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PubMed1992

[Schoenlein-Henoch syndrome and salmonella infection: a new association?].

Schoenlein-Henoch's disease has a immunological pathogenesis (mediated by immunocomplexes), is characterised by a number of differently associated signs and symptoms, and leads to the possible involvement of the cutis, joints, abdomen and kidneys. Two cases of Schoenlein-Henoch's disease associated with acute salmonella enterocolitis were recently brought to our attention. In two girls, aged 2 years and 8 months and 13 months respectively, the onset of diarrheic alvus was followed, after an interval of 4-5 days, by the sudden appearance of pompho-erythemato-hemorrhagic and petechial cutaneous lesions localised symmetrically on the extensor surfaces of the lower limbs and buttocks, and accompanied in the first case by intense abdominal pain and in the second by diffuse arthralgia, with predominant involvement of the tibio-tarsal joints. Laboratory tests showed slight alterations of phlogosis indexes and high levels of serum IgA (182 and 204 mg/dl respectively). The examination of feces showed the presence of occult blood and salmonella (belonging to C and D groups respectively) were isolated in the coproculture. Other culture and serological tests carried out while in hospital were negative. The clinical manifestations gradually resolved within the space of two weeks following the normalisation of the alvus obtained after a few days using dietary regulation. After two months the girls were found negative on clinical examination; in the second case described there was a positive response to Widal's reaction with high antibody titres against both O and H antigens, whereas the coproculture continued to be positive for Salmonella.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed1989

NE-58095: a diphosphonate which prevents bone erosion and preserves joint architecture in experimental arthritis.

The rat adjuvant arthritis model, like human rheumatoid arthritis, is characterized by fulminating intra- and periarticular inflammation and bone lysis. This model was used to determine the effectiveness of a potent antiresorptive diphosphonate (NE-58095: monosodium [2-(3-pyridinyl) ethylidene] hydroxy diphosphonate) prophylactically in Lewis rats and therapeutically in Sprague-Dawley rats. Modified Freund's adjuvant (MFA) was injected into the tail of Lewis and Sprague-Dawley rats. Prophylactic treatment in Lewis rats [oral (PO): 14.8 mg/kg/day); subcutaneous (SC): 0.148 mg/kg/day] was begun on the day of MFA injection. A significant reduction in paw swelling was seen as early as day 12 after MFA injection with both oral and parenteral treatment. NE-58095 produced a reduction in paw swelling of 28, 39 and 61% on days 12, 17 and 24 respectively, as compared to the saline-treated MFA control. Bone lysis in the saline-treated MFA group was 85% of total possible incidence for 6 joint regions in the hind paws and 4 regions in the front paws at day 24. This resorption was reduced by 70% in the rats administered NE-58095 PO and SC at 24 days after MFA. In the therapeutic experiments with Sprague-Dawley rats, treatment with NE-58095 (SC: 0.148 mg/kg/day) was begun on day 14 after MFA injection, at which time significant paw swelling (greater than 0.5cc) had occurred. On day 25 (12 days of treatment), paw swelling was reduced 70% by NE-58095 treatment as compared to the saline-treated MFA controls. Histologically, the architecture of the tibio-tarsal joints in the saline-treated MFA rats was affected, in contrast to the NE-58095-treated MFA rats where the architecture of the joint was preserved. This new potent diphosphonate is not an anti-inflammatory compound by any of the classical tests and is effective both orally and parenterally. The mechanism by which this diphosphonate protects joint integrity is not clear but appears to be related to its ability to block bone resorption and the consequent inhibition of the diffusion into the joint space of calcium, chemotactic factors and cytokinas released from bone matrix, resulting in a quenching of the arthritic process.

Animals↗
PubMedDate not supplied

Histological examination on Achilles tendon lesions induced by quinolone antibacterial agents in juvenile rats.

