The effect of macrophage-colony stimulating factor and other humoral factors (interleukin-1, -3, -6, and -11, tumor necrosis factor-alpha, and granulocyte macrophage-colony stimulating factor) on human osteoclast formation from circulating cells

Macrophage-colony stimulating factor (M-CSF) is an essential requirement for human osteoclast formation, but its effect on the proliferation and differentiation of circulating osteoclast precursor cells is unknown. Other growth factors and cytokines are also known to support/stimulate osteoclast formation from mouse marrow precursors, but it is not certain whether these factors similarly influence human osteoclast formation. In this study, human monocytes were cocultured with osteoblast-like UMR-106 cells on coverslips and dentine slices for up to 21 days in the presence of 1,25 dihydroxyvitamin D(3) (10(-7) mol/L), dexamethasone (10(-8) mol/L), and various concentrations of either M-CSF or other humoral factors (interleukin [IL]-1beta, IL-3, IL-6, and IL-11; tumor necrosis factor-alpha [TNF-alpha]; and granulocyte macrophage [GM]-CSF). The effect on osteoclast formation was assessed by tartrate-resistant acid phosphatase (TRAP) and vitronectin receptor staining and lacunar bone resorption. The results of time-course and proliferation studies showed that M-CSF stimulated both the proliferative and differentiation stages of human osteoclast formation from circulating osteoclast precursors in a dose-dependent manner. A high concentration of M-CSF (100 ng/mL) did not inhibit osteoclast formation. IL-3 and GM-CSF were also capable of stimulating human osteoclast formation, although these growth factors were much less potent than M-CSF. IL-3- and GM-CSF-stimulated osteoclast formation was inhibited by an antibody specific for human M-CSF. Osteoclast formation and lacunar resorption was not seen when either TNF-alpha, IL-1beta, IL-6 (+ soluble IL-6 receptor), or IL-11 was substituted for M-CSF during coculture. These results confirm that M-CSF is essential for human osteoclast formation from circulating mononuclear precursors, and also shows that IL-3 and GM-CSF may support osteoclast differentiation via the stimulation of M-CSF production by human monocytes.

Atlantoaxial subluxation associated with ossification of posterior longitudinal ligament of the cervical spine

STUDY DESIGN

Two case reports.

OBJECTIVE

To demonstrate two rare cases of atlantoaxial subluxation associated with ossification of the posterior longitudinal ligament of the cervical spine, in which spastic quadriplegia developed.

SUMMARY OF BACKGROUND DATA

There are only two reports of an association of diffuse idiopathic skeletal hyperostosis with atlantoaxial subluxation. This condition often accompanies ossification of the posterior longitudinal ligament of the cervical spine, but there is nothing in the literature about the association of ossification of the posterior longitudinal ligament with atlantoaxial subluxation.

METHODS

Clinical and radiographic findings of these two cases were demonstrated. In both cases laminoplasty of the cervical spine was performed with occipitoaxial arthrodesis.

RESULTS

The spastic quadriplegia of these two patients caused by myelocompression improved after surgical intervention.

CONCLUSION

Ossification of the posterior longitudinal ligament of the cervical spine may cause atlantoaxial subluxation.

Role of multinuclear cells in granulation tissue in osteomyelitis: immunohistochemistry in 66 patients

We investigated the origin of multinuclear cells (MNCs) in the granulation tissue in osteomyelitis by immunohistochemical techniques in 66 patients. 12 samples were analyzed for the presence of CD68, cathepsin K, CD11b and tartrate-resistant acid phosphatase (TRAP) activity. Many MNCs were present in the granulation tissue adjacent to a sequestrum. MNCs in contact with the sequestrum were also noted, however, no osteoblasts were found. Immunohistochemically, CD68, cathepsin K and TRAP were strongly expressed in most of the MNCs, while CD11b positive cells were not found. MNCs remote from and in contact with the sequestrum showed the same immunohistochemical features which are characteristic of osteoclasts. Further, MNCs in contact with the sequestrum had originally developed in the granulation tissue and directly infiltrated towards the sequestrum without cell-to-cell interaction with osteoblasts.

Regulation of human jaw tapping force with visual biofeedback

The purpose of this study, which made use of visual biofeedback, was to determine whether jaw tapping force reproduction is related to the strength of tapping and to investigate how jaw tapping force affects the tapping movement curve. Nine healthy examinees were asked to reproduce jaw tapping force. We found that the ease and method of regulating jaw tapping force differed depending on the target force. We also found that jaw tapping force was regulated by alteration of the jaw opening distance, the duration of the tooth contact phase, the duration of the jaw closing phase, the maximum jaw opening velocity, and the maximum jaw closing velocity. However, the duration of the jaw opening phase and cycle time was not affected by force regulation under our experimental conditions.

