Evaluation of a relationship between malocclusion and idiopathic scoliosis in children and adolescents.

PURPOSE: Idiopathic scoliosis is a developmental deformation of the vertebral column of an unknown aetiology. Its clinical symptoms and hypothetical causative factors may affect the stomatognathic system. The aim of this study was to analyse the relationships between the prevalence and type of malocclusions, and the presence of idiopathic scoliosis, its location and severity. METHODS: This was a prospective longitudinal study. The study group consisted of 80 patients with idiopathic scoliosis and the control group of 61 healthy individuals. Standard standing long-cassette radiographs were taken of all of the patients in the idiopathic scoliosis group in order to confirm diagnosis, to determine localization and the Cobb angle of the curve. Both groups underwent standard clinical dental examination. RESULTS: The most commonly observed types included right main thoracic (R-MT) and thoracolumbar or left lumbar scoliosis (Cobb angle 11° to 125°). In the idiopathic scoliosis group, prevalence of malocclusions was greater than in the control group (95% versus 82%). In the idiopathic scoliosis group more than one type of malocclusion was observed with a higher incidence than that in the control group (63.8% versus 37.7%; p = 0.002). A correlation between the left proximal thoracic (L-PT) curve with anterior partial open bite was demonstrated (p = 0.323), between thoracic dextroscoliosis main thoracic with lateral partial cross bite (p = 0.230) and a correlation between scoliosis severity and malocclusion in the event of L-PT and anterior partial open bite (p = 0.330) and R-MT and scissors bite (p = 0.248). CONCLUSION: The incidence of malocclusions is greater in children with idiopathic scoliosis than in their healthy peers. LEVEL OF EVIDENCE: III.

Dega pelvic osteotomy: indications, results and complications.

PURPOSE: Developmental dysplasia of the hip (DDH) after walking age is difficult to treat. Dega pelvic osteotomy is combined with open reduction and femoral osteotomy to obtain concentric stable reduction with good coverage of the femoral head. The purpose of this study is to evaluate the use of the Dega osteotomy in the treatment of DDH in two different age groups. METHODS: A total of 45 patients (52 hips) with a mean age of 3.9 years (1.2 to 12.8) were treated with open reduction, Dega osteotomy and femoral osteotomy. There were 38 dislocated and 14 subluxated hips. Bilateral DDH was observed in seven female patients. Radiographic parameters included acetabular index, centre-edge angle of Wiberg and migration percentage. The final radiographic outcome was evaluated according to the Severin classification. RESULTS: The mean follow-up period was four years (3 to 9). According to the Severin criteria 78.8% were types I or II whereas 21.2% showed types III or IV. There was no statistically significant difference in final outcome between children less than three years of age and older children at the time of surgery.One hip in children with unilateral involvement had developed coxa magna, that interfered with hip concentricity. Three hips (5.8%) showed avascular necrosis of the femoral head. CONCLUSION: Dega osteotomy is a safe and adequate procedure for the management of developmental dysplasia of the hip in walking patients with low complication rates. Restoring the acetabulum to normal or nearly normal can result in good medium-term results. LEVEL OF EVIDENCE: III.

The origin of the medial femoral circumflex artery, lateral femoral circumflex artery and obturator artery.

INTRODUCTION: The most significant blood vessel supplying the hip joint is the medial femoral circumflex artery (MFCA). MFCA with lateral femoral circumflex artery (LFCA) are the first branches of the deep femoral artery (DFA) or they originate directly from the common femoral artery (CFA) or superficial femoral artery (SFA). PURPOSE AND METHODS: We analyzed 100 CT angiogram of the hip region [72 men, 28 women; mean age 46.4 (14-80)] to assess the frequency of each type of division of the MFCA and LFCA from either the DFA or directly from the CFA or SFA. To assess the variations on each side in one individual we analyzed both hips in 73 patients [mean age 46.6 (14-80)]. RESULTS: Many different types of division have been described. The most frequent one in which both the MFCA and LFCA originate from the DFA, was observed in 50% of patients. In 31% of hips the MFCA originates from the CFA. In our study, a normal origin of the obturator artery from the internal iliac artery was observed in 67% of patients and an atypical origin, called corona mortis was observed in 33% of patients. CONCLUSIONS: The deep branch of the MFCA is the main artery supplying the femoral head, it is at risk during surgical approach to the hip joint. The atypical anastomosis called corona mortis is also at risk while performing the approach to pubic bone. Therefore, knowledge of their topography is very important.

