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[The value of labyrinthectomy in the treatment of Menière's disease (author's transl)].

Surgical labyrinthectomy in patients with Menière's disease produces unsatisfactory results in 10-70% of the cases. A pathological process in the vestibular nerve comprising an increase in connective tissue formation and the development of bony material within the nerve is possibly the reason for the pathological function of the vestibular system. This process may arise after a mechanical trauma to the labyrinth. Labyrinthectomy should be performed only for the treatment of Menière's disease if other therapeutical regimens or neurectomy under general anaesthesia cannot be tolerated by the patients.

Cochlear Nerve↗

Chondrodysplasia in Australian Dexter cattle.

OBJECTIVE: To describe the occurrence of chondrodysplasia in Australian Dexter cattle. DESIGN: A pathological and genetic case report. PROCEDURE: Congenital lethal chondrodysplasia was studied in two female Dexter foetuses aborted mid to late gestation. Clinicopathological findings including histological changes in limb bones, and analysis of pedigree information were evaluated. RESULTS: Characteristic features of congenital lethal chondrodysplasia (Dexter bulldog) include abortion, disproportionate dwarfism, a short vertebral column, marked micromelia, a relatively large head with retruded muzzle, cleft palate and protruding tongue and a large abdominal hernia. Histological changes in limb bones are consistent with failure of endochondral ossification. Dexter chondrodysplasia is considered to be inherited in an incompletely dominant manner with the homozygous form producing the congenital lethal condition. A preliminary minimum estimate of heterozygote frequency is 19% within the registered Australian Dexter herd, based on analysis of the contribution of three obligate heterozygotes whose semen has been widely used by artificial insemination in Australia. CONCLUSION: Dexter chondrodysplasia is present in Australian cattle and further cases of the homozygous form, congenital lethal chondrodysplasia, are likely to occur. RECOMMENDATION: It is requested that spleen and liver tissue from bulldog foetuses and blood from their parents be collected to assist research into Dexter chondrodysplasia.

Abortion, Veterinary↗

Evaluation of the rat stifle joint after transection of the cranial cruciate ligament and partial medial meniscectomy.

Osteoarthritis (OA) was induced in the rat stifle joint by partial medial meniscectomy (PMM) and transection of the cranial cruciate ligament (CCL). At 10 weeks after destabilization, joint morphologic and pathologic changes were observed, scored, and compared. The intact rat stifle joint was observed in a mid-saggital plane. Articular cartilage of the distal portion of the femur and proximal portion of the tibia had thicker and thinner sites, and the thicker sites were located caudally on the distal portion of the femur and centrally on the proximal portion of the tibia. The two separate triangular portions of the medial meniscus observed in the mid-saggital plane contained a center of ossification in the cranial portion and fibrocartilage in the caudal portion. The synovium was one to three cells thick, and contained rare inflammatory cells. Although lesions were more severe in stifles after PMM, both treatments produced OA lesions that closely simulated OA lesions of other species. Lesions consistent with idiopathic OA included chondrocytic clones with increased metachromasia around them, chondrocytic death, loss of metachromasia, fibrillation, fissuring, erosion of articular cartilage, osteophyte formation, and variable synovial inflammation. The results indicate that PMM and CCL transection in the rat are useful in vivo models for study of the etiopathogenesis of OA and therapeutic efficacy of anti-arthritic drugs and treatment concepts.

Animals↗

Rehabilitation experience in a case of Ollier's disease.

This paper describes a case of Ollier's disease, an uncommon, nonhereditary skeletal disorder affecting enchondral ossification. The patient was referred to our Rehabilitation Unit after resection of scapular chondroma. He had previously been submitted to several surgical treatments for multiple enchondromatosis. Rehabilitation goals were increasing range of motion, relieving pain and training activities of daily living (ADL). After one month treatment, the patient reported pain relief and showed good improvement of articular function and better performances on ADL. According to our experience, it seems that rehabilitation could play a complementary role as regards surgical treatment of this complex pathology.

Activities of Daily Living↗

Acquired laryngeal lesions. Pathologic study using serial macrosections.

OBJECTIVE: To present the pathologic findings of acquired lesions of the larynx in infants. SETTING: The Laryngeal Development Laboratory of Children's Memorial Hospital, Chicago, Ill. MATERIALS: One hundred fifteen larynges received at postmortem examination from 1975 to 1992. MAIN OUTCOME MEASURE: Acquired laryngeal lesions from intubation trauma. TECHNIQUE: Whole-organ serial section of larynges. RESULTS: Fifty-three of the 115 specimens exhibited acquired laryngeal lesions: 36, submucosal mucous gland hyperplasia; 12, submucosal fibrosis; 10, granulation tissue; eight, ulceration; eight, fragmented or distorted cricoid; four, cricoid ossification; four, ductal cysts; three, healed furrows, and one, anterior glottic synechia. Some specimens exhibited more than one type of acquired abnormality.

