The effects of the anti-adhesive membrane on the reconstruction of zone II flexor tendon deficits in hand

The effects of an anti-adhesive membrane on a cut tendon site have been adequately studied in animal models up to now. What has not been studied enough is the effect of the same membrane on a tendon deficit that is reconstructed with a tendon autograft.Purpose: The purpose of this study is to check the hypothesis that the application of an anti-adhesive membrane over a tendon autograft used to treat a zone II flexor tendon deficit in a rabbit model, will have a histologic and biomechanic influence. Methods: Thirty New Zealand rabbits were operated on. In each we created an approximately 3 cm long traumatic deficit of the deep flexor tendon of the first and fourth or the second and third fingers of its right rear leg, in zone II. The deficit was bridged with a tendon autograft, which was covered with an anti-adhesive membrane in one finger, but not in the other. Three weeks post- operatively, we operated on 23 of the animals and took 23 pairs of tendon grafts that were macroscopically and microscopically studied. On completion of six post-operative weeks, we operated on the rest animals and received 14 (7 pairs) more tendons, which were put to biomechanical testing in the Institute of Technology of AUTH.Results: In all cases we detected a foreign body type reaction around the membrane and a high presence of collagen type III at 3 weeks post-operatively. In cases with anti-adhesive membrane there was relatively less collagen type III and less macroscopic adhesions at 3weeks post-op when compared to cases without the membrane. At the same time, there was a mild to moderate increase of expression of Matrix Metalloproteinase-1(MMP1) and a mild increase of MMP2. No differentiation was observed in the expression and presence of collagen type I between cases with the membrane and cases without it. At 6 weeks post-operatively, no statistically significant difference was detected in mechanical strength (maximum load before rupture) between tendon grafts with the membrane and grafts without it (p=0,511>0,05). On the contrary, grafts coated with the anti-adhesive membrane, at six weeks, showed significantly greater flexibility (greater maximum elongation before rupture, p=0,0290,05), αλλά είχαμε στατιστικώς σημαντικά μεγαλύτερη ελαστικότητα (μέγιστη επιμήκυνση προ θραύσεως) των μοσχευμάτων που επικαλύφθηκαν με αντισυμφυτική μεμβράνη (p=0,029<0,05).Συμπεράσματα: Με τη χρήση της αντισυμφυτικής μεμβράνης σε αποκατάσταση ελλείμματος με τενόντιο μόσχευμα μειώνεται η παρουσία συμφύσεων και κολλαγόνου τύπου ΙΙΙ, ευοδώνεται το remodeling του εξωκυττάριου στρώματος και αυξάνεται η ελαστικότητα του μοσχεύματος, ενώ δεν επηρεάζεται η έκφραση του κολλαγόνου τύπου Ι και η μηχανική αντοχή του ίδιου του μοσχεύματος.Κλινική εφαρμογή: Με τα αποτελέσματα της παρούσας μελέτης, είναι λογικό να σκεφτούμε ότι η κλινική πράξη, σε περιπτώσεις που καλούμεθα να αποκαταστήσουμε σε πρώτο χρόνο τενόντια ελλέιμματα στη ζώνη ΙΙ στο ανθρώπινο χέρι, μπορεί να κατευθυνθεί προς την επιλογή της επικάλυψης του αυτομοσχεύματος με αντισυμφυτική μεμβράνη, ώστε να μειωθούν κατά το δυνατό οι πιθανότητες ανάπτυξης μετεγχειρητικών συμφύσεων

The Influence of Physical Training on Blood Levels of Human Growth Hormone, Testosterone and Procollagen in Young Rowers

Objective: The purpose of this study was to investigate muscle strength and skeletal age in trained and untrained pubertal boys and its relationship to the levels of Testosterone (T), Growth Hormone (GH) and Procollagen (PICP). Methods: Both the exercise and control groups consisted of 24 (mean 12.91, sd = 0.63) and 17 (mean 12.91, sd = 0.48) year old boys, respectively. The exercise group (EG), in addition to school activities, participated in a rowing training program for six months (rowing technique, strength & aerobic exercises, 60 min/day, three days/week). The control group (CG) only participated in the school physical education program, two to three times/week. Hormonal concentrations were measured by radioimmunoassay techniques. Venus blood samples were taken at rest from both groups. Results: Testosterone was increased in both groups (p<0.001). Significant differences were found within groups in T before training (p<0.01) There was an increase of PICP in EG after training (p<0.01). Differences on GH were observed before the training period in both groups (p<0.01). Both groups significantly differed in upper and lower limbs strengths. Significant correlation was found between PICP and skeletal age in both (p<0.05 and p<0.02, respectively) Conclusions: The gains in muscle strength in both groups may partly be explained by the increase in the concentrations of hormone levels and the changes in body size. Key words: skeletal age, muscle strength, anabolic hormones, rowin

