and the branches of the central retinal artery. Formation of the channels is believed to be promoted by prelaminar obstruction of the central retinal artery.

  5. Isolated lateral collateral ligament complex injury in rock climbing and Brazilian Jiu-jitsu.

    PubMed

    Davis, Bryan A; Hiller, Lucas P; Imbesi, Steven G; Chang, Eric Y

    2015-08-01

    We report two occurrences of high-grade tears of the lateral collateral ligament complex (LCLC), consisting of the anterolateral ligament (ALL) and fibular collateral ligament (FCL). One injury occurred in a rock climber and the other in a martial artist. Increasing awareness of isolated injuries of the LCLC will allow for appropriate diagnosis and management. We review and discuss the anatomy of the LCLC, the unique mechanism of isolated injury, as well as physical and imaging examination findings.

  6. Occlusion of the left main coronary artery and collateral circulation via the conus branch.

    PubMed

    de Agustin, Jose Alberto; Nunez-Gil, Ivan Javier; del Carmen Manzano, Maria; Vivas, David; Mateos, Borja Ruiz; Carda, Rocio; Vilacosta, Isidre; Zamorano, Jose Luis; Macaya, Carlos

    2009-05-01

    We report the case of a 71-year-old-man, a smoker, admitted for unstable angina. Subsequent investigation revealed complete proximal occlusion of the left main coronary with an unusual collateral circulation. The left coronary artery was filled by a large conus branch originating from the right sinus of Valsalva. This case shows the importance of looking for atypical collateral circulation in patients with chronic occlusion of the left main coronary artery and normal left ventricular function.

  7. "One-stop" Hybrid approach for tetralogy of fallot with aortopulmonary collateral arteries in adults.

    PubMed

    Jiang, Yiyao; Zhang, Wei; Pei, Yu; Yang, Li; Xue, Langang; Liu, Xiaocheng

    2013-04-01

    We report a 45 year-old Chinese woman with tetralogy of fallot that had two aortopulmonary collateral arteries and tricuspid regurgitation. Collateral circulation was blocked and total correction was successfully performed in our "one-stop" hybrid operation room. The patient was weaned from cardiopulmonary bypass after 97 minutes and was transferred to the intensive care unit for about 36 hours. Without any complications, the patient was discharged home in the following eight days.

  8. Semiconstrained Distal Radioulnar Joint Prosthesis

    PubMed Central

    Savvidou, Christiana; Murphy, Erin; Mailhot, Emilie; Jacob, Shushan; Scheker, Luis R.

    2013-01-01

    Distal radioulnar joint (DRUJ) problems can occur as a result of joint instability, abutment, or incongruity. The DRUJ is a weight-bearing joint; the ulnar head is frequently excised either totally or partially, and in some cases it is fused, because of degenerative, rheumatoid, or posttraumatic arthritis. Articles about these procedures report the ability to pronate and supinate, but they rarely discuss grip strength, and even less do they address lifting capacity. We report the long term results of the first 35 patients who underwent total DRUJ arthroplasty with the Aptis DRUJ prosthesis after 5 years follow-up. Surgical indications were all causes of dysfunctional DRUJ (degenerative, posttraumatic, autoimmune, congenital). We recorded data for patient demographics, range of motion (ROM), strength, and lifting capacity of the operated and of the nonoperated extremity. Pain and functional assessments were also recorded. The Aptis DRUJ prosthesis, a bipolar self-stabilizing DRUJ endoprosthesis that restores forearm function, consists of a semiconstained and modular implant designed to replace the function of the ulnar head, the sigmoid notch of the radius, and the triangular fibrocartilage ligaments. The surgical technique is presented in detail. The majority of the patients regained adequate ROM and improved their strength and lifting capacity to the operated side. Pain and activities of daily living were improved. Twelve patients experienced complications, most commonly being extensor carpi ulnaris (ECU) tendinitis, ectopic bone formation, bone resorption with stem loosening, low-grade infection, and need for ball replacement. The Aptis total DRUJ replacement prosthesis is an alternative to salvage procedures that enables a full range of motion as well as the ability to grip and lift weights encountered in daily living activities. PMID:24436788

  9. Rotational Alignment of Femoral Component for Minimal Medial Collateral Ligament Release in Total Knee Arthroplasty

    PubMed Central

    Chon, Je Gyun; Jung, Jae Yong; Kim, Tae In; Jang, Seong Won

    2011-01-01

    Purpose We attempted to determine the degree of rotation of the femoral component to achieve an ideal rectangular flexion gap with minimal medial collateral ligament (MCL) release using a modified measured technique. Materials and Methods Group I consisted of 60 osteoarthritis patients (72 cases) who underwent total knee arthroplasty (TKA) with minimal MCL release and Group II consisted of 48 patients without osteoarthritis (61 cases). We performed computed tomography (CT) scanning of the knee with 90 degree flexion in all of the patients and analyzed the angles between the distal femur landmarks and the tibial mechanical axis using a Picture Archiving Communication system. External rotation of the femoral component from the Whiteside line and posterior condylar line was measured in group I who underwent TKA with minimum MCL release. The variance in the mediolateral flexion gap according to the degree of rotation was also measured using an Auto-Computer Aided Design program. Results The CT scans showed that the Whiteside line, posterior condylar line, and transepicondylar line was more internally rotated on average from the longitudinal axis of tibia by 4.12°, 5.54°, and 4.64°, respectively, in group I compared to group II. In group I, the femoral component was inserted with an average external rotation of 5.6° from the posterior condylar line and with an average external rotation of 2.0° from the Whiteside line with minimal MCL release. From the measurements of the femoral component size and the variance in the degree of rotation using an Auto-CAD program, it was found that the change in the mediolateral flexion gap was greater when the rotation angle was greater and it was greater when the size of femoral component was larger at the same rotation angle. Conclusions The average rotation angle of the femoral component to achieve an ideal rectangular flexion gap with minimal MCL release in TKA was an external rotation of 5.6° from the posterior condylar line

  10. [Approach to the road of vigorously developing Chinese medicine by scientific location of channels and collaterals].

    PubMed

    Li, Ding-zhong; Fu, Song-tao; Mi, He-yin; Li, Xiu-zhang; Zhang, Chang-lin; Zhang, Wei-bo

    2008-12-01

    Through researches of channels and collaterals and clinical practice of many years, the authors understand that Chinese medicine, which considers the human body as an interrelated, mutual constraints, whole, dynamic living system, has gradually become an important part of modern medicine. Channels and collaterals are a closed loop system which is communicated and linked by energy and information in the form of electromagnetic oscillation, reflecting many characteristics similar to quantum. Channels and collaterals are not a fixed organizational structure. Studies on channel and collaterals find that the track of the propagated sensation along channels (PSC) have the phenomenon drifting about. This exactly reflects the law of channels dynamically running. By information triggering and living resonance, channels and collaterals bring into play entirely regulative action. The innovative treatment of channels and collaterals followed by characteristics and laws of quantum can get a better curative effect. Theory of channels in the position of quantum information medical science provides an important breach for modernization of Chinese medicine.

  11. Cerebral collateral therapeutics in acute ischemic stroke: A randomized preclinical trial of four modulation strategies.

    PubMed

    Beretta, Simone; Versace, Alessandro; Carone, Davide; Riva, Matteo; Dell'Era, Valentina; Cuccione, Elisa; Cai, Ruiyao; Monza, Laura; Pirovano, Silvia; Padovano, Giada; Stiro, Fabio; Presotto, Luca; Paternò, Giovanni; Rossi, Emanuela; Giussani, Carlo; Sganzerla, Erik P; Ferrarese, Carlo

    2017-01-01

    Cerebral collaterals are dynamically recruited after arterial occlusion and highly affect tissue outcome in acute ischemic stroke. We investigated the efficacy and safety of four pathophysiologically distinct strategies for acute modulation of collateral flow (collateral therapeutics) in the rat stroke model of transient middle cerebral artery (MCA) occlusion. A composed randomization design was used to assign rats (n = 118) to receive phenylephrine (induced hypertension), polygeline (intravascular volume load), acetazolamide (cerebral arteriolar vasodilation), head down tilt (HDT) 15° (cerebral blood flow diversion), or no treatment, starting 30 min after MCA occlusion. Compared to untreated animals, treatment with collateral therapeutics was associated with lower infarct volumes (62% relative mean difference; 51.57 mm(3) absolute mean difference; p < 0.001) and higher chance of good functional outcome (OR 4.58, p < 0.001). Collateral therapeutics acutely increased cerebral perfusion in the medial (+40.8%; p < 0.001) and lateral (+19.2%; p = 0.016) MCA territory compared to pretreatment during MCA occlusion. Safety indicators were treatment-related mortality and cardiorespiratory effects. The highest efficacy and safety profile was observed for HDT. Our findings suggest that acute modulation of cerebral collaterals is feasible and provides a tissue-saving effect in the hyperacute phase of ischemic stroke prior to recanalization therapy.

  12. Acute development of collateral circulation and therapeutic prospects in ischemic stroke.

    PubMed

    Iwasawa, Eri; Ichijo, Masahiko; Ishibashi, Satoru; Yokota, Takanori

    2016-03-01

    In acute ischemic stroke, collateral circulation plays an important role in maintaining blood flow to the tissue that is at risk of progressing into ischemia, and in increasing the successful recanalization rate without hemorrhagic transformation. We have reported that well-developed collateral circulation is associated with smaller infarct volume and better long-term neurological outcome, and it disappears promptly once the effective recanalization is achieved. Contrary to the belief that collateral vessels develop over time in chronic stenotic condition, there exists a phenomenon that collateral circulation develops immediately in acute stenosis or occlusion of the arteries and it seems to be triggered by fluid shear stress, which occurs between the territories of stenotic/occluded arteries and those fed by surrounding intact arteries. We believe that this acute development of collateral circulation is a target of novel therapeutics in ischemic stroke and refer our recent attempt in enhancing collateral circulation by modulating sphingosine-1-phosphate receptor 1, which is a known shear-stress mechanosensing protein.

  13. Direct Cortical Inputs Erase LTP at Schaffer Collateral Synapses

    PubMed Central

    Izumi, Yukitoshi; Zorumski, Charles F.

    2008-01-01

    Long-term potentiation (LTP), a synaptic mechanism thought to underlie memory formation, has been studied extensively at hippocampal Schaffer collateral (SC) synapses. The SC pathway transmits information to area CA1 that originates in entorhinal cortex and is processed by the dentate gyrus and area CA3. CA1 also receives direct excitatory input from entorhinal cortex via the perforant path (PP), but the role of this cortical input is less certain. Here we report that low frequency stimulation of PP inputs to CA1 has no lasting effect on basal SC transmission, but effectively depotentiates SC synapses that have undergone LTP in a fashion that can be reversed by subsequent high frequency stimulation of SC inputs. This depotentiation does not require N-methyl-D-aspartate receptors, Group I metabotropic glutamate receptors or L-type calcium channels, but involves adenosine acting at A1 receptors. Given the limited storage capacity of the hippocampus, these observations provide a mechanism by which input from cortex can help to reset synaptic transmission in the hippocampus and facilitate further information processing. PMID:18799687

  14. Collateral pathways from the ventromedial hypothalamus mediate defensive behaviors

    PubMed Central

    Wang, Li; Chen, Irene Z.; Lin, Dayu

    2014-01-01

    Summary The ventromedial hypothalamus (VMH) was thought to be essential for coping with threat, although its circuit mechanism remains unclear. To investigate this, we optogenetically activated steroidogenic factor 1 (SF1)-expressing neurons in the dorsomedial and central part of VMH (VMHdm/c), and observed a range of context dependent somatomotor and autonomic responses resembling animals' natural defensive behaviors. By activating independent pathways emanating from VMHdm/c, we demonstrated that VMHdm/c projection to the dorsolateral periaqueductal gray (dlPAG) induces inflexible immobility, while the VMHdm/c to anterior hypothalamic nucleus (AHN) pathway promotes avoidance. Furthermore, consistent with the behavior changes induced by VMH to AHN pathway activation, direct activation of the AHN elicited avoidance and escape jumping but not immobility. Finally, retrograde tracing studies revealed that nearly 50% of PAG- projecting VMHdm/c neurons send collateral projection to the AHN and vice versa. Thus, VMHdm/c neurons employ a one-to-many wiring configuration to orchestrate multiple aspects of defensive behaviors. PMID:25754823

  15. Targeting pathogen metabolism without collateral damage to the host

    PubMed Central

    Haanstra, Jurgen R.; Gerding, Albert; Dolga, Amalia M.; Sorgdrager, Freek J. H.; Buist-Homan, Manon; du Toit, François; Faber, Klaas Nico; Holzhütter, Hermann-Georg; Szöör, Balázs; Matthews, Keith R.; Snoep, Jacky L.; Westerhoff, Hans V.; Bakker, Barbara M.

    2017-01-01

    The development of drugs that can inactivate disease-causing cells (e.g. cancer cells or parasites) without causing collateral damage to healthy or to host cells is complicated by the fact that many proteins are very similar between organisms. Nevertheless, due to subtle, quantitative differences between the biochemical reaction networks of target cell and host, a drug can limit the flux of the same essential process in one organism more than in another. We identified precise criteria for this ‘network-based’ drug selectivity, which can serve as an alternative or additive to structural differences. We combined computational and experimental approaches to compare energy metabolism in the causative agent of sleeping sickness, Trypanosoma brucei, with that of human erythrocytes, and identified glucose transport and glyceraldehyde-3-phosphate dehydrogenase as the most selective antiparasitic targets. Computational predictions were validated experimentally in a novel parasite-erythrocytes co-culture system. Glucose-transport inhibitors killed trypanosomes without killing erythrocytes, neurons or liver cells. PMID:28084422

  16. Villous adenoma of the distal appendix.

    PubMed

    Taylor, J V; Thomas, M G; Kelly, S; Sutton, R

    1997-04-01

    Villous adenoma confined to the distal appendix has not been previously reported in conjunction with acute apendicitis. The presence of an adenoma indicates a need for further investigation due to an association with neoplasia elsewhere.

  17. Genetics Home Reference: Laing distal myopathy

    MedlinePlus

    ... Laing distal myopathy is a condition that affects skeletal muscles, which are muscles that the body uses for ... in heart (cardiac) muscle and in type I skeletal muscle fibers. Type I fibers, which are also known ...

  18. Aortopulmonary collateral flow in cystic fibrosis assessed with phase-contrast MRI

    PubMed Central

    McPhail, Gary; VanDyke, Rhonda; Knowlton, Joshua; Radhakrishnan, Rupa; Clancy, John; Amin, Raouf

    2013-01-01

    Background Cystic fibrosis (CF) is a common genetic disease in Caucasians. Chronic pulmonary disease and progressive destruction of the pulmonary parenchyma are one of the major morbidities, but the relationship between clinical severity of CF and aortopulmonary collateral blood flow has not been assessed. Objective The purpose of this study is to measure changes in aortopulmonary collateral blood flow by phase-contrast magnetic resonance imaging (MRI) in children with CF across the spectrum of disease severity as measured by the forced expiratory volume in one second as percent predicted value (FEV1%). Materials and methods Sixteen patients with CF were prospectively evaluated. Eight were classified as having mild CF lung disease (FEV1 ≥80% predicted) and eight were classified as having moderate to severe CF lung disease (FEV1 <80% predicted). Seventeen age and gender matched non-CF subjects without cardiac or lung disease served as controls. Phase-contrast flow was measured at the ascending aorta, main pulmonary artery and both pulmonary arteries. Aortopulmonary collateral blood flow was calculated for each subject. The relationship between collateral flow and FEV1%P was modeled using nonparametric regression. Group differences were assessed by analysis of variance. Results Aortopulmonary collateral blood flow began to increase as FEV1%P in subjects with CF fell below 101.5% with significant further increase in the aortopulmonary collateral blood flow in the subjects with CF with moderate to severe lung disease compared to controls (0.89 vs. 0.20 L/min, (P<0.0001). Aortopulmonary collateral blood flow correlated negatively with FEV1%P (r, 0.70, P=0.0050) confirming its relationship to this established marker of disease severity. There was no statistically significant difference in results obtained from two independent observers. Conclusion These preliminary findings suggest that phase-contrast MRI can be performed reliably with consistent results and without

  19. Proprioception in the ACL-ruptured knee: the contribution of the medial collateral ligament and patellar ligament. An in vivo experimental study in the cat.

    PubMed

    Bonsfills, N; Raygoza, J J; Boemo, E; Garrido, J; Núñez, A; Gómez-Barrena, E

    2007-01-01

    In the absence of anterior cruciate ligament (ACL), secondary restraints such as menisci, ligaments, and tendons restrict anterior knee laxity. Strain detection at these sites could define the contribution of this alternative signalling system to knee proprioception after ACL injury. The hypothesis in this study questions if measurements of anterior tibial translation (ATT) from surface strain gauges on the insertions of the medial collateral ligament (MCL) and the patellar tendon (PT) are sufficiently sensitive and specific to differentiate normal, stable knees from acutely unstable knees due to ACL section. Twelve cats received miniaturized strain gauges on the surface of MCL and PT distal insertions. A purpose-made receiver transformed into measurements any voltage variation obtained during passive knee flexion-extension and anterior tibial translation manoeuvres. Variables under evaluation included first peak latency, normalized amplitude, and slope of voltage along time. Femorotibial displacements were video recorded, digitized, and used as the ATT reference. The proposed system detected significant changes in the slope of the voltage/time signal, with higher specificity and sensitivity during ATT after experimental ACL section. Changes were not significant during flexion or extension. It was found that a pattern of earlier and more intense strain in MCL and PT distal insertions was found during ATT in the ACL deficient knee. Enhanced pattern recognition learning from these structures could be a future target for proprioceptive training after ACL injury.

  20. Bypass flap reconstruction, a novel technique for distal revascularization: outcome of first 10 clinical cases.

    PubMed

    Malikov, Serguei; Magnan, Pierre-Edouard; Casanova, Dominique; Lepantalo, Mauri; Valerio, Nicolas; Ayari, Raouf; Champsaur, Pierre; Branchereau, Alain

    2009-01-01

    Combined distal venous bypass grafting and free flap transfer can achieve successful treatment of soft tissue defects due to advanced leg ischemia. However, this combined approach is a complex technique involving multiple anastomoses on the same arterial axis with an increased risk of thrombosis. To reduce this risk, we have proposed a new bypass-flap (BF) reconstruction technique using an arterial graft and a free flap supplied by a collateral branch of the graft. The purpose of this report is to document the outcome in the first 10 patients treated using the BF reconstruction technique. From 2002 to 2004, a total of 10 patients with a mean age of 67 years (range 55-78) were treated using a BF. All patients presented critical ischemia with soft tissue defects resulting in exposure of tendons and muscles on the foot or ankle. Distal anastomosis was made between the distal branch of the BF and the pedal artery in five cases, the posterior tibial artery or plantar artery in four cases, and the peroneal artery in one case. In six cases proximal anastomosis was performed between the leg artery and arterial autograft. In the remaining four cases proximal anastomosis required extension of the bypass using a venous graft. The mean duration of hospitalization was 25 days. During the postoperative period, one patient died due to stercoral peritonitis and one patient required major amputation due to unrelenting sepsis. Bypass occlusion was not observed. Mean follow-up was 24 months (range 14-36). No patient was lost to follow-up and no patient died after the first 30 postoperative days. Follow-up examinations including clinical assessment and Doppler ultrasound imaging were performed at 3 months and every 6 months thereafter. Findings demonstrated bypass patency and healing of the covered defect in all cases. Outcome in this initial series demonstrates the clinical feasibility of the new BF reconstruction technique, which allows revascularization and coverage of tissue

  1. Distal Hypoxic stroke: A new mouse model of stroke with high throughput, low variability and a quantifiable functional deficit

    PubMed Central

    Doyle, Kristian P.; Fathali, Nancy; Siddiqui, Mohammad R; Buckwalter, Marion S.

    2012-01-01

    C57BL/6J are the most commonly used strain of mouse for stroke experiments but vascular anatomy of the Circle of Willis within this strain is extremely variable and the cortex has extensive collateralization. This causes large variability in stroke models that target the middle cerebral artery proximally and confers resistance to ischemia in those that target it distally. We tested the hypothesis that by combining distal middle cerebral artery occlusion with 1 hour of hypoxia, we could generate a large lesion that causes a behavioral deficit with low variability. We found that this new distal hypoxic (DH) model of stroke generates a lesion with a volume of 25% of the ipsilateral hemisphere, extends to the motor cortex and causes a behavioral deficit. It also has a very clear border, exceptionally low variability, and can be performed by a single surgeon on up to 30 animals a day. Moreover, survivability is 100% in young adult animals, the model can be performed on old animals, and therapeutic intervention can reduce infarct volume. Therefore DH stroke is an excellent complement to existing stroke models and could be used for preclinical studies in C57BL/6J mice. PMID:22465679

  2. Interrogating the functional correlates of collateralization in patients with intracranial stenosis using multi-modal hemodynamic imaging

    PubMed Central

    Roach, Brent A.; Donahue, Manus J.; Davis, L. Taylor; Faraco, Carlos C.; Arteaga, Daniel; Chen, Sheau-Chiann; Ladner, Travis; Scott, Allison O.; Strother, Megan K.

    2016-01-01

    Background and Purpose The importance of collateralization for maintaining adequate cerebral perfusion is increasingly recognized. However, measuring collateral flow noninvasively has proved elusive. The aim of this study was to assess correlations among (1) baseline perfusion and arterial transit time artifact, (2) cerebrovascular reactivity (CVR), and (3) the presence of collateral vessels on digital subtraction angiography (DSA). Materials and Methods The relationship between the presence of collateral vessels on arterial-spin-labeling (ASL) MRI and DSA was compared to blood-oxygenation-level-dependent (BOLD) MRI measures of hypercapnic cerebrovascular reactivity (CVR) in patients with symptomatic intracranial stenosis (n=18). DSA maps were reviewed by a neuroradiologist and assigned the following scores: 1) collaterals to the periphery of the ischemic site; 2) complete irrigation of the ischemic bed via collateral flow; 3) normal antegrade flow. ASL maps were scored according to 0) low signal; 1) moderate signal with arterial transit artifact (ATA); 2) high signal with ATA; 3) normal signal. Results In regions with normal-to-high signal on ASL, collateral vessel presence on DSA strongly correlated with declines in CVR as measured on BOLD MRI (p<0.001), most notably in patients with non-atherosclerotic disease. There was a trend toward increasing CVR with increases in the degree of collateralization on DSA (p=0.082). Conclusion Collateral vessels may have fundamentally different vasoreactivity properties than healthy vessels, a finding that is observed most prominently in non-atherosclerotic disease and to a lesser extent in atherosclerotic disease. PMID:27056428

  3. Sextant of Sapphires for Molar Distalization

    PubMed Central

    Palla, Yudistar Venkata; Ganugapanta, Vivek Reddy

    2016-01-01

    Introduction Space analysis quantifies the amount of crowding within the arches estimating the severity of space discrepancy. The space gaining procedures include extraction and non-extraction procedures like expansion, proximal stripping and molar distalization. Aim To identify features seen in molar distalization cases. Materials and Methods The sample size comprised 20 patients in whom molar distalization was decided as the treatment plan. The study models and lateral cephalograms of all the patients were taken. Occlusograms were obtained. Model analysis and cephalometric analysis were performed. Descriptive statistical analysis like mean, standard deviation, standard error and mode were done. Results The parameters in Question gave following results. The Bolton analysis showed anterior mandibular excess with mean value of 1.56mm±1.07. The first order discrepancy between maxillary central and lateral incisors was 5±1.95. The premolar rotation showed mean value of 16.58±5.12. The molar rotation showed the value of 7.66±2.26. The nasolabial angle showed the mean of 101.25±8.7 IMPA of 101.4±5.74. Conclusion The six features studied in molar distalization cases [First order discrepancy between upper central and lateral incisors; Rotation of premolars and molars; Bolton’s discrepancy in anterior dentition; Average to horizontal growth pattern; Proclined lower incisors and Obtuse nasolabial angle] can be taken as patterns seen in molar distalization cases and considered as a valid treatment plan. PMID:27656572

  4. Embolization of Collateral Vessels Using Mechanically Detachable Coils in Young Children with Congenital Heart Disease

    SciTech Connect

    Sato, Y.; Ogino, H.; Hara, M.; Satake, M.; Oshima, H.; Banno, T.; Mizuno, K.; Mishima, A.; Shibamoto, Y.

    2003-11-15

    Our objective was to evaluate the usefulness of embolizing collateral vessels using mechanically detachable coils (MDCs) in children aged 3 years or younger with congenital heart disease. The subjects were 8 children with congenital heart disease featuring collateral vessels (age 18 days-3 years): 3 with a single ventricle, 2 with the tetralogy of Fallot, 2 with pulmonary atresia, and 1 with a ventricular septal defect. The embolized vessels were the major aortopulmonary collateral artery (MAPCA) in 5 patients, the persistent left superior vena cava in 2, and the coronary arteriovenous fistula in 1. A 4 or a 5 F catheter was used as the guiding device, and embolization was performed using MDCs and other conventional coils introduced through the microcatheter. One patient had growth of new MAPCAs after embolization, and these MAPCAs were also embolized with MDCs. Thus, a total of 9 embolization procedures were performed in 8 patients. Complete occlusion of the collateral vessels was achieved in 8 of 9 procedures (89%). Seven of 8 patients (88%) had uneventful courses after embolization, and MDC procedures appeared to play important roles in avoiding coil migration and achievement of safe coil embolization. One patient who underwent MAPCA embolization showed no improvement in heart function and died 2 months and 19 days later. Embolization of collateral vessels using MDCs in young children with congenital heart disease can be an effective procedure and a valuable adjunct to surgical management.

  5. Trans-illuminated laser speckle imaging of collateral artery blood flow in ischemic mouse hindlimb.

    PubMed

    Meisner, Joshua K; Niu, Jacqueline; Sumer, Suna; Price, Richard J

    2013-09-01

    The mouse ischemic hindlimb model is used widely for studying collateral artery growth (i.e., arteriogenesis) in response to increased shear stress. Nonetheless, precise measurements of regional shear stress changes along individual collateral arteries are lacking. Our goal is to develop and verify trans-illumination laser speckle flowmetry (LSF) for this purpose. Studies of defibrinated bovine blood flow through tubes embedded in tissue-mimicking phantoms indicate that trans-illumination LSF better maintains sensitivity with an increasing tissue depth when compared to epi-illumination, with an ∼50% reduction in the exponential decay of the speckle velocity signal. Applying trans-illuminated LSF to the gracilis muscle collateral artery network in vivo yields both improved sensitivity and reduced noise when compared to epi-illumination. Trans-illuminated LSF images reveal regional differences in collateral artery blood velocity after femoral artery ligation and are used to measure an ∼2-fold increase in the shear stress at the entrance regions to the muscle. We believe these represent the first direct measurements of regional shear stress changes in individual mouse collateral arteries. The ability to capture deeper vascular signals using a trans-illumination configuration for LSF may expand the current applications for LSF, which could have bearing on determining how shear stress magnitude and direction regulate arteriogenesis.

  6. Noncoronary Collateral Myocardial Blood Flow: The Human Heart’s Forgotten Blood Supply

    PubMed Central

    Picichè, Marco

    2015-01-01

    The “noncoronary collateral circulation” (NCCC) or “noncoronary collateral myocardial blood flow” (NCCMBF), reaches the heart through a micro-vascular network arising from the bronchial, esophageal, pericardial, diaphragmatic, and aortic arteries. The left and right internal thoracic arteries (ITAs) along with their collateral branches also serve as a source of NCCMBF-a feature seen in other mammals. Under certain circumstances the ITAs have a high potential for developing collateral branches. In the case of severe Leriche syndrome or with chronic obstruction of the abdominal aorta, the ITAs can serve as the main or even sole source of blood supply to the lower limbs. It is also possible for the ITAs to develop angiographically visible branches that directly connect with the coronary arteries. In ischemic conditions there is a functional, ischemia-reducing extracardiac coronary artery supply via natural ipsilateral ITA anastomosis. To date we know little about NCCMBF and its potential benefits in clinical applications, which makes this a challenging and intriguing field of research. This paper reviews all available data on noncoronary collateral blood supply to the human heart. PMID:27006713

  7. The Effect of Placing Flow-Diverting Stents in Intracranial Collateral Arteries of Miniature Pig

    PubMed Central

    Wang, Jiwei; Ding, Yanan; Wang, Qiuxia; Wang, Yanan; Mu, Shiqing; Bi, Lixin; Li, Youxiang

    2017-01-01

    Background Flow-diverting stent (FDS) has been suggested as an effective intracranial aneurysm treatment. However, the effects of FDS on collateral branches of an aneurysm parent artery still remain unknown. Thus, the present study aimed to comprehensively evaluate the effects of placing a FDS in the intracranial collateral artery, using a miniature pig animal model. Material/Methods Ten healthy miniature pigs were included in the study: one pig was reserved as a control and the remaining nine pigs were placed in three experimental groups: FDS (i.e., Pipeline), LVIS, and Solitaier-AB stent groups. Pigs in the experimental groups were examined by cerebral angiography immediately after stent placement, followed by hemodynamic analyses. In addition, magnetic resonance imaging (MRI) of the brain of pigs in the experimental groups was performed to inspect the brain for obstruction and blood flow. Stents were examined for the growth of neointimas. Results The results showed that neointimas, consisting of smooth muscle cells, collagenous fibers, and macrophages, were 0.67 mm thick on average and partially covered the stent wires. The thickness of neointimas in the FDS group was significantly higher than in the two conventional intracranial stent groups. There was no obvious obstruction identified in collateral arteries where the FDS was placed. Conclusions These results indicated that neointimas in collateral arteries of a miniature pig would be slightly thickened after one month of FDS placement; and FDS was shown to be safe for collateral arteries. PMID:28333907

  8. Increased circulating monocyte count is related to good collateral development in coronary artery disease.

    PubMed

    Kocaman, Sinan Altan; Arslan, Uğur; Tavil, Yusuf; Okuyan, Hizir; Abaci, Adnan; Cengel, Atiye

    2008-04-01

    Monocytes have been shown to take an important role in collateral growth in animal studies. The aim of the study was to investigate the relation of circulating monocyte count with collateral development in patients with severely stenotic CAD. Patients who had > or =95% stenosis in at least one major coronary artery were included in the study. Coronary angiograms of 210 eligible patients from our database were analyzed again and 103 of them had good and 107 had poor collateral development according to Cohen-Rentrop method. Only the monocyte count was found to be significantly different between two groups (671+/-218 mm(-3) versus 522+/-195 mm(-3), p<0.001) when multivariate analysis was performed and an increased monocyte count was observed in the good collateral group (Odds ration [OR], 2.918; 95% confidence interval [CI], 1.281-6.648, p=0.011). This study in which the relationship between monocyte count in blood and collateral development was disclosed has a potential importance in clinical and basic cardiovascular medicine.

  9. Self-, collateral- and clinician assessment of depression in persons with cognitive impairment

    PubMed Central

    Chopra, Mohit P.; Sullivan, Jan R.; Feldman, Zachary; Landes, Reid D.; Beck, Cornelia

    2011-01-01

    Objectives This investigation examined the associations between self-reports, collateral-source reports and a clinician’s diagnosis of depression in persons with cognitive impairment. Method Responses on the Geriatric Depression Scale – 15 (GDS-15) from 162 participants with a diagnosis of Mild Cognitive Impairment (n = 78) or Alzheimer’s Dementia and a Mini-Mental State score ≥15 (n = 84) were compared with both their collateral sources’ report on either the Neuropsychiatric Inventory Questionnaire (n = 93) and/or the collateral-source GDS-15 (n = 67), or a clinician’s diagnosis of Major Depression (MD). Results Significant differences were seen between self- versus collateral-source reports of depression in these participants. Participants’ reports of loss of interest (anhedonia) significantly increased the odds of disagreement with their collateral sources (OR = 3.78, 95% CI: 1.3–11.2) while reports of negative cognitions significantly decreased the odds of such a disagreement (OR = 0.31, 95% CI: 0.1–0.9). The symptom of anhedonia also showed the strongest association with the clinician’s diagnosis of MD. Conclusion A motivational symptom like loss of interest was seen to play an important role in depression experienced by those with cognitive impairment. PMID:19023719

  10. Biomechanics of a less invasive procedure for reconstruction of the ulnar collateral ligament of the elbow.

    PubMed

    Hechtman, K S; Tjin-A-Tsoi, E W; Zvijac, J E; Uribe, J W; Latta, L L

    1998-01-01

    A reconstruction of the anterior bundle of the ulnar collateral ligament of the elbow using bone anchors was compared regarding strain and valgus load strength with the intact ulnar collateral ligament and the reconstructed ulnar collateral ligament using bone tunnels. In both normal and reconstructed elbows, the anterior band and posterior band were tight during only a portion of the range of motion. Toward extension, the mean peak strain in the anterior band was tight for the normal and bone anchor groups, but lax in the bone tunnel group. Toward extension, the mean peak strain in the posterior band was lax in all elbows. Toward flexion, the strain in the anterior band was lax in the normal and bone anchor groups, but tight in the bone tunnel group. The mean of the peak strains for the posterior band toward flexion was tight for all elbows. Mean valgus load strength of normal elbows was 22.7 +/- 9.0 N.m. The bone tunnel and bone anchor mean strengths were 76.3% and 63.5%, respectively, of normal elbow strength. We concluded that the bone anchor reproduced the normal anatomy and mechanical function of the ulnar collateral ligament more closely than the bone tunnel, and that both reconstruction methods were significantly weaker than the normal ulnar collateral ligament. However, we found no significant difference in reconstruction strength between bone anchor and bone tunnel.

  11. Topographic matching of distal radius and proximal fibula articular surface for distal radius osteoarticular reconstruction.

    PubMed

    Zhang, H; Chen, S; Wang, Z; Guo, Y; Liu, B; Tong, D

    2016-07-01

    During osteoarticular reconstruction of the distal radius with the proximal fibula, congruity between the two articular surfaces is an important factor in determining the quality of the outcome. In this study, a three-dimensional model and a coordinate transformation algorithm were developed on computed tomography scanning. Articular surface matching was performed and parameters for the optimal position were determined quantitatively. The mean radii of best-fit spheres of the articular surfaces of the distal radius and proximal fibula were compared quantitatively. The radial inclination and volar tilt following reconstruction by an ipsilateral fibula graft, rather than the contralateral, best resembles the values of the native distal radius. Additionally, the ipsilateral fibula graft reconstructed a larger proportion of the distal radius articular surface than did the contralateral. The ipsilateral proximal fibula graft provides a better match for the reconstruction of the distal radius articular surface than the contralateral, and the optimal position for graft placement is quantitatively determined.

