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Hyperostotic bone disease in red pandas (Ailurus fulgens).

Three adult red pandas (Ailurus fulgens) developed multiple periarticular exostoses in their elbow joints. Two of these animals also had extensive periosteal new bone formation and osteosclerosis of the ulnae and radii and mild periosteal new bone deposition on the femurs. One animal also showed extensive hyperostosis of the cranium and mandibles. Dietary concentrations of calcium and phosphorus were estimated to be adequate, but dietary vitamin A and D appeared excessive when compared with recommended levels for this species. Serum vitamin A concentrations were not elevated in the two most severely affected animals, but their liver vitamin A content was higher than what is considered normal for most domestic animal species. Serum 25-hydroxy vitamin D concentrations were within normal ranges for domestic species. A definitive diagnosis for the cause of the lesions was not established, but hypervitaminosis A was suspected.

Animals↗

A comparison of mandibular lingual surgical flaps with and without a vertical releasing incision.

The purpose of this study was to evaluate the short-term postoperative pain for surgical flaps with mandibular lingual vertical releasing incisions (ML-VRI) compared with envelope flaps and to observe the postoperative clinical healing of ML-VRI. Using a split mouth design, 12 adult periodontal patients received bilateral posterior mandibular surgery with an envelope flap on one side and a flap with an ML-VRI on the contralateral side. Surgical procedures were performed at separate appointments, varied in order, and performed an equal number of times on the right and left sides. Postoperative pain was scored by the patients, and scores for each technique were compared using an analysis of variance and covariance with repeated measures. Photographs were used to assess postoperative clinical healing of ML-VRI with various degrees of initial closure. Results indicated no significant statistical difference (P greater than 0.05) between pain levels for the two surgical techniques. There was complete clinical healing despite variations in the degree of closure of ML-VRI. The findings of this study support the use of ML-VRI. They are indicated in areas with flat contours or with slight ledges and inferior concavities. ML-VRI are contraindicated in areas with prominent ledges and inferior concavities and in areas with exostoses. Suturing the vertical incision is unnecessary and may be detrimental to the tissues. A "step down" incision that preserves attachment levels in nondiseased sites is discussed.

Adult↗

[Otologic surgical procedures in an Ear, Nose and Throat Department in Subotica from 1987 to 2001].

INTRODUCTION: This paper deals with otologic surgical procedures performed in a an Ear, Nose and Throat Department during a 15-year period. The authors compared the number of otologic surgical procedures with the number of laryngomicroscopies and procedures performed in Waldeyer's ring. RESULTS: From January 1, 1987 to December 31, 2001, 1184 patients underwent the following surgical procedures in total endotracheal anesthesia: 285 paracenteses, 473 ventilation tubes insertions, 175 antrotomies or mastoidectomies, 194 tympanoplasties, 34 radical mastoidectomies, 4 facial nerve decompressions, 5 exostoses or osteoma of the external auditory canal operations and 14 stapedectomies. DISCUSSION: Otologic surgical procedures are presented in table 1. In Yugoslav literature Topolac reports approximately 700 tympanoplasties in a 10-year period (1968-1978). Radonjić and associates report 2272 ear operations in the period 1975-1985. Distribution of operations is presented in table 2, whereas in table 3 we can see that the number of operated ears is much greater than the number of operated patients. CONCLUSION: We think that the number of operations is not bigger, because we operate only in critical cases. Our human and technical resources should provide advanced ear microsurgery, but only with financial and organizational support.

Hospital Departments↗

Proximal interphalangeal arthrodesis in 22 horses.

