Silicone-induced synovial and osseal granuloma following metacarpophalangeal and carpal arthroplasty

Intraarticular particulate silicone rubber created by abrasion of silicone arthroplasty of the hand may be responsible for the development of an iatrogenic granulomatous synovitis and ostitis. Histological and ultrastructural appearances of the involved tissues are presented, together with a discussion of the possible mechanism and methods of pathological diagnosis.

Amianthoid fibres in ruptured human tendons

So-called amianthoid fibres were identified in 17 of 460 tendons (3.7%) after spontaneous rupture. These tendons belonged to 10 men and 7 women with an age-range from 18 to 67 years. In 445 postmortem control tendons taken of accidentally killed previously healthy persons amianthoid fibres were not found. Ultrastructurally the tendineal amianthoid fibres differ from normal tendon collagen fibrils in many respects. Their diameter (600-1400 nm) is many times larger than that of native collagen fibrils (20-120 nm). The fibre profile is often irregular and the cross-sectioned fibres have a homogeneous granular appearance. In longitudinal sections, the amianthoid fibres are frequently disintegrated and outspread, and some of the fibres have lost their periodicity. In addition, some of the fibres are angulated and show nonparallel organization. Occasionally the amianthoid fibres are calcified.

Vascular changes in the ruptured Achilles tendon and paratenon

Thirty patients with ruptures of the Achilles tendon were studied. There were 21 men and 9 women with an average age of 36 years. Specimens from the tendon and paratenon in 24 were examined histologically. Tissue samples of 20 were studied by electron microscopy. Marked degenerative, obliterative and/or inflammatory vascular changes were found in all the ruptured tendons and their paratenon. Our findings indicate that poor vascularity play a role in the aetiology of rupture of the Achilles tendon.

Immunohistochemical characterization of pigmented villonodular synovitis

Pigmented villonodular synovitis is made up of a variety of cells, including round or oval mononuclear cells, fibroblasts, synovial cells and multinucleated giant cells. The mononuclear cells were found to stain positively with anti-lysozyme, anti-alpha-1-antitrypsin, anti-alpha-1-antichymotrypsin and anti-fibronectin. Vimentin was detected in fibroblasts and in lining cells of the synovial membrane as well as in cells of acinus-like structures. The multinuclear giant cells contained lysozyme, alpha-1-antitrypsin and alpha-1-antichymotrypsin but no vimentin.

Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients

We evaluated specimens obtained from the biopsy of spontaneously ruptured tendons in 891 patients who were treated between 1968 and 1989. The specimens, which were removed at the time of repair, included 397 Achilles tendons, 302 biceps brachii tendons, forty extensor pollicis longus tendons, eighty-two quadriceps tendons and patellar ligaments, and seventy other tendons. Age and sex-matched control specimens, from 445 tendons taken at the time of death from the cadavera of previously healthy individuals who died accidentally, also were obtained and evaluated. The histopathological analyses of the specimens included light and polarized light microscopy and scanning and transmission electron microscopy. A healthy structure was not seen in any spontaneously ruptured tendon, but two-thirds of the control tendons were structurally healthy (p less than 0.001). There were characteristic histopathological patterns in the spontaneously ruptured tendons. Most (97 per cent) of the pathological changes were degenerative; they included hypoxic degenerative tendinopathy, mucoid degeneration, tendolipomatosis, and calcifying tendinopathy, either alone or in combination. These changes were also found in 34 per cent of the control tendons, but significantly less frequently (p less than 0.001). In the other twenty-six ruptured tendons (3 per cent), the pathological change was an intratendinous foreign body, rheumatoid tendinitis, a xanthoma, a tumor, or a tumor-like lesion such as an intratendinous ganglion. The findings clearly indicate that, at least in an urban population, degenerative changes are common in the tendons of people who are older than thirty-five years and that these changes are associated with spontaneous rupture.

Tumors and tumor-like lesions arising in tendons. A clinicopathological study of 75 cases

Eight cases of malignant tumors, 38 cases of benign tumors, 15 cases of metastatic tumors, and 14 cases of tumor-like lesions arising in tendons seen over a period of 22 years (1967-1988) are surveyed. Benign tumors of tendon occur relatively frequently - in 38 (1.7%) of 2143 tendon biopsies - but malignant tumors (0.37%) and metastases (0.70%) are extremely rare. Malignant tumors occurred most frequently in lower limb tendons, while benign tumors were most often found in the tendons of the hand.