  12. Fabrication and Evaluation of a Noncompliant Molar Distalizing Appliance: Bonded Molar Distalizer

    PubMed Central

    Sodagar, A.; Ahmad Akhoundi, M. S.; Rafighii, A.; Arab, S.

    2011-01-01

    Objective Attempts to treat class II malocclusions without extraction in non-compliant patients have led to utilization of intraoral molar distalizing appliances. The purpose of this study was to investigate dental and skeletal effects of Bonded Molar Distalizer (BMD) which is a simple molar distalizing appliance. Materials and Methods Sixteen patients (12 girls, four boys) with bilateral half-cusp class II molar relationship, erupted permanent second molars and normal or vertical growth pattern were selected for bilateral distalization of maxillary molars via BMD. The screws were activated every other day, alternately. Lateral cephalograms and study models were obtained before treatment and after 11 weeks activation of the appliance. Results Significant amounts of molar distalization, molar distal tipping and anchorage loss were observed. The mean maxillary first molar distal movement was 1.22±0.936 mm with a distal tipping of 2.97±3.74 degrees in 11 weeks. The rate of distal movement was 0.48 mm per month. Reciprocal mesial movement of the first premolars was 2.26±1.12 mm with a mesial tipping of 4.25±3.12 degrees. Maxillary incisors moved 3.55±1.46 mm and tipped 9.87±5.03 degrees mesially. Lower anterior face height (LAFH) decreased 1.28±1.36 mm. Conclusion BMD is appropriate for distalizing maxillary molars, especially in patients with critical LAFH, although significant amounts of anchorage loss occur using this appliance. PMID:22457837

  13. Osteochondritis of the Distal Tibial Epiphysis

    PubMed Central

    EL Hajj, Firass; Sebaaly, Amer; Kharrat, Khalil; Ghanem, Ismat

    2012-01-01

    Osteochondritis of the distal tibial epiphysis is a very rare entity. 9 cases have been described in 7 articles and 8 other cases have been mentioned in textbooks. This paper describes the 10th case of osteochondritis of the distal tibial epiphysis and summarizes the clinical and radiological presentations of the 9 other cases. The etiology of this entity is well debated in the literature. We believe that it results from a vascular abnormality in the distal tibial epiphysis associated with a mechanical stress (trauma, excessive overload, etc.). Since it is a self-limited disease, the prognosis is good and the younger the patient is the better the prognosis will be. In general, this entity responds well to conservative treatment. PMID:23193412

  14. Operative treatment of distal radius fractures.

    PubMed

    Vasenius, J

    2008-01-01

    The incidence of distal radius fractures is increasing together with the average age of population. Intra-articular incongruity is the most probable cause of unsatisfactory outcome of distal radius fractures in younger and more active patients. Thus, the main goal in the treatment of distal radius fractures should be restoration of articular congruence. A computed tomography (CT) is recommended to help surgeon in preoperative planning in the treatment of comminuted intra-articular fractures. New implants have been designed to provide stable enough fixation for early mobilisation after surgery and to lower rather high complication rates related to conventional fixation methods such as external fixation and dorsal plating. The most common complications related to volar fixed angle plating such as flexor and extensor tendon problems, median nerve neuropathy, and screw diplacement into the radiocarpal joint are surgeon related and are avoidable with proper education. More randomized prospective studies are needed to prove superiority of any fixation method to another.

  15. Physeal arrest of the distal radius.

    PubMed

    Abzug, Joshua M; Little, Kevin; Kozin, Scott H

    2014-06-01

    Fractures of the distal radius are among the most common pediatric fractures. Although most of these fractures heal without complication, some result in partial or complete physeal arrest. The risk of physeal arrest can be reduced by avoiding known risk factors during fracture management, including multiple attempts at fracture reduction. Athletes may place substantial compressive and shear forces across the distal radial physes, making them prone to growth arrest. Timely recognition of physeal arrest can allow for more predictable procedures to be performed, such as distal ulnar epiphysiodesis. In cases of partial arrest, physeal bar excision with interposition grafting can be performed. Once ulnar abutment is present, more invasive procedures may be required, including ulnar shortening osteotomy or radial lengthening.

  16. Treatment of Ulnar Collateral Ligament Tears of the Elbow

    PubMed Central

    Erickson, Brandon J.; Bach, Bernard R.; Verma, Nikhil N.; Bush-Joseph, Charles A.; Romeo, Anthony A.

    2017-01-01

    Background: Ulnar collateral ligament (UCL) tears have become common, and UCL reconstruction (UCLR) is currently the preferred surgical treatment method for treating UCL tears. Purpose/Hypothesis: The purpose of this study was to review the literature surrounding UCL repair and determine the viability of new repair techniques for treatment of UCL tears. We hypothesized that UCL repair techniques will provide comparable results to UCLR for treatment of UCL tears. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review was registered with PROSPERO and performed with PRISMA guidelines using 3 publicly available free databases. Biomechanical and clinical outcome investigations reporting on UCL repair with levels of evidence 1 through 4 were eligible for inclusion. Descriptive statistics were calculated for each study and parameter/variable analyzed. Results: Of the 46 studies eligible, 4 studies (3 clinical and 1 biomechanical) were included. There were 92 patients (n = 92 elbows; 61 males [62.3%]; mean age, 21.9 ± 4.7 years) included in the clinical studies, with a mean follow-up of 49 ± 14.4 months. Eighty-six percent of repairs performed were on the dominant elbow, and 38% were in college athletes. Most UCL repairs (66.3%) were performed via suture anchors. After UCL repair, 87.0% of patients were able to return to sport. Overall, 94.9% of patients scored excellent/good on the Andrews-Carson score. Patients who were able to return to sport after UCL repair did so within 6 months after surgery. Biomechanically, when UCL repair was compared with the modified Jobe technique, the repair group showed significantly less gap formation than the reconstruction group. Conclusion: In patients for whom repair is properly indicated, UCL repair provides similar return-to-sport rates and clinical outcomes with shorter return-to-sport timing after repair compared with UCL reconstruction. Future outcome studies evaluating UCL repair

  17. Torsion of wandering spleen and distal pancreas

    SciTech Connect

    Sheflin, J.R.; Lee, C.M.; Kretchmar, K.A.

    1984-01-01

    Wandering spleen is the term applied to the condition in which a long pedicle allows the spleen to lie in an abnormal location. Torsion of a wandering spleen is an unusual cause of an acute abdomen and is rarely diagnosed preoperatively. Associated torsion of the distal pancreas is even more uncommon. The authors describe a patient with torsion of a wandering spleen and distal pancreas, who was correctly diagnosed, and define the merits of the imaging methods used. The initial examination should be /sup 99//sup m/Tc-sulfur colloid liner-spleen scanning.

  18. Contemporary Management of Primary Distal Urethral Cancer.

    PubMed

    Traboulsi, Samer L; Witjes, Johannes Alfred; Kassouf, Wassim

    2016-11-01

    Primary urethral cancer is one of the rare urologic tumors. Distal urethral tumors are usually less advanced at diagnosis compared with proximal tumors and have a good prognosis if treated appropriately. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Organ-preserving modalities have shown effective and should be used whenever they do not compromise the oncological safety to decrease the physical and psychological trauma of dismemberment or loss of sexual/urinary function.

  19. Distal Femur Locking Plate: The Answer to All Distal Femoral Fractures

    PubMed Central

    Garg, Sudhir Kumar; Gupta, Parmanand; Jangira, Vivek; Singh, Jagdeep; Rana, Sudhir

    2016-01-01

    Introduction Good results have been published by researchers with distal femur nail, dynamic condylar screw and even addition of a medial plate to a distal femur locking plate for treating distal femur fractures. By this study, we explore the capability of a distal femur locking plate to counter distal femur fractures of extra- articular, partial or intra- articular nature. Positive results have been published by various groups from all over the world. Aim To study the functional and radiological outcome of distal femoral fractures in skeletally mature patients treated by open reduction and internal fixation with distal femur locking plate. Materials and Methods This was a prospective study conducted from January 2012 to March 2014 at the Government Medical College and Hospital (GMCH) with a 2 year follow-up. Twenty five skeletally mature patients with post-traumatic distal femur fractures were included. Patients with open grade 3B and 3C distal femur fractures, according to the Gustilo- Anderson classification and pathological distal femur fractures were excluded from the study. Patients with any fracture other than the distal femur in the ipsilateral limb were excluded from the study. Follow-up at 3 months, 6 months, 1 year and 2 years was carried out and evaluation was done according to the Neer scoring system. The statistical data analysis was carried out using SPSS version 20 (IBM, Chicago, USA). The p-value <0.05 was considered significant. Results Following all principles of fracture reduction, union was achieved in all patients with mean time to radiological union being 19 weeks. The mean Range of Motion (ROM) was 109 degrees with 20 patients having a Neer score graded as excellent to satisfactory. Our study had nine cases which required additional surgeries. Out of these, all nine cases required bone grafting, three also required antibiotic cement bead insertion initially. Three patients developed complications in the form of infection (two cases) and mal

  20. [Original relations of acupoints with channels-collaterals and acupuncture therapy].

    PubMed

    Bai, Xing-hua

    2008-03-01

    With analysis and systematization of ancient medical books being unearthed Mazoangdui tomb and other literatures, it is found that ancient names and meanings of moxibustion and acupuncture parts passed the courses from Mai to Maikou, the place and region above Mai, then to acupoints on the body surface showing channels, gi and blood. This change trace reveals original relationship acupoints with channels-collaterals, and acupuncture therapy. The acupoint is a point and channels-collaterals are lines, except a less acupoints which located by obvious anatomic markers, most of are special parts on the channels and collaterals, are not a isolated point. The acupoint is the gate of needle inserting the human body, proposal of this concept and increase of the number of acopoints are closely related with invention, popularity and spreading of acupuncture therapy.

  1. Systematic and differential myelination of axon collaterals in the mammalian auditory brainstem

    PubMed Central

    Seidl, Armin H.; Rubel, Edwin W

    2015-01-01

    A brainstem circuit for encoding the spatial location of sounds involves neurons in the cochlear nucleus that project to medial superior olivary (MSO) neurons on both sides of the brain via a single bifurcating axon. Neurons in MSO act as coincidence detectors, responding optimally when signals from the two ears arrive within a few microseconds. To achieve this, transmission of signals along the contralateral collateral must be faster than transmission of the same signals along the ipsilateral collateral. We demonstrate that this is achieved by differential regulation of myelination and axon caliber along the ipsilateral and contralateral branches of single axons; ipsilateral axon branches have shorter internode lengths and smaller caliber than contralateral branches. The myelination difference is established prior to the onset of hearing. We conclude that this differential myelination and axon caliber requires local interactions between axon collaterals and surrounding oligodendrocytes on the two sides of the brainstem. PMID:26556176

  2. Indocyanine Green Lymphographic Signs of Lymphatic Collateral Formation in Lower Extremity Lymphedema After Cancer Resection.

    PubMed

    Tashiro, Kensuke; Shibata, Takashi; Mito, Daisuke; Ishiura, Ryohei; Kato, Motoi; Yamashita, Shuji; Narushima, Mitsunaga; Iida, Takuya; Koshima, Isao

    2016-08-01

    Indocyanine green lymphography has recently been used to assess lymphatic vessel function in lymphedema patients. Postoperative collateral lymphatic vessels toward ipsilateral axillary lymph nodes are rarely seen above the umbilical level in lower lymphedema patients. Between January 2012 and December 2014, we performed indocyanine green lymphography of 192 limbs in 96 lower extremity lymphedema cases. As a result, dermal back flow appeared in 95 cases, with 38 in the lower abdominal area and 31 in the genital area. We confirmed 3 cases of superficial lymphatic collateral ways extending above the umbilical level to the axillary lymph nodes. All 3 cases had similarity in lower abdominal edema, so excessive lymphatic fluid in the lower abdomen was assumed to be the cause. Lymphatic collateral ways from abdomen to axillary lymph nodes in this study was likely to be designed to prevent the progress of lymphedema.

  3. Comparing main and collateral effects of extinction and differential reinforcement of alternative behavior.

    PubMed

    Petscher, Erin Seligson; Bailey, Jon S

    2008-07-01

    This study evaluated the effects and collateral effects of extinction (EXT) and differential reinforcement of alternative behavior (DRA) interventions with inappropriate vocalizations and work refusal. Both interventions have been used frequently to reduce problem behaviors. The benefits of these interventions have been established yet may be outweighed by the reported negative side effects that result. However, these collateral effects have rarely been measured or reported. DRA produced the most rapid reductions in behavior for 4 of the 5 participants. Other behaviors were measured for changes and showed that the desirable collateral effect of academic engagement tended to be higher during EXT than DRA. No evidence of EXT bursts was present with any participant, although EXT-induced aggression occurred with 1 participant.

  4. Reconstruction of the Distal Oblique Bundle of the Interosseous Membrane: A Technique to Restore Distal Radioulnar Joint Stability.

    PubMed

    Riggenbach, Michael D; Wright, Thomas W; Dell, Paul C

    2015-11-01

    The distal radioulnar ligament reconstruction is a technique that may be used for distal radioulnar joint instability without arthritis and failed nonsurgical management; clinical results demonstrate resolved or improved stability. Recent literature has focused on the distal oblique bundle of the interosseous membrane and its contributions to stability. This article describes a technically simple surgical technique to reconstruct the distal oblique bundle and restore distal radioulnar joint stability.

  5. Genetic lineage tracing discloses arteriogenesis as the main mechanism for collateral growth in the mouse heart

    PubMed Central

    He, Lingjuan; Liu, Qiaozhen; Hu, Tianyuan; Huang, Xiuzhen; Zhang, Hui; Tian, Xueying; Yan, Yan; Wang, Li; Huang, Yu; Miquerol, Lucile; Wythe, Joshua D.; Zhou, Bin

    2016-01-01

    Aims Capillary and arterial endothelial cells share many common molecular markers in both the neonatal and adult hearts. Herein, we aim to establish a genetic tool that distinguishes these two types of vessels in order to determine the cellular mechanism underlying collateral artery formation. Methods and results Using Apln-GFP and Apln-LacZ reporter mice, we demonstrate that APLN expression is enriched in coronary vascular endothelial cells. However, APLN expression is reduced in coronary arterial endothelial cells. Genetic lineage tracing, using an Apln-CreER mouse line, robustly labelled capillary endothelial cells, but not arterial endothelial cells. We leveraged this differential activity of Apln-CreER to study collateral artery formation following myocardial infarction (MI). In a neonatal heart MI model, we found that Apln-CreER-labelled capillary endothelial cells do not contribute to the large collateral arteries. Instead, these large collateral arteries mainly arise from pre-existing, infrequently labelled coronary arteries, indicative of arteriogenesis. Furthermore, in an adult heart MI model, Apln-CreER activity also distinguishes large and small diameter arteries from capillaries. Lineage tracing in this setting demonstrated that most large and small coronary arteries in the infarcted myocardium and border region are derived not from capillaries, but from pre-existing arteries. Conclusion Apln-CreER-mediated lineage tracing distinguishes capillaries from large arteries, in both the neonatal and adult hearts. Through genetic fate mapping, we demonstrate that pre-existing arteries, but not capillaries, extensively contribute to collateral artery formation following myocardial injury. These results suggest that arteriogenesis is the major mechanism underlying collateral vessel formation. PMID:26768261

  6. Ligation of the left hepatic vein for dilated intrahepatic collaterals late after fontan operation.

    PubMed

    Park, Chun Soo; Park, Jeong-Jun; Park, In-Sook; Goo, Hyun Woo

    2014-07-01

    A 17-year-old male presented with two episodes of syncope, cyanosis, and exercise intolerance 13 years after the Fontan operation. Echocardiography and magnetic resonance imaging showed dilated intrahepatic collaterals, which drained into the atrium through the left hepatic vein, and 24-hour Holter monitoring revealed sinus node dysfunction. We performed ligation of the left hepatic vein using intrahepatic collaterals as channels draining hepatic venous blood into the Fontan pathway, and implanted an epicardial dual chamber pacemaker. At one-year follow-up, the patient remained asymptomatic and his cardiac performance was much improved.

  7. Investigation of water spray to reduce collateral thermal damage during laser resection of soft tissue

    NASA Astrophysics Data System (ADS)

    Theisen-Kunde, D.; Wolken, H.; Ellebrecht, D.; Danicke, V.; Wurster, L.; Kleemann, M.; Birngruber, R.

    2013-06-01

    To reduce unwanted collateral thermal damage to surrounding tissue and organs during laparoscopic laser dissection (cw, wavelength: 1.9μm) of porcine liver water spray was used. Size and amount of the produced water droplets of the water spray were photographed by short time imaging and analyzed by imaging software. At in vivo measurements on fresh porcine liver the depth of thermal damage was reduced by 85 % with water spray and the lateral size of thermal damage at the tissue surface could be reduced by 67%. This results show that especially for laparoscopic laser surgery water spray application might be a useful tool to avoid unwanted collateral thermal damage.

  8. Who died? The murder of collaterals related to intimate partner conflict.

    PubMed

    Dobash, Russell P; Dobash, R Emerson

    2012-06-01

    Using data from the Murder in Britain Study, the authors focus on murders that are related to intimate partner conflict but involve the killing of a person other than the intimate partner. Intimate partner collateral murders (IPCM) include children, allies, and new partners. The findings expand the number and types of murder associated with intimate partner conflict, characterize the three main types of collaterals, compare the childhood and adulthood of the perpetrators of intimate partner murder [IPM] (n = 104) and IPCM (n = 62), and reflect similarities and differences. Various disciplinary approaches are reflected in the research design, data collection, findings, and conclusions.

  9. Nettleship collaterals: circumpapillary cilioretinal anastomoses after occlusion of the central retinal artery.

    PubMed Central

    Ragge, N K; Hoyt, W F

    1992-01-01

    In extremely rare cases, after occlusion of the central retinal artery, a complete ring of peripapillary anastomotic channels develops. One such case is described and a proposed term given to these channels--'Nettleship collaterals'--after the man who first described them. These collaterals are dilated pathways within the terminal capillary networks of the posterior ciliary arteries and the branches of the central retinal artery. Formation of the channels is believed to be promoted by prelaminar obstruction of the central retinal artery. Images PMID:1540571

  10. Transhepatic Venous Approach for Balloon-assisted Cervical Collateral Venous Access

    SciTech Connect

    Eyheremendy, Eduardo P.; Malizia, Patricio; Sierre, Sergio

    2011-12-15

    Central venous catheter placement is indicated in many situations, and an increasing number of patients require temporary and long-term central catheters. Frequently, patients who have undergone multiple central veins catheterizations develop complete and diffuse venous occlusion, and this constitutes a difficult-to-manage clinical problem. We report a case of a 20-year-old patient who was referred to our department for central venous line placement who manifested bilateral femoral, jugular, and subclavian veins occlusion. A central venous catheter was implanted through a cervical collateral vein, targeting on and puncturing an angioplasty balloon, and advanced into the collateral vein through a transhepatic venous access.

  11. [Destruction of residual varicose collaterals by subcutaneous dilaceration with a needle].

    PubMed

    Lengua, F; Pajot, A; Buffet, J M; Kassem, S; Fernandez, R

    1980-01-01

    The persistence of collaterals after a properly conducted surgical treatment of varicose veins of the lower limbs often presents a problem which is difficult to resolve. The authors put forward a simple and original method, in which a long and slightly curved triangular needle is used, without incisions, to destroy by dilaceration the collaterals whatever their degree of dilatation and their location. This technique has also been used as a first stage preceding stripping, and over a 5 year period has given results in 70 patients which are very satisfactory both from the point of view of efficacy as well as from the aesthetic point of view.

  12. Selective cortical control of information flow through different intraspinal collaterals of the same muscle afferent fiber.

    PubMed

    Eguibar, J R; Quevedo, J; Jiménez, I; Rudomin, P

    1994-04-18

    We have analyzed in the anesthetized cat the effects of electrical stimulation of the cerebral cortex on the intraspinal threshold of two collaterals belonging to the same muscle spindle or tendon organ afferent fiber. The results obtained provide, for the first time, direct evidence showing that the motor cortex is able to modify, in a highly selective manner, the synaptic effectiveness of individual collaterals of the same primary afferent fiber. This presynaptic control could function as a mechanism that allows funneling of information to specific groups of spinal neurons in the presence of extensive intraspinal branching of the afferent fibers.

  13. Aberrant Ovarian Collateral Originating from External Iliac Artery During Uterine Artery Embolization

    SciTech Connect

    Kwon, Joon Ho; Kim, Man Deuk Lee, Kwang-hun; Lee, Myungsu; Lee, Mu Sook; Won, Jong Yun; Park, Sung Il; Lee, Do Yun

    2013-02-15

    We report a case of a 35-year-old woman who underwent uterine artery embolization (UAE) for symptomatic multiple uterine fibroids with collateral aberrant right ovarian artery that originated from the right external iliac artery. We believe that this is the first reported case in the literature of this collateral uterine flow by the right ovarian artery originated from the right external iliac artery. We briefly present the details of the case and review the literature on variations of ovarian artery origin that might be encountered during UAE.

  14. Comparative evaluation of molar distalization therapy using pendulum and distal screw appliances

    PubMed Central

    Cafagna, Alessandra; Fontana, Mattia; Cozzani, Mauro

    2015-01-01

    Objective To compare dentoalveolar and skeletal changes produced by the pendulum appliance (PA) and the distal screw appliance (DS) in Class II patients. Methods Forty-three patients (19 men, 24 women) with Class II malocclusion were retrospectively selected for the study. Twenty-four patients (mean age, 12.2 ± 1.5 years) were treated with the PA, and 19 patients (mean age, 11.3 ± 1.9 years) were treated with the DS. The mean distalization time was 7 months for the PA group and 9 months for the DS group. Lateral cephalograms were obtained at T1, before treatment, and at T2, the end of distalization. A Mann-Whitney U test was used for statistical comparisons of the two groups between T1 and T2. Results PA and DS were equally effective in distalizing maxillary molars (4.7 mm and 4.2 mm, respectively) between T1 and T2; however, the maxillary first molars showed less distal tipping in the DS group than in the PA group (3.2° vs. 9.0°, respectively). Moreover, significant premolar anchorage loss (2.7 mm) and incisor proclination (5.0°) were noted in the PA group, whereas premolar distal movement (1.9 mm) and no significant changes at the incisor (0.1°) were observed in the DS group. No significant sagittal or vertical skeletal changes were detected between the two groups during the distalization phase. Conclusions PA and DS seem to be equally effective in distalizing maxillary molars; however, greater distal molar tipping and premolar anchorage loss can be expected using PA. PMID:26258063

  15. 12 CFR 221.117 - When bank in “good faith” has not relied on stock as collateral.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... the margin stock as collateral,” contained in paragraph (2)(iv) of the definition of indirectly... because of fluctuations in market value of the stock, but instead was payable on one or more fixed... stock as collateral. 221.117 Section 221.117 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED)...

  16. Distally based dorsalis pedis island flap for a distal lateral electric burn of the big toe.

    PubMed

    Governa, M; Barisoni, D

    1996-12-01

    Reconstruction of the small defects in the distal portion of the foot has always represented a difficult problem. A case of a young man with a deep electric burn of the distal lateral side of the big toe successfully treated with a distally based dorsalis pedis island flap based on the first dorsal metatarsal artery (FDMA) is presented. The donor site area of the dorsum of the foot was grafted, and deambulation was reassumed 3 weeks later. Advantages; limits and anatomical consideration regarding the viability of the flap are also discussed.

  17. A New Distal Radioulnar Joint Prosthesis

    PubMed Central

    Schuurman, Arnold H.

    2013-01-01

    Pain and instability of the distal radioulnar joint (DRUJ) are common sequelae following a fracture of the distal radius. Many soft tissue procedures have been described, not all of which are successful. Ulnar head replacement prostheses are available but do not always provide stability. We designed a two-part, easy to implant, distal radioulnar prosthesis and implanted it in 19 patients. The first prototype was inserted in 2002 and is still in place. During the study, the design was changed twice, resulting in three groups with four patients in group A, five in group B, and ten in group C. Unfortunately all five prostheses in group B had to be removed because of loosening, while only two prostheses in group C had to be removed, for nonprosthetic reasons. For the 12 patients who retained their prosthesis, forearm function increased while grip strength increased significantly. Pain scores decreased and the Disabilities of the Arm, Shoulder, and Hand (DASH) score improved but remained high. We conclude that the prosthesis offers a new treatment option for ulnar instability following distal ulnar resection. PMID:24436843

  18. Anaesthetic management in thoracoscopic distal tracheal resection.

    PubMed

    Acosta Martínez, J; Beato López, J; Domínguez Blanco, A; López Romero, J L; López Villalobos, J L

    2017-03-01

    Surgical resection of tracheal tumours, especially distal tracheal tumours, is a challenge for the anaesthesiologists involved, mainly due to difficulties in ensuring adequate control of the airway and ventilation. We report the case of a patient undergoing tracheal resection and anastomosis by VATS, emphasizing the anaesthetic management.

  19. Arthroscopic Arthrodesis of the Distal Tibiofibular Syndesmosis.

    PubMed

    Lui, Tun Hing

    2015-01-01

    Chronic syndesmosis disruption can occur if an acute lesion is missed or inadequately managed. This can result in significant functional deficit and development of post-traumatic ankle arthritis. Anatomic reduction of the syndesmosis and maintenance of the reduction by syndesmotic screw fixation alone, ligamentous reconstruction, or fusion of the syndesmosis are recommended. A technique of arthroscopic distal tibiofibular syndesmosis arthrodesis is described.

  20. Ipsilateral jugular to distal subclavian vein transposition to relieve central venous hypertension in rescue vascular access surgery: a surgical report of 3 cases.

    PubMed

    Acri, Ignazioe; Carmignani, Amedeo; Vazzana, Giovanni; Massara, Mafalda; Acri, Edvige; Lentini, Salvatore; Spinelli, Francesco

    2013-01-01

    Central venous thrombosis may often arise following central venous cannulation for temporary haemodialysis access. Venous thrombosis may be clinically asymptomatic due to the presence of collateral circulation. However, if an arteriovenous (AV) fistula is prepared below the obstructed venous segment, then symptoms may occur. Central venous hypertension interferes with dialysis, compromises limb function and threatens its safety. Percutaneous treatment is mostly used. However, in some cases endovascular treatment may not be as easy and long term patency uncertain.We report our experience on 3 patients on chronic hemodialysis treatment presenting with a patent AV fistula and ipsilateral subclavian vein chronic fibrotic obstruction. They were treated by ipsilateral internal jugular to distal subclavian vein transposition. Two separate surgical incisions were performed to expose the subclavian vein distally to the occlusion and the jugular vein that was distally ligated and transposed. There was no mortality nor significant postoperative complications. Resolution of hypertensive symptoms was achieved within 3-4 weeks in all patients. The AV fistula was used for dialysis treatment starting from the first postoperative day. At follow-up (mean 13 months), there was no recurrence of upper limb venous hypertension.In patients with subclavian occlusion and ipsilateral low flow, patent AV fistula, jugular to distal subclavian vein transposition may prove useful in cases when percutaneous angioplasty is technically not feasible or long term patency is not expected.

  1. Relationship between thrombospondin-1, endostatin, angiopoietin-2, and coronary collateral development in patients with chronic total occlusion

    PubMed Central

    Qin, Qing; Qian, Juying; Ma, Jianying; Ge, Lei; Ge, Junbo

    2016-01-01

    Abstract This study is aimed to investigate whether serum angiostatic factors (thrombospondin-1 [TSP-1] and endostatin) or angiogenic factors (angiopoietin-2 [Ang-2]) are related to coronary collateral vessel development in patients with chronic total occlusion (CTO). A total of 149 patients were enrolled in the study, and 39 patients with coronary artery disease but without significant stenosis were included in control group. In 110 patients with CTO lesion, 79 with Rentrop grades 2 to 3 collaterals were grouped as good collateral, while 31 with Rentrop grades 0 to 1 collaterals were grouped as poor collateral. Serum TSP-1, endostatin, and Ang-2 levels were studied. Serum endostatin level was significantly higher in poor collateral group compared with control group and good collateral group, respectively (96.2 ± 30.4 vs 77.8 ± 16.5 ng/mL, P = 0.007; 96.2 ± 30.4 vs 81.2 ± 30.4 ng/mL, P = 0.018). In multivariate analysis, decreased serum endostatin level was independently related to good coronary collateral development. Serum TSP-1 level was lower in patients with CTO compared with control group. However, no difference in TSP-1 level was detected between poor and good collateral group. The serum Ang-2 level did not show a significant difference among 3 groups. Circulatory endostatin may be a useful biomarker for coronary collateral development and potential target for therapeutic angiogenesis in patients with CTO. PMID:27537575

  2. Collateral Damage Related to Rape and Interpersonal Violence in Higher Education

    ERIC Educational Resources Information Center

    Jones, Dan L.

    2014-01-01

    Collegiate communities are often faced with difficult situations from sexual assault, rape, and other forms of interpersonal violence. These events are not only tragic or traumatic for the individuals involved but also have ripple effects and create collateral damage within the campus community. Many universities are instituting bystander training…

  3. 10 CFR 609.15 - Default, demand, payment, and collateral liquidation.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... PROJECTS THAT EMPLOY INNOVATIVE TECHNOLOGIES § 609.15 Default, demand, payment, and collateral liquidation... to such effect (without the need for consent or other action on the part of the Holders of the... Agreement, to become immediately due and payable by giving the Borrower written notice to such...

  4. Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collaterals Associated with Left Pulmonary Artery Interruption

    PubMed Central

    Mun, Da-Na; Park, Chun Soo; Kim, Young-Hwue; Goo, Hyun Woo

    2016-01-01

    A multistage plan and multidisciplinary approach are the keys to successful repair in patients with pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCAs). In this article, we present a multidisciplinary approach adopted to treat a patient with PA with VSD and MAPCAs associated with left pulmonary artery interruption. PMID:27733998

  5. CUDA-based acceleration of collateral filtering in brain MR images

    NASA Astrophysics Data System (ADS)

    Li, Cheng-Yuan; Chang, Herng-Hua

    2017-02-01

    Image denoising is one of the fundamental and essential tasks within image processing. In medical imaging, finding an effective algorithm that can remove random noise in MR images is important. This paper proposes an effective noise reduction method for brain magnetic resonance (MR) images. Our approach is based on the collateral filter which is a more powerful method than the bilateral filter in many cases. However, the computation of the collateral filter algorithm is quite time-consuming. To solve this problem, we improved the collateral filter algorithm with parallel computing using GPU. We adopted CUDA, an application programming interface for GPU by NVIDIA, to accelerate the computation. Our experimental evaluation on an Intel Xeon CPU E5-2620 v3 2.40GHz with a NVIDIA Tesla K40c GPU indicated that the proposed implementation runs dramatically faster than the traditional collateral filter. We believe that the proposed framework has established a general blueprint for achieving fast and robust filtering in a wide variety of medical image denoising applications.

  6. 12 CFR 150.320 - What is acceptable collateral for uninsured deposits?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... collateral for self deposits or affiliate deposits under § 150.310: (a) Direct obligations of the United States, or other obligations fully guaranteed by the United States as to principal and interest. (b... to invest fiduciary funds under applicable state law. (c) Other readily marketable securities as...

  7. The Collateral Effects of Behavioral Interventions: Applied Implications from JEAB, January 1993.

    ERIC Educational Resources Information Center

    Shull, Richard L.; Fuqua, R. Wayne

    1993-01-01

    A review of the January 1993 issue of the "Journal of the Experimental Analysis of Behavior" concludes that behavioral interventions produce collateral effects, but predicting those effects in applied work is complicated because of verbal and instructional influences and because of interactions among reinforcer types. (JDD)

  8. Comparing Main and Collateral Effects of Extinction and Differential Reinforcement of Alternative Behavior

    ERIC Educational Resources Information Center

    Petscher, Erin Seligson; Bailey, Jon S.

    2008-01-01

    This study evaluated the effects and collateral effects of extinction (EXT) and differential reinforcement of alternative behavior (DRA) interventions with inappropriate vocalizations and work refusal. Both interventions have been used frequently to reduce problem behaviors. The benefits of these interventions have been established yet may be…

  9. Supplemental Transcatheter Arterial Chemoembolization Through a Collateral Omental Artery: Treatment for Hepatocellular Carcinoma

    SciTech Connect

    Won, Jong Yun Lee, Do Yun; Lee, Jong Tae; Park, Sung Il; Kim, Myeong-Jin; Yoo, Hyung Sik; Suh, Sang-Hyun; Park, Sang Joon

    2003-04-15

    Purpose: To evaluate the therapeutic efficacy and safety of supplemental transcatheter arterialchemoembolization (TACE) through the extrahepatic collateral omentalartery (OA) for the treatment of hepatocellular carcinoma (HCC). Methods: We studied 21 patients with extrahepatic collaterals of the OA, among 1,512 patients with HCC who had undergone angiography. HCCs supplied by collateral OAs were located at: segment IV in seven, segment V in five, segment III in three, segment VI in three and segment VIII in three patients (Couinaud classification of segments). On preoperative CT scans, every HCC was abutting the liver surface. Adjacent omental infiltration or engorgement was noted in 11 patients. Celiac and hepatic arteriograms showed hypertrophy of the feeding OA in all patients. TACE of the OA was performed in 19 patients with an emulsion of iodized oil and doxorubicin hydrochloride.Embolization with gelatin sponge particles was added in five patients. Results: Collaterals of the OA to the HCC were found on the first to seventeenth sessions of TACE. On follow-up CT scans, five patients showed complete uptake of iodized oil in the tumor. Partial uptake of iodized oil was noted in 13 patients and no uptake in one patient. There was no serious complication that related to the omental embolization, such as omental or bowel ischemia. The cumulative survival rates from the time of the TACE of the OA were 81% at 6 months and 68% at 12 months. Conclusion: TACE of the OA is safe and has a potential therapeutic effect in the treatment of HCC.

  10. 17 CFR 22.3 - Derivatives clearing organizations: Treatment of cleared swaps customer collateral.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 17 Commodity and Securities Exchanges 1 2014-04-01 2014-04-01 false Derivatives clearing... Exchanges COMMODITY FUTURES TRADING COMMISSION CLEARED SWAPS § 22.3 Derivatives clearing organizations: Treatment of cleared swaps customer collateral. (a) General. A derivatives clearing organization shall...