The purpose of this study was to evaluate a new method of internal fixation technique for pastern arthrodesis. Pastern arthrodeses are performed commonly in horses with chronic osteoarthritis of the pastern joint or, in cases of acute traumatic injury to the pastern, in which the weightbearing bony column must be restored. Chronic osteoarthritis of the pastern is a frequent cause of lameness in the equine athlete and is evidenced by chronic lameness localised to the pastern joint, and supported radiographically by periosteal proliferation and loss of joint space. Nonsurgical and surgical treatments have both been described in the literature. Complications following pastern arthrodesis have been reported on several occasions and appear to focus on excessive periarticular exostoses and increased time in a cast due to prolonged time to bony fusion. The hospital records of horses presenting for pastern arthrodesis to the Rood and Riddle Equine Hospital in Lexington, Kentucky, were reviewed and 22 met criteria for inclusion in the study. Horses with chronic osteoarthritis of the proximal interphalangeal joint or horses with an acute traumatic injury to the pastern undergoing pastern arthrodesis with one of the following techniques were included in the study. Horses with severe comminution of the middle phalanx were excluded. Three 5.5 mm cortical bone screws placed in lag fashion alone or in combination with a 4 or 3 hole dynamic compression plate affixed with 4.5 mm cortical bone screws were compared. A lower limb fibreglass cast was applied in all cases. Period in cast, time to return to intended use, complications encountered and outcome were evaluated. Seven of the 8 hindlimbs treated with the combination technique became sound. Three out of 6 of the front limbs treated with the combination technique became sound. Four of the 5 horses with hindlimbs, and one of the 2 with front limbs, treated with screws only returned to their intended use. The type of internal fixation did not appear to influence the overall number of horses returning to the intended level of performance. The period spent in cast and the time to return to soundness were decreased in horses operated on using the combination technique. We concluded that, in the immediate postoperative period, the combination of the parallel screw technique with a dorsally-applied dynamic compression plate provides the most stable and secure fixation, minimising motion, expediting bone remodelling and therefore favouring rapid fusion of that joint.

Animals↗

Ectopic bone formation following Charnley hip arthroplasty.

In a consecutive series of 309 patients the degree of ectopic bone formation was assessed 3 months, 2 years, and 5 years after total hip arthroplasty. At the three follow-up examinations ectopic bone formation was found in 49 per cent, 61 per cent, and 71 per cent. In men ectopic bone formation was more common and more pronounced than in women. It was demonstrated that walking ability and range of hip movement may be reduced in the presence of ectopic bone formation. A past history of hip surgery, preoperative exostoses, and postoperative elevation of the erythrocyte sedimentation rate did not appear to influence the formation of ectopic bone. There was no correlation between the degree of ectopic bone formation in the two hips of patients who had undergone bilateral operation. In the present study it was not possible to demonstrate preoperatively which groups of patients are most liable to develop ectopic bone postoperatively.

Adult↗

On spinal osteochondromas.

Osteochondromas (or osteocartilaginous exostoses) make up about 30% to 40% of benign bone tumors. Most are solitary lesions but some are multiple, usually with autosomal dominant inheritance. From 1% to 4% of osteochondromas occur in the spine, where they can cause a variety of signs and symptoms, including those of spinal cord or spinal root compression. The authors present five patients with osteochondromas of the spine and review the findings together with those of over 130 cases reported since 1907. The cases were divided into: 1) spinal osteochondromas in patients with multiple osteochondromas, and 2) solitary osteochondromas occurring in the spine. The age (mean +/- standard error of the mean) of patients in the first group was 21.6 +/- 1.8 years compared to 30.0 +/- 2.1 years for those in the second group (p less than 0.02). There was a significant male predominance overall (M:F = 2.5:1; p less than 0.0005). In both groups, one-half of the lesions involved the cervical spine. Symptoms are caused by pressure on adjacent structures. Spinal cord compression was reported more than twice as frequently in the multiple osteochondroma group as in the single osteochondroma group (77% vs 33%; p less than 0.0005). Computerized tomography (CT) is the imaging procedure of choice. In both groups, the majority of surgically treated patients (90% and 88%, respectively) improve, with about three-quarters of the improved patients having no residual disease or only minor deficits.

Adolescent↗

Perthes-like disease and the tricho-rhino-phalangeal syndromes: the first black patient.