Delayed paraplegia caused by the gradual collapse of an infected vertebra

A case of delayed paraplegia caused by a gradual and progressive collapse of a vertebra after healing of pyogenic spondylitis is reported. A 73-year-old man was treated for a hematogenously seeded pyogenic spondylitis of the first lumbar vertebra. Magnetic resonance imaging showed a high signal intensity of the involved vertebra and adjacent discs and a paravertebral abscess without disc space narrowing. Eight months after healing of the infection, the patient had muscle weakness and paresthesia of the lower extremities, which gradually increased. The plane radiographs revealed a kyphotic deformity of 36 degrees with a collapse of the first lumbar vertebra.

MR appearance of paraganglioma of the cauda equina. Case reports

PURPOSE

To investigate the value of MR imaging for preoperative diagnosis of paraganglioma of the cauda equina.

MATERIAL AND METHODS

A retrospective review of 2 cases of paraganglioma of the cauda equina examined with MR imaging was undertaken. Features assessed included the homogeneity of the lesions, presence or absence of serpiginous flow void and thin hypointense margins.

RESULTS

In case 1, the tumor was hyperintense on the postcontrast examination and serpiginous flow void suggested vessels in the upper pole of the tumor. In case 2, the tumor was encapsulated by a thin hypointense margin on both T1- and T2-weighted images, which suggested hemosiderin.

CONCLUSION

The MR appearance may be of great value in the preoperative diagnosis of paraganglioma of the cauda equina.

Extraosseous calcified plasmacytoma causing thoracic myelopathy

We report on a rare, calcified, plasma cell tumor of the spine causing progressive myelopathy. Other unusual features were the lack of an osseous lesion at the site of the mass, considerable calcified amyloid within the mass but no identifiable amyloid elsewhere, and normal serum immunoelectrophoresis.

Propagation of various tooth impacts in the human body

The purpose of this study was to investigate how far tooth impacts were propagated in the body and whether the propagation would be influenced by posture. The impacts were propagated to all recording sites on the head and neck of the 10 examinees tested. In the recordings on the limbs, even at the most distal site, the number of examinees detecting the vibration was seven out of nine examinees. These results showed that the impacts exerted on the tooth were propagated to distal sites of limbs through the bones and soft tissues and implied that the propagated vibration would influence the whole of the body. On the other hand, as the amplitude of propagated vibration was influenced by posture and recording site, the posture during jaw functioning appears to be important.

Painful snapping in rheumatoid knees

Painful snapping caused by a solitary intra-articular nodular mass was found in 11 knee joints of 8 patients with rheumatoid arthritis. The masses were characteristically situated in the anterolateral aspect of the lateral femoral condyle of each joint, and appeared to jump and slip in and out of the patellofemoral articulation during flexion and extension. The snapping caused by the solitary mass was noticed as the joint flexed from 15 degrees to 30 degrees in 9 knees and from 50 degrees to 60 degrees in 3. Histopathological examination of the masses revealed typical findings of a rheumatoid nodule in 4 knee joints and myxomatous degeneration and collagen necrosis in 7.

Bone resorption by tartrate-resistant acid phosphatase-positive multinuclear cells isolated from rheumatoid synovium

Inflammatory reactions in rheumatoid arthritis (RA) often cause severe joint destruction. However, the mechanism of bone destruction is still a matter of controversy. To determine whether multinuclear cells found in the rheumatoid synovium can resorb bone, isolated synovial cells were assessed for tartrate-resistant acid phosphatase (TRAP) staining and the ability to resorb bone in a dentine resorption assay. TRAP-positive multinuclear cells were found in six out of 10 samples. These six samples showed resorption pit formation on dentine slices. The other four samples did not form resorption pits. The results of this study demonstrate that TRAP-positive multinuclear cells isolated from the rheumatoid synovium form resorption pits on dentine slices. Our results suggest that inflamed synovial cells in rheumatoid joints might participate in bone destruction.