  11. 17 CFR 22.3 - Derivatives clearing organizations: Treatment of cleared swaps customer collateral.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 17 Commodity and Securities Exchanges 1 2013-04-01 2013-04-01 false Derivatives clearing... Exchanges COMMODITY FUTURES TRADING COMMISSION CLEARED SWAPS § 22.3 Derivatives clearing organizations: Treatment of cleared swaps customer collateral. (a) General. A derivatives clearing organization shall...

  12. 17 CFR 22.3 - Derivatives clearing organizations: Treatment of Cleared Swaps Customer Collateral.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 17 Commodity and Securities Exchanges 1 2012-04-01 2012-04-01 false Derivatives clearing... Exchanges COMMODITY FUTURES TRADING COMMISSION CLEARED SWAPS (Eff. 4-9-2012) § 22.3 Derivatives clearing organizations: Treatment of Cleared Swaps Customer Collateral. (a) General. A derivatives clearing...

  13. 7 CFR 1434.16 - Release of the honey pledged as collateral for a loan.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... MARKETING ASSISTANCE LOAN AND LDP REGULATIONS FOR HONEY § 1434.16 Release of the honey pledged as collateral... county office. Any such approval shall not constitute a release of CCC's security interest in the... and security agreement shall not be released until all loan liability has been satisfied in full....

  14. 7 CFR 1421.106 - Warehouse-stored marketing assistance loan collateral.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... commodities, or marketing assistance loan proceeds, after execution of the note and security agreement by CCC... 7 Agriculture 10 2014-01-01 2014-01-01 false Warehouse-stored marketing assistance loan collateral... SIMILARLY HANDLED COMMODITIES-MARKETING ASSISTANCE LOANS AND LOAN DEFICIENCY PAYMENTS FOR 2008 THROUGH...

  15. 7 CFR 1421.106 - Warehouse-stored marketing assistance loan collateral.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... commodities, or marketing assistance loan proceeds, after execution of the note and security agreement by CCC... 7 Agriculture 10 2011-01-01 2011-01-01 false Warehouse-stored marketing assistance loan collateral... SIMILARLY HANDLED COMMODITIES-MARKETING ASSISTANCE LOANS AND LOAN DEFICIENCY PAYMENTS FOR 2008 THROUGH...

  16. Gene therapy during cardiac surgery: role of surgical technique to minimize collateral organ gene expression

    PubMed Central

    Katz, Michael G.; Swain, JaBaris D.; Fargnoli, Anthony S.; Bridges, Charles R.

    2013-01-01

    Effective gene therapy for heart failure has not yet been achieved clinically. The aim of this study is to quantitatively assess the cardiac isolation efficiency of the molecular cardiac surgery with recirculating delivery (MCARD™) and to evaluate its efficacy as a means to limit collateral organ gene expression. 1014 genome copies (GC) of recombinant adeno-associated viral vector 6 encoding green fluorescent protein under control of the cytomegalovirus promoter was delivered to the nine arrested sheep hearts. Blood samples were assessed using real-time quantitative polymerase chain reaction (RT QPCR). Collateral organ gene expression was assessed at four-weeks using immunohistochemical staining. The blood vector GC concentration in the cardiac circuit during complete isolation trended from 9.59±0.73 to 9.05±0.65 (log GC/cm3), and no GC were detectable in the systemic circuit (P<0.001). The washing procedure performed prior to relinquishing the cardiac circuit decreased the systemic blood vector GC concentration >800-fold (P<0.001), consistent with >99% isolation efficiency. Conversely, incomplete isolation resulted in equalization of vector GC concentration in the circuits, leading to robust collateral organ gene expression. MCARD™ is an efficient, clinically translatable myocardial delivery platform for cardiac specific gene therapy. The cardiac surgical techniques utilized are critically important to limit collateral organ gene expression. PMID:20861057

  17. 45 CFR 1336.67 - Security and collateral: Responsibilities of the Loan Administrator.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) As a Credit Factor. The availability of collateral security normally is considered an important... interests which may be taken by the lender include, but are not limited to, liens on real or personal... the replacement value of the property secured (whichever is less) must be taken naming the lender...

  18. 7 CFR 1980.443 - Collateral, personal and corporate guarantees and other requirements.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... insurance. Collateral may also include assignments of leases or leasehold interest, revenues, patents, and... flow to service its debts and meets key industry standards such as those of Robert Morris Associates... when the security instruments are filed. (2) Hazard insurance with a standard mortgage clause...

  19. 7 CFR 1902.7 - Pledging collateral for deposit of funds in supervised bank accounts.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Analysis Division, that collateral has been pledged, contact should be made with the financial institution... financial institution, deposited for borrowers in supervised bank accounts, must be secured by pledging... applicant has selected or tentatively selected a financial institution for the supervised bank account,...

  20. 7 CFR 1902.7 - Pledging collateral for deposit of funds in supervised bank accounts.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Analysis Division, that collateral has been pledged, contact should be made with the financial institution... financial institution, deposited for borrowers in supervised bank accounts, must be secured by pledging... applicant has selected or tentatively selected a financial institution for the supervised bank account,...

  1. Intractable Postpartum Hemorrhage Resulting from Uterine Artery Pseudoaneurysm: Superselective Arteriographic Embolization via the Collateral Route

    SciTech Connect

    Doenmez, Halil Oztuerk, M. Halil; Guergen, Fatma; Soylu, Serra O.; Hekimoglu, Baki

    2007-04-15

    We present a patient with intractable postpartum hemorrhage resulting from uterine artery pseudoaneurysm despite bilateral hypogastric artery ligation who was successfully treated by an endovascular approach via the collateral route. Although there is a good argument for postponing surgery until transcatheter embolization has been attempted, this case shows that embolization can still be successful even if the iliac vessels have been ligated.

  2. 46 CFR 308.522 - Collateral deposit fund, letter of transmittal, Form MA-302.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Collateral deposit fund, letter of transmittal, Form MA-302. 308.522 Section 308.522 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Open Policy War Risk Cargo Insurance §...

  3. The morphology of hair follicle afferent fibre collaterals in the spinal cord of the cat.

    PubMed

    Brown, A G; Rose, P K; Snow, P J

    1977-11-01

    1. The enzyme horseradish peroxidase (HRP) was injected into single axons that innervated hair follicle receptors to study the morphology of their collaterals in the dorsal horn of the cord. The axons were impaled near the dorsal root entrance zone in the lumbosacral spinal cord of anaesthetized cats and HRP injected by passing current through the intra-axonal micro-electrode. The morphology was revealed by subsequent histochemistry.2. Thirteen hair-follicle afferent fibres were stained including six that innervated tylotrichs (type T hair follicle afferent units) and one that innervated guard hairs (type G unit). The remaining six axons were not classified according to hair type, but, on the basis of their axonal conduction velocities, would have been either type G or T.3. Eleven axons could be traced back into the dorsal roots. Eight of these, upon entering the cord, turned and ran towards the brain. They did not divide into rostral and caudal branches. Three of the eleven did divide and gave rise to both rostral and caudal branches.4. Sixty-three collaterals were given off the thirteen stained axons. All well-filled collaterals had a strikingly similar morphology. They descended through laminae I-III of the dorsal horn into the deeper parts of lamina IV or into lamina V, before turning and ascending back into superficial lamina IV and lamina III where they branched profusely to give rise to their terminal arborizations. Terminal boutons, most commonly of the ;en passant' type, were numerous in lamina III, but were also seen in the dorsal part of lamina IV and in ventral lamina II. None were observed in dorsal lamina II or near the junction of the grey and white matter (lamina I) or in lamina V.5. The terminal arborizations of collaterals from a single hair follicle afferent fibre were in line with one another in the longitudinal axis of the cord. In the better-stained preparations the terminal arborizations of adjacent collaterals from a single axon formed a

  4. INDICATIONS FOR DISTAL RADIOULNAR ARTHROPLASTY: REPORT ON THREE CLINICAL CASES

    PubMed Central

    Santos, Cláudia; Pereira, Alexandre; Sousa, Marco; Trigeuiros, Miguel; Silva, César

    2015-01-01

    Distal radioulnar arthroplasty is an attractive solution for treating various pathological conditions of the distal radioulnar joint because it allows restoration of stability, load transmission and function. The main indications are: radioulnar impingement after partial or complete resection of the distal ulna; and degenerative, inflammatory or post-traumatic arthritis of the distal radioulnar joint. The authors present three clinical cases of distal radioulnar pathological conditions: two patients with post-traumatic sequelae and one case of distal radioulnar impingement after a Sauvé-Kapandji operation. The three cases were treated surgically with a metallic prosthesis to replace the distal ulna (First Choice - Ascension®). The first two were treated with a resurfacing prosthesis and the last one with a modular prosthesis. All of the patients had achieved pain relief and increased movement of the distal radioulnar joint after one year of postoperative follow-up. PMID:27047827

  5. HEREDITARY DISTAL FORELEG CURVATURE IN THE RABBIT

    PubMed Central

    Pearce, Louise

    1960-01-01

    An inwardly directed curvature of the distal segment of both forelegs of the rabbit has been described. The condition was detected at 2 to 3 weeks of age, developed rapidly, and reached its final and permanent stage at 2 to 3 months of age. Only the distal epiphysis of the ulna was primarily affected and this in the form of a massive chondrodystrophic lesion accompanied by a progressive curvature of the shaft. The curvature of the growing radius was a secondary effect due to the firm, immovable, anatomical connection of the ulna and radius. The positional changes of the wrist and paw were likewise effects secondary to the changed form of the ulna and radius. The bowing abnormality occurred only in certain families of pure bred Beveren, Belgian, French Silver, and Dutch rabbits and was found to be inherited. The mode of inheritance was on the basis of a single recessive unit factor (5). PMID:13733755

  6. Diagnostic and Therapeutic Advances: Distal Symmetric Polyneuropathy

    PubMed Central

    Callaghan, Brian C.; Price, Raymond S.; Feldman, Eva L.

    2016-01-01

    Importance Peripheral neuropathy is a highly prevalent and morbid condition affecting 2–7% of the population. Patients frequently suffer from pain and are at risk of falls, ulcerations, and amputations. We aimed to review recent diagnostic and therapeutic advances in peripheral neuropathy in distal symmetric polyneuropathy, the most common subtype of peripheral neuropathy. Observations and Advances Current evidence supports limited routine laboratory testing in patients with distal symmetric polyneuropathy. Patients without a known cause should have a complete blood count, comprehensive metabolic panel, B12, serum protein electrophoresis with immunofixation, fasting glucose, and a glucose tolerance test. The presence of atypical features such as asymmetry, non-length-dependence, motor predominance, acute or subacute onset, and/or prominent autonomic involvement should prompt a consultation with a neurologist or neuromuscular specialist. Electrodiagnostic tests and magnetic resonance imaging of the neuroaxis are the main drivers of the cost of the diagnostic evaluation, but evidence supporting their use is lacking. Strong evidence supports the use of tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, and voltage-gated calcium channel ligands in the treatment of neuropathic pain. More intensive glucose control substantially reduces the incidence of distal symmetric polyneuropathy in patients with type 1 diabetes, but does not in type 2 diabetes. Conclusions and Relevance The opportunity exists to improve guideline concordant testing in distal symmetric polyneuropathy patients. Moreover, the role of electrodiagnostic tests needs to be further defined, and interventions to reduce magnetic resonance imaging use in this population are needed. Even though several efficacious medications exist for neuropathic pain treatment, pain is still under-recognized and undertreated. New disease modifying medications are needed to prevent and treat

  7. [Laparoscopic distal resection of the pancreas].

    PubMed

    Gürlich, R; Sixta, B; Oliverius, M; Kment, M; Rusina, R; Spicák, J; Sváb, J

    2005-09-01

    During the last two years, reports on laparoscopic procedures of the pancreas have been on increase. Laparoscopic resection of the pancreatic cauda is indicated, primarily, for benign cystic lesions of the cauda of the pancreas and for neuroendocrine tumors of the pancreas (mainly insulinomas). We have not recorded any report on the above procedure in the Czech literature. Therefore, in our case review, we have described laparoscopic distal resection of the pancreas with splenectomy for a pseudopapillary tumor of the pancreas.

  8. Distal renal tubular acidosis with hereditary spherocytosis.

    PubMed

    Sinha, Rajiv; Agarwal, Indira; Bawazir, Waleed M; Bruce, Lesley J

    2013-07-01

    Hereditary spherocytosis (HS) and distal renal tubular acidosis (dRTA), although distinct entities, share the same protein i.e. the anion exchanger1 (AE1) protein. Despite this, their coexistence has been rarely reported. We hereby describe the largest family to date with co-existence of dRTA and HS and discuss the molecular basis for the co-inheritance of these conditions.

  9. Distal biceps tendon injuries: diagnosis and management.

    PubMed

    Ramsey, M L

    1999-01-01

    Rupture of the distal biceps tendon occurs most commonly in the dominant extremity of men between 40 and 60 years of age when an unexpected extension force is applied to the flexed arm. Although previously thought to be an uncommon injury, distal biceps tendon ruptures are being reported with increasing frequency. The rupture typically occurs at the tendon insertion into the radial tuberosity in an area of preexisting tendon degeneration. The diagnosis is made on the basis of a history of a painful, tearing sensation in the antecubital region. Physical examination demonstrates a palpable and visible deformity of the distal biceps muscle belly with weakness in flexion and supination. The ability to palpate the tendon in the antecubital fossa may indicate partial tearing of the biceps tendon. Plain radiographs may show hypertrophic bone formation at the radial tuberosity. Magnetic resonance imaging is generally not required to diagnose a complete rupture but may be useful in the case of a partial rupture. Early surgical reattachment to the radial tuberosity is recommended for optimal results. A modified two-incision technique is the most widely used method of repair, but anterior single-incision techniques may be equally effective provided the radial nerve is protected. The patient with a chronic rupture may benefit from surgical reattachment, but proximal retraction and scarring of the muscle belly can make tendon mobilization difficult, and inadequate length of the distal biceps tendon may necessitate tendon augmentation. Postoperative rehabilitation must emphasize protected return of motion for the first 8 weeks after repair. Formal strengthening may begin as early as 8 weeks, with a return to unrestricted activities, including lifting, by 5 months.

  10. Fractures of Distal Radius: An Overview

    PubMed Central

    Meena, Sanjay; Sharma, Pankaj; Sambharia, Abhishek Kumar; Dawar, Ashok

    2014-01-01

    Fractures of distal radius account for up to 20% of all fractures treated in emergency department. Initial assessment includes a history of mechanism of injury, associated injury and appropriate radiological evaluation. Treatment options include conservative management, internal fixation with pins, bridging and non-bridging external fixation, dorsal or volar plating with/without arthroscopy assistance. However, many questions regarding these fractures remain unanswered and good prospective randomized trials are needed. PMID:25657938

  11. Distal Embolic Protection for Renal Arterial Interventions

    SciTech Connect

    Dubel, Gregory J. Murphy, Timothy P.

    2008-01-15

    Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices (DPDs) have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. Early experience with DPDs in the renal arteries in patients with suitable anatomy suggests retrieval of embolic materials in approximately 71% of cases and renal functional improvement/stabilization in 98% of cases. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices.

  12. Triplane fracture of the distal radius.

    PubMed

    García-Mata, Serafín; Hidalgo-Ovejero, Angel

    2006-07-01

    A case of triplane fracture of the distal radius is reported in a 13-year-old boy. This exceptional fracture showed displacement, and was healed by closed reduction and 6 weeks of external immobilization. Eighteen months later, the patient showed complete physeal arrest of the distal radius, with radio-ulnar length discrepancy but without any repercussion on wrist mobility. The patient was declared asymptomatic 3 years after the injury. Prompt, physiological physeal arrest reduces the potential of growth deformity. These fractures must be treated conservatively by closed reduction (if displacement exists) and external immobilization, just like a normal one-plane fracture. We may suppose that final radio-ulnar discrepancy could lead to a painful and symptomatic ulno-carpal conflict in adult life. The following characteristics can be associated with this rare fracture: (1) occurrence close to the end of the growth period, as in other types of triplane fractures; (2) evolution towards partial or complete growth arrest of the physis, not requiring treatment and (3) stability of the fracture after closed reduction. In the present case, as in the other reported cases, it may also be added that orthopaedic treatment has been the rule, in contrast with triplane fractures occurring in the distal tibia, in which surgical treatment is indicated.

  13. Novel topical therapies for distal colitis.

    PubMed

    Lawrance, Ian Craig

    2010-10-06

    Distal colitis (DC) can be effectively treated with topical 5ASA agents. Suppositories target the rectum while enemas can reliably reach the splenic flexure. Used in combination with oral 5ASAs, the control of the inflammation is even more effective. Unfortunately, resistant DC does occur and can be extremely challenging to manage. In these patients, the use of steroids, immunosuppressants and the anti-tumor necrosis factor α agents are often required. These, however, can be associated with systemic side effects and are not always effective. The investigation of new topical therapeutic agents is thus required as they are rarely associated with significant blood drug levels and side effects are infrequent. Some of the agents that have been proposed for use in resistant distal colitis include butyrate, cyclosporine and nicotine enemas as well as tacrolimus suppositories and tacrolimus, ecabet sodium, arsenic, lidocaine, rebamipide and Ridogrel(®) enemas. Some of these agents have demonstrated impressive results but the majority of the agents have only been assessed in small open-labelled patient cohorts. Further work is thus required with the investigation of promising agents in the context of randomized double-blinded placebo controlled trials. This review aims to highlight those potentially effective therapies in the management of resistant distal colitis and to promote interest in furthering their investigation.

  14. Distal symmetrical polyneuropathy: definition for clinical research.

    PubMed

    England, J D; Gronseth, G S; Franklin, G; Miller, R G; Asbury, A K; Carter, G T; Cohen, J A; Fisher, M A; Howard, J F; Kinsella, L J; Latov, N; Lewis, R A; Low, P A; Sumner, A J

    2005-01-01

    The objective of this report was to develop a case definition of "distal symmetrical polyneuropathy" to standardize and facilitate clinical research and epidemiological studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetrical polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy (useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy (useful for field or epidemiological studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach for defining distal symmetrical polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiological research studies will ensure greater consistency of case selection.

  15. Combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after acute reperfused myocardial infarction

    PubMed Central

    Leclercq, F; Messner-Pellenc, P; Descours, Q; Daures, J; Pasquie, J; Hager, F; Davy, J; Grolleau-Raoux, R

    1999-01-01

    OBJECTIVE—To evaluate the combined assessment of reflow and collateral blood flow by myocardial contrast echocardiography after myocardial infarction.
DESIGN—Myocardial contrast echocardiography was performed in patients with acute myocardial infarction shortly after successful coronary reperfusion (TIMI 3 patency) by direct angioplasty. Collateral flow was assessed before coronary angioplasty, and contrast reflow was evaluated 15 minutes after reperfusion. The presence of contractile reserve was assessed by low dose dobutamine echocardiography (5 to 15 µg/kg/min) at (mean (SD)) 3 (2) days after myocardial infarction. Recovery of segmental function (myocardial viability) was evaluated by resting echocardiography at a two month follow up. The study was prospective.
PATIENTS—35 consecutive patients referred for acute transmural myocardial infarction.
RESULTS—Contrast reflow was observed in 20 patients (57%) and collateral flow in 14 (40%). Contrast reflow and collateral contrast flow were both correlated with reversible dysfunction on initial dobutamine echocardiography and at follow up (p < 0.05). The presence of reflow or collateral flow on myocardial contrast echocardiography was a highly sensitive (100%) but weakly specific (60%) indicator of segmental dysfunction recovery. Simultaneous presence of contrast reflow and collateral flow was more specific of reversible dysfunction than reflow alone (90% v 60%).
CONCLUSIONS—Combined assessment of reflow and collateral blood flow enhanced the sensitivity of myocardial contrast echocardiography in predicting myocardial viability after acute, reperfused myocardial infarction. The simultaneous presence of reflow and collateral blood flow was highly specific of recovery of segmental dysfunction.


Keywords: contrast echocardiography; coronary reflow; collateral blood flow; dobutamine echocardiography; myocardial dysfunction PMID:10377311

  16. Rare combination and transcatheter treatment during single session in an infant: Patent ductus arteriosus and major aortopulmonary collateral artery concordance.

    PubMed

    Güvenç, Osman; Ödemiş, Ender; Saygı, Murat; Demir, İbrahim Halil

    2016-10-01

    Major aortopulmonary collateral arteries are abnormal vascular structures that may be seen in cyanotic diseases that progress with reduced pulmonary flow. They occur rather rarely in the absence of cyanotic congenital heart disease. Presently described is the case of an infant who underwent patent ductus arteriosus (PDA) and major aortopulmonary collateral artery occlusion in a single session, without presence of cyanotic congenital heart disease. To the best of our knowledge, this is the first case of congenital aortopulmonary collateral artery to be reported in a symptomatic infant with PDA.

  17. Distal clavicle osteolysis unrelated to trauma, overuse, or metabolic disease.

    PubMed

    Hawkins, B J; Covey, D C; Thiel, B G

    2000-01-01

    Osteolysis of the distal clavicle has been reported to occur from traumatic, atraumatic (overuse), or systemic causes. Three patients with bilateral osteolysis of the distal clavicles whose osteolysis did not fit these etiologic categories were evaluated. Clinical, imaging, and laboratory evaluations were nonspecific, and histologic sections of the distal clavicle showed evidence of chronic inflammation with reactive change of the articular surface. Patients either had complete resolution or marked improvement of their symptoms after bilateral distal clavicle resection at mean followup of 5 years 3 months. These cases of osteolysis of the distal clavicle represent a category of this disorder not previously described.

  18. Complications of Distal Biceps Tendon Repair

    PubMed Central

    Amin, Nirav H.; Volpi, Alex; Lynch, T. Sean; Patel, Ronak M.; Cerynik, Douglas L.; Schickendantz, Mark S.; Jones, Morgan H.

    2016-01-01

    Background: Anatomic reinsertion of the distal biceps is critical for restoring flexion and supination strength. Single- and double-incision surgical techniques have been reported, analyzing complications and outcomes measures. Which technique results in superior clinical outcomes and the lowest associated complications remains unclear. Hypothesis: We hypothesized that rerupture rates would be similar between the 2 techniques, while nerve complications would be higher for the single-incision technique and heterotopic ossification would be more frequent with the double-incision technique. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review was conducted using the PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SPORTSDiscus, and the Cochrane Central Register of Controlled Trials databases to identify articles reporting distal biceps ruptures up to August 2013. We included English-language articles on adult patients with a minimum of 3 cases reporting single- and double-incision techniques. Frequencies of each complication as a percentage of total cases were calculated. Fisher exact tests were used to test the association between frequencies for each repair method, with P < .05 considered statistically significant. Odds ratios with 95% CIs were also computed. Results: A total of 87 articles met the inclusion criteria. Lateral antebrachial cutaneous nerve neurapraxia was the most common complication in the single-incision group, occurring in 77 of 785 cases (9.8%). Heterotopic ossification was the most common complication in the double-incision group, occurring in 36 of 498 cases (7.2%). Conclusion: The overall frequency of reported complications is higher for single-incision distal biceps repair than for double-incision repair. The frequencies of rerupture and nerve complications are both higher for single-incision repairs while the frequency of heterotopic ossification is higher for

  19. Retrospective angiographic study to determine the effect of atherosclerotic stenoses of upstream arteries on the degree of atherosclerosis in distal vascular territories

    PubMed Central

    Rehwald, Rafael; Petersen, Johannes; Gratl, Alexandra; Zoller, Heinz; Mader, Andreas; Loizides, Alexander; Grams, Astrid E; Klocker, Josef; Glodny, Bernhard

    2016-01-01

    Objective Experimental coarctation of the aorta prevents the development of downstream atherosclerosis. The aim of this study was to find out whether or not atherosclerotic stenoses protect distal vascular territories from developing atherosclerosis in humans. Design and setting A total of 2125 vascular segments from angiographies of 101 patients were evaluated by calculating the maximum degree of stenosis (NASCET criteria), the degree of calcification, the degree of collaterals and the Friesinger score. Results Stenosis ≥30–49% was found in 685 vascular segments (32.2%), ≥50–69% in 490 (23.1%), ≥70–89% in 373 (17.6%) and ≥90% in 265 (12.5%). If a stenosis of at least ≥70–89% was present in the common iliac, the external iliac or the common femoral artery, the degrees of stenosis distal to it were lower than those on the contralateral side (19.8±22.3% (CI 11.7 to 28.0) vs 25.2±20.7% (CI 21.2 to 29.1); Friesinger scores 1.1±1.2 (CI 0.6 to 1.5) vs 1.4±1.1 (CI 1.2 to 1.6); degrees of calcification 0.8±1.0 (CI 0.4 to 1.1) vs 1.2±1.1 (CI 1.2 to 1.6); p<0.05 each). This effect depended on the degree of proximal stenosis, but not on collaterals, and was most pronounced distal to stenoses of the common iliac, the superficial femoral and the popliteal artery. In regression models, stenoses of the pelvic arteries were shown to be an independent protective factor for the distal vascular territories. Conclusions Atherosclerotic stenoses seem to protect distal vascular territories from developing atherosclerosis. The underlying pathophysiological mechanism of this phenomenon remains to be determined. It could be based on pulse pressure reduction. PMID:27256089

  20. Hyperammonaemia with distal renal tubular acidosis.

    PubMed

    Miller, S G; Schwartz, G J

    1997-11-01

    The case is reported of an infant with hyperammonaemia secondary to severe distal renal tubular acidosis. A clinical association between increased concentrations of ammonia in serum and renal tubular acidosis has not previously been described. In response to acidosis the infant's kidneys presumably increased ammonia synthesis but did not excrete ammonia, resulting in hyperammonaemia. The patient showed poor feeding, frequent vomiting, and failure to thrive, but did not have an inborn error of metabolism. This case report should alert doctors to consider renal tubular acidosis in the differential diagnosis of severely ill infants with metabolic acidosis and hyperammonaemia.

  1. Total Elbow Arthroplasty for Distal Humerus Fractures.

    PubMed

    Harmer, Luke S; Sanchez-Sotelo, Joaquin

    2015-11-01

    Total elbow arthroplasty is a good treatment alternative for selected patients with distal humerus fractures. Its attractiveness is related to several factors, including the possibility of performing the procedure; leaving the extensor mechanism intact; faster, easier rehabilitation compared with internal fixation; and overall good outcomes reported in terms of both pain relief and function. Implant failure leading to revision surgery does happen, and patients must comply with certain limitations to extend the longevity of their implant. Development of high-performance implants may allow expanding the indications of elbow arthroplasty for fractures.

  2. Creation of distal canine limb lymphedema

    SciTech Connect

    Chen, H.C.; Pribaz, J.J.; O'Brien, B.M.; Knight, K.R.; Morrison, W.A.

    1989-06-01

    A canine model of distal limb lymphedema was established in order to study the treatment of this condition by lymph node transfer. This model was more difficult to establish than whole-limb lymphedema. Significant edema was achieved by a combination of preoperative irradiation and circumferential removal of skin from the irradiated areas followed by removal of the contents of the popliteal fossa. Despite these measures, it was not possible to produce lymphedema in every case, possibly because of the presence of lymphaticovenous shunts and panvascular compensation mechanisms.

  3. [Vascularized iliac crest and distal radius reconstruction].

    PubMed

    Pic Gomis, L; Gomis, R

    2010-12-01

    The authors relate their experience concerning the vascularized iliac crest flap. In the first chapter, they detail the anatomic vascularized osteocutaneous iliac crest. Blood supply arises from the deep and superficial circonflexe iliac artery. Many anastomoses connect the two systems. In the second chapter, they detail the operative technique of free and pedicule hone iliac crest flap. Composite cutaneous bone flaps are also detailed. In the third chapter, they detail informations about treatment of distal radius bone defects with associated skeen flap if necessary.

  4. Distal Renal Tubular Acidosis and Calcium Nephrolithiasis

    NASA Astrophysics Data System (ADS)

    Moe, Orson W.; Fuster, Daniel G.; Xie, Xiao-Song

    2008-09-01

    Calcium stones are commonly encountered in patients with congenital distal renal tubular acidosis, a disease of renal acidification caused by mutations in either the vacuolar H+-ATPase (B1 or a4 subunit), anion exchanger-1, or carbonic anhydrase II. Based on the existing database, we present two hypotheses. First, heterozygotes with mutations in B1 subunit of H+-ATPase are not normal but may harbor biochemical abnormalities such as renal acidification defects, hypercalciuria, and hypocitraturia which can predispose them to kidney stone formation. Second, we propose at least two mechanisms by which mutant B1 subunit can impair H+-ATPase: defective pump assembly and defective pump activity.

  5. Distal oblique osteotomy for tailor's bunion.

    PubMed

    Zvijac, J E; Janecki, C J; Freeling, R M

    1991-12-01

    Thirty-six patients with a total of 50 symptomatic tailor's bunions were evaluated clinically, radiographically, and subjectively, both before and after a distal oblique osteotomy procedure was performed. Thirty-four of 36 patients were satisfied with pain relief. Radiographic measurements derived from this study were consistent with those of other studies. Avascular necrosis, nonunions, or neuroma formation were not encountered in this study. The significant advantages of this procedure are its simplicity, safety, and predictability. The procedure does not require internal fixation or postoperative immobilization.

  6. Placement of a port catheter through collateral veins in a patient with central venous occlusion.

    PubMed

    Teichgräber, Ulf Karl-Martin; Streitparth, Florian; Gebauer, Bernhard; Benter, Thomas

    2010-04-01

    Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.

  7. [Chinese translation of "nerve" and its influences on research of meridians and collaterals].

    PubMed

    Li, Su-Yun; Zhao, Jing-Sheng

    2011-05-01

    Authors investigated the whole introduction and translation course of the word "nerve" into China during the Ming dynasty (1368-1644), Qing dynasty(1644-1911) and the Republic of China (1912-1949), when western medicine was introduced into the East, as well as its influences on the cognition and researches of meridians and collaterals. The result shows that "nerve" was once translated into "Xijin" and "Naoqijin" in the Ming and Qing dynasties. Only until the period of the late Qing dynasty and the early stage of the Republic of China, the word "Shenjing", which is known as the unique Chinese translation of nerve nowadays, was introduced from Japan. From that time on, the Chinese physicians started to explore the relation between nerves and meridians, which led to the transform of the academic methodology on essence of meridian. Thus, profound as well as prolong influences were made on study of meridians and collaterals until nowadays.

  8. Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy.

    PubMed

    Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam

    2017-03-14

    Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

  9. [Practice on the case-based teaching innovation of Science of Meridians, Collaterals and Acupoints].

    PubMed

    Yin, Zhen-Jin; Zhang, Shu-Feng; Yan, Yuan-Jie; Bao, Hong-Ling; Wang, Bei-Bei

    2012-12-01

    The case-based teaching method which is applied to the teaching of Science of Meridians, Collaterals and Acupoints is discussed in this paper, in which the typical cases such as the growth of the acupuncture-moxibustion eminent physicians, the application of acupoints by the eminent physicians and the experiences in the acupoint combination are integrated. The students are instructed to launch the clinical practical activity through establishing the clinical base of Science of Meridians, Collaterals and Acupoints, in association with the true cases. It is proved that the case-based teaching method can promote the training of the manipulation techniques of the students and the inheritance of the experiences of eminent physicians in higher education.

  10. Spatially Interpolated Disease Prevalence Estimation Using Collateral Indicators of Morbidity and Ecological Risk

    PubMed Central

    Congdon, Peter

    2013-01-01

    This paper considers estimation of disease prevalence for small areas (neighbourhoods) when the available observations on prevalence are for an alternative partition of a region, such as service areas. Interpolation to neighbourhoods uses a kernel method extended to take account of two types of collateral information. The first is morbidity and service use data, such as hospital admissions, observed for neighbourhoods. Variations in morbidity and service use are expected to reflect prevalence. The second type of collateral information is ecological risk factors (e.g., pollution indices) that are expected to explain variability in prevalence in service areas, but are typically observed only for neighbourhoods. An application involves estimating neighbourhood asthma prevalence in a London health region involving 562 neighbourhoods and 189 service (primary care) areas. PMID:24129116

  11. Outcome review on the percutaneous release of the proximal interphalangeal joint accessory collateral ligaments

    PubMed Central

    Cerovac, Sonja; Stanley, John

    2009-01-01

    The percutaneous release of accessory collateral ligaments was introduced in 1986 as a safe and quick procedure to be attempted before open, more extensive joint release in the treatment of proximal interphalangeal joint flexion contracture. Our study analyzed the long-term results and patient satisfaction following a percutaneous release in 30 joints after a mean follow-up period of 34 months. In one half of cases the preoperative joint flexion deformity was reduced from 78° to 34°. The best results were observed in patients with osteoarthritis and stiff, immobilized joints. In patients with inflammatory arthritides, marked intraoperative correction was maintained rarely, joint contractures recurred early, and patients were unsatisfied. There were no intraoperative complications. Percutaneous release of the accessory collateral ligaments can produce a long lasting correction of the joint contracture, but careful patient selection and strict postoperative rehabilitation are essential for favorable outcome. PMID:21808681

  12. Sphingosine-1-Phosphate Receptor-1 Selective Agonist Enhances Collateral Growth and Protects against Subsequent Stroke

    PubMed Central

    Ichijo, Masahiko; Ishibashi, Satoru; Li, Fuying; Yui, Daishi; Miki, Kazunori; Mizusawa, Hidehiro; Yokota, Takanori

    2015-01-01

    Background and Purpose Collateral growth after acute occlusion of an intracranial artery is triggered by increasing shear stress in preexisting collateral pathways. Recently, sphingosine-1-phosphate receptor-1 (S1PR1) on endothelial cells was reported to be essential in sensing fluid shear stress. Here, we evaluated the expression of S1PR1 in the hypoperfused mouse brain and investigated the effect of a selective S1PR1 agonist on leptomeningeal collateral growth and subsequent ischemic damage after focal ischemia. Methods In C57Bl/6 mice (n = 133) subjected to unilateral common carotid occlusion (CCAO) and sham surgery. The first series examined the time course of collateral growth, cell proliferation, and S1PR1 expression in the leptomeningeal arteries after CCAO. The second series examined the relationship between pharmacological regulation of S1PR1 and collateral growth of leptomeningeal anastomoses. Animals were randomly assigned to one of the following groups: LtCCAO and daily intraperitoneal (ip) injection for 7 days of an S1PR1 selective agonist (SEW2871, 5 mg/kg/day); sham surgery and daily ip injection for 7 days of SEW2871 after surgery; LtCCAO and daily ip injection for 7 days of SEW2871 and an S1PR1 inverse agonist (VPC23019, 0.5 mg/kg); LtCCAO and daily ip injection of DMSO for 7 days after surgery; and sham surgery and daily ip injection of DMSO for 7 days. Leptomeningeal anastomoses were visualized 14 days after LtCCAO by latex perfusion method, and a set of animals underwent subsequent permanent middle cerebral artery occlusion (pMCAO) 7days after the treatment termination. Neurological functions 1hour, 1, 4, and 7days and infarction volume 7days after pMCAO were evaluated. Results In parallel with the increase in S1PR1 mRNA levels, S1PR1 expression colocalized with endothelial cell markers in the leptomeningeal arteries, increased markedly on the side of the CCAO, and peaked 7 days after CCAO. Mitotic cell numbers in the leptomeningeal arteries

  13. Evidence of primary, secondary, and collateral paraphilias left at serial murder and sex offender crime scenes.

    PubMed

    White, John H

    2007-09-01

    This paper is a descriptive review of the phenomenon of paraphilias, the relationship of possessing multiple paraphilias with the commission of sexual crimes and serial murder and the recognition of evidence related to sexual crimes committed by offenders with paraphilias. Several case studies are presented and the manifestations of multiple paraphilias, such as those experienced by Jeffrey Dahmer, Albert Fish, and others, are conceptualized and divided into three types: (i) replacement--no overlap; (ii) replacement with overlap; and (iii) cumulative. The categories are further divided into primary, secondary, and collateral paraphilias. Primary and secondary paraphilias are mutually exclusive and one does not build upon the other. Collateral paraphilias may serve to enhance the overall sexual experience of the primary and secondary paraphilias, including the sexualization of props or weapons. Implications for criminalists and criminal investigators are explained, particularly the value in discerning hidden as well as salient evidence of paraphilic behaviors left at crime scenes.