The TRPS I has been reported in European, Asian, Australian, and North American populations. To the best of our knowledge, this is the first case reported in the black population. Like many patients with this syndrome, it was the presence of "Perthes-like" disease that eventually lead to the diagnosis. This hip complication is very common, and often bilateral. A review of the literature stresses the importance of early diagnosis in that many patients are presenting late with severe degenerative arthritis. When present, "Perthes-like" changes should direct the observer to look for the abnormal hair and facies that are typical of these syndromes. Radiographs of the hands should also be obtained which will usually reveal the characteristic cone-shaped epiphyses. Clinical or radiographic evidence of multiple cartilaginous exostoses is diagnostic of TRPS II in the presence of other stigmata of the tricho-rhino-phalangeal syndrome (TRPS I).

Braces↗

Endoscopically assisted removal of unilateral coronoid process hyperplasia.

Coronoid process hyperplasia (CPH) is an uncommon disorder characterized by an enlarged coronoid process impinging against the posterior aspect of the zygomatic arch. Young male adults are usually affected, presenting with limited mouth opening, which is typically painless and progressive in nature. The diagnosis of true CPH is established by the findings of (1) uniform coronoid enlargement on radiographic examination and (2) normal bone structure on histopathological examination (i.e., the specimen should be free of any neoplastic growth, such as the previously reported cases of coronoid osteomas, osteochondromas, or exostoses). The treatment is mainly surgical, by means of a coronoidectomy. An intraoral approach is mostly preferred for this procedure to avoid an external scar. However, to avoid the drawbacks of this approach, such as limited exposure and the risk of hematoma and subsequent fibrosis, an extraoral approach may be indicated. This report describes a case of true unilateral CPH in a 17-year-old boy who presented with progressive limited mouth opening in the absence of any pain. Computed tomography (CT) demonstrated a uniformly enlarged right coronoid process. A coronoidectomy was performed with the aid of endoscopic systems, approaching via two short incisions in the temporal scalp. Histopathological examination of the specimen demonstrated essentially a normal bony structure with no evidence of a neoplasm. The authors present the endoscopically assisted technique of coronoid process excision as an alternative method of surgical treatment of CPH and any mass of the coronoid process in general. With this method, the incision is much shorter than a conventional coronal incision and thus morbidity is diminished considerably.

Adolescent↗

Survivorship and clinical evaluation of cementless, meniscal-bearing total ankle replacements.

A porous-coated, cementless, congruent-contact, meniscal-bearing total ankle replacement with a centrally placed trochlear groove and a cylindrical articulating axis representing the lateral talar curvature was developed and used clinically over a 10-year period. An initial clinical series of 40 ankle replacements involved the use of cobalt-chromium-molybdenum tibial and talar components with sintered-bead porous coating of 275-mum pore size and a shallow-sulcus trochlear groove with a central fixation fin for the talar onlay component. The congruent meniscal bearing, made of ultrahigh molecular-weight polyethylene (UHMWPe), was flat superiorly and matched the shallow-sulcus and cylindrical geometry inferiorly. Two bearings in two patients subluxed laterally and required revision within 2 years. The overall cumulative survival at the 10-year interval for this group using revision as an end point was 94.75%. The clinical results, using a strict ankle evaluation scoring scale, demonstrated 85% overall good to excellent results. Three patients required further treatment for intermalleolar exostoses, one patient required a debridement for infection, two ankles had medially subluxed bearings, eight ankles developed talar component subsidence, and two patients suffered from chronic reflex-sympathetic dystrophy. A second clinical series of 14 ankle replacements involved the use of polished titanium-nitride-coated titanium-6 aluminum-4 vanadium tibial and talar components with sintered-bead porous coating of 350-mum pore size and a deep-sulcus trochlear groove with two lateral fixation fins for the talar onlay component. The bearing element was similar to the initial series except that it had a deeper engagement in the trochlear groove to prevent subluxation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

A radiographic and histological analysis of 17 retrieved ultrahigh-molecular-weight polyethylene porous-coated femoral stems.

Radiographic and histological and evaluation for failure of 17 retrieved implants was performed. The implants consisted of a titanium stem with a 3-mm ultrahigh-molecular-weight polyethylene coating and an outer 1.5-mm ultrahigh-molecular-weight polyethylene fiber layer. Particular attention was paid to osteolysis, subsidence, debris, and foreign body reaction. Radiographic analysis showed subsidence (14 of 17), osteolytic lesions (9 of 14), and unique posterior medial exostoses (8 of 14). Histological analysis showed no significant evidence of acrylic bone cement either as debris or reactive tissue. There was an intense foreign body reaction directly related to the amount and size of polyethylene debris.

