Halo-vest辅助下前路手术治疗严重颈椎结核伴后凸畸形

目的：探讨使用halo-vest支具牵引复位并通过前路手术治疗严重颈椎结核并后凸畸形的方法和疗效。方法：通过对2004年10月至2010年9月在我科住院治疗的14例严重颈椎结核并后凸畸形的患者进行回顾性研究。本组患者中男8例,女6例,术前颈椎后凸Cobb角24-42°,平均34°。术前使用四联抗结核药物治疗2-4周,通过Halo-vest支具牵引复位。纠正颈椎后凸畸形后,采用一期前路手术治疗。手术处理包括：结核病灶清除、自体髂骨植骨或钛网植入、颈前路钢板内固定。术后继续抗结核治疗12-24个月。结果：术后随访12-48个月,平均26个月。所有颈椎结核并后凸畸形的患者都能通过halo-vest支具牵引恢复基本的颈椎序列,并能很好地耐受手术。术后患者局部疼痛和全身结核中毒症状明显缓解,神经功能均较术前有所恢复,后凸畸形得到矫正。术后3-6个月植骨融合,无内固定及伤口并发症,无严重halo-vest支具相关并发症,无结核复发。结论：对于严重颈椎结核并后凸畸形的患者,术前通过halo-vest支具牵引复位,可矫正畸形,恢复颈椎正常生理序列,为后期手术治疗创造条件并降低术中复位可能引起的脊髓损伤风险。Halo-vest辅助下的前路手术是治疗严重颈椎结核伴后凸畸形的有效手段。     

Kyphectomy for severe kyphosis with pyogenic spondylitis associated with myelomeningocele: a case report

Cavernous hemangioma consists mainly of congenital vascular malformations present before birth and gradually increasing in size with skeletal growth. A small number of patients with cavernous hemangioma develop scoliosis, and surgical treatment for the scoliosis in such cases has not been reported to date. Here we report a 12-year-old male patient with severe progressive scoliosis due to a huge subcutaneous cavernous hemangioma, who underwent posterior correction and fusion surgery. Upon referral to our department, radiographs revealed a scoliosis of 85° at T6-L1 and a kyphosis of 58° at T4-T10. CT and MR images revealed a huge hemangioma extending from the subcutaneous region to the paraspinal muscles and the retroperitoneal space and invading the spinal canal. Posterior correction and fusion surgery using pedicle screws between T2 and L3 were performed. Massive hemorrhage from the hemangioma occurred during the surgery, with intraoperative blood loss reaching 2800 ml. The scoliosis was corrected to 59°, and the kyphosis to 45° after surgery. Seven hours after surgery, the patient suffered from hypovolemic shock and disseminated intravascular coagulation due to postoperative hemorrhage from the hemangioma. The patient developed sensory and conduction aphasia caused by cerebral hypoxia during the shock on the day of the surgery. At present, two years after the surgery, although the patient has completely recovered from the aphasia. This case illustrates that, in correction surgery for scoliosis due to huge subcutaneous cavernous hemangioma, intraoperative and postoperative intensive care for hemodynamics should be performed, since massive hemorrhage can occur during the postoperative period as well as the intraoperative period.     

Sagittal plane assessment of spino-pelvic complex in a Central European population with adolescent idiopathic scoliosis: a case control study

Background

Scoliosis is a complex three-dimensional deformity. While the frontal profile is well understood, increasing attention has turned to balance in the sagittal plane. The present study evaluated changes in sagittal spino-pelvic parameters in a large Hungarian population with adolescent idiopathic scoliosis.

Methods

EOS 2D/3D images of 458 scoliotic and 69 control cases were analyzed. After performing 3D reconstructions, the sagittal parameters were assessed as a whole and by curve type using independent sample t test and linear regression analysis.