  14. Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy

    PubMed Central

    Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam

    2017-01-01

    Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management. PMID:28348478

  15. Placement of a Port Catheter Through Collateral Veins in a Patient with Central Venous Occlusion

    SciTech Connect

    Teichgraeber, Ulf Karl-Martin Streitparth, Florian; Gebauer, Bernhard; Benter, Thomas

    2010-04-15

    Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.

  16. Management of medial-sided knee injuries, part 1: medial collateral ligament.

    PubMed

    Marchant, Milford H; Tibor, Lisa M; Sekiya, Jon K; Hardaker, William T; Garrett, William E; Taylor, Dean C

    2011-05-01

    The medial collateral ligament complex is a primary stabilizer that combines static and dynamic resistance to direct valgus stress while contributing significant restraints to rotatory motion and anterior-posterior translation. Varying opinions exist among investigators regarding injury classification and treatment algorithms. Whereas most agree that the majority of isolated medial collateral ligament complex injuries can be treated nonoperatively, isolated injuries with chronic instability and multiligament injuries may require operative intervention. Substantial confounding factors are present within published reports, making comparative analyses and systematic review challenging. This review focuses on the anatomy and biomechanics of the medial structures of the knee; it discusses the clinical evaluation of complex injuries; and it reviews nonoperative and operative treatment methods.

  17. The receptor for advanced glycation end products impairs collateral formation in both diabetic and non-diabetic mice.

    PubMed

    Hansen, Laura M; Gupta, Divya; Joseph, Giji; Weiss, Daiana; Taylor, W Robert

    2017-01-01

    Diabetics often have poor perfusion in their limbs as a result of peripheral artery disease and an impaired ability to generate collateral vessels. The receptor for advanced glycation end products (RAGE) is one protein that is thought to play a detrimental role in collateral development in diabetics due to increased levels of advanced glycation end products (AGE), one of its ligands, in diabetes. Thus, the aim of this study was to investigate the role of RAGE in both diabetic and non-diabetic settings in a model of collateral formation in mice. Streptozotocin was used to induce diabetes in both wild type and RAGE knockout mice. Increased levels of the AGE, N(ɛ)-(carboxymethyl) lysine (CML), were confirmed via an ELISA. A hindlimb ischemia model, in which the femoral artery is ligated, was used to drive collateral growth and reperfusion was assessed using laser Doppler perfusion imaging and histological analysis of vessels in the muscle. Both of these measurements showed impaired collateral growth in diabetic compared with wild-type mice as well as improved collateral growth in both diabetic and non-diabetic RAGE knockout mice when compared their wild-type counterparts. Distance on a freely accessed running wheel, used as a measure of perfusion recovery, showed that wild-type diabetic mice had functionally impaired recovery compared with their wild-type counterparts. Immunohistochemistry and immunoblotting showed that HMGB-1 (high-mobility group box 1), another RAGE ligand, was increased in the ischemic leg compared with the non-ischemic leg in all mice. This increase in HMGB-1 may explain improvement in animals lacking RAGE and its subsequent signaling. In conclusion, this study shows that RAGE impairs collateral growth in a diabetic setting and also in a non-diabetic setting. This demonstrates the importance of RAGE and alternate RAGE ligands in the setting of collateral vessel growth.

  18. Arterial Spin-Labeling MRI Can Identify the Presence and Intensity of Collateral Perfusion in Patients With Moyamoya Disease

    PubMed Central

    Zaharchuk, Greg; Do, Huy M.; Marks, Michael P.; Rosenberg, Jarrett; Moseley, Michael E.; Steinberg, Gary K.

    2011-01-01

    Background and Purpose Determining the presence and adequacy of collateral blood flow is important in cerebrovascular disease. Therefore, we explored whether a noninvasive imaging modality, arterial spin labeling (ASL) MRI, could be used to detect the presence and intensity of collateral flow using digital subtraction angiography (DSA) and stable xenon CT cerebral blood flow as gold standards for collaterals and cerebral blood flow, respectively. Methods ASL and DSA were obtained within 4 days of each other in 18 patients with Moyamoya disease. Two neurointerventionalists scored DSA images using a collateral grading scale in regions of interest corresponding to ASPECTS methodology. Two neuroradiologists similarly scored ASL images based on the presence of arterial transit artifact. Agreement of ASL and DSA consensus scores was determined, including kappa statistics. In 15 patients, additional quantitative xenon CT cerebral blood flow measurements were performed and compared with collateral grades. Results The agreement between ASL and DSA consensus readings was moderate to strong, with a weighted kappa value of 0.58 (95% confidence interval, 0.52–0.64), but there was better agreement between readers for ASL compared with DSA. Sensitivity and specificity for identifying collaterals with ASL were 0.83 (95% confidence interval, 0.77–0.88) and 0.82 (95% confidence interval, 0.76–0.87), respectively. Xenon CT cerebral blood flow increased with increasing DSA and ASL collateral grade (P<0.05). Conclusions ASL can noninvasively predict the presence and intensity of collateral flow in patients with Moyamoya disease using DSA as a gold standard. Further study of other cerebrovascular diseases, including acute ischemic stroke, is warranted. PMID:21799169

  19. Combat Stress: A Collateral Effect in the Operational Effectiveness Loss Multiplier (OELM) Methodology

    DTIC Science & Technology

    2015-02-01

    5202, Draft Final (Alexandria, VA: IDA, April 2015), 10-4. 14 North Atlantic Treaty Organization (NATO) Standardization Agency ( NSA ), NATO Glossary of...Belgium: NSA , 2012), 2-C-2. 15 Disraelly et al., “A New Methodology for CBRN Casualty Estimation,” 228. 16 Disraelly et al., A Methodology for...20 NATO NSA , AAP-06, 2-K-1. 21 Ibid., 2-D-6. 22 Disraelly et al., A Methodology for Examining Collateral Effects on Military Operations during

  20. Combat Stress: A Collateral Effect in the Operational Effectiveness Loss Multiplier (OELM) Methodology

    DTIC Science & Technology

    2015-02-01

    Organization (NATO) Standardization Agency ( NSA ), NATO Glossary of Terms and Definitions (English and French), Allied Administration Publication (AAP)-06...Edition 2012 Version 2 (hereafter referred to as AAP-06) (Belgium: NSA , 2012), 2-C-2. 15 Disraelly et al., “A New Methodology for CBRN Casualty...20 NATO NSA , AAP-06, 2-K-1. 21 Ibid., 2-D-6. 22 Disraelly et al., A Methodology for Examining Collateral Effects on Military Operations during

  1. Post traumatic osteoma of tibial insertion of medial collateral ligament of knee joint.

    PubMed

    Shanker, V S; Gadikoppula, S; Loeffler, M D

    1998-03-01

    Two cases are presented of post traumatic para-articular osteoma developing at the site of tibial attachment of the medial collateral ligament of knee joint. These occurred after injuries sustained while playing football and in one case the ossified mass was treated with surgical excision for unresolved symptoms after conservative measures. A comparison is made with Pellegrini Stieda disease, which is a similar affection of the femoral insertion of the medial ligament of the knee joint.

  2. Acute experimental distal colitis alters colonic transit in rats.

    PubMed

    Myers, B S; Dempsey, D T; Yasar, S; Martin, J S; Parkman, H P; Ryan, J P

    1997-04-01

    Data from humans with active distal colitis suggest that the proximal colon exhibits increased contractile activity and delayed transit, whereas the distal colon shows decreased contractile activity and rapid transit. The present study used the acetic acid rat model of experimental colitis to determine the effect of distal colitis on total and regional colonic transit in vivo and on the in vitro contractility of circular smooth muscle from the proximal and distal colon. Distal colitis was induced in rats by intracolonic administration of 4% acetic acid; sham control rats received saline enemas. Control and colitic rats were studied 2 days postenemas. Total colon transit was determined by calculating the geometric center of distribution of a radiolabeled marker (51Cr) instilled into the proximal colon. Regional transit was assessed by expressing the radioactivity in the cecum, proximal and distal colon, and excreted stool as a percent of total radioactivity. Muscle strips from the proximal and distal colon were stimulated with 100 microM acetylcholine (ACh) and 60 mM KCl and the tension was expressed as kilograms per square centimeter. Distal colitis was characterized by decreased total colon transit, increased retention of marker in the cecum and proximal colon, and decreased retention of marker in the distal colon. In vitro contractility studies revealed that distal colitis increased proximal colon circular smooth muscle contractility and decreased distal colon circular smooth muscle contractility to both ACh and potassium. Distal colitis is associated with regional differences in colonic circular smooth muscle contractility, which may contribute to delayed transit in the proximal colon and rapid transit in the distal colon.

  3. [Does ST-elevation in stress ECG depend on the extent of collateral circulation?].

    PubMed

    Bettinger, R; Wendt, T; Klepzig, H; Kaltenbach, M

    1993-01-01

    As a possible cause of exercise-induced ST-elevation in patients without myocardial infarction, a poor or absent coronary circulation to the poststenotic coronary segment was postulated. To check this thesis, we examined 10 patients (pts.) with ST-elevation, respectively, ST-depression and comparable coronary status (coronary score 12 vs. 12; mean stenosis diameter 86 vs. 85%) and exercise parameters (work load 150 vs. 137.5 Watts; exercise duration 2.8 vs 3.5 min) with regard to their collateral circulation. In the group with ST-elevation there were nine pts. with severe proximal stenosis of the left anterior descending artery (LAD) and one pt. with a stenosis in the middle third of the right coronary artery. The 10 patients with ST-depression had a proximal stenosis in the LAD. The extent of the angiographically seen collaterals was equal in both groups. As a result, this study demonstrates that the size of the collateral circulation has no influence on the exercise-induced ST-elevation. The most plausible cause of exercise-induced ST-elevation is a functional decrease of the lumen of a severe stenosis.

  4. Local control of information flow in segmental and ascending collaterals of single afferents.

    PubMed

    Lomelí, J; Quevedo, J; Linares, P; Rudomin, P

    1998-10-08

    In the vertebrate spinal cord, the activation of GABA(gamma-amino-butyric acid)-releasing interneurons that synapse with intraspinal terminals of sensory fibres leading into the central nervous system (afferent fibres) produces primary afferent depolarization and presynaptic inhibition. It is not known to what extent these presynaptic mechanisms allow a selective control of information transmitted through specific sets of intraspinal branches of individual afferents. Here we study the local nature of the presynaptic control by measuring primary afferent depolarization simultaneously in two intraspinal collaterals of the same muscle spindle afferent. One of these collaterals ends at the L6-L7 segmental level in the intermediate nucleus, and the other ascends to segment L3 within Clarke's column, the site of origin of spinocerebellar neurons. Our results indicate that there are central mechanisms that are able to affect independently the synaptic effectiveness of segmental and ascending collaterals of individual muscle spindle afferents. Focal control of presynaptic inhibition thus allows the intraspinal branches of afferent fibres to function as a dynamic assembly that can be fractionated to convey information to selected neuronal targets. This may be a mechanism by which different spinal postsynaptic targets that are coupled by sensory input from a common source could be uncoupled.

  5. Collateral Consequences of Juvenile Sex Offender Registration and Notification: Results From a Survey of Treatment Providers.

    PubMed

    Harris, Andrew J; Walfield, Scott M; Shields, Ryan T; Letourneau, Elizabeth J

    2016-12-01

    Among many in the research, policy, and practice communities, the application of sex offender registration and notification (SORN) to juveniles who sexually offend (JSO) has raised ongoing concerns regarding the potential collateral impacts on youths' social, mental health, and academic adjustment. To date, however, no published research has systematically examined these types of collateral consequences of juvenile SORN. Based on a survey of a national sample of treatment providers in the United States, this study investigates the perceived impact of registration and notification on JSO across five key domains: mental health, harassment and unfair treatment, school problems, living instability, and risk of reoffending. Results indicate that treatment providers overwhelmingly perceive negative consequences associated with registration with an incremental effect of notification indicating even greater concern across all five domains. Providers' demographics, treatment modalities, and client profile did not influence their perceptions of the collateral consequences suggesting that provider concern about the potential harm of SORN applied to juveniles is robust. Policy implications are discussed.

  6. The association between prolongation in QRS duration and presence of coronary collateral circulation in patients with acute myocardial infarction

    PubMed Central

    Altıntaş, Bernas; Uğurlu, Murat; Kaya, İlyas; Uçaman, Berzal; Uluğ, Ali Veysel; Altındağ, Rojhat; Altaş, Yakup; Adıyaman, Mehmet Şahin; Öztürk, Önder

    2016-01-01

    Background It is known that QRS duration is related to prognosis in acute myocardial infarction. The relation between QRS duration and coronary collateral circulation is uncertain. In the present study, we aimed to determine the relation between QRS duration and coronary collateral circulation in patients admitted with acute myocardial infarction. Methods The present study was composed of 109 consecutive patients with acute myocardial infarction. All patients had total occlusion in the left anterior descending coronary artery. Electrocardiographic recordings on admission were obtained for the assessment of QRS duration. The Rentrop classification was used to define coronary collateral circulation on coronary angiography. Patients were divided into two groups as follows: Group 1 with poor coronary collateral circulation (Rentrop 0–1) and Group 2 with good coronary collateral circulation (Rentrop 2–3). Results Of all patients, 62 patients were included in group 1 and 47 patients in group 2, respectively. In the present study, patients in the group 1 had longer QRS duration than patients in the group 2 (p < 0.005). Additionally, we found that Rentrop grading had negative correlation with both QRS duration and white blood cell count (r: −0.28; p < 0.005 and r: −0.35; p < 0.001). Conclusion Our study showed that there was an inverse relationship between QRS duration on admission and presence of coronary collateral circulation in patients with acute myocardial infarction. PMID:27570619

  7. Collateral circulation as a marker of the presence of viable myocardium in patients with recent myocardial infarction

    SciTech Connect

    Fujita, M.; Ohno, A.; Wada, O.; Miwa, K.; Nozawa, T.; Yamanishi, K.; Sasayama, S. )

    1991-08-01

    The relationship between the presence of viable myocardium and the extent of coronary collateral circulation to the infarct area was evaluated in 20 patients with a recent anterior myocardial infarction who had complete obstruction of the left anterior descending coronary artery. The viability of myocardial tissue was assessed by exercise thallium-201 myocardial scintigraphy, and the collateral circulation was angiographically evaluated by means of a collateral index ranging from 0 to 3. Patients were divided into two groups according to the presence (group 1, n = 10) or absence (group 2, n = 10) of viable myocardium in the perfusion territory of the infarct-related artery. The collateral index in group 1 was 2.5 {plus minus} 0.5 (SD), which was significantly higher than the 0.7 {plus minus} 0.8 in group 2. These findings indicate that the presence of ischemic but viable myocardium is intimately related to the development of collateral circulation in patients with myocardial infarction, and the existence of well-developed collateral channels predicts the presence of viable myocardium in the infarct area.

  8. Aqueous outflow: Segmental and distal flow

    PubMed Central

    Swaminathan, Swarup S.; Oh, Dong-Jin; Kang, Min Hyung; Rhee, Douglas J.

    2014-01-01

    A prominent risk factor of primary open-angle glaucoma is ocular hypertension, a pathologic state caused by impaired outflow of aqueous humor through the trabecular meshwork within the iridocorneal angle. The juxtacanalicular region of the trabecular meshwork and the inner wall of Schlemm canal have been identified as the main contributors to aqueous outflow resistance, and both extracellular matrix within the trabecular meshwork and trabecular meshwork cell shape have been shown to affect outflow. Overexpression of multiple ECM proteins in perfused cadaveric human eyes has led to increased outflow resistance and elevated IOP. Pharmacologic agents targeting trabecular meshwork cytoskeletal arrangements have been developed after multiple studies demonstrated the importance of cell shape on outflow. Several groups have shown that aqueous outflow occurs only at certain segments of the trabecular meshwork circumferentially, a concept known as segmental flow. This is based on the theory that aqueous outflow is dependent on the presence of discrete pores within the Schlemm canal. Segmental flow has been described in the eyes of multiple species, including primate, bovine, mouse, and human samples. While the trabecular meshwork appears to be the major source of resistance, trabecular meshwork bypass procedures have been unable to achieve the degree of IOP reduction observed with trabeculectomy, reflecting the potential impact of distal flow, or flow through Schlemm canal and collector channels, on outflow. Multiple studies have demonstrated that outflow occurs preferentially near collector channels, suggesting that these distal structures may be more important to aqueous outflow than previously believed. PMID:25088623

  9. Maxillary molar distalization with first class appliance

    PubMed Central

    Ramesh, Namitha; Palukunnu, Biswas; Ravindran, Nidhi; Nair, Preeti P

    2014-01-01

    Non-extraction treatment has gained popularity for corrections of mild-to-moderate class II malocclusion over the past few decades. The distalization of maxillary molars is of significant value for treatment of cases with minimal arch discrepancy and mild class II molar relation associated with a normal mandibular arch and acceptable profile. This paper describes our experience with a 16-year-old female patient who reported with irregularly placed upper front teeth and unpleasant smile. The patient was diagnosed to have angles class II malocclusion with moderate maxillary anterior crowding, deep bite of 4 mm on a skeletal class II base with an orthognathic maxilla and retrognathic mandible and normal growth pattern. She presented an ideal profile and so molar distalization was planned with the first-class appliance. Molars were distalised by 8 mm on the right and left quadrants and class I molar relation achieved within 4 months. The space gained was utilised effectively to align the arch and establish a class I molar and canine relation. PMID:24577171

  10. Distal radius fracture after proximal row carpectomy

    PubMed Central

    Igeta, Yuka; Naito, Kiyohito; Sugiyama, Yoichi; Obata, Hiroyuki; Aritomi, Kentaro; Kaneko, Kazuo; Obayashi, Osamu

    2015-01-01

    Introduction We encountered a patient with distal radius fracture (DRF) after proximal row carpectomy (PRC). The mechanism of the DRF after PRC is discussed in this report. Presentation of case The patient was a 73-year-old female who had undergone PRC due to Kienböck disease before. The wrist range of motion was: 45° on dorsiflexion and 20° on flexion. DRF has occurred at 3 years after PRC. The fracture type was extra-articular fracture. Osteosynthesis was performed using a volar locking plate. No postoperative complication developed, the Mayo score was excellent at 6 months after surgery, and the daily living activity level recovered to that before injury. Discussion Since the wrist range of motion decreased and the lunate fitted into the joint surface after PRC, making the forearm join with the hand like a single structure, pressure may have been loaded on the weak distal end of the radius from the dorsal side, causing volar displacement and fracture. Conclusion The pressure distribution and range of motion of the radiocarpal joint after PRC are different from those of a normal joint, and the mechanism of fracture also changes due to PRC. PMID:25623755

  11. Role of dopamine in distal retina.

    PubMed

    Popova, E

    2014-05-01

    Dopamine is the most abundant catecholamine in the vertebrate retina. Despite the description of retinal dopaminergic cells three decades ago, many aspects of their function in the retina remain unclear. There is no consensus among the authors about the stimulus conditions for dopamine release (darkness, steady or flickering light) as well as about its action upon the various types of retinal cells. Many contradictory results exist concerning the dopamine effect on the gross electrical activity of the retina [reflected in electroretinogram (ERG)] and the receptors involved in its action. This review summarized current knowledge about the types of the dopaminergic neurons and receptors in the retina as well as the effects of dopamine receptor agonists and antagonists on the light responses of photoreceptors, horizontal and bipolar cells in both nonmammalian and mammalian retina. Special focus of interest concerns their effects upon the diffuse ERG as a useful tool for assessment of the overall function of the distal retina. An attempt is made to reveal some differences between the dopamine actions upon the activity of the ON versus OFF channel in the distal retina. The author has included her own results demonstrating such differences.

  12. Atypical Miyoshi distal myopathy: A case report

    PubMed Central

    Wang, Meiling; Guo, Yujie; Fu, Yong; Jia, Rui; Chen, Gang

    2016-01-01

    Five distinct predominant distal myopathies have been identified with discrete clinical and genetic patterns. Miyoshi myopathy (MM; early adult-onset, type 2) is a subtype of dysferlinopathy. Furthermore, MM is the most common form of autosomal recessive distal myopathy. MM is typically characterized by muscular weakness, initially affecting the gastrocnemius or soleus muscle from the late teens or early adulthood. The present study reports a case of MM that was confirmed by pathological and immunohistochemical methods, in addition to a review of the relevant literature. A 37-year-old male patient presented with muscular weakness in the left foot. This clinical manifestation was not typical of MM, and the patient was initially diagnosed with inflammatory myopathy. He was treated with dexamethasone at a dose of 10 mg for 5 days followed by gradual tapering, following which the symptoms were alleviated; however, the pathology, immunohistochemistry and electromyography eventually confirmed the diagnosis of MM. The treatment was then terminated and the patient was discharged. The present study further supports the underlying heterogeneity in atypical MM-like phenotypes. Dysferlin protein deficiency can be identified by pathological examination. The pathology of dysferlinopathy is characterized by changes of muscular dystrophy. Inflammatory cellular infiltration is a relatively common finding in the muscle biopsies from numerous patients with dysferlinopathy. Therefore, the detection of dysferlin deficiency or marked reduction on the sarcolemma using immunohistochemical staining is important for the diagnosis of dysferlinopathy. PMID:27882118

  13. Biotin absorption by distal rat intestine

    SciTech Connect

    Bowman, B.B.; Rosenberg, I.H.

    1987-12-01

    We used the in vivo intestinal loop approach, with short (10-min) and long (3-h) incubations, to examine biotin absorption in proximal jejunum, distal ileum, cecum and proximal colon. In short-term studies, luminal biotin disappearance from rat ileum was about half that observed in the jejunum, whereas absorption by proximal colon was about 12% of that in the jejunum. In 3-h closed-loop studies, the absorption of 1.0 microM biotin varied regionally. Biotin absorption was nearly complete in the small intestine after 3 h; however, only about 15% of the dose had been absorbed in the cecum and 27% in the proximal colon after 3 h. Independent of site of administration, the major fraction of absorbed biotin was recovered in the liver; measurable amounts of radioactive biotin were also present in kidney and plasma. The results support the potential nutritional significance for the rat of biotin synthesized by bacteria in the distal intestine, by demonstrating directly an absorptive capability of mammalian large bowel for this vitamin.

  14. Ruptures of the distal biceps tendon.

    PubMed

    Ward, James P; Shreve, Mark C; Youm, Thomas; Strauss, Eric J

    2014-01-01

    Distal biceps ruptures occur most commonly in middle-aged males and result from eccentric contraction of the biceps tendon. The injury typically presents with pain and a tearing sensation in the antecubital fossa with resultant weakness in flexion and supination strength. Physical exam maneuvers and diagnostic imaging aid in determining the diagnosis. Nonoperative management is reserved for elderly, low demand patients, while operative intervention is generally pursued for younger patients and can consist of nonanatomic repair to the brachialis or anatomic repair to the radial tuberosity. Anatomic repair through a one-incision or two-incision approach is commonplace, while the nonanatomic repairs are rarely performed. No clear advantage exists in operative management with a one-incision versus two-incision techniques. Chronic ruptures present a more difficult situation, and allograft augmentation is often necessary. Common complications after repair include transient nerve palsy, which often resolves, and heterotopic ossification. Despite these possible complications, most studies suggest that better patient outcomes are obtained with operative, anatomic reattachment of the distal biceps tendon.

  15. Distal metatarsal coalition: A rare case report

    PubMed Central

    Vun, Shen Hwa; Drampalos, Efstathios; Shareef, Sajan; Sinha, Satyajit; Bramley, Diane

    2015-01-01

    Introduction Metatarsal coalition is an extremely rare condition. We report the second documented case of 4th and 5th distal metatarsal coalition in the literature. Presentation of case An eight-year-old girl was referred to an orthopaedic clinic with a four-month history of forefoot pain and swelling on the plantar aspect of the right little toe. Radiograph and clinical examination confirmed distal metatarsal coalition between the 4th and 5th metatarsals. Following a period of conservative treatment, excision was eventually performed due to worsening symptoms. Patient re-attended two years later with a recurrence of the coalition confirmed by computed tomography (CT) scan. The case was discussed at a tertiary paediatric orthopaedic insititution. Decision was made to manage patient conservatively with insole and physiotherapy until skeletal maturity. A year later, patient’s symptoms did not worsen, and her foot displayed no evidence of change in the arch and shape. Discussion The timing of ossification of coalition varies from one anatomical site to another. Surgery when performed before ossification is complete runs the risk of recurrence. Conclusion Our case report illustrates the importance of restoring normal weight bearing dynamics and pain relief when managing metatarsal coalition, or synostosis in skeletally immature patients. We recommend persevering with conservative treatment, with operative treatment reserved only as a later option, and ideally, until skeletal maturity is achieved. PMID:25670408

  16. Growth disturbances after distal tibial physeal fractures.

    PubMed

    Berson, L; Davidson, R S; Dormans, J P; Drummond, D S; Gregg, J R

    2000-01-01

    Twenty-four patients with distal tibial growth disturbance were reviewed. Disturbances were classified as physeal bar (prior to deformity), angular, linear or combined deformities. Treatment consisted of osteotomy in fourteen, epiphyseodesis in seven, excision of bony bar in two, and observation in one patient. Follow up was an average 36.6 months (range 4-129 months) after treatment of growth disturbance. The age at time of injury was 10.4 years of age average (range 3-15 years). There were 12 SH2, 2 SH3, 7 SH4, and 3 SH5 distal tibial physeal fractures. Thirteen of 15 fractures considered high energy and only 1 of 9 fractures considered low energy resulted in angular deformity. Angular and linear deformities presented an average 46 months (range 12-120 months) and physeal bars at an average 14 months (range 6-25 months) after injury. Patients with a delay in presentation of growth disturbance greater than 24 months had angular deformities in 92% compared with 33% in children presenting less than or at 24 months. Treatment based on type of deformity, age at time of injury, and growth remaining was considered successful in 83%. Patients with angular or linear deformities were more likely to present late, have high energy injuries, be male patients and have Salter-Harris types IV and V. Early diagnosis and treatment of growth disturbance can prevent severe deformity.

  17. Biomechanical Comparison of Osteoporotic Distal Radius Fractures Fixed by Distal Locking Screws with Different Length

    PubMed Central

    Liu, Xiong; Wu, Wei-dong; Fang, Ya-feng; Zhang, Mei-chao; Huang, Wen-hua

    2014-01-01

    Objectives To evaluate the postoperative stability of osteoporotic distal radius fractures fixed with distal locking screws with different length. Methods A comminuted extra-articular dorsally unstable distal radius fracture, treated with volar locking plate system, was created. The 18 specimens were randomized into 3 groups based on distal locked screws with different length: Group A had unicortical screws with 50% length to the dorsal cortex. Group B had unicortical screws with 75% length to the dorsal cortex. Group C had bicortical screws. Axial compression and bending loads were imposed on the models before and after cycling testing as well as load to clinical and catastrophic failure. Results Minimum change in stiffness was observed before and after fatigue for all groups. The final stiffness to bending forces was statistically similar in all groups, but stiffness to axial compression was statistically significant different: Group A approached significance with respect to groups B and C (P = 0.017, 0.009), whereas stiffness in group B and C was statistically similar (P = 0.93). Load to clinical failure was significantly less for group A (456.54±78.59 N) compared with groups B (580.24±73.85 N) and C (591.07±38.40 N). Load to catastrophic failure was statistically similar between groups, but mean values for Group A were 18% less than means for Group C. Conclusions The volar locking plate system fixed with unicortical locking screws with at least 75% length not only produced early stability for osteoporotic distal radius fractures, but also avoided extensor tendon complications due to dorsal screw protrusion. PMID:25080094

  18. Elevated 20-HETE impairs coronary collateral growth in metabolic syndrome via endothelial dysfunction.

    PubMed

    Joseph, Gregory; Soler, Amanda; Hutcheson, Rebecca; Hunter, Ian; Bradford, Chastity; Hutcheson, Brenda; Gotlinger, Katherine H; Jiang, Houli; Falck, John R; Proctor, Spencer; Schwartzman, Michal Laniado; Rocic, Petra

    2017-03-01

    Coronary collateral growth (CCG) is impaired in metabolic syndrome (MetS). microRNA-145 (miR-145-Adv) delivery to our rat model of MetS (JCR) completely restored and neutrophil depletion significantly improved CCG. We determined whether low endogenous levels of miR-145 in MetS allowed for elevated production of 20-hydroxyeicosatetraenoic acid (20-HETE), which, in turn, resulted in excessive neutrophil accumulation and endothelial dysfunction leading to impaired CCG. Rats underwent 0-9 days of repetitive ischemia (RI). RI-induced cardiac CYP4F (neutrophil-specific 20-HETE synthase) expression and 20-HETE levels were increased (4-fold) in JCR vs. normal rats. miR-145-Adv and 20-HETE antagonists abolished and neutrophil depletion (blocking antibodies) reduced (~60%) RI-induced increases in CYP4F expression and 20-HETE production in JCR rats. Impaired CCG in JCR rats (collateral-dependent blood flow using microspheres) was completely restored by 20-HETE antagonists [collateral-dependent zone (CZ)/normal zone (NZ) flow ratio was 0.76 ± 0.07 in JCR + 20-SOLA, 0.84 ± 0.05 in JCR + 20-HEDGE vs. 0.11 ± 0.02 in JCR vs. 0.84 ± 0.03 in normal rats]. In JCR rats, elevated 20-HETE was associated with excessive expression of endothelial adhesion molecules and neutrophil infiltration, which were reversed by miR-145-Adv. Endothelium-dependent vasodilation of coronary arteries, endothelial nitric oxide synthase (eNOS) Ser1179 phosphorylation, eNOS-dependent NO(·-) production and endothelial cell survival were compromised in JCR rats. These parameters of endothelial dysfunction were completely reversed by 20-HETE antagonism or miR-145-Adv delivery, whereas neutrophil depletion resulted in partial reversal (~70%). We conclude that low miR-145 in MetS allows for increased 20-HETE, mainly from neutrophils, which compromises endothelial cell survival and function leading to impaired CCG. 20-HETE antagonists could provide viable therapy for restoration of CCG in MetS.NEW & NOTEWORTHY

  19. Hemodynamic contribution of transdural collateral flow in adult patients with moyamoya disease.

    PubMed

    Hong, Ji Man; Hong, Yoon Hee; Lee, Seong-Joon; Lee, Sung Eun; Lee, Jin Soo; Shin, Dong Hoon

    2016-12-01

    To evaluate the hemodynamic contributions of collateral flow in adult patients with moyamoya disease, neurological deterioration or fluctuation during admission, Suzuki grade, various collateral routes, lesion volume, cerebral blood flow (CBF), and their associations were analyzed. Thirty patients (60 cerebral hemispheres, mean age 45 ± 25 years, and 73.3 % female) who were diagnosed with moyamoya disease or syndrome were enrolled over 3 years. Moyamoya stages from each hemisphere were stratified according to the Suzuki's criteria through six-vessel angiography into internal carotid arteries (ICAs), external carotid arteries (ECAs), and vertebral arteries (VAs). Collateral routes were categorized into the circle of Willis, leptomeningeal, and transdural. The volume of ipsilateral infarction was analyzed by magnetic resonance imaging. CBF volume was measured using color-coded duplex sonography. Suzuki's grade was inversely correlated with flow volume of the ICAs (p < 0.001), whereas no association was found with that of the ECAs (p = 0.445) or VAs (p = 0.096). Among hemispheres with ≥ grade 3 (n = 36), patients with transdural ECA collateral flow had less neurological deterioration or fluctuation (0.0 vs. 30.8 %, p = 0.047), smaller lesion volume (2.4 ± 3.6 vs. 27.6 ± 59.3 mL, p = 0.041), lower ICA flow (88.4 ± 45.9 vs. 146.2 ± 121.7 mL/min, p = 0.022), higher ECA flow (205.7 ± 77.7 vs. 135.9 ± 52.7 mL/min, p = 0.046), and a higher ECA/ICA flow volume ratio (31.8 ± 92.8 vs. 1.7 ± 1.9, p = 0.024). Our results suggest that ICA flow volume is inversely correlated with Suzuki grade, and that transdural ECA collaterals appear to be an important detour in adult patients with advanced stage moyamoya disease, suggesting a protector against an impending ischemic attack.

  20. Distal Communication by Chimpanzees (Pan troglodytes): Evidence for Common Ground?

    PubMed Central

    Leavens, David A.; Reamer, Lisa A.; Mareno, Mary Catherine; Russell, Jamie L.; Wilson, Daniel; Schapiro, Steven J.; Hopkins, William D.

