In vitro effects of concentrated growth factors (CGF) on human SH-SY5Y neuronal cells.

OBJECTIVE: The aim of this study was to test the in vitro differentiation effects of concentrated growth factors (CGF), a platelet rich preparation, using SH-SY5Y cells, derived from human neuroblastoma. MATERIALS AND METHODS: SH-SY5Y cells were cultured in presence of CGF or retinoic acid (RA). After 72 h of treatment, different parameters were investigated: cell proliferation by an automated cell counter; cell viability by thiazolyl blue tetrazolium bromide (MTT) assay; cell differentiation markers, i.e., neuronal nuclear antigen (NeuN), synaptophysin (SYP) and ß3-tubulin, by immunocytochemistry and Western blotting techniques; release of nerve growth factor (NGF) and brain-derived growth factor (BDNF) by enzyme-linked immunosorbent assay (ELISA) and neurite outgrowth by a dedicated image software. RESULTS: In presence of CGF, the cell proliferation rate and viability decreased, as expected for differentiated SH-SY5Y cells. On the contrary, the cellular differentiation markers increased their expression together with the release of growth factors. Moreover, the neurite outgrowth was improved. CONCLUSIONS: The data suggest that CGF treatment positively affects the cell differentiation, regulating the expression of neuronal markers, the release of growth factors and the neurite length. Taken together these results seem to be promising in the development of new approaches for neural regeneration.

Instability of the trapezio metacarpal joint: related arthritis and surgery.

Arthritis of the trapezio metacarpal joint (TMJ) is a very frequent condition, which affects women more than men, especially in the fifth or sixth decade of life. It can be very painful and disabling and the patient will need surgery for relief even if it can result in painless stiffening (in adduction of the metacarpal and hypertension of the metacarpal, which in turn is very disabling). TMJ arthritis is rarely primary or idiopathic; in general, it is secondary to instability of the joint, which, in turn, may be primary or secondary.

[Sensory retraining of the hand using gnosis rings]. / La rééducation sensitive de la main au moyen des anneaux gnosiques.

Sensory reeducation is very important. Many methods are used but it is difficult to assess their efficiency. Besides the routine methods we are using the gnostic rings which have on their periphery 5 symbols: a letter = A, a number = 3, a geometrical figure = a circle, a rough surface and a smooth convex surface. The symbols of the rings are in 3 different sizes (1.5 - 1 and 0.5 cm). The gnostic rings have 3 advantages: 1) they allow a precise evaluation in percentage. 2) they require an important brain effort, 3) they may be kept in the pocket and used several times during the day.

[Direct muscular neurotization]. / La neurotisation musculaire directe.

The authors present a technique of direct muscular neurotization consisting of re-innervation by direct implantation of a nerve into one or several muscles in cases of avulsion of the nerve supplying the muscle or traumatic or surgical avulsion of the neural part of the muscle. The biological basis for this operation is that a denervated muscle can accept a new innervation by a foreign nerve even in an aneural zone because its sensitivity to acetylcholine is present throughout the muscle, while, in a normally innervated muscle, sensitivity to acetylcholine is confined to the motor endplates. The results of 47 cases are presented: 42 of them obtained good or very good results.

Stabilisation of the trapezio-metacarpal joint.

A new technique of trapezio-metacarpal stabilisation is described which uses the abductor pollicis longus tendon passed through the bases of the first and second metacarpals to fasten the base of the thumb. A biomechanical rationale is presented, as well as the surgical technique and 12 results at follow-up one to six years later.

Trapeziometacarpal stabilisation in arthrosis.

The trapeziometacarpal (TM) joint is often the site of painful arthrosis, particularly in women at the onset of the fourth decade. It is generally associated with capsuloligamentous laxity of the joint or with work requiring the repetitive use of the thumb and index finger and thus work which is typically done by women. It may also be of traumatic origin following joint fracture, but this is not discussed in the present paper. The treatment of this syndrome by stabilisation of the joint is described.

Direct muscular neurotization.

Direct muscular neurotization has limited indications: loss of the distal stump of a motor nerve or avulsion of the "neural" part of one or more muscles. These lesions cannot be repaired with conventional microsurgery techniques, and without the presented technique, the denervated muscles will remain permanently paralyzed. Despite rare failures from poor local vascular or muscular conditions, direct muscular neurotization has provided the vast majority of good results, with scores similar to those obtained with good microsurgical sutures or grafts and has been adopted by several microsurgeons.

Problems in nerve lesions surgery.

An overview of the concepts on peripheral nerve regeneration and of research on the progress in this field is carried out. Problems of regeneration and factors influencing it, both improving and worsening it, are considered, especially with respect to the clinical treatment of nerve lesions. Classical techniques of repair (sutures and grafts) as well as very new methods (e.g., direct muscular neurotization) are discussed. Postoperative treatment and result evaluation are presented.

Neurotization of avulsed roots of brachial plexus by means of anterior nerves of cervical plexus.

In summary, this technique provides a number of well-differentiated sensory and voluntary motor fibers. This number is certainly less than that of a normal plexus but is much more and of much better quality than that of intercostal nerves. If we distribute these fibers to well-chosen branches of the brachial plexus, limiting the neurotization to few selective components, we have the possibility of a useful recovery of essential movements of the shoulder and elbow. Sensation to the hand will also recover to a certain extent. Subsequent palliative operations (as for instance different kinds of arthrodesis) can supply a limb that, although paralyzed and severely impaired, can still be useful.

[Personal technique for suturing the flexor tendons of the fingers with immediate mobilization]. / Technique personnelle de suture des tendons fléchisseurs des doigts avec mobilisation immédiate.

Immediate mobilization of flexor tendons repairs creates a conflict between muscle strength and suture solidity. Non removable sutures are brittle and require to prevent extension by means of either a cast in flexion of the wrist and of the metacarpo-phalangeal joints or a rubber band traction. Pull-out sutures do not permit early mobilization because of their anchorages. The authors present a new technique they have been using for the last five years. It consists in a simple solid slip-knot which tightening the tendon when the muscle pulls. This knot is fixed at the distal bone insertion of the tendon, which makes immediate mobilization possible. Sixty three patients have been treated with by this technique over the past five years. We have not encountered any rupture of the suture. The results, even in the least favorable cases have been considered as very good.