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Intraosseous pneumatocyst is a gas-containing cyst-like lesion that occurs most frequently in the ilium, sacrum or vertebrae. We present a case involving the left scapula that was found incidentally on CT. To our knowledge, intraosseous pneumatocyst of the scapula has not been previously reported.
Aside from vertebral compression fractures, the most common site of insufficiency fractures is the pelvis and lower extremities. In the pelvis, the fractures usually occur in the ilium, the pubis and the ischium, but rarely in the fossa acetabuli. We report a severe insufficiency fracture of the fossa acetabuli in a 78-year-old woman with rheumatoid arthritis (RA). She had associated insufficiency fractures of the rib, the thoracic spine and the sacrum. In our case, senile osteoporosis was present before the onset of the fracture was recognized on radiographs, and RA and corticosteroid therapy might have further aggravated the porosis, resulting in the destruction of the fossa acetabuli. Regarding treatment for the fracture, a cemented total hip replacement without bone graft was attempted for several reasons such as the patient's activities, postoperative rehabilitation and the bone mass of the acetabulum. The postoperative course was satisfactory during study period. However, further follow-up is needed to monitor carefully how the patient will be in the future.
Biomechanical experiments were performed on sacroiliac joints of the cadaver pelvis in three different positions to determine changes in stress pattern. The infrared stress analyzing method was used. In the neutral position, principal stress was observed in the middle to upper part of the sacrum, adjacent to the sacroiliac joints, in the central area of the ilium, and in the acetabular region. In the anterior tilting position, the stress on the sacroiliac joints was smaller than in the posterior tilting position, while it was greater in the symphysis pubis area. Further experiments with dial gauges were performed to measure load-displacement value in four cadaver pelves. Vertical loads of up to 100 kg were applied to the fourth lumbar vertebra. At the maximum test loads, displacement of the anterior surface of the first sacral vertebra ranged from 0.18 mm to 0.73 mm in the anterior direction. In conclusion, it is clear that the range of movement in the sacroiliac joints is very small and that this joint plays a significant role in the maintenance of stability in the pelvic girdle.
Effects of estrogen and progesterone on the first abdomino-inguinal mammary gland and the associated blood vessels in ovariectomized mice were investigated morphometrically, and light and electron microscopically. Although there were no significant differences in the area of the fat pad of the mammary gland among the experimental groups, the area of the mammary parenchyma and diameters of the blood vessels supplying the mammary gland, i.e., A. et V. circumflexa ilium profunda and A. et V. epigastrica caudalis superficialis, reached the maximal value in ovariectomized mice treated with estradiol (E) + progesterone (P). Similarly, the blood capillaries around buds and ducts of the mammary gland were most densely distributed in E + P treated mice. In the adipose tissues of the mammary stroma in intact mice, fat cells were of multilocular type in the peripheral regions around the main vessel, and of unilocular type in the other part. In E and E + P treated mice, however, fat cells were mostly of unilocular type. These findings suggest that the formation of mammary fat tissues may occur in advance of that of the mammary parenchyma. By TEM, epithelial cells of the mammary parenchyma contained a large number of mitochondria and ribosomes, well-developed Golgi apparatus and rER, and large lipid droplets. Endothelial cells of blood capillaries displayed numerous pinocytotic vesicles, longer marginal folds and microvillous processes. Each organelle in these two cell types increased in number or developed to a greater degree in E + P treated mice than the other experimental groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Effects of estrogen and progesterone on the first abdomino-inguinal mammary gland and associated blood vessels in ovariectomized adult mice were investigated morphometrically and by light and electron microscopy. Although there were no significant differences in the area of the mammary gland fat pad among ovariectomized groups, development of mammary parenchyma reached maximal degree in ovariectomized mice treated with estradiol (E) + progesterone (P). Epithelial cells of the mammary buds and ducts contained a small number of mitochondria and ribosomes, under-developed Golgi apparatus and rough-surfaced endoplasmic reticulum, and lipid droplets. Each organelle was more abundant in E + P treated mice than in other experimental groups. In adipose tissues of the mammary stroma in intact mice, fat cells were of a multilocular type in peripheral regions around the main vessel in the rear of the inguinal lymph node and of a unilocular type in other regions. In E and E + P treated mice, however, most of fat cells were unilocular. These findings suggest that mammary fat tissues may be formed in advance of mammary parenchyma. Blood capillaries around buds and ducts of the mammary gland were most densely distributed in E + P treated mice. Although there were no significant differences in the density of pinocytotic vesicles of endothelial cells of blood capillaries among the ovariectomized groups, marginal folds and microvillous processes reached maximal length in E + P treated mice. The diameters of blood vessels supplying the mammary gland, i.e., V. circumflexa ilium profunda and V. epigastrica caudalis superficialis, reached maximal size in ovariectomized mice treated with E + P.(ABSTRACT TRUNCATED AT 250 WORDS)
