Human group II phospholipase A2 in normal and diseased intervertebral discs

We measured calcium-dependent phospholipase A2 (PLA2) activity and immunoreactive group II PLA2 levels of 54 normal discs obtained from cadavers and 73 disc samples surgically obtained from patients with spinal disorders, including intervertebral disc herniations, spondylosis, and spondylolisthesis. Both cadaveric and surgical disc specimens contained about two-fold greater PLA2 activity than the ileal mucosa, one of the richest sources of group II PLA2. Discs of middle-aged cases had significantly higher activity than those of younger and elder cases. In cadaveric normal discs, calcium-dependent PLA2 activity was significantly higher in females than in males. Annulus fibrosus and nucleus pulposus contained the same PLA2 levels. In diseased disc, herniated fragments that had extruded or protruded out of the discs possessed lower activity than other parts of discs in the intervertebral space. Immunoreactive group II PLA2 levels of intervertebral discs closely correlated with PLA2 enzymatic activity. We purified a PLA2 from human intervertebral disc to homogeneity to further identify the isozymic nature of discal PLA2. Its NH2-terminal amino acid sequences and molecular weight were identical to those of human group II PLA2. Immunohistochemical analysis using a monoclonal anti-group II PLA2 antibody showed that in both annulus fibrosus and nucleus pulposus chondrocytes contained intense group II PLA2 immunoreactivity in their cytoplasm, and that the matrix contained no substantial immunoreactivity. These results suggest that group II PLA2 in chondrocytes has important physiological roles in discal ordinary metabolism, maintaining discal homeostasis.

Alternating sciatica while jogging: an early symptom of cauda equina tumor

Three athletic patients with cauda equina or lumbosacral cord tumor noticed, as an early symptom of the disease, alternating bilateral sciatica synchronized with each stride while jogging. Comparison with athletic patients who developed lumbar disc hernia suggested that this symptom was significant. The authors speculated that the mechanism producing this symptom is the inertial force induced while jogging, which acts on the tumor in its early stage, when it is still quite mobile in the intradural space. The diagnostic role of this symptom in cauda equina and lumbosacral cord tumor should be recognized.

Large vertebral body, in addition to narrow spinal canal, are risk factors for cervical myelopathy

It is well known that a narrow spinal canal is frequently associated with cervical spondylotic myelopathy. However, few investigators have studied the relationship between the size of the cervical spinal canal and that of the cervical spinal cord. Moreover, no studies mention the correlation between the size of the vertebral body and that of the spinal canal in the pathogenesis of cervical myelopathy. In the present study, we used computed tomographic myelography to measure the size of the vertebral body, spinal canal, and spinal cord in patients who had classic cervical myelopathy and in control subjects. We found that patients with cervical spondylotic had a narrow spinal canal as well as a slender spinal cord in the cervical region. Moreover, the vertebral body is significantly larger in the myelopathy group than in controls. A large vertebral body is thought to be associated with a large osteophyte and large disc protrusion. We conclude that a large vertebral body is another risk factor for cervical myelopathy, along with a narrow spinal canal.

Glomus tumor of the musculotendinous junction of the rotator cuff. A case report

A rare case of glomus tumor of the rotator cuff is presented. A 35-year-old man had a 20-year history of left shoulder pain. Through physical examination, muscular atrophy in the supraspinatus and infraspinatus muscles and restriction of shoulder motion was seen. Magnetic resonance imaging showed an abnormal oval shadow in the supraspinatus musculotendinous junction, and postcontrast computed tomographic scanning showed a small calcification focus in the tumor. Surgical excision of the tumor and rotator cuff reconstruction using Debeyre's procedure were done. Microscopic examination of the tumor showed a typical glomus tumor. It was difficult to diagnose glomus tumor in this patient before surgical intervention. Retrospective consideration indicated that the history of the present illness, computed tomographic scanning, and magnetic resonance imaging were critical for differential diagnosis.

Use of preoperative autologous blood donations and erythropoietin for treatment of giant cell tumor of the ischium

A 24-year-old man with an osteolytic lesion of the ischium was referred to the authors' institution. Computed tomography and magnetic resonance imaging studies showed that the lesion extended to and involved the subchondral bone of the acetabulum. Histologic examination of the biopsy specimen revealed giant cell tumor of bone. Following the biopsy, autologous blood was collected 4 times with recombinant human erythropoietin treatment definitive surgery was performed. Three weeks after the biopsy, the lesion was curetted and bone cementation was performed. The total blood loss during surgery was 3100 ml, which was replaced successfully with stored autologous blood without the need for homologous blood transfusion. The authors believe that without the erythropoietin treatment, autologous blood could have been collected only 3 times instead of 4 times, and the patient would have needed homologous blood.