We examined the effects of the quinolone antibacterial agents pefloxacin (PFLX) and ofloxacin (OFLX) on the Achilles tendon of Sprague-Dawley rats. A single oral administration of PFLX 300 and 900 mg/kg or OFLX 900 mg/kg induced edema with mononuclear cell infiltration mainly in the inner sheath of the inner Achilles tendon just proximal to the tuber calcanei in rats killed on the next day. Cell infiltration was also seen in the adjacent synovial membrane and joint space. With progression of severity, the lesions extended to the surface tendon tissue, wherein irregularly arranged collagen bundles were detached from each other and nuclei of fibroblasts were pyknotic and fragmented. After 2-wk repeated administration, these lesions were replaced by fibrotic foci with regenerated tendon fibroblasts, and the incidence and severity were reduced in the OFLX but not PFLX groups. Coadministration of cyclosporin A with OFLX 300 mg/kg induced these lesions despite the fact that neither induced lesions alone. The tendon lesions were induced in juvenile rats (4 wk of age) but not in young adults (12 wk). The articular cartilage of juvenile rats showed focal degeneration and/or cavitation in the tarsal joints after a single and 2-wk administration of PFLX or OFLX. Hydrocortisone slightly increased the incidence of OFLX-induced lesions in both the tendon and cartilage after a 2-wk administration. The occurrence of the tendon lesions is different from that of the Achilles tendon disorders reported in older humans, but they are thought to be a useful model for them.

4-Quinolones↗
PubMedDate not supplied

Rigid painful flatfoot secondary to tarsal coalition.

Rigid flatfoot secondary to tarsal coalition requires proper clinical and roentgenographic evaluation. In patients with limited subtalar motion and pain in the tarsal area, a coalition should be suspected. Proper roentgenographic evaluation with standard anteroposterior, lateral, and oblique views is essential. Calcaneonavicular coalition, as visible on an oblique film, may be a solid bony fusion or, more often, a cartilaginous coalition, which is characterized by flattening of the calcaneus and navicular at their junction. Axial (Harris) views demonstrate coalition in the middle and posterior facets, which may be cartilaginous or osseous. Lateral tomography is used to demonstrate irregularities of the anterior facet or the undersurface of the talar head. When symptomatic, a calcaneonavicular coalition with no degenerative changes of the tarsal joints is treated by resecting the bar and inserting the extensor digitorum brevis into the area from which the coalition is excised. An osseous bar is resected, or, if degenerative changes are noted, a triple arthrodesis is performed. Talocalcaneal coalition is first treated conservatively by a regimen of Plastizote shoe inserts, short-leg casts, or an ankle-foot orthosis. If conservative treatment fails to alleviate pain, a triple arthrodesis is indicated.

Adolescent↗
PubMed2002

The geometric architecture of the subtalar and midtarsal joints in rheumatoid arthritis based on magnetic resonance imaging.

OBJECTIVE: To compare in vivo the 3-dimensional (3-D) geometric architecture of the subtalar and midtarsal joints in normal and rheumatoid arthritic (RA) feet, using magnetic resonance imaging (MRI) analysis. METHODS: MRI was performed on 23 patients with RA, all of whom had disease activity in the subtalar and/or midtarsal joints. Image processing techniques were used to create 3-D reconstructions of the calcaneus (C), cuboid (c), navicular (N), and talus (T) bones. Twenty-four standard architectural parameters were measured from the reconstructions and were compared with data from 10 normal subjects. These parameters defined both 3-D distance and angular relationships among the 4 bones studied. Pattern classification techniques were used to establish a geometric architecture foot profile for the RA patients. The degree of individual patient fit to the new RA foot profile and to profiles for normal, pes planus, and pes cavus foot types was derived. Logistic regression was used to examine the relationship of foot architecture to inflammatory disease characteristics and physical examination variables. RESULTS: Subtalar or midtarsal pain was reported by all 23 patients, and 22 of the 23 patients presented with >/=1 clinical feature of pes planovalgus deformity. In 21 patients, ultrasonography revealed synovitis at >/=1 tarsal joint or surrounding tendon. In the RA group, the normalized distances between the geometric centroids were significantly closer for bone pairs Cc and cT and significantly distracted for bone pair CN compared with the distances in normal subjects. In RA patients (versus normal subjects), the angles subtended at the bone centroids were significantly decreased in 3 bone groups (CNc, TCN, and TNc) and significantly increased in 3 bone groups (CcN, CcT, NTc). The angles formed between the major principal axes of bone pairs CT and cT were significantly increased in RA patients compared with those in normal subjects. Pattern classification defined 11 RA feet as having normal structure and 12 as having abnormal structure. However, the abnormal feet did not fit consistently with structures defined for RA, pes planus, or pes cavus foot types. Logistic regression demonstrated that subtalar joint synovitis was the only predictive factor for abnormal subtalar and midtarsal architecture (odds ratio 19.2, 95% confidence interval 1.77-200.0). CONCLUSION: This unique 3-D MRI-based technique successfully quantified the effects of RA on the geometric architecture of the foot and the patient-specific nature of these changes. This technique can be used to provide logical therapy for correction.