    2015-01-01

    van der Goot et al. (2014) proposed that distal, deictic communication indexed the appreciation of the psychological state of a common ground between a signaler and a receiver. In their study, great apes did not signal distally, which they construed as evidence for the human uniqueness of a sense of common ground. This study exposed 166 chimpanzees to food and an experimenter, at an angular displacement, to ask, “Do chimpanzees display distal communication?” Apes were categorized as (a) proximal or (b) distal signalers on each of four trials. The number of chimpanzees who communicated proximally did not statistically differ from the number who signaled distally. Therefore, contrary to the claim by van der Goot et al., apes do communicate distally. PMID:26292996

  1. New concepts in the treatment of distal radius fractures.

    PubMed

    Taras, John S; Ladd, Amy L; Kalainov, David M; Ruch, David S; Ring, David C

    2010-01-01

    Fracture of the distal radius is the type of fracture most commonly seen in emergency departments. The understanding of nonsurgical and surgical care of distal radius fractures is evolving with recently developed methods of fixation. It is worthwhile to review some new methods of treatment, the role of bone grafting and synthetic substitutes, the principles of complex fracture management, and the treatment of common complications of distal radius fractures.

  2. Pitfalls in the application of distal femur plates for fractures.

    PubMed

    Collinge, Cory A; Gardner, Michael J; Crist, Brett D

    2011-11-01

    Despite design features intended to aid the surgeon in restoring proper alignment, malunion and implant-related problems are relatively common after a distal femur fracture treated with plate fixation. This article presents case examples of these problems followed by a discussion of the relevant distal femoral anatomy, design features of modern locked distal femur plating systems, and technical points necessary to avoid malunion and implant-related problems when using these devices.

  3. Ultrasound-Assisted Distal Radius Fracture Reduction

    PubMed Central

    Socransky, Steve; Skinner, Andrew; Bromley, Mark; Smith, Andrew; Anawati, Alexandre; Middaugh, Jeff; Ross, Peter

    2016-01-01

    Introduction Closed reduction of distal radius fractures (CRDRF) is a commonly performed emergency department (ED) procedure. The use of point-of-care ultrasound (PoCUS) to diagnose fractures and guide reduction has previously been described. The primary objective of this study was to determine if the addition of PoCUS to CRDRF changed the perception of successful initial reduction. This was measured by the rate of further reduction attempts based on PoCUS following the initial clinical determination of achievement of best possible reduction. Methods  We performed a multicenter prospective cohort study, using a convenience sample of adult ED patients presenting with a distal radius fracture to five Canadian EDs. All study physicians underwent standardized PoCUS training for fractures. Standard clinically-guided best possible fracture reduction was initially performed. PoCUS was then used to assess the reduction adequacy. Repeat reduction was performed if deemed indicated. A post-reduction radiograph was then performed. Clinician impression of reduction adequacy was scored on a 5 point Likert scale following the initial clinically-guided reduction and following each PoCUS scan and the post-reduction radiograph. Results  There were 131 patients with 132 distal radius fractures. Twelve cases were excluded prior to analysis. There was no significant difference in the assessment of the initial reduction status by PoCUS as compared to the clinical exam (mean score: 3.8 vs. 3.9; p = 0.370; OR 0.89; 95% CI 0.46 to 1.72; p = 0.87). Significantly fewer cases fell into the uncertain category with PoCUS than with clinical assessment (2 vs 12; p = 0.008). Repeat reduction was performed in 49 patients (41.2%). Repeat reduction led to a significant improvement (p < 0.001) in the PoCUS determined adequacy of reduction (mean score: 4.3 vs 3.1; p < 0.001). In this group, the odds ratio for adequate vs. uncertain or inadequate reduction assessment using PoCUS was 12.5 (95% CI 3

  4. Reconstruction of the hepatic artery with the middle colic artery is feasible in distal pancreatectomy with celiac axis resection: A case report

    PubMed Central

    Suzuki, Hideki; Hosouchi, Yasuo; Sasaki, Shigeru; Araki, Kenichiro; Kubo, Norio; Watanabe, Akira; Kuwano, Hiroyuki

    2013-01-01

    Despite the advance of diagnostic modalities, carcinoma in the body and tail of the pancreas are commonly presented at a late stage. With unresectable lesions, long-term survival is extremely rare, and surgery remains the only curative option for pancreatic cancer. An aggressive approach by applying extended distal pancreatectomy with the resection of the celiac axis may increase the resectability and analgesic effect but great care must be taken with the arterial blood supply to the liver and stomach. Sometimes, accidental injury to the pancreatoduodenal artery compromises collateral blood flow and leads to fatal complications. Therefore, knowledge of any alternative restoration of the compromised collateral flow before surgery is essential. The present case report shows a patient with a pancreatic body cancer in whom the splenic, celiac, and common hepatic arteries were involved with the tumor, which extended almost to the root of the gastroduodenal artery. We modified the procedure by reanastomosis between the proper hepatic artery and middle colic artery without vascular graft. The postoperative course was uneventful, and the patient was discharged on postoperative day 19. The patient was immediately free of epigastric and back pain. PMID:23894691

  5. [Post-transplant distal limb syndrome].

    PubMed

    Borghi Torzillo, María Florencia; Bavcar, Paula; Lutfi, Rubén; Díaz, Alberto C

    2017-01-01

    The post-transplant distal limb syndrome is a not well known entity, with a prevalence of 5% in patients with renal transplant. Its diagnosis is based on clinical symptoms, bone scintigraphy and MRI, it has a benign course and the patient recovers without sequel. We present the case of a 37-year-old male, with medical history of hypertension, Berger's disease in 1999 that required dialysis three times a week for four years (2009-2013) and renal transplant in 2013. The patient consults on January 2014 referring severe pain in both feet, with sudden onset; he remembers the exact date of the beginning of the pain and denies trauma, pain prevents ambulation. The bone scintigraphy shows pathological uptake in both feet with no difference between the two. Although there is no treatment for this disease, it has a benign course.

  6. Effects of BRL 38227, sodium nitroprusside and verapamil on collateral perfusion following acute arterial occlusion in the rabbit isolated ear.

    PubMed Central

    Randall, M. D.; Griffith, T. M.

    1992-01-01

    1. We have used an isolated, buffer-perfused, rabbit ear model of acute arterial occlusion to investigate the effects of the nitrovasodilator sodium nitroprusside, the potassium channel activator BRL 38227 (the active (-)-enantiomer of cromakalim) and the calcium antagonist, verapamil, on collateral perfusion in the absence of pharmacological tone. 2. Verapamil was the most potent vasodilator (EC50 = 72.6 +/- 32.0 nM) of 5-hydroxytryptamine/histamine-induced tone in the rabbit isolated perfused ear. Sodium nitroprusside and BRL 38227 were less potent with respective EC50 values of 488 +/- 75 nM and 296 +/- 40 nM. Following inhibition of endothelium-derived relaxing factor (EDRF) synthesis, the potency of BRL 38227 was significantly (P less than 0.001) increased with an EC50 of 55.6 +/- 5.0 nM. 3. BRL 38227 at 500 nM and 3 microM induced substantial increases in collateral perfusion following arterial ligation in the absence of pharmacological tone compared to control. Furthermore 3 microM BRL 38227 completely reversed the attenuation of collateral perfusion which followed inhibition of EDRF synthesis with 100 microM NG-nitro-L-arginine methyl ester (L-NAME). 4. Sodium nitroprusside (500 nM and 3 microM) induced modest improvements in collateral perfusion in the early stages after arterial occlusion. 5. Verapamil did not influence collateral perfusion at either of the concentrations used (50 nM and 3 microM), even though it was a potent vasodilator. 6. The results of this study indicate that BRL 38227, and to a much lesser extent sodium nitroprusside, selectively improve collateral perfusion following arterial occlusion, even in the presence of effects of EDRF on acute collateralization, while verapamil has no effect.(ABSTRACT TRUNCATED AT 250 WORDS) Images Figure 1 PMID:1393264

  7. Three-dimensional in vivo kinematics of the distal radioulnar joint in malunited distal radius fractures.

    PubMed

    Moore, Douglas C; Hogan, Kathleen A; Crisco, Joseph J; Akelman, Edward; Dasilva, Manuel F; Weiss, Arnold-Peter C

    2002-03-01

    How malunion of the distal radius affects the kinematics of the distal radioulnar joint in vivo was evaluated. A novel computed tomography image-based technique was used to quantify radioulnar motion in both wrists of 9 patients who had unilateral malunited distal radius fractures. In the injured wrists dorsal angulation averaged 21 degrees +/- 6 degrees, radial inclination averaged 18 degrees +/- 5 degrees, and radial shortening averaged 21 +/- 3 mm. Clinically, the average range of motion of the injured wrists was 75 degrees +/- 25 degrees pronation and 73 degrees +/- 23 degrees supination. Kinematics of the radius during pronation and supination in the malunited forearms was indistinguishable from that in the uninjured forearms. In both the axis of rotation of the radius passed through the center of the ulnar head, although it shifted slightly ulnar and volar in supination and radial and dorsal during pronation. In contrast to previous in vitro biomechanical findings, there was no dorsovolar radial translation at the extremes of pronation or supination and no translation of the radius along the rotation axis. Soft tissues may play a larger role in limiting function than previously appreciated, and treatment may require correction of altered soft tissue structures as well as any abnormal bone anatomy.

  8. Incidence of distal femoral and distal tibial deformities in infantile and adolescent blount disease.

    PubMed

    Myers, Thomas G; Fishman, Michael K; McCarthy, James J; Davidson, Richard S; Gaughan, John

    2005-01-01

    The purpose of this study was to assess distal femoral and tibial deformity in patients with infantile and adolescent Blount disease. This was a retrospective review of patients at the authors' institution diagnosed with Blount disease. Thirty-eight patients (21 in the infantile group and 17 in the adolescent group) met the study criteria. Measurements of the anatomic lateral distal femoral angle (aLDFA), anatomic lateral distal tibial angle (aLDTA), and tibiofemoral angle (TFA) were made from long-leg radiographs. The results of the infantile and adolescent measurements were compared with each other and to a normal database. Intraobserver and interobserver error was determined. The adolescent aLDFA measurements were significantly greater (more varus) than for the infantile group and normal database. The aLDTA (ankle) measurements were not statistically different between the two groups, or from the normal database. Analysis of both intraobserver and interobserver error for the aLDFA and aLDTA showed good reliability.

  9. Calpain Inhibition Improves Collateral Dependent Perfusion in a Hypercholesterolemic Swine Model of Chronic Myocardial Ischemia

    PubMed Central

    Sabe, Ashraf A.; Potz, Brittany A.; Elmadhun, Nassrene Y.; Liu, Yuhong; Feng, Jun; Abid, M. Ruhul; Abbott, Jinnette D; Senger, Donald R; Sellke, Frank W.

    2015-01-01

    Background Calpain over-expression is implicated in aberrant angiogenesis. We hypothesized that calpain inhibition (CI, MDL28170) would improve collateral perfusion in a swine model with hypercholesterolemia and chronic myocardial ischemia. Methods and Results Yorkshire swine fed a high cholesterol diet for 4 weeks underwent surgical placement of an ameroid constrictor to their left circumflex coronary artery. Three weeks later, animals received either: no drug, high cholesterol control group (HCC; n= 8); low dose CI (0.12 mg/kg; LCI, n= 9); or high dose CI (0.25 mg/kg; HCI, n= 8). The heart was harvested after 5 weeks. There was a trend toward increased right to left collateral vessels on angiography with HCI. Myocardial perfusion in ischemic myocardium significantly improved with HCI at rest and with demand pacing (p = 0.016 and 0.011). Endothelium-dependent microvessel relaxation was significantly improved with LCI (p = 0.001). There was a significant increase in capillary density, with LCI and HCI (p= 0.01 and 0.01), and arteriolar density with LCI (p= 0.001). CI significantly increased several proangiogenic proteins including VEGF (p= 0.02), VEGFR1 (p= 0.003), VEGFR2 (p= 0.003) and talin, a microvascular structural protein (p= 0.0002). There was a slight increase in proteins implicated in endothelial-dependent (NO Mediated) relaxation including ERK, p-ERK and iNOS with CI. Conclusions In the setting of hypercholesterolemia, CI improved perfusion, with a trend toward increased collateralization on angiography and increased capillary and arteriolar densities in ischemic myocardium. CI also improved endothelium-dependent microvessel relaxation and increased expression of proteins implicated in angiogenesis and vasodilatation. PMID:26478238

  10. Dynamic change of collateral flow varying with distribution of regional blood flow in acute ischemic rat cortex

    NASA Astrophysics Data System (ADS)

    Wang, Zhen; Luo, Weihua; Zhou, Fangyuan; Li, Pengcheng; Luo, Qingming

    2012-12-01

    Cerebral blood flow (CBF) is critical for the maintenance of cerebral function by guaranteed constant oxygen and glucose supply to brain. Collateral channels (CCs) are recruited to provide alternatives to CBF to ischemic regions once the primary vessel is occluded during ischemic stroke. However, the knowledge of the relationship between dynamic evolution of collateral flow and the distribution of regional blood flow remains limited. In this study, laser speckle imaging was used to assess dynamic changes of CCs and regional blood flow in a rat cortex with permanent middle cerebral artery occlusion (MCAo). We found that CCs immediately provided blood flow to ischemic territories after MCAo. More importantly, there were three kinds of dynamic changes of CCs during acute stroke: persistent CC, impermanent CC, and transient CC, respectively, related to different distributions of regional blood flow. Although there was the possible occurrence of peri-infarct depolarization (PID) during ischemia, there was no obvious significance about the onset time and duration of CCs between rats with and without PID. These results suggest that the initial arising of CCs does not ensure their persistence, and that collateral flow could be varied with distribution of regional blood flow in acute ischemic stroke, which may facilitate the understanding of collateral recruitment and promote the development of collateral therapeutics in the future.

  11. An intrinsic timer specifies distal structures of the vertebrate limb.

    PubMed

    Saiz-Lopez, Patricia; Chinnaiya, Kavitha; Campa, Victor M; Delgado, Irene; Ros, Maria A; Towers, Matthew

    2015-09-18

    How the positional values along the proximo-distal axis (stylopod-zeugopod-autopod) of the limb are specified is intensely debated. Early work suggested that cells intrinsically change their proximo-distal positional values by measuring time. Recently, however, it is suggested that instructive extrinsic signals from the trunk and apical ectodermal ridge specify the stylopod and zeugopod/autopod, respectively. Here, we show that the zeugopod and autopod are specified by an intrinsic timing mechanism. By grafting green fluorescent protein-expressing cells from early to late chick wing buds, we demonstrate that distal mesenchyme cells intrinsically time Hoxa13 expression, cell cycle parameters and the duration of the overlying apical ectodermal ridge. In addition, we reveal that cell affinities intrinsically change in the distal mesenchyme, which we suggest results in a gradient of positional values along the proximo-distal axis. We propose a complete model in which a switch from extrinsic signalling to intrinsic timing patterns the vertebrate limb.

  12. Surgical management of pancreatic cancer--distal pancreatectomy.

    PubMed

    Parikh, Purvi Y; Lillemoe, Keith D

    2015-02-01

    Distal pancreatectomy is the standard procedure for tumors located in the body and tail of the pancreas. In the last three decades, significant progress has been made with regard to technical aspects as well as perioperative care so that excellent mortality and morbidity rates can be achieved. Recently, there is growing evidence that distal pancreatectomy may be performed laparoscopically in selected patients, offering the advantages of minimally invasive surgery. Unfortunately, the oncologic outcomes for pancreatic adenocarcinoma remain poor, in part due to the late stage of presentation in most patients. We review the history of distal pancreatectomy, discuss current indications for performing this procedure, compare operative techniques in performing distal pancreatectomy, and review both the early complications seen in patients who have undergone a distal pancreatectomy and the long-term metabolic and oncologic outcomes of these patients.

  13. Lateral collateral ligament reconstruction for chronic varus instability of the hallux interphalangeal joint.

    PubMed

    Cho, Jaeho

    2014-01-01

    Chronic varus instability of the hallux interphalangeal joint is a rare injury, and only a few reports of this injury have been published. In some studies, this injury has been related to taekwondo. Taekwondo is an essential martial art in the Korean military. We have described a case of varus instability of the hallux interphalangeal joint in a professional soldier who had practiced taekwondo for 5 years and the surgical outcome after reconstruction of the lateral collateral ligament with the fourth toe extensor tendon.

  14. Post traumatic osteoma of tibial insertion of medial collateral ligament of knee joint

    PubMed Central

    Shanker, V. S.; Gadikoppula, S.; Loeffler, M. D.

    1998-01-01

    Two cases are presented of post traumatic para-articular osteoma developing at the site of tibial attachment of the medial collateral ligament of knee joint. These occurred after injuries sustained while playing football and in one case the ossified mass was treated with surgical excision for unresolved symptoms after conservative measures. A comparison is made with Pellegrini Stieda disease, which is a similar affection of the femoral insertion of the medial ligament of the knee joint. 




 PMID:9562171

  15. Collateral damage-free debridement using 193nm ArF laser

    NASA Astrophysics Data System (ADS)

    Wynne, James J.; Felsenstein, Jerome M.; Trzcinski, Robert; Zupanski-Nielsen, Donna; Connors, Daniel P.

    2011-03-01

    Burn eschar and other necrotic areas of the skin and soft tissue are anhydrous compared to the underlying viable tissue. A 193 nm ArF excimer laser, emitting electromagnetic radiation at 6.4 eV at fluence exceeding the ablation threshold, will debride such necrotic areas. Because such radiation is strongly absorbed by aqueous chloride ions through the nonthermal process of electron photodetachment, debridement will cease when hydrated (with chloride ions) viable tissue is exposed, avoiding collateral damage to this tissue. Such tissue will be sterile and ready for further treatment, such as a wound dressing and/or a skin graft.

  16. Science from Kepler Collateral Data: 50 Kilosecond per Year from 13 Million Star?

    NASA Technical Reports Server (NTRS)

    Kolodziejczak, J. J.; Caldwell, D. A.

    2011-01-01

    As each Kepler frame is read out, light from each star in a CCD column accumulates in successive pixels as they wait for the next row to be read out. This accumulation is the same in the masked rows at the start of the readout and virtual rows at the end of the readout as it is in the science data. A range of these "smear" rows are added together for each long cadence and sent to the ground for calibration purposes. We will introduce and describe this smear collateral data, discuss and demonstrate its potential use for scientific studies exclusive of Kepler calibration,.

  17. The Association between Whole Blood Viscosity and Coronary Collateral Circulation in Patients with Chronic Total Occlusion

    PubMed Central

    Ozcan Cetin, Elif Hande; Balcı, Kevser Gülcihan; Aydin, Selahattin; Ediboglu, Emek; Bayraktar, Muhammed Fatih; Balcı, Mustafa Mücahit; Maden, Orhan; Temizhan, Ahmet; Aydogdu, Sinan

    2016-01-01

    Background and Objectives Coronary collateral circulation (CCC) has been attributed as inborn bypass mechanisms supporting ischemic myocardium. Various factors have been postulated in CCC. Whole blood viscosity (WBV) has been an underappreciated entity despite close relationships between multiple cardiovascular diseases. WBV can be calculated with a validated equation from hematocrit and total plasma protein levels for a low and high shear rate. On the grounds, we aimed to evaluate the association between WBV and CCC in patients with chronic total occlusion. Subjects and Methods A total of 371 patients diagnosed as having at least one major, chronic total occluded coronary artery were included. 197 patients with good CCC (Rentrop 2 and 3) composed the patient group. The poor collateral group consisted of 174 patients (Rentrop grade 0 and 1). Results Patients with poor CCC had higher WBV values for a low-shear rate (LSR) (69.5±8.7 vs. 60.1±9.8, p<0.001) and high-shear rate (HSR) (17.0±2.0 vs. 16.4±1.8, p<0.001) than the good collateral group. Correlation analysis demonstrated a significant negative correlation between the grade of CCC and WBV for LSR (β=0.597, p<0.001) and HSR (β=0.494, p<0.001). WBV for LSR (β=0.476, p<0.001) and HSR (β=0.407, p<0.001) had a significant correlation with the synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score. A multivariate analysis showed that the WBV for both shear rates were independent risk factors of poor CCC (WBV at LSR, OR: 1.362 CI 95%: 1.095-1.741 p<0.001 and WBV at HSR, 1.251 CI 95%: 1.180-1.347 p<0.001). Conclusion WBV has been demonstrated as the overlooked predictor of poor coronary collateralization. WBV seemed to be associated with microvascular perfusion and angiogenesis process impairing CCC development. PMID:27826336

  18. The fundamental theorem of asset pricing under default and collateral in finite discrete time

    NASA Astrophysics Data System (ADS)

    Alvarez-Samaniego, Borys; Orrillo, Jaime

    2006-08-01

    We consider a financial market where time and uncertainty are modeled by a finite event-tree. The event-tree has a length of N, a unique initial node at the initial date, and a continuum of branches at each node of the tree. Prices and returns of J assets are modeled, respectively, by a R2JxR2J-valued stochastic process . In this framework we prove a version of the Fundamental Theorem of Asset Pricing which applies to defaultable securities backed by exogenous collateral suffering a contingent linear depreciation.

  19. A Technique of Superficial Medial Collateral Ligament Reconstruction Using an Adjustable-Loop Suspensory Fixation Device.

    PubMed

    Deo, Shaneel; Getgood, Alan

    2015-06-01

    This report describes superficial medial collateral ligament reconstruction of the knee using a novel method of graft fixation with the ACL Tightrope RT (Arthrex, Naples, FL). After tibial fixation with either a standard interference screw or staple, femoral fixation of the semitendinosus tendon is performed with the adjustable-loop suspensory fixation device, which allows for both initial graft tensioning and re-tensioning after cyclical knee range of motion. This provides the ability for the graft to accommodate for resultant soft-tissue creep and stress relaxation, thereby allowing for optimal soft-tissue tension and reduction in laxity at the end of the procedure.

  20. Rupture of the ulnar collateral ligament of the thumb – a review

    PubMed Central

    2013-01-01

    Skier’s thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier’s thumb. This article provides a review of the relevant anatomy, the correct method of physical examination and the options for additional imaging and treatment with attention to possible pitfalls. PMID:23938194

  1. Rupture of the ulnar collateral ligament of the thumb - a review.

    PubMed

    Mahajan, Mandhkani; Rhemrev, Steven J

    2013-08-12

    Skier's thumb is a partial or complete rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. It is an often-encountered injury and can lead to chronic pain and instability when diagnosed incorrectly. Knowledge of the anatomy and accurate physical examination are essential in the evaluation of a patient with skier's thumb. This article provides a review of the relevant anatomy, the correct method of physical examination and the options for additional imaging and treatment with attention to possible pitfalls.

  2. Elbow ulnar collateral ligament injuries in athletes: Can we improve our outcomes?

    PubMed Central

    Redler, Lauren H; Degen, Ryan M; McDonald, Lucas S; Altchek, David W; Dines, Joshua S

    2016-01-01

    Injury to the ulnar collateral ligament (UCL) most commonly occurs in the overhead throwing athlete. Knowledge surrounding UCL injury pathomechanics continues to improve, leading to better preventative treatment strategies and rehabilitation programs. Conservative treatment strategies for partial injuries, improved operative techniques for reconstruction in complete tears, adjunctive treatments, as well as structured sport specific rehabilitation programs including resistive exercises for the entire upper extremity kinetic chain are all important factors in allowing for a return to throwing in competitive environments. In this review, we explore each of these factors and provide recommendations based on the available literature to improve outcomes in UCL injuries in athletes. PMID:27114930

  3. Pulmonary atresia and ventricular septal defect with aortopulmonary collaterals in an adult dog.

    PubMed

    Tou, Sandra P; Keene, Bruce W; Barker, Piers C A

    2011-12-01

    Pulmonary atresia and ventricular septal defect (PA-VSD) was diagnosed in a 2-year-old castrated male Terrier mix. Transthoracic echocardiography identified a large ventricular septal defect, overriding aorta and severe right ventricular hypertrophy. A main pulmonary artery could not be identified, consistent with pulmonary atresia or persistent truncus arteriosus. Transesophageal echocardiography and angiography confirmed PA-VSD with aortopulmonary collateral circulation arising from the descending thoracic aorta. This case report describes the antemortem diagnosis of the rare congenital defect PA-VSD in an adult dog.

  4. Distal Expression of knotted1 in Maize Leaves Leads to Reestablishment of Proximal/Distal Patterning and Leaf Dissection

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Maize (Zea mays) leaves provide a useful system to study how proximal/distal patterning is established because of the distinct tissues found in the distal blade and the proximal sheath. Several mutants disrupt this pattern, including the dominant knotted1-like homeobox (knox) mutants. knox genes enc...

  5. Review article: problematic proctitis and distal colitis.

    PubMed

    Gionchetti, P; Rizzello, F; Morselli, C; Campieri, M

    2004-10-01

    About two-thirds of patients with ulcerative colitis have an inflammatory involvement distal to the splenic flexure, and therefore may be effectively treated with topical treatment, allowing the delivery of the active drug directly to the site of inflammation and limiting systemic absorption and potential side-effects. Topical aminosalicylate therapy is the most effective approach, and most patients will benefit hugely, provided that the formulation reaches the upper extent of the disease. Therefore, the choice of topical preparation should be based on the proximal extent of the disease and on patient preference. Oral aminosalicylates are less effective than topical therapies; however, a combination of oral and topical aminosalicylates can be successful in refractory patients. Alternatives to aminosalicylates are the new glucocorticoids, budesonide and beclometasone dipropionate, either as enemas or oral formulations (only beclometasone dipropionate). A combination of oral or rectal new glucocorticoids with rectal aminosalicylates should be considered in patients refractory to either approach. When these measures fail, treatment with oral glucocorticoids is necessary. An intensive intravenous steroid regimen is also helpful for patients refractory to oral steroids. Alternative treatments include short-chain fatty acid enemas, nicotine enemas and patches, acetarsol suppositories, ciclosporin enemas and epidermal growth factor enemas. Several factors potentially having a negative impact on therapeutic response include concurrent enteric pathogens, coexistent irritable bowel syndrome, patient nonadherence to therapy, inadequate dosing and duration of therapy, and proximal progression of the disease. Surgical colectomy may be required in those rare patients refractory or intolerant to pharmacotherapy.

  6. Distal interstitial epididymitis in young rats.

    PubMed

    Hoffmann, Guenther; Belote, Duane A; Suttie, Andrew W; Buetow, Bernard S; Muhumuza, Luke

    2015-04-01

    A sporadic, diffuse, interstitial mixed cell epididymitis of unknown etiology was noted in the epididymal cauda and distal corpus of young control Sprague-Dawley (SD) rats. Rats from 2 different suppliers were examined as part of routine toxicology studies. The incidence of this finding was 5/5 (study 1), 2/7 (study 2), and 2/7 (study 3). Although 2 of these studies partially overlapped temporally, none of the affected animals from any study was maintained concurrently with affected animals from any of the other 2 studies, and infectious causes, control article toxicity, or autoimmune processes were considered unlikely etiologies. Inflammation similar to that noted in the epididymides of these young rats was not present in other tissues and was not noted in study cohorts sacrificed at ages older than approximately 11 weeks or in rats of similar age from other concurrent studies. Similar findings were noted sporadically in historical control data, and consequently an age-related finding of unknown etiology and occurring in sporadic clusters is reported in SD rats ≤11 weeks old.

  7. Collateral Damage

    DTIC Science & Technology

    1978-10-01

    prev-ntion of burns (except while swimming, at nudist camps, etc.). Large-area burns which con- tribute directly to letha’ity must be produced under...0 0)V -44-4 0 to *9: j ej 0 r 0 =4-) I I I I--a C - C"O -• -. tot Aanf0 0 30 (atjjqvqoi. 7-37 " •,•; o t " • 0 0. .. 4IU(W4co 0.0 0 -60~ 2~. .) 041

  8. Formation of Collateral Veins in a Graft Pancreas After a Simultaneous Pancreas and Kidney Transplantation: A Case Report.

    PubMed

    Choi, B H; Lee, H Y; Park, Y M; Yang, K H; Ryu, J H; Chu, C W

    2015-09-01

    A graft vein thrombosis is the main cause of early graft failure after pancreas transplantation. We report a case of formation of collateral veins in a graft pancreas after transplant. A 30-year-old woman underwent simultaneous pancreas and kidney transplantation. She was discharged 16 days after the operation with good pancreas and kidney function. A total occlusion of the portal vein was discovered on computed tomography (CT) performed at an outpatient clinic. She had no symptoms or signs of hyperglycemia. Venography was attempted for vein thrombectomy but failed. After 2 weeks of heparinization therapy, the edema disappeared and perfusion of the graft pancreas improved. However, the thrombotic occlusion was not resolved on CT. Arteriography of the Y-graft revealed collateral veins. She was discharged with warfarin. She is currently doing well without any symptoms or signs. This is the first reported case of collateral vein formation in a grafted pancreas after pancreas transplantation.

  9. Traversing and dilating venous collaterals: a useful adjunct in left ventricular electrode placement.

    PubMed

    Abben, Richard P; Chaisson, Gary; Nair, Vinod

    2010-06-01

    In patients receiving cardiac resynchronization therapy (CRT), the left ventricular electrode cannot always be positioned in the preferred lateral or posterolateral locations due to technical factors and anatomic variations in the coronary sinus. Recent reports also suggest that CRT outcomes are improved by pacing the site of latest dyssynchrony and accessing these regions is not always possible. We report the utility of applying a technique described in the interventional literature over the past 3 years, effectively traversing and dilating collateral channels. Our patients demonstrated either no venous targets in the optimal location, or problems accessing this location using a antegrade approach. Subsequently, collaterals supplying this region were traversed with a guidewire using a retrograde approach and dilated with a balloon catheter. In the first case, the pacing electrode was then advanced in similar fashion and successfully positioned in an ideal lateral location. In the second case, the retrograde guidewire was captured with a vascular snare and pulled into a second guiding catheter, allowing appropriate dilatation and stenting of a problematic proximal venous stenosis with resultant facile placement of the pacing electrode. This technique offers a potential alternative to patients with challenging venous anatomy as a method to facilitate optimal CRT outcomes.

  10. Dopaminergic modulation of axon collaterals interconnecting spiny neurons of the rat striatum.

    PubMed

    Guzmán, Jaime N; Hernández, Adán; Galarraga, Elvira; Tapia, Dagoberto; Laville, Antonio; Vergara, Ramiro; Aceves, Jorge; Bargas, José

    2003-10-01

    Dopamine is a critical modulator of striatal function; its absence produces Parkinson's disease. Most cellular actions of dopamine are still unknown. This work describes the presynaptic actions of dopaminergic receptor agonists on GABAergic transmission between neostriatal projection neurons. Axon collaterals interconnect projection neurons, the main axons of which project to other basal ganglia nuclei. Most if not all of these projecting axons pass through the globus pallidus. Thus, we lesioned the intrinsic neurons of the globus pallidus and stimulated neostriatal efferent axons antidromically with a bipolar electrode located in this nucleus. This maneuver revealed a bicuculline-sensitive synaptic current while recording in spiny cells. D1 receptor agonists facilitated whereas D2 receptor agonists depressed this synaptic current. In contrast, a bicuculline-sensitive synaptic current evoked by field stimulation inside the neostriatum was not consistently modulated, in agreement with previous studies. The data are discussed in light of the most recent experimental and modeling results. The conclusion was that inhibition of spiny cells by axon collaterals of other spiny cells is quantitatively important; however, to be functionally important, this inhibition might be conditioned to the synchronized firing of spiny neurons. Finally, dopamine exerts a potentially important role regulating the extent of lateral inhibition.

  11. Shear induced collateral artery growth modulated by endoglin but not by ALK1

    PubMed Central

    Seghers, Leonard; de Vries, Margreet R; Pardali, Evangelia; Hoefer, Imo E; Hierck, Beerend P; ten Dijke, Peter ten; Goumans, Marie Jose; Quax, Paul HA

    2012-01-01

    Transforming growth factor-beta (TGF-β) stimulates both ischaemia induced angiogenesis and shear stress induced arteriogenesis by signalling through different receptors. How these receptors are involved in both these processes of blood flow recovery is not entirely clear. In this study the role of TGF-β receptors 1 and endoglin is assessed in neovascularization in mice. Unilateral femoral artery ligation was performed in mice heterozygous for either endoglin or ALK1 and in littermate controls. Compared with littermate controls, blood flow recovery, monitored by laser Doppler perfusion imaging, was significantly hampered by maximal 40% in endoglin heterozygous mice and by maximal 49% in ALK1 heterozygous mice. Collateral artery size was significantly reduced in endoglin heterozygous mice compared with controls but not in ALK1 heterozygous mice. Capillary density in ischaemic calf muscles was unaffected, but capillaries from endoglin and ALK1 heterozygous mice were significantly larger when compared with controls. To provide mechanistic evidence for the differential role of endoglin and ALK1 in shear induced or ischaemia induced neovascularization, murine endothelial cells were exposed to shear stress in vitro. This induced increased levels of endoglin mRNA but not ALK1. In this study it is demonstrated that both endoglin and ALK1 facilitate blood flow recovery. Importantly, endoglin contributes to both shear induced collateral artery growth and to ischaemia induced angiogenesis, whereas ALK1 is only involved in ischaemia induced angiogenesis. PMID:22436015

  12. Synergistic, collaterally sensitive β-lactam combinations suppress resistance in MRSA

    PubMed Central

    Gonzales, Patrick R.; Pesesky, Mitchell W.; Bouley, Renee; Ballard, Anna; Biddy, Brent A.; Suckow, Mark A.; Wolter, William R.; Schroeder, Valerie A.; Burnham, Carey-Ann D.; Mobashery, Shahriar; Chang, Mayland; Dantas, Gautam

    2015-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most prevalent multidrug-resistant pathogens worldwide, exhibiting increasing resistance to the latest antibiotic therapies. Here we show that the triple β-lactam combination meropenem/piperacillin/tazobactam (ME/PI/TZ) acts synergistically and is bactericidal against MRSA N315 and 72 clinical MRSA isolates in vitro, and clears MRSA N315 infection in a mouse model. ME/PI/TZ suppresses evolution of resistance in MRSA via reciprocal collateral sensitivity of its constituents. We demonstrate that these activities also extend to other carbapenem/penicillin/β-lactamase inhibitor combinations. ME/PI/TZ circumvents the tight regulation of the mec and bla operons in MRSA, the basis for inducible resistance to β-lactam antibiotics. Furthermore, ME/PI/TZ subverts the function of penicillin-binding protein 2a (PBP2a) action via allostery, which we propose as the mechanism for both synergy and collateral sensitivity. Showing similar in vivo activity to linezolid, ME/PI/TZ demonstrates that combinations of older β-lactam antibiotics could be effective against MRSA infections in humans. PMID:26368589

  13. Myeloperoxidase targets oxidative host attacks to Salmonella and prevents collateral tissue damage.

    PubMed

    Schürmann, Nura; Forrer, Pascal; Casse, Olivier; Li, Jiagui; Felmy, Boas; Burgener, Anne-Valérie; Ehrenfeuchter, Nikolaus; Hardt, Wolf-Dietrich; Recher, Mike; Hess, Christoph; Tschan-Plessl, Astrid; Khanna, Nina; Bumann, Dirk

    2017-01-23

    Host control of infections crucially depends on the capability to kill pathogens with reactive oxygen species (ROS). However, these toxic molecules can also readily damage host components and cause severe immunopathology. Here, we show that neutrophils use their most abundant granule protein, myeloperoxidase, to target ROS specifically to pathogens while minimizing collateral tissue damage. A computational model predicted that myeloperoxidase efficiently scavenges diffusible H2O2 at the surface of phagosomal Salmonella and converts it into highly reactive HOCl (bleach), which rapidly damages biomolecules within a radius of less than 0.1 μm. Myeloperoxidase-deficient neutrophils were predicted to accumulate large quantities of H2O2 that still effectively kill Salmonella, but most H2O2 would leak from the phagosome. Salmonella stimulation of neutrophils from normal and myeloperoxidase-deficient human donors experimentally confirmed an inverse relationship between myeloperoxidase activity and extracellular H2O2 release. Myeloperoxidase-deficient mice infected with Salmonella had elevated hydrogen peroxide tissue levels and exacerbated oxidative damage of host lipids and DNA, despite almost normal Salmonella control. These data show that myeloperoxidase has a major function in mitigating collateral tissue damage during antimicrobial oxidative bursts, by converting diffusible long-lived H2O2 into highly reactive, microbicidal and locally confined HOCl at pathogen surfaces.

