The ideal position of sacral transpedicular endplate screws in Jackson's intrasacral fixation. An anatomic study of 50 sacral specimens

STUDY DESIGN: This study directly measures the ideal point of insertion and direction of sacral screws in the Jackson intrasacral fixation. OBJECTIVE: To design a template for safe positioning of transpedicular endplate screws that does not require fluoroscopy. SUMMARY OF BACKGROUND DATA: Screw and rod insertion into the sacrum as described by Jackson requires careful intraoperative fluoroscopic or radiographic control. The technique can *be difficult and demanding, especially in the case of severe pelvic obliquity. No anatomic data based on cadaveric studies are available to aid in the described technique for screw insertion. METHODS: Fifty dry sacrums were used. On each bone, the length of the intrasacral portion and the ideal direction of transpedicular endplate pins introduced at the originally described point of insertion were measured in reference to the plane formed by the two posterior sacral foramen and the posterior arch of S1. The limit angles in each direction, where the pin perforated the cortex outside of the S1 endplate, were noted. Then, the point of insertion of a pin with the ideal angles was progressively modified to determine the limits of the safe insertion area. The 95% confidence interval was reduced to the smallest safe angle. RESULTS: The safe angles were 54.3 degrees to 57.9 degrees for the sagittal plane, 47 degrees to 50 degrees for the coronal plane, and between 46.9 degrees and 49.7 degrees for the horizontal plane. CONCLUSIONS: A "cylinder of safety" for the transpedicular endplate screws was determined. Its coordinates are related to the sacrum and not to the sacral position. This allowed for a template to be designed, the efficiency of which will have to be confirmed by anatomic and clinical studies.     

Biochemical hallmarks of tyrosine hydroxylase deficiency

We report the biochemical hallmarks of tyrosine hydroxylase deficiency with emphasis on reliable diagnostic strategies of four new cases of an inborn error of tyrosine hydroxylase (TH). Three of our patients from different parts of the Netherlands were found homozygous for a mutation in exon 6 (G698A) of the TH gene, and one patient was found compound heterozygous for the same mutation and an additional mutation in exon 3. The first clinical symptoms of hypokinesia, rigidity of arms and legs and axial hypotonia, developed between 3 and 7 months of age. Cerebrospinal fluid investigations revealed a characteristic metabolite constellation in every case: low homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylethyleneglycol concentrations in the presence of normal reference range 5-hydroxyindolacetic acid concentrations. Strict adherence to a standardized lumbar puncture protocol and adequate age-related reference values are essential for diagnosis of this "new" treatable neurometabolic disorder. Urinary measurements of HVA, vanillylmandelic acid, and catecholamines can lead to false-negative conclusions. All patients showed a remarkable clinical improvement on a low dose of L-dihydroxyphenylalanine/ (S)-2-(3,4-dihydroxybenzyl)-2-hydrazinpropionic acid. During treatment, cerebrospinal fluid HVA, and 3-methoxy-4-hydroxy-phenylethyleneglycol increased substantially.     

Recombinant bovine somatotropin increases milk yield and calf gain in diverse breeds of beef cattle: associated changes in hormones and indices of metabolism

In Exp. 1, Angus (A, n = 30), Charolais (C, n = 37), and Simmental (S, n = 30) multiparous cows received (s.c.) recombinantly derived bovine somatotropin (bST; sometribove, 500 mg) or vehicle (VEH) at 2-wk intervals from 124 to 228 d postpartum (DPP). Calves were weaned at 228 DPP. Bovine somatotropin increased (P < .01) milk yield and percentage of milk fat similarly in A, C, and S cows. Calf weaning weight was greater (P < .05) in cows treated with bST than in those given VEH. Administration of bST decreased deposition of fat and increased concentrations of IGF-I, insulin, glucose, and nonesterified fatty acids. In Exp. 2, we compared effects of bST initiated before or after the breeding season. Charolais (n = 33) and S (n = 40) cows were administered (at 2-wk intervals) VEH or bST beginning at 28 DPP (B-bST) or bST beginning at 105 DPP (A-bST). Calves were weaned at 243 DPP. Administration of bST before or after the breeding season increased milk yield on DPP 136 and 194; however, yields were greater in A-bST than in B-bST cows. Milk yields were similar in all cows at 236 DPP, corresponding to decreased forage availability. Calf body weight was greater (P < .05) in A-bST than VEH; B-bST calves were similar to VEH. Fat depth was greater in VEH than in bST-treated cows in C but not in S cows. Serum IGF-I was greater in A- and B-bST than in VEH cows. Mean days from calving to serum progesterone > 1 ng/mL and pregnancy rates were similar in VEH, A-, and B-bST cows. Administration of bST increased cow milk yield and subsequent calf weaning weight when initiated after 100 d postpartum. As anticipated, bST increased IGF-I, insulin, glucose, and nonesterified fatty acids. Administration of bST before and during the breeding season did not affect reproductive performance.     

