Intramedullary spinal cord metastasis of ovarian tumor

STUDY DESIGN

Case report.

OBJECTIVES

To report a case of a thoracic intramedullary spinal cord metastasis of ovarian tumor in a 59-year-old woman.

SETTING

Shiga, Japan.

CASE REPORT

A case of a thoracic intramedullary spinal cord metastasis of ovarian tumor in a 59-year-old woman is reported. She received abdominal ovariectomy for the ovarian adenocarcinoma 4 years before she suffered from back pain and showed neurological symptoms. The thoracic intramedullary lesion was confirmed by preoperative magnetic resonance imaging. She showed complete paralysis before operation. The excision of the tumor was achieved through the posterior approach. Histologically, the diagnosis of metastasis of adenocarcinoma was made.

CONCLUSION

Although she did not show any postoperative neurologic recovery, her general condition was good and there was no evidence of recurrence 24 months after surgery.

Antibacterial and antipeptide antibodies in Japanese and Finnish patients with rheumatoid arthritis

It has been suggested that Proteus infection may be involved in the pathogenesis of rheumatoid arthritis (RA). Bacterial and peptide immune responses in patients with RA and other control subjects were investigated in two geographically different populations. Serum samples from Finnish patients with early ( n=72) and advanced ( n=27) RA and 30 Finnish healthy controls, as well as from Japanese RA patients from two different locations: Tokyo ( n=30) and Otsu ( n=30), 18 patients with systemic lupus erythematosus (SLE) and 23 Japanese healthy controls were all screened for the total, and class-specific (IgG, IgA and IgM) antibodies against Proteus mirabilis, Escherichia coli and Serratia marcescens by indirect immunofluorescence assay. These samples were also tested for the determination of levels of isotypic antibodies against the shared epitope involving 16-mer synthetic peptides containing the EQRRAA or ESSRAL sequences and compared to scrambled control peptide by using an enzyme-labeled immunosorbent assay method. Significantly elevated levels of IgG and IgM antibodies to P. mirabilis and antibodies against both EQRRAA and ESSRAL peptides were detected in sera of Finnish patients with early and advanced RA, and in Japanese patients from Otsu or Tokyo compared to their corresponding control groups. In contrast, no difference either in the total or in any of the isotypic antibodies were observed between these groups when serum samples were screened against each of E. coli and S. marcescens or against the control peptide. Furthermore, there was a significant correlation between the antibody levels against Proteus bacteria only and both EQRRAA and ESRRAL peptides. Our findings support the possibility for specific involvement of P. mirabilis in the etiopathogenesis of RA even in early cases.

Esophageal carcinoma with tracheal stenosis due to tumor invasion and long survival after chemoradiotherapy

For patients who have esophageal carcinoma with tracheal invasion surgery is usually not indicated because operative complications are considerable and the prognosis is poor. We experienced complete regression of a large esophageal carcinoma with tracheal stenosis due to tumor invasion without tracheo-esophageal fistula. Irradiation of 68 Gy was delivered to a long T field from the neck to the lower thoracic esophagus, and was combined with chemotherapy using cisplatin and 5-fluorouracil. The tumor decreased markedly in size and the tracheal stenosis resolved. The patient has survived for 4 years, although second primary early esophageal carcinoma and hypopharyngeal carcinoma were detected 2 years after his initial chemoradiotherapy. Although the prognosis of advanced esophageal carcinoma with invasion of other organs is usually poor, the effect of chemoradiotherapy can sometimes be dramatic and a good result can be achieved in such patients.

Effects of serotonin 1A agonist on acute spinal cord injury

STUDY DESIGN

We evaluated the effects of serotonin (5-HT) agonists on in vitro models of spinal cord compressive injury. Evoked potentials in injured rat spinal cords (n=24) were recorded during perfusion with 5-HT agonists.

OBJECTIVES

To evaluate the therapeutic effects of 5-HT agonists on the recovery of compound action potentials in injured spinal cords.

METHODS

Rat dorsal columns were isolated, placed in a chamber, and injured by extradural compression with a clip. Conducting action potentials were activated by supramaximal constant current electrical stimuli and recorded during perfusion with 5-HT agonists and antagonists.

RESULTS

After inducing compression injuries, mean action potential amplitudes were reduced to 33.9+/-5.4% of the pre-injury level. After 120 min of perfusion with Ringer's solution, the mean amplitudes recovered to 62.8+/-8.4% of the pre-injury level. At a concentration of 100 micro M, perfusion with tandospirone (a 5-HT1A agonist) resulted in a significantly greater recovery of mean action potential amplitudes at 2 h after the injury (86.2+/-6.9% of pre-injury value) as compared with the control Ringer's solution (62.8+/-8.4% of pre-injury value, P<0.05). In contrast, quipazine (a 5-HT2A agonist) accelerated the decrease of amplitude (54.5+/-11.7% of pre-injury value). 5-HT1A and 5-HT2A agonist did not consistently alter latencies of the action potentials.

CONCLUSION

The 5-HT1A receptor agonist was effective for the recovery of spinal action potential amplitudes in a rat spinal cord injury model.

Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels

The aim of this study was to determine whether postoperative malalignment of the cervical spine after anterior interbody fusion surgery promotes degenerative changes in the neighboring intervertebral discs. Forty-two patients who underwent anterior interbody fusion surgery for cervical spondylosis and disc herniation (34 men, 8 women) were followed for an average of 9.8 years. The average age at surgery was 50.2 years. Twenty-three patients underwent a single-level fusion, 17 underwent two-level fusion, and 2 had three levels fused. The Japanese Orthopaedic Association cervical myelopathy score, with a normal score 17 points, was 11.7 before surgery and 14.9 at follow-up. Neurological status was significantly improved postoperatively, and the improvement was preserved thereafter in most cases (paired t-test, P<0.001). Degenerative changes were evident on radiological examination in the levels adjacent to the fused segment in 21 of the 42 (50%) patients. Eight of these 21 patients demonstrated neurological deterioration caused by an adjacent disc lesion. A total of 43% of the patients with adjacent-level degeneration had malalignment of the cervical spine, such as kyphosis or sigmoid curvature. In addition, degenerative change in adjacent intervertebral levels was observed in 77% of kyphoses of the fused segment. These were statistically significant (Fisher exact method, P<0.05, P<0.04, respectively). Our findings suggest that one of the factors promoting degenerative change in adjacent intervertebral levels after anterior cervical fusion for degenerative disorders is postoperative kyphotic change in the cervical spine and the fused segment.

Spondyloarthropathies in Japan: nationwide questionnaire survey performed by the Japan Ankylosing Spondylitis Society

OBJECTIVE

The Japan Ankylosing Spondylitis Society conducted a nationwide questionnaire survey of spondyloarthropathies (SpA) in 1990 and 1997, (1) to estimate the prevalence and incidence, and (2) to validate the criteria of Amor and the European Spondylarthropathy Study Group (ESSG) in Japan.