  14. Transcriptional changes in sensory ganglia associated with primary afferent axon collateral sprouting in spared dermatome model

    PubMed Central

    Harrison, Benjamin J.; Venkat, Gayathri; Hutson, Thomas; Rau, Kristofer K.; Bunge, Mary Bartlett; Mendell, Lorne M.; Gage, Fred H.; Johnson, Richard D.; Hill, Caitlin; Rouchka, Eric C.; Moon, Lawrence; Petruska, Jeffrey C.

    2015-01-01

    Primary afferent collateral sprouting is a process whereby non-injured primary afferent neurons respond to some stimulus and extend new branches from existing axons. Neurons of both the central and peripheral nervous systems undergo this process, which contributes to both adaptive and maladaptive plasticity (e.g., [1], [2], [3], [4], [5], [6], [7], [8], [9]). In the model used here (the “spared dermatome” model), the intact sensory neurons respond to the denervation of adjacent areas of skin by sprouting new axon branches into that adjacent denervated territory. Investigations of gene expression changes associated with collateral sprouting can provide a better understanding of the molecular mechanisms controlling this process. Consequently, it can be used to develop treatments to promote functional recovery for spinal cord injury and other similar conditions. This report includes raw gene expression data files from microarray experiments in order to study the gene regulation in spared sensory ganglia in the initiation (7 days) and maintenance (14 days) phases of the spared dermatome model relative to intact (“naïve”) sensory ganglia. Data has been deposited into GEO (GSE72551). PMID:26697387

  15. Resection Interposition Arthroplasty for Failed Distal Ulna Resections

    PubMed Central

    Papatheodorou, Loukia K.; Rubright, James H.; Kokkalis, Zinon T.; Sotereanos, Dean G.

    2013-01-01

    The major complications of distal ulna resection, the Darrach procedure, are radioulnar impingement and instability. High failure rates have been reported despite published modifications of the Darrach procedure. Several surgical techniques have been developed to treat this difficult problem and to mitigate the symptoms associated with painful convergence and impingement. No technique has demonstrated clinical superiority. Recently, implant arthroplasty of the distal ulna has been endorsed as an option for the management of the symptomatic patient with a failed distal ulna resection. However, there are concerns for implant longevity, especially in young, active adults. Resection interposition arthroplasty relies on interposition of an Achilles tendon allograft between the distal radius and the resected distal ulna. Although this technique does not restore normal mechanics of the distal radioulnar joint, it can prevent painful convergence of the radius on the ulna. Achilles allograft interposition arthroplasty is a safe and highly effective alternative for failed distal ulna resections, especially for young, active patients, in whom an implant or alternative procedure may not be appropriate. PMID:24436784

  16. Proximal and distal muscle fatigue differentially affect movement coordination

    PubMed Central

    Cowley, Jeffrey C.

    2017-01-01

    Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proximal (shoulder flexor) or distal (finger flexor) muscles. Pre/Post changes in trunk, shoulder, elbow, and wrist kinematics were compared to determine how proximal and distal fatigue affected multi-joint movement patterns and variability. Proximal fatigue caused a significant increase (7°, p < 0.005) in trunk lean and velocity, reduced humeral elevation (11°, p < 0.005), and increased elbow flexion (4°, p < 0.01). In contrast, distal fatigue caused small but significant changes in trunk angles (2°, p < 0.05), increased velocity of wrench movement relative to the hand (17°/s, p < 0.001), and earlier wrist extension (4%, p < 0.005). Movement variability increased at proximal joints but not distal joints after both fatigue protocols (p < 0.05). Varying movements at proximal joints may help people adapt to fatigue at either proximal or distal joints. The identified differences between proximal and distal muscle fatigue adaptations could facilitate risk assessment of occupational tasks. PMID:28235005

  17. Unilateral maxillary molar distalization with zygoma-gear appliance.

    PubMed

    Kilkis, Dogan; Bayram, Mehmet; Celikoglu, Mevlut; Nur, Metin

    2012-08-01

    The aim of this study was to present the orthodontic treatment of a 15-year-old boy with a unilateral maxillary molar distalization system, called the zygoma-gear appliance. It consisted of a zygomatic anchorage miniplate, an inner bow, and a Sentalloy closed coil spring (GAC International, Bohemia, NY). A distalizing force of 350 g was used during the distalization period. The unilateral Class II malocclusion was corrected in 5 months with the zygoma-gear appliance. The maxillary left first molar showed distalization of 4 mm with an inclination of 3°. The maxillary premolars moved distally with the help of the transseptal fibers. In addition, there were slight decreases in overjet (-0.5 mm) and maxillary incisor inclination (-1°), indicating no anchorage loss from the zygoma-gear appliance. Preadjusted fixed appliances (0.022 × 0.028-in, MBT system; 3M Unitek, Monrovia, Calif) were placed in both arches to achieve leveling and alignment. After 14 months of unilateral distalization with the zygoma-gear appliance and fixed appliances, Class I molar and canine relationships were established with satisfactory interdigitation of the posterior teeth. Acceptable overjet and overbite were also achieved. This article shows that this new system, the zygoma-gear appliance, can be used for unilateral maxillary molar distalization without anchorage loss.

  18. Hybrid Coronary Artery Revascularization for Takayasu Arteritis with Major Visceral Collateral Circulation from the Left Internal Thoracic Artery

    PubMed Central

    Sim, Hyung Tae; Kim, Jeong-Won; Yoo, Jae Suk; Cho, Kwang Ree

    2017-01-01

    Coronary arterial involvement in Takayasu arteritis (TA) is not uncommon. Herein, we describe a case of TA with celiac trunk and superior mesenteric artery occlusion combined with coronary artery disease. Bilateral huge internal thoracic arteries (ITAs) and the inferior mesenteric artery provided the major visceral collateral circulation. After percutaneous intervention to the right coronary artery, off-pump coronary artery bypass grafting for the left coronary territory was done using a right ITA graft and its large side branch because of its relatively minor contribution to the visceral collateral circulation. PMID:28382269

  19. An Asian Perspective on the Management of Distal Radius Fractures

    PubMed Central

    Sebastin, Sandeep J.; Chung, Kevin C.

    2012-01-01

    Synopsis There is little data with regards to the epidemiology, pathology, or management of distal radius fractures from centers in Asia. Asia includes five advanced economies, namely Hong Kong SAR, Japan, Korea, Singapore, and Taiwan and a number of emerging economies prominent among which are China, India, Malaysia, Philippines, and Thailand. This article examines the available epidemiological data from Asia, and compares the management of distal radius fractures in the advanced and emerging Asian economies and how they match up to the current management in the west. It concludes by offering solutions for improving outcomes of distal radius fractures in both the advanced and emerging economies of Asia. PMID:22554658

  20. Hyperammonaemia in a child with distal renal tubular acidosis.

    PubMed

    Seracini, D; Poggi, G M; Pela, I

    2005-11-01

    A 5-month-old girl with distal renal tubular acidosis (RTA) and hyperammonaemia that had lasted for 12 days, despite metabolic acidosis correction, is presented in this report. The patient showed failure to thrive, poor feeding, hypotonia and vomiting crisis in absence of inborn errors of metabolism. Probably, hyperammonaemia was the result of an imbalance between the increased ammonia synthesis, in response to metabolic acidosis, and the impaired ammonia excretion, typical of distal RTA. Our case confirms that hyperammonaemia may be observed in distal RTA, mimicking an inborn error of metabolism, and it underlines that hyperammonaemia may persist several days after metabolic acidosis correction.

  1. Two-wave propagation in in vitro swine distal ulna

    NASA Astrophysics Data System (ADS)

    Mano, Isao; Horii, Kaoru; Matsukawa, Mami; Otani, Takahiko

    2015-07-01

    Ultrasonic transmitted waves were obtained in an in vitro swine distal ulna specimen, which mimics a human distal radius, that consists of interconnected cortical bone and cancellous bone. The transmitted waveforms appeared similar to the fast waves, slow waves, and overlapping fast and slow waves measured in the specimen after removing the surface cortical bone (only cancellous bone). In addition, the circumferential waves in the cortical bone and water did not affect the fast and slow waves. This suggests that the fast-and-slow-wave phenomenon can be observed in an in vivo human distal radius.

  2. Computational Modeling of Distal Protection Filters

    PubMed Central

    Siewiorek, Gail M.; Finol, Ender A.

    2010-01-01

    Purpose: To quantify the relationship between velocity and pressure gradient in a distal protection filter (DPF) and to determine the feasibility of modeling a DPF as a permeable surface using computational fluid dynamics (CFD). Methods: Four DPFs (Spider RX, FilterWire EZ, RX Accunet, and Emboshield) were deployed in a single tube representing the internal carotid artery (ICA) in an in vitro flow apparatus. Steady flow of a blood-like solution was circulated with a peristaltic pump and compliance chamber. The flow rate through each DPF was measured at physiological pressure gradients, and permeability was calculated using Darcy's equation. Two computational models representing the RX Accunet were created: an actual representation of the filter geometry and a circular permeable surface. The permeability of RX Accunet was assigned to the surface, and CFD simulations were conducted with both models using experimentally derived boundary conditions. Results: Spider RX had the largest permeability while RX Accunet was the least permeable filter. CFD modeling of RX Accunet and the permeable surface resulted in excellent agreement with the experimental measurements of velocity and pressure gradient. However, the permeable surface model did not accurately reproduce local flow patterns near the DPF deployment site. Conclusion: CFD can be used to model DPFs, yielding global flow parameters measured with bench-top experiments. CFD models of the detailed DPF geometry could be used for “virtual testing” of device designs under simulated flow conditions, which would have potential benefits in decreasing the number of design iterations leading up to in vivo testing. PMID:21142490

  3. Distal Pancreatectomy With En Bloc Resection of the Celiac Trunk for Extended Pancreatic Tumor Disease: An Interdisciplinary Approach

    SciTech Connect

    Denecke, Timm; Andreou, Andreas; Podrabsky, Petr; Grieser, Christian; Warnick, Peter; Bahra, Marcus; Klein, Fritz; Hamm, Bernd; Neuhaus, Peter; Glanemann, Matthias

    2011-10-15

    Purpose: Infiltration of the celiac trunk by adenocarcinoma of the pancreatic body has been considered a contraindication for surgical treatment, thus resulting in a very poor prognosis. The concept of distal pancreatectomy with resection of the celiac trunk offers a curative treatment option but implies the risk of relevant hepatic or gastric ischemia. We describe initial experiences in a small series of patients with left celiacopancreatectomy with or without angiographic preconditioning of arterial blood flow to the stomach and the liver. Materials and Methods: Between January 2007 and October 2009, six patients underwent simultaneous resection of the celiac trunk for adenocarcinoma of the pancreatic body involving the celiac axis. In four of these cases, angiographic occlusion of the celiac trunk before surgery was performed to enhance collateral flow from the gastroduodenal artery. Radiologic and surgical procedures, findings, and outcome were analyzed retrospectively. Results: Complete tumor removal (R0) succeeded in two patients, whereas four patients underwent R1-tumor resection. After surgery, one of the two patients without angiographic preparation experienced an ischemic stomach perforation 1 week after surgery. The other patient died from severe bleeding from an ischemic gastric ulcer. Of the four patients with celiac trunk embolization, none presented ischemic complications after surgery. Mean survival was 371 days. Conclusion: In this small series, ischemic complications after celiacopancreatectomy occurred only in those patients who did not receive preoperative celiac trunk embolization.

  4. Combined open proximal and stent-graft distal repair for distal arch aneurysms: an alternative to total debranching.

    PubMed

    Zierer, Andreas; Sanchez, Luis A; Moon, Marc R

    2009-07-01

    We present herein a novel, combined, simultaneous open proximal and stent-graft distal repair for complex distal aortic arch aneurysms involving the descending aorta. In the first surgical step, the transverse arch is opened during selective antegrade cerebral perfusion, and a Dacron graft (DuPont, Wilmington, DE) is positioned down the descending aorta in an elephant trunk-like fashion with its proximal free margin sutured circumferentially to the aorta just distal to the left subclavian or left common carotid artery. With the graft serving as the new proximal landing zone, subsequent endovascular repair is performed antegrade during rewarming through the ascending aorta.

  5. Distal Renal Tubular Acidosis in Infancy: A Bicarbonate Wasting State

    ERIC Educational Resources Information Center

    Rodriguez-Soriano, J.; And Others

    1975-01-01

    Studied were three unrelated infants with distal renal tubular acidosis (a condition characterized by an inability to acidify the urine to minimal pH levels resulting in the loss of bicarbonates). (DB)

  6. Distal femoral osteotomy using a novel deformity reduction device.

    PubMed

    Panichi, Enrico; Cappellari, Fulvio; Olimpo, Matteo; Piras, Lisa A; Radasch, Robert; Ferretti, Antonio; Peirone, Bruno

    2016-09-20

    Distal femoral osteotomy is a surgical procedure used to correct patellar luxation, secondary to a femoral deformity. A distal femoral osteotomy using the tibial plateau levelling osteotomy-jig to temporarily provide stability of the distal femoral osteotomy, maintaining limb alignment in the frontal and axial planes prior to internal plate fixation of the osteotomy, has been described. This report describes a novel jig named Deformity Reduction Device (DRD). This device was developed with the specific aim of increasing precision and predictability during corrective osteotomy execution in order to be consistent with the preoperative planning. The distal femoral osteotomy DRD-assisted procedure is described in detail, discussing the theoretical and practical principles of the application.

  7. Differential permeability of the proximal and distal rabbit small bowel

    PubMed Central

    Ross, Allan; Rubin, Allen W.; Deren, Julius J.

    1972-01-01

    The permeability of the proximal and distal rabbit intestine for two to six carbon polyhydric alcohols was compared. Intestinal segments were mounted in chambers that permitted the measurement of the unidirectional flux across the brush border membrane. For both proximal and distal intestine, the permeability for a series of polyhydric alcohols decreased with increasing size. The proximal intestine was more permeable for four, five, and six carbon polyhydric alcohols than distal intestine. This regional permeability difference can be attributed to variations in the permeability characteristics of the brush border specifically. The uptake of alcohols was nonsaturable and was not inhibited by phlorizine or n-ethylmaleimide. The results are compatible with the concept that the brush border membrane has properties similar to artificial porous membranes and that the equivalent radius of the pores of the proximal intestine exceeds that of the distal gut. PMID:4639025

  8. Endovascular Treatment of Basilar Artery Aneurysms Associated with Distal Fenestration

    PubMed Central

    Juszkat, R.; Nowak, S.; Moskal, J.; Kociemba, W.; Zarzecka, A.

    2009-01-01

    Summary Segmental non-fusion of the basilar artery results from failed fusion of the neural arteries and from regression of the bridging arteries that connect the longitudinal arteries. This condition is associated with aneurysm formation in 7% of cases. Distally unfused arteries with associated aneurysms are very rare. We report on a case of successful endovascular treatment of an aneurysm of the distally unfused basilar trunk. PMID:20465939

  9. Comparison of Chevron and Distal Oblique Osteotomy for Bunion Correction.

    PubMed

    Scharer, Brandon M; DeVries, J George

    2016-01-01

    The chevron osteotomy is a standard procedure by which bunions are corrected. One of us routinely performs a distal oblique osteotomy, which, to the best of our knowledge, has not been described for the correction of bunion deformities. The purpose of the present study was to compare the short- and medium-term results of the distal oblique and chevron osteotomies for bunion correction. We performed a retrospective clinical and radiographic comparison of patients who had undergone a distal oblique or chevron osteotomy for the correction of bunion deformity. In addition, a prospective patient satisfaction survey was undertaken. A total of 55 patients were included in the present study and were treated from January 2012 to November 2014. Of the 55 patients, 27 (49.2%) were in the chevron group and 28 (50.8%) in the distal oblique group. Radiographically, no statistically significant difference was found between the 2 groups with respect to postoperative first intermetatarsal angle (p < .0001) and hallux valgus angle (p < .0001), but a greater change was found in the intermetatarsal angle in the distal oblique group (p = .467). Prospective patient satisfaction scores were available for 33 patients (60%), 16 (29%) in the chevron group and 17 (31%) in the distal oblique group. When converting the satisfaction score to a numerical score, the chevron group scored 3.3 ± 1.1 and the distal oblique group scored 3.2 ± 0.8 (p = .812). We found that the distal oblique osteotomy used in the present study is simple and reliable and showed radiographic correction and patient satisfaction equivalent to those in the chevron osteotomy.

  10. Transient Distal Renal Tubular Acidosis in Organophosphate Poisoning

    PubMed Central

    Narayan, Ram; Abdulla, Mansoor C.; Alungal, Jemshad

    2017-01-01

    Renal complications due to organophosphate poisoning are very rare. We are presenting a unique case of transient distal renal tubular acidosis due to organophosphate poisoning, which to the best of our knowledge is the first of its kind. An elderly female after deliberate self-harm with ingestion of chlorpyrifos had multiple ventricular arrhythmias due to hypokalemia secondary to distal renal tubular acidosis which improved completely after treatment.

  11. Split cord malformation type I distal to segmental myelomeningocele

    PubMed Central

    Addas, Bassam M.

    2014-01-01

    The coexistence of myelomeningocele (MMC) and split cord malformation (SCM) is a well-known phenomenon. The SCM is usually above or at the level of the MMC. Split cord malformation distal to the MMC is considered to be the rarest form of such a combination. We report a case of SCM (type I) distal to the MMC diagnosed pre-operatively. Repair of the MMC and the SCM were carried out in the same setting. PMID:25551117

  12. Distal airway dysfunction identifies pulmonary inflammation in asymptomatic smokers

    PubMed Central

    Berger, Kenneth I.; Pradhan, Deepak R.; Goldring, Roberta M.; Oppenheimer, Beno W.; Rom, William N.

    2016-01-01

    Smoking induced inflammation leads to distal airway destruction. However, the relationship between distal airway dysfunction and inflammation remains unclear, particularly in smokers prior to the development of airway obstruction. Seven normal controls and 16 smokers without chronic obstructive pulmonary disease (COPD) were studied. Respiratory function was assessed using the forced oscillation technique (FOT). Abnormal FOT was defined as elevated resistance at 5 Hz (R5). Parameters reflecting distal lung function included frequency dependence of resistance (R5–20) and dynamic elastance (X5). Inflammation was quantified in concentrated bronchoalveolar lavage utilising cell count differential and cytokines expressed as concentration per mL epithelial lining fluid. All control subjects and seven smokers had normal R5. Nine smokers had elevated R5 with abnormal R5–20 and X5, indicating distal lung dysfunction. The presence of abnormal FOT was associated with two-fold higher lymphocyte and neutrophil counts (p<0.025) and with higher interleukin (IL)-8, eotaxin and fractalkine levels (p<0.01). Reactivity of R5–20 and X5 correlated with levels of IL-8, eotaxin, fractalkine, IL-12p70 and transforming growth factor-α (r>0.47, p<0.01). Distal airway dysfunction in smokers without COPD identifies the presence of distal lung inflammation that parallel reported observations in established COPD. These findings were not evident on routine pulmonary function testing and may allow the identification of smokers at risk of progression to COPD. PMID:27995132

  13. Distal attribution and distance perception in sensory substitution

    PubMed Central

    Siegle, Joshua H.; Warren, William H.

    2013-01-01

    In sensory substitution, the user may be directly aware of distal objects, as in everyday perception, or make explicit cognitive inferences based on an awareness of the proximal stimulation. Anecdotal evidence supports the experience of distal attribution, but so far there have been few rigorous experimental tests of the claim. In this study, blindfolded participants observed a target light using a device consisting of a finger-mounted photodiode that drives tactile vibration on the back. With the blindfold off and the target removed, participants moved a reference object to match the perceived egocentric distance of the target. Participants who were instructed to attend to the distal target improved significantly during two hours of practice, whereas those instructed to attend to proximal variables showed no improvement. Unsigned error increased with ratings of proximal attention but decreased with ratings of target object solidity, consistent with distal attribution. Performance transferred to the non-dominant arm and to a rotated body orientation, demonstrating that learning did not depend on a joint-specific sensorimotor relationship between target distance and arm configuration. The results experimentally confirm that distal attribution can occur in sensory substitution, based on a perceptual strategy rather than an explicit cognitive strategy. Moreover, they suggest that the informational basis for distal attribution is not a joint-specific sensorimotor relation, but a more abstract spatial invariant. PMID:20402243

  14. Distal airway dysfunction identifies pulmonary inflammation in asymptomatic smokers.

    PubMed

    Berger, Kenneth I; Pradhan, Deepak R; Goldring, Roberta M; Oppenheimer, Beno W; Rom, William N; Segal, Leopoldo N

    2016-10-01

    Smoking induced inflammation leads to distal airway destruction. However, the relationship between distal airway dysfunction and inflammation remains unclear, particularly in smokers prior to the development of airway obstruction. Seven normal controls and 16 smokers without chronic obstructive pulmonary disease (COPD) were studied. Respiratory function was assessed using the forced oscillation technique (FOT). Abnormal FOT was defined as elevated resistance at 5 Hz (R5). Parameters reflecting distal lung function included frequency dependence of resistance (R5-20) and dynamic elastance (X5). Inflammation was quantified in concentrated bronchoalveolar lavage utilising cell count differential and cytokines expressed as concentration per mL epithelial lining fluid. All control subjects and seven smokers had normal R5. Nine smokers had elevated R5 with abnormal R5-20 and X5, indicating distal lung dysfunction. The presence of abnormal FOT was associated with two-fold higher lymphocyte and neutrophil counts (p<0.025) and with higher interleukin (IL)-8, eotaxin and fractalkine levels (p<0.01). Reactivity of R5-20 and X5 correlated with levels of IL-8, eotaxin, fractalkine, IL-12p70 and transforming growth factor-α (r>0.47, p<0.01). Distal airway dysfunction in smokers without COPD identifies the presence of distal lung inflammation that parallel reported observations in established COPD. These findings were not evident on routine pulmonary function testing and may allow the identification of smokers at risk of progression to COPD.

  15. Incidence and predictors for the development of significant supradiaphragmatic decompressing venous collateral channels following creation of Fontan physiology.

    PubMed

    Weber, H S

    2001-05-01

    The occurrence of supradiaphragmatic decompressing venous collateral channels following construction of a bidirectional cavopulmonary connection or completion of the Fontan operation resulting in abnormal systemic hypoxemia has been infrequently described. In addition, the incidence and predictors of these channels have not been well delineated, especially in those patients without formation of such structures preoperatively. I evaluated, retrospectively, 40 patients who had undergone either construction of a bidirectional cavopulmonary shunt or completion of the Fontan operation, and who had complete pre and postoperative hemodynamic and angiographic data. Of the patients, 17 (43%) had developed a total of 21 decompressing venous collateral channels, of which 7 (18%) were considered to be hemodynamically significant requiring transcatheter coil occlusion. Of all variables examined, seven patients with significant decompressing collaterals had a greater transpulmonary gradient at follow-up catheterization (8 +/- 2 vs 5 +/- 2 mmHg, p=.01) and lower systemic saturations at routine clinical follow-up visits (82 +/- 5 vs 89 +/- 5 mmHg, p =.007) in comparison to the 33 others. When not evident preoperatively, decompressing venous collateral channels develop in a significant number of patients following conversion to Fontan physiology. If sufficiently large, they may produce lower than expected systemic saturations for the observed cardiac physiology. The larger decompressing channels are more likely to occur when a greater transpulmonary gradient exists postoperatively, which may require cardiac catheterization and transcatheter coil occlusion.

  16. Somatic membrane potential and Kv1 channels control spike repolarization in cortical axon collaterals and presynaptic boutons.

    PubMed

    Foust, Amanda J; Yu, Yuguo; Popovic, Marko; Zecevic, Dejan; McCormick, David A

    2011-10-26

    The shape of action potentials invading presynaptic terminals, which can vary significantly from spike waveforms recorded at the soma, may critically influence the probability of synaptic neurotransmitter release. Revealing the conductances that determine spike shape in presynaptic boutons is important for understanding how changes in the electrochemical context in which a spike is generated, such as subthreshold depolarization spreading from the soma, can modulate synaptic strength. Utilizing recent improvements in the signal-to-noise ratio of voltage-sensitive dye imaging in mouse brain slices, we demonstrate that intracortical axon collaterals and en passant presynaptic terminals of layer 5 pyramidal cells exhibit a high density of Kv1 subunit-containing ion channels, which generate a slowly inactivating K(+) current critically important for spike repolarization in these compartments. Blockade of the current by low doses of 4-aminopyridine or α-dendrotoxin dramatically slows the falling phase of action potentials in axon collaterals and presynaptic boutons. Furthermore, subthreshold depolarization of the soma broadened action potentials in collaterals bearing presynaptic boutons, an effect abolished by blocking Kv1 channels with α-dendrotoxin. These results indicate that action potential-induced synaptic transmission may operate through a mix of analog-digital transmission owing to the properties of Kv1 channels in axon collaterals and presynaptic boutons.

  17. Editorial Commentary: Chondrocytes Trump Ligaments! Partial Release of the Medial Collateral Ligament During Knee Arthroscopy Protects Chondrocytes.

    PubMed

    Leland, J Martin

    2016-10-01

    With knee arthroscopy being the most common orthopaedic procedure performed in the United States, it is crucial to be able to access the entire knee without iatrogenic injury. Frequently orthopaedic surgeons encounter tight medial compartments, creating difficulty in accessing the posterior horn of the medial meniscus without damaging the articular cartilage. Partial release of the medial collateral ligament during knee arthroscopy protects chondrocytes.

  18. Investigating the Effectiveness of Collateral Information on Small-Sample Equating. Research Report. ETS RR-08-52

    ERIC Educational Resources Information Center

    Kim, Sooyeon; Linvingston, Samuel A.; Lewis, Charles

    2008-01-01

    This paper describes an empirical evaluation of a Bayesian procedure for equating scores on test forms taken by small numbers of examinees, using collateral information from the equating of other test forms. In this procedure, a separate Bayesian estimate is derived for the equated score at each raw-score level, making it unnecessary to specify a…

  19. Trauma resulting in hemarthrosis and long medial collateral ligament desmitis of the tarsocrural joint in a horse

    PubMed Central

    Tokateloff, Nathalie; Carmalt, James; Manning, Stephen

    2011-01-01

    A horse was initially diagnosed with hemarthrosis and desmitis of the long medial collateral ligament of the right tarsus and later developed prominent enthesiophytosis at the site of insertion of the ligament’s deep portion. Hemarthrosis due to intra- or peri-articular pathology can cause recurrent lameness, even without evident external trauma. PMID:22043073

  20. Endothelial-Specific EphA4 Negatively Regulates Native Pial Collateral Formation and Re-Perfusion following Hindlimb Ischemia

    PubMed Central

    Okyere, Benjamin; Giridhar, Kaavya; Hazy, Amanda; Chen, Miao; Keimig, David; Bielitz, Robert C.; Xie, Hehuang; He, Jia-Qiang; Huckle, William R.; Theus, Michelle H.

    2016-01-01

    Leptomeningeal anastomoses play a critical role in regulating vascular re-perfusion following obstruction, however, the mechanisms regulating their development remains under investingation. Our current findings indicate that EphA4 receptor is a novel negative regulator of collaterogenesis. We demonstrate that EphA4 is highly expressed on pial arteriole collaterals at post-natal day (P) 1 and 7, then significantly reduced by P21. Endothelial cell (EC)-specific loss of EphA4, EphA4f/f/Tie2::Cre (KO), resulted in an increase in the density but not diameter of pial collaterals compared to WT mice. ECs isolated from KO mice displayed a 3-fold increase in proliferation, enhanced migration, tube formation and elevated levels of phospho(p)-Akt compared to WT ECs. Attenuating p-Akt, using LY294002, reduced the proliferative and migration effects in the KO ECs. RNAseq analysis also revealed altered expression patterns for genes that regulate cell proliferation, vascular development, extracellular matrix and immune-mediate responses, namely MCP-1, MMP2 and angiopoietin-1. Lastly, we show that induction of hindlimb ischemia resulted in accelerated re-perfusion, collateral remodeling and reduced tissue necrosis in the absence of EC-specific EphA4 compared to WT mice. These findings demonstrate a novel role for EphA4 in the early development of the pial collateral network and suggests a role in regulating vascular remodeling after obstruction. PMID:27467069

  1. A Report on Using General-Case Programming to Teach Collateral Academic Skills to a Student in a Postsecondary Setting

    ERIC Educational Resources Information Center

    Chezan, Laura C.; Drasgow, Erik; Marshall, Kathleen J.

    2012-01-01

    The authors' purpose in this report is to examine the application of general-case programming to teach collateral academic skills to a student with pervasive developmental disorder-not otherwise specified (PDD-NOS) and with a mild intellectual disability who was attending college. The authors use data drawn from their work with Tom to explain and…

  2. Surgical strategy to minimize ischemia during trapping/resection of giant extracranial carotid artery aneurysm stratified by collateral evaluation

    PubMed Central

    Hongo, Hiroki; Inoue, Tomohiro; Tamura, Akira; Saito, Isamu

    2017-01-01

    Background: Extracranial carotid artery aneurysm (ECAA) is a rare clinical entity, and no standard treatment strategy has been established for this condition. Methods: Data from three patients who underwent surgical treatment of enlarging giant ECAAs were retrospectively reviewed. Based on the collateral status, as evaluated by preoperative digital subtraction angiography (DSA), surgical strategy was stratified into (1) high flow bypass followed by cervical ICA (internal carotid artery) ligation, when the collateral status was judged as poor/fair or (2) direct cervical repair with patch application after aneurysmal wall resection when the collateral status was judged as robust. Postoperative results were evaluated by magnetic resonance imaging (MRI). Results: Postoperative follow-up (day 0 to 1, as well as midterm at approximately 6 months) confirmed completely trapped aneurysm with successful robust bypass and robust anterograde flow of the reconstructed cervical carotid artery on magnetic resonance angiography with no additional ischemic lesions on diffusion weighted imaging and T2-weighted imaging when compared with preoperative imaging in all three patients. Postoperatively, there was no stroke event during the midterm follow-up at 6 months. Conclusions: Clinical results of ECAAs treated by a surgical strategy stratified based on collateral status, as evaluated by preoperative DSA, were favorable, without postoperative ischemic event, and with satisfactory mid-term MRI results. PMID:28303208

  3. 13 CFR 120.545 - What are SBA's policies concerning the liquidation of collateral and the sale of business loans...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false What are SBA's policies concerning the liquidation of collateral and the sale of business loans and physical disaster assistance loans, physical disaster business loans and economic injury disaster loans? 120.545 Section 120.545...

  4. 46 CFR 308.525 - Application for decrease in amount of cash collateral fund, Form MA-305.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Application for decrease in amount of cash collateral fund, Form MA-305. 308.525 Section 308.525 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Open Policy War Risk...

  5. 46 CFR 308.526 - Certificate for repayment of decrease of collateral deposit fund, Form MA-306.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 8 2014-10-01 2014-10-01 false Certificate for repayment of decrease of collateral deposit fund, Form MA-306. 308.526 Section 308.526 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE War Risk Cargo Insurance Open Policy War Risk...

  6. [Explanation of essence and substance basis of channels and collaterals with fasciology].

    PubMed

    Wang, Jun; Wang, Chun-lei; Shen, Bao-lin; Yang, Lin-lin; Yuan, Lin

    2007-08-01

    In our research of digital human body, construct of image structures close to the recorder of human channels and collaterals, and trace back to development biology of connective tissue and process of organic evolution, and it is concluded that connective tissue bracket in human body may constitute a new functional system--human self-supervision and control system, meanwhile, we propose a new study field, fasciology. The significance is that it introduces a new functional system in human body and develops new field of scientific research; and it annotate biological foundation and therapeutic mechanisms of traditional Chinese medicine therapy, which provides medical biological foundation for modern channel research of traditional Chinese medicine; it proposes a suggestion for development strategy of traditional Chinese medicine.

  7. The ulnar collateral ligament of the human elbow joint. Anatomy, function and biomechanics.

    PubMed Central

    Fuss, F K

    1991-01-01

    The posterior portion of the ulnar collateral ligament, which arises from the posterior surface of the medial epicondyle, is taut in maximal flexion. The anterior portion, which takes its origin from the anterior and inferior surfaces of the epicondyle, contains three functional fibre bundles. One of these is taut in maximal extension, another in intermediate positions between middle position and full flexion while the third bundle is always taut and serves as a guiding bundle. Movements of the elbow joint are checked by the ligaments well before the bony processes forming the jaws of the trochlear notch lock into the corresponding fossae on the humerus. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:2050566

  8. [Science of Meridians, Collaterals and Acupoints--Exploration on teaching method of meridian syndromes].

