Posterior/anterior combined surgery for thoracolumbar burst fractures--posterior instrumentation with pedicle screws and laminar hooks, anterior decompression and strut grafting.

STUDY DESIGN: A prospective clinical study. OBJECTIVE: The purpose of this study was to evaluate prospectively a large group of patients with thoracolumbar burst fractures who were treated with a posterior/anterior combined procedure and to report on the surgical outcomes, complications and radiographic results. METHODS: A total of 100 consecutive patients were surgically managed with posterior instrumentation, anterior decompression and anterior strut grafting. There were 71 males and 29 females; the mean age was 36 years. Patients with osteoporotic delayed vertebral body collapse were excluded. The mean follow-up period was 30 months. Surgical outcomes such as operative time, blood loss and sagittal alignment were investigated. A neurological assessment was performed by a rating system based on the American Spine Injury Association impairment scale. An interbody fusion was judged using plain X-ray and computed tomographic scans. RESULTS: The mean operative time was 256 min and the mean operative bleeding was 985 ml. Most of the patients were ambulatory within 3 days after surgery. Of the 76 patients with neurological injury, 54 (71.1%) recovered function following surgery. The mean local kyphosis angle was 12.2° kyphotic preoperatively and 0.8° lordotic at the final observation. The mean correction angle was 15.7° and correction loss was 2.6°. No instrumentation failure was observed and the postoperative fusion rate was 99%. CONCLUSIONS: Posterior/anterior combined surgery with posterior pedicle screws and hooks fixation, and reconstruction by simultaneous strut grafting and anterior decompression, achieved short segment fixation and can be a useful option for surgically treating thoracolumbar burst fractures.

Induction of apoptosis by dopamine in human oral tumor cell lines.

Dopamine dose-dependently reduced the viable cell number of both human salivary gland tumor HSG and oral squamous cell carcinoma HSC-2, HSC-4, and NA cells. CoCl2 significantly reduced both the cytotoxic activity and radical intensity of dopamine (determined by ESR spectroscopy). Dopamine produced DNA fragments (demonstrated by TUNEL method) and induced degradation of cytokeratin by activated caspase in HSG cells (detected by an immunocytochemical method, using a specific M30 monoclonal antibody). FACS analysis demonstrated that dopamine induced DNA fragmentation, a biochemical hallmark of apoptosis, in human promyelocytic leukemia HL-60 cells. The addition of catalase did not prevent the apoptosis-inducing activity of dopamine, reducing the possibility of the involvement of H2O2 for dopamine-induced apoptosis. Dopamine transiently induced p38 mitogen-activated protein kinase (MAP kinase) phosphorylation. However, an inhibitor of p38 MAP kinase phosphorylation, SB203680, failed to inhibit the dopamine-induced apoptosis. These data suggest that p38 phosphorylation at an early stage may not be a causative event for apoptosis.

[Experimental study on injury of the rat nasal mucosa by distilled water irrigation, and its regeneration].

Injuries caused by distilled water and the regeneration process in the nasal mucosa in the respiratory region of the rat were examined electron microscopically and immunohistochemically by light microscopy. The mucosal injury was observed as exfoliation and desquamation of ciliated cells and goblet cells almost everywhere. The basal cells and basal membrane were intact. The regeneration process was completed by the migration, proliferation and differentiation of basal cells. The numbers of nuclear mitotic figures started to increase in a group of rats observed 6 hours after treatment (6-hour group), peaked at 48 hours, and returned to the baseline state after day 4. The BrdU labeling index, on the other hand, started to increase after 6 hours, peaked at 36 hours, and returned to the baseline state after day 4. The goblet cells were predominant even in the 21-day group, compared to the control group. Nuclear mitotic figures and secretory granules were observed together in one cell in the 36-hour group.

[Meatoplasty using island pedicle flap].

Meatoplasty is designed to create a lasting external auditory canal and provide improvement in hearing acuity. In three patients with congenital atresia of the external auditory canal not requiring otoplasty, we carried out meatoplasty using an island pedicle flap obtained from the postauricular region. The island pedicle flap was made into a tubed pedicle when sutured with the epidermis facing inward, which was then made into a blind tube pedicle flap when sutured to a free skin graft. The external auditory canal was completed when the blind tubed pedicle flap was inserted into a newly created external auditory canal. Since the operation, two of the three patients have benefited from remarkable improvement in hearing acuity, and all three patients have been free of atresia in the newly created auditory canal. This procedure has the following major advantages: the island pedicle flap is nourished by the posterior auricular artery; the procedure provides an island flap wide enough to cover the newly created auditory canal; and the operation can be performed in a one-stage procedure.