Fine structure and distribution of lymphatics in the synovial membrane of monkey and human knee joints. A study using an enzyme-histochemical method

The fine structure and distribution of lymphatics in the synovial membrane of monkey knee joints, and human knees with osteoarthritis and rheumatoid arthritis, were studied by light and electron microscopy using an enzyme-histochemical method. Whole mount preparations and tissue sections were doubly stained for 5'-nucleotidase and alkaline phosphatase. The 5'-nucleotidase positive lymphatics could be distinguished from the alkaline phosphatase positive blood vessels. In monkey specimens the 5'-nucleotidase lymphatics were densely distributed in the medial and lateral parts of the suprapatellar pouch and infrapatellar fat pad, in both the superficial and deep of the sublining cell layers. Collecting lymphatics were well developed in the deep fibrous layer and in the merging epimysium. In the knees with both types of arthritis, the patterns of distribution were the same as in the monkey. No lymphatics were found in well developed villi in rheumatoid arthritis, but many blood vessels were present.

Grafted bone used in acetabular reconstruction: assessment by SPECT scintigraphy

OBJECTIVE

To investigate incorporation of the grafted bone used for acetabular reconstruction.

DESIGN

Single photon emission computed tomography (SPECT) was carried out at the 1st, 6th, and 12th month after the operation and the uptakes on serial SPECT scintigrams were normalized. The horizontal histogram of scintigraphic activity at the level of the central grafted bone in the coronal image was designated the profile curve.

PATIENTS

Seven patients who had undergone bipolar hip arthroplasty for osteoarthritis of the hip were randomly selected.

RESULTS AND CONCLUSION

Five of seven profile curves obtained at the 1st month demonstrated a single peak at the host-graft junction. The profile curve obtained at the 6th month showed two peaks at the host-graft junction and the periphery of the grafted bone in all patients. The profile curve at the 12th month showed slightly increased activity in the center of the grafted bone. This preliminary study demonstrates that comparison of the serial profile curves on SPECT is valuable in evaluating the progress of incorporation of the grafted bone in hip arthroplasty.

Iliopsoas bursa of the rheumatoid hip joint. A case report and review of the literature

Presented is the case of a 63-year-old woman, with a 30-year history of rheumatoid arthritis, whose hip was completely destroyed and accompanied with enlargement of the iliopsoas bursa. Preoperative diagnosis was confirmed by computed tomography, magnetic resonance (MR) imaging and arthrography. She was treated by resection of the iliopsoas bursa and total prosthetic replacement of the hip joint. The pathogenesis is uncertain. In the literature, enlargement of the iliopsoas bursa with rheumatoid arthritis, osteoarthritis, pigmented villonodular synovitis, and synovial chondromatosis had been reported. Nevertheless, a correct preoperative diagnosis of the enlargement of the iliopsoas bursa is very difficult. MR imaging with enhanced Gadolinium-DTPA (Gd-DTPA) is proposed as the most useful examination for preoperative diagnosis.

Interleukin-1 receptor antagonist production in cultured synovial cells from patients with rheumatoid arthritis and osteoarthritis

OBJECTIVE

To measure the amounts of interleukin-1 receptor antagonist (IL-1ra) protein produced by cultured synovial cells obtained from patients with rheumatoid arthritis (RA) and osteoarthritis (OA).

METHODS

Synovial cells obtained from patients with either RA or OA were cultured and the supernatants were measured for IL-1ra by enzyme linked immunosorbent assay.

RESULTS

The synovial cells obtained from patients with RA produced significantly smaller amounts of IL-1ra than did those obtained from patients with OA, in a late passage (third to fifth) without stimulation and a first passage both with and without stimulation (p < 0.025, respectively). In addition, when the patients with RA were divided into two groups according to the maximum number of lining cell layers, the amounts of IL-1ra produced by the proliferative type were smaller than those produced by the less proliferative type (p < 0.025).

CONCLUSIONS

The above findings suggest that IL-1ra production in RA synovial cells is suppressed, and that reduced IL-1ra protein production is one of the causes which leads to the proliferation of lining cells and persistent joint inflammation.

Joint motion of bipolar femoral prostheses

From 1982 to 1992, 251 bipolar hip arthroplasties were performed on 213 patients. Among them, 117 bipolar femoral prostheses were randomly selected to examine the behavior of abduction motion under weight-bearing loads. Roentgenographic motion study was performed at an average of 46.5 months after surgery (range, 2-110 months). One hundred one prostheses used in dysplastic osteoarthritic, rheumatoid, and revised failed total hip arthroplasty patients moved 18.2% at the outer bearing and 81.8% at the inner bearing, while 16 prostheses used in femoral neck fracture and osteonecrosis of the femoral head patients moved 49.7% at the inner bearing and 50.3% at the outer bearing. There was a statistical difference in the motion pattern between the two groups. The abduction motion behavior of the bipolar femoral prostheses was not affected by the length of the follow-up period, the diameter of the outer heads, or the position of the prostheses on immediate postoperative roentgenograms.