The role of GM1-ganglioside in the injured spinal cord of rats: an immunohistochemical study using GM1-antisera

The effect of GM1-ganglioside (GM1) administration was investigated in the injured spinal cord of rats. Immunohistochemistry using GM1-antisera was applied in the study of GM1 distribution, and locomotor recovery was also evaluated. A total of 86 rats, subdivided into four groups, were used in the study. The SI + GM1 group (n = 30) underwent a thoracic cord injury, and then received daily intraperitoneal injections of GM1 (10 mg/kg) from 0 to 13 days after injury. The SI group (n = 30) also underwent thoracic cord injury, but did not receive GM1 treatment. The GM1 group (n = 20) received daily injections of GM1 in the absence of any spinal cord injury. The control group (n = 6) neither underwent spinal cord injury nor received GM1 treatment. The animals were sacrificed at 1, 3, 5, 7, and 14 days after injury for immunohistochemical evaluation. GM1 immunoreactive axons, myelin sheaths, and glial cells were counted in 5 light microscopic fields of spinal white matter. Immunohistochemical studies of the spinal cord revealed that GM1 treatment significantly increased both GM1-positive axons and GM1-positive myelin sheaths in the lateral funiculus surrounding the lesion site. The exogenous GM1 was incorporated predominantly into the myelin sheath rather than the axon. This distribution was detectable by day 1 of injury and persisted until day 14, and was significantly different from that of the control group on days 1 and 7. Moreover, GM1 treatment significantly accelerated the recovery of motor function. Collectively, these results suggest that exogenous GM1 administration after a spinal cord injury results in the rapid transfer of GM1 to the lateral funiculus where the motor transmission pathway is located. Furthermore, exogenous GM1 was shown to be specifically incorporated into the myelin sheath. Thus GM1 treatment may prevent demyelination and may contribute to motor function recovery.

Lumboperitoneal shunt for cauda equina syndrome in ankylosing spondylitis

Cauda equina syndrome is a rare complication in the late stage of ankylosing spondylitis, for which approximately 60 cases have been reported in the literature. The cause of the syndrome is unclear, and there is no effective treatment. Recently lumboperitoneal shunt was reported to have been effective in two patients. In our study, we performed lumboperitoneal shunt in a patient and evaluated the condition after the operation compared with that preoperatively. Some alleviation of neurologic symptoms was observed for 6 months after operation. Histopathologic examination of the dural diverticulum revealed a residual change after old inflammation. Lumboperitoneal shunt was an effective surgical treatment for cauda equina syndrome in this patient with ankylosing spondylitis, but its effects were not extreme. Arachnoiditis is suggested to be involved in the pathogenesis of cauda equina syndrome.

Immunohistochemical study of matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1 human intervertebral discs

STUDY DESIGN

Immunohistologic staining of human intervertebral discs collected at the time of surgery (100 intervertebral discs from 80 patients) and 10 discs collected from 7 cadavers within 12 hours of death was performed using antimatrix metalloproteinase-3 monoclonal antibody and antitissue inhibitor of metalloproteinase-1 monoclonal antibody.

OBJECTIVES

To examine the relationship between matrix destruction and staining for matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1 in intervertebral disc degeneration.

SUMMARY OF BACKGROUND DATA

Matrix metalloproteinase-3, which decomposes aggregating proteoglycans, has attracted research attention as a substance contributing to matrix destruction in the articular cartilage and intervertebral disc. However, except for a few in vitro studies, the relationship between matrix destruction of the intervertebral disc and matrix metalloproteinase-3 has been little studied.

METHODS

Immunohistologic staining was performed to examine the relationship between matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1 in the intervertebral disc, and the relationship of these two agents to magnetic resonance imaging, radiographic, and surgical findings.

RESULTS

Those cases testing positive for matrix metalloproteinase-3 and negative for tissue inhibitor of metalloproteinase-1 accounted for most of the surgical specimens. The matrix metalloproteinase-3-positive cell ratio was significantly correlated with the magnetic resonance imaging grade of intervertebral disc degeneration, and the matrix metalloproteinase-3-positive cell ratio observed in prolapsed lumbar intervertebral discs was significantly higher than that in nonprolapsed discs. In cervical intervertebral discs, the matrix metalloproteinase-3-positive cell ratio and staining of cartilaginous endplate were correlated with the size of osteophyte formation.

CONCLUSIONS

These findings suggested that intervertebral disc degeneration is caused by disturbance in the equilibrium of matrix metalloproteinase-3 and tissue inhibitor of metalloproteinase-1, and that matrix metalloproteinase-3 contributes to degeneration of the cartilaginous endplate.

Dually innervating nociceptive networks in the rat lumbar posterior longitudinal ligaments

STUDY DESIGN

The present study investigated the distribution of sensory and autonomic nerves to the posterior longitudinal ligament of the rat lumbar vertebra.

OBJECTIVE

The results were analyzed to provide a new insight into the pathogenesis of low back pain.

SUMMARY OF BACKGROUND DATA

Previous studies that have descriptively reported on posterior longitudinal ligament innervation have attributed important roles to the sinuvertebral nerve as an output of nociceptive sensation. Meanwhile, development of immunohistochemistry has made it possible to identify numerous neurotransmitters, and thus various suggested pathophysiologic roles of the nerve fibers in the posterior longitudinal ligament. However, such microscopic identification of the nerve fibers has not been able to reveal comprehensive distributions of the various fibers, which are presumed to be derived from the sinuvertebral nerve.