Can palmar creases serve as landmarks for the deeper neuro-vascular structures?

PURPOSE: The aim of this study was the examination of the superficial anatomy of palmar creases and their relation to deeper neuro-vascular structures. METHODS: Four creases: distal wrist flexion crease, thenar crease, proximal palmar crease and distal palmar crease were evaluated with reference to the following structures: palmar cutaneous branch of median nerve, palmar cutaneous branch of ulnar nerve, the nerve of Henle, transverse palmar branches from ulnar nerve, recurrent motor branch of median nerve, radial proper palmar digital nerve to the index and the ulnar proper palmar digital nerve to the thumb, Berrettini's communicating branch, ulnar nerve and artery, superficial palmar arch. We performed dissections of 20 cadaveric upper limbs derived from a homogenous Caucasian group. In our study we measured the location of surgically important structures with reference to palmar skin creases. RESULTS: Among the other observations we noticed that the palmar cutaneous branches of the median and ulnar nerves were located at least 0.5 cm away from the thenar crease. The superficial palmar arch was found between the thenar and proximal palmar crease and never crossed the proximal or distal palmar creases. CONCLUSIONS: These anatomical dissections will provide reference material for further ultrasound studies on the arrangements of neuro-vascular structures in reference to superficial palmar creases.

The blood supply to the femoral head after posterior fracture/dislocation of the hip, assessed by CT angiography.

The femoral head receives blood supply mainly from the deep branch of the medial femoral circumflex artery (MFCA). In previous studies we have performed anatomical dissections of 16 specimens and subsequently visualised the arteries supplying the femoral head in 55 healthy individuals. In this further radiological study we compared the arterial supply of the femoral head in 35 patients (34 men and one woman, mean age 37.1 years (16 to 64)) with a fracture/dislocation of the hip with a historical control group of 55 hips. Using CT angiography, we identified the three main arteries supplying the femoral head: the deep branch and the postero-inferior nutrient artery both arising from the MFCA, and the piriformis branch of the inferior gluteal artery. It was possible to visualise changes in blood flow after fracture/dislocation. Our results suggest that blood flow is present after reduction of the dislocated hip. The deep branch of the MFCA was patent and contrast-enhanced in 32 patients, and the diameter of this branch was significantly larger in the fracture/dislocation group than in the control group (p = 0.022). In a subgroup of ten patients with avascular necrosis (AVN) of the femoral head, we found a contrast-enhanced deep branch of the MFCA in eight hips. Two patients with no blood flow in any of the three main arteries supplying the femoral head developed AVN.

Imaging the vascularisation of the femoral head by CT angiography.

The femoral head receives its blood supply primarily from the medial femoral circumflex artery, with its deep branch being the most important. In a previous study, we performed classical anatomical dissections of 16 hips. We have extended our investigation with a radiological study, in which we aimed to visualise the arteries supplying the femoral head in healthy individuals. We analysed 55 CT angiographic images of the hip. Using 64-row CT angiography, we identified three main arteries supplying the femoral head: the deep branch of the medial femoral circumflex artery and the posterior inferior nutrient artery originating from the medial femoral circumflex artery, and the piriformis branch of the inferior gluteal artery. CT angiography is a good method for visualisation of the arteries supplying the femoral head. The current radiological studies will provide information for further investigation of vascularity after traumatic dislocation of the hip, using CT angiography.

Anatomy of the medial femoral circumflex artery with respect to the vascularity of the femoral head.

We performed a series of 16 anatomical dissections on Caucasian cadaver material to determine the surgical anatomy of the medial femoral circumflex artery (MFCA) and its anastomoses. These confirmed that the femoral head receives its blood supply primarily from the MFCA via a group of posterior superior nutrient arteries and the posterior inferior nutrient artery. In terms of anastomoses that may also contribute to the blood supply, the anastomosis with the inferior gluteal artery, via the piriformis branch, is the most important. These dissections provide a base of knowledge for further radiological studies on the vascularity of the normal femoral head and its vascularity after dislocation of the hip.

Repair of articular cartilage defects with cultured chondrocytes on polysulphonic membrane: experimental studies in rabbits.

