Outcome of a Modified Broström-Gould Procedure for Lateral Ankle Instability

Introduction: Ankle sprains affect 200'000 persons/year in Switzerland. Most incidences are successfully treated by conservative measures but 20% require reconstruction for symptomatic chronic lateral ankle instability. This study evaluates the functional outcome after a modified Broström-Gould technique as measured by different clinical scores and compares the functional outcome of this technique with other surgical treatments of ankle instability. Methods: This retrospective cohort study evaluates 47 patients who underwent a modified Broström-Gould procedure using suture anchors to refix the lateral ankle capsuloligamentary structures at our institution from 2005 to 2009 with a minimum follow-up of one year (13-72 Mo). All patients were operated by one single surgeon and evaluated by an independent examiner. The function was assessed using 4 scores including: the AOFAS (American Orthopaedic Foot and Ankle Society's Score) hindfoot score; the FAAM (Foot and Ankle Ability Measurement); the CAIT (Cumberland Ankle Instability Tool); the CAIS (Chronic Ankle Instability Scale). Results: Six patients were excluded leaving 41 patients for examination. 34 patients (83%) thought that their ankle was more stable after the surgery, 7 (17%) did not feel any difference. 27 patients were very satisfied, 11 satisfied and 3 not satisfied. Reasons for non satisfaction included persistent instability and pain. Ankle mobility returned to normal in 93% of patients. Five patients had transcient hypoesthesy in the area of the superficial peroneal nerve. One patient suffered from a superficial infection treated successfully by local measures. 80% had the perception of a normal ankle, 20% thought to be below normal. At follow-up the AOFAS was 89/100 (37-100), the FAAM 85/100% (35-100%), the CAIT 20/30 (5-30), and the CAIS 74/100% (27-100%). Conclusions: The modified Broström-Gould procedure, which belongs to the anatomic ankle stabilizations is relatively simple and offers good outcome that satisfied 93% of the patients in the present study. No active stabilisator is sacrificed. Preservation of the ankle mobility is better and the complication rate is lower than after non-anatomical procedures described in the literature. The CAIT appeared as the most severe score compared to the other scales used in our study.

Role of α2-adrenoceptors in the lateral parabrachial nucleus in the control of body fluid homeostasis

Central α2-adrenoceptors and the pontine lateral parabrachial nucleus (LPBN) are involved in the control of sodium and water intake. Bilateral injections of moxonidine (α2-adrenergic/imidazoline receptor agonist) or noradrenaline into the LPBN strongly increases 0.3 M NaCl intake induced by a combined treatment of furosemide plus captopril. Injection of moxonidine into the LPBN also increases hypertonic NaCl and water intake and reduces oxytocin secretion, urinary sodium, and water excreted by cell-dehydrated rats, causing a positive sodium and water balance, which suggests that moxonidine injected into the LPBN deactivates mechanisms that restrain body fluid volume expansion. Pretreatment with specific α2-adrenoceptor antagonists injected into the LPBN abolishes the behavioral and renal effects of moxonidine or noradrenaline injected into the same area, suggesting that these effects depend on activation of LPBN α2-adrenoceptors. In fluid-depleted rats, the palatability of sodium is reduced by ingestion of hypertonic NaCl, limiting intake. However, in rats treated with moxonidine injected into the LPBN, the NaCl palatability remains high, even after ingestion of significant amounts of 0.3 M NaCl. The changes in behavioral and renal responses produced by activation of α2-adrenoceptors in the LPBN are probably a consequence of reduction of oxytocin secretion and blockade of inhibitory signals that affect sodium palatability. In this review, a model is proposed to show how activation of α2-adrenoceptors in the LPBN may affect palatability and, consequently, ingestion of sodium as well as renal sodium excretion.