The objective of this experiment was to evaluate the influences of Ca and P contents in an anionic diet on the mineral metabolism in plasma, urine and bone in periparturient diary cows. Fifteen multiparous Holstein-Friesian cows were divided into 3 dietary groups (5 cows/group) by dietary Ca and P contents and dietary cation-anion balance [(Na + K) - (Cl + S) mEq/kg DM]; diet 1 [low Ca (0.46%), low P (0.24%), cationic (+195.8 mEq/kg DM)]; diet 2 [low Ca (0.46%), low P (0.24%), anionic (-32.4 mEq/kg DM)]; and diet 3 [high Ca (0.93%), high P (0.60%), anionic (-41.0 mEq/kg DM)]. Cows were fed one of these 3 diets from approximately 4 weeks before the expected calving date to 5 days after calving. There was no outbreak of milk fever in any cows fed these 3 diets; however, plasma Ca levels at 1 and 2 days after calving tended to be higher in the cows fed diet 3 than those in the cows fed diets 1 or 2. Fractional urinary excretion of Ca in the cows fed diet 2 or 3 was higher than that in the cows fed diet 1. Fractional urinary excretion and plasma level of Pi were higher during the periparturient period in the cows fed diet 3 than those in the cows fed diets 1 or 2. There were no significant differences in plasma parathyroid hormone levels among the 3 groups. In the spongy substance of ilium at 5 days after calving, the Ca and Mg contents bone volume and trabecular thickness were the lowest, but not significant, in the cows fed diet 2. These data suggest that sufficient Ca and P contents in an anionic diet may be effective in maintaining plasma Ca and Pi levels of periparturient cows and further in preventing of potential bone damage brought about by increased urinary mineral excretion following the feeding of an anionic diet.
The changes in bone metabolism and morphology of chondrocytes in bovine Hyena disease caused by administration of vitamin AD3E premix (V-AD3E) or vitamin A (V-A) were examined. At the each age, 5 calves were used. Among them, Hyena disease was recognized in 3 calves; a calf administered a high dose of V-AD3E premix (V-A 3,000,000, V-D3 300,000, and V-E 1,200 I.U./day), a calf administered a half dose of the V-AD3E premix, and a calf administered only V-A 3,000,000 I.U./day. The remaining calves without Hyena disease were a calf administered only V-D3 300,000 I.U./day and a control calf. Each agent was administered orally for 10 days from 1 week after birth. In the 3 calves with Hyena disease, the bone metabolism in bone histomorphometry of ilium was in the state of low turnover at the age of 50 days. The bone volume was small at the age of 12 months. The epiphysial growth plates of the distal femurs and the proximal tibias partially disappeared and the chondrocyte lacunas in them were flattened. The matrix fibers of epiphysial growth plates were thinner in diameter and higher in density than those of the control calf. In the calf administered only V-D3, the values of bone volume decreased with aging. In conclusion, Hyena disease may be caused by excessive administration of V-A, because hypervitaminosis A suppressed the activity of differentiation and proliferation in chondrocytes and osteoblasts, and excessive administration of V-D3 may promote these actions.
Fifty-four adults with eighty hips affected by congenital disease which had not been treated have been reviewed. Fifty-nine per cent of forty-two dislocated hips had fair or poor grading scores. The incidence of osteoarthritis was markedly increased in the presence of a well-developed false acetabulum. Unilateral dislocation led to valgus deformity and degenerative changes in the ipsilateral knee in seven of twenty-two patients. Dislocation did not increase the incidence of symptomatic lumbar spondylosis. The height of the dislocated head on the ilium was not found to be related to the prognosis for the hip, the knee or the lumbar spine and did not correlate with the development of the false acetabulum. Frank congenital subluxation eventually led to osteoarthritis of the hip.
The results of surgery in 59 patients with Scheuermann's kyphosis are reported at an average follow-up of 56 months. These show that in skeletally immature patients, in whom the iliac apophysis has not yet fused to the body of the ilium, posterior fusion alone is adequate and is followed by little loss of correction. For skeletally mature patients combined anterior and posterior surgery is recommended. In all cases a period of pre-operative treatment is important. It is stressed that the indications for surgery are limited.
