Biochemical features of pseudomembrane at the bone-cement interface of loosened total hip prostheses

Biochemical features of pseudomembrane formed at the bone-cement interface of 13 failed total hip replacements were studied and histological examination of the pseudomembrane was conducted. The results of biochemical analyses revealed on average hydroxyproline, 86 micrograms/mg; water content, 57%; hexosamine, 12 micrograms/mg; glucosamine/galactosamine, 1.4%; and calcium, 2.1%. Approximately 78% of collagen was extracted with pepsin, whereas only 8 and 0.3% collagen were extracted with acetic acid and neutral salt, respectively. On further differential salting out of the extracted collagen, about 77% was type I collagen, 19% type III, and 2.6% type V. Unlike pseudoarthrosis of fracture, no type II collagen was identified. Overall biochemical features in the light of the histological appearance suggested that pseudomembrane resembles granulation tissue. Bone healing mechanisms at the bone-cement interface appear to differ from that of fracture healing.

A search for rheumatoid arthritis-associated nuclear antigen and Epstein-Barr virus specific antigens or genomes in tissues and cells from patients with rheumatoid arthritis

Pannus extracts and/or cells and tissues from rheumatoid arthritis (RA) patients and controls were tested for the presence of RA-associated nuclear antigen (RANA), anti-RANA, Epstein-Barr virus (EBV)-specific antigens, and EBV genomes. Using our present rather insensitive methods, RANA was rarely detected in RA pannus extracts or tissues, whereas anti-RANA was commonly found. EBV-specific antigens or genomes could not be detected in a limited number of tissues tested using our present methods. The data suggest that EBV may not be the primary event causing RA through direct infection and transformation of synovial tissues.

Voice disorders without organic diseases of the larynx. A 10-year review of 62 patients

We reviewed the clinical records of 62 patients with voice disorders without organic diseases of the larynx who were examined in the Department of Otolaryngology, Kurume University Hospital during the 10 years from 1971 to 1980. There were 9 patients with psychogenic dysphonia, 24 with vocal abuse, 4 with spastic dysphonia, 9 with mutational voice disturbance, 8 with virilization of voice, 7 with dysphonia attributed to diseases of other organs than the larynx, and 1 with senile change of voice. The clinical service to the patients with these kinds of dysphonia has been poor in Japan for lack of trained voice pathologists. This has been also the case with our department. Recognition for the necessity of voice pathologists is strongly demanded.

Secular trends in mortality for cerebrovascular diseases in Japan, 1960 to 1979

In Japan the age-adjusted death rate from cerebrovascular diseases has decreased for both males and females since 1965. This downward trend accelerated in 1971. This is not due to artifacts such as changes in diagnostic methods of stroke and in rules for coding cause of death on death certificates. The progress and spread of detection, treatment and control of hypertension appears to have been the greatest contributing factor. Furthermore, improvement in the dietary habits, that is, a decrease in salt intake and an appropriate increase in the amount of animal fat and protein taken are also considered to have contributed to the decline in stroke mortality. The regional difference in the standardized mortality ratio for stroke markedly observed in 1960 was still seen even in the 1970's, but the difference became smaller. Mechanization of farming works may be partly accountable for the decrease in the regional difference.

Compositional changes of glycosaminoglycans of the human menisci with age and degenerative joint disease

The compositional profiles of meniscal glycosaminoglycans (GAG) at different ages and in the presence of osteoarthritis were determined. The major components of meniscal GAG were chondroitin sulphates and dermatan sulphate. Other major elements were keratan sulphate and hyaluronic acid. Chondroitin sulphate-4 and -6 decreased with age. Dermatan sulphate content remained unchanged with age whereas keratan sulphate and hyaluronic acid increased. GAG compositional profiles of meniscus from osteoarthritis were similar to those of comparable age group. The results indicate that GAG compositional make-up of the meniscus changes with age. These changes may make it more susceptible to horizontal tears in the elderly.