Geology of the Gander Group, Gander River Ultramafic Belt and Davidsville Group in the Jonathan's Pond - Weir's Pond Area, northeast Newfoundland /

The study area is situated in NE Newfoundland between Gander Lake and the north coast and on the boundary between the Gander and Botwood tectonostratigraphic zones (Williams et al., 1974). The area is underlain by three NE trending units; the Gander Group, the Gander River Ultramafic Belt (the GRUB) and the Davidsville Group. The easternmost Gander Group consists of a thick, psammitic unit composed predominantly of psammitic schist and a thinner, mixed unit of semipelitic and pelitic schist with minor psammite. The mixed unit may stratigraphically overlie the psammitic unit or be a lateral facies equivalent of the latter. No fossils have been recovered from the Gander Group. The GRUB is a terrain of mafic and ultramafic plutonic rocks with minor pillow lava and plagiogranite. It is interpreted to be a dismembered ophiolite in thrust contact with the Gander Group. The westernmost Davidsville Group consists of a basal conglomerate, believed deposited unconformably upon the GRUB from which it was derived, and an upper unit of greywacke and slate, mostly of turbidite origin, with minor limestone and calcareous sandstone. The limestone, which lies near the base of the unit, contains Upper Llanvirn to Lower Llandeilo fossils. The Gander and Davidsville Groups display distinctly different sedimentological , structural and metamorphic histories. The Gander Group consists of quartz-rich, relatively mature sediment. It has suffered three pre-Llanvirn deformations, of which the main deformation, Dp produced a major, NE-N-facing recumbent anticline in the southern part of the study area. Middle greenschist conditions existed from D^ to D- with growth of metamorphic minerals during each dynamic and static phase. In contrast, the mineralogically immature Davidsville Group sediment contains abundant mafic and ultramafic detritus which is absent from the Gander Group. The Davidsville Group displays the effects of a single penetrative deformation with localized D_ and D_ features, all of which can be shown to postdate D_ in the Gander Group. Rotation of the flat Gander S- into a subvertical orientation near the contact with the GRUB and the Davidsville Group is believed to be a Davidsville D^ feature. Regional metamorphism in the Davidsville Group is lower greenschist with a single growth phase, MS . These sedimentological, structural and metamorphic differences between the Gander and Davidsville Groups persist even where the GRUB is absent and the two units are in contact, indicating that the tectonic histories of the Gander and Davidsville Groups are distinctly different. Structural features in the GRUB, locally the result of multiple deformations, may be the result of Gander and/or Davidsville deformations. Metamorphism is in the greenschist facies. Geochemical analyses of the pillow lava suggest that these rocks were formed in a back-arc basin. Mafic intrusives in the Gander Group appear to be the result of magraatism separate from that producing the pillow lava. The Gander Group is interpreted to be a continental rise prism deposited on the eastern margin of the Late Precambrian-Lower Paleozoic lapetus Ocean. The GRUB, oceanic crust possibly formed in a marginal basin to the west, is believed to have been thrust eastward over the Gander Group, deforming the latter, during the pre-Llanvirnian, possibly Precambrian, Ganderian Orogeny. The Middle Ordovician and younger Davidsville Group was derived from, and deposited unconformably on, this deformed terrain. Deformation of the Davidsville Group occurred during the Middle Devonian Acadian Orogeny.

Evaluación de la vía aérea superior en pacientes con sahos mediante cefalometría 3D y multiplanar

Objetivo: determinar parámetros biométricos para evaluación y diagnóstico de pacientes con SAHOS por medio de Cefalometría Tridimensional y reconstrucción Multiplanar escanográfica. Materiales y Métodos: se realizó estudio observacional tipo cross-sectional, con 25 pacientes diagnosticados con SAHOS, a los cuales se les hizo TAC simple de cara con reconstrucción multiplanar y tridimensional, evaluando volumen de vía aérea, longitud, promedio del área en corte transversal, área retropalatal, área reglosal, espacio retrogloso lateral y anteroposterior. Resultados: se incluyeron 25 pacientes y realizaron medidas de volumen, longitud, promedio del área en corte transversal, área retropalatal, área retroglosal y espacios regloso lateral y anteroposterior, realizando análisis estadístico mediante el programa SPSS 17.0 reportando medidas de tendencia central como promedio, media, moda, rango, desviación estándar, y concordancia inter e intra observador. Conclusión: la Cefalometría tridimensional con reconstrucción multiplanar ha mostrado ser un excelente método de evaluación de vía aérea en pacientes con SAHOS, obteniendo propias clasificaciones dentro del estudio de estos pacientes. Sin embargo, ante la escasa literatura y difícil obtención de parámetros de referencia es necesario promover el estudio y la investigación de este método diagnostico en pacientes con SAHOS.