Results

Patients with scoliosis had significantly decreased thoracic kyphosis (p <?0.001) with values T1–T12, 34.1?±?17.1^o vs. 43.4?±?12.7^o in control; T4–T12, 27.1?±?18.8^o vs. 37.7?±?15.1^o in control; and T5–T12, 24.9?±?15.8^o vs. 32.9?±?15.0^o in control. Changes in thoracic kyphosis correlated with magnitude of the Cobb angle (p <?0.001). No significant change was found in lumbar lordosis and the pelvic parameters. After substratification according to the Lenke classification and individually evaluating subgroups, results were similar with a significant decrease in only the thoracic kyphosis. A strong correlation was seen between sacral slope, pelvic incidence, and lumbar lordosis, and between pelvic version and thoracic kyphosis in control and scoliotic groups, whereas pelvic incidence was also seen to be correlated with thoracic kyphosis in scoliosis patients.

Conclusion

Adolescent idiopathic scoliosis patients showed a significant decrease in thoracic kyphosis, and the magnitude of the decrease was directly related to the Cobb angle. Changes in pelvic incidence were minimal but were also significantly correlated with thoracic changes. Changes were similar though not identical to those seen in other Caucasian studies and differed from those in other ethnicities. Scoliotic curves and their effect on pelvic balance must still be regarded as individual to each patient, necessitating individual assessment, although changes perhaps can be predicted by patient ethnicity.

     

CT and radiographic analysis of sagittal profile changes following thoracoscopic anterior scoliosis surgery

ABSTRACT: BACKGROUND: Previous studies report an increase in thoracic kyphosis after anterior approaches and a flattening of sagittal contours following posterior approaches. Difficulties with measuring sagittal parameters on radiographs are avoided with reformatted sagittal CT reconstructions due to the superior endplate clarity afforded by this imaging modality. METHODS: A prospective study of 30 Lenke 1 adolescent idiopathic scoliosis (AIS) patients receiving selective thoracoscopic anterior spinal fusion (TASF) was performed. Participants had ethically approved low dose CT scans at minimum 24 months after surgery in addition to their standard care following surgery. The change in sagittal contours on supine CT was compared to standing radiographic measurements of the same patients and with previous studies. Inter-observer variability was assessed as well as whether hypokyphotic and normokyphotic patient groups responded differently to the thoracoscopic anterior approach. RESULTS: Mean T5-12 kyphosis Cobb angle increased by 11.8 degrees and lumbar lordosis increased by 5.9 degrees on standing radiographs two years after surgery. By comparison, CT measurements of kyphosis and lordosis increased by 12.3 degrees and 7.0 degrees respectively. 95% confidence intervals for inter-observer variability of sagittal contour measurements on supine CT ranged between 5-8 degrees. TASF had a slightly greater corrective effect on patients who were hypokyphotic before surgery compared with those who were normokyphotic. CONCLUSIONS: Restoration of sagittal profile is an important goal of scoliosis surgery, but reliable measurement with radiographs suffers from poor endplate clarity. TASF significantly improves thoracic kyphosis and lumbar lordosis while preserving proximal and distal junctional alignment in thoracic AIS patients. Supine CT allows greater endplate clarity for sagittal Cobb measurements and linear relationships were found between supine CT and standing radiographic measurements. In this study, improvements in sagittal kyphosis and lordosis following surgery were in agreement with prior anterior surgery studies, and add to the current evidence suggesting that anterior correction is more capable than posterior approaches of addressing the sagittal component of both the instrumented and adjacent non instrumented segments following surgical correction of progressive Lenke 1 idiopathic scoliosis.     

Historical overview of spinal deformities in ancient Greece

Little is known about the history of spinal deformities in ancient Greece. The present study summarizes what we know today for diagnosis and management of spinal deformities in ancient Greece, mainly from the medical treatises of Hippocrates and Galen. Hippocrates, through accurate observation and logical reasoning was led to accurate conclusions firstly for the structure of the spine and secondly for its diseases. He introduced the terms kyphosis and scoliosis and wrote in depth about diagnosis and treatment of kyphosis and less about scoliosis. The innovation of the board, the application of axial traction and even the principle of trans-abdominal correction for correction of spinal deformities have their origin in Hippocrates. Galen, who lived nearly five centuries later impressively described scoliosis, lordosis and kyphosis, provided aetiologic implications and used the same principles with Hippocrates for their management, while his studies influenced medical practice on spinal deformities for more than 1500 years.     