METHODS

Rat posterior longitudinal ligaments of whole thickness was immunohistochemically stained for calcitonin gene-related peptide and tyrosine hydroxylase, which have been considered markers of nociceptive and noradrenergic fibers respectively. Light-microscopic and electron-microscopic observation was reinforced with another experimental study in which resection of the dorsal root ganglia induced characteristic denervation patterns to the rat posterior longitudinal ligament.

RESULTS

The present study revealed that the lumbar. PLL was dually innervated by two distinctive systems of nociceptive fibers. One of the systems was polysegmentally innervated and closely associated with autonomic innervation, whereas the other was unisegmentally innervated and not associated with autonomic fibers.

CONCLUSION

Pathogenesis of low back pain can be better understood if the presence of the two distinctive nerve systems innervating the posterior longitudinal ligament is taken into account.

Increased rate of hysterectomy in women undergoing surgery for osteoarthritis of the knee

We performed a case-controlled study to determine whether previous gynecological surgery is associated with severe osteoarthritis (OA) of the knee, the hip or the spine, as well as mild OA of the knee. Patients who underwent surgical treatment for OA were defined as having severe OA. Patients with knee pain and radiographic grade 2 OA in a tibiofemoral joint on the Kellgren and Lawrence scale were defined as having mild knee OA. An increased rate of hysterectomy was observed in the severe knee OA group after adjustment for age and number of children, or even after adjustment for body mass index. Hysterectomy in this group was most often performed for myoma uteri. Patients with mild knee OA tended to have previous hysterectomy. From the results, we speculate that certain subsets of OA which often take a progressive course might be related to hysterectomy.

Anaplastic large cell Ki-1 lymphoma with bone involvement: report of two cases

Two cases of anaplastic large cell Ki-1 lymphoma involving bone as the most prominent and initial manifestation are reported. The first patient was a 20-year-old male who had back pain and incomplete paraparesis due to vertebral involvement. The second was a 14-year-old girl, whose first clinical signs were fever of unknown origin and sternal bone pain. Radiologically, skeletal lesions were lytic and destructive. Histopathologically, the tumour cells had pleomorphic bizarre nuclei and abundant basophilic cytoplasm. Immunohistochemically, Ki-1(CD30) reactivity was strongly positive in both cases. Tumour cells were also CD3, CD4, epithelial membrane antigen and interleukin-2 receptor positive in the first case, and CD10, HLA-DR positive in the second case. The former tumour was considered to be of T-cell lineage and the latter of lymphoid progenitor cell origin. Radiation and chemotherapy were temporarily effective. However, both patients died 14 and 7 months after diagnosis, respectively, due to systemic lymph node involvement. These observations suggest that the prognosis for Ki-1 lymphoma involving bone is poorer than indicated in previous reports.

Distribution of neuropeptide-containing nerve fibers in the synovium and adjacent bone of the rat knee joint

OBJECTIVE

The innervation of normal rat synovium and adjacent bone, especially the communicatory nerve fibers between them, were investigated.

METHODS

Nerve fibers were visualized using immunohistochemistry. Antisera to substance P(SP) and antisera to calcitonin gene-related peptide (CGRP) were employed to identify sensory nerves, while antisera to neuropeptide Y (NPY) were used to identify sympathetic nerves.

RESULTS

In the synovium, SP-positive nerve fibers were found in the lining cell layer, with some fibers branching toward the joint space. In the sublining layer of the synovium, SP-positive and CGRP-positive fibers were observed mainly near the blood vessels. NPY-positive fibers were predominantly seen as a network around the blood vessels in the sublining layer. A large number of SP-positive and CGRP-positive fibers were seen near the attachment of the meniscus to the synovium. Toluidine blue positive mast cells were detected in close proximity to all three types of fibers, especially near the blood vessels. In bones forming the knee joint, nerve fibers immunoreactive to SP, CGRP and NPY were present in the bone marrow and some of these fibers communicated with the synovium through the synovium-bone junction located in the bare area.

CONCLUSION

The role of nerves, especially the role of the communicatory nerves between the synovium and the bone marrow, should be considered in the pathophysiolosy of erosive arthritis.

Cervical radiculomyelopathy due to deposition of calcium pyrophosphate dihydrate crystals in the ligamentum flavum: historical and histological evaluation of attendant inflammation

Deposition of calcium pyrophosphate dihydrate (CPPD) crystals in the yellow ligament occasionally leads to neurological deficits through compression of the spinal cord. Although it is widely accepted that CPPD crystal induces severe inflammation in arthropathy, little attention has been paid to the acute inflammation that may accompany the CPPD crystals in the ligamentum flavum. The present study reviews eight patients with radiculomyelopathy due to calcification of the cervical yellow ligament. Acute inflammation of the yellow ligament accompanying the crystalline deposits, both with and without attendant granulation tissue-proliferation, was evaluated as contributing to cervical radiculomyelopathy. Three cases with attendant granulation tissue suffered from recurrent attacks of neck pain and fever with coincidental radicular pain in the upper arm. The local inflammation of the ligamentum flavum might have participated in the exacerbation of the cervical radiculopathy.