METHODS

Japan was divided into 9 districts, to each of which a survey supervisor was assigned. According to unified criteria, each supervisor selected all the clinics and hospitals with potential for SpA patients in the district. The study population consisted of all patients with SpA seen at these institutes during a 5 year period (1985-89) for the 1st survey and a 7 year period (1990-96) for the 2nd survey.

RESULTS

The 1st survey recruited 426 and the 2nd survey 638 cases, 74 of which were registered in both studies. The total number of patients with SpA identified 1985-96 was 990 (760 men, 227 women). They consisted of patients with ankylosing spondylitis (68.3%), psoriatic arthritis (12.7%), reactive arthritis (4.0%), undifferentiated SpA (5.4%), inflammatory bowel disease (2.2%), pustulosis palmaris et plantaris (4.7%), and others (polyenthesitis, etc.) (0.8%). The maximum onset number per year was 49. With the assumption that at least one-tenth of the Japanese population with SpA was recruited, incidence and prevalence were estimated not to exceed 0.48/100,000 and 9.5/100,000 person-years, respectively. The sensitivity was 84.0% for Amor criteria and 84.6 for ESSG criteria.

CONCLUSION

The incidence and prevalence of SpA in Japanese were estimated to be less than 1/10 and 1/200, respectively, of those among Caucasians. The adaptability of the Amor and ESSG criteria was validated for the Japanese population.

Prevalence of large-joint osteoarthritis in Asian and Caucasian skeletal populations

OBJECTIVE

To determine ethnic variations of large-joint osteoarthritis (OA) in past populations.

METHODS

One thousand two hundred and nine adult skeletons, excavated from archaeological sites in Japan, China and France were assessed for OA as defined by the presence of eburnation.

RESULTS

Within Asian skeletal populations, elbow OA and patellofemoral joint OA were more common in hunter-gatherers than in agriculturalists. Compared with Caucasians, the Asian skeletal population had a higher prevalence of tibiofemoral joint OA.

CONCLUSION

The relative frequencies of OA within and between ethnic groups at certain joint sites have changed over time from the past to the present.

Effects of estrogen on interleukin-6 production in rheumatoid fibroblast-like synoviocytes

OBJECTIVE

In view of the importance of estrogen and IL-6 in the pathogenesis of rheumatoid arthritis (RA), the effects of 17 beta-estradiol (E2) on interleukin (IL)-6 production in cultured rheumatoid fibroblast-like synoviocytes were investigated.

METHODS

Cultured fibroblast-like synoviocytes obtained from RA joints were treated with the vehicle (control), as well as 10(-8) and 10(-6) M of E2, with or without IL-1 beta stimulation. After 72 hours of culture, the levels of IL-6 in supernatants were measured by ELISA.

RESULTS

Treatment with 10(-8) and 10(-6) M of E2 had no effect on the constitutive production of IL-6 in cultured fibroblast-like synoviocytes. However, E2 increased IL-1 beta-induced IL-6 production in a dose-dependent manner, with a mean 12.5% increase with 10(-8) M of E2 (p = 0.048) and 33.4% with 10(-6) M (p < 0.0001) versus the control.

CONCLUSION

Estrogen up-regulates IL-1 beta-induced IL-6 production in cultured fibroblast-like synoviocytes, possibly contributing to the enhancement of rheumatoid inflammation in synovial tissues.

Did ossification of the posterior longitudinal ligament of the spine evolve in the modern period? A paleopathologic study of ancient human skeletons in Japan

OBJECTIVE

To investigate the historical origins of ligamentous ossifications of the spine in Japan.

METHODS

We studied skeletons of Jomonese of the period 5000-2300 years BP, of Japanese of the 17th-19th century Edo Period, and of Ainu of the 18th-20th century in Japan with special emphasis on spinal ligament ossifications as in the posterior longitudinal ligament. A comparison to our previous study on ancient Chinese skeletons was done.

RESULTS

Cervical ossification of the posterior longitudinal ligament (OPLL) was the only ossification that increased significantly in prevalence in people of the near-modern period in comparison to the Neolithic gathering-hunting people.

CONCLUSION

Socioeconomic changes from a subsistence gathering-hunting economy to the near-modern livelihood depending on rice-eating and a diet high in vegetable protein are speculated to be responsible for the prevalence increase of cervical OPLL.

Spontaneous atlantoaxial rotatory fixation in old age after cerebral infarction: case report

STUDY DESIGN

Case report of spontaneous Fielding and Hawkins Type I atlantoaxial rotatory fixation in a 78-year-old man after hemiplegia and homonymous hemianopsia caused by cerebral infarction.

OBJECTIVES

To describe a case of spontaneous atlantoaxial rotatory fixation in old age and review previous adult cases of atlantoaxial rotatory fixation without fracture.

SUMMARY OF BACKGROUND DATA

Atlantoaxial rotatory fixation in adults is a relatively rare finding and is mainly caused by trauma. To the author's knowledge, there has been no previous report of spontaneous atlantoaxial rotatory fixation in old age.

METHODS

The patient's head was fixed in a 40 degrees left-rotated position. Left hemiplegia and homonymous left-side hemianopsia developed due to cerebral infarction. Computed tomography of the cervical spine clearly showed rotatory fixation of the atlas on the axis.

RESULTS

Successful reduction was obtained after 1 day of skull traction.

CONCLUSIONS

It was hypothesized that repeated left-rotational stress due to homonymous hemianopsia loaded to the atlantoaxial joint caused abnormal laxity of the joint.

Prevalence of hip osteoarthritis and acetabular dysplasia in french and japanese adults

OBJECTIVE

: To determine ethnic variations of acetabular morphology, and to delineate their relationship with hip osteoarthritis (OA).

METHODS

: Radiographs of 283 French men, 118 French women, 414 Japanese men and 368 Japanese women, aged 20-79 yr, who underwent intravenous urography were assessed by a single observer for morphometric measurement and hip OA scoring.

RESULTS

: The standardized morbidity ratio (SMR) for hip OA was highest in French men and lowest in Japanese men, whereas the SMR for acetabular dysplasia was highest in Japanese women and lowest in French men. French men and women had the highest centre-edge angle, followed by Japanese men then Japanese women.

CONCLUSION

: In a large number of subjects assessed by a single observer, this study confirms other previous reports that the relationship between acetabular dysplasia and risk of hip OA is negative.