早期伤口切开对血循毒蛇咬伤患者预后的影响

目的探讨血循毒类毒蛇咬伤患者早期伤口切开对预后的影响。方法回顾性分析我院2011年3月~2014年3月诊治的血循毒类毒蛇咬伤患者223例的临床资料,总结并比较其临床特点及预后。结果本组患者轻度肿胀97例中,伤后12h内切开21例,未溃疡12例,Ⅰ°溃疡7例,Ⅱ°溃疡2例;晚期切开或未切开76例,未溃疡15例,Ⅰ°溃疡41例,Ⅱ°溃疡16例,Ⅲ°溃疡4例。中度肿胀患者85例中,伤后12h内切开32例,未溃疡8例,Ⅰ°溃疡21例,Ⅱ°溃疡2例,Ⅲ°溃疡1例;晚期切开或未切开53例,未溃疡6例,Ⅰ°溃疡16例,Ⅱ°溃疡24例,Ⅲ°溃疡7例。重度肿胀患者41例中,伤后12h内切开17例,Ⅰ°溃疡11例,Ⅱ°溃疡4例,Ⅲ°溃疡2例;晚期切开或未切开24例,Ⅰ°溃疡2例,Ⅱ°溃疡6例,Ⅲ°溃疡16例。在蛇伤后12h内切开的患者坏死溃疡的形成、肿胀程度的改善均明显优于晚期切开或未切开的患者,差异有显著统计学意义(P0.05)。结论随着患者凝血功能的改善,早期伤口切开对血循毒类毒蛇伤患者局部伤口状况有较好的改善作用。     

A new brace treatment similar for adolescent scoliosis and kyphosis based on restoration of thoracolumbar lordosis. Radiological and subjective clinical results after at least one year of treatment

Study design

A prospective treatment study with a new brace was conducted Objective. To evaluate radiological and subjective clinical results after one year conservative brace treatment with pressure onto lordosis at the thoracolumbar joint in children with scoliosis and kyphosis.

Summary of background data

Conservative brace treatment of adolescent scoliosis is not proven to be effective in terms of lasting correction. Conservative treatment in kyphotic deformities may lead to satisfactory correction. None of the brace or casting techniques is based on sagittal forces only applied at the thoracolumbar spine (TLI= thoracolumbar lordotic intervention). Previously we showed in patients with scoliosis after forced lordosis at the thoracolumbar spine a radiological instantaneous reduction in both coronal curves of double major scoliosis.

Methods

A consecutive series of 91 children with adolescent scoliosis and kyphosis were treated with a modified symmetric 30 degrees Boston brace to ensure only forced lordosis at the thoracolumbar spine. Scoliosis was defined with a Cobb angle of at least one of the curves [greater than or equal to] 25 degrees and kyphosis with or without a curve <25 degrees in the coronal plane. Standing radiographs were made i) at start, ii) in brace at beginning and iii) after one year treatment without brace.

Results

Before treatment start ??in brace?? radiographs showed a strong reduction of the Cobb angles in different curves in kyphosis and scoliosis groups (sagittal n = 5 all p < 0.001, pelvic obliquity p < 0.001). After one year of brace treatment in scoliosis and kyphosis group the measurements on radiographs made without brace revealed an improvement in 3 Cobb angles each.

Conclusion

Conservative treatment using thoracolumbar lordotic intervention in scoliotic and kyphotic deformities in adolescence demonstrates a marked improvement after one year also in clinical and postural criteria. An effect not obtained with current brace techniques.     