Experimental study of intervertebral disc allografting in the dog

STUDY DESIGN

An investigation of the use of intervertebral disc allografting as a potential alternative to intervertebral fusion was performed. In 13 adult mongrel dogs, intervertebral disc units cryopreserved after slow freezing were grafted.

OBJECTIVES

To evaluate the morphologic and biosynthetic damage caused by cryopreserving the canine intervertebral disc before allografting.

SUMMARY OF BACKGROUND DATA

Cryopreservation did not alter the normal histologic appearance. The metabolic activity, measured by 35S-sulfate incorporation, was observed to be 44% of the fresh control.

METHODS

Transplanted intervertebral discs were examined histologically and radiographically at 12, 24, and 48 weeks after surgery.

RESULTS

The allografted disc had preserved anular and nuclear architecture with moderate loss of chondrocytes 12 weeks after grafting. However, the intervertebral disc showed evidence of progressive disc degeneration 1 year after transplantation.

CONCLUSIONS

More investigation of storage methods is needed to enhance the viability of the intervertebral disc for successful intervertebral disc allografting.

Etretinate-induced heterotopic bone formation about the hip joint. A case report including ultrastructural study

Despite considerable documentation for retinoid-induced hyperostosis, sufficient knowledge regarding its management and histologic features is not available. In a 26-year-old man with etretinate-induced heterotopic bone formation about the hip joint, the use of etidronate disodium was unsuccessful. Surgical excision of the heterotopic bone dramatically improved restricted motion of the hip joint without initiating significant postoperative heterotopic ossification. Ultrastructural study showed abundant myofibroblasts in the fibrous tissue close to the heterotopic bone. Their role in local biologic events should be determined.

Substance P-immunoreactive and protein gene product 9.5-immunoreactive nerve fibres in bone marrow of rat coccygeal vertebrae

Previous investigations have focused mainly on the nerve terminals in soft tissues surrounding the vertebrae to determine the source of spinal pain. Our study on rat coccygeal vertebrae compared intramedullary immunostaining for substance P with that of a more generally distributed neural marker, protein gene product 9.5, to suggest another source of spinal pain. Free intramedullary fibres staining for protein gene product 9.5 were rare compared with the abundant staining associated with intramedullary vessels. Shortly after entering the marrow with the nutrient vessels, substance P-immunoreactive fibres parted from the vessels and then proceeded longitudinally and terminated on the end-plates. Other (although fewer) substance P-immunoreactive fibres entered the marrow at enthetic aspects of the vertebrae. The presence of free substance P-immunoreactive fibres innervating endplates and penetrating entheses suggests that they may represent a novel source of spinal pain.

Mast cells alter granular properties and spatial relation to nerve fibres in spondylitis of adjuvant-treated rats

It has been long implicated that mast cells (MCs) have a close spatial relationship to the peripheral nerve fibres. In the present study, which used spondylitis of adjuvant-treated rats, we investigated the behaviour of MCs in relation to peripheral nerve fibres and other inflammatory cells. Rat MCs with staining properties like connective tissue MCs decreased in number as inflammation progressed. With additional electron microscopic studies it was possible to observe the sequence of changes in their granular ultrastructure during active inflammation. Thus, the decrement of MCs with staining properties like connective tissue MCs was attributable to the changes in their granular conformation. In contrast, enzyme histochemistry of nerve fibres indicated that the percentages of MCs which were distant from nerve fibres increased significantly during the early stage of inflammation (p < 0.01). We speculate that while other inflammatory cells infiltrate, MCs deviate actively form nerve fibres and release their granular content.

Periosteal osteosarcoma and parosteal chondrosarcoma evaluated by double immunohistochemical staining. Report of 2 cases

Differentiation of periosteal osteosarcoma and parosteal (periosteal) chondrosarcoma by conventional histology may be difficult. One case each of clinically and histologically proven periosteal osteosarcoma and parosteal chondrosarcoma were evaluated by a double-immunohistochemical staining method using proliferating cell nuclear antigen (PCNA) and S-100 protein (S-100). Conventional histology showed proliferation of both osteoblastic and chondroblastic cells in the periosteal osteosarcoma, while there was a growth of only chondroblastic tumor cells in the parosteal chondrosarcoma. Immunohistochemical studies indicated that the nuclei of chondroblastic cells recognized by S-100 were PCNA-negative, while osteoblastic stromal cells were PCNA-positive in the periosteal osteosarcoma. In contrast, chondroblastic cells in the parosteal chondrosarcoma were both S-100- and PCNA-positive. Our findings suggest that periosteal osteosarcoma is characterized by the proliferation of osteoblastic stromal cells, whereas parosteal chondrosarcoma is characterized by the proliferation of chondroblastic cells. This method of double immunohistochemical staining, using PCNA and S-100, may be useful in differentiating these chondroblastic tumors.