Purification of a low-molecular-weight phospholipase A(2) associated with soluble high-molecular-weight acidic proteins from rabbit nucleus pulposus and its comparison with a rabbit splenic group IIa phospholipase A(2)

An intervertebral disc is a large peice of avascular cartilage rich in proteoglycans and water consisting of gelatinous nucleus pulposus and fibrous annulus fibrosus. The soluble fraction of rabbit nucleus pulposus exhibited unusually high Ca(2+)-dependent phospholipase A(2) (PLA(2)) activity (about 70% of the total PLA(2) activity). The soluble PLA(2) activity was 6-7-fold higher than those of rabbit annulus fibrosus and spleen. The PLA(2) was bound to an anion-exchange column at pH 7.4, and eluted near the void volume as a broad peak on gel-filtration on a TSKgel SuperSW3000 column developed with a buffer containing 0.1-0.2 M salt. When the gel-filtration column was developed in the presence of 1 M salt, almost all the PLA(2) activity was eluted near the total available volume. The soluble PLA(2) was purified to near homogeneity. A Ca(2+)-dependent PLA(2) was also purified from the fractions extracted with 1 M KBr from nucleus pulposus. For comparison, we purified a Ca(2+)-dependent PLA(2) from the KBr fraction of spleen. The splenic PLA(2) was identical to a group IIa PLA(2), as judged from its N-terminal amino acid sequences and mass spectra. On SDS-polyacrylamide gel electrophoresis the enzymes purified from the soluble and KBr fractions of nucleus pulposus both gave a major 15. 7-kDa band at the same position as splenic group IIa PLA(2). These results suggest that group IIa PLA(2) is associated with soluble high-molecular-weight proteins, most likely proteoglycans, in the extracellular matrix of rabbit nucleus pulposus.

Polymorphic CAG repeats of the androgen receptor gene in Japanese male patients with ankylosing spondylitis

OBJECTIVE

In view of a possible role of androgens in the pathogenesis of ankylosing spondylitis (AS), we investigated the association between Japanese male patients with AS and CAG microsatellites of the androgen receptor (AR) gene which related to the AR transactivation function.

METHODS

Peripheral blood was collected from 39 men with AS and 305 male control subjects. The number of CAG repeats in exon 1 of the AR gene was determined.

RESULTS

CAG repeat lengths in AS patients were significantly shorter than those in the controls (median value 22 vs 23; P = 0.03). However, there was no significant difference in CAG repeats between HLA-B27-positive and -negative patients (median value 22 vs 22; P = 0.78).

CONCLUSIONS

Shorter CAG repeats of the AR gene, presenting high levels of transactivation activity, may play a role in male AS.

Liposarcoma associated with multiple intramuscular lipomas. A case report

A 71-year-old slender, previously healthy man was admitted to the authors' institution because of a huge painless mass in his left scapular area. Physical examination revealed a second soft tissue mass in his right scapular region and a third soft tissue mass in the anterior side of his right shoulder. Surgical treatment including marginal resection of the second and third small masses followed by wide local resection of the huge tumor was performed. Histologic examination showed that the first mass was a well differentiated lipomalike liposarcoma, whereas the second and third lesions were identified as intramuscular lipomas. A review of the literature showed two cases of retroperitoneal liposarcoma associated with multiple subcutaneous lipomas and two cases of liposarcoma involving an extremity associated with multiple subcutaneous lipomas. There is no previous report in which intramuscular liposarcoma was associated with multiple intramuscular lipomas.

Mechanical stress induces the expression of high molecular mass heat shock protein in human chondrocytic cell line CS-OKB

OBJECTIVE

Mechanical stress is an important regulator of chondrocyte function, but it is unknown how chondrocytes respond to mechanical stress. This study was performed to clarify the underlying mechanisms in human chondrocytes.

DESIGN

Using a Flexercell strain unit (25% maximal elongation, 0.05 Hz-cyclic manner, and 48 h), mechanical stimulation was applied to confluent CS-OKB cells, human chondrocytic cells. To analyze transcriptional changes in response to mechanical stress, differential display reverse transcription-polymerase chain reaction (DDRT-PCR) and Northern blot analysis were performed.

RESULTS

Among several differentially displayed fragments, one fragment (927 bp) tentatively named as SIC (Stress-Induced Chondrocytic) 1 was isolated from the human chondrocytic cell line and identified as one of the high molecular mass heat shock proteins.

CONCLUSION

Mechanical stress induces the expression of a high molecular mass heat shock protein corresponding to SIC 1 in human chondrocytic cells. SIC 1 may play an important role in the mechanical stress-responded metabolism of human chondrocytes.

Altered postnatal expression of insulin-like growth factor-I (IGF-I) and type X collagen preceding the Perthes' disease-like lesion of a rat model

The spontaneously hypertensive rat (SHR) is a widely used animal model for the study of hypertension. It also exhibits an osteonecrosis of the femoral epiphysis that resembles the clinical features of Perthes' disease in humans. In this rat model, occlusion of the epiphyseal vessels occurs as a result of a breakdown of the mechanically vulnerable epiphysis. The postnatal development of the epiphysis recapitulates the serial events of the endochondral ossification (i.e., cartilage formation), chondrocyte hypertrophy, cartilage mineralization, vascularization, and introduction of osteoblasts that form the secondary ossification center within the epiphysis. In the present study, a detailed radiographic and histological analysis demonstrates that the osteonecrosis is preceded by a disturbance of the cartilage mineralization and a disturbance of the ossification, despite a normal hypertrophy of the epiphyseal cartilage. These observations suggest that abnormal development of the femoral epiphysis occurs much earlier than manifestation of the osteonecrosis. They lead us to a hypothesis that yet-unclarified transitional events between the cartilage hypertrophy and the cartilage mineralization may be affected in SHRs. Type X collagen is a developmentally regulated matrix molecule that is implicated in the mineralization of the hypertrophied chondrocytes. We show that the expression of type X collagen during epiphyseal ossification is delayed in SHRs (vs. normal controls), suggesting disturbed growth and/or differentiation of the epiphyseal chondrocytes. Postnatal growth and differentiation of the chondrocytes at least partly depend on insulin-like growth factor-I (IGF-I), which is produced by the chondrocytes in response to the pituitary growth hormone and stimulates cartilage growth in situ. The present study demonstrates an altered IGF-I expression during early postnatal life in SHRs and suggests that the altered IGF-I expression as well as the following delay in upregulation of type X collagen may cause the mechanical vulnerability of the femoral epiphysis in SHRs.

Vitamin D receptor gene polymorphisms and osteoarthritis of the hand, hip, and knee: acase-control study in Japan

OBJECTIVE

To investigate the association between vitamin D receptor (VDR) gene polymorphisms andJapanese female patients with osteoarthritis (OA) of the hand, hip, and knee.

METHODS

BsmI,ApaI, andTaqI restriction fragment length polymorphisms (RFLPs) of the VDR gene were analysed in 270Japanese female patients with radiographic OA of the hand, hip, tibiofemoral (TF) joint, andpatellofemoral (PF) joint, as well as in female controls.

RESULTS

There was no significant association between the VDR gene RFLPs and OA of the hand, hip, TFjoint, PF joint, or polyarticular involvement. The previously detected preventive genotype of the VDRgene was uncommon in our test population.

CONCLUSION

The relative importance of VDR gene polymorphism in the development of OA may vary betweenethnic groups.

Expression of genes for estrogen receptors alpha and beta in human articular chondrocytes

OBJECTIVE

To investigate the gene expression of estrogen receptor (ER) alpha and ERbeta in human articular chondrocytes.

