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Biomedical subjects

D Wessinghage

Publications and source records attributed to D Wessinghage.

104 records · Page 6Linked to original sources
PubMedDate not supplied

[Chronic polyarthritis and polytrauma. A case report].

Rheumatoid arthritis already can lead to an extreme limited range of motion of the whole patient in an early age. A female patient of 39 years has been immobilized for a period of about 6 years. By accident she was suffering too from multiple fractures, especially of both femora and both elbow-joints. Rheumatoid arthritis and traumatic lesions lead to incommon surgical procedures. Both hip-, both elbow- and both kneejoints, regarding to the fractures, were replaced during three operation periods. Within half a year the patient was far extending independent of nursing and able to walk again.

Adult↗
PubMedDate not supplied

[Active acetabulum base stabilization as a supplement to endoprosthesis in polyarthritis-induced acetabular protrusion].

In many cases, rheumatoid arthritis results in protrusio acetabuli. In order to effect a durably stable support over the whole extent of the acetabulum, the active stabilization of the socket base in an endoprothetic joint replacement through a corticospongy plastic is more promising than the application of passive measures. Rheumatoid arthritic persons underwent 127 hip-joint replacements as first-time surgeries. In 47 operations out of the 127, we also carried out the active stabilization of socket bases because of protrusio acetabuli. Through the implantation of corticospongy bone material into the protrusions, socket bases with enough strain capacity could be recreated. Loosenings or reprotrusions were not observed over a period of up to 5 years.

Acetabulum↗
PubMedDate not supplied

[Ultrastructure of reparation collagen and its relations to residual hyaline joint cartilage in inflammatory cartilage destruction].

The development of collagenous fibrils in reparative tissues replacing hyaline cartilage in arthritic joints was investigated by electron microscopy: granulation tissue consists of a loose network of collagenous fibrils, scar tissue is characterized by dense bundles of parallel arranged collagenous fibrils, chondroid tissue that may develop under certain instances is characterized by a network of random orientated fibrils that differ from those of the normal hyaline cartilage by their uniformity. The fibrils of the reparative tissues often exhibited an intense contact with those of the original hyaline cartilage.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Detritus synovitis in chronic polyarthritis: a clinical and operation histologic evaluation].

In rheumatoid arthritis (RA) joint inflammation is due to two processes: 1) the underlying inflammatory process (UIP) characterized by a lymphoplasmacellular infiltration of the synovial tissue, as well as pannus formation, and 2) the detritogenic synovitis (DS), a synovial response to articular wear products from cartilage and bone (detritus) that induces a preferentially fibrinous inflammation. In order to estimate the role of DS in the clinical presentation of such joints, 40 patients with RA undergoing knee-joint surgery on 48 occasions were evaluated for clinical parameters, radiological stage (Larsen), and histopathological characteristics of UIP and DS. The clinical parameters were comparable in knee joints with predominantly UIP or DS. However, DS was regularly seen in knees with advanced destruction according to Larsen's stages 4 to 5, while UIP occurres in joints even without radiological damage. In conclusion, it is assumed that the poor response of patients with advanced RA to so-called long-term drug therapy may be in part explained by the modifying influence of joint detritus on the underlying "rheumatoid" inflammatory process.

Aged↗
PubMedDate not supplied

[Active stabilization of the acetabular floor by auto-/homologous bone transplantation in inflammatory rheumatic protrusion hip].

Inflammatory changes of the hip joint in rheumatoid arthritis often lead to secundary protrusio acetabuli. Total joint replacement may lead to problems, especially in mounting the acetabular component firmly to the pelvis. For about 7 years we have been using the so-called "active stabilisation of the acetabular floor" by implantation of autologeous bone prepared from the resected femoral neck. In changing the artificial joint homologeous bone from our bone bank was used. Up to Dec. 31, 1983 neither graft versus host reactions nor failure in healing were seen. 107 total joint replacements with bone transplantation in rheumatoid arthritis were performed. In all cases we could see optimal growing in of the transplanted bone, often confirmed by X-ray tomograms, with good support of the acetabular component. So far we have not seen any negative results. The active stabilisation of the acetabular floor seems to be a worthwhile addition to known surgical possibilities.

Acetabulum↗
PubMedDate not supplied

[Immune complexes: mediators for the formation of inflammatory granulation tissue? Immunohistologic studies of the hyaline articular cartilage in chronic polyarthritis].

Previous reports describe the presence of immunoglobulins and complement components within rheumatoid articular cartilage, thereby suggesting an effect of immune complexes on the formation of pannus. This hypothesis is reinvestigated in this paper. As confirmed in our work, the superficial layer of rheumatoid hyaline cartilage may fulfill the immunohistological criteria for the presence of immune complexes. In osteoarthritis, however, a noninflammatory disease not mediated by immunologic mechanisms, similar results can be obtained. The presence of immune-proteins within hyaline cartilage therefore requires a cautious interpretation. Hyaline cartilage in rheumatoid arthritis is replaced by granulation tissue growing not only at its surface (pannus), but also in subchondral bone. We therefore also thoroughly investigated deep layers of hyaline cartilage in the vicinity of such subchondral tissue, but could not obtain any evidence for the presence of immune complexes therein. The growth of subchondral granulation tissue and the accumulation of PMN in the region of its junction with hyaline cartilage therefore appear to be independent of immune complexes within rheumatoid hyaline cartilage. It is suggested on the basis of these data that immune complexes possibly present in hyaline cartilage do not play an essential role in the formation of granulation tissue replacing cartilage in rheumatoid arthritis. It is, however, not entirely excluded that during advanced stages of rheumatic cartilage degradation immune complexes are formed within the matrix or carried into it from the extra-cartilaginous environment, and that they may then contribute to further cartilage destruction by enzyme release during phagocytic processes.