Wind-tunnel modelling of dispersion from a scalar area source in urban-like roughness

A wind-tunnel study was conducted to investigate ventilation of scalars from urban-like geometries at neighbourhood scale by exploring two different geometries a uniform height roughness and a non-uniform height roughness, both with an equal plan and frontal density of λ p = λ f = 25%. In both configurations a sub-unit of the idealized urban surface was coated with a thin layer of naphthalene to represent area sources. The naphthalene sublimation method was used to measure directly total area-averaged transport of scalars out of the complex geometries. At the same time, naphthalene vapour concentrations controlled by the turbulent fluxes were detected using a fast Flame Ionisation Detection (FID) technique. This paper describes the novel use of a naphthalene coated surface as an area source in dispersion studies. Particular emphasis was also given to testing whether the concentration measurements were independent of Reynolds number. For low wind speeds, transfer from the naphthalene surface is determined by a combination of forced and natural convection. Compared with a propane point source release, a 25% higher free stream velocity was needed for the naphthalene area source to yield Reynolds-number-independent concentration fields. Ventilation transfer coefficients w T /U derived from the naphthalene sublimation method showed that, whilst there was enhanced vertical momentum exchange due to obstacle height variability, advection was reduced and dispersion from the source area was not enhanced. Thus, the height variability of a canopy is an important parameter when generalising urban dispersion. Fine resolution concentration measurements in the canopy showed the effect of height variability on dispersion at street scale. Rapid vertical transport in the wake of individual high-rise obstacles was found to generate elevated point-like sources. A Gaussian plume model was used to analyse differences in the downstream plumes. Intensified lateral and vertical plume spread and plume dilution with height was found for the non-uniform height roughness

Organization of ventral tegmental area projections to the ventral tegmental area-nigral complex in the rat

The ventral tegmental area (VTA) is a nodal link in reward circuitry. Based on its striatal output, it has been subdivided in a caudomedial part which targets the ventromedial striatum, and a lateral part which targets the ventrolateral striatum [Ikemoto S (2007) Dopamine reward circuitry: two projection systems from the ventral midbrain to the nucleus accumbens-olfactory tubercle complex. Brain Res Rev 56:27-78]. Whether these two VTA parts are interconnected and to what extent the VTA innervates the substantia nigra compacta (SNc) and retrorubral nucleus (RR) are critical issues for understanding information processing in the basal ganglia. Here, VTA projections to the VTA-nigral complex were examined in rats, using Phaseolus vulgaris leucoagglutinin (PHA-L) as anterograde tracer. The results show that the dorsolateral VTA projects to itself, as well as to the dorsal tier of the SNc and RR, largely avoiding the caudomedial VTA. The ventrolateral VTA innervates mainly the interfascicular nucleus. The components of the caudomedial VTA (the interfascicular, paranigral and caudal linear nuclei) are connected with each other. In addition, the caudomedial VTA (especially the paranigral and caudal linear nuclei) innervates the lateral VTA, and, to a lesser degree, the SNc and RR. The caudal pole of the VTA sends robust, bilateral projections to virtually all the VTA-nigral complex, which terminate in the dorsal and ventral tiers. Modest inputs from the medial supramammillary nucleus to ventromedial parts of the VTA-nigral complex were also identified. In double-immunostained sections, PHA-L-labeled varicosities were sometimes found apposed to tyrosine hydroxylase-positive neurons in the ventral mesencephalon. Overall, the results underscore that VTA projections to the VTA-nigral complex are substantial and topically organized. In general, these projections, like the spiralated striato-nigro-striatal loops, display a medial-to-lateral organization. This anatomical arrangement conceivably permits the ventromedial striatum to influence the activity of the lateral striatum. The caudal pole of the VTA appears to be a critical site for a global recruitment of the mesotelencephalic system. (C) 2008 IBRO. Published by Elsevier Ltd. All rights reserved.