    PubMed

    Wang, Yinping; Zhang, Zongquan; Wang, Wenlin; Yuan, Limin

    2015-04-01

    Meridian syndromes are the required basic knowledge for mastering Science of Meridians, Collaterals and Acupoints but have not brought the adequate attention on the teaching program. The writers discovered' that the content of this section occupied a decisive role for developing the students' clinical thinking ability and, stimulating their interests to learn classical TCM theories. It's necessary to enhance the importance on meridian syndromes during teaching program. The teaching program was discussed in three aspects, named workshop pattern, competitive pattern and multimedia pattern. This teaching method may improve students' interests in the study on classical TCM theories, deepen the understanding on knowledge and motivate students' learning autonomy so that the teaching quality can be improved.

  9. Arthroscopic trans-portal deep medial collateral ligament pie-crusting release.

    PubMed

    Atoun, Ehud; Debbi, Ronen; Lubovsky, Omri; Weiler, Andreas; Debbi, Eytan; Rath, Ehud

    2013-02-01

    Arthroscopic treatments of meniscal injuries of the knee are among the most common orthopaedic procedures performed. Adequate visualization of the posterior horn of the medial meniscus might be challenging, especially in patients with tight medial compartments. In these cases instrument manipulation in an attempt to reach the posterior horn of the meniscus can cause an iatrogenic chondral injury because of the narrow medial joint space. A transcutaneous medial collateral ligament (MCL) pie-crusting release facilitates expansion of the medial joint space in a case of a tight medial compartment. Nevertheless, it might cause injury to the superficial MCL, infection, and pain and injury to the saphenous nerve because of multiple needle punctures of the skin. We describe an inside-out, arthroscopic deep MCL pie-crusting release, which allows access to the medial meniscus through the anterior approach to provide good visualization of the footprint and sufficient working space.

  10. Retention of retinal axon collateral is responsible for induced ipsilateral retinotectal projections in adult goldfish.

    PubMed

    Sharma, S C; Tsai, C

    1991-01-01

    In normal goldfish, optic axons innervate only the contralateral optic tectum. When one eye was enucleated and the optic nerve of the other eye crushed, the regenerating optic axons innervated both optic tecta. We studied the presence of bilaterally projecting retinal ganglion cells by double retrograde cell labeling methods using Nuclear Yellow and True Blue dyes. About 10% of the retinal ganglion cells were double labeled and these cells were found throughout the retina. In addition, HRP application to the ipsilateral tectum revealed retrogradely-labeled retinal ganglion cells of all morphological types. These results suggest that induced ipsilateral projections are formed by regenerating axon collaterals and that all cell types are involved in the generation of normal mirror image typography.

  11. Suppression of ischemia in arterial occlusive disease by JNK-promoted native collateral artery development

    PubMed Central

    Ramo, Kasmir; Sugamura, Koichi; Craige, Siobhan; Keaney, John F; Davis, Roger J

    2016-01-01

    Arterial occlusive diseases are major causes of morbidity and mortality. Blood flow to the affected tissue must be restored quickly if viability and function are to be preserved. We report that disruption of the mixed-lineage protein kinase (MLK) - cJun NH2-terminal kinase (JNK) signaling pathway in endothelial cells causes severe blockade of blood flow and failure to recover in the murine femoral artery ligation model of hindlimb ischemia. We show that the MLK-JNK pathway is required for the formation of native collateral arteries that can restore circulation following arterial occlusion. Disruption of the MLK-JNK pathway causes decreased Dll4/Notch signaling, excessive sprouting angiogenesis, and defects in developmental vascular morphogenesis. Our analysis demonstrates that the MLK-JNK signaling pathway is a key regulatory mechanism that protects against ischemia in arterial occlusive disease. DOI: http://dx.doi.org/10.7554/eLife.18414.001 PMID:27504807

  12. Failure of cast immobilization for thumb ulnar collateral ligament avulsion fractures.

    PubMed

    Dinowitz, M; Trumble, T; Hanel, D; Vedder, N B; Gilbert, M

    1997-11-01

    To determine if small avulsion fractures of the thumb ulnar collateral ligament (UCL) with minimal (< or = 2.0 mm) displacement can successfully be treated by cast immobilization, the authors reviewed 9 patients with minimally displaced fractures initially treated by casting. Despite immobilization within an average of 2 days of the initial injury (range, 0-6 days), a minimum of 6 weeks of immobilization in a cast, and adequate rehabilitation, all 9 patients had persistent thumb pain, especially with activities requiring strong pinch. After undergoing open reduction and internal fixation, the patients had relief of thumb pain and pinch strength improved from 36% of the contralateral side to 89% (p < .01). Grip strength increased from 77% to 93% (p < .05), but the ranges of motion of the thumb metacarpophalangeal and interphalangeal joints were not significantly altered. Minimally displaced UCL avulsion fractures frequently have significant rotation that prevents successful fracture healing even with prompt cast immobilization.

  13. Science from Kepler Collateral Data: 50 Kilosecond per Year from 13 Million Stars

    NASA Technical Reports Server (NTRS)

    Kolodziejczak, J. J.; Caldwell, D. A.

    2012-01-01

    As each Kepler frame is read out, light from each star in a CCD column accumulates in successive pixels as they wait for the next row to be read out. This accumulation is the same in the masked rows at the start of the readout and virtual rows at the end of the readout as it is in the science data. A range of these "smear" rows are added together for each long cadence and sent to the ground for calibration purposes. We will introduce and describe this smear collateral data, discuss and demonstrate its potential use for scientific studies exclusive of Kepler calibration,[1,2] including global characteristics of stellar variability, which are influenced by parameters of galactic evolution.

  14. A new surgical technique for medial collateral ligament balancing: multiple needle puncturing.

    PubMed

    Bellemans, Johan; Vandenneucker, Hilde; Van Lauwe, Johan; Victor, Jan

    2010-10-01

    In this article, we present our experience with a new technique for medial soft tissue balancing, where we make multiple punctures in the medial collateral ligament (MCL) using a 19-gauge needle, to progressively stretch the MCL until a correct ligament balance is achieved. Ligament status was evaluated both before and after the procedure using computer navigation and mediolateral stress testing. The procedure was considered successful when 2 to 4-mm mediolateral joint line opening was obtained in extension and 2 to 6 mm in flexion. In 34 of 35 cases, a progressive correction of medial tightness was achieved according to the above described criteria. One case was considered overreleased in extension. Needle puncturing is a new, effective, and safe technique for progressive correction of MCL tightness in the varus knee.

  15. Ovarian Artery Embolization in Patients With Collateral Supply to Symptomatic Uterine Leiomyomata

    SciTech Connect

    Scheurig-Muenkler, C. Poellinger, A. Wagner, M. Hamm, B. Kroencke, T. J.

    2011-12-15

    Purpose: To evaluate the safety and outcome of ovarian artery embolization (OAE) in patients with collateral supply to symptomatic uterine leiomyomata. Materials and Methods: Thirteen patients with relevant leiomyoma perfusion by way of enlarged ovarian arteries underwent additional OAE during the same (N = 10) or a second procedure (N = 3). Uterine artery embolization (UAE) was performed bilaterally in 10 and unilaterally in 2 patients with a single artery. One patient had no typical uterine arteries but bilaterally enlarged ovarian arteries, prompting bilateral OAE. OAE was accomplished with coil embolization in one and particle embolization in 12 patients. Symptoms before therapy and clinical outcome were assessed using a standardized questionnaire. Contrast-enhanced magnetic resonance (MR) imaging after embolization was available in 11 of 13 patients and was used to determine the percentage of fibroid infarction. Results: UAE and OAE were technically successful in all patients. One patient experienced prolonged irritation at the puncture site. Median clinical follow-up time was 16 months (range 4-37). Ten of 13 patients showed improvement or complete resolution of clinical symptoms. One patient reported only slight improvement of her symptoms. These women presented with regular menses. Two patients (15%), 47 and 48 years, both with unilateral OAE, reported permanent amenorrhea directly after embolization. Their symptoms completely resolved. Seven patients showed complete and 4 showed >90% fibroid infarction after embolization therapy. Conclusions: OAE is technically safe and effective in patients with ovarian artery collateral supply to symptomatic uterine leiomyomata. The risk of permanent amenorrhea observed in this study is similar to the reported incidence after UAE.

  16. Redox-sensitive Akt and Src regulate coronary collateral growth in metabolic syndrome.

    PubMed

    Reed, Ryan; Potter, Barry; Smith, Erika; Jadhav, Rashmi; Villalta, Patricia; Jo, Hanjoong; Rocic, Petra

    2009-06-01

    We have recently shown that the inability of repetitive ischemia (RI) to activate p38 MAPK (p38) and Akt in metabolic syndrome [JCR:LA-cp (JCR)] rats was associated with impaired coronary collateral growth (CCG). Furthermore, Akt and p38 activation correlated with optimal O(2)(-). levels and were altered in JCR rats, and redox-sensitive p38 activation was required for CCG. Here, we determined whether the activation of Src, a possible upstream regulator, was altered in JCR rats and whether redox-dependent Src and Akt activation were required for CCG. CCG was assessed by myocardial blood flow (microspheres) and kinase activation was assessed by Western blot analysis in the normal zone and collateral-dependent zone (CZ). RI induced Src activation (approximately 3-fold) in healthy [Wistar-Kyoto (WKY)] animals but not in JCR animals. Akt inhibition decreased (approximately 50%), and Src inhibition blocked RI-induced CCG in WKY rats. Src inhibition decreased p38 and Akt activation. Myocardial oxidative stress (O(2)(-). and oxidized/reduced thiols) was measured quantitatively (X-band electron paramagnetic resonance). An antioxidant, apocynin, reduced RI-induced oxidative stress in JCR rats to levels induced by RI in WKY rats versus the reduction in WKY rats to very low levels. This resulted in a significant restoration of p38 (approximately 80%), Akt (approximately 65%), and Src (approximately 90%) activation in JCR rats but decreased the activation in WKY rats (p38: approximately 45%, Akt: approximately 65%, and Src: approximately 100%), correlating with reduced CZ flow in WKY rats (approximately 70%), but significantly restored CZ flow in JCR rats (approximately 75%). We conclude that 1) Akt and Src are required for CCG, 2) Src is a redox-sensitive upstream regulator of RI-induced p38 and Akt activation, and 3) optimal oxidative stress levels are required for RI-induced p38, Akt, and Src activation and CCG.

  17. Nerve Growth Factor Promotes Reorganization of the Axonal Microtubule Array at Sites of Axon Collateral Branching

    PubMed Central

    Ketschek, Andrea; Jones, Steven; Spillane, Mirela; Korobova, Farida; Svitkina, Tatyana; Gallo, Gianluca

    2015-01-01

    The localized debundling of the axonal microtubule array and the entry of microtubules into axonal filopodia are two defining features of collateral branching. We report that nerve growth factor (NGF), a branch inducing signal, increases the frequency of microtubule debundling along the axon shaft of chicken embryonic sensory neurons. Sites of debundling correlate strongly with the localized targeting of microtubules into filopodia. Platinum replica electron microscopy suggests physical interactions between debundled microtubules and axonal actin filaments. However, as evidenced by depolymerization of actin filaments and inhibition of myosin II, actomyosin force generation does not promote debundling. In contrast, loss of actin filaments or inhibition of myosin II activity promotes debundling, indicating that axonal actomyosin forces suppress debundling. MAP1B is a microtubule associated protein that represses axon branching. Following treatment with NGF, microtubules penetrating filopodia during the early stages of branching exhibited lower levels of associated MAP1B. NGF increased and decreased the levels of MAP1B phosphorylated at a GSK-3β site (pMAP1B) along the axon shaft and within axonal filopodia, respectively. The levels of MAP1B and pMAP1B were not altered at sites of debundling, relative to the rest of the axon. Unlike the previously determined effects of NGF on the axonal actin cytoskeleton, the effects of NGF on microtubule debundling were not affected by inhibition of protein synthesis. Collectively, these data indicate that NGF promotes localized axonal microtubule debundling, that actomyosin forces antagonize microtubule debundling and that NGF regulates pMAP1B in axonal filopodia during the early stages of collateral branch formation. PMID:25846486

  18. Genomic deletion of malic enzyme 2 confers collateral lethality in pancreatic cancer.

    PubMed

    Dey, Prasenjit; Baddour, Joelle; Muller, Florian; Wu, Chia Chin; Wang, Huamin; Liao, Wen-Ting; Lan, Zangdao; Chen, Alina; Gutschner, Tony; Kang, Yaan; Fleming, Jason; Satani, Nikunj; Zhao, Di; Achreja, Abhinav; Yang, Lifeng; Lee, Jiyoon; Chang, Edward; Genovese, Giannicola; Viale, Andrea; Ying, Haoqiang; Draetta, Giulio; Maitra, Anirban; Wang, Y Alan; Nagrath, Deepak; DePinho, Ronald A

    2017-02-02

    The genome of pancreatic ductal adenocarcinoma (PDAC) frequently contains deletions of tumour suppressor gene loci, most notably SMAD4, which is homozygously deleted in nearly one-third of cases. As loss of neighbouring housekeeping genes can confer collateral lethality, we sought to determine whether loss of the metabolic gene malic enzyme 2 (ME2) in the SMAD4 locus would create cancer-specific metabolic vulnerability upon targeting of its paralogous isoform ME3. The mitochondrial malic enzymes (ME2 and ME3) are oxidative decarboxylases that catalyse the conversion of malate to pyruvate and are essential for NADPH regeneration and reactive oxygen species homeostasis. Here we show that ME3 depletion selectively kills ME2-null PDAC cells in a manner consistent with an essential function for ME3 in ME2-null cancer cells. Mechanistically, integrated metabolomic and molecular investigation of cells deficient in mitochondrial malic enzymes revealed diminished NADPH production and consequent high levels of reactive oxygen species. These changes activate AMP activated protein kinase (AMPK), which in turn directly suppresses sterol regulatory element-binding protein 1 (SREBP1)-directed transcription of its direct targets including the BCAT2 branched-chain amino acid transaminase 2) gene. BCAT2 catalyses the transfer of the amino group from branched-chain amino acids to α-ketoglutarate (α-KG) thereby regenerating glutamate, which functions in part to support de novo nucleotide synthesis. Thus, mitochondrial malic enzyme deficiency, which results in impaired NADPH production, provides a prime 'collateral lethality' therapeutic strategy for the treatment of a substantial fraction of patients diagnosed with this intractable disease.

  19. Ethical responsibilities toward indirect and collateral participants in pragmatic clinical trials.

    PubMed

    Smalley, Jaye Bea; Merritt, Maria W; Al-Khatib, Sana M; McCall, Debbe; Staman, Karen L; Stepnowsky, Carl

    2015-10-01

    Pragmatic clinical trials are designed to inform decision makers about the benefits, burdens, and risks of health interventions in real-world settings. Pragmatic clinical trials often use for research purposes data collected in the course of clinical practice. The distinctive features of pragmatic clinical trials demand fresh thinking about what is required to act properly toward people affected by their conduct, in ways that go beyond ensuring the protection of rights and welfare for "human research subjects" under conventional research ethics regulations. To stimulate such work, we propose to distinguish among categories of research participants in pragmatic clinical trials as follows: Direct participants: (1) individuals being directly intervened upon and/or (2) individuals from whom personal identifiable data are being collected for the purposes of the pragmatic clinical trial. Indirect participants: individuals who are (1) not identified as direct participants and (2) whose rights and welfare may be affected by the intervention through their routine exposure to the environment in which the intervention is being deployed. Collateral participants: patient groups and other stakeholder communities who may be otherwise affected by the occurrence and findings of the pragmatic clinical trial. We illustrate these distinctions with case examples and discuss the distinctive responsibilities of researchers and pragmatic clinical trial leadership toward each type of participant. We suggest that pragmatic clinical trial investigators, institutional review boards, health systems leaders, and others engaged in the research enterprise work together to identify these participants. For indirect participants, risks and benefits to which they are exposed should be weighed to ensure that their rights and welfare are protected accordingly, and communication strategies should be considered to help them make well-informed decisions. Collateral participants could provide input on the

  20. Collateral circulation in ferrets (Mustela putorius) during temporary occlusion of the caudal vena cava.

    PubMed

    Calicchio, Kristina W; Bennett, R Avery; Laraio, Leonard C; Weisse, Chick; Zwingenberger, Allison L; Rosenthal, Karen L; Johnston, Matthew S; Campbell, Vicki L; Solomon, Jeffrey A

    2016-05-01

    OBJECTIVE To determine whether extent of collateral circulation would change during temporary occlusion of the caudal vena cava (CVC) in ferrets (Mustela putorius), a pressure change would occur caudal to the occlusion, and differences would exist between the sexes with respect to those changes. ANIMALS 8 adult ferrets (4 castrated males and 4 spayed females). PROCEDURES Ferrets were anesthetized. A balloon occlusion catheter was introduced through a jugular vein, passed into the CVC by use of fluoroscopy, positioned cranial to the right renal vein, and inflated for 20 minutes. Venography was performed 5 and 15 minutes after occlusion. Pressure in the CVC caudal to the occlusion was measured continuously. A CBC, plasma biochemical analysis, and urinalysis were performed immediately after the procedure and 2 or 3 days later. RESULTS All 8 ferrets survived the procedure; no differences were apparent between the sexes. Vessels providing collateral circulation were identified in all ferrets, indicating blood flow to the paravertebral venous plexus. Complications observed prior to occlusion included atrial and ventricular premature contractions. Complications after occlusion included bradycardia, seizures, and extravasation of contrast medium. Mean baseline CVC pressure was 5.4 cm H2O. During occlusion, 6 ferrets had a moderate increase in CVC pressure (mean, 24.3 cm H2O) and 2 ferrets had a marked increase in CVC pressure to > 55.0 cm H2O. CONCLUSIONS AND CLINICAL RELEVANCE Caval occlusion for 20 minutes was performed in healthy ferrets with minimal adverse effects noted within the follow-up period and no apparent differences between sexes. The CVC pressure during occlusion may be prognostic in ferrets undergoing surgical ligation of the CVC, which commonly occurs during adrenal tumor resection.

  1. Excimer laser debridement of necrotic erosions of skin without collateral damage

    NASA Astrophysics Data System (ADS)

    Wynne, James J.; Felsenstein, Jerome M.; Trzcinski, Robert; Zupanski-Nielsen, Donna; Connors, Daniel P.

    2011-07-01

    Pulsed ArF excimer laser radiation at 6.4 eV, at fluence exceeding the ablation threshold, will debride burn eschar and other dry necrotic erosions of the skin. Debridement will cease when sufficiently moist viable tissue is exposed, due to absorption by aqueous chloride ions (Cl-) through the non-thermal process of electron photodetachment, thereby inhibiting collateral damage to the viable tissue. ArF excimer laser radiation debrides/ablates ~1 micron of tissue with each pulse. While this provides great precision in controlling the depth of debridement, the process is relatively time-consuming. In contrast, XeCl excimer laser radiation debrides ~8 microns of tissue with each pulse. However the 4.0 eV photon energy of the XeCl excimer laser is insufficient to photodetach an electron from a Cl- ion, so blood or saline will not inhibit debridement. Consequently, a practical laser debridement system should incorporate both lasers, used in sequence. First, the XeCl excimer laser would be used for accelerated debridement. When the necrotic tissue is thinned to a predetermined thickness, the ArF excimer laser would be used for very precise and well-controlled debridement, removing ultra-thin layers of material with each pulse. Clearly, the use of the ArF laser is very desirable when debriding very close to the interface between necrotic tissue and viable tissue, where the overall speed of debridement need not be so rapid and collateral damage to viable tissue is undesirable. Such tissue will be sterile and ready for further treatment, such as a wound dressing and/or a skin graft.

  2. Unstable Simple Elbow Dislocation Treated with the Repair of Lateral Collateral Ligament Complex

    PubMed Central

    Yi, Jin Woong; Lee, Jung Bum; Lee, Dae Hee; Park, Won Keun; Kim, Sun Joong

    2015-01-01

    Background Unstable simple elbow dislocation (USED) repair is challenged by the maintenance of joint reduction; hence, primary repair or reconstruction of disrupted ligaments is required to maintain the congruency and allow early motion of the elbow. We evaluated the effectiveness and the outcome of lateral collateral ligament (LCL) complex repair with additional medial collateral ligament (MCL) repair in cases of USED. Methods We retrospectively reviewed 21 cases of diagnosed USED without fractures around the elbow that were treated with primary ligament repair. In all cases, anatomical repair of LCL complex with or without common extensor origin was performed using suture anchor and the bone tunnel method. Next, the instability and congruency of elbow for a full range of motion were evaluated under the image intensifier. MCL was repaired only if unstable or incongruent elbow was observed. Clinical outcomes were evaluated using the Mayo elbow performance score (MEPS) and radiographic outcomes on last follow-up images. Results All cases achieved a stable elbow on radiographic and clinical results. LCL complex repair alone was sufficient to obtain the stable elbow in 17 of 21 cases. Four cases required additional MCL repair after restoration of the LCL complex. The overall mean MEPS was 91 (range, 70 to 100): excellent in 12 cases, good in 7 cases, and fair in 2 cases. All 17 cases with LCL complex repair only and 2 of 4 cases with additional MCL repair had excellent or good results by MEPS. Conclusions USED requires surgical treatment to achieve a congruent and stable joint. If the repair of lateral stabilizer such as LCL complex acquires enough joint stability to maintain a full range of motion, it may not be necessary to repair the medial stabilizer in all cases of USED. PMID:26217472

  3. Contralateral needling at unblocked collaterals for hemiplegia following acute ischemic stroke

    PubMed Central

    Gao, Huanmin; Li, Xugang; Gao, Xia; Ma, Benxu

    2013-01-01

    Hemiplegia caused by stroke indicates dysfunction of the network between the brain and limbs, namely collateral shock in the brain. Contralateral needling is the insertion of needles into acupoints on the relative healthy side of the body to treat diseases such as apoplexy. However, there is little well-designed and controlled clinical evidence for this practice. This study investigated whether contralateral needling could treat hemiplegia after acute ischemic stroke in 106 randomly selected patients with acute ischemic stroke. These patients were randomly assigned to three groups: 45 in the contralateral needling group, receiving acupuncture on the unaffected limbs; 45 in the tional acupuncture group, receiving acupuncture on the hemiplegic limbs; and 16 in the control group, receiving routine treatments without acupuncture. Acupuncture at acupoints Chize (LU5) in the upper limb and Jianliao (TE14) in the lower limb was performed for 45 minutes daily for 30 consecutive days. The therapeutic effective rate, Neurological Deficit Score, Modified Barthel Index and Fugl-Meyer Assessment were evaluated. The therapeutic effective rate of contralateral needling was higher than that of conventional acupuncture (46.67% vs. 31.11%, P < 0.05). The neurological deficit score of contralateral needling was significantly decreased compared with conventional acupuncture (P < 0.01). The Modified Barthel Index and Fugl-Meyer Assessment score of contralateral needling increased more significantly than those of conventional acupuncture (both P < 0.01). The present findings suggest that contralateral needling unblocks collaterals and might be more effective than conventional acupuncture in the treatment of hemiplegia following acute ischemic stroke. PMID:25206612

  4. Arthroplasty of the distal ulna distal in managing patients with post-traumatic disorders of the distal radioulnar joint: measurement of quality of life☆

    PubMed Central

    Aita, Marcio Aurélio; Ibanez, Daniel Schneider; Saheb, Gabriel Cunha Barbosa; Alves, Rafael Saleme

    2015-01-01

    Objective To measure the quality of life and clinical–functional results from patients diagnosed with osteoarthrosis of the distal radioulnar joint who underwent surgical treatment using the technique of total arthroplasty of the ulna, with a total or partial Ascension® prosthesis of the distal ulna. Methods Ten patients were evaluated after 12 months of follow-up subsequent to total or partial arthroplasty of the distal ulna. All of them presented post-traumatic osteoarthrosis and/or chronic symptomatic instability of the distal radioulnar joint. The study was prospective. Seven patients had previously undergone wrist procedures (two cases with Darrach, three with Sauvé–Kapandji and two with ligament reconstruction of the fibrocartilage complex) and three presented fractures of the distal ulna that evolved with pain, instability and osteoarthrosis of the distal radioulnar joint. The following were assessed: quality of life (DASH scale); percentage degree of palm grip strength (kgf) and pronosupination range of motion in relation to the unaffected side; pain (VAS); return to work; subjective evaluation of radiography; and complications. Results The patients presented a mean range of motion of 174.5° (normal side: 180°). Quality of life was analyzed by applying the DASH questionnaire and the mean value found was 5.9. The mean pain score using the VAS was 2.3. The mean degree of palm grip strength (kgf) was 50.7, which represented 90.7% of the strength on the unaffected side. The complication rate was 10%: this patient presented slight dorsal instability of the ulna and persistent pain, and did not return to work. This patient is still being followed up in the outpatient clinic and occupational therapy sector, with little improvement. He does not wish to undergo a new procedure. The mean length of follow-up was 16.8 months, with a minimum of 10 and maximum of 36 months. Conclusion This concept is subject to the test of time. Implantation of a prosthesis is a

  5. The distal classification and management of choledochal cyst in adults

    PubMed Central

    Liu, Yanfeng; Sun, Jingxian; Guo, Sen; Liu, Zengli; Zhu, Min; Zhang, Zong-li

    2017-01-01

    Abstract Todani classification is extensively used to guide the surgical strategy of choledochal cysts, but no systematic investigations on the distal management of intrapancreatic choledochal cysts have been conducted. This study reports the distal classification and management of choledochal cysts in adults based on the relation between the cyst and pancreatic duct. Patients with choledochal cyst who underwent operation, including distal management, in our department from January 2009 to December 2014 were retrospectively reviewed. Patients presenting symptoms, coexisting diseases, surgical treatment, perioperative complications, and long-term follow-up according to the distal classification of choledochal cyst were analyzed. A total of 54 patients with choledochal cyst were included in the present retrospective study. Based on the distal classification of choledochal cyst, 39 patients (72.22%) were type 1, 13 patients (24.07%) were type 2, and 2 patients (3.70%) were type 3. Thirty-nine type 1 patients and 10 type 2 patients underwent excision of intrapancreatic choledochal cyst or bile duct. Three type 2 patients received excision of distal cylindrical cyst and papilla, followed by pancreatic duct plasty with duodenum mucosa. One type 3 patient underwent endoscopic sphincteroplasty, and another type 3 patient underwent transduodenal sphincteroplasty. After the operation, 11 patients (20.37%, 11/54) had short-term perioperative complications. The long-term follow-up results showed that the satisfactory rate (excellent and good outcomes) was 95.83%. Current distal classification of choledochal cysts could provide a more targeted strategy for complete excision to eliminate potential dead space within the pancreas, protect the pancreatic duct, and prevent reoperation. PMID:28328818

  6. Distal gap junctions and active dendrites can tune network dynamics.

    PubMed

    Saraga, Fernanda; Ng, Leo; Skinner, Frances K

    2006-03-01

    Gap junctions allow direct electrical communication between CNS neurons. From theoretical and modeling studies, it is well known that although gap junctions can act to synchronize network output, they can also give rise to many other dynamic patterns including antiphase and other phase-locked states. The particular network pattern that arises depends on cellular, intrinsic properties that affect firing frequencies as well as the strength and location of the gap junctions. Interneurons or GABAergic neurons in hippocampus are diverse in their cellular characteristics and have been shown to have active dendrites. Furthermore, parvalbumin-positive GABAergic neurons, also known as basket cells, can contact one another via gap junctions on their distal dendrites. Using two-cell network models, we explore how distal electrical connections affect network output. We build multi-compartment models of hippocampal basket cells using NEURON and endow them with varying amounts of active dendrites. Two-cell networks of these model cells as well as reduced versions are explored. The relationship between intrinsic frequency and the level of active dendrites allows us to define three regions based on what sort of network dynamics occur with distal gap junction coupling. Weak coupling theory is used to predict the delineation of these regions as well as examination of phase response curves and distal dendritic polarization levels. We find that a nonmonotonic dependence of network dynamic characteristics (phase lags) on gap junction conductance occurs. This suggests that distal electrical coupling and active dendrite levels can control how sensitive network dynamics are to gap junction modulation. With the extended geometry, gap junctions located at more distal locations must have larger conductances for pure synchrony to occur. Furthermore, based on simulations with heterogeneous networks, it may be that one requires active dendrites if phase-locking is to occur in networks formed

  7. Ejecta emplacement: from distal to proximal

    NASA Astrophysics Data System (ADS)

    Artemieva, N.

    2008-09-01

    Introduction Most part of impact ejecta is deposited ballistically at some distance from a crater, defined by ejection velocity V and ejection angle α: d=v2sinα/g. In case of giant impacts, planetary curvature should be taken into account [1]. Combined with ejecta scaling [2], these relations allow to define ejecta thickness as a function of distance. Ejecta from large craters are deposited at velocity high enough to mobilize substrate material and to thicken ejecta deposits [3]. Ballistic approximation is valid for airless bodies (if impact vaporization is not vast) or for proximal ejecta of large impact craters, where ejecta mass per unit area is substantially greater than the mass of involved vapor/atmosphere (M-ratio). Deposition of distal ejecta, in which ejecta mass is negligible compared to the atmosphere, may be also treated in a simplified manner, i.e. as 1) passive motion of ejected particles within an impact plume and 2) later, as sedimentation of particles in undisturbed atmosphere (equilibrium between gravity and drag). In all intermediate M-ratio values, impact ejecta move like a surge, i.e. dilute suspension current in which particles are carried in turbulent flows under the influence of gravity. Surges are well-known for near-surface explosive tests, described in detail for volcanic explosions (Plinian column collapse, phreato-magmatic eruption, lateral blast), and found in ejecta from the Chicxulub [4] and the Ries [5]. Important aspects of surge transport include its ability to deposit ejecta over a larger area than that typical of continuous ballistic ejecta and to create multiple ejecta layers. Numerical model Two-phase hydrodynamics. Surges should be modeled in the frame of two-phase hydrodynamics, i.e. interaction between solid/molten particles and atmospheric gas/impact vapor should be taken into account. There are two techniques of solving equations for dust particle motion in a gas flow. The first one describes solid/molten particles as a

  8. A New Orthodontic Appliance with a Mini Screw for Upper Molar Distalization

    PubMed Central

    2016-01-01

    The aim of this study is to present a new upper molar distalization appliance called Cise distalizer designed as intraoral device supported with orthodontic mini screw for upper permanent molar distalization. The new appliance consists of eight main components. In order to understand the optimum force level, the appliance under static loading is tested by using strain gage measurement techniques. Results show that one of the open coils produces approximately 300 gr distalization force. Cise distalizer can provide totally 600 gr distalization force. This range of force level is enough for distalization of upper first and second molar teeth. PMID:27528796

  9. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy in a patient with a chronic total occlusion of the right coronary artery: “beware of collateral damage”

    PubMed Central

    de Hemptinne, Quentin; Picard, Fabien

    2017-01-01

    Alcohol septal ablation (ASA) is an effective semi-invasive alternative to surgical myectomy in selected patients for the management of severely symptomatic and drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). One contraindication of this procedure is the presence of collateral flow originating from the target septal perforator to a remote myocardial territory. In such circumstances, ethanol injection could cause remote non-target myocardial necrosis in the collateralized territory. Percutaneous revascularization of the collateralized vessel prior to ASA might cope with this contraindication by restoring normal antegrade flow in the occluded artery. We report a case that illustrates the feasibility and efficacy of such strategy. PMID:28164017

  10. An intrinsic timer specifies distal structures of the vertebrate limb

    PubMed Central

    Saiz-Lopez, Patricia; Chinnaiya, Kavitha; Campa, Victor M.; Delgado, Irene; Ros, Maria A.; Towers, Matthew

    2015-01-01

    How the positional values along the proximo-distal axis (stylopod-zeugopod-autopod) of the limb are specified is intensely debated. Early work suggested that cells intrinsically change their proximo-distal positional values by measuring time. Recently, however, it is suggested that instructive extrinsic signals from the trunk and apical ectodermal ridge specify the stylopod and zeugopod/autopod, respectively. Here, we show that the zeugopod and autopod are specified by an intrinsic timing mechanism. By grafting green fluorescent protein-expressing cells from early to late chick wing buds, we demonstrate that distal mesenchyme cells intrinsically time Hoxa13 expression, cell cycle parameters and the duration of the overlying apical ectodermal ridge. In addition, we reveal that cell affinities intrinsically change in the distal mesenchyme, which we suggest results in a gradient of positional values along the proximo-distal axis. We propose a complete model in which a switch from extrinsic signalling to intrinsic timing patterns the vertebrate limb. PMID:26381580

  11. Complications of Minimally Invasive Percutaneous Plating for Distal Tibial Fractures

    PubMed Central

    Muzaffar, Nasir; Bhat, Rafiq; Yasin, Mohammad

    2016-01-01

    Background The management of distal tibia fractures continues to remain a source of controversy and debate. Objectives The aim of this study was to evaluate the various complications of minimally invasive percutaneous plate osteosynthesis (MIPPO) using a locking plate for closed fractures of distal tibia in a retrospective study. Patients and Methods Twenty-five patients with distal tibial fractures, treated by minimally invasive percutaneous plate osteosynthesis, were evaluated in a retrospective study. We studied the rate, probable etiological factors and preventive and corrective measures of various complications associated with minimally invasive plating of distal tibia. Results Mean age of the patients was 41.16 years (range 22 - 65). There were 13 male and 12 female patients. All fractures united at an average duration of 16.8 weeks. There were two cases of superficial and two cases of deep infection, and deep infections required removal of hardware for cure. There were four cases of ankle stiffness, most of them occurring in intra-articular fractures, three cases of palpable implant, three cases of malunion, one case of loss of reduction and one patient required reoperation. The average AO foot and ankle score was 83.6. Conclusions We found MIPPO using locking plate to be a safe and effective method for the treatment of distal tibial fractures in properly selected patients yet can result in a variety of complications if proper precautions before, during and after surgery are not taken care of. PMID:28182170

  12. Distal Radius Radiographic Indices and Perilunate Fracture Dislocation

    PubMed Central

    Bagherifard, Abolfazl; Jafari, Davod; Keihan Shokouh, Hassan; Motavallian, Ebrahim; Najd Mazhar, Farid

    2016-01-01

    Background Distal radius radiographic indices may play a role as risk factors in pathogenesis of Kienbock’s disease, scaphoid fracture and nonunion. Perilunate fracture dislocations are devastating wrist injuries, and their relationship and distal radius indices have not been addressed in the literature. Objectives The aim of this study was to evaluate the possible role of distal radius radiographic indices including radial height, radial inclination, ulnar variance and volar tilt as risk factors in the perilunate fracture dislocation injury of the wrist. Patients and Methods We studied distal radius radiographic indices including radial height, radial inclination, ulnar variance and volar tilt in 43 patients with perilunate fracture dislocations and compared them with 44 wrists in the control group. Results The mean values of the radial height, radial inclination, ulnar variance and volar tilt were 12.74 (5 - 18), 24.20 (7 - 35), -0.73 (-5 - 4) and 12.28 (2 - 20) in the patient group. These values were 12.68 (9 - 22), 23.22 (17 - 30), -0.11 (-4 - 3) and 11.05 (-3 - 20), respectively in the control group. There was no statistically significant difference between the two groups. Conclusions This study did not show that distal radius anatomical indices including the radial height, radial inclination, ulnar variance and volar tilt influence perilunate fracture dislocation as risk factors. PMID:27626004

  13. Far cortical locking screws in distal femur fractures.

    PubMed

    Adams, John D; Tanner, Stephanie L; Jeray, Kyle J

    2015-03-01

    Distal femur fractures routinely heal by secondary bone healing, which relies on interfragmentary motion. Periarticular locking plates are commonly used for fixation in distal femur fractures but are associated with a high nonunion rate, likely due to the stiffness of the constructs. Far cortical locking (FCL) screws are designed to allow micromotion at the near cortex while maintaining purchase in only the far cortex. Although clinical data are limited, these screws have been shown in biomechanical studies to provide excellent interfragmentary motion, and animal models have shown increased callus formation compared with traditional locking screws. The purpose of this study was to examine the clinical effects that FCL screws have on healing in distal femur fractures treated with locked constructs. In this retrospective case series, 15 patients with a distal femur fracture treated with MotionLoc screws (Zimmer, Warsaw, Indiana) were analyzed. Serial radiographs were evaluated for callus presence and time to union. All fractures were either 33-A3 or 33-C2 according to the AO classification system, and 5 (33%) were open. Bone loss was recorded in 2 patients. There were no nonunions, and average time to union was 24 weeks. There were no implant failures, and all 5 open fractures, including the 2 with bone loss, healed without intervention. There was 1 reoperation due to painful hardware. Although this is a small case series, these results are promising. Far cortical locking screws may provide the answer to the high nonunion rate associated with distal femur fractures treated with traditional locked constructs.

