Self-reinnervated cat medial gastrocnemius muscles. II. analysis of the mechanisms and significance of fiber type grouping in reinnervated muscles

1. The technique of glycogen depletion was used to determine whether regenerating motor axons reestablish the normal regionalization of motor units (MUs) in the cat medial gastrocnemius (MG) muscle, 2) whether the extent of clumping between MU fibers and/or type grouping of muscle fibers progressively increases with a decrease in reinnervated MU numbers, and 3) whether the pattern of innervation can explain why MUs fail to increase significantly in size when the cut nerve is sutured directly to the muscle, even when few axons make functional connections. 2. Distributions of MU fibers were analyzed in 5 normal and 14 reinnervated cat MG muscles 4.5-16 mo after sectioning of its nerve and suturing of the proximal end to the distal nerve sheaths (N-N suture) or directly to the muscle fascia (N-M suture). Muscle unit distributions were quantified according to location, territory size, density, and extent of clumping between fibers from the same MU. 3. Normal MU fibers were regionalized within five regions along the muscle's longitudinal and transverse axes. Reinnervated MUs were located within similar regions, indicating that regenerating axons follow the major proximal nerve branches to restore normal compartmentalization. 4. Muscle unit fibers were diffusely scattered within discrete MU territories in normal muscles. Territory size tended to increase with MU size, whereas density of muscle unit fibers within the territory decreased. 5. Territories increased with MU size after N-N suture but were smaller and showed little size variation after N-M suture. The extent of muscle unit fiber clumping was inversely related to the number of reinnervated MUs. On average, the extent of clumping was substantially higher in muscles reinnervated after N-M suture. These results indicate that distal nerve sheaths facilitate proximal axon branching, which establishes MU territory size. Once the territory is established, motor axons branch distally to increase MU size, which in turn compensates for reduced MU numbers. 6. Muscles reinnervated by < 80% of the MUs exhibited fiber type grouping of type I fibers, and on average the extent of clumping was substantially higher in muscles reinnervated after N-M suture. With less innervation, type grouping increased inversely with the number of reinnervated MUs. However, for a similar number of MUs, type I fiber type grouping was substantially higher in muscle reinnervated after N-M suture. Type grouping therefore reflects muscle unit fiber clumping under conditions where MU size increased (N-N suture) or MU territory size decreased (N-M suture).     

Yeast opsonization in newborn infants and its relationship to parental atopy

Sera from 30 of 303 (9.9%) unselected term newborn infants were deficient in their ability to opsonize heat-killed baker's yeasts, an incidence which is almost double that seen in adults. Genetic influence is important in some since the mothers of 10 infants with defective opsonization showed the same defect, but it was not related to the sex or race of the infant or to the atopic state of the parents. In others the defect could be due to a functional maturation delay of the complement system, but not to inhibitory factors in neonatal serum since correction of opsonization was achieved with subopsonizing amounts of normal sera. Significantly more infants had sera with high opsonizing capacity (greater than 80% yeasts phagocytosed) when compared with adults; perhaps antibody independent immune mechanisms like this are important in the newborn. This study shows that a common specific immunodeficiency which may predispose to severe infection or atopy can be identified at birth.     

Basement membranes of small cardiac vessels in patients with diabetes and myxoedema: preliminary observations

A method of treating completely displaced supracondylar fractures of the humerus in children by 'straight lateral traction', as originally used by John Dunlop, is recommended. The results in 26 children, selected because manipulation had failed to achieve reduction, is examined, and indicates that this treatment is satisfactory for some problem fractures, leading usually to good results in terms of resolution of complications and return of function. It also avoids the ugly deformities of the elbow which follow reliance on a single form of treatment for all supracondylar fractures. Failure of anatomical reduction by the appliance is shown to be in the plane of elbow movement, where normal physiological mechanisms correct the bone by remodelling. Where there is epiphyseal damage, deformities may occur with any form of treatment.     

Current management of digitalis intoxication

Of the commonly used drugs, digitalis has one of the highest therapeutic-toxic ratios. Mortality is significantly increased in the 20% to 30% of patients on digitalis who are in a toxic state when admitted to the hospital. Successful use of digitalis depends on avoidance of its use in situations likely to result in toxicity; recognition of the signs, symptoms, and electrocardiographic findings of digitalis intoxication; and stopping digitalis completely as the initial treatment of digitalis intoxication.