Risk factors for cerebral hemorrhage and cerebral infarction in a Japanese rural community

A ten-year follow-up study of stroke among residents 40 years and older in a rural community located on Shikoku Island, Japan, was completed in 1977. The response rate for the initial examinations was 85% of 920 males and 90% of 1,012 females. Seven hundred and seventy-two males and 901 females who were initially free of stroke were followed from July 1967 through June 1977. The incidence of all strokes was 10.47 per thousand person-years for males and 6.41 per thousand person-years for females. The statistically significant risk factors for stroke were age, male sex, elevated blood pressure, ECG abnormalities, and funduscopic abnormalities. Elevated blood pressure was the strongest risk factor and mean arterial pressure was the best predictive measure. Twice as high a proportion of strokes were subclassified as cerebral hemorrhage (26%) in this study as have been reported in comparable studies in the United States (12-15%). An inverse relationship between serum cholesterol levels and cerebral hemorrhage incidence, but not cerebral infarct, was observed. High alcohol intake was a risk factor for cerebral hemorrhage but not for cerebral infarct. No relationship between stroke and weight was observed despite the relationship of stroke to blood pressure and of weight to blood pressure.

Heel deformity in hereditary spastic paraplegia

The association of pes cavus deformity and neurological disorder is well known. Varus deformity of the heel is often associated with, and may even precede the development of pes cavus. Clinical and radiographic examinations of the feet of members of three kindreds of hereditary spastic paraplegia, a rare neurologic disorder, suggested that the autosomal dominant form manifests a significantly higher incidence and degree of heel varus deformity than the autosomal recessive form of the disease. Therefore, heel varus deformity may be a sign suggestive of autosomal dominant inheritance of hereditary spastic paraplegia.

Incidence of stroke in Shibata, Japan: 1976-1978

A stroke registry was established in Shibata City, Niigata Prefecture, Japan (population 75,000) in 1976. WHO recommendations for criteria were followed. This paper reports stroke incidence for the initial 3 years of the registry: 1976 through 1978. All living patients were examined clinically by a staff physician. Only patients with a diagnosis of first stroke were included in the study. Sensitivity of the referral system was estimated at 85 + %, comparable to that in American studies. Average annual incidence per 1,000 in resident greater than or equal to 20 years was 2.61 for all strokes (3.42 for males; 1.88 for females), 0.20 for subarachnoid hemorrhage, 0.61 for cerebral hemorrhage, 1.51 for cerebral infarction - rates similar to those reported 10-20 years previously for the United States. The male-female ratio, 2:1, reflected a high rate among males, low among females. Rats among Shibata males were higher than 1972 U.S. rates reported by the Epidemiologic Study Group; rates among Shibata females were lower than corresponding U.S. rates. Incidence of all strokes combined increased with age, the age relationship being strongest for cerebral infarction. No subarachnoid hemorrhage was observed in Shibata residents greater than or equal to 70 years of age.

Expression of Forssman antigen of avian lymphoblastoid cell lines transformed by Marek's disease virus or avian leukosis virus

The expression of Forssman-type heterophile antigen on Marek's disease (MD) virus (MDV)-transformed cell lines, MDCC-MSBI 1, -HP1, -RP1 and -BP1, and avian leukosis virus (ALV)-transformed cell lines, LSCC-1104B1 and -1104X5 was investigated by membrane immunofluorescence and complement-dependent antibody cytotoxicity tests. Forssman antigen was detected on a high percentage of the cells in two ALV-transformed cell lines and on a smaller percentage of splenic lymphocytes from normal chicken. Of the MDV-transformed cell lines tested only the RP1 and BP1 cell lines, derived from transplantable MD tumours, expressed Forssman antigen, while the MSB1 and HP1 cell lines, derived from MD lymphomas, did not. Forssman antigen appears to be unrelated to MD tumour-associated surface antigen (MATSA).