Adult↗

Loss of heterozygosity and DNA ploidy point to a diverging genetic mechanism in the origin of peripheral and central chondrosarcoma.

Chondrosarcomas are malignant cartilaginous tumors arising centrally in bone (central chondrosarcoma), or secondarily within the cartilaginous cap of a hereditary or sporadic exostosis (peripheral chondrosarcoma). Loss of heterozygosity (LOH) was studied by microsatellite analysis at the loci harboring the EXT genes (implicated in hereditary multiple exostoses), the EXT-like genes, and at 9p21, 13q14, 17p13, and chromosome 10. Nineteen of 20 peripheral chondrosarcomas showed LOH at all loci tested, while only 3 of 12 central chondrosarcomas exhibited LOH, restricted to 9p21, 10, 13q14, and 17p13. LOH at 9p21 did not appear to involve the CDKN2A gene, as assessed by SSCP analysis. DNA flow cytometry demonstrated a wide variation in the ploidy status in peripheral chondrosarcomas (DNA indexes, 0.56-2.01), whereas central chondrosarcomas were predominantly peridiploid. Near-haploidy found in peripheral chondrosarcomas could explain part of the high LOH percentages. Ki-67 immunohistochemistry suggested a higher proliferation rate in peripheral chondrosarcomas. Our results indicate that peripheral chondrosarcomas, arising secondarily to an exostosis, may obtain genetic alterations during malignant transformation, with subsequent genetic instability as demonstrated by a high percentage of LOH and a wide variation in ploidy status. In contrast, peridiploidy and a low percentage of LOH in central tumors suggest that a different oncogenic molecular mechanism may be operative.

Adolescent↗

Nail surgery.

Nail surgery is not particularly difficult but often delicate. Profound knowledge of the anatomy, physiology and pathology of the nail organ as well as surgical skills and atraumatic instruments are prerequisites for successful nail operations. Careful preoperative preparation of the patient as well as consistent post-operative care are necessary. The following article will give information about the essentials of nail surgery, such as adequate anaesthesia, instrumentation, and complications. The most frequently performed nail operations are described focussing on techniques proven to be safe and successful. Nail avulsions, ingrowing nail, myxoid pseudocysts and subungual exostoses as well as the treatment of haematomas and nail tumours are outlined. Ungual melanomas are the most frequent malignant tumours of the nail apparatus and deserve special attention. Some indications for cryosurgery, laser and electro-surgery are given.

Humans↗

[Study by gel electrophoresis, of alpha chains and of CNBr peptides of collagen from epiphyseal cartilage in chondrodysplasia].

The alpha chains and the major CNBr - derived peptides of collagen of growth cartilage were studied in the following syndromes: thanatophoric dwarfism, pseudothanatophoric dwarfism, achondroplasia, pseudoachondroplasia, diastrophic dwarfism, metatropic dwarfism, Kniest disease, parastremmatic dwarfism, multiple exostoses, Blount disease and pycnodysostosis. After extraction of proteoglycans the collagen was solubilized by limited pepsin digestion purified, and the alpha chains were analysed by electrophoresis. The major CNBr - derived peptides were obtained by cleaving directly the cartilage after proteoglycan extraction. In some syndromes purified collagen was also cleaved. The CNBr peptides were analyzed by disc electrophoresis in SDS-polyacrylamide. Human normal growth cartilage and baboon cartilage were used as controls. The pattern of alpha chains and of major CNBr peptides was similar in all the cases studied, except one case of lethal diastrophic dwarfism in which the pattern of peptides showed the presence of type I collagen in quantities detectable by the present method. However in a milder case of diastrophic dwarfism the pattern of CNBr peptides was found normal. The present study does not exclude possible abnormalities of collagen at a higher lever of supramolecular organization in osteochondrodysplasias.

Adolescent↗

Cytogenetic investigations in cases of multiple developmental anomalies in children.