Ciliated mucous cells found in the nasal mucosa of a patient with Kartagener's syndrome.

Transmission electron microscopy revealed the presence of ciliated cells containing many mucous secretory granules in the nasal surface epithelium of a 13-year-old patient suffering from Kartagener's syndrome. In these cells, mucous secretory granules were accumulated in the apical cytoplasm, and the Golgi apparatus was well developed in the supranuclear region. Mucous secretory granules were discharged infrequently through the apical cell membranes by single or compound exocytosis. The cells were considered to be ciliated mucous cells, which have already been reported to be present in the lower respiratory tract but not in the upper respiratory tract.

Polymyxin B binding sites in Escherichia coli as revealed by polymyxin B-gold labeling.

A complex of polymyxin B, bovine serum albumin, and colloidal gold was prepared and used for the ultrastructural localization of polymyxin B binding sites on thin sections of Epon-embedded Escherichia coli cells. Gold particles were found on the outer membrane of E. coli, which is consistent with reported biochemical findings. We concluded that gold labeling with polymyxin B is useful in localizing the binding sites of polymyxin.

Cytochemical localization of specific carbohydrates in the cochlea using wheat germ agglutinin-gold.

Localization of specific carbohydrates in the cochlea was examined by postembedding labelling by wheat germ agglutinin (WGA)-gold at the electron microscopic level. Gold labelling was observed in the tectorial membrane, basilar membrane, basal membrane of the capillary and other connective tissues. In these areas, the labelling was observed over either fibrous structures or the ground substance. WGA is known to bind specifically with N-acetylneuraminic acid, N-acetyl-D-galactosamine, N-acetyl-D-glucosamine and its beta-(1-4)-linked oligosaccharides. The labelled sites, therefore, are considered to indicate the presence of glycoconjugates that contain these carbohydrates as their constituent.

Wheat germ agglutinin binding sites in the organ of Corti as revealed by lectin-gold labeling.

The distribution of wheat germ agglutinin(WGA)-binding sites in the organ of Corti of the guinea pig and mongolian gerbil was studied. WGA was conjugated with gold particles and applied on thin sections of the cochlea embedded in Spurr's resin and in Lowicryl K4M. WGA-binding sites were found on the plasma membrane, lysosomes and cytoskeletons of hair and supporting cells as well as on the tectorial and basilar membranes. No distinct difference was discovered between hair cells and supporting cells in terms of WGA-binding activities.

Cupulogenesis and glycoconjugates in the labyrinthine ampulla as revealed by WGA-gold labeling.

We studied the distribution of wheat germ agglutinin (WGA)-bindable glycoconjugates in the vestibular ampulla of mongolian gerbils. WGA was conjugated with gold particles and applied to Lowicryl K4M sections of the ampulla. WGA-binding sites were found on the cupula and some of the secretory granules and Golgi apparatuses in the supporting cells of the sensory epithelia. The granules were seen to secrete into the endolymphatic space through reticular membrane. It is likely, therefore, that glycoconjugates are glycosylated at the Golgi apparatus in the supporting cells, stored in the granules, and secreted through the reticular membrane into the endolymphatic space to be used as a component of the cupula. The cell membranes of various cells, connective tissue filaments in the perilymphatic space and the cytoplasm of melanocytes were also labeled with WGA-gold.

Amylase secretion by nasal glands. An immunocytochemical study.

Amylase, an enzyme that hydrolyzes starch, has been localized in the nasal mucosa for the first time by the protein A-gold technique. The amylase appeared to be produced by serous cells of the nasal glands. This enzyme has the potential for use as a tumor marker for cancer of the nasal cavity. The function of amylase in the physiology of nasal secretions is discussed.

Lysozyme producers in nasal mucosa. An immunocytochemical study.

The question of whether or not goblet cells in the nasal mucosa are lysozyme producers has yet to be examined. In the present study, lysozyme was localized by the protein A-gold technique in human nasal mucosa with special attention to goblet cells. Both light and electron microscopic immunostaining revealed lysozyme in the secretory granules of the goblet cells, although far less than the amount present in the serous cells of the nasal glands. We concluded that the nasal glands were the main producer and goblet cells the subsidiary producer of lysozyme in nasal mucosa.

L-thyroxine, cortisol, and diet affect the postnatal development of the facial part of the skull in developing rats.