Total hip replacement for adults with unreduced congenital dislocation presents a difficult problem because soft-tissue contractures usually prevent sitting at the normal anatomical level. Extensive soft-tissue division or a high-level acetabulum leads to reduced function and poor fixation of the components. We describe a new technique for hip replacement in such cases. The shortened abductors and flexors are released proximally and excision of the upper third of the ilium allows them to be repaired without tension, while providing bone graft to reconstruct the acetabular roof. We report 12 such replacements in 10 patients with good results and few early complications.
Revision hip arthroplasty in patients with massive acetabular bone deficiency has generally given poor long-term results. We report the use of an 'anti-protrusio cage', secured to the ischium and ilium, which bridges areas of acetabular bone loss, provides support for the acetabular socket, and allows pelvic bone grafting in an environment protected from excessive stress. Forty-two failed hip arthroplasties with massive acetabular bone loss were revised with the Burch-Schneider anti-protrusio cage and evaluated after two to 11 years (mean five years). There was failure due to sepsis in five hips (12%) and aseptic loosening in five (12%); the remaining 32 hips (76%) showed no evidence of acetabular component failure or loosening.
In order to investigate the functional anatomy of gluteus minimus we dissected 16 hips in fresh cadavers. The muscle originates from the external aspect of the ilium, between the anterior and inferior gluteal lines, and also at the sciatic notch from the inside of the pelvis where it protects the superior gluteal nerve and artery. It inserts anterosuperiorly into the capsule of the hip and continues to its main insertion on the greater trochanter. Based on these anatomical findings, a model was developed using plastic bones. A study of its mechanics showed that gluteus minimus acts as a flexor, an abductor and an internal or external rotator, depending on the position of the femur and which part of the muscle is active. It follows that one of its functions is to stabilise the head of the femur in the acetabulum by tightening the capsule and applying pressure on the head. Careful preservation or reattachment of the tendon of gluteus minimus during surgery on the hip is strongly recommended.
Survivorship analysis of 215 medial displacement pelvic osteotomies undertaken for symptomatic, incongruent dysplasia of the hip since 1966 showed that four of every five hips had not required conversion to a total hip arthroplasty. The radiological characteristics of 86 osteotomies were evaluated at a mean of 18 years (5 to 30) after surgery which was performed at the age of 15.9 +/- 9.5 years. Revision was significantly (p < 0.05) more likely in those patients operated on after the age of 25 years. The centre-edge (CE) angle increased from 2.5 +/- 13.9 degrees before to 41.8 +/- 15.0 degrees immediately after operation. The increase in CE angle was maintained at later review (38.5 +/- 16.5 degrees). Even with severe dysplasia with a CE angle less than zero a substantial improvement in the cover of the femoral head was achieved, usually by medial shift of the lower pelvic fragment. However, the head was not invariably medialised by the osteotomy and lateral movement of the ilium was noted when the position of the joint was relatively medial before operation or when the hip was arthritic. In the longer term pelvic remodelling did not reverse the medialisation produced by the osteotomy, and the cover of the femoral head was maintained.
Bertolotti's syndrome is characterised by anomalous enlargement of the transverse process(es) of the most caudal lumbar vertebra which may articulate or fuse with the sacrum or ilium and cause isolated L4/5 disc disease. We analysed the elective MR scans of the lumbosacral spine of 769 consecutive patients with low back pain taken between July 2003 and November 2004. Of these 568 showed disc degeneration. Bertolotti's syndrome was present in 35 patients with a mean age of 32.7 years (15 to 60). This was a younger age than that of patients with multiple disc degeneration, single-level disease and isolated disc degeneration at the L4/5 level (p </= 0.05). The overall incidence of Bertolotti's syndrome in our study was 4.6% (35 of 769). It was present in 11.4% (20 patients) of the under-30 age group. Our findings suggest that Bertolotti's syndrome must form part of a list of differential diagnoses in the investigation of low back pain in young people.
The aim of the present study was to assess the initial stability of uncemented press-fit acetabular components using a newly developed reamer designed to optimize the surgical preparation of the acetabulum. Ten synthetic human pelves were used to investigate the stability of 20 uncemented press-fit acetabular components, each of which was tested in a servohydraulic testing machine for 6 cycles under an axial load of 2.4 kN. The results of the micrometric measurements revealed satisfactory stability for a reaming depth of 2 mm, and a press-fit of 2 mm. Micromotion was less than 200 microns in all the anatomical sections of the acetabulum (ischium 63 microns, pubis 150 microns, ilium 85 microns). A press-fit of 4 mm and the smaller reaming depth of 1 mm were associated with a substantial decrease in mechanical stability.