METHODS

16 articular cartilage specimens were obtained from 15 patients during surgery. Three of the specimens were from men and 13 from women; three from hip joints and 13 from knee joints; four were normal and 12 showed osteoarthritic cartilage. Total RNA was extracted from the articular chondrocytes and the expression of both ERalpha and ERbeta genes was investigated by the reverse transcription-polymerase chain reaction (RT-PCR) method.

RESULTS

Gene expressions of ERalpha were detected in all specimens and those of ERbeta were found in 15 specimens by the RT-PCR method. There was a significant correlation between the amounts of ERalpha and ERbeta. Expression levels of both genes were significantly higher in men than in women. There were no significant differences in the expression levels of both ER genes between the hip and knee joint sites, nor between normal and osteoarthritic tissues.

CONCLUSION

This study is to our knowledge the first to demonstrate the gene expression of both ERalpha and ERbeta in human articular chondrocytes. Since there are some functional differences between the two receptors, the effects of estrogen on cartilage metabolism should be elucidated by two different receptor mechanisms.

Sociodemographic factors and failure of hip arthroplasty

To identify the sociodemographic and lifestyle factors related to development of aseptic loosening after a cemented total hip arthroplasty (THA), 151 consecutive primary THAs performed at a single hospital in a rural district of Japan, at a mean follow-up of 7.5 years, were reviewed. Based on the medical records collected during hospital admission for THA, in which sociodemographic and lifestyle backgrounds had been recorded by the nurse, answers regarding residence, education, employment, engagement in agricultural work, marital status, family members living together, religion, recreational activity, smoking, and alcohol intake were analyzed in relation to the development of loosening, using a multivariate Cox proportional hazards model. With adjustment for cementing technique, diagnosis, age, and sex, agricultural work had a significant relation with prosthetic loosening (relative risk=2.85, P=0.03). Restriction of physical work in agriculture for patients undergoing THA should be considered.

Expression of genes for estrogen receptors alpha and beta in human articular chondrocytes

OBJECTIVE

To investigate the gene expression of estrogen receptor (ER) alpha and ERbeta in human articular chondrocytes.

METHODS

16 articular cartilage specimens were obtained from 15 patients during surgery. Three of the specimens were from men and 13 from women; three from hip joints and 13 from knee joints; four were normal and 12 showed osteoarthritic cartilage. Total RNA was extracted from the articular chondrocytes and the expression of both ERalpha and ERbeta genes was investigated by the reverse transcription-polymerase chain reaction (RT-PCR) method.

RESULTS

Gene expressions of ERalpha were detected in all specimens and those of ERbeta were found in 15 specimens by the RT-PCR method. There was a significant correlation between the amounts of ERalpha and ERbeta. Expression levels of both genes were significantly higher in men than in women. There were no significant differences in the expression levels of both ER genes between the hip and knee joint sites, nor between normal and osteoarthritic tissues.

CONCLUSION

This study is to our knowledge the first to demonstrate the gene expression of both ERalpha and ERbeta in human articular chondrocytes. Since there are some functional differences between the two receptors, the effects of estrogen on cartilage metabolism should be elucidated by two different receptor mechanisms.

Possible association of CYP17 gene polymorphisms with the onset of rheumatoid arthritis

OBJECTIVE

The etiologic role of sex hormones in rheumatoid arthritis (RA) has been discussed. Cytochrome P450c 17 alpha (CYP17) regulates steroidogenesis and the restriction fragment length polymorphisms (RFLPs) of the CYP17 gene are related to serum sex hormone production. In this study, the relationship between CYP17 gene RFLPs and RA was investigated.

METHODS

Genomic DNA was extracted from the peripheral blood of 91 male and 285 female patients with RA, as well as from 380 male and 579 female controls, and the RFLPs of the CYP17 gene (denoted as the A1 and A2 alleles) were determined. Clinical variables were recorded for the RA patients.

RESULTS

There were no significant differences in CYP17 genotype distribution between the male RA patients and male controls, nor between the female RA patients and female controls. RA patients with the A2 allele tended to develop the disease at a younger age than those without (in men 50.1 vs 54.7 yrs, p = 0.15; in women 43.9 vs 47.4 yrs, p = 0.038). In women, having the A2 allele was a weak protective factor against developing RA at an older age (odds ratio: 0.63, 95% confidence interval: 0.41-0.95, p = 0.026).

CONCLUSION

The RFLPs of the CYP17 gene may constitute a disease modifying factor through sex hormone production.

A migrated lumbar disc herniation simulating a dumbbell tumor

We report a case of a migrated lumbar disc hemiation, which on magnetic resonance imaging (MRI) simulated a dumbbell tumor in a 44-year-old woman who had severe pain in her right buttock and leg. A large epidural mass mimicking a dumbbell tumor was detected at the L5 vertebral level by MRI and computed tomography over myelography. Surgical fenestration of the L4/L5 interlaminar space revealed a dorsolateral epidural mass connected to the L5/S1 intervertebral disc extending laterally through the right L5/S1 intervertebral foramen. Histologically, it was degenerative disc material without active inflammation. Reevaluation of the MRI suggested some clues that might be useful in differentiating such a herniated disc from an epidural tumor.

Polymorphic CAG repeats of the androgen receptor gene and rheumatoid arthritis

OBJECTIVE

In view of the possible role of androgens in the pathogenesis of rheumatoid arthritis (RA), this study investigated the association between repeat lengths of CAG microsatellites of the androgen receptor (AR) gene and RA.

METHODS

The number of CAG repeats in exon 1 of the AR gene was determined in 90 men and 276 women with RA, as well as in 305 male and 332 female controls.

RESULTS

The male RA patients tended to have shorter repeats than the male controls (22.5 versus 23.1, p=0.07), whereas the female RA patients had similar repeats to the female controls (22.7 versus 22.9, p=0.17). Patients of both sexes were divided into younger and older age at onset groups, and compared with younger and older controls. Younger onset male RA patients had significantly shorter CAG repeat lengths than the younger male controls (21.8 versus 23.2, p=0.007) or the older onset male RA patients (21.8 versus 23.2, p=0.04). Older onset male RA and both younger and older onset female RA patients had similar CAG repeat lengths when compared with their controls. Neither seropositivity nor rheumatoid nodule positivity had a significant relation with CAG repeat lengths.

CONCLUSION

Shorter CAG repeats of the AR gene, presenting high levels of transactivation activity, are related to younger age onset male RA, suggesting the possible role of androgens as a modulating factor.

A long-term follow-up study of cervical spondylotic myelopathy treated by "French window" laminoplasty

We investigated 30 patients with multilevel cervical spondylotic myelopathy (22 males and 8 females) treated by "French window" laminoplasties from 1979 to 1988. Patients averaged 62.6 years of age, and were followed an average of 5 years and 2 months. The average preoperative and postoperative Japanese Orthopaedic Association (JOA) scores were assessed, rising from the original 8.8 +/- 3.4 to 11.9 +/- 3.3 (p < 0.001). Patients were divided into two groups, demonstrating poor alignment and no malalignment after surgery. There was no statistical difference regarding improvement in the neurological examinations between these two groups. The "French window" laminoplasty achieved good clinical results in the management of cervical spondylotic myelopathy irrespective of whether or not alignment deteriorated in the postoperative period.

