Pseudoaneurysm of the deep circumflex iliac artery: a rare complication at an anterior iliac bone graft donor site treated by coil embolization.
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Pseudoaneurysm formation of the deep circumflex iliac artery (DCIA) after harvesting an anterior iliac bone graft for spinal fusion is reported herein. A 76-year-old man with cervical myelopathy underwent anterior cervical decompression and fusion with a left anterior iliac bone graft. A painful left inguinal mass was noted 1 month later. He was admitted to our emergency ward. Angiography of the left external iliac artery was performed which showed a pseudoaneurysm of the DCIA. Selective transarterial coil embolization of the artery was performed, and bleeding was arrested. In a review of the previous literature, only 1 pseudoaneurysm of the DCIA was reported to be associated with anterior iliac bone graft. In conclusion, vascular injury after anterior iliac bone harvesting is rare but can occur. Selective transarterial coil embolization is a prompt and effective solution. (+info)
Serotonin receptor blockade improves distal perfusion after lower limb ischemia in the fatty Zucker rat.
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OBJECTIVE: Lower limb perfusion following arterial occlusion depends on the recruitment of collateral vessels. Blood flow through these collateral vessels may be jeopardized by hypersensitivity to vasoconstriction by serotonin (5-HT), as has been reported during hyperlipidemia and diabetes. Therefore the aim of this study was to determine the benefits of chronic treatment with SL65.0472, a mixed 5-HT(1B)/5-HT(2A) receptor antagonist, on lower limb ischemia in fatty fa/fa Zucker rats, a strain characterized by obesity, diabetes and hyperlipidemia. Comparison was made with lean control fa/+ Zucker rats. METHODS: SL65.0472 (3 mg/kg/day, n=16) or its vehicle (n=20) were administered orally for 13 days to male fatty fa/fa Zucker rats submitted to lower limb ischemia. Hindlimb ischemia was induced unilaterally by resection of the left femoral and external iliac arteries and embolization of the left internal iliac artery with microspheres. Distal perfusion was measured under mild anesthesia by laser Doppler imaging of both feet. The perfusion deficit (Delta%) was calculated before and 3, 7 and 14 days after induction of hindlimb ischemia. Twenty-four hours after the last administration of SL65.0472, muscular partial oxygen pressure, iliac blood flows, maximal vasodilatory reserve and the vasoreactivity to 5-HT were measured in both limbs. RESULTS: Chronic administration of SL65.0472 improved the distal perfusion from day 3. At day 14, the deficit of perfusion was limited to -36+/-7% in SL65.0472-treated animals vs. -70+/-6% in the vehicle-treated group (P<0.001) and was accompanied by a significant improvement of partial oxygen pressure in the ischemic limb (SL65.0472: 10.4+/-3.9 mmHg vs. vehicle: 3.5+/-1.1 mmHg, P<0.05). Maximal vasodilatory reserve tended to increase from 2.2+/-0.4 ml/min in the vehicle-treated group to 3.8+/-0.6 ml/min after SL65.0472. SL65.0472 markedly reduced 5-HT-mediated vasoconstriction, which was enhanced in the hypoperfused limb, without altering arterial pressure. Induction of hindlimb ischemia led to the overexpression of both 5-HT(1B) and 5-HT(2A) receptors only in the hypoperfused skeletal muscle as assessed by semi-quantitative RT-PCR. CONCLUSION: These results suggest that the recruitment of collateral vessels after the induction of hindlimb ischemia is significantly impaired in obese fa/fa Zucker rats due to a persistent vasoconstriction mediated by 5-HT and involving stimulation of 5-HT(1B) and/or 5-HT(2A) receptors. (+info)
Comparative study of iliac bone graft and carbon cage with local bone graft in posterior lumbar interbody fusion.
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We performed a comparative study of iliac bone graft (the iliac bone group) and carbon cage with local bone graft (the cage group) in PLIF to evaluate the clinical results of both methods. We examined both groups about the operating time, the estimated blood loss, the operative results using the score rating system of Japanese Orthopaedic Association (JOA score), and the presence of bone union on radiography. The operating time and the estimated blood loss of the cage group were statistically less than those of the iliac bone group. There were no significant differences between both groups about the operative results. The radiographic evaluation on bone union showed that half of the iliac bone group had collapsed union, but all cases of the cage group revealed union without collapse. (+info)
Human, rat and chicken small intestinal Na+ - Cl- -creatine transporter: functional, molecular characterization and localization.
