By Z. Ballock. Rider University.
OCCIPITAL LOBE One of the four subdivisions of the cerebral PSYCHOSIS A severe symptom of mental disorders character- cortex generic 2mg cardura free shipping. The occipital lobe plays a role in processing visual ized by an inability to perceive reality cardura 1mg. RECEPTOR CELL A specialized sensory cell designed to pick up PARASYMPATHETIC NERVOUS SYSTEM A branch of the auto- and transmit sensory information generic 1 mg cardura otc. Many neurotransmitters and hormones exert their cortex purchase cardura 2 mg on line. The parietal lobe plays a role in sensory processes, e∑ects by binding to receptors on cells. REUPTAKE A process by which released neurotransmitters are PARKINSON’S DISEASE A movement disorder caused by death absorbed for subsequent reuse. Symptoms include tremor, shuΩing gait and gen- The rod is sensitive to light of low intensity and specialized eral paucity of movement. PEPTIDES Chains of amino acids that can function as neuro- SCHIZOPHRENIA A chronic mental disorder characterized by transmitters or hormones. These chemicals PHOSPHORYLATION A process that modifies the properties of play a role in the manufacture and release of neurotransmit- neurons by acting on an ion channel, neurotransmitter receptor ters, intracellular movements, carbohydrate metabolism and or other regulatory protein. During phosphorylation, a phos- processes of growth and development. The messengers direct phate molecule is placed on a protein and results in the activa- e∑ects on the genetic material of cells may lead to long-term tion or inactivation of the protein. Phosphorylation is believed alterations of behavior, such as memory and drug addiction. Neurons and resources during times of stress and arousal. A number of antidepressant drugs are targeted to site of information transfer from one neuron to another. TEMPORAL LOBE One of the four major subdivisions of each SHORT-TERM MEMORY A phase of memory in which a limited hemisphere of the cerebral cortex. The temporal lobe func- amount of information may be held for several seconds to tions in auditory perception, speech and complex visual per- minutes. STIMULUS An environmental event capable of being detected THALAMUS A structure consisting of two egg-shaped masses by sensory receptors. The key relay station for sensory information is an impeded blood supply to the brain. Stroke can be caused flowing into the brain, the thalamus filters out only informa- by a rupture of a blood vessel wall, an obstruction of blood tion of particular importance from the mass of signals enter- flow caused by a clot or other material or by pressure on a ing the brain. Deprived of oxygen, which is VENTRICLES Of the four ventricles, comparatively large spaces carried by blood, nerve cells in the a∑ected area cannot func- filled with cerebrospinal fluid, three are located in the fore- tion and die. Thus, the part of the body controlled by those brain and one in the brainstem. The lateral ventricles, the two cells cannot function either. Stroke can result in loss of con- largest, are symmetrically placed above the brainstem, one in sciousness and death. WERNICKE’S AREA A brain region responsible for the compre- hension of language and the production of meaningful speech. Acetylcholine 4 Down syndrome 40–41 Magnetoencephalography Pons 3, 23 Action potential 4 Drug reward system 34 (MEG) 44 Positron emission tomography Addiction 33–36 Endocrine system 6–7, 25–27 Marijuana 36 (PET) 19, 43 Aging 28–29 Endorphins 6, 17 Memory 18–19 Primary visual cortex 12 and intellectual capacity 29 Epilepsy 31–32 Methylprednisolone 39 Procedural knowledge 18 AIDS 40 Epinephrine 25–26 Midbrain 3, 8 Prostaglandins 17, 31 Alcohol 34–36 Estrogen 7 Mitochondria 45 