Treatment of children scoliosis by corrective brace with regulated force effect

Rigid structural spine scoliosis of a child and even non progressive congenital scoliosis (e.g. isolated hemivertebra) can be treated by hypercorrective brace in full day regime. The article shows the new type of corrective brace with adjustable force effect. The brace consists of 3 stiff parts connected by joints and telescopes. The parts of brace are made from plastic according to plaster form of child trunk. The joints allow only mutual turning brace parts at frontal plane. The special telescopes were developed which operated with prescribed forces, it means the brace and trunk parts are mutually turned at prescribed moments. The article shows the algorithm for calculation of spine stress state, and spine curve correction for given brace with adjusted telescope forces. The second algorithm calculates the telescope forces for demanded spine curve correction. The computer program can be used for computer aid design of brace forces. The force effect of the new type of brace is demonstrated on a 14 months old boy with congenital scoliosis of lumbar spine (hemivertebra L1 and L3 on the right side). Curvature measured according to Coob was changed after application of this brace from 47.5° to 32.0°.     

The use of Irradiated Allografts in Posterior Spinal Fusion for Healed Tubercular Kyphosis in Children

Post-tubercular spinal kyphosis in children is not only cosmetically unacceptable but functionally disabling as well, as with the progression of the deformity there is a very significant risk of late onset paraplegia. We present our preliminary results in a prospective study of 12 cases of healed post-tubercular kyphosis in children treated with isolated posterior spinal fusion using irradiated allografts and autogenous cancellous grafts.The study included 12 patients of healed post-tubercular kyphosis documented by clinical, radiological and haematological criteria, with >2 spine at risk signs radiologically. The mean age was 7 years. In situ posterior spinal fusion with irradiated allografts and autogenous cancellous bone graft without any instrumentation was done for all the patients. The total follow-up is 5 years (mean 2.8 years).Eight patients (66%) showed a correction of the kyphosis, 3 patients (25%) were static and only 1 patient showed worsening of the deformity. Eleven patients had sound fusion and 1 patient had good fusion but a pseudoarthrosis at the lower vertebral level.Good posterior fusion was achieved because of the judicious use of morcellised, irradiated cancellous allografts with autogenous cancellous grafts. The proposed mechanism of correction is selective anterior column growth vis-à-vis posterior fused mass leading to gradual self-correction and remodelling.Conclusion. In situ posterior spinal fusion with irradiated allografts is a simple, safe, easily reproducible, less morbid surgical procedure with good results which may alter the long term disability of the patients.     

Biomechanical basis of optimal scoliosis surgical correction

For an optimal approach to surgical correction of scoliosis, it was deemed desirable to biomechanically simulate the set of corrective forces applied by alternative internal fixation systems, so as to determine and apply the internal fixation system producing the best correction under safe levels of forces applied by the fixation systems to the spinal structures. To this end, we have developed, and presented here, (1) a spinal finite-element model relating the applied corrective forces to the corrected spinal configurations, (2) a method for determining the stiffness of the patient's spine prior to surgery, (3) computerized finite-element analysis simulation of alternative internal correction-fixation systems, so as to determine the most efficacious system, (4) instrumentations for surgically implementing the recommendations of the surgical simulation analysis and (5) comparisons of the model-simulated and surgically-obtained corrected spinal configurations. These procedures together constitute the biomechanical foundations of scoliosis surgical correction.     

The utility of superficial abdominal reflex in the initial diagnosis of scoliosis: a retrospective review of clinical characteristics of scoliosis with syringomyelia

Background

The incidence of spinal deformity in children with Prader-Willi syndrome (PWS) is high, with 86% of these patients found to have a significant structural scoliosis; however, there are very few case reports describing surgical treatment for this deformity.

Methods

The authors reviewed a case series consisting of 6 patients who underwent spine surgery for scoliosis. Children's mean age at index surgery was 12 years and 10 months (range, 10 to 15 yrs). Clinical evaluation revealed the typical phenotypic features of the PWS in all of the patients; 4 subjects had a karyotype confirmation of PWS. Major structural curves showed preoperative mean Cobb angles of 80.8° (range, 65° to 96°). Hybrid instrumentation with sublaminar wires, hooks and screws was used in the first 2 patients, while the remaining 4 were treated with titanium pedicle screw constructs.