Antigen-Antibody Complex↗
PubMedDate not supplied

The relationship between polymorphonuclear granulocytes and cartilage destruction in rheumatoid arthritis.

The pannus-cartilage junction was investigated in cases of rheumatoid joint destruction. By a histochemical method for demonstrating the presence of neutrophil granulocytes, it became obvious that these cells in some cases were found in high numbers in the immediate vicinity of the cartilage in the process of being destroyed. It is concluded that these blood-carried cells may also participate in cartilage destruction in acute phases of chronic rheumatoid disease.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Granulocyte elastase at the site of cartilage erosion by rheumatoid synovial tissue.

Elastase, an enzyme in the azurophilic granules of polymorphonuclear cells (PMN), is like other granular PMN proteases characterized by its degradative activity at physiological pH towards native macromolecules as shown in a serum free medium. Joint tissue specimen obtained during elective surgery in cases of various rheumatic conditions were examined in order to elucidate the role of this enzyme during joint cartilage destruction. An indirect immunofluorescence microscopic technique utilizing a rabbit immunoglobulin G preparation raised against purified elastase was used for this purpose. Immunoreactive elastase was seen bound to cells which were recognized as PMN by their nuclear characteristics and staining in a histochemical reaction with naphtol AS-D chloroacetate. PMN were encountered more or less often in the pannus but clearly accumulated in a significant amount at the pannus-cartilage junction in one case of rheumatic monarthritis and three out of four cases with rheumatoid arthritis. This finding shows that PMN--contrary to other descriptions--belong to the morphologic characteristics of inflammatory rheumatic conditions and directly supports the hypothesis that PMN enzymes play an active role in rheumatoid cartilage destruction.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Ultrastructure of hyaline cartilage and articular capsule tissue in alkaptonuric ochronosis].

The biochemical defect leading to alcaptonuria is well known. However, the pathogenesis of ochronotic arthropathy is poorly understood. The present ultrastructural study elucidated the localization of ochronotic pigment in the articular cartilage and evidence was found that suggests a pathway for cartilage destruction and further degradation. The amount of ochronotic pigment enlarged with increasing distance from chondrocytes. Pigment was neither seen in chondrocytes nor in the immediate vicinity of the chondrocytic lacunae. The interfibrillar localization as well as the preferential deposits in the deeper zone of the cartilage may indicate a binding of ochronotic pigment to proteoglycans of the cartilage. It is assumed that altered proteoglycans are responsible for the increased fragility of articular cartilage leading to cartilage fragmentation. Fragments of ochronotic cartilage are phagocytosed by connective tissue cells. Incomplete digestion of ochronotic pigment results in the formation of ochronotic residual bodies in these cells.

Alkaptonuria↗
PubMedDate not supplied

[Neutrophil granulocytes in rheumatic tissue destruction].

Periarticular rheumatoid nodules from 27 patients with rheumatoid arthritis were investigated with a histochemical method to identify polymorphonuclear granulocytes (PMN's). In all necrotic areas PMN's were present, however, in different densities. Most of the necrotic areas contained a minimal or intermediate infiltration with these inflammatory cells. Six rheumatoid nodules exhibited a severe vasculitis with dense perivascular infiltrations of PMN's. This vasculitis was preferentially seen in nodules with necrosis densely infiltrated with PMN's. From the present results it is assumed that PMN's may be involved in the pathogenesis of fibrinoid necrosis in rheumatoid nodules.

Adult↗
PubMedDate not supplied

[Chronic polyarthritis and carpal tunnel syndrome. Results of follow-up].

Between July 1974 and December 1989, carpal tunnel-syndromes (CTS) were operated on in 903 hands of 746 patients. 147 of these patients (191 hands) were suffering from chronic inflammatory joint diseases. In 11 patients CTS was the first sign of rheumatoid arthritis (R.A.). The hands showed intraoperatively in 44.8% (n = 86/191) an extensive tenosynovitis with an aggressive infiltration. In 19% (n = 36/191), we had to extend the obligate tenosynovectomy on the flexor tendon parts of the fingers and ligaments (28 hands). 21 articulosynovectomies on the wrist or finger joints were performed. In 6 hands (8.0%) tendon ruptures were repaired. A questionnaire was completed for 107 of 147 patients (72.8%) (with 145 operated hands). Clinical (77 hands) and electromyographical examinations (49 hands) were performed an average of 5.1 (0.7-15) years postoperatively. 20 patients (13.6%) died, 20 could not be traced. In 86% (n = 125/145) of the patients we achieved relief of pain and a marked reduction of neurological deficits. 96.3% of the patients were content. The improvement of function of the hand after surgical intervention is of a great benefit for the patient with R. A. The overall risks of the procedure are low (complications 14%; no recidivism). Therefore, we recommend surgery in early stages after a confirmed diagnosis or a reasonable suspicion.

Adult↗