Distribution of Forssman antigen in chickens

The distribution of Forssman antigen in various tissues of chickens was studied by the indirect and direct immunofluorescence (IF) tests using rabbit immune serum against purified Forssman glycosphingolipid (GSL) [GalNAc (alpha, 1-3)GalNAc(beta, 1-3)Gal(alpha, 1-4)Gal(beta, 1-4)Glc-ceramide]. A general finding in all tissue sections was the presence of Forssman antigen in vascular endothelium and perivascular connective tissues. Erythrocytes gave a Forssman positive reaction, but the intensity of fluorescence was slight. Forssman antigen was found in about 20% of all peripheral leukocytes. Fractionation of lymphocytes from peripheral blood into T and B lymphocytes showed that about 30% of the B lymphocytes gave a positive reaction, while only 2-3% of the T lymphocytes gave a positive reaction. About 40% of bone marrow cells expressed Forssman antigens. On the other hand, about 40-50% of adherent cells in vitro cultures from spleen were Forssman-positive. The antigen was also abundant in hematopoietic organs, such as spleen, thymus and the bursa of Fabricius. Positive reactions in the digestive tract, ovary, testis and skin varied from portion to portion of the tissues. In brain and spinal cord, only the vascular endothelium gave a positive reaction. In peripheral nerves, only the connective tissue stroma around the nerve fibers gave a positive reaction. In other tissues, the distribution of the antigen was generally in accord with the results of Tanaka and Leduc (1956). These positive reactions in the IF test were specifically inhibited by addition of purified Forssman GSL. The distributions of Forssman antigen in tissues were found to be the same in chickens of various ages.

A case of facial diplegi following herpes zoster ophthalmicus

A 71-year-old man developed a facial diplegia following right ophthalmic zoster. Neurological examination also revealed loss of reflexes in the lower limbs with increase of CSF protein. Unusual cases of the Ramsay Hunt syndrome and Guillain-Barré syndrome seen with herpes zoster were reviewed. These cases including our case may suggest that the bilateral involvement or its wider spread throughtout nervous tissue can rarely occur in the Ramsay Hunt syndrome and its subgroups.

Partial Klüver-Bucy Syndrome following probably herpes simplex encephalitis

An autopsy case of probable herpes simplex encephalitis (HSE) showed the partial Klüver-Bucy syndrome from 1 to 7 months after the onset, which consists of strong oral tendencies, emotional changes and possible hypersexuality. Several cases of the syndrome in definite or probable HSE were reviewed in this paper. In these cases including our case, the partial or complete Klüver-Bucy syndrome has appeared from some interval (2 weeks--1 month) after the acute phase, so that the syndrome should be noticed in survived or prolonged cases of HSE, as significant clinical symptoms suggesting bilateral involvement of the temporal lobes and limbic areas.

Effects of ligamentous injury on ankle and subtalar joints: a kinematic study

Using 10 normal fresh cadaveric legs, kinematic effects of ligamentous injuries around the ankle joint were studied while the ankle joint moved from maximum plantar flexion to maximum dorsiflexion in saggittal plane. A series of anteroposterior and lateral sequential roentgenograms was taken both in the normal and subsequently created injured condition, to evaluate instant center of rotation and horizontal rotation pattern in the hindfoot complex. Although the pattern of instant center of rotation of the ankle joint varied among normal condition, the majority fell in a prescribed area. The deviation of instant centers from those in uninjured condition was most evident in lateral ligament injury. The average horizontal rotation between the tibia and calcaneus was 8 degrees in the uninjured condition; 6 degrees in the subtalar joint and 2 degrees in the ankle joint. In both medial and lateral injuries, more rotation in the subtalar joint was noted in plantar flexion phase. In the ankle joint, the degree of excessive rotation in plantar flexion range was greater in lateral injury than medial injury, but that in dorsiflexion range was greater in medial injury. It appeared that while every component of collateral ligaments around the ankle was important in controlling rotation in plantar flexion range, the posterior portion of the deltoid ligament is most important in the forsiflexion range.

Zoster meningitis and radiculomeningitis after tick bite. Cytological findings in cerebrospinal fluid

Cytological changes in 9 samples of cerebrospinal fluid (CSF) from 5 patients with zoster meningitis and 12 samples from 5 patients with radiculomeningitis after tick bite were examined. 5 days after the onset of the skin eruption, the CSF cells in zoster meningitis consisted of many mononuclear blast forms--large lymphocytes and 'immature' plasma cells. 11-15 days after the onset of the skin rash, they were replaced by small lymphocytes, some 'mature' plasma cells and monohistiocytes. In radiculomeningitis after tick bite, however, the CSF cells examined 10-21 days after the onset of radicular pain consisted of many large lymphocytes, immature plasma cells and a few neutrophils. From these findings, it might be suggested that the acute meningeal reaction of zoster meningitis subsides within about 1 week after the onset of the skin rash, but that of radiculomeningitis after tick bite continues at least for 2-3 weeks after the onset of radicular pain.

