Conservative management of Morel-Lavallée lesion: a case study.

OBJECTIVE: To illustrate the conservative clinical management of Morel-Lavallée lesion. CLINICAL FEATURES: A 34 year-old male presented with a forced flexion induced right knee injury that was diagnosed as a Morel-Lavallée lesion by way of Magnetic Resonance Imaging (MRI). INTERVENTION AND OUTCOME: The patient was co-managed by a sports medicine physician and a chiropractor with a combination of percutaneous aspiration, dry needling, soft tissue therapy, extracorporeal shockwave therapy (ESWT), and corrective exercise. SUMMARY: The patient experienced improved function throughout chiropractic care. Almost complete resolution was achieved at 18 weeks after injury and maintained at 35 weeks after injury. Further research is needed to understand if this improvement in function is better than the natural history of this condition.

OBJECTIF: Illustrer la prise en charge conservatrice clinique de la lésion de Morel-Lavallée. CARACTÉRISTIQUES CLINIQUES: Un homme de 34 ans s'est présenté avec une blessure au genou droit provoquée par une flexion forcée qui a été diagnostiquée comme une lésion de MorelLavallée grâce à l'imagerie par résonance magnétique (IRM). INTERVENTION ET RÉSULTATS: Le patient a été pris en charge conjointement par un médecin du sport et un chiropraticien avec une combinaison d'aspiration percutanée, d'aiguilles sèches, de thérapie des tissus mous, de thérapie par ondes de choc extracorporelles et d'exercices correctifs. RÉSUMÉ: L'état du patient s'est amélioré tout au long des soins chiropratiques. Une guérison presque complète a été atteinte 18 semaines après la blessure et 35 semaines après la blessure, le patient été guéri. D'autres recherches sont nécessaires pour comprendre si cette amélioration de la fonction est meilleure que l'histoire naturelle de cette condition.

A major fraction of glycosphingolipids in model and cellular cholesterol-containing membranes is undetectable by their binding proteins.

Glycosphingolipids (GSLs) accumulate in cholesterol-enriched cell membrane domains and provide receptors for protein ligands. Lipid-based "aglycone" interactions can influence GSL carbohydrate epitope presentation. To evaluate this relationship, Verotoxin binding its receptor GSL, globotriaosyl ceramide (Gb(3)), was analyzed in simple GSL/cholesterol, detergent-resistant membrane vesicles by equilibrium density gradient centrifugation. Vesicles separated into two Gb(3/)cholesterol-containing populations. The lighter, minor fraction (<5% total GSL), bound VT1, VT2, IgG/IgM mAb anti-Gb(3), HIVgp120 or Bandeiraea simplicifolia lectin. Only IgM anti-Gb(3), more tolerant of carbohydrate modification, bound both vesicle fractions. Post-embedding cryo-immuno-EM confirmed these results. This appears to be a general GSL-cholesterol property, because similar receptor-inactive vesicles were separated for other GSL-protein ligand systems; cholera toxin (CTx)-GM1, HIVgp120-galactosyl ceramide/sulfatide. Inclusion of galactosyl or glucosyl ceramide (GalCer and GlcCer) rendered VT1-unreactive Gb(3)/cholesterol vesicles, VT1-reactive. We found GalCer and GlcCer bind Gb(3), suggesting GSL-GSL interaction can counter cholesterol masking of Gb(3). The similar separation of Vero cell membrane-derived vesicles into minor "binding," and major "non-binding" fractions when probed with VT1, CTx, or anti-SSEA4 (a human GSL stem cell marker), demonstrates potential physiological relevance. Cell membrane GSL masking was cholesterol- and actin-dependent. Cholesterol depletion of Vero and HeLa cells enabled differential VT1B subunit labeling of "available" and "cholesterol-masked" plasma membrane Gb(3) pools by fluorescence microscopy. Thus, the model GSL/cholesterol vesicle studies predicted two distinct membrane GSL formats, which were demonstrated within the plasma membrane of cultured cells. Cholesterol masking of most cell membrane GSLs may impinge many GSL receptor functions.

New aspects of the regulation of glycosphingolipid receptor function.

We propose that the fatty acid heterogeneity of glycosphingolipids may compensate for the relative few and simple glycosphingolipid structures found in mammalian cells. Variation in GSL fatty acid composition may mediate aglycone regulation of GSL membrane receptor function by a differential interaction with cholesterol and other membrane components which may be differentially organized within plasma membrane lipid domains. These concepts are specifically illustrated in model membrane studies and in relation to the role of the glycolipid, globotriaosyl ceramide (Gb(3)) in verotoxin-induced renal pathology and gp120 binding in HIV infection.

Fatty acid-dependent globotriaosyl ceramide receptor function in detergent resistant model membranes.

Glycosphingolipid (GSL) fatty acid strictly regulates verotoxin 1 (VT1) and the HIV adhesin, gp120 binding to globotriaosyl ceramide within Gb(3)/cholesterol detergent resistant membrane (DRM) vesicle constructs and in Gb(3) water-air interface monolayers in a similar manner. VT2 bound Gb(3)/cholesterol vesicles irrespective of fatty acid composition, but VT1 bound neither C18 nor C20Gb(3)vesicles. C18/C20Gb(3) were dominant negative in mixed Gb(3) fatty acid isoform vesicles, but including C24:1Gb(3) gave maximal binding. VT1 bound C18Gb(3) vesicles after cholesterol removal, but C20Gb(3)vesicles required sphingomyelin in addition for binding. HIV-1gp120 also bound C16, C22, and C24, but neither C18 nor C20Gb(3) vesicles. C18 and C20Gb(3) were, in mixtures without C24:1Gb(3), dominant negative for gp120 vesicle binding. Gp120/VT1bound C18 and C24:1Gb(3) mixtures, although neither isoform bound alone. Monolayer surface pressure measurement showed VT1, but not VT2, bound Gb(3) at cellular DRM surface pressures, and confirmed loss of VT1 and gp120 (but not VT2) specific C18Gb(3) binding. We conclude fatty-acid mediated fluidity within simple model GSL/cholesterol DRM can selectively regulate GSL carbohydrate-ligand binding.