Results

The mean clinical and radiological follow-up was 3 years and 10 months (range, 2 years to 9 years). Major complication rate was 50%. One patient who developed a major intraoperative complication (paraparesis) prevented spinal fusion to be obtained: the neurologic deficit resolved completely after instrumentation removal. Solid arthrodesis and deformity correction in both coronal and sagittal plane was, however, achieved in the other 5 cases and no significant curve progression was observed at follow-up. Another major short-term complication was encountered 3 months after surgery in a patient who experienced the detachment of a distally located rod and required correction through revision surgery and caudal extension by one level. Cervico-thoracic kyphosis was seen in 1 patient who did not require revision surgery.

Conclusions

Spine reconstructive surgery in patients with PWS is rare and highly demanding. The best method of reconstruction is posterior multilevel pedicle screw fixation. Moreover, even with modern techniques, the risk of complications is still high. These new techniques, however, have shown to improve the postoperative course by allowing for immediate mobilization without any brace or cast. The use of the growing rod techniques, requiring repeated surgeries, should be carefully evaluated in each single case.     

重度脊柱侧凸后路一期小切口矫形对肺功能的影响

目的:探讨采用脊柱后路分期矫形策略治疗重度脊柱侧后凸,一期小切口矫形术对患者肺功能的影响。方法:自2007年05月-2010年12月采用脊柱后路分期矫形策略中一期小切口矫形术治疗重度脊柱侧凸患者32例,其中男12例,女20例,年龄5～25(13.5±6.12)岁。一期小切口矫形术前侧凸主弯冠状面Cobb’s角为108°～150°(128.75°±13.51°),胸腰段矢状位后凸角60°～140°(97.78°±27.88°)。测量一期矫形术前及术后2周、3月、6月肺功能,包括肺活量(VC)、用力肺活量(FVC)、第一秒时间肺活量(FEV1)、最大呼气中段流速(MMEF)、最大通气量(MVV),计算其占预计值的百分比[VC%、FVC%、FEV1%、MMEF%、MVV%]。观察患者术前与术后不同时期肺功能的变化。结果:术后3月时肺功能较术前有明显提高(P<0.05),术后6月较术后3个月无显著提高(P>0.05)。结论:对于严重的脊柱侧凸患者,后路一期小切口矫形术后3月肺功能即可获得明显改善,可行二期手术治疗。     

两种植骨方式在胸腰椎结核手术中的应用

目的:比较不同植骨方式治疗胸腰椎结核的手术效果,探讨颗粒自体骨与块状自体骨两种植骨方式在治疗胸腰椎结核的临床疗效。方法:2008年1月至2010年12月期间在我院手术治疗的胸腰椎结核患者132例,其中采用块状自体骨进行骨移植的患者60例,采用颗粒状自体骨进行骨移植的患者72例,随机从两种植骨方式中各抽取20例患者进行回顾性分析,对两组患者术中出血量、住院时间、术后神经功能改善情况、植骨融合情况、后凸畸形矫正状况进行对比。结果:所有患者均一期愈合,无全身并发症,两组患者随访12~36个月,平均18个月,影像学提示内固定位置良好,无松动及断裂,结核病灶无复发。块状骨组术后6个月随访植骨融合率15%(3/20)术后9个月融合率45%(9/20),术后12个月融合率95%(19/20)。颗粒骨组术后6个月随访植骨融合率45%(9/20)术后9个月融合率80%(16/20),术后12个月融合率100%。块状骨组术前Cobb角为29.8°±5.0°,术后Cobb角为14.7°±2.5°,末次随访Cobb角为16.0°±2.9°。颗粒骨组术前Cobb角为30.9±7.6°,术后Cobb角为15.6°±3.8°,末次随访Cobb角为16.7°±3.8°,两组病人术后cobb角较术前有明显矫正,末次随访无明显丢失,两组比较无显著性差异(P0.05)。颗粒骨组术中出血量明显少于块状骨组,两组比较有统计学意义(P0.05)。住院时间两组比较无显著性差异(P0.05)。结论:颗粒状自体骨与块状自体骨相比在胸腰椎结核手术中植入方便,出血量少,植骨融合时间短,融合率高,是胸腰椎结核植骨的理想选择。     

The use of dynamic elastomeric fabric orthosis suits as an orthotic intervention in the management of children with neuropathic onset scoliosis: A retrospective audit of routine clinical case notes