In rats, the effects of L-thyroxine (T4; 0.2 micrograms/g body weight), hydrocortisone (HC; 5 micrograms/g body weight) and mastication on the postnatal development of the facial part of the skull were examined. Administration of T4 and/or HC to rats for 5 consecutive days from day 5 after birth induced a precocious increase in the ratio of the facial length to the head length. The effects of these hormones decreased with the progression of weaning, and after the 20th postnatal day, the hormones had no effects on the postnatal development of either (facial and head) part of the skull. Moreover, these hormones played an additive role in the growth of facial part. On the other hand, continuous suckling from birth to the 30th postnatal day caused a significant decrease in the ratio of the facial length to the head length. These results suggest that increases in the circulating levels of T4 and HC in suckling rats and mastication in the weaning period are involved in development of the postnatal development of the facial part of the skull.

Bacteriolytic activity of lysozyme in the nasal mucosa.

During an experiment to study the localization of the lysozyme in the nasal mucosa of humans by the protein A-gold technique, we observed the accumulation of lysozymes around bacteria possibly causing bacteriolysis. The lysozyme, therefore, seems to play a preventive role against some kind of bacterial infection in the nasal mucosa in situ.

Polymyxin-B-binding sites in the cochlea as demonstrated by polymyxin-B/gold labeling.

A polymyxin-B/bovine-serum-albumin/gold complex was used as a probe to detect the binding sites of polymyxin B on thin sections of cochlea embedded in Spurr's resin. The binding sites were found to be mainly located on the stereocilia, the cuticular plate of hair cells, the head plate of Deiters' cells, the tonofilaments in pillar cells and Deiters' cells, fibrous structures in the spiral limbus, the tectorial membrane and the basilar membrane and neural elements such as nerve endings, fibers, and the myelin sheath. The mitochondria, plasma membrane, and chromatin of the nuclei of the cells observed also exhibited binding. Our results suggest that phospholipids, glycoconjugates, cytoskeletal proteins and nucleic acids are responsible for this binding activity.

Aminoglycoside binding sites in the cochlea as revealed by neomycin-gold labelling.

Neomycin/bovine serum albumin/gold was used as a probe to detect the binding sites of aminoglycosides on the thin sections of the cochlea embedded in Spurr. The binding sites were mainly located on the stereocilia, the cuticular plate of hair cells, the head plates of Deiters' cells, fibrous structures in pillar cells, in the spiral limbus and tectorial membrane and basilar membrane, plasma membranes, mitochondria and the chromatin of various kinds of cells. Triphosphoinositide, acidic glycosaminoglycans, and RNA were considered to be responsible for the binding activity.

Immunocytochemical detection of triphosphoinositide in vestibular hair cells.

Triphosphoinositide (TPI), an aminoglycoside receptor and a possible regulator of cationic permeation through its ability to bind with Ca++, was localized by the protein-A gold technique in vestibular sensory epithelia using an antibody highly specific to TPI. TPI was detected on the stereocilia, kinocilia, and cuticular plate of hair cells, and in the reticular membrane of supporting cells. The cilia of hair cells are damaged by aminoglycosides at a relatively early stage of toxicity. Ca++-regulated bioactivity in this area is probably involved.

Localization of lysozyme in the frozen section of nasal mucosa by protein A-gold technique.

The location of lysozyme was studied in frozen sections of the nasal gland by protein A-gold technique, modified for the frozen section. Serous glands were enriched with lysozyme. Within the glands, the apical portion of the serous cells was most heavily stained. The epithelial layer was virtually unstained for lysozyme. The result was essentially the same as that obtained by the peroxidase-antiperoxidase method. Electronmicroscopic examination of the stained sections supports the possible application of this method for pre-embedding immunostaining, although further improvement of the technique is necessary.

Experimental immune complex otitis media: localization of IgG by protein A-gold technique.

Immune complex (IC) was made of bovine serum albumin (BSA) and anti-BSA guinea pig serum, and instilled into the tubotympanic cavity of untreated guinea pigs. The location of IgG was determined by using the protein A-gold technique to trace IC in the tubotympanic mucosa of the otitis media with effusion (OME) caused by the instillation. IgG was found on the effusion, degenerated ciliated cells and on granules of goblet cells. There was no evidence of intense accumulation of IgG on the basement membrane of the mucosal epithelium or the capillaries. It is likely that IC activates complements in the tubotympanic cavity to cause OME.