[Protothecosis. A new, or rarely recognized disease?]

Two cases of infection caused by Prototheca, belonging to the colourless algae, are discussed. In one of the patients colpitis, in the other one disease of the cubital bursa developed due to Prototheca. In the first case recovery was attained with tetracyclin, in the second case with surgical treatment. Microbiology, epidemiology, pathology and clinical aspects of the insufficiently known in Hungary protothecosis are outlined.

[Recurrent infantile digital fibromatosis]

In connection with a boy's case, receiving treatment in their institute several times, authors sum up our knowledge on infantile relapsing digital fibromatosis, first time in Hungary. Results of histological and electronmicroscopic examination are reported compared to results of foreign authors' studies of similar subject.

The effect of tenotomy and immobilisation on intramuscular connective tissue. A morphometric and microscopic study in rat calf muscles

The effect of tenotomy and of immobilisation in lengthened and shortened positions on the intramuscular connective tissue of the calf muscles of the rat was studied morphometrically and with a scanning electron microscope. Both tenotomy and immobilisation produced a marked increase in both the endomysial and the perimysial collagen networks, with a simultaneous decrease in intramuscular capillary density. The increase in connective tissue volume was more pronounced and occurred more rapidly in the soleus, which consists mainly of type I, slow-twitch fibres than in the gastrocnemius, which is mainly of type II, fast-twitch fibres. The relative volume of connective tissue increased in parallel with the duration of immobilisation or after tenotomy. There was slightly more increase after immobilisation in a shortened rather than in a lengthened position.

Histochemical profile of muscle spindles of rat's sural muscles

The histochemical profile of intrafusal fibres of muscle spindles and muscle spindle capsule were analysed in normal sural muscles of a rat. Weak activity of oxidative enzymes (NADH diaphorase, succinic dehydrogenase, lactate dehydrogenase) and creatine phosphokinase were found in bag1 and bag2 fibres, but the oxidative enzyme activity was moderate in chain fibres. High phosphorylase activity was demonstrated in bag fibres as well as in chain fibres. No differences could be detected in adenosine desaminase activity between these various intrafusal fibres. In the outer capsule of muscle spindles, high amount of type III collagen and elastin, but only small amount of type I collagen and fibronectin could be observed.

Pathological alterations in human tendons

The present authors analyzed the pathological alterations of 1966 tendons examined in the National Institute of Traumatology, Budapest, during the past 18 years. The majority of cases proved to be tendinopathies (hypoxic-degenerative tendinopathy or calcific tendinitis, tendolipomatosis and mucoid degeneration) leading to tendon rupture. The incidence of tendon tumors, foreign bodies, infectious tendon diseases, and other pathological conditions was clearly lower. The methods of tissue preparation and of examination of tendon specimens were also evaluated. Light microscopy was sufficient for the diagnosis of pyogenic tendinitis, tumors, xanthoma, gout, and gangrene. In degenerative tendinopathies and alterations due to hereditary disease, electron microscopy was necessary. Polarization microscopy had a key role in examination of collagen structure and architecture, and identification of foreign bodies in the tendons. Enzyme histochemical and immunohistochemical examination were reliable but not absolutely necessary in the diagnosis of tendon pathology.

The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociological study of 292 cases

During the last few decades, the incidence of tendon ruptures has increased in civilized countries. Our material comprises 749 patients who had 832 tendon ruptures treated surgically between 1972 and 1985. There were no competitive athletes among the patients studied. There were 292 single ruptures of the Achilles tendon, 274 of the proximal biceps brachii, 113 of the extensor pollicis longus, and 70 of other tendons. Forty-eight patients had multiple ruptures and 35 patients had reruptures. Achilles tendon ruptures often occurred in recreational sports activities (59%), in contrast to other tendon ruptures (2%; P less than 0.001). The mean age for patients who had Achilles tendon rupture was 35.2 years and for patients with other ruptures, 50.7 years (P less than 0.001). There was a connection between the high incidence of blood group O and tendon ruptures (P less than 0.001). In cases of multiple ruptures and reruptures, the frequency of blood group O was 71%. Sixty-two point three percent of the patients with Achilles tendon rupture were professionals or white collar workers, which is markedly more than in the Hungarian population (12.7%; P less than 0.001). Two hundred and six Achilles tendon ruptures were studied histologically, and all cases displayed pathological alterations. The results indicate that complete rupture of the Achilles tendon is usually a sequel to a sedentary life-style and participation in sports activities.