Female↗

Successful surgical treatment of an odontogenic ossified craniopharyngioma. Case report.

A large, highly ossified craniopharyngioma was diagnosed and surgically treated in a 2-year-old girl. About 20 teeth were macroscopically identified in the operative specimen, some of them totally developed, complete with crown and root. Pathological study established the diagnosis of craniopharyngioma with formation of teeth. Only five cases have been reported previously, and only one patient survived the operation. The patient is alive 3 years after surgical treatment. Radiotherapy was not used.

Child, Preschool↗

Clinical, radiographic, pathologic, and genetic features of osteochondrodysplasia in Scottish deerhounds.

Clinical, radiographic, pathologic, and genetic features of a form of osteochondrodysplasia in 5 related Scottish Deerhound pups from 2 litters were evaluated. All pups appeared to be phenotypically normal at birth. At approximately 4 or 5 weeks, exercise intolerance and retarded growth were observed. Kyphosis, limb deformities, and joint laxity gradually developed. Radiography of the affected pups revealed skeletal changes characterized by abnormalities in long bones and vertebrae, with involvement of epiphyses, growth plates, and metaphyses. Short long bones and vertebrae and irregular and delayed epiphyseal ossification were most noticeable in younger pups; in older pups, bony deformities became more prominent. In skeletally mature dogs, osteopenia and severe deformities were seen. The histologic changes of the growth plate were compatible with a diagnosis of chondrodysplasia. Growth plate chondrocytes contained periodic acid Schiff-positive, diastase-resistant cytoplasmic inclusions. A single autosomal recessive mode of inheritance was suspected.

Animals↗

Congenital nasal pyriform aperture stenosis: diagnosis and treatment.

Congenital nasal pyriform aperture stenosis is a rare and an unusual cause of airway obstruction in infants. It has been described as a clinical entity only since 1989. Presenting symptoms in infants include cyclical cyanosis, feeding difficulty or sudden total obstruction. Embryologically, an overgrowth of maxillary ossification at the area of the nasal process of the maxilla may be responsible for this deformity. Definitive surgical management may be accomplished via a sublabial approach with magnification, drilling and post-operative stenting of the airway. Two new cases are presented. The diagnosis, embryology and technique of surgical correction are discussed.

Constriction, Pathologic↗

Tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) distribution in normal and pathological human bone.

Degradation of skeletal connective tissue is regulated, at least in part, by the balance between matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinase (TIMPs), their natural inhibitors. The balance between MMPs and TIMPs may therefore be a determinant of normal bone turnover, and imbalance could thus lead to reduced organization of bone structure. To test this hypothesis, the cellular expression of MMPs and TIMP-1 was investigated by immunohistochemistry in human neonatal rib and osteophytic and heterotopic bone; these differ in their structure, with heterotopic bone showing the least and normal rib the most organized development. In all samples, high levels of MMPs were expressed. Collagenase and stromelysin-2 were detected in chondrocytes, osteoblasts, and osteoclasts, whereas gelatinase-B was confined to osteoclasts and mononuclear cells. Matrix-associated stromelysin-1 was present in fibrous tissue and osteoid. In contrast, the expression of TIMP-1 varied markedly between the three types of bone. In heterotopic bone only occasional low level TIMP-1 expression was detected in chondrocytes and osteoblasts. Osteophytic bone showed varying levels of TIMP-1, which was matrix-bound in fibrous tissue and cell-associated in osteoblasts, chondrocytes, and occasional mononuclear cells. In both types of bone, expression of TIMP-1 by osteoclasts was absent despite large numbers of these cells. Neonatal rib bone showed consistent expression of TIMP-1, particularly in chondrocytes, osteoblasts, and lining cells. In contrast to pathological bone, many osteoclasts were TIMP-1 positive. These results suggest that, in heterotopic and osteophytic bone, the low levels of TIMP-1, and in particular its absence in osteoclasts, may partly explain the more poorly organized bone formation in these pathological bone samples. Furthermore, TIMP-1 may play a role in the regulation of bone modeling and remodeling in normal developing human bone.

Adult↗

Metopic sutural closure in the human skull.

The present study reveals the presence in the sutural area of secondary cartilage, assuring the passive growth of the bones and undergoing an endochondral ossification, but without playing a direct role in the synostosis. The chondroid tissue is responsible for the growth of each frontal bone towards the other and constitutes the first bridge of union between the two bones. It is the most important finding in this study, which provides a description of the closure of the metopic suture and of the maintenance of an open sutural space by a process of active resorption. This new knowledge will help to understand better the whole process of suture closure and its pathology.

Cartilage↗

Laminectomy for cervical myelopathy.