Gene expressions of antiinflammatory mediators in THR retrieved interfacial membranes

We investigated gene expression of antiinflammatory mediators in the interfacial membranes retrieved at hip revision arthroplasty using reverse transcription-polymerase chain reaction (RT-PCR). Levels of RT-PCR products were compared with those of synovial tissue from patients with osteoarthrosis or rheumatoid arthritis. Antiinflammatory mediators such as type II interleukin (IL)-1 receptor, IL-4, IL-10, IL-1 receptor antagonist, and transforming growth factor-beta 1 (TGF-beta 1) were expressed in the interfacial membrane. In interfacial tissue, the level of IL-10 was lower, but that of the IL-1 receptor antagonist higher than in diseased synovial tissue.

MRI findings in intramuscular lipomas

OBJECTIVE

To investigate the spectrum of magnetic resonance (MR) findings of intramuscular lipoma.

DESIGN AND PATIENTS

A retrospective review of 17 consecutive cases of intramuscular lipoma examined with MR imaging was undertaken. Features assessed included the size and margin of the mass; the homogeneity of the contents, including the presence or absence of intermingled muscle fibers; whether the mass was uninodular or multinodular; and the presence of linear structures between and within the tumor nodules. Three well-differentiated liposarcomas and one dedifferentiated liposarcoma associated with lipoma-like components were also studied to allow a comparison of the benign and malignant lesions.

RESULTS

The diameter of the intramuscular lipomas varied from less than 3 cm to more than 10 cm. Ten of the intramuscular lipomas were homogeneous but the remaining seven were inhomogeneous with intermingled muscle fibers within the mass. The intramuscular lipomas were well defined in 12 cases, and infiltrative in five. In one case the margin of the lesion showed prominent infiltration of the surrounding muscle tissue. Of the 17 cases of intramuscular lipoma, 15 were composed of a single nodule, whereas three of four cases of liposarcoma were composed of multinodular masses.

CONCLUSION

The MR findings of intramuscular lipoma varied from a small, single and homogeneous mass identical to ordinary (superficial) lipoma, to a large, inhomogeneous lesion with an infiltrative margin. The presence of infiltrative margins and intermingled muscle fibers in intramuscular lipoma indicates a benign lesion rather than malignancy. In addition, uninodularity of the mass is helpful in differentiating intramuscular lipoma from well-differentiated liposarcoma.

Association of oestrogen receptor gene polymorphisms with age at onset of rheumatoid arthritis

OBJECTIVE

In view of the possible role of oestrogens in the pathogenesis of rheumatoid arthritis (RA), this study investigated the association between oestrogen receptor (OR) gene polymorphisms and RA.

METHODS

Pvu II and Xba I restriction fragment length polymorphisms of the OR gene were analysed in 70 male and 240 female patients with RA, and in 300 male and 350 female controls. The absence or presence of restriction sites were represented as P, p (Pvu II) or X, x (Xba I). The distribution of OR genotypes was compared between the RA and control subjects by sex. RA patients were divided into subgroups according to their OR genotypes, then the age at onset, seropositivity, and rheumatoid nodule positivity were compared between the subgroups.

RESULTS

The OR genotype frequency of distribution did not have significant differences between the male RA and male controls nor between the female RA and female controls. In women with RA, there was a significant difference of age at onset between the subgroups (uncorrected p = 0.047, corrected p = 0.94). Female patients with the OR genotype PPxx (homozygote of Px) tended to have developed RA at a younger age, whereas those with PPXX and ppxx (lack of Px haplotype) developed RA at an older age. In men with RA, there was no association between the OR genotype and age at onset. In seropositivity and rheumatoid nodule positivity, there was no significant difference between subgroups for either sex.

CONCLUSIONS

Some variants of the OR gene are related to the onset of RA in women in certain age periods, suggesting the role of the interaction between the OR gene and serum concentrations of oestrogen at the onset of the disease.

Influence of retinyl acetate on osteochondral junction chondrocytes in C3H and balb mice

OBJECTIVE

To establish the pathophysiology of retinoid induced hyperostosis.

METHODS

Radiographical, histological, ultrastructural, and immunohistochemical features of retinoid induced hyperostosis were evaluated using C3H-Heston mice and Balb mice.

RESULTS

Dose dependent and progressive ossification was noted at extraosseous sites of both mouse strains. New bone formation was seen not only in the extraosseous tissues, but subchondral bone showed prominent proliferation. Major histopathological abnormalities appeared to take place in the chondrocytes near the osteochondral junctions, and some of the metaplastic chondrocytes near the osteochondral junction expressed osteocalcin and type I collagen, extracellular molecules normally present in bone. Species dependent responsiveness was also noted.

CONCLUSION

Longterm administration of retinoids may induce an aberrant differentiation of the articular and entheseal chondrocytes near the osteochondral junctions, and the affected cells appeared to produce extracellular components including osteocalcin and type I collagen.

A morphometric analysis of protein gene product 9.5-, substance P-, and calcitonin gene-related peptide immunoreactive innervation in the shoulder joint of the Japanese macaque

The shoulder capsule and labrum of Japanese macaque monkeys were studied immunohistochemically with the use of antisera against protein gene product 9.5 (PGP 9.5), calcitonin gene-related peptide (CGRP), and substance P (SP) to further characterize the innervation of the supporting structures of the shoulder joint. With PGP 9.5 immunohistochemistry thick nerve fibers (diameter > or = 10 microm) presumed to be proprioceptive based on topographic location were found to be abundant in the posterior half of the capsule. Thinner fibers (diameter <10 microm) presumed to contain nociceptive and autonomic fibers were located in the posterior half of the capsule. Ruffini-like corpuscles were predominantly located in the inferior portion of the capsule. SP and CGRP immunoreactive thin fibers presumed to be nociceptive were abundant in the posterior half of the capsule. Thin fibers that appeared to be nociceptive fibers were found in the marginal portion and the parenchyma of the labrum, although the number was small. The predominant distribution of the Ruffini-like corpuscles in the inferior portion of the capsule suggest an important role of the inferior portion in generation of the proprioceptive output, which should be advantageous in stabilization of the joint in motion. The abundance of nociceptive fibers in the posterior half of the capsule may be responsible for the pathophysiological transmission of pain around the shoulder joint.