Adult↗
PubMed1995

Idiopathic carpotarsal osteolysis with Bartter's syndrome. A case report and review of the literature.

Idiopathic carpotarsal osteolysis is 1 of the rare types of disappearing bone diseases characterized by painful limitation of movement and deformity of the wrist and tarsal joints, and associated with frequent episodes of joint inflammation and a radiographic appearance of osteolysis. Reported here is an 8-year-old girl with idiopathic carpotarsal osteolysis and Bartter's syndrome with significantly decreased re-absorption of chloride at distal renal tubules, low level of serum potassium, a metabolic alkalosis, and high levels of aldosterone and renin. Bartter's syndrome associated with idiopathic carpotarsal osteolysis has not been published previously. The typical plantar nodule in this patient confirmed the presence of fibromatosis with aggressive histologic signs in light and electron microscopic examination.

Aldosterone↗
PubMed1999

Restoration of normal bone development by human homologue of collagen type II (COL2A1) gene in Col2a1 null mice.

Development of the vertebrate skeleton is a highly complex process in which collagen type II plays a vital role in the formation of long bones via endochondral ossification. Collagen type II, which is encoded by a single COL2A1/ Col2a1 gene, is the most abundant structural protein in the cartilage matrix, where it undergoes complex interactions with several other proteins. The sequence of mature collagen type II chains, each with about 1,100 amino acids, is conserved between different mammalian species. There are 37 amino acid positions that are different between mouse and human collagen type II. Previously, we have demonstrated that transgenic mice, in which Col2a1 gene is knocked out, exhibit a lethal phenotype due to the absence of endochondral bone formation. To investigate whether the biological role of collagen type II is conserved between the species, human COL2A1 gene was expressed in Col2a1 null mice by crossing with transgenic mice in which human COL2A1 gene was integrated. The collagen type II from human gene rescued the lethal phenotype in null mice, indicating that the biological function of collagen type II is conserved between human and mouse. The animals exhibited normal endochondral bone formation and a normal growth plate in tibio-tarsal joint. Chondrocytes isolated from the cartilage of these mice secreted human protein, suggesting that the animals incorporated heterologous protein to form cartilage which is essentially "humanized." The animals reached puberty and produced normal progeny. A completely normal phenotype in newborns indicates that human COL2A1 gene is expressed properly both temporally and spatially. These animals may be useful to generate models to study the effect of COL2A1 mutations on skeletal development in humans by introducing mutated gene constructs either into embryos or by crossing with transgenic animals with COL2A1 mutations.

Animals↗
PubMed1998

Evaluating motor end-plate-targeted injections of botulinum toxin type A in a canine model.

Tarsal joint forces were measured in dogs over 70 days following botulinum toxin type A (BTX-A) injections. Three dogs were injected at motor end-plates located by electromyography (EMG), while 3 dogs were similarly injected, but without EMG guidance. Extension forces were significantly (P < 0.05) smaller in limbs injected at motor end-plates than in corresponding limbs on days 14 and 35. There were no significant differences at other times. Using these techniques, EMG end-plate targeting potentiates effects of BTX-A.

Animals↗
PubMed1991

[Results of the surgical treatment of chronic hematogenous osteomyelitis of the tibia. A series of 122 cases].

Between 1968 and 1987 the authors treated 122 cases of chronic haematogenous osteomyelitis of the tibia by operation. The procedures used were drilling, sequestrectomy, and saucerisation, with bone resection in 2 cases. Operation was combined with chemotherapy for between 10 and 60 days. Eleven patients, thought to be healed, were lost to follow-up after 4 months. The remainder were reviewed for between 4 and 288 months, 97 for more than one year. After the first operation 102 patients healed completely, while 20 relapsed. Of these, 12 were treated by further operation and 8 by drainage of the abscess. Two patients relapsed twice and another 4 times. When last seen 110 patients were healed, 6 had an intermittent discharge and 6 had a permanent sinus. Special features of chronic osteomyelitis of the tibia are discussed, including destructive lesions of the knee and tibio-tarsal joints, a high incidence of axial deformity, indications for particular surgical approaches, the use of cancellous grafts and arguments against bone resection. The lesions carry a relatively good prognosis.