INTRODUCTION: Autologous osteochondral transplantation is one method that can be used to create hyaline or hyaline-like repair in a defect area. The purpose of the present study was to repair full-thickness articular cartilage defects in 9 rabbit knee joints with autologous cultured chondrocytes. METHODS: An articular cartilage defect was created on the patellar groove of the femur. The defect was filled with chondrocytes cultured in vitro and placed into the knee on a polysulphonic membrane. At 8 weeks after the operation, the reparative tissue was analyzed macroscopically and histologically. RESULTS: At 8 weeks after the operation, the surfaces of the reparative tissue were smooth, and the defects were filled with mature hyaline cartilage in 5 cases. In 2 cases, the reparative hyaline cartilage was immature and there was worse integration of grafted tissue into the adjacent normal cartilage. In 2 cases, the surface of the grafted area was irregular, and the reparative tissue was disintegrated and incompletely differentiated. CONCLUSION: The results suggest that transplantation of autologous chondrocytes cultured in vitro and placed into the knee on polysulphonic membrane is effective in repairing an articular cartilage defect.

Rhodanese in mouse brain: regional differences and their metabolic implications.

Our results concern the regional localization of rhodanese in the mouse brain. A histoenzymatic examination was undertaken in telencephalon, diencephalon, mesencephalon, and rhombencephalon. The sites of rhodanese activity are revealed as punctuate, granular, dark dots, small in some regions such as hippocampus or bigger in others, and as long, thread-like particles especially, abundant in the region of the telencephalon in the astroglia cells and in the region of the mesencephalon in the hippocampus. There were sites with a high density of the histochemical test products, for example, the ependymoma of the forth cerebral ventricle, choroid plexus, and nerve ducts. These findings support the detoxifying role of rhodanese in brain regions.

Rhodanese (thiosulfate:cyanide sulfurtransferase) from frog Rana temporaria.

The molecular mass of rhodanese from the mitochondrial fraction of frog Rana temporaria liver, equaling 8.7 kDa, was determined by high-performance size exclusion chromatography (HP-SEC). The considerable difference in molecular weight and the lack of common antigenic determinants between frog liver rhodanese and bovine rhodanese suggest the occurrence of different forms of this sulfurtransferase in the liver of these animals.

Ultrasound measurements of the newborn hip. Comparison of two methods in 657 newborns.

We compared ultrasound measurements using the Graf and Terjesen methods in 657 newborns. The alpha angle and femoral head coverage (FHC) were analyzed. The rate of DDH was 3.9%, according to Graf and 2.9%, according to Terjesen. The spontaneous increases in alpha angle and FHC were 5 degrees and 7%, respectively, during the first 2 months. Good accordance between the two methods was shown. A few hips were normal, according to one method and were subluxated, according to the other one. The methods gave similar results, except the percentage of "immature hips" IIa (29%) and "possible dysplastic hips" (14%). This might be a sign of better specificity of the Terjesen method. Good interosberver agreement and simple classification favor use of the Terjesen method. The method of Graf is the most commonly used and gives adequate evaluation of the hip, if the method of examination and rather complicated classification are followed closely.

Hamstring shortening: postural defect or congenital contracture.

The clinical appearance of hamstring shortening in 10 patients referred with diagnosis of asymmetry of the trunk, scoliosis, postural defect, strange gait, and back pain is reported. Additionally, an assessment of knee extension deficit (KED) angle in 575 healthy children (4-15 years of age) was performed. The mean KED angle in the group of healthy children was 35 degrees (SD = 14 degrees). The border between norm and disease was defined as a mean + 2 SD and equaled 63 degrees. A KED angle greater than 60 degrees occurred in 10% of normal children. There was no correlation between age and a value of KED angle. In the study group, KED angle greater than 40 degrees was more frequent in boys. A correlation between disorders within musculoskeletal system and greater KED angle was found. These disorders were more frequent in children with asymmetrical KED angle. In our opinion, the border value of the KED angle is not a good differentiating factor between hamstring shortening and contracture because it does not explain the cause of the disorder.

Selective effect of 2-(polyhydroxyalkyl)-thiazolidine-4-carboxylic acids on nonprotein sulfhydryl groups in tumor bearing mice.