STUDY DESIGN: Cervical laminectomy with or without fusion, or laminoplasty, successfully address congenital or acquired stenosis, multilevel spondylosis, ossification of the posterior longitudinal ligament (OPLL), and ossification of the yellow ligament (OYL). To optimize surgical results, however, these procedures should be applied to carefully selected patients. OBJECTIVES: To determine the clinical, neurodiagnostic, appropriate posterior cervical approaches to be employed in patients presenting with MR- and CT-documented multilevel cervical disease. To limit perioperative morbidity, dorsal decompressions with or without fusions should be performed utilizing awake intubation and positioning and continuous intraoperative somatosensory-evoked potential monitoring. SETTING: United States of America. METHODS: The clinical, neurodiagnostic, and varied dorsal decompressive techniques employed to address pathology are reviewed. Techniques, including laminectomy, laminoforaminotomy, and laminoplasty are described. Where preoperative dynamic X-rays document instability, simultaneous fusions employing wiring or lateral mass plate/screw or rod/screw techniques may be employed. Nevertheless, careful patient selection remains one of the most critical factors to operative success as older individuals with prohibitive comorbidities or fixed long-term neurological deficits should not undergo these procedures. RESULTS: Short- and long-term outcomes following dorsal decompressions with or without fusions vary. Those with myelopathy over 65 years of age often do well in the short-term, but demonstrate greater long-term deterioration. Factors that correlated with greater susceptibility to deterioration include advanced age (>70 years at the time of the first surgery), severe original myelopathy, and recent trauma. CONCLUSIONS: Success rates of laminectomy with or without fusion, or laminoplasty may be successfully employed to address multilevel cervical pathology in a carefully selected population of patients.

Bone Wires↗

Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients.

Ten patients who suffered iatrogenic injury to a vertebral artery during anterior cervical decompression were reviewed to assess the mechanisms of injury, their operative management, and the subsequent outcome. All had been undergoing a partial vertebral body resection for spondylitic radiculopathy or myelopathy (4), tumour (2), ossification of the posterior longitudinal ligament (1), nonunion of a fracture (2), or osteomyelitis (1). The use of an air drill had been responsible for most injuries. The final control of haemorrhage had been by tamponade (3), direct exposure and electrocoagulation (1), transosseous suture (2), open suture (1), or open placement of a haemostatic clip (3). Five patients had postoperative neurological deficits, but most of them resolved. We found direct arterial exposure and control to be safe, quick and reliable. Careful use of the air drill, particularly in pathologically weakened bone, as in infection or tumour, is essential. Arterial injury is best avoided by a thorough knowledge of the anatomical relationships of the artery, the spinal canal, and the vertebral body.

Adult↗

[Effects of calcitonin on the pathology of spinal fusion in rabbit models].

OBJECTIVE: To observe the effect of calcitonin on the pathology of fusion in lumbar posterior/facet spinal fusion in rabbit model. METHODS: Thirty-two male New Zealand white rabbits were used to establish spinal fusion model. Sixteen rabbits received calcitonin at a dose of 1 IU x kg(-1) x d(-1) were classified as calcitonin group, and the remaining 16 rabbits as control group. Rabbits were killed 1, 2, 4, and 8 weeks after operations. Haematoxylin-eosin staining was applied to observe the pathological process of spinal fusion. Expression of bone morphogenetic protein-2 (BMP2) was detected by immunohistochemistry. RESULTS: Bone resorption and fibrovascular stroma formation were the main histological presentation 1 week after surgery. Two and 4 weeks after surgery, more cartilage formed with varying degrees of mineralization, while less trabeculae could be observed in the phase of active bone formation. No remarked margin was seen between cartilage and bone tissues. Eight weeks after surgery, trabeculae distributed widely. The pathological process of spinal fusion in calcitonin group was faster than in control group. Emery scores showed significant differences at different time points (F = 265.44, P < 0.001). Calcitonin and time had a positively synergistic effect on Emery scores, and calcitonin caused significant difference in terms of Emery scores since the second week (F = 22.43, P < 0.001). Expressions of BMP, were significantly different at different time points (F = 1186.54, P < 0.001). Also, calcitonin and time had a synergistic effect on BMP2 expression (F = 13.14, P < 0. 001). CONCLUSIONS: Endochondral ossification exists in the spinal fusion process and may be the main way of ossification. Calcitonin may stimulate the expression of BMP2 and thus accelerate the process of spinal fusion.

Animals↗

Periosteal new bone formation in chronic renal failure.