Adolescent↗
PubMed1990

Long-term results of arthrodesis of the ankle.

Forty-four arthrodeses of the ankle were carried out between 1965 and 1984 in forty-three patients with post-traumatic osteoarthritis or poliomyelitis. Twenty-eight patients, one of whom had a bilateral arthrodesis, were followed up after an average of ten years. Twenty-four were satisfied and the patients with poliomyelitis were better than those with osteoarthritis. The condition of the tarsal joints before the operation influences the result, but the arthrodesis does not cause degenerative changes in these joints.

Adolescent↗
PubMed1984

[Congenital convex clubfoot: a diagnostic and therapeutic study of 71 cases].

We have studied 71 feet with congenital vertical talus in 51 patients. The condition is characterised by two fixed deformities, equinus of the hindfoot with a vertical talus and dislocation of the mid tarsal joint due to malposition of the navicular with respect to the head of the talus. The forefoot is usually everted, but lay in inversion in 25% of our cases. The deformity must be recognised within a few weeks of birth, and the diagnosis is facilitated by radiographs taken in extreme dorsiflexion and plantarflexion. The radiographic appearances allow classification of the deformity into three groups which aid in the choice of the correct management. Treatment is by operation. We have performed 48 open reductions, followed by lengthening of the Achilles tendon six weeks later. Our results can be equally divided into good, fair and poor. We have excised the talus on three occasions only, but we feel that this operation may well be useful in the presence of marked deformity of the talus, particularly in the older child.

Child, Preschool↗
PubMed1987

Radiologic findings in lesions of the ligamentum bifurcatum of the midfoot.

In a consecutive study of 106 patients presenting with a history of ankle sprain, 40.5% showed clinical signs of damage to the ligamentum bifurcatum. Eighteen of these patients showed 20 radiologic signs related to a lesion of this ligament; these signs included avulsions from the points of insertion and laxity in the lateral part of the transverse tarsal joint. The supplementary radiographs revealing these signs are demonstrated, and a more differentiated radiologic handling of the patient with ankle sprain is suggested.

Adolescent↗
PubMed1987

[Familial Mycoplasma pneumonia. The varied picture of pulmonary and extrapulmonary manifestations].

Mother, father (26 y.o.) and their only child (5 y.o.) developed nonproductive cough, fever (39.5 to 40.4 degrees C) and bilateral pulmonary infiltrates within three weeks. In addition the mother developed a small left pleural effusion and a pericardial effusion, a relative bradycardia, a pruritic vesicular exanthem of the extremities and the trunk, an erythema nodosum and arthritis of the tarsal joints. The father's coulter counter red blood count was distorted by microagglutination at room temperature (hemoglobin 13.2 gr/dl; erythrocytes 1,91 X 10(6) mm-3 and MCH 69.1 pg; MCV 120 fl and hematocrit 23.8%) but not at 37 degrees C (13.2; 4.15 and 31.8; 92 and 39.3, respectively). In the daughter myringitis, pharyngitis, cervical lymphadenopathy and splenomegaly were observed. Cold agglutinins and serologic evidence for mycoplasma pneumoniae infection were demonstrable in all three. Treatment with Tetracycline (parents) and Erythromycin (child) was effective.

Adult↗
PubMed1994

Retention of B. burgdorferi pathogenicity and infectivity after multiple passages in a co-culture system.

In vitro cultivation of B. burgdorferi in BSK medium results in the loss of infectivity and pathogenicity after repeated passages. To prevent this loss, a feeder layer of tibio-tarsal joint tissue derived from newborn LEW/N rats was grown on Cytodex 3 microcarriers in ESG (formerly BSKE), a novel medium developed to support the growth of both the feeder layer and B. burgdorferi. A new pathogenic isolate (FNJ) and a high passage, non-pathogenic strain (TNJ) grew well in this co-culture system with high yields of viable organism. FNJ caused no growth inhibition or visible damage to the cells in the feeder layer. FNJ remained arthritogenic for newborn LEW/N rats after 22 passages in the co-culture system, but lost its arthritogenicity after 7 passages when cultured in BSK medium. This borrelia-mammalian tissue co-culture technique presents an experimental system to study the long term interactions of B. burgdorferi with the infected host tissues in vitro, as well as facilitate diagnostic tests and vaccine development.