Bipolar hip arthroplasty without acetabular bone-grafting for dysplastic osteoarthritis. Results after 6-9 years

The authors report the clinical and radiographic results of 36 bipolar hip arthroplasties after performing excavation of the steep and shallow acetabulum without acetabular bone-grafting for dysplastic osteoarthritis. The procedures were carried out between 1981 and 1985. Survivorship analysis showed that 84.6 of the bipolar hip arthroplasties were retained for 8 years. Twenty-nine patients, which were followed for 6-9 years after surgery, were reviewed. Severity of acetabular dysplasia was classified according to the method of Crowe. Class 1 included 17 hips and class 2 included 12 hips. The average preoperative clinical score was 49 points. The average postoperative clinical hip score improved to 87 points after 6 years. Twenty-seven of the 29 hips assessed were classified as either excellent or good by Charnley's function score. Stress fracture, due to excessive acetabular excavation at the time of surgery, and femoral component loosening were major symptomatic complications. The cessation of radiographic evidence of migration of the bipolar socket was recognized in 25 of 29 procedures at 6 years after surgery (86.2%). Cineradiographic study demonstrated that the abduction motion under standing position for 20 of 24 hip joints functioned dominantly at the inner-bearing and metallic-stem interface.

[Infection after implant arthroplasty]

From 1982 to 1990, ten patients (twelve joints) who developed deep infection after total joint replacement were analysed. An average follow-up period after the surgical management was two years and eight months (range, one year and seven months to three years and ten months). Synovectomy and closed irrigation were carried out in seven of ten patients without waiting the results of cultures. In six of seven patients, the infection was successfully eradicated without removal of the components. Antibiotics were administered orally for two years after the closed irrigation. There was no recurrence. In four of ten patients, the components had to be removed. In one of four patients, synovectomy and closed irrigation failed, and arthrodesis was carried out. In three patients, loosening of the components were radiographically noticed.

Association of HLA-DR and HLA-DQ antigens with congenital dislocation and dysplastic osteoarthritis of the hip joints in Japanese people

OBJECTIVE

To investigate the frequency of HLA-DR and DQ antigens among patients with congenital dislocation of the hip joint or dysplastic osteoarthritis (OA) and to determine whether tissue typing might contribute to better understanding of these disorders.

METHODS

HLA-DR and DQ typing was undertaken in 18 patients with congenital dislocation of the hip joints, 65 patients with dysplastic OA of the hip, 42 patients with primary OA of the knee, and 40 normal controls. Typing for HLA-D antigens was performed using the standard microlymphocytotoxicity method.

RESULTS

The frequency of HLA-DR4 in patients with congenital dislocation of the hip joint (61.1%) and patients with dysplastic OA of the hip (58.5%) was significantly increased compared with normal controls (27.5%) (Pcorr < 0.05 and P < 0.01, respectively). The relative risk for HLA-DR4 was 4.1428 and 3.7104, respectively, in these 2 disease groups. The frequency of HLA-DR4 in the patients with primary OA of the knee (35.7%) did not differ significantly from that in normal controls.

CONCLUSION

The results strongly indicate that development of congenital dislocation of the hip joint and progression of dysplastic OA of the hip are associated with genes of the HLA-D region.

[The signification of total elbow replacement in the treatment of rheumatoid arthritis]

The purpose of this paper is to emphasis the signification of total elbow replacement in the treatment of rheumatoid arthritis. Total elbow replacement were performed in twenty elbows in fourteen patients who had rheumatoid arthritis from 1982 to 1990. The follow-up period ranged from 2 to 9 years. Pain relief was complete in twelve patients. Preoperation flexion averaged 119 degrees, increasing to 127 degrees. Preoperation extension averaged -34 degrees, increasing to -24 degrees postoperation. There were no infection and fracture postoperatively. Radiolucent lines were seen in four humeral components, in one ulnar component. Proximal subsidence of the humeral component were found in two elbows. Posterior dislocation occurred in three elbows. In two cases, reduction was successful by three weeks immobilization in a plaster cast with the elbow in the flexion position. Transient ulnar nerve palsy was evident in two elbows. Revision surgeries were performed in two cases, which occurred dislocation and progressive subsidence. Multiple replacements of major joints were performed in ten patients. Two joints were replaced in two patients, three joints were replaced in six patients, four joints were replaced in two patients. Four total elbow replacements were performed accompanied with other joints replacement in the same anesthesia. We recommended two joint replacements in the same anesthesia in patient with good general condition. All patients had functional improvements after total elbow replacement, especially reaching of the arm. Four patients improved the walking by being able to use stich after total elbow replacement.