Background

To date the main treatment approach for neuropathic onset scoliosis has utilised thoracic lumbar sacral orthoses (TLSO) to stabilize the spine and enable stable sitting. Dynamic elastomeric fabric orthoses (DEFOs) may achieve both of these aims if used as an early intervention. Due to a lack of evidence in this area, a retrospective audit of case notes was undertaken to understand current orthotic practice investigating the usage, outcomes and clinical characteristics of treated children with neuropathic onset scoliosis. Clinical notes of 180 children at risk for, or identified with, scoliosis were audited using a search matrix to identify diagnostic group, spinal muscle tone, Gross Motor Functional Classification Scale (GMFCS) level, orthotic treatment modalities, scoliosis specific data, surgical interventions, adaptive technologies used, and outcome measurements reported.

Results

Of the 180 notes examined, 85 were male; mean age nine years one month [SD four years seven months]. Spinal muscle tone was reported in 137 cases: 122/137 presented as low tone, 4/137 high tone, 6/137 fluctuating tone and 5/137 typical tone. Scoliosis was confirmed in (77/180) of whom (39/77) used a DEFO. Another (43/180) had a spinal curve developing, of whom (22/43) used a DEFO. The remaining (60/180) had no report of spinal curvature, but used a DEFO as a preventative measure. GMFCS scores were reported for 49 children of whom 14/49 were graded as level 4 and 17/49 level 5. Of the children with scoliosis who had spinal curve shapes reported, 48/60 had a C-shape presentation and 12/60 had an S-shape.

Conclusions

The findings confirm previously reported papers in children with neuropathic onset scoliosis in relation to curve shape and GMFCS levels. It provides some evidence of the role DEFOs may have in the management of these children, and highlights the need for further research in this area due to the lack of peer-reviewed publications.

     

甜叶菊RAPD反应体系的优化

以甜叶菊为试材,对影响其RAPD反应体系的7个因子进行优化.结果表明,20 μL的优化体系包括:双蒸水13.6 μL,10×Buffer(含15 mmol/L MgCI2)溶液3μL,2.5 mmol/L的dNTPS 1.2 μL,10 μmol/L的引物1μL,20 ng的模板DNA 1μL,1UTaq聚合酶;热循环...     

Oxygen absorption by skin exposed to oxygen supersaturated water

The present study tests the hypothesis that skin on the plantar surface of the foot absorbs oxygen (O(2)) when immersed in water that has a high dissolved O(2) content. Healthy male and female subjects (24.2 ± 1.4 years) soaked each foot in tap water (1.7 ± 0.1 mg O(2)·L(-1); 30.7 ± 0.3 °C) or O(2)-infused water (50.2 ± 1.7 mg O(2)·L(-1); 32.1 ± 0.5 °C) for up to 30 min in 50 different experiments. Transcutaneous oximetry and near infrared spectroscopy were used to evaluate changes in skin PO(2), oxygenated haemoglobin, and cytochrome oxidase aa(3) that resulted from treatment. Compared with the tap water condition, tissue oxygenation index was 3.5% ± 1.3% higher in feet treated for 30 min with O(2)-infused water. This effect persisted after treatment, as skin PO(2) was higher in feet treated with O(2)-infused water at 2 min (237 ± 9 vs. 112 ± 5 mm HG) and 15 min (131 ± 1 vs. 87 ± 4 mm HG) post-treatment. When blood flow to the foot was occluded for 5 min, feet resting in O(2)-infused water maintained a 3-fold higher O(2) consumption rate than feet treated with tap water (9.1 ± 1.4 vs. 3.0 ± 1.0 μL·100 g(-1)·min(-1)). We estimate that skin absorbs 4.5 mL of O(2)·m(-2)·min(-1) from O(2)-infused water. Thus, skin absorbs appreciable amounts of O(2) from O(2)-infused water. This finding may prove useful and assist development of treatments targeting skin diseases with ischemic origin.     