Clinical outcomes of cervical spinal cord injuries without radiographic evidence of trauma

We investigated 33 cervical spinal cord injury patients (25 males and eight females) without bony injury. Patients whose neurologic recovery had reached a plateau and who had evidence on imaging of persistent spinal cord compression were considered candidates for surgical decompression. When imaging did not show spinal cord compression or patients were maintaining a good neurologic recovery from the early days after injury, we pursued conservative treatment. Age at injury varied from 20 to 76 years (mean, 55.6). Average follow-up was 31 months. Twelve patients were treated conservatively (Group 1). Groups 2 and 3 had surgery. Group 2 (14 cases) had multi-level compression of spinal cord due to pre-existing cervical spine conditions such as ossification of posterior longitudinal ligament, cervical canal stenosis, and cervical spondylosis. Group 3 (7 cases) patients existed single-level compression of spinal cord by cervical disc herniations or spondylosis. We evaluated clinical results according to the Frankel classification, the American Spinal Injury Association (ASIA) scales and Japanese Orthopaedic Association (JOA) scores. Overall improvement of JOA and ASIA scores after treatment was 56.3 +/- 35.5% and 67.1 +/- 38.0%, respectively. Patients in Group 1 showed very good recovery after conservative treatment, with improvement of JOA and ASIA scores being 70.4 +/- 40.2% and 77.4 +/- 34.2%, respectively. The average interval between injury and operation was 4.3 +/- 4.4 months. The improvement of the surgically treated patients (Groups 2 and 3) in JOA and ASIA score was 48.2 +/- 30.7% and 61.2 +/- 39.6% respectively. We obtained good neurological recovery after operation, with significantly more improvement in Group 3 than in Group 2. No significant neurologic recovery had occurred preoperatively in these groups. In such patients operative intervention is essential for neurologic recovery.

Characterization of a newly established human chondrosarcoma cell line, CS-OKB

A clonal cell line, CS-OKB, was derived from a human chondrosarcoma and characterized by cytogenetic study, immunocytochemical staining, and reverse transcriptase polymerase chain reaction (RT-PCR). Chromosomal abnormalities characteristic of malignant cartilaginous neoplasms were identified. CS-OKB cells were intensely stained with anti-type II collagen and anti-keratan sulphate antibodies. RT-PCR indicated that CS-OKB transcribes cartilage-specific genes such as type II, X procollagen, and aggrecan. This human chondrosarcoma cell line is stable and expresses well-differentiated chondrocyte-specific genes. It synthesizes well-differentiated chondrocyte-specific molecules in uncoated plastic dishes. CS-OKB may be useful for studies of human chondrocytes and in characterizing human chondrosarcomas.

Prolonged and increasing expression of Fos related antigens in the hippocampus of adjuvant arthritic rats

OBJECTIVE

To study the influence of chronic arthritis on induction of Fos related antigens in the brain.

METHODS

We studied 3 different experimental rat groups: rats with adjuvant induced arthritis (AR), paraffin oil (vehicle) injected rats (VR), and normal control rats (NCR). At 2, 4, and 6 days after and 2.4, 8, 12, and 18 weeks after inoculation, sections from the hippocampus were immunostained with antibodies against c-Fos and other Fos related antigens (FRA). Immunostained neurons in CA1, CA2, CA3, and dentate gyrus were counted and their expression pattern was studied. To relate the expression of FRA to the upregulation of an opioid peptide, leucine-enkephalin (Leu-enk), double immunohistochemistry for FRA and Leu-enk was performed.

RESULTS

Brain samples of the NCR group exhibited very few FRA immunoreactive cells. All the 4 regions of AR and VR hippocampus had upregulated FRA expression in very early stages of arthritis induction. Hippocampus of the VR rats showed generally diminished FRA expression in later stages of arthritis. Hippocampus of the AR rats, in contrast, showed increased FRA expression in the later stages. This increased expression of FRA topographically and chronologically coincided with upregulation of Leu-enk.

CONCLUSION

Longterm arthritis presumably caused prolonged and increased expression of FRA. Increased expression of Leu-enk, which temporally and spatially colocalized with FRA, may represent longterm genomic changes that occur in patients with rheumatoid arthritis.

Intramedullary fibular graft for supracondylar fracture of the femur following total knee arthroplasty

We describe a successful treatment, intramedullary fibular grafting, for a patient with a supracondylar fracture of the femur following total knee arthroplasty in which the fracture region was comminuted and a segmental large bone defect was present. Free autogenous fibular was inserted into the medullary cavity from the intercondylar region and fixed to the proximal fragment of the femur with augmented fixation using a small plate and screws. Our procedure makes it easy to perform large segmental bone grafting and internal fixation at the same time for such a condition.

Estrogen receptor gene polymorphism and generalized osteoarthritis

OBJECTIVE

Generalized osteoarthritis (OA) is a common disease, more often affecting women than men. Although genetic factors are known to be the major risk factor, the genes related to its development are as yet undetermined. We investigated the association between estrogen receptor gene polymorphisms and generalized OA.

METHODS

Pvu II and Xba I restriction fragment length polymorphisms (RFLP) of estrogen receptor gene were analyzed in 65 Japanese patients with generalized OA and in 318 healthy control women. The RFLP were represented as Pp(Pvu II) and Xx(Xba I), with capital and small letters signifying the absence and the presence of restriction sites, respectively.

RESULTS

Estrogen receptor genotype PpXx, with the combination of the Pvu II and Xba I RFLP, is a significant risk factor for the disease subset (odds ratio 1.86, 95% confidence interval 1.03-3.24; p = 0.039). The association of this genotype was more obvious in patients with severe radiographic changes and in younger patients.

CONCLUSION

Some variant of the estrogen receptor gene is a genetic marker for generalized OA. How this genotype affects development of the disease remains to be elucidated.

Serum IgA1 and IgA2 subclass antibodies against collagens in patients with ankylosing spondylitis

We measured IgA1 and IgA2 subclass antibody levels against human type I, II, III and IV collagens in patients with ankylosing spondylitis (AS) by enzyme linked immunosorbent assay (ELISA). Significant elevations of IgA1 antibodies against type II collagen (p < 0.01) and IgA2 antibodies against type I (p < 0.001), III (p < 0.001), and IV (p < 0.01) collagens were observed in AS patients compared with those of healthy controls. These findings suggest that serum IgA antibodies against type I, III and IV collagens were mainly produced in secretory lesions in AS patients.

Ultrastructure of the synovial sensory peptidergic fibers is distinctively altered in different phases of adjuvant induced arthritis in rats: ultramorphological characterization combined with morphometric and immunohistochemical study for substance P, calcitonin gene related peptide, and protein gene product 9.5

OBJECTIVE

To characterize sequential ultramorphological changes in synovial sensory peptidergic fibers in different phases of adjuvant induced arthritis.

METHODS

Topographically defined regions of the tarsal joints from arthritic rats were evaluated 7, 10, 14, and 21 days after inoculation with Freund's adjuvant. Peptidergic fibers were identified by high resolution video microscope, then fibers containing calcitonin gene related peptide (CGRP) were visualized by electron microscopy. Morphometric quantification of synovial fibers immunohistochemically stained for CGRP, substance P (SP), and protein gene product 9.5 (PGP 9.5) was done at this time.