Neonatal capsaicin pretreatment suppresses intramedullary inflammation in adjuvant-induced spondylitis

In order to investigate the proposed involvement of neuropeptides in musculoskeletal inflammation we pretreated rats, in an adjuvant spondylitis model, with capsaicin, a neurotoxin. Immunohistochemistry showed that administration of capsaicin to newborn rats depleted irreversibly the neuropeptide, substance P. Elimination of capsaicin-sensitive fibres by the neonatal injection of capsaicin did not suppress the peridiscitis of rats in which adjuvant spondylitis was induced at 7 weeks of age. However, elimination of capsaicin-sensitive fibres did suppress the inflammation usually seen in the bone marrow. We speculate that this intramedullary inflammation is normally induced or sustained by capsaicin-sensitive fibres.

Osteosarcoma of the talus. A case report

A 20-year-old man complained of increasing pain and swelling in the right ankle joint. Radiographs of the ankle demonstrated an ill-defined osteolytic lesion in the talus associated with a small, round bone formation just proximal to the neck of that bone. Histologic examination of the lesion showed osteoblastic osteosarcoma originating in the talus. Below-knee amputation was performed because of the peripheral location of the tumor and the close anatomic confines of the foot. A literature review demonstrated that the calcaneus and metatarsals are favorite sites of this tumor in the foot, with only one case in the talus. A second case of osteosarcoma in the talus seems to have not been previously reported.

Parosteal (juxtacortical) chondrosarcoma of the humerus associated with regional lymph node metastasis. A case report

Recurring parosteal (juxtacortical) chondrosarcoma of the humerus occurred in a 79-year-old man. Roentgenograms of the left humerus showed minimal cortical irregularity and a large soft tissue mass without calcification or periosteal reaction. Magnetic resonance imaging (MRI) showed a multilobular tumor of high intensity (T2-weighted imaging) without marrow involvement. During the left shoulder disarticulation an enlarged axillary lymph nodes was discovered and removed. Macroscopic examination of the disarticulated humerus showed a large yellow parosteal mass, which looked like cartilage, completely surrounding the humeral shaft. The marrow cavity was almost normal except for a small erosion at the site of the olecranon fossa. The histologic diagnosis of the mass was Grade 2 chondrosarcoma of parosteal (juxtacortical or periosteal) origin associated with regional lymph node metastasis. The features that made this case unique were a long history of the tumor (for 32 years), minimal cortical destruction of the bone by the tumor, and regional lymph node metastasis. This case illustrates the differential diagnosis of the parosteal chondrosarcoma from periosteal osteosarcoma and extraskeletal myxoid chondrosarcoma.

Rheumatoid nodules at the cement-bone interface in revision arthroplasty of rheumatoid patients

We studied the histology of the cement-bone interface and the regenerated synovium in ten aseptically loosened arthroplasties in rheumatoid patients. In two patients we found rheumatoid nodules at the cement-bone interface and marked lymphoplasmacytic infiltration in another three. Failed joints in osteoarthritic patients did not show these changes, and it seems likely that the presence of abundant immunocompetent cells was due to the background disease. We speculate that rheumatoid inflammation contributed to the process of loosening.

Ossification of the ligamentum teres as a possible mechanism of lateral subluxation in coxopathy associated with ankylosing spinal hyperostosis

The cases are reported of two patients with coxopathy associated with ankylosing spinal hyperostosis who showed ossification of the ligamentum teres. It is suggested that considerable ossification at the medial acetabular floor including the ligamentum teres can explain the mechanism of development of coxopathy with lateral subluxation of the femoral head which is often seen in patients with ankylosing spinal hyperostosis.

Rupture of the Achilles tendon in rheumatoid arthritis with histologic evidence of enthesitis. A case report

Spontaneous Achilles tendon rupture occurred in a 60-year-old man with a two-year history of sero-positive rheumatoid arthritis (RA). Histologic section of the ruptured Achilles tendon revealed the existence of rheumatoid granulation that consisted of lymphocytes, histiocytes, and small vascular proliferation within the tendon tissue. The enthesis of the tendon to the calcaneus also revealed lymphocyte infiltration in the bone marrow and rheumatoid granulation within the tendon. Throughout the course of his disease, the patient had not been treated with corticosteroids. These facts suggested that enthesis (attachment of tendon to bone) was one of the extraarticular sites of the rheumatoid inflammation and that enthesitis was a possible cause of Achilles tendon rupture in this RA patient.

Iliopsoas bursal distension caused by acetabular loosening after total hip arthroplasty. A rare complication of total hip arthroplasty

In a 58-year-old woman, a cystic mass at the ileocecal region communicated with the loosened hip prosthesis 20 years after total hip arthroplasty (THA). The preoperative arthrogram of the hip and the intraoperative cystogram suggested a one-way communication from the hip to the cystic mass. The mass was diagnosed as an iliopsoas bursitis distended by the influx of the synovial fluid from the loosened THA.