The Influence of Physical Training on Blood Levels of Human Growth Hormone, Testosterone and Procollagen in Young Rowers

Objective: The purpose of this study was to investigate muscle strength and skeletal age in trained and untrained pubertal boys and its relationship to the levels of Testosterone (T), Growth Hormone (GH) and Procollagen (PICP). Methods: Both the exercise and control groups consisted of 24 (mean 12.91, sd = 0.63) and 17 (mean 12.91, sd = 0.48) year old boys, respectively. The exercise group (EG), in addition to school activities, participated in a rowing training program for six months (rowing technique, strength aerobic exercises, 60 min/day, three days/week). The control group (CG) only participated in the school physical education program, two to three times/week. Hormonal concentrations were measured by radioimmunoassay techniques. Venus blood samples were taken at rest from both groups. Results: Testosterone was increased in both groups (p0.001). Significant differences were found within groups in T before training (p0.01) There was an increase of PICP in EG after training (p0.01). Differences on GH were observed before the training period in both groups (p0.01). Both groups significantly differed in upper and lower limbs strengths. Significant correlation was found between PICP and skeletal age in both (p0.05 and p0.02, respectively) Conclusions: The gains in muscle strength in both groups may partly be explained by the increase in the concentrations of hormone levels and the changes in body size.Key words: skeletal age, muscle strength, anabolic hormones, rowin

Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion. A case series

<p>Abstract</p> <p>Background</p> <p>Interspinous distraction devices (IPDD) are indicated as stand-alone devices for the treatment of spinal stenosis. The purpose of this study is to evaluate the results of patients undergoing surgery for spinal stenosis with a combination of unilateral microdecompression and interspinous distraction device insertion.</p> <p>Methods</p> <p>This is a prospective clinical and radiological study of minimum 2 years follow-up. Twenty-two patients (average age 64.5 years) with low-back pain and unilateral sciatica underwent decompressive surgery for lumbar spinal stenosis. Visual Analogue Scale, Oswestry Disability Index and walking capacity plus radiologic measurements of posterior disc height of the involved level and lumbar lordosis Cobb angle were documented both preoperatively and postoperatively. One-sided posterior subarticular and foraminal decompression was conducted followed by dynamic stabilization of the diseased level with an IPDD (X-STOP).</p> <p>Results</p> <p>The average follow-up time was 27.4 months. Visual Analogue Scale and Oswestry Disability Index improved statistically significantly (p < 0.001) in the last follow-up exam. Also, the walking distance increased in all patients but two. Posterior intervertebral disc height of the diseased level widened average 1.8 mm in the postoperative radiograph compared to the preoperative. No major complication, including implant failure or spinous process breakage, has been observed.</p> <p>Conclusions</p> <p>The described surgical technique using unilateral microdecompression and IPDD insertion is a clinically effective and radiologically viable treatment method for symptoms of spinal stenosis resistant to non-operative treatment.</p

Lipoma Arborescens of the Knee: Report of Three Cases and Review of the Literature

Lipoma arborescens is a chronic, slow-growing, intra-articular lesion of benign nature, which is characterized by villous proliferation of the synovium, with replacement of the subsynovial connective tissue by mature fat cells. It usually involves the suprapatellar pouch of the knee joint. It is not a neoplasm but is rather considered a nonspecific reactive response to chronic synovial irritation, due to either mechanical or inflammatory insults. We report three cases of lipoma arborescens affecting the knee, the first in a young male without previous history of arthritis or trauma, the second in a 58-year-old male associated with osteoarthritis, and the final in a 44-year-old male diagnosed with psoriatic arthritis, which cover the entire pathologic spectrum of this unusual entity. We highlight the clinical findings and imaging features, by emphasizing especially the role of MRI, in the differential diagnosis of other, more complex intra-articular masses