Animals↗
PubMed1988

Copper and zinc status in rats with acute inflammation: focus on the inflamed area.

Status of copper and zinc in plasma, blood cells, liver and hind paws (sectioned at the tibio-tarsal joint) were evaluated in rats with carrageenan-induced paw-oedema; moreover, concentrations of copper and zinc in the supernatant and cell fractions obtained from exudates pooled from rats with carrageenan-induced pleurisy were also determined. The evaluation of copper and zinc status in the blood and in the liver of rats with carrageenan-induced paw oedema, showed that only minor variations differentiated this experimental pathology from the previously studied carrageenan-induced pleurisy in rat. In inflammatory exudates withdrawn from pleural cavity, copper concentrations were found to be higher than the basal values measured in the whole paw, whereas zinc concentrations were found to be dramatically lower. Thus, the induction of the carrageenan paw-oedema determined an increase in copper and a decrease in zinc concentrations in the inflamed paw; however, in the inflamed paw, the total amounts of both copper and zinc were found to be significantly increased.

Acute Disease↗
PubMed1999

Cartilage degeneration in talocrural and talocalcaneal joints from Japanese cadaveric donors.

In a study human cadavers, degenerative change (DC) was observed more frequently on articular surfaces of the talocrural joint (55. 8%) than on the articular surfaces of the talocalcaneal joint (29. 5%). In the talocrural joint, the anteromedial segments of the tibial plafond, talar dome, and the medial malleolar facet exhibited a high frequency of DC. Moreover, most DCs were found to coexist in multiple segments that often included both the tibial and talar sides. In the talocalcaneal joint, by contrast, DC tended to be distributed diffusely over the articular surfaces. If the DC occurred initially and progressed to a cartilage defect, it tended to be restricted to a certain portion of the talocalcaneal joint. Mirror-image lesions were observed much less frequently than expected in both the talocrural (28.3%) and talocalcaneal joint (25. 0%). Notably, these lesions were not usually observed even if the DC had progressed to a cartilage defect. We considered that the DC tended to advance to the adjacent segment on the same side rather than to the complementary segment on the opposite side. We demonstrated that the more multiple DC lesions were present in the talocrural joint, the more often DC occurred in the talocalcaneal joint. Consequently, we believe than multiplicity of DCs is more critical for the downward joint-to-joint progression of DC than is increased severity.

Adult↗
PubMed1984

Natural cutaneous stimulation induces late and long-lasting facilitation of extensor motoneurons in the cat.

An investigation was made of the effects of physiological cutaneous stimulation on the excitability of extensor motoneurons in spinal unanesthetized cats. The time course of changes in the monosynaptic reflex (MSR) amplitude of the soleus (Sol) and gastrocnemius medialis (GM) and lateralis (GL) was studied after conditioning stimulation with air jets (delivered to different regions of the skin of the ipsilateral hind limb), pinpricks, or stretching of the skin of the heel induced by passive rotation of the tibio-tarsal joint. Low-intensity electrical stimulation of the sural or saphenous nerves was also employed in order to condition the MSRs of the triceps surae muscles. Hair bending, skin indentation or stretching, as well as electrical nerve stimulation, can induce a similar biphasic excitability cycle of the extensor MSRs, characterized by an early inhibition followed by a late facilitatory period (LFP). The LFP started approximately 20 ms after the arrival of the cutaneous afferent volley, and lasted about 80 ms. Conditioned MSRs could attain values corresponding to 200% or more of controls. The receptive field of the LFP evoked by the air jet proved to be as large as the whole leg and foot skin surface. No significant differences were found in the extent of the late facilitation in the MSRs of Sol, GM and GL, conditioned by electrical stimulation. The LFP was also present, after conditioning stimulation of the same types as above, in intact (and spinal) chloralose-anesthetized cats.

Anesthesia, Intravenous↗