Provas de carga estática com carregamento lateral em estacas escavadas hélice contínua e cravadas metálicas em areia

An experimental study has been conducted to investigate the behavior of continuous flight auger (cfa) bored piles and metalic driven H-section piles under lateral loading in cohesionless soils. The piles were tested in two different areas at the same site. Both areas consisted of a 3-m thick compacted superficial fill of pure fine sand, underlain by layers of naturally occurring pure fine-thick sand. Fills are differentiated by the relative densities which were compressed, 45% e 70%, respectively. Each area received one identical pair of cfa piles and two identical pairs of H-piles. A static lateral loading test was performed in each pair of piles. In this work, the pile load test results are reported and interpreted. The horizontal coefficient of subgrade reaction was determined from the results of the loading tests and compared with values determined by correlations based on penetration resistance index of SPT tests (NSPT). p-y formulations describing the static behavior of the piles were applied to the problem under evaluation. Back Analyses were made through theoretical and experimental p-y curves for obtaining input parameters for the analytic models, among which the coefficient of horizontal reaction. The soil pile system horizontal loading at rupture was determined by the theoretical methods and the results were compared with the experimental results, checking its validity

Early healing after elevation of the maxillary sinus floor applying a lateral access: a histological study in monkeys

AimTo describe the early healing within the void obtained after the elevation of the sinus mucosa and simultaneous implant installation without the use of any grafting material in monkeys.Material and methodsImplants were installed simultaneously with the elevation of the maxillary sinus using the lateral approach in eight monkeys without the use of grafting material. The healing after 4, 10, 20 and 30 days was evaluated in the area distal to the implants. Paraffin sections were prepared and analyzed using qualitative histological methods.ResultsThe healing process was initiated by the formation of a coagulum and followed by a provisional matrix and woven bone. Subsequently, a parallel-fiber bone replaced woven bone. The dimension of the elevated area shrank during the healing process. Sprouts of woven bone, present to a moderate extent after 4 days, were more numerous after 10 and 20 days. Newly formed bone originated from the sinus walls and septa, while there was no evidence of participation of the Schneiderian membrane in this process. After 30 days, the window access appeared to be closed by a layer of newly formed trabecular bone.ConclusionsThe coagulum that filled the void distal to the implant after simultaneous elevation of the sinus floor gave rise to newly formed bone. However, the void occupied by the coagulum shrank substantially. The Schneiderian membrane did not provide a basis for new bone formation in the early phase of healing.To cite this article:Scala A, Botticelli D, Rangel IG Jr, de Oliveira JA, Okamoto R, Lang NP. Early healing after elevation of the maxillary sinus floor applying a lateral access: a histological study in monkeys.Clin. Oral Impl. Res. 21, 2010; 1320-1326.doi: 10.1111/j.1600-0501.2009.01964.x.

Natriorexigenic effect of baclofen is reduced by AT(1) receptor blockade in the lateral parabrachial nucleus

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Alpha(2)-adrenergic activation in the lateral parabrachial nucleus induces NaCi intake under conditions of systemic hyperosmolarity