[Experimental study of intrinsic healing of the flexor tendon: collagen synthesis of the cultured flexor tendon cells of the canine]

The roles of the tendon cells, such as epitenon cells and tenocytes, through the reparative process of the flexor tendon are controversial. This study was performed to investigate the collagen synthesis of cultured tendon cells derived from the sheathed flexor tendons of the canine under electron microscopy using "Floating Sheet" method introduced by Arnold, J. R., et al (1983). Morphologically epitenon cells gave an appearance of large and oval fibroblasts, while tenocytes were small, spindle shaped fibroblasts. Electron microscopy revealed large amount of collagen and non-collagen fibers in the intercellular spaces of both cell populations. The collagen fibers produced by tenocyte populations were 200 A to 400 A in thickness, whereas those of the cultured epitenon cells ranged from 150 A to 300 A. These results indicated that tenocytes secreted larger and more matured collagen fibers than epitenon cells. Promotion of collagen synthesis by the tenocytes in the early stage of the flexor tendon repair was thought to be more favorable for its quality of the healing process.

Immunohistochemical analysis of spinal intradural xanthomatosis developed in a patient with phytosterolemia

Multiple intradural xanthomatous tumors developed in 48-year-old female with familial phytosterolemia. These tumors were restricted to the spinal denticulate ligaments. Histological and immunohistochemical findings were fundamentally similar to those of tendinous xanthomas. The major cellular component of these tumors were identified as of mono-histiocytic origin because they possessed myeloid histiocytic antigen (Mac 387), CD11c and lysozyme but not CD15. Sitosterols, campesterols and cholestanols were recovered from the extract of the tumors and the lesions were confirmed to be phytosterolemic xanthomas. Schwann cells stained with anti-S100 protein were confined to the perivascular small nerve bundles and did not show xanthomatous change. Although immunohistochemical preparation of epithelial membrane antigen and desmoplakin I+II revealed the presence of non-neoplastic meningothelial cells in the superficial portion of the tumors, they were too few to play a significant role in the development of these xanthomas.

The effect of constant direct electrical current on intrinsic healing in the flexor tendon in vitro. An ultrastructural study of differing attitudes in epitenon cells and tenocytes

Light and electron microscopy were performed in a study of the effects of electrical stimulation upon the reparative processes in flexor tendons cultured in vitro. After one or two weeks of incubation, the unstimulated control tendons were covered with fibroblastic surface cells, thought to have originated from the epitenon. In contrast, the tendons subjected to electrical stimulation had no proliferation of the epitenon cells in the surface layer. The results indicate that electrical currents of low amperage suppress adhesion-causing synovial proliferation in the epitenon and promote active collagen synthesis in the tenocytes. This suggests the potential value of electrical stimulation in the control of adhesion formation after flexor tendon repair.

1-Hydroxyethylidene-1,1-bisphosphonate decreases the postovariectomy enhanced interleukin 1 secretion from peritoneal macrophages in adult rats

Bisphosphonates are potent inhibitors of bone resorption. In previous studies, we have shown that ovariectomy accelerates bone resorption and 1-hydroxyethylidene-1, 1-bisphosphonate (HEBP) inhibits ovariectomy-accelerated bone resorption in female Wistar adult rats. As interleukin 1 (IL-1) stimulates bone resorption in vitro and in vivo, we have investigated the effects of ovariectomy and HEBP administered in vivo on IL-1 secretion from peritoneal macrophages in adult rats. Ovariectomy or sham surgery were performed in female Wistar rats at 40 weeks of age. Ovariectomized and sham-operated rats were administered with HEBP (10 mg) or saline, 10 times in total, from 43 to 46 weeks of age. Paraffin oil-induced peritoneal macrophages at 46 weeks of age were cultured for 24 hours. Lipopolysaccharide (LPS)-stimulated peritoneal macrophages from ovariectomized rats secreted more IL-1 than sham-operated rats. HEBP decreased LPS-stimulated IL-1 secretion from peritoneal macrophages in ovariectomized rats, but not in sham-operated rats. In vivo administration of HEBP decreased IL-1 secretion only in postovariectomy hyperresorptive states. These results suggest that alterations in LPS-stimulated IL-1 secretion from oil-induced peritoneal macrophages may be responsible, at least in part, for the postovariectomy acceleration in bone resorption and its inhibition by HEBP.

[Endoscopic manometry of common bile duct and the sphincter of Oddi in patients with biliary tract stones and in controls]

Endoscopic manometry using microtransducer was applied to evaluate the motor activity of the sphincter of Oddi (SO) and common bile duct (CBD) in patients with biliary tract stones and in controls. CBD pressure, SO pressure and the incidence of irregular phasic wave pattern (IRPWP) were relatively higher in patients with biliary tract stones than those in controls. There was no significant difference in CBD and SO pressure between patients with dilated CBD and patients with non-dilated CBD, however the incidence of IRPWP was significant higher in patients with dilated CBD than that in patients with non-dilated CBD. SO pressure and the incidence of IRPWP were significant higher in patients with papillitis than those in patients without it. Patients with valvular orifice of the papilla of Vater showed high incidence of IRPWP, and in such cases it was suggested that SO had different motor functions for CBD and pancreatic duct because these ducts were seen opening onto the papilla separately according to the findings of pancreatocholangiogram. We concluded that endoscopic manometry of CBD and the SO was useful to evaluate the motor activity of SO and provided a basis for the assessment of the motor function mechanism of SO. Our results indicated the motor activity of SO had close relationship with biliary tract stones, CBD dilatation and endoscopic findings of the papilla of Vater.