RESULTS

The control synovial lining contained numerous ramified axon terminals, whereas the sublining contained mostly nerve fiber bundles, except for axon terminals visible around the blood vessels. In arthritis, on Day 14, there were few immunoreactive nerve fibers and terminals. Instead, electron microscopy disclosed numerous activated and/or degenerated axons [CGRP: 2973 +/- 345 vs 495 +/- 288; SP: 657 +/- 344 vs 199 +/- 60; PGP 9.5: 4473 +/- 944 vs 886 +/- 299, all p < 0.05 (units: microm/mm2)]. On Day 21 CGRP and PGP 9.5 immunoreactive fibers were numerous again (4892 +/- 551 and 3613 +/- 1350, respectively), but SP immunoreactive nerve fibers did not seem to regenerate (126 +/- 44). Regenerating nerve fibers had a distinctive ultrastructure and they were always seen in association to Schwann cells.

CONCLUSION

The healthy synovial lining is innervated by peptidergic nerve terminals. During the inflammatory phase of arthritis neuropeptides are locally released due to stimulation and degeneration of the axons. The apparently unaffected Schwann cells seem to play a pivotal role in subsequent regeneration of peptidergic axons. However, the ultrastructure and the neuropeptide content (and probably the function) of the regenerating axons are different from those of the normal synovial nerve fibers.

An ultrastructural study of calcitonin gene-related peptide-immunoreactive nerve fibers innervating the rat posterior longitudinal ligament. A morphologic basis for their possible efferent actions

STUDY DESIGN

The present study investigated ultrastructural characteristics of calcitonin gene-related peptide-immunoreactive nerve fibers in the posterior longitudinal ligament of the rat lumbar spine.

OBJECTIVES

To provide a morphologic basis for assessment of the afferent and, in particular, efferent functions of calcitonin gene-related peptide immunoreactive nerves in the posterior longitudinal ligament and their eventual role in degenerative spondylarthropathies and low back pain.

SUMMARY OF BACKGROUND DATA

Previous studies using light-microscopic localization of sensory neuronal markers such as calcitonin gene-related peptide have reported the presence of sensory fibers in the supporting structures of the vertebral column. Meanwhile, accumulating research data have suggested efferent properties for calcitonin gene-related peptide, i.e., a trophic action that alters the intrinsic properties of target cells not through transient action of synaptic transmission, but through long-lasting signal transmission by the secreted neuropeptides. To verify such trophic, paracrine actions of the calcitonin gene-related peptide-containing fibers in the posterior longitudinal ligament, however, ultrastructural details of the terminals and their spatial relationship to their eventual target structures have to be elucidated.

METHODS

Rat posterior longitudinal ligaments were stained immunohistochemically for calcitonin gene-related peptide. Light-microscopic analysis of the semithin sections facilitated subsequent electron microscopy of specific sites of the posterior longitudinal ligament to determine ultrastructural details and nerve fiber-target relationships.

RESULTS

The rat lumbar posterior longitudinal ligament was found to be innervated by two distinctive calcitonin gene-related peptide immunoreactive nerve networks. In immunoelectronmicroscopy, the fibers of the deep network had numerous free nerve endings, whereas those of the superficial network showed spatial associations with other non-calcitonin gene-related peptide immunoreactive components of the network. In both systems, naked axons not covered by the Schwann cells made close spatial contact with smooth muscle cells: of blood vessels and resident posterior longitudinal ligament fibroblasts.

CONCLUSIONS

The ultrastructural characteristics of the innervation of the rat posterior longitudinal ligament would be compatible not only with a nociceptive function, but also with neuromodulatory, vasoregulatory, and trophic functions, as has already been established in some visceral organs.

Efferent targets of osseous CGRP-immunoreactive nerve fiber before and after bone destruction in adjuvant arthritic rat: an ultramorphological study on their terminal-target relations

We report the ultramorphological characterization of the terminal-target relation of sensory peptidergic nerve fibers in healthy and diseased osseous tissues. Bone tissue sections were immunoelectronmicroscopically investigated for calcitonin gene-related peptide (CGRP), a neuropeptide widely distributed in sensory peptidergic fibers. Ultramorphological relation of the osseous CGRP-immunoreactive (ir) nerve terminals and their target cells was comparatively analyzed using healthy, arthritic, and postarthritic bone specimens from control and adjuvant-induced arthritic rats. Terminal-like profiles of the osseous CGRP-ir axons were evidenced in direct contact with the metaphyseal osteoblasts and osteoclasts of the control animals. Terminal-like profiles were also noted in the vicinity of the periosteal lining cells. Nonterminal-like profiles did not make intimate spatial relation to the cells/structures surrounding the nerve. Osseous CGRP-ir terminals and axons, which are either uncovered or thinly ensheathed by the supportive tissues, were extensively degenerated in adjuvant-induced infiltration, whereas larger fibers were relatively resistant. Numerous CGRP-ir axons with distinctive features reinnervated the postarthritic, ossifying periosteum. CGRP-ir axons appeared to reinnervate the eroded surface of metaphyseal bone and cartilage as early as the recruited osteoblasts resume osteogenesis in the postarthritic metaphysis. The observed terminal-target relations in the healthy and diseased bone tissues give an ultramorphological basis for the putative trophic, modulatory actions of CGRP innervation of the bone cells.

Pubic osteolysis mimicking a malignant lesion: report a case with a fracture dislocation of the sacroiliac joint

We report the case of a 67-year-old woman who presented to our institution with osteoblastic and osteolytic lesions of the pubis and fracture dislocation of the left sacroiliac joint. She had presented 7 months earlier to an outside institution with a left gluteal mass, which had been biopsied and had been believed to represent malignancy. A second biopsy at our institution showed no evidence of malignancy and was felt to represent fracture healing. A diagnosis of public osteolysis was made based on the radiographic and histologic findings. A follow-up radiograph 6 years after presentation revealed healing of the lesions, confirming its benignity.

Autoantibodies to collagens in Japanese patients with ankylosing spondylitis

OBJECTIVE

We measured antibody levels against human type I, II, III and IV collagens in Japanese patients with ankylosing spondylitis (AS) by enzyme linked immunosorbent assay (ELISA).

RESULTS

Significant elevations of antibodies against type II (IgG and IgA classes) and type IV (IgA class) collagens were observed in AS patients, whilst there was no significant elevation of any antibody class against type I or III collagen when compared to controls.

CONCLUSION

These findings indicate that AS patients have immune responses to type II and IV collagens, which may be responsible for sustaining the characteristic local inflammations in AS.

Antibodies against bacterial lipopolysaccharides in Japanese patients with ankylosing spondylitis

We investigated IgG, IgA and IgM class specific antibodies to five bacterial (Klebsiella pneumoniae, Escherichia coli, Salmonella enteritidis, Salmonella typhimurium and Shigella flexneri) lipopolysaccharides (LPS) by enzyme-linked immunosorbent assay in 144 Japanese patients with ankylosing spondylitis (AS). AS patients had significantly elevated IgA antibodies to K. pneumoniae LPS, Salmonella enteritidis LPS and Salmonella typhimurium LPS; however, there was no correlation between antibody level to LPS and acute-phase reactants, erythrocyte sedimentation rate and serum C-reactive protein.