The authors studied 59 children including 48 with multiple developmental anomalies and 11 with disturbances of sexual development. In 11 cases (18.6%) the following chromosomal abnormalities were found: in 5 cases of Down's syndrome, 3 cases of full trisomy G, 1 case of 46XX/47XYG+ mosaicism, and in 1 case translocation 46XYD--G--t (DqGq)+. In 3 cases Turner's syndrome was present, with 45XG in 2 cases and 45XO/46XX in the 3rd case. Klinefelter's syndrome was disclosed in 1 case (47XXY), true hermaphroditism with mosaicism 45XO/46XX in one case, and Edwards' syndrome in 1 case with 47XYE+. Multiple chromosome breaks were found in 2 children. In the remaining 46 cases cytogenetic investigations of lymphocyte cultures stained (without using the banding technique) failed to demonstrate any differences in the number and structure of the chromosomes. The following groups were isolated in this material: 8 cases (13.6%) of gene mutation determining systemic defects (homocystinuria, chondrodystrophy, and two cases of intestinal polyposis, adrenogenital syndrome and hereditary osteocartilagineous exostoses each), 6 cases of malformations of hereditary origin (10.2%)-- and 32 cases with negative family history (54.2%). In 12 cases of the last group (37.2%) a history of various teratogenic factors acting during pregnancy was elicited (viral and protozoan infections, drugs and other chemicals, quantitative and qualitative malnutrition, hypoxia, mechanical trauma, vibration).

Abnormalities, Multiple↗

[Quantitative morphological analysis of bone remodelling in an experimentally-induced skeletal disease (author's transl)].

In the lumbar vertebrae of lathyritic rats bone remodelling was investigated using histomorphometrical and tetracycline labelling methods and a newly developed, computer-aided photometrical quantitation of mineral densities in microradiographs. The morphometrical analysis showed a high-graded decrease in cancellous bone due to increased resorption and cessation of endochondral bone formation. On the other hand, increased formation of new bone in sites of muscular insertion led to the formation of exostoses. Disturbed mineralisation of the newly-formed bone is indicated by increased osteoid volume and diffuse labelling with tetracycline. These findings were confirmed by the quantitation of the mineral densities. The mineralisation defect is related to the disturbed collagen synthesis in lathyrism.

Animals↗

Osteoma of the internal auditory canal.

Osteomas of the internal auditory canal, inaccesible to clinical examination, are rare lesions. There are only 14 cases of osteomas and exostoses of the internal auditory canal reported in the international medical literature. A patient with an osteoma of the internal auditory canal is presented, along with differential diagnosis and possible etiologic factors for the lesion. The auditory brainsteam evoked response testing showed increased absolute latencies of 1 wave and discrepancy of the wave morphology due to bony compression of the eight nerve in the internal auditory canal. Computed tomography showed a bony growth in the internal auditory canal. Magnetic response showed no abnormalities. No surgery was performed since the symptoms improved by conservative therapy.

Adult↗

CT diagnosis of macrodystrophia lipomatosa. A case report.

Radiographs and CT scans of a 45-year-old male with progressive enlargement of his right upper limb and shoulder are presented. Extensive soft-tissue hypertrophy with linear radiolucent bands (fat) limited to the lateral aspect of the limb were seen. Exostoses-like bony overgrowth were also seen along interphalangeal joints. At CT, hypertrophic adipose tissue intermingling with muscle fibers was demonstrated, a diagnostic finding distinguishing the lesion from plexiform neurofibrolipomatosis, Klippel-Trenaunay syndrome and other angiomatous lesions.

Arm↗

[A rare cause of spinal cord compression: osteochondroma of the thoracic spine. A case report].

Osteochondroma or exostosis is the most common benign tumor of bone, but vertebral involvement is rare. The authors report the case of a 16 years old male with a family history of hereditary multiple exostoses who presented with spinal cord compression. MR examination showed an intraspinal extradural bone lesion at the T1-T2 level, hyperintense on T1 weighted and hypointense on T2 weighted images, causing marked cord deformity. The CT scan showed a tumor of the body and left pedicle of T2 with severe narrowing of the spinal canal.

Adolescent↗