Psychostimulants 34–35 Alpha motor neurons 20 Fetal alcohol syndrome 35 Monoamine oxidase inhibitors Receptive field 12 Alzheimer’s disease 36–37 Firing of neurons 4–5 (MAOIs) 32 Receptors 4 Amino acid transmitters 4–5 Flexion withdrawal 20–21 Morphine 6, 30, 31, 34 Reflex 20–21 Amphetamines 34 Fluoxetine 32 Motor cortex 3, 20 Regeneration 46 Amyloid protein 36–37 Forebrain 3 Motor neuron 20 Reproduction 7 Amyotrophic lateral sclerosis Functional Magnetic Reso- Motor unit 20 Schizophrenia 39–40 (ALS) 42 nance Imaging (fMRI) 44 Movement 20–21 Second messengers 7 Analgesia 30 Gamma-amino butyric acid MPTP 30 Selye, Hans 25 Androgen 7 (GABA) 5, 24, 32, 35 Multiple sclerosis 40 Serotonin 6, 32 Anxiety disorders 39 Gamma motor neurons 20 Myasthenia gravis 4 Single photon emission Autoimmune response 27 Gene 45 Myelin 4–5 computed tomography Autonomic nervous system diagnosis 44–45 Narcolepsy 24 (SPECT) 43 11, 25 therapy 46–47 Nerve growth factor (NGF) 46 Sleep 22–24 Axon 4–5 Glucocorticoids 7, 26–27 Nerve impulse 4, 5 REM sleep 22–24 Basal ganglia 19, 21, 30 Glutamate 5, 36, 38 Neurofibrillary tangles 36 stages 22 Biological clock 7, 27 Hearing 14–15 Neurological trauma 38–39 disorders 23–24 Brain Heroin 34 Neuron 4–5 Smell 15–16 aging 28–29 Hippocampus 3, 18–19, 27 birth 9–10 Spinal cord 6, 11, 17, 20–21, anatomical organization 3 Huntington’s disease 41 migration 9–10 38–39, 46 development 8–11 Hypothalamus 3, 7, 24, 32 pathfinding 10 Strabismus 14 diseases 2–3 Immune system 27 survival 10–11 Stress 25–27 tumors 42 Information processing, Neurotransmitters 4–7 in arousal 25–26 Broca’s area 19 and hearing 14–15 Nicotine 33–34 chronic 27 Catecholamines 6 and learning and memory NMDA receptors 5, 18 and endocrine system 25–27 Central nervous system 6, 11 18–19 Norepinephrine 6 and schizophrenia 39 Cerebellum 19, 21 and movement 20–21 Obsessive-compulsive Stroke 37–38 Cerebral cortex and pain 16–17 disorder 39 Substance P 6 3, 17, 19, 23, 31 and taste and smell 15–16 Occipital lobe 3, 12 Synapse 4, 5, 29 Club drugs 36 and vision 12–13 Olfactory bulbs 15–16 Taste 15–16 Cocaine 34–35 Inhibitory neurons 20–21 Opiates 34–35 Temporal lobe 3, 18 Cortisol 25–26 Ion channels 4 Pain 16–17, 30–31 Testosterone 7 Costs of brain diseases 2–3 Language 19 Panic disorder 39 Thalamus 3 Crossed extension reflex 20–21 Learning 18–19 Parietal lobe 3 Touch 16–17 Declarative knowledge 18 Learning disorders 37 Parkinson’s disease 30, Tourette syndrome 41–42 Dementia 28, 36 Levodopa 6, 30 46–47 Tricyclic antidepressants 32 Dendrite 4–5 Limbic system 15 Peptides 6 Trophic factors 6, 46 Depression Long-term potentiation 18 Peripheral nervous system 11 Vision 12, 13–15 major 32 Lou Gehrig’s disease 42 Phenytoin 31 Wernicke’s area 19 manic 32 Magnetic resonance imaging Phobias 39 Working memory 18 Dopamine 6, 30, 34 (MRI) 43–44 Pituitary gland 6, 7, 32 53 Copyright © 2002 The Society for Neuroscience 11 Dupont Circle, NW, Suite 500 Washington, DC 20036 USA Telephone (202) 462-6688 www. No portion of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without permission of the The Society for Neuroscience. To acquire additional copies of this book, please visit our Web site www. The Society for Neuroscience Editor: Joseph Carey, Senior Director, Communications & Public Affairs Science writer: Leah Ariniello Researcher: Mary McComb Produced by Meadows Design Office Incorporated, Washington, DC www. Kibiuk, Baltimore, Maryland Printed and bound in China by Everbest Printing Company Fourth edition 06 05 04 03 02 5 4 3 2 1 isbn 0-916110-00-1 ISBN 0-916110-00-1 . No part of this publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner except in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90 Tottenham Court Road, London, England W1P 9HE.