Tyrosine hydroxylase-immunoreactive nerve fibres in rat posterior longitudinal ligament

The nerve supply to the posterior longitudinal ligament (PLL) of the lumbar vertebrae has been the focus of considerable interest to gain insight into the pathogenesis of low back pain. The present study aimed to characterize the sympathetic fibres in the PLL by immuno-electronmicroscopy for tyrosine hydroxylase (TH), the rate limiting enzyme in catecholamine synthesis. The posterior central branches of the segmental lumbar arteries received numerous communicating fibres from the sinuvertebral nerve (SVN), but only shortly after their entrance to the spinal canal. The non-vessel-associated branches of the SVN formed transverse bundles, which met fibres from the opposite side in a plexus-like mid-sagittal network. As these fibres approached the midline, they gradually lost their Schwann cell cover. The free and naked fibres contained numerous terminal-like varicosities. The TH-ir and 6-hydroxydopamine (6-OH-DA) sensitive fibres were intermingled with non-TH-ir fibres. The TH-ir sympathetic fibres had no obvious target structures except for the numerous, intermingled, closely related and communicating terminal-like axons in the mid-sagittal network in contact with non-TH-ir fibres. This may represent a neuroanatomical equivalent reflecting modulatory functions, which could participate in the pathogenesis of low back pain.

Antibodies to Klebsiella, Proteus, and HLA-B27 peptides in Japanese patients with ankylosing spondylitis and rheumatoid arthritis

OBJECTIVE

To determine whether patients with ankylosing spondylitis (AS) and patients with rheumatoid arthritis (RA) from Japan have antibodies to Klebsiella pneumoniae and Proteus mirabilis and to assess whether such antibodies are activated against peptides sharing sequences with HLA-B27.

METHODS

Serum samples from 152 Japanese patients, 52 with AS, 50 with RA, and 50 healthy controls, were tested against 3 bacteria (K. pneumoniae, P. mirabilis, and Escherichia coli) and 3 synthetic peptides (HLA-B27, pullulanase-D, and scrambled pullulanase-D control peptide) by ELISA under coded conditions. Samples were tested for elevations in IgG, IgA, and IgM antibody classes in patients with active AS or RA, in patients with RA with probable disease, and in patients with inactive AS. Disease activity was determined by an elevated serum C-reactive protein (> 10 mg/l) level and elevated erythrocyte sedimentation rate (> 20 mm/h).

RESULTS

Patients with active AS showed specific elevations in serum IgA antibody levels against K. pneumoniae compared to patients with RA and controls (p < 0.001). No such elevation was seen in the IgG and IgM antibody classes. Patients with inactive AS showed no elevation in any class of antibody against K. pneumoniae compared to controls or patients with RA. Patients with active or probably active RA showed significant elevations in IgG antibody levels against P. mirabilis compared to AS and controls (p < 0.001). Patients with AS (active or inactive), RA (active or probably active), and controls showed no elevations in any antibody class to E. coli. Both active and inactive AS patients had specific autoantibodies against HLA-B27 peptide compared to patients with RA and controls (active AS: IgG, IgA, IgM, p < 0.001; inactive AS: IgG and IgA, p < 0.001). Patients with active AS had IgG and IgA antibodies against pullulanase-D peptide, which contains a sequence that cross reacts with HLA-B27 compared to controls (p < 0.001).

CONCLUSION

These results provide the first evidence of AS and RA patients in Japan having specific elevations of antibody to K. pneumoniae and P. mirabilis, respectively. This suggests that K. pneumoniae in AS and P. mirabilis in RA may play a role in triggering and/or exacerbating these diseases.

Calcitonin gene-related peptide, substance P, and tyrosine hydroxylase-immunoreactive innervation of rat bone marrows: an immunohistochemical and ultrastructural investigation on possible efferent and afferent mechanisms

The presence of nerve fibers in bone marrow has been noted by various investigators, and recent developments in immunohistochemistry have enabled differential localization of the intramedullary nerve fibers. Much interest has been devoted to the efferent activities of the afferent fibers, which probably act on the target tissues by secreting a variety of neurotransmitters. The present study aimed to further characterize intramedullary substance P, calcitonin gene-related peptide, and tyrosine hydroxylase-immunoreactive nerve fibers of the rat lower limb by comparing those of the knee, ankle, and tarsal joints. The ultrastructural details of intramedullary calcitonin gene-related peptide-immunoreactive axons were also investigated to provide a morphological basis for their possible efferent actions. Intramedullary calcitonin gene-related peptide and substance P-immunoreactive fibers in the proximal tibia and the knee joint were found to be as reported earlier, but the marrow of the distal metaphysis was also noted to be richly innervated, and the tarsal joints displayed dense innervation at the subchondral regions that underlie the joint cartilage. The articular and intramedullary innervations that function for joint protection might participate in characteristic clinical features of joint damage secondary to the neuropathies. Ultrastructurally, the intramedullary calcitonin gene-related peptide-immunoreactive axons were minimally engulfed by the Schwann cell, and naked intramedullary calcitonin gene-related peptide-immunoreactive axons were noted along an extraordinarily long extension, suggesting much efferent activity.

Anterior cervical plate used in degenerative disease can maintain cervical lordosis

The aim of this study was to show whether anterior cervical plate stabilization is able to maintain cervical lordosis or not when used for cervical degenerative disease. Thirty cases that underwent anterior fusion at multiple levels without cervical plating before 1986 were compared with 44 cases treated with cervical plating since 1986. Changes in the alignment of the total cervical spine and of the fused segment were studied in both groups. Collapse of the grafted bone, which was observed in 9 of 30 cases in the nonplate group, was not observed in the plate group. Alignment of the cervical spine was corrected and well maintained in the plated group, compared with the nonplate group. Anterior cervical plate stabilization could maintain the normal alignment of the cervical spine damaged by degenerative processes, whereas anterior cervical fusion without plating could not.

Cervical myelopathy caused by calcium pyrophosphate dihydrate crystal deposition in facet joints. A case report

STUDY DESIGN

This report illustrates a case of cervical myelopathy caused by degenerative changes of the facet joints in which calcium pyrophosphate dihydrate crystals were found histologically.

OBJECTIVES

To evaluate the treatment of this patient, which involved the principles of laminoplasty and posterolateral fusion, and to analyze surgical specimens and preoperative radiographs taken after the patient's surgery.

SUMMARY OF BACKGROUND DATA

Calcium pyrophosphate dihydrate deposition occurs in cartilage, ligaments, tendons, and joint capsules. Radiographic changes of the cervical facet joints caused by such deposition have already been reported in cadaveric studies. Cases with neurologic compromise rarely occur.

METHODS

Surgical specimens that were obtained from the cervical facet joints, i.e., capsule and synovium, were analyzed histopathologically.

RESULTS

The preoperative radiographic study showed severe degenerative changes of the cervical facet joints, and analysis of the surgical specimens indicated the presence of calcium pyrophosphate dihydrate crystals.

CONCLUSIONS

The cervical facet joints can be involved in calcium pyrophosphate dihydrate crystal deposition and this involvement may accelerate the degenerative changes of the facet joints.