The aim of the present study was to develop surgical instruments necessary to achieve a precisely reamed surface and stable initial fixation. The instruments used to prepare the socket were a gauge-drill guide, a liner for the spigot hole and two spigotted reamers of different design and indentation intended to achieve a precisely reamed surface while preserving subchondral bone. For each reamer we implanted in a synthetic hip model 10 uncemented cups with 2 mm press-fit and loaded at 2.4 kN in the physiological axis (Mod. 8501, Instron, Canton, MA, USA). The micromotion between implant and bone socket was measured using an inductive micrometric measuring system (MultiNCDT-500, Micro-Epsilon, Ortenburg, Germany) and compared with that seen after using conventional instruments. The use of the new reamer of elliptical design significantly reduced the standard deviations of the measured values (p < 0.01 at the ischium and pubis) and also reduced maximum movement (p < 0.01 at the ischium); at the same time, all the components showed overall limited movement (< 150 microns at the ischium, pubis and ilium) under maximum loading (2.4 kN). Manufacturing tolerances, the quality and wear of the instruments, acetabular bone stock and surgical technique all impact on the degree of press-fit obtainable at surgery. The results of our study show that press-fit and initial stability can be optimized by using adequate instruments to prepare the socket.
Modular acetabular components with alumina ceramic liners are currently used in total hip arthroplasty, but concerns have emerged regarding their high stiffness, which could cause impairment of stability, stress-shielding phenomena, and loosening. The purpose of the present biomechanical investigation was to compare the in-vitro initial stability of a modular press-fit acetabular component using a polyethylene liner and using an alumina liner. The initial stability was investigated by measuring the micromotion between the implant and the acetabulum during the application of physiological load (2.39 kN). The micromotion of the acetabular component was investigated in 10 acetabuli using a polyethylene liner and in 10 acetabuli using an alumina liner. Micromotion was assessed at the level of the Os ilium, Os pubis, and Os ischium using 3 electromagnetic transducers. The transducers have a sensitivity of 1 micron and a range of measurement of 500 microns. All implants have been fixed on human pelves made of polyurethane. Measurement of implant micromotion showed stable conditions at the level of the three main sectors of the acetabulum during all tests. No statistically significant differences of results were observed between the group of specimens with polyethylene liner and the group of specimens with alumina liner. The mean micromotion values of the uncemented cups were similar to the mean micromotion values of 10 cemented cups investigated to achieve comparative data of stability. In conclusion, the modular acetabular components inserted using an alumina liner showed a satisfactory initial stability in-vitro. The results do not contrast with those achieved using the same cup inserted with a polyethylene liner.
Even though adjuvant chemotherapy has improved the 5-year survival rate of osteosarcoma patients, a significant percentage of patients eventually die from lung metastasis. Since transforming growth faCtor-beta (TGF-beta) has been demonstrated to be related to the tumor progression, we investigated the clinical implications of the presence of TGF-beta isoforms in 16 human osteosarcoma tissue. There were 10 males and 6 females with a mean age of 20.8 years of age (range, 8 to 57 years). Biopsied specimen before chemotherapy was fixed in 10% formalin, demineralized and followed by paraffin embedding. The locations of tumor included femur (10), tibia (3), humerus (1), fibula (1), and ilium (1). Histologic subtypes included osteoblastic (11), chondroblastic (2), and fibroblastic (3). All patients were followed for a minimum of 1 year (range 12 to 44 months) or to the development of lung metastasis. Five patients (31.3%) developed subsequent lung metastasis during the follow up. We used immunohistochemistry technique to investigate the presence of the TGF-beta isoforms in osteosarcoma tissue and its relationship to the subsequent pulmonary metastasis. The results showed the presence of one or more TGF-beta isoforms in tumor cells in osteosarcoma tissues (13 of 16, 81.3%) in all of the subtypes. However, minimal presence of TGF-beta isoforms was shown in the tumor bone matrix. The expression of TGF-beta1 or TGF-beta3 isoforms was associated with a higher rate of subsequent lung metastasis (p < 0.05, chi-square test). Further research is warranted to determine the utility of routine TGF-beta analysis in the clinical practice.