The patients are carefully informed the borders of the surrounding cartilage purchase 4 mg cardura amex. The that this type of operation is a new method that periosteum is taken from the proximal tibia still is under development and nothing can be with the use of a sharp dissector in order to pre- said about the prognosis of this treatment cheap cardura 2 mg mastercard. They serve the cambium layer of the periosteum purchase cardura 1mg without prescription, and are also informed that the goal with the opera- is anchored to the underlying bed with the cam- tion and rehabilitation is to regain the ability to bium layer (inner layer) turned inward (i purchase 4mg cardura fast delivery. The operation is performed in a bloodless field, and Surgical Technique after the fixation of the transplant is done, com- The findings during arthroscopy (a full-thick- pression onto the transplant is applied and the ness cartilage defect) are verified through a bloodless field is released. Thereafter the medial for 3 to 4 minutes and is followed by inspection incision is lengthened proximally and distally, of the fixation of the transplant to the underly- the quadriceps tendon is incised, and the patella ing bed. No blood accumulation beneath the is partially or totally everted depending on the periosteum is allowed. The surgical procedure for the periosteum Postoperative Treatment Regimen transplantation is visualized in Figures 13. The chondral lesion is excised, sclerotic continuous epidural anesthesia the first 3 to 5 subchondral bone is removed, and multiple days postoperatively, which is necessary for the Figure 13. The chondral lesion is excised and sclerotic subchondral bone is removed (a). Through drilling close to the borders of the defect, and multiple drilling into the cancellous bone (b). The periosteum is taken from the proximal medial tibia and fitted into the defect with the cambium layer (inner layer) facing the cancellous bone (c). A fibrin sealant is injected under the trans- plant and the sutures are knotted on the dorsal side of the patella (d). The periosteal transplant is fixed to the bottom of the defect with through sutures (a) and a fibrin sealant (b). CPM treat- bearing loading of the femoropatellar joint is ment (0–70˚ flexion in the knee joint) is started allowed during the first 12 weeks. Thereafter, the day after operation, and is done one hour slowly progressing strength training and weight- every three hours six times a day for four to five bearing activities are introduced. At day 5–6 postoperatively, the CPM regi- followed regularly by the operating doctor and men is extended to 0–90˚. Pain and effusion in the knee plus isometric quadriceps training is added, and joint are defined as signs of overloading, and partial weight bearing with crutches is intro- lead to a lowered (less loading and less repeti- duced. At day 6–7 the patient leaves the hospital tions) rehabilitation level. The patients are with a home training program containing iso- informed that the duration of the postoperative metric quadriceps training and active flexibility rehabilitation period is at least one year. CPM (continuous passive motion) in the immediate postoperative period. Evaluation in by the patients at home, and is not under any Our goal with the treatment is no knee-pain dur- influence of the investigators. Strenuous gous periosteum transplanation) we decided to knee-loading activities are not encouraged. However, we have now stopped using MRI and Therefore, we have decided to use that score in biopsies for the postoperative evaluation. This is the clinical evaluation of our group of patients. In our Excellent: No pain, swelling, or locking with patients, repeated MRI examinations showed strenuous heavy knee-loading activity (soc- progressive and finally complete filling of the cer, icehockey, floor ball, downhill skiing, articular defects. For biopsies, all our five biopsies ing (on flat ground) without pain, no swelling showed hyaline-like cartilage, but the only infor- or locking mation we get is about the tissue at that exact Fair: Moderate pain with strenuous activity, spot were the biopsy is taken. We know nothing occasional swelling but no locking at all about the rest of the transplanted area. It is Poor: Pain at rest, swelling, and locking our experience that the quality of the tissue is varying between different parts of transplanted To try to minimize the risks of bias, we also use area, making it questionable to draw any con- a questionnaire assessing patient satisfaction clusions from the result of one or two minor with the treatment. It is demonstrated that in two cases the Autologous Periosteum Transplantation to Treat Full-Thickness Patellar Cartilage Defects Associated with Severe Anterior Knee Pain 235 biopsy showed hyaline-like cartilage but the lent, 34 patients were graded as good, 12 clinical results were poor and fair, and in one patients were graded as fair, and 11 patients case where the biopsy showed no signs of hya- were graded as poor according to the Brittberg line-like cartilage the clinical result was good. Eleven of the fair and poor cases Another experience is that quite often it is diffi- had nontraumatic (chondromalacia NUD) cult to see the borders between the transplanted patellar cartilage defects.