ABSTRACT
In summary, there is a complex interplay between the extrinsic and intrinsic components of the digital extensor mechanism. Numerous examples of dynamic anatomy and pathology of the extensor mechanism in common clinical settings have been described. Treatment principles have been outlined. This review should provide the orthopaedic surgeon with a framework for management of common hand problems.
Subject(s)
Fingers/abnormalities , Fingers/physiology , Hand Deformities/diagnosis , Hand/physiology , Hand/surgery , Tendons/physiology , Diagnosis, Differential , Finger Joint/anatomy & histology , Finger Joint/physiology , Fingers/anatomy & histology , Fingers/surgery , Hand/anatomy & histology , Hand Deformities/physiopathology , Hand Deformities/surgery , Hand Deformities, Acquired/diagnosis , Hand Deformities, Congenital/diagnosis , Humans , Ligaments, Articular/anatomy & histology , Ligaments, Articular/physiology , Metacarpophalangeal Joint/anatomy & histology , Metacarpophalangeal Joint/physiology , Tendons/anatomy & histology , Tendons/surgeryABSTRACT
Important aspects of successful adenovirus gene transfer include the amount and persistence of gene expression, the ability to readminister virus and the localization of virus-directed gene expression to target organs. Our objective in this study was to use a single recombinant adenovirus bearing a quantifiable reporter gene [chloramphenicol acetyltransferase (CAT)] to establish the parameters which define the limits of adenovirus gene expression in a rat model. First, we determined how the route of virus administration affected the amount, duration and distribution of expression in different tissues and in rats of different developmental stages. All routes resulted in infection of all tissues tested. Surprisingly, the most efficient and widespread gene transfer was achieved by intracardiac muscle injection. The high levels of CAT protein that can be produced in a liver (< or = 1.7 mg) or a heart (< or = 196 micrograms) 5 days after infection suggest that the amount of gene product will not be a limitation in the use of adenovirus. Following peak activity at 5 days after infection, a gradual decline of CAT expression was observed in all tissues assayed; by 80 days neither CAT activity nor adenovirus DNA were detectable. In addition, adults could not be boosted by a second administration of virus, presumably due to the presence of high levels of neutralizing antibodies. The limited persistence of gene expression could be circumvented when virus was injected into neonates. Blocking T lymphocyte expansion by cyclosporine enhanced the persistence of CAT gene product over a 25-day period in heart and lung but not in liver compared with control animals.(ABSTRACT TRUNCATED AT 250 WORDS)