  14. Accuracy of distal radius positioning using an anatomical plate.

    PubMed

    Vroemen, Joy C; Dobbe, Johannes G G; Sierevelt, Inger N; Strackee, Simon D; Streekstra, Geert J

    2013-04-01

    Over the past decade, several anatomical plates have been introduced to improve the result of open reduction and internal fixation of the distal radius. Using 3-dimensional imaging techniques, the authors studied the accuracy and reproducibility of distal radius positioning using anatomical plates.Distal radius fractures and the correction of these fractures were simulated with plastic bone models of radii. The authors simulated a defect by removing an arbitrary wedge shape from the artificial radii. Two surgeons corrected these fractures by placing 2 anatomical plate types according to the plate manufacturers' instructions. The residual positioning errors of the distal segment in relation to the unaffected radii were determined using 3-dimensional imaging and were compared with naturally occurring bilateral radius differences in healthy individuals. In many cases, positioning does not agree with differences based on bilateral asymmetry in healthy patients.This study indicated the accuracy of anatomical plates. Positioning an anatomical plate may lead to considerable residual errors in individual patients. Volar distal radius plate shapes differ among plate manufacturers. Therefore, one plate may perform better than another in an individual.

  15. Clinicopathological features of carcinoma of the distal penile urethra.

    PubMed

    Corbishley, Catherine M; Rajab, Ramzi M; Watkin, Nicholas A

    2015-05-01

    Distal urethral carcinomas are very rare and are similar in their pathology and behaviour to tumours of the glans penis and foreskin. Similarly they are associated with penile intraepithelial neoplasia (PeIN) of both differentiated and undifferentiated types. Current management is mainly surgical, but increasingly involves specialist penile-preserving techniques. Handling and dissection of the specimens is broadly the same as other primary penile tumours. The prognosis of distal urethral lesions is believed to be worse than penile tumours and better than prostatic urethral tumours, but the evidence is sparse. The staging system for urethral tumours does not distinguish between proximal and distal, apart from prostatic urethra, and has led to much confusion in the literature. Although the subtypes of tumours seen in the distal urethra are the same as those on the glans and foreskin, there is an increased proportion of basaloid squamous carcinoma and malignant melanoma whereas the majority of tumours seen in the proximal and prostatic urethra are of urothelial origin. In future, distal urethral tumours should be separately designated with site-specific staging/TNM and reporting system and pathologically classified in the same way as penile and foreskin tumours. Ultimately, this will improve the quality of data and produce evidence to inform management.

  16. Implant Size Availability Affects Reproduction of Distal Femoral Anatomy.

    PubMed

    Morris, William Z; Gebhart, Jeremy J; Goldberg, Victor M; Wera, Glenn D

    2016-07-01

    A total knee arthroplasty system offers more distal femoral implant anterior-posterior (AP) sizes than its predecessor. The purpose of this study is to investigate the impact of increased size availability on an implant system's ability to reproduce the AP dimension of the native distal femur. We measured 200 cadaveric femora with the AP-sizing guides of Zimmer (Warsaw, IN) NexGen (8 sizes) and Zimmer Persona (12 sizes) total knee arthroplasty systems. We defined "size deviation" as the difference in the AP dimension between the anatomic size of the native femur and the closest implant size. We defined satisfactory reproduction of distal femoral dimensions as < 1 mm difference between the implant and native femur size. The NexGen system was associated with a mean 0.46 mm greater implant size deviation than Persona (p < 0.001). When using a 1 mm size deviation as a cutoff for satisfactory replication of the native distal femoral anatomy, 85/200 specimens (42.5%) were a poor fit by NexGen, but a satisfactory fit by Persona. Only 1/200 specimens (0.5%) was a poor fit by Persona, but a satisfactory fit by NexGen (p < 0.001). The novel knee system with 12 versus 8 sizes reproduces the AP dimension of the native distal femur more closely than its predecessor. Further study is needed to determine the clinical impact of these differences.

  17. Segmental high amplitude peristaltic contractions in the distal esophagus.

    PubMed

    Freidin, N; Mittal, R K; Traube, M; McCallum, R W

    1989-06-01

    High amplitude peristaltic contractions in the distal esophagus ("nutcracker esophagus") is the most common manometric disorder seen in patients with noncardiac chest pain. Although this abnormality is found in the distal esophagus, the definition regarding its precise level in the esophagus is unclear. A careful analysis of 99 consecutive manometric tracings performed during a 1-yr period revealed that in patients with noncardiac chest pain and/or dysphagia, the location of the abnormal esophageal contractions varied: 1) in 11 patients the esophageal contractions were abnormal at 2 cm, as well as 7 cm, above the lower esophageal sphincter (LES); 2) the abnormality was limited to the 2-cm location above the LES in six patients; and 3) was confined to the 7-cm location above the LES in five patients. If the conventional criteria of averaging the distal esophageal contraction amplitudes at 2 and 7 cm above the LES were adopted, six of the 11 patients with segmental esophageal contraction abnormality would not have been identified. We suggest that, by inspection of each location of the distal esophagus separately, localized high amplitude contractions can be identified, and the distal 2 cm segment of the esophagus should be routinely included in the manometric evaluation.

  18. [Diagnostic of group A streptococcal blistering distal dactylitis].

    PubMed

    Cohen, R; Levy, C; Cohen, J; Corrard, F; Deberdt, P; Béchet, S; Bonacorsi, S; Bidet, Ph

    2014-11-01

    Blistering distal dactylitis is a distinct clinical entity, generally due to S. pyogenes, unfrequently reported. Characteristically, blistering distal dactylitis is described as a localized infection involving the distal phalanx of the digits, and it usually presents as a fluid-filled blister. Between October 2009 and June 2014, 69 children (median age: 60 months, extremes: 0,6-176) were enrolled. The sensitivity of GAS rapid antigen detection test was 97 % (CI 95 %: 83-100 %), the specificity was 76 % (CI 95 %: 60-89 %), the negative predictive value was 97 % (CI 95 %: 83-100 %), and the positive predictive value 76 % (CI 95 %: 60-89 %). All patients with a positive GAS rapid antigen test were treated with antibiotics (amoxicillin essentially) and cured without surgery.

  19. Whole Exome Sequencing Identifies Atypical Welander Distal Myopathy in Patient

    PubMed Central

    Blackburn, Patrick; Jackson, Jessica; Harris, Kimberly; Selcen, Duygu; Dimberg, Elliot; Atwal, Paldeep

    2017-01-01

    Abstract Welander distal myopathy is a rare autosomal dominant disorder characterized by muscle weakness in the hands and feet. Exome sequencing of affected families discovered a segregating p.Glu384Lys pathogenic variant in TIA-1 as the main genetic cause of Welander distal myopathy. TIA-1 encodes an RNA-binding protein which serves as a key component of stress granules. This protein also regulates splicing and translation of mRNA. Our patient developed progressive weakness in his hands and feet during his late 40s that was misdiagnosed as a neuropathy that caused muscle atrophy. Follow-up genetic testing revealed a p.Glu384Lys pathogenic variant in TIA-1, and he was then diagnosed with Welander distal myopathy. Our case report underlines the importance of electrodiagnostic and genetic testing of patients. PMID:28221306

  20. Molar distalization with the assistance of Temporary Anchorage Devices.

    PubMed

    Palencar, Adrian J

    2015-01-01

    This article describes efficient techniques for distalization of maxillary and mandibular molars with the assistance of Temporary Anchorage Devices (TADs). There are numerous occasions where the distalization of molars is required in lieu of the odontectomy of bicuspids. In the past, extra-oral force has been used, (i.e. Cervical or Combination Head Gear, or intra-oral force, i.e. Posterior Sagittal Appliance, Modified Greenfield Appliance, Williams DMJ 20001, CD Distalizer, Magill Sagittal, Pendulum Appliance, etc.). All the intra-oral appliances have a common denominator the orthodontic clinician has to deal with, the undesirable expression of the Third Law of Newton. The utilization of TADs allows us to circumvent this shortcoming, establishing an absolute anchorage, and thus completely negate the expression of the Third Law of Newton.

  1. [Proximal and distal rupture of the m. biceps brachii].

    PubMed

    Lorbach, O; Kieb, M; Grim, C; Engelhardt, M

    2010-12-01

    Ruptures of the biceps tendon account for a high percentage of tendon ruptures. The aetiology of proximal ruptures of the long head of the biceps tendon is often degenerative and they are frequently associated with lesions of the rotator cuff. The clinical findings are often not specific and long lasting. Distal ruptures of the biceps tendon mostly occur during eccentric contraction of the biceps muscle.Clinical tests, the associated haematoma and a distalisation or proximalisation of the muscle belly in combination with ultrasound or MRI to rule out combined diseases lead to the diagnosis. The possible options include conservative and operative treatment. Tenotomy and tenodesis lead to comparable results in the literature. Therefore, conservative treatment is mostly recommended in proximal ruptures. Operative treatment is preferred in distal ruptures of the biceps tendon in order to achieve an anatomical reconstruction of the muscle function. Chronic ruptures of the distal biceps tendon can be successfully treated with free autografts or allografts.

  2. Intramedullary Tibial Nail Fixation of Simple Intraarticular Distal Tibia Fractures.

    PubMed

    Scolaro, John A; Broghammer, Francis H; Donegan, Derek J

    2016-11-01

    The optimal treatment strategy for distal tibia fractures, especially those with intraarticular extension, remains controversial. Although open reduction and internal fixation with a plate and screw device is commonly performed for these injuries, the risk of soft tissue complications using this approach is significant. Staged treatment protocols and alternative means of fixation have been proposed to address these undesired events. Although potentially more technically demanding than fixation of diaphyseal or extraarticular tibial fractures, intramedullary nail (IMN) fixation of simple intraarticular distal tibia fractures is a viable treatment alternative with unique advantages. This article presents a review of the literature and rationale for intramedullary tibial nail fixation of simple intraarticular distal tibia fractures and a surgical approach commonly utilized for successful implementation.

  3. Two-stitch technique for distal shaft hypospadias repair.

    PubMed

    Herman, Oscar; Heller, Lior; Dorenbaum, Arye; Westreich, Melvyn

    2002-02-01

    The authors present a new technique for distal shaft hypospadias repair using a flip flap fashioned with only two stitches. In raising the flap, the tissues lateral and proximal to the flap are undermined but there is no undermining beneath the flap. The flap is sutured up to the glans with two 4-0 Vicryl sutures. No sutures are placed at the lateral edges of the flap to create the "tube" of the neo-urethra, and no postoperative urinary drainage is used. Thirty-three children with distal shaft hypospadias underwent the "two-stitch" flip flap operation. The complications were one fistula and one case of urinary retention. The technique is an easy method for reconstructing distal penile hypospadias with a very low rate of complications and is suitable for an outpatient surgical setting.

  4. Reverse telescoping in distal skarns at Campiglia Marittima (Italy)

    NASA Astrophysics Data System (ADS)

    Vezzoni, Simone; Dini, Andrea; Rocchi, Sergio

    2014-05-01

    Skarn deposits commonly results from the metasomatic alteration of a rock, usually carbonate-rich, by infiltration of hydrothermal fluids. Most carbonate-hosted skarn deposits show a direct spatial relationship with magmatic intrusions and an intimate relationship with porphyry copper deposits. Their primary mineralogical and geochemical features indicate metasomatism by high-temperature magmatic fluids. Conversely, many distal Pb-Zn-Ag skarns pose an important challenge because there is no apparent association with magmatic intrusions and external, meteoric and/or basinal fluids should become increasingly dominant with increasing distance from the igneous source. Nevertheless recent investigation of distal skarn deposits indicates that ore-forming fluids match the composition of proximal magmatic fluids in granitoid-related mineral deposits. Besides that metal producer (Pb, Zn, Ag, Cu, Fe, W, Sn), skarn deposits can be key to understanding fluid dynamics at the periphery of magmatic-hydrothermal systems, unraveling pathways to hidden ore deposits (e.g porphyry copper). In this scenario, research on distal skarns opens new perspectives for deep mineral exploration and/or modeling of intrusion centered geothermal systems, because they should represent the outer limit of the hydrothermal system dominated by magmatic aqueous fluids. Here we present exceptional evidences from a distal Pb-Zn-Ag skarn deposit in Campiglia Marittima, Italy, where the magma, after having released the metasomatic fluids, fled up chasing its own fluid stream and invading large pockets of the newly formed skarn bodies at shallower level. Detailed underground mapping and petrologic data indicate that, after the formation of a typical distal Pb-Zn-Ag skarn, the intrusion of the parent magma produced prograde reactions in the skarn silicates, mobilization of the Pb-Zn-Ag sulfides and precipitation of a new Cu-Fe sulfide assemblage. This is a very unusual case of reverse telescoping during which

  5. A practical guide to the management of distal ulcerative colitis.

    PubMed

    Ardizzone, S; Bianchi Porro, G

    1998-04-01

    This article reviews the role of corticosteroids, sulfasalazine and mesalazine (5-aminosalicylic acid, mesalamine), immunosuppressive agents and alternative novel drugs for the treatment of distal ulcerative colitis. Short cycles of traditional, rectally administered corticosteroids (methylprednisolone, betamethasone, hydrocortisone) are effective for the treatment of mild to moderately active distal ulcerative colitis. In this context, their systemic administration is limited to patients who are refractory to either oral 5-amino-salicylates, topical mesalazine or topical corticosteroids. Of no value in maintaining remission, the long term use of either or topical corticosteroids may be hazardous. A new class of topically acting corticosteroids [budesonide, fluticasone, beclomethasone dipropionate, prednisolone-21-methasulphobenzoate, tixocortol (tixocortol pivalate)] represents a valid alternative for the treatment of active ulcerative colitis, and may be useful in the treatment of refractory distal ulcerative colitis. Although there is controversy concerning dosage or duration of therapy, oral and topical mesalazine is effective in the treatment of mild to moderately active distal ulcerative colitis. Sulfasalazine and mesalazine remain the first-choice drugs for the maintenance therapy of distal ulcerative colitis. Evidence exists showing a trend to a higher remission rate with higher doses of oral mesalazine. Topical mesalazine (suppositories or enemas) also is effective in maintenance treatment. For patients with chronically active or corticosteroid-dependent disease, azathioprine and mercaptopurine are effective in reducing either the need for corticosteroids or clinical relapses. Moreover, they are effective for long term maintenance remission. Cyclosporin may be useful in inducing remission in patients with acutely severe disease who do not achieve remission with an intensive intravenous regimen. Existing data suggest that azathioprine and mercaptopurine may

  6. Unstable Distal Radius Fractures Treated by Volar Locking Anatomical Plates

    PubMed Central

    Jose, Anto; Deniese, Pascal Noel; Babu, Abey Thomas; Rengasamy, Kanagasabai; Najimudeen, Syed

    2017-01-01

    Introduction Fracture of the distal end of radius represents the most common fracture of the upper extremity accounting for 16-20% of all fractures. Plating is now emerging as the gold standard for management of distal radius fractures due to increased rate of complications such as malunion, subluxation/dislocation of distal radio-ulnar joint or late collapse of fracture. Procedures such as closed reduction and cast immobilization, ligamentotaxis with external fixator and percutaneous pin fixation are no longer acceptable. Aim The purpose of the study was to evaluate the functional and radiological outcome of unstable distal radius fractures treated with the volar locking plate. Materials and Methods We reviewed 53 patients from January 2011 to December 2015, treated for unstable distal radius fractures using a volar locking compression plate. Standard radiographic and clinical assessment after 12 months (range 12-16 months) were measured and final functional and radiological outcome were assessed using the Modified Mayo wrist scoring system and Sarmiento’s modification of Lindstorm criteria respectively. Results There were 42 males and 11 females with an average age of 39.12±31.78 years (18-71 years). At the end of 12 months, 36 patients had an excellent radiological outcome and 10 patients had good radiological outcome as per Sarmiento’s modification of Lindstorm criteria. Eleven patients had an excellent functional outcome and 26 patients had a good functional outcome as per modified Mayo wrist scoring system. There was one case of superficial wound infection which subsided with intravenous antibiotics. Conclusion The volar locking plate fixation helps in early mobilization of the wrist, restores anatomy, allows early return to function, prevents secondary loss of reduction and hence is an effective treatment for unstable fractures of the distal radius. PMID:28274009

  7. Traumatic ulnar physeal arrest after distal forearm fractures in children.

    PubMed

    Ray, T D; Tessler, R H; Dell, P C

    1996-01-01

    A review of the orthopaedic literature suggests that traumatic ulnar physeal arrest associated with radial fracture is a rare occurrence. Twenty-three cases of traumatic ulnar physeal arrest have been reported in patients with distal radius fractures, and we report five additional cases. A classification system for the distal ulnar growth deformities is proposed, and the compensatory radial changes are reviewed. Surgical indications for treatment include cosmetic deformity, progressive carpal subluxation, and decreased range of motion. Surgical options for treatment are discussed and include epiphysiodesis, ulnar lengthening, radial osteotomy, and the Suave-Kapandji procedure.

  8. Nontraumatic osteonecrosis of the distal pole of the scaphoid

    PubMed Central

    Garg, Bhavuk; Gupta, Himanshu; Kotwal, Prakash P

    2011-01-01

    Post traumatic osteonecrosis of distal pole of scaphoid is very rare. We present a case of 34 years old male, drill operator by occupation with nontraumatic osteonecrosis of distal pole of the scaphoid. The patient was managed conservatively and was kept under regular follow-up every three months. The patient was also asked to change his profession. Two years later, the patient had no pain and had mild restriction of wrist movements (less than 15 degrees in either direction). The radiographs revealed normal density of the scaphoid suggesting revascularization. PMID:21430877

  9. Supramalleolar Osteotomies for Posttraumatic Malalignment of the Distal Tibia.

    PubMed

    Krause, Fabian; Veljkovic, Andrea; Schmid, Timo

    2016-03-01

    Supramalleolar osteotomies of the tibia (SMOT) for posttraumatic distal tibial malalignment has shown to reduce pain, improve function and radiographic signs of osteoarthritis, and delay ankle arthrodesis or total joint replacement. The procedure also protects the articular cartilage from further degenerative processes by shifting and redistributing loads in the ankle joint. It is technically demanding and requires extensive preoperative planning. The type of osteotomy (opening vs closing wedge) does not influence the final outcome. However, based on the limited evidence, a grade I treatment recommendation has been given for supramalleolar osteotomies of the tibia to treat mild to moderate ankle arthritis in the presence of distal tibial malalignment.

  10. A Unified Approach to Outcomes Assessment for Distal Radius Fractures.

    PubMed

    Waljee, Jennifer F; Ladd, Amy; MacDermid, Joy C; Rozental, Tamara D; Wolfe, Scott W

    2016-04-01

    Distal radius fractures are one of the most common upper extremity injuries. Currently, outcome assessment after treatment of these injuries varies widely with respect to the measures that are used, timing of assessment, and the end points that are considered. A more consistent approach to outcomes assessment would provide a standard by which to assess treatment options and best practices. In this summary, we review the consensus regarding outcomes assessment after distal radius fractures and propose a systematic approach that integrates performance, patient-reported outcomes, pain, complications, and radiographs.

  11. Future treatment and research directions in distal radius fracture.

    PubMed

    Jupiter, Jesse

    2012-05-01

    Whether or not they will have their lives dramatically extended in the next few decades, it is clear that people are living longer, healthier, and more active lives. The two peak incidences of distal radius fractures will remain within the pediatric and geriatric age groups, with the latter experiencing a substantial increase in the coming years. This article attempts to project future developments with regard to epidemiology, risk and prevention, fracture assessment, and treatment of distal radius fractures, and the ever increasing concern for the economic impact of this prevalent injury.

  12. Tool use and the distalization of the end-effector

    PubMed Central

    Bonaiuto, James B.; Jacobs, Stéphane; Frey, Scott H.

    2009-01-01

    We review recent neurophysiological data from macaques and humans suggesting that the use of tools extends the internal representation of the actor’s hand, and relate it to our modeling of the visual control of grasping. We introduce the idea that, in addition to extending the body schema to incorporate the tool, tool use involves distalization of the end-effector from hand to tool. Different tools extend the body schema in different ways, with a displaced visual target and a novel, task-specific processing of haptic feedback to the hand. This distalization is critical in order to exploit the unique functional capacities engendered by complex tools. PMID:19347356

  13. Intracranial collateral pathways assessed by contrast-enhanced three-dimensional transcranial color-coded sonography.

    PubMed

    Wessels, Tiemo; Bozzato, Alessandro; Mull, Michael; Klötzsch, Christof

    2004-11-01

    Individual parameter settings of the duplex machine and limited insonation angles may influence the visualization of small intracranial vessels in 2-D transcranial color-coded sonography. The aim of our study was the morphologic assessment of intracranial collateral pathways (first auditory area celiac artery, A(1)CA; anterior communicating artery, AComA; first parental generation celiac artery P(1)CA; posterior communicating artery, PComA) using 3-D transcranial color-coded duplex sonography (3-D TCCS) and digital subtraction angiography (DSA). A total of 41 patients with large vessel disease and 30 patients who had suffered subarachnoidal hemorrhage (mean age 52 +/- 15 years) were involved. In all patients, angiography was performed within 10 days following 3-D sonography. The patients were investigated with a color-coded duplex system using the power mode. Contrast enhancement was achieved by continuous infusion of a galactose-based echo-enhancer using a perfusor pump. The 3-D system consists of an electromagnet that induces a low-intensity magnetic field near the head of the patient. A magnetic position sensor is attached to the ultrasound (US) probe and transmits the spatial orientation to a personal computer, which also receives the corresponding 2-D images from the video port of the duplex machine. Angiography revealed a "complete" circle of Willis in one third of the patients and, in the remaining patients at least one vessel was hypoplastic or absent. Sufficient temporal bone windows allowed the sonographic investigation of 466 (94%) of 497 expected arterial segments. The comparison of both techniques resulted in a weighted kappa value of 0.56 for the A(1)CA and 0.63 for the AComA. In the posterior circulation kappa values of 0.56 for the P(1)CA and 0.43 for the PComA were calculated. In 50 vessels (10%), 3-D sonography misdiagnosed the diameter of a collateral vessel as normal and angiography revealed hypoplasia or aplasia of this vessel. The main

  14. POST OPERATIVE REHABILITATION OF GRADE III MEDIAL COLLATERAL LIGAMENT INJURIES: EVIDENCE BASED REHABILITATION AND RETURN TO PLAY.

    PubMed

    Logan, Catherine A; O'Brien, Luke T; LaPrade, Robert F

    2016-12-01

    The medial collateral ligament is the most commonly injured ligament of the knee, with injury generally sustained in the athletic population as a result of valgus contact with or without tibial external rotation. The capacity of the medial collateral ligament to heal has been demonstrated in both laboratory and clinical studies; however, complete ruptures heal less consistently and may result in persistent instability. When operative intervention is deemed necessary, anatomical medial knee reconstruction is recommended. Post-operative rehabilitation focuses on early motion and the return of normal neuromuscular firing patterns with progression based on attainment of specific phase criteria and goals. The purpose of this clinical commentary is to discuss the determinants of phase progression and the importance of objectively assessing readiness for advancement that is consistent with post-operative healing. Additional tests and validated measures to assess readiness for sport are also presented.

  15. POST OPERATIVE REHABILITATION OF GRADE III MEDIAL COLLATERAL LIGAMENT INJURIES: EVIDENCE BASED REHABILITATION AND RETURN TO PLAY

    PubMed Central

    O'Brien, Luke T.; LaPrade, Robert F.

    2016-01-01

    The medial collateral ligament is the most commonly injured ligament of the knee, with injury generally sustained in the athletic population as a result of valgus contact with or without tibial external rotation. The capacity of the medial collateral ligament to heal has been demonstrated in both laboratory and clinical studies; however, complete ruptures heal less consistently and may result in persistent instability. When operative intervention is deemed necessary, anatomical medial knee reconstruction is recommended. Post-operative rehabilitation focuses on early motion and the return of normal neuromuscular firing patterns with progression based on attainment of specific phase criteria and goals. The purpose of this clinical commentary is to discuss the determinants of phase progression and the importance of objectively assessing readiness for advancement that is consistent with post-operative healing. Additional tests and validated measures to assess readiness for sport are also presented. Level of Evidence 5 PMID:27999730

  16. CT-angiographic demonstration of hepatic collateral pathways due to superior vena cava obstruction in Behçet disease.

    PubMed

    Temizöz, Osman; Genchellac, Hakan; Yekeler, Ensar; Demir, Mustafa Kemal; Unlü, Ercüment; Ozdemir, Hüseyin

    2010-12-01

    Behçet disease (BD) is a chronic multisystemic inflammatory disorder, mainly characterized by recurrent oral and genital ulcers, skin lesions, and uveitis. Large vein thrombosis in BD is unusual; when present, it is most frequently seen in the inferior or superior vena cava (SVC). The authors describe an unusual hepatic pseudolesion caused by abnormal focal enhancement through collateral pathways to the liver in two BD patients with SVC occlusion on three-dimensional multi-detector computed tomography, using volume rendering and maximum intensity projection techniques. BD should be suspected in patients presenting a focal increased hepatic enhancement area with collaterals caused by occlusion of the SVC without evidence of a hypercoagulable state or malignant mediastinal or thoracic venous inlet obstruction.

  17. A common variant of endothelial nitric oxide synthase (Glu298Asp) is associated with collateral development in patients with chronic coronary occlusions

    PubMed Central

    Lamblin, Nicolas; Cuilleret, François J; Helbecque, Nicole; Dallongeville, Jean; Lablanche, Jean-Marc; Amouyel, Philippe; Bauters, Christophe; Van Belle, Eric

    2005-01-01

    Background Experimental studies support an important role for endothelial nitric oxide synthase (eNOS) in the regulation of angiogenesis. In humans, a common polymorphism exists in the eNOS gene that results in the conversion of glutamate to aspartate for codon 298. In vitro and in vivo studies have suggested a decreased NOS activity in patients with the Asp298 variant. We hypothesized that a genetic-mediated decreased eNOS activity may limit collateral development in patients with chronic coronary occlusions. Methods We selected 291 consecutive patients who underwent coronary angiography and who had at least one chronic (>15 days) total coronary occlusion. Collateral development was graded angiographically using two different methods: the collateral flow grade and the recipient filling grade. Genomic DNA was extracted from white blood cells and genotyping was performed using previously published techniques. Results Collateral development was lower in patients carrying the Asp298 variant than in Glu-Glu homozygotes (collateral flow grade: 2.64 ± 0.08 and 2.89 ± 0.08, respectively, p = 0.04; recipient filling grade: 3.00 ± 0.08 and 3.24 ± 0.07, respectively, p = 0.04). By multivariable analysis, three variables were independently associated with the collateral flow grade: female gender, smoking, and the Asp298 variant (p = 0.03) while the Asp298 variant was the sole variable independently associated with the recipient filling grade (p = 0.03). Conclusion Collateral development is lower in patients with the Asp298 variant. This may be explained by the decreased NOS activity in patients with the Asp298 variant. Further studies will have to determine whether increasing eNOS activity in humans is associated with coronary collateral development. PMID:16164743

  18. Cutaneous collateral axonal sprouting re-innervates the skin component and restores sensation of denervated Swine osteomyocutaneous alloflaps.

    PubMed

    Ibrahim, Zuhaib; Ebenezer, Gigi; Christensen, Joani M; Sarhane, Karim A; Hauer, Peter; Cooney, Damon S; Sacks, Justin M; Schneeberger, Stefan; Lee, W P Andrew; Polydefkis, Michael; Brandacher, Gerald

    2013-01-01

    Reconstructive transplantation such as extremity and face transplantation is a viable treatment option for select patients with devastating tissue loss. Sensorimotor recovery is a critical determinant of overall success of such transplants. Although motor function recovery has been extensively studied, mechanisms of sensory re-innervation are not well established. Recent clinical reports of face transplants confirm progressive sensory improvement even in cases where optimal repair of sensory nerves was not achieved. Two forms of sensory nerve regeneration are known. In regenerative sprouting, axonal outgrowth occurs from the transected nerve stump while in collateral sprouting, reinnervation of denervated tissue occurs through growth of uninjured axons into the denervated tissue. The latter mechanism may be more important in settings where transected sensory nerves cannot be re-apposed. In this study, denervated osteomyocutaneous alloflaps (hind- limb transplants) from Major Histocompatibility Complex (MHC)-defined MGH miniature swine were performed to specifically evaluate collateral axonal sprouting for cutaneous sensory re-innervation. The skin component of the flap was externalized and serial skin sections extending from native skin to the grafted flap were biopsied. In order to visualize regenerating axonal structures in the dermis and epidermis, 50 um frozen sections were immunostained against axonal and Schwann cell markers. In all alloflaps, collateral axonal sprouts from adjacent recipient skin extended into the denervated skin component along the dermal-epidermal junction from the periphery towards the center. On day 100 post-transplant, regenerating sprouts reached 0.5 cm into the flap centripetally. Eight months following transplant, epidermal fibers were visualized 1.5 cm from the margin (rate of regeneration 0.06 mm per day). All animals had pinprick sensation in the periphery of the transplanted skin within 3 months post-transplant. Restoration of

  19. Cutaneous Collateral Axonal Sprouting Re-Innervates the Skin Component and Restores Sensation of Denervated Swine Osteomyocutaneous Alloflaps

    PubMed Central

    Ibrahim, Zuhaib; Ebenezer, Gigi; Christensen, Joani M.; Sarhane, Karim A.; Hauer, Peter; Cooney, Damon S.; Sacks, Justin M.; Schneeberger, Stefan; Lee, W. P. Andrew

    2013-01-01

    Reconstructive transplantation such as extremity and face transplantation is a viable treatment option for select patients with devastating tissue loss. Sensorimotor recovery is a critical determinant of overall success of such transplants. Although motor function recovery has been extensively studied, mechanisms of sensory re-innervation are not well established. Recent clinical reports of face transplants confirm progressive sensory improvement even in cases where optimal repair of sensory nerves was not achieved. Two forms of sensory nerve regeneration are known. In regenerative sprouting, axonal outgrowth occurs from the transected nerve stump while in collateral sprouting, reinnervation of denervated tissue occurs through growth of uninjured axons into the denervated tissue. The latter mechanism may be more important in settings where transected sensory nerves cannot be re-apposed. In this study, denervated osteomyocutaneous alloflaps (hind- limb transplants) from Major Histocompatibility Complex (MHC)-defined MGH miniature swine were performed to specifically evaluate collateral axonal sprouting for cutaneous sensory re-innervation. The skin component of the flap was externalized and serial skin sections extending from native skin to the grafted flap were biopsied. In order to visualize regenerating axonal structures in the dermis and epidermis, 50um frozen sections were immunostained against axonal and Schwann cell markers. In all alloflaps, collateral axonal sprouts from adjacent recipient skin extended into the denervated skin component along the dermal-epidermal junction from the periphery towards the center. On day 100 post-transplant, regenerating sprouts reached 0.5 cm into the flap centripetally. Eight months following transplant, epidermal fibers were visualized 1.5 cm from the margin (rate of regeneration 0.06 mm per day). All animals had pinprick sensation in the periphery of the transplanted skin within 3 months post-transplant. Restoration of

  20. Optimal Positioning for Volar Plate Fixation of a Distal Radius Fracture: Determining the Distal Dorsal Cortical Distance.

    PubMed

    Vosbikian, Michael M; Ketonis, Constantinos; Huang, Ronald; Ilyas, Asif M

    2016-01-01

    Distal radius fractures are currently among the most common fractures of the musculoskeletal system. With a population that is living longer, being more active, and the increasing incidence of osteoporosis, these injuries will continue to become increasingly prevalent. When operative fixation is indicated, the volar locking plate has recently become the treatment of choice. However, despite its success, suboptimal position of the volar locking plate can still result in radiographic loss of reduction. The distal dorsal cortical distance is being introduced as an intraoperative radiographic tool to help optimize plate position and minimize late loss of fracture reduction.