1. Thiazolidine derivatives (TD), the products of condensation of L-cysteine (cys) with sugars (D-glucose, D-xylose, D-arabinose, D-galactose, and D-mannose), successfully elevated nonprotein sulfhydryl (NPSH) levels in livers of Ehrlich ascites tumor (EAT)-bearing mice. 2. At the same time, TD promoted a significant drop of NPSH in EAT cells. 3. Thus, TD, through their selective influence on the levels of NPSH in liver and cancer cells appear to be promising compounds for anticancer therapy.

[Multilevel osteotomy with Rush pin fixation in treatment of osteogenesis imperfecta]. / Wielopoziomowa osteotomia z zespoleniem pretem Rusha w leczeniu osteogenesis imperfecta.

Fourteen multilevel osteotomies with Rush pin fixation have been performed in 5 children with osteogenesis imperfecta. The age of patients at the operation ranged from 6.5 to 15.5 years. Plaster of Paris immobilization never exceeded 8 weeks. An axial correction, improved ambulating and equalization of the limbs have been achieved in all cases. Complications of the method included varus deformity of the proximal tibia (1 case), migration of the pin (1 case) and supracondylar fracture of the femur at the level of pin end (2 cases).

Transamination and transsulphuration of L-cysteine in Ehrlich ascites tumor cells and mouse liver. The nonenzymatic reaction of L-cysteine with pyruvate.

1. The activity of cysteine aminotransferase (CAT), 3-mercaptopyruvate sulfurtransferase (MPST) and rhodanese is much lower in Ehrlich ascites tumor cells (EATC) than in mouse liver. 2. Contrary to mouse liver homogenate, no synthesis of sulphane sulphur-containing compounds from L-cysteine is observed in EATC homogenate. 3. 2-Methyl-thiazolidine-2,4-dicarboxylic acid (CP), 2-methyl-thiazolidine-4-carboxylic acid (CA) and thiazolidine-4-carboxylic acid (CF) can be used as sources of low molecular-weight thiol compounds both in EATC and mouse liver homogenate. 4. Pyruvate formed from phosphoenolpyruvate (PEP) in EATC homogenates reacts with L-cysteine (L-CYS) to CP.

The antioxidative properties of thiazolidine derivatives.

Antioxidative properties of thiazolidine compounds, adducts of L-cysteine with formaldehyde (thiazolidine-4-carboxylic acid), with pyruvate (2-methyl-thiazolidine-2,4-dicarboxylic acid), and glucose (2-/D-gluco-1',2',3',4',5'-penthahydroxypentyl/- thiazolidine-4-carboxylic acid) were studied. The investigated compounds, as well as L-cysteine and DL-penicillamine inhibited in vitro lipid peroxidation induced by NADPH, ethanol, and hydrogen peroxide in the suspension of rat liver microsomes.

Formation of 2-methyl-2,4-thiazolidinedicarboxylic acid from L-cysteine in rat tissues.

The adduct formed non-enzymatically from L-cysteine and pyruvate: 2-methyl-2,4-thiazolidinecarboxylic acid (CP) was isolated, and identified by the electron impact mass spectroscopy. It was found that CP is formed (by cysteine transformation) and is metabolized in rat tissues. Formation of CP from cysteine or cystine was catalysed by partially purified rat liver gamma-cystathionase.

Phosphoprotein phosphatase activity of human prostate acid phosphatase.

Human prostate acid phosphatase (EC 3.1.3.2) has been shown to dephosphorylate different phosphoproteins with the maximum rate at pH 4.0-4.5. The activity with phosvitin is distinctly higher than with beta-casein, casein and most of all than with riboflavin-binding protein. The native phosvitin is homogeneous on isoelectric focusing with pI value of 2.1, whereas phosvitin partially dephosphorylated (in about 15%) by the prostate acid phosphatase shows multiple bands with pI values of 3.5 - 6.8 or higher. The phosphate groups bound to serine residues are removed enzymatically twice as fast as phosphothreonine residues. The apparent Km value for phosvitin was 2.4 X 10(-7) M, and is by three orders of magnitude lower than Km of p-nitrophenyl phosphate (2.9 X 10(-4) M). The competitive inhibitors of prostate acid phosphatase, fluoride and L(+)-tartrate, show the same Ki values for phosvitin and p-nitrophenyl phosphate.