Classification and treatment of ankle fractures

Treatment of ankle fractures should restore normal ankle joint anatomy. The systematic approach in analysis based on understanding of the anatomy, the roentgenograms and the mechanism of injury allow one to determine the elements of the lesion. The Lauge-Hansen classification is most helpful because it takes into account the ligamentous damage that may have occurred, therefore, giving one a better appreciation of the extent of the injury. Open reduction that accurately restores the joint anatomy produces the best and most enduring end-results. Early mobilization of the ankle is possible when internal fixation has produced stability that withstands the dynamic activity of controlled use. A "cook book" approach should not be used; rather, the fundamental principles should be understood, and then the methods of treatment will be self-evident.

Current concepts in synovial fluid analysis

The systematic examination of synovial fluid confirms the noninflammatory nature of degenerative joint disease, is diagnostic of gout, pseudogout, and septic arthritis, and will usually allow the identification of rheumatoid arthritis, systemic lupus erythematosus and Reiter's syndrome.

Scintigraphy in the diagnosis of osteonecrosis

Scintigraphy, using 99mTc diphosphonate, has the potential for diagnosing osteonecrosis before irreversible changes are visible in routine roentgenograms. If obtained within weeks of an avascular insult, a cold area will appear on scintiscan. However, months later, the revascularization and reparative processes of the dead bone produce a hot area on scintiscan.

Autosterilization in low-velocity bullets

Following a previous study (1) in which contaminated low-velocity bullets were discharged into sterile gelatin blocks with resultant growth of organisms along projectile tracts, the authors fired bullets coated with 1 drop of Staph. aureus-contaminated medium and bullets under sterile conditions into sterilized sand. Each contaminated projectile and its gun barrel were culture positive after firing. Therefore bullets should not be ruled out as possible sources of infection.

Scintimetric evaluation of complications after femoral neck fractures

The primary surgical approach to the femoral neck fracture should be one with the lowest mortality and morbidity. Internal fixation appears to be the safe and logical approach for most of the reducible intracapsular fractures. Careful follow-up of these patients then is important. 85Sr scintimetry is a simple and accurate method in the early detection and evaluation of secondary complications in these patients. The 85Sr scintimetric pattern in the normal healing process was defined in relation to time interval after the fracture. At any time after 4 months following fracture, those hips destined for osteonecrosis, with or without non-union, showed significantly more radionuclide uptake over the femoral head than those hips which healed normally. In non-union there was a trend toward increased counts over the fracture site during 6 to 18 months after fracture, but no such tendency was noted in other periods.

In vitro effects of bone cement on S. aureus growth and phagocytosis and glucose metabolism of macrophage: a preliminary study

A preliminary study of the effects of Surgical Simplex, mixed for various time periods, was performed on S. aureus growth rate, and phagocytosis and glucose metabolism of macrophage in vitro. Quantitatively, no significant effects of the mixture on S. aureus growth rate were observed. The cement mixed for less than 4 min tended to cause adverse effects on phagocytosis rate and hexose monophosphate shunt activity of macrophage. This information may not be directly applicable to in vivo, but in vitro the cement mixture in a certain situation can cause decreased phagocytosis and hexose monophosphate shunt activity of macrophage.

Failed polycentric total knee prostheses

Four failed polycentric total knee prostheses were evaluated by clinical examination of the patients and surface analysis of the removed prosthetic components. The failures were secondary to a poor relationship of the prosthetic components in three cases and to abutment of the tibial spine against the femoral condyle in the fourth. A poor relationship of the prosthetic components was not necessarily secondary to malpositioning, because the positioning may have been accurate but the relationships became abnormal when the knee was unstable. Scanning electron-microscope examination revealed various wear patterns but no significant correlation was noted between the morphological type and the degree of wear. Accurate placement of the components and restoration of knee stability were critical requirements for the polycentric total knee prosthesis to be successful.