Sexual dimorphism in the volume of song control nuclei in European starlings: assessment by a Nissl stain and autoradiography for muscarinic cholinergic receptors

Previous studies have found that the volume of several song control nuclei is larger in male songbirds than in female songbirds. The degree of this volumetric sex difference within a given species appears to be systematically related to the degree of the behavioral sex difference. The largest volumetric differences have been reported in species in which the male sings and the female sings little, if at all, and the smallest sex differences in volume have been reported in species in which males and females both sing in nearly equal amounts. We compared the volume of three song control nuclei in male and female European starlings (Sturnus vulgaris), a species in which females are known to sing, though at a much lower rate than males. We investigated the volume of hyperstriatum ventrale, pars caudale, nucleus robustus archistriatalis, and area X of the lobus parolfactorius as defined with the use of a Nissl stain. In addition, we measured the volume of area X as defined by the density of muscarinic cholinergic receptors visualized by in vitro receptor autoradiographic methods. The volumes of all three of the song nuclei, as defined by Nissl staining, are significantly larger in males than in females. For area X, Nissl staining and receptor autoradiography indicate the same significant volumetric sex difference. The three nuclei are approximately one and one half to two times larger in males than in females, a degree of dimorphism that is intermediate to those reported for other species. Previous investigations of sex differences in the avian vocal control system have used only Nissl stains to define nuclear volumes. We demonstrate in this paper that receptor autoradiography can be used to assess dimorphisms in nuclear volume. Broad application of this approach to a number of neurotransmitter receptor systems will better characterize the dimorphisms in the song system, and therefore will provide greater insight into the neuroanatomical and neurochemical control of birdsong.     

Comparative mapping of two adjacent regions of MMU19 with their human counterpart on HSA11q13

High resolution physical maps of two adjacent regions of MMU19 were constructed in order to establish a comparative map between the pericentromeric region of MMU19 and its human counterpart on HSA11q13. These two physical maps span 2.5 and 0.5 megabases on MMU19. Long range restriction analysis and YAC contigs have been built, five genes were located on MMU19 and eight new STSs were generated. The 0.5-Mb map which has been positioned close to the centromere of MMU19, based on dual-color FISH experiments and genetic data, includes eight genes (Type I markers), three microsatellites (Type II markers) and five new STSs. The 2.5-Mb map is located more telomeric and contains seven genes, four microsatellites and four new STSs. Gene order and physical distances appear to be similar in human and in mouse in this 2.5-Mb region. Strikingly, the 0.5-Mb region has a similar size in human but gene order is shuffled. The overall comparative map shows that these two regions are inverted on MMU19 when compared with HSA11q13.     

Aging and heparin-related bleeding

BACKGROUND: Many studies have suggested that elderly patients are at increased risk of bleeding during heparin therapy. OBJECTIVE: To establish whether the risk of bleeding in the elderly results from concomitant risk factors or is associated with the aging process itself. METHODS: One hundred ninety-nine patients who presented with proximal deep vein thrombosis were treated with a standard intravenous heparin protocol in a double-blind, randomized, prospective study. Bleeding complications were monitored. Activated partial thromboplastin times and heparin levels were assessed 4 to 6 hours after a standard intravenous heparin bolus and infusion. Heparin doses and heparin levels were also assessed after stable therapeutic heparin infusion rates were established. RESULTS: There was an increase in total and major bleeding complications with aging (P < .05) that was not accounted for by standard risk factors for bleeding. Aging was associated with an increase in heparin levels (r = .239, P = .003) and a tendency for an increase in activated partial thromboplastin time (r = .134, P = .07) after standard heparin doses. Aging was also associated with lower heparin dose requirements (r = .267, P = .003) after therapeutic activated partial thromboplastin times were achieved. CONCLUSION: Aging is a risk for heparin-related bleeding that may be explicable by age-related changes in the pharmacologic characteristics of heparin.