A retrospective analysis of the skeletal surveys of 47 patients with periosteal new bone formation (PNB) associated with chronic renal failure was performed in order to determine the radiological features of this abnormality. Sequential skeletal surveys identified the time of development of PNB in 11 patients. The aetiology of PNB was investigated by reviewing biochemical and pathological data for these patients during this period. Symmetrical involvement of weight bearing bones was a typical feature of PNB. PNB was often identified at multiple sites. No association of PNB with radiological, biochemical or pathological evidence of aluminium induced osteomalacia was found. Both hyperparathyroidism and osteosclerosis were common in patients with PNB but since hyperparathyroidism is a frequent occurrence in patients with chronic renal failure its relationship to PNB is not necessarily causal.

Adolescent↗

Endometrial pathology and infertility.

OBJECTIVE: To call attention to endometrial pathologies, which in addition to causing menstrual problems, are a cause of infertility. DESIGN: Controlled clinical study. SETTING: Specialized unit in the management of infertile patients. PATIENT(S): Fifteen infertile women between the ages of 26 and 39 years and suffering infertility from endometrial problems for a period of 4 to 18 years were included in the study. Six patients had primary infertility and nine others had secondary infertility. INTERVENTION(S): Once the endometrial pathology was diagnosed, treatment was initiated according to the type of problem: hysteroscopy, curettage, and hormonal replacement with or without corticoids or antiphymic drugs. MAIN OUTCOME MEASURE(S): Clinical studies, laboratory tests, hormonal serum levels, and endoscopy. RESULT(S): After initiating specific treatment for each of the pathologies, menstruation was re-established in 14 of 15 patients. Nine patients became pregnant (8 of 10 cases with bone, squamous cell, or muscular metaplasia). CONCLUSION(S): Pathological changes of the endometrium are causes of infertility. These problems are not as rare as thought. They must be searched for carefully and diagnosed promptly. The majority carry a good prognosis when adequately treated.

Adult↗

Heterotopic bone in the ovary associated with a mucinous cystadenoma.

Bone formation in the ovary, with the exception of developing in the setting of a mature cystic teratoma, is exceedingly uncommon. We report a case of bone formation within a mucinous cystadenoma of the ovary. A 19-year-old active duty female presented with an asymptomatic pelvic mass; sonographic imaging revealed a 5.7-cm complex right adnexal mass. A laparoscopic cystectomy was performed. Pathologic evaluation of the cyst revealed a mucinous cystadenoma. Contained within several of the thick fibrous septae were areas of well-formed bone. Although a benign finding, bone formation and associated fibrosis may lead to sonographic findings of concern during the evaluation of patients with a pelvic mass.

Adult↗

Primary dedifferentiated liposarcoma of the retroperitoneum. Prognostic significance of computed tomography and magnetic resonance imaging features.

OBJECTIVES: To describe computed tomography (CT) and magnetic resonance (MR) imaging findings and to determine the prognostic significance of radiologic appearances in primary dedifferentiated liposarcoma of the retroperitoneum. METHODS: Initial CT and MR imaging studies of 20 pathologically confirmed cases of primary dedifferentiated liposarcoma of the retroperitoneum were retrospectively reviewed and assessed for correlations with the histopathologic features. CT and MR images were evaluated by 2 radiologists with agreement by consensus, and univariate analyses were conducted to evaluate survival with a mean clinical follow-up duration of 47 months (range, 5-114 months). RESULTS: Tumor invasion was more frequent in the anterior or posterior pararenal originating tumors than in pararenal tumors (P<0.05). Well-defined nonlipomatous masses juxtaposed with fatty tumors were identified in all cases. Calcification or ossification was seen in 6 patients (30%) on unenhanced CT. Imaging findings including attenuation, signal characteristics, and enhancement patterns of nonlipomatous masses were nonspecific regardless of histologic variances. Recurrent tumors (n=6) tended to invade surrounding organs. Univariate analysis revealed that calcification or ossification (P<0.05) and first recurrence with duration of a mean 13 months (P<0.05) identified by imaging studies had significant impacts on overall survival. CONCLUSIONS: Calcification or ossification and first recurrence identified by CT and MR imaging studies are significant adverse prognostic factors in primary dedifferentiated liposarcoma of the retroperitoneum.

Female↗

Skeletal findings in human neutrolethyrism. Is there a human osteolathyrism?

In a review of the roentgenological files of 22 patients suffering from spastic paraplegia due to neurolathyrism, 3 patients were found to present abnormal skeletal findings. 2 patients showed absence of union of the secondary ossification centres of the iliac crests, the ischial tuberosities and the vertebral bodies. Their age at the time of ingestion of poisonous Lathyrus sativus plants was 19 and 20 years. The 3rd patient had bowing and thickening of his right femoral shaft. He was 22 years old at the time of poisoning. These findings which are similar to those found in experimental osteolathyrism have never been described in clinical neurolathyrism. They are of a nature to throw some doubt on the correctness of the currently prevailing concept of sharp distinction between these two pathological entities.

Bone Diseases↗