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In spite of all the fascinating properties of oral creatine supplementation, the mechanism(s) mediating its intestinal absorption has(have) not been investigated. The purpose of this study was to characterize intestinal creatine transport. [(14)C] creatine uptake was measured in chicken enterocytes and rat ileum, and expression of the creatine transporter CRT was examined in human, rat and chicken small intestine by reverse transcription-polymerase chain reaction, Northern blot, in situ hybridization, immunoblotting and immunohistochemistry. Results show that enterocytes accumulate creatine against its concentration gradient. This accumulation was electrogenic, Na(+)- and Cl(-)-dependent, with a probable stoichiometry of 2 Na(+): 1 Cl(-): 1 creatine, and inhibited by ouabain and iodoacetic acid. The kinetic study revealed a K(m) for creatine of 29 microM. [(14)C] creatine uptake was efficiently antagonized by non-labelled creatine, guanidinopropionic acid and cyclocreatine. More distant structural analogues of creatine, such as GABA, choline, glycine, beta-alanine, taurine and betaine, had no effect on intestinal creatine uptake, indicating a high substrate specificity of the creatine transporter. Consistent with these functional data, messenger RNA for CRT was detected only in the cells lining the intestinal villus. The sequences of partial clones, and of the full-length cDNA clone, isolated from human and rat small intestine were identical to previously cloned CRT cDNAs. Immunological analysis revealed that CRT protein was mainly associated with the apical membrane of the enterocytes. This study reports for the first time that mammalian and avian enterocytes express CRT along the villus, where it mediates high-affinity, Na(+)- and Cl(-)-dependent, apical creatine uptake. (+info)
Medial superior cluneal nerve entrapment neuropathy in teenagers: a report of two cases.
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Medial superior cluneal nerve entrapment neuropathy causes pain radiating from the low back down to the posterior thigh. It tends to be misdiagnosed as a lumbar spine disorder. Patients in previous reports were in the middle or old age at the onset. Proposing simultaneous full flexion of the ipsilateral hip and knee joints as a provocation test, we present two cases of teenager females who spent long before diagnosis of their condition. Both of them had engaged in vigorous sports activities and completely recovered from the disability following local anaesthetic and corticosteroid injection at the trigger point. (+info)
Acetabular roof reconstruction with pedicled iliac graft.
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Reconstruction of the acetabular roof in patients with hip dysplasia shows disappointing mid-term results due to insufficient incorporation and collapse of the bone graft. We have developed a new reconstructive method using a pedicled iliac graft. We simulated surgical reconstruction of the acetabular roof in ten cadaver specimens. The purpose was to evaluate whether the deep circumflex artery was long enough to allow transfer of the graft without requiring micro-vascular anastomosis. In all cadavers, the length of the pedicle was sufficient to reach any desired position of the acetabular roof. The use of such a pedicled structural graft may provide good primary stability and allow local bony remodelling and incorporation under load. (+info)
Genotype-phenotype relationship in human ATP6i-dependent autosomal recessive osteopetrosis.
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Autosomal-recessive osteopetrosis is a severe genetic disease caused by osteoclast failure. Approximately 50% of the patients harbor mutations of the ATP6i gene, encoding for the osteoclast-specific a3 subunit of V-ATPase. We found inactivating ATP6i mutations in four patients, and three of these were novel. Patients shared macrocephaly, growth retardation and optic nerve alteration, osteosclerotic and endobone patterns, and high alkaline phosphatase and parathyroid hormone levels. Bone biopsies revealed primary spongiosa lined with active osteoblasts and high numbers of tartrate-resistant acid phosphatase (TRAP)-positive, a3 subunit-negative, morphologically unremarkable osteoclasts, some of which located in shallow Howship lacunae. Scarce hematopoietic cells and abundant fibrous tissue containing TRAP-positive putative osteoclast precursors were noted. In vitro osteoclasts were a3-negative, morphologically normal, with prominent clear zones and actin rings, and TRAP activity more elevated than in control patients. Podosomes, alphaVbeta3 receptor, c-Src, and PYK2 were unremarkable. Consistent with the finding in the bone biopsies, these cells excavated pits faintly stained with toluidine blue, indicating inefficient bone resorption. Bone marrow transplantation was successful in all patients, and posttransplant osteoclasts showed rescue of a3 subunit immunoreactivity. (+info)
Marginal wedge resection for chronic osteomyelitis of the iliac bone.
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Six patients with chronic osteomyelitis of the iliac bone were treated with marginal resection of the infected segment. All patients were healthy active males without predisposing factors. Their age ranged between 14 and 38 years. All patients had recurrent drainage of abscesses for 2-9 years. In three patients, the infection followed a gunshot injury, in two the infection was haematogenous in origin, and in one the infection followed a surgical bone graft procedure. The outcome was successful for all patients, who have been followed regularly for 2-10 years. (+info)