Evidence for a neural source of acute accumulation of serotonin in platelets in the injured spinal cord of rats. An experimental study using 5,6-dihydroxytryptamine treatment

It was found previously that large numbers of platelets showing high serotonin (5-hydroxytryptamine; 5-HT) immunoreactivity appeared in hemostatic plugs at the traumatized cord segment in the acute phase of a trauma. In order to determine the origin of 5-HT in the platelets, we investigated the 5-HT immunoreactivity of platelets accumulating in hemostatic plugs at the traumatized spinal cord segment at 5 minutes after injury. This investigation was carried out by light and electron microscopic immunohistochemistry in rat spinal cord pretreated with 5,6-dihydroxytryptamine (5,6-DHT). The hemorrhagic lesion formed at the neural 5-HT-depleted spinal cord segment was completely 5-HT immunonegative, while platelets in lesions in cord segments of control animals or rostral to the injection site of 5,6-DHT in experimental animals where neural 5-HT was not depleted were 5-HT immunoreactive. The results strongly suggest that a significant amount of 5-HT is released from neural elements at the injury site and is transiently incorporated into the platelets in situ.

Spinal cord compression with paraplegia in xanthomatosis due to normocholesterolemic sitosterolemia

A 48-year-old woman with a 30-year history of tendinous xanthomatosis developed paraplegia. The magnetic resonance image revealed extramedullary tumors. The analysis of her sera and tumors revealed increased amount of plant sterols, especially sitosterol, and the diagnosis of sitosterolemia was made. This is the first reported case of a patient with sitosterolemia who had the neurological complication of spinal cord compression due to extramedullary sitosterolemic xanthomas.

Acute aggregation of serotonin-immunoreactive platelets in the injured spinal cord of rat and change of serotonin content in the neural fibers

Serotonin (5-HT) immunoreactivity was investigated at the injury site of the rat spinal cord by light and electron microscopic immunohistochemistry. The animals were perfused with fixative immediately, 1-5 min, 7-60 min, and 1-48 h after a 3-sec extradural compression of the thoracic cord with a Sugita aneurysm clip. Five minutes after injury, abundant hemostatic plugs containing platelets with high 5-HT immunoreactivity appeared at the traumatized cord segment, whereas 5-HT-containing varicose fibers became less immunoreactive. The 5-HT-immunoreactive platelets initially were localized to the periphery of the hemostatic plugs. By 30 min after injury, the platelets had decreased 5-HT, but neural fibers and terminals began to show increased 5-HT immunoreactivity, which increased and lasted as long as 48 h. These results indicate that platelets contributed to the initial 5-HT concentration increase at the injury site but that later 5-HT accumulation occurred in the neural elements.

Altered lymphocyte proliferation by low dosage laser irradiation

The effect of gallium-aluminum-arsenide laser irradiation on the proliferation of human lymphocytes in culture in response to mitogenic stimulation by phytohemagglutinin was investigated. Mitogenic proliferation was inhibited by the laser irradiation at a low energy fluence and enhanced at a high energy fluence. The results indicate that low-watt laser irradiation can interfere with the immune response in vitro, and similar interference could occur in patients with rheumatoid arthritis subjected to laser therapy, if an appropriate dosage is chosen.

Osteoma cutis associated with disordered ossification of the clavicle. A case report

Congenital multiple osteomas of the skin associated with disordered ossification of the clavicle occurred in a four-year-old boy. There were no clinical and laboratory findings of pseudohypoparathyroidism, pseudopseudohypoparathyroidism, or fibrodysplasia ossificans progressiva in this case. The clavicular bony mass was excised in segments. Samples of the cutaneous osteomas were removed for histologic study. On microscopic examination, the specimen from the clavicle consisted of trabecular bone in hyaline cartilage, resembling enchondral ossification, but the specimen from the osteoma cutis revealed a mature membraneous bone without cartilage.

Suppressed tuberculin reaction in guinea pigs following laser irradiation

Tuberculin reactions were tested at the bilateral sites of the backs of sensitized guinea pigs. Laser irradiation at an energy fluence of 3.6 J at one site of reaction suppressed the reaction not only at the irradiated site but also at the contralateral nonirradiated site. These phenomena were observed when mononuclear cells were dominant in the perivascular cellular infiltration. The results indicate that local irradiation with a low-power laser has systemic inhibitory effects on delayed hypersensitivity reactions.

Experimental study on acute aggravating factors of cervical spondylotic myelopathy

Systemic arterial hypotension, systemic arterial hypertension, cervical hyperflexion, cervical hyperextension, and cervical instability were induced in experimental animal with cervical spondylotic myelopathy, and their effects on spinal cord pathology were investigated. An experimental animal model of cervical spondylotic myelopathy was produced by combining anterior cervical cord compression with occlusion of the cervical vertebral arteries in dogs. Spinal cord pathology at the site of compression was characteristically different and depended on the type of load; that is, peripheral necrosis of the central gray matter in systemic hypotension, capillary congestion and subarachnoid hemorrhage in systemic hypertension, and linear necrosis of the transversely elongated central gray matter combined with occluded anterior spinal artery in cervical hyperflexion, and the pathologic severity was proportional to the number of loadings. This study suggests that cervical spondylotic myelopathy might progress stepwise rather than linearly when these aggravating factors are loaded.