Evidence of spinal tuberculosis at the beginning of the fourth millennium BC from Arene Candide cave (Liguria, Italy)

This paper describes tuberculosislike lesions affecting the spine of Neolithic skeleton found in Arene Candide cave (Liguria, Italy) and representing one of the earliest cases of this disease in Europe. The burial is attributed to middle Neolithic (square-mouthed pottery culture) whose layers date, by 14C, to the first half of the fourth millennium BC. The skeleton, well preserved in the postcranial portion, belongs to a male aged about 15 years having a very light body build. Resorptive lesions localized to the lower thoracic and upper lumbar vertebral bodies, collapse and angular kyphosis, resulting from complete destruction of T11 and T12 and partial destruction of T10 and L1, are the main pathologic features. The morphology of the lesions, sites involved, and age of the specimen are consistent with a diagnosis of tuberculous spondylitis (Pott's disease). The extreme gracility of the skeleton, along with other signs of stress (Harris lines, enamel hypoplasia) suffered during the last years of life, and the limited bony regeneration point to a disease process in its late phase having arisen at the beginning of adolescence. The funerary ritual suggests that the social integration of this adolescent was not prevented by the severe infirmity.     

The colour change of the minnow, Phoxinus phoxinus with particular reference to the effect of spinal lesions

An account is given of the anatomy of the spinal cord of the minnow, Phoxinus phoxinus L., and comparisons are made with the spinal cords of other teleosts. The effects on the rapid, neurally controlled colour responses of complete transection of the spinal cord at different levels indicated that, in the particular fish used for this work, the sympathetic pigmento-motor fibres had a localized outflow from the spinal cord around vertebra 13. Partial lesions of the spinal cord at vertebrae 3, 4, 10 and 11 and their effects on the colour responses indicated that, at these spinal levels, the pigmento-motor fibres were dorsomedially located within the dorsal horns. Complete and partial transection of the spinal cord at any single level between vertebrae 12 and 14 and partial transection of the dorsomedial spinal tissues at vertebrae 3, 4, 10 and 11 resulted in differential paling of the entire dorsolateral skin of the fish in response to a change of background from black to white. It would appear that in both cases this differential response of the melanophores was the result of transecting a proportion of the spinal pigmento-motor fibres.     

Tolerance induction of allo-class II H-2 antigen-reactive L3T4+ helper T cells and prolonged survival of the corresponding class II H-2-disparate skin graft

The present study investigates the effects of i.v. presensitization with class II H-2-disparate allogeneic cells on various L3T4+ T cell functions including the capability of rejecting the corresponding allogeneic skin graft. C57BL/6 (B6) mice were i.v. presensitized with class II H-2 disparate B6-C-H-2bm12 (bm12) spleen cells. Such presensitization did not affect the bm12-specific L3T4+ T cell-mediated proliferative and interleukin 2 (IL-2)-producing capacities. A single cell suspension of (B6 x bm12)F1 spleen cells was depleted of APC by two round-passages over Sephadex G-10 columns. This APC-depleted fraction of (B6 x bm12)F1 cells failed to stimulate B6 responding cells in mixed lymphocyte reactions (MLR). The addition of recombinant IL-1 to the MLR restored anti-bm12 MLR responses, indicating that APC-depleted (B6 x bm12)F1 cells bear bm12 alloantigens but are unable to stimulate B6 anti-bm12 L3T4+ T cells. A single i.v. administration of APC-depleted (B6 x bm12)F1 cells into B6 mice resulted in almost complete abrogation of the capacity of recipient B6 lymphoid cells to give anti-bm12 MLR and IL2 production. This suppression was bm12 alloantigen-specific and attributed to the elimination or functional impairment of anti-bm12 T cell clones rather than the induction of suppressor cells. The tolerance was also observed in graft-rejection responses. The strikingly prolonged survival of bm12 skin grafts was produced when grafts were implanted into B6 mice which had been presensitized with APC-depleted, but not with untreated (B6 x bm12)F1 spleen cells. These results indicate that allo-class II H-2 antigen-reactive L3T4+ T cells are rendered tolerant by i.v. presensitization with APC-depleted fraction of the corresponding allogeneic cells.