The inhibition of sodium intake by increased plasma osmolarity may depend on inhibitory mechanisms present in the lateral parabrachial nucleus. Activation of alpha(2)-adrenergic receptors in the lateral parabrachial nucleus is suggested to deactivate inhibitory mechanisms present in this area increasing fluid depletion-induced 0.3 M NaCl intake. Considering the possibility that lateral parabrachial nucleus inhibitory mechanisms are activated and restrain sodium intake in animals with increased plasma osmolarity, in the present study we investigated the effects on water and 0.3 M NaCl intake produced by the activation of alpha(2)-adrenergic receptors in the lateral parabrachial nucleus in rats with increased plasma osmolarity. Male Holtzman rats with stainless steel cannulas implanted bilaterally into the lateral parabrachial nucleus were used. One hour after intragastric 2 M NaCl load (2 ml), bilateral injections of moxonidine (alpha(2)-adrenergic/imidazoline receptor agonist, 0.5 nmol/0.2 mu l, n=10) into the lateral parabrachial nucleus induced a strong ingestion of 0.3 M NaCl intake (19.1 +/- 5.5 ml/2 h vs. vehicle: 1.8 +/- 0.6 ml/2 h), without changing water intake (15.8 +/- 3.0 ml/2 h vs. vehicle: 9.3 +/- 2.0 ml/2 h). However, moxonidine into the lateral parabrachial nucleus in satiated rats not treated with 2 M NaCl produced no change on 0.3 M NaCl intake. The pre-treatment with RX 821002 (alpha(2)-adrenergic receptor antagonist, 20 nmol/0.2 mu l) into the lateral parabrachial nucleus almost abolished the effects of moxonidine on 0.3 M NaCl intake (4.7 +/- 3.4 ml/2 h). The present results suggest that alpha(2)-adrenergic receptor activation in the lateral parabrachial nucleus blocks inhibitory mechanisms, thereby allowing ingestion of hypertonic NaCl under conditions of extracellular hyperosmolarity. We suggest that during cell dehydration, circuits subserving sodium appetite are activated, but at the same time strongly inhibited through the lateral parabrachial nucleus. (c) 2006 IBRO. Published by Elsevier Ltd. All rights reserved.

Central cholinergic blockade reduces the pressor response to L-glutamate into the rostral ventrolateral medullary pressor area

Injections of the excitatory amino acid L-glutamate (L-glu) into the rostral ventrolateral medulla (RVLM) directly activate the sympathetic nervous system and increase mean arterial pressure (MAP). A previous study showed that lesions of the anteroventral third ventricle region in the forebrain reduced the pressor response to L-glu into the RVLM. In the present study we investigated the effects produced by injections of atropine (cholinergic antagonist) into the lateral ventricle (LV) on the pressor responses produced by L-ghl into the RVLM. Male Holtzman rats (280-320 g, n=5 to 12/group) with stainless steel cannulas implanted into the RVLM, LV or 4th ventricle (4th V) were used. MAP and heart rate (HR) were recorded in unanesthetized rats. After saline into the LV, injections of L-glu (5 nmol/100 nl) into the RVLM increased MAP (51 +/- 4 mm Hg) without changes in HR. Atropine (4 nmol/1 PI) injected into the LV reduced the pressor responses to L-glu into the RVLM (36 +/- 5 mm Hg), However, atropine at the same dose into the 4th V or directly into the RVLM did not modify the pressor responses to L-glu into the RVLM (45 +/- 2 and 49 +/- 4 mm Hg, respectively, vs. control: 50 +/- 4mmHg). Central cholinergic blockade did not affect baro and chemoreflex nor the basal MAP and HR. The results suggest that cholinergic mechanisms probably from forebrain facilitate or modulate the pressor responses to L-glu into the RVLM. The mechanism is activated by acetylcholine in the forebrain, however, the neurotransmitter released in the RVLM to facilitate the effects of glutamate is not acetylcholine. (C) 2007 Elsevier B.V. All rights reserved.

Baclofen into the lateral parabrachial nucleus induces hypertonic sodium chloride and sucrose intake in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Activation of alpha(2)-adrenoceptors in the lateral hypothalamus reduces pilocarpine-induced salivation in rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Adrenergic mechanisms of the Kölliker-Fuse/A7 area on the control of water and sodium intake

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

AT(1) receptor blockade in the lateral parabrachial nucleus reduces the effects of muscimol on sodium intake

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)