Operations for cervical spondylotic myelopathy. A comparison of the results of anterior and posterior procedures

Over the past 19 years we have operated on 269 patients with myelopathy associated with cervical spondylosis. We report our results in 191 cases which we have followed up for 1 to 12 years (average 31 months). The clinical state before and after operation was recorded using the criteria of the Japanese Orthopaedic Association. Posterior operations gave better results than anterior for the more advanced myelopathies such as transverse lesions, the Brown-Séquard syndrome and the motor syndromes, but the brachialgia and cord syndrome and the central cord syndrome were satisfactorily treated by anterior operations. Of the three anterior and three posterior techniques used, no single one showed an overall superiority. A short duration of symptoms before operation was associated with better results, but these were not influenced by the age of the patients.

The pattern of spinal and extraspinal hyperostosis in patients with ossification of the posterior longitudinal ligament and the ligamentum flavum causing myelopathy

Thirty one patients suffering from myelopathy associated with ossification of the posterior longitudinal ligament and ligamentum flavum of the spine have been investigated. The pattern of spinal and peripheral hyperostosis was recorded in each case. Flowing anterior vertebral hyperostosis and ligamentous ossification at the enthesis around the pelvis and hips were the most frequent associations, occurring in approximately 86% of patients. The distribution and incidence of the spinal and extraspinal hyperostosis in this series corresponds closely to the findings in diffuse idiopathic skeletal hyperostosis (DISH). The present findings indicate that patients suffering from cervical myelopathy and ossification of the posterior longitudinal ligament should be regarded as manifesting focal features of a more generalised disorder producing skeletal hyperostosis.

Spinal cord tissue oxygen in experimental ischemia, compression, and central necrosis

A polarographic electrode of the surface reservoir type was applied to the canine cervical cord to obtain tissue oxygen tension. Normal, ischemic, compressed, and centrally necrotized spinal cords were examined. Effects of hypertension, hypotension, and pure oxygen inhalation on the cord oxygen were checked. Both ischemic and compressed cord demonstrated tissue oxygen lower than normal cord. Centrally necrotized cord showed normal oxygen in air ventilation but responded less markedly to 100% oxygen ventilation than did normal cord. Hypertension and hypotension made the cord oxygen rise and fall, respectively, more consistently in centrally necrotized cord than in normal cord. This method was shown to be useful for monitoring the spinal cord blood flow.

Effect of hypercarbia and hypertension on spinal cord tissue oxygen in experimental cervical myelopathy

Tissue oxygen tension of the cervical cord was measured by the polarographic technique described in the preceding paper on dogs whose cervical cords had sustained combined compression and ischemia. Both hypercarbia and systemic hypertension elevated the tissue oxygen of the cord effectively even at the compressed and ischemic segments, and their effects were additive. Clinical applicability of combined hypercarbia and hypertension to the treatment of ischemia of the human cord was suggested.

Effects of hypertension and hypercarbia on spinal cord tissue oxygen in acute experimental spinal cord injury

Spinal cord tissue oxygen was measured by polarography at the dorsum of the spinal cord for 24 hours after acute spinal cord injury, and the effects of hypertension, hypercarbia, and hyperoxia were examined. Acute spinal cord injury was produced in mongrel dogs by constriction of the midthoracic cord with an epidural tourniquet inflated to 400 mm Hg, which was maintained for 5 minutes. At the injury site spinal cord tissue oxygen was slightly increased immediately after injury but was depressed significantly at 1 hour and remained unchanged thereafter. Hypertension induced by the intravenous infusion of norepinephrine elevated the tissue oxygen only slightly after 3 hours. Hypercarbia and hyperoxia produced by ventilation with a 95% O2:5% CO2 mixture did not elevate the depressed spinal cord oxygen content. When hypertension, hypercarbia, and hyperoxia were combined, the spinal cord oxygen value was elevated to the normal level even at 3 hours after injury, when the cord oxygen was at its lowest, and it increased steadily thereafter.

Therapeutic trial of combined hypertension and hypercarbia on experimental acute spinal cord injury

Combined hypertension and hypercarbia, which was found to improve post-traumatic spinal cord hypoxia and presumably ischemia in our previous study, was used in dogs subjected to experimental spinal cord injury to determine its therapeutic effects against acute spinal cord trauma. Intermittent hypertension and hypercarbia therapy, in which 15 minutes of hypertension and 95% O2:5% CO2 gas ventilation were alternated with 10 minutes of air ventilation, was given for 3 hours beginning 3 hours after injury. The treated dogs and untreated control dogs were checked neurologically and electrophysiologically at weekly intervals for up to 8 weeks. The treated dogs showed higher grades of neurological function within 1 week, but the results were statistically insignificant. Both groups demonstrated steady neurological improvement for the next 2 weeks and remained paraparetic thereafter with no group difference. The size of the intramedullary lesion was identical in both groups. Recovery of the somatosensory evoked potentials coincided well with neurological improvement, with again no difference between the two groups.