Bursal Fluid Research Articles

The presence of lymphatic stomata in the ovarian bursa of the golden hamster

The histology and function of the lymphatic system in the ovarian bursa of the golden hamster were examined at each day of the estrous cycle. The lymphatic passage from the ovarian bursa to a para-aortic lymph node was stained black by india ink injected into the bursal cavity. This suggests that bursal fluid drains from the cavity via lymphatic vessels. Lymphatic stomata connecting the bursal cavity with the lymphatic lumen were consistently present throughout the cycle. However, the stomata were more frequently observed in the bursae on day 1 than on day 4 of the cycle. Also, they were more frequently observed in the bursa injected with 5 microliters of chick erythrocytes than in the contralateral (not injected) bursa in hamsters on day 4 of the cycle. These results suggest that the stomata are openings the patency of which varies in response to changes in the bursal cavity. There were regions where the lymphatic lumen was separated from the bursal cavity only by lymphatic endothelial cells. These regions were present throughout the estrous cycle. They may be patent stomata; dehiscence of junctions between the endothelial cells may give rise to stomata or widen the stomata orifices that are already present.

Bursal fluid lactate determination and the diagnosis of bursitis.

Bursal fluid lactate determination and the diagnosis of bursitis.

Septic Bursitis in Childhood

Ten cases of septic bursitis in children during a 25 year period were reviewed. Infection occurred in five girls and five boys with a mean age of 9 1/6 years. None had prior bursal disease. Direct trauma or local infection preceded the bursitis in seven children. The involved bursae were prepatellar (eight), olecranon (one), and subacromial (one). Presenting signs included fever with localized swelling, tenderness, and erythema; superficial fluctuance and painless joint motion were helpful diagnostic findings. Bursal fluid cultures yielded Staphylococcus aureus (nine) and Streptococcus pyogenes (one). Surgical therapy included needle aspiration (three), incision and drainage (three), and both procedures (four). Antimicrobial therapy was given to nine children; four received only oral antimicrobials. Nine children including all who received oral antimicrobials recovered rapidly without apparent sequelae. One child's course was complicate by patellar osteomyelitis and septic arthritis. Septic bursitis is an uncommon infection in children and should be differentiated from cellulitis and septic arthritis. Rapid recovery is usually seen with appropriate therapy.

Septic bursitis in childhood.

Ten cases of septic bursitis in children during a 25 year period were reviewed. Infection occurred in five girls and five boys with a mean age of 9 1/6 years. None had prior bursal disease. Direct trauma or local infection preceded the bursitis in seven children. The involved bursae were prepatellar (eight), olecranon (one), and subacromial (one). Presenting signs included fever with localized swelling, tenderness, and erythema; superficial fluctuance and painless joint motion were helpful diagnostic findings. Bursal fluid cultures yielded Staphylococcus aureus (nine) and Streptococcus pyogenes (one). Surgical therapy included needle aspiration (three), incision and drainage (three), and both procedures (four). Antimicrobial therapy was given to nine children; four received only oral antimicrobials. Nine children including all who received oral antimicrobials recovered rapidly without apparent sequelae. One child's course was complicate by patellar osteomyelitis and septic arthritis. Septic bursitis is an uncommon infection in children and should be differentiated from cellulitis and septic arthritis. Rapid recovery is usually seen with appropriate therapy.

Antibiotic therapy of septic bursitis. Its implication in the treatment of septic arthritis.

Infected olecranon, prepatellar, and infrapatellar bursae offer a unique opportunity to study the response of a closed-space infection to antibiotic therapy. Using percutaneous needle aspirations, serial bursal fluids were cultured. The length of time necessary to achieve culture sterility with antibiotic therapy (an average of 4 days in 25 patients) was correlated with the duration of symptoms prior to diagnosis (r = 0.68, P less than 0.001). In patients treated within 2 weeks from onset of symptoms, bursal fluid sterility was achieved within 1 week of therapy, while longer duration of symptoms was associated with delayed response. When antibiotic therapy was continued for 5 additional days after documented culture sterility, all 19 patients in the prospective trial were cured (average followup period of 6.8 months). In septic bursitis, the effects of delay in treatment are deleterious by prolonging culture-positivity despite adequate antibiotic therapy. By analogy, delay in treatment of septic arthritis may result in the persistence of an adverse environment which can lead to further articular damage. After accurate diagnosis of septic bursitis, a therapeutic approach consisting of prompt and appropriate antibiotic usage, frequent needle drainage, and treatment duration based on the culture results of serial aspirations is effective and may be applicable in the management of certain nongonococcal bacterial joint infections.

Reaction of superficial bursae in response to specific disease stimuli.

Although microscopic studies have shown similarities between bursal and joint membranes, little is known about bursae and their response to disease states. Eighty-six cases of superficial bursitis due to trauma, bacterial infection, or gout were reviewed and compared with cases of joint inflammation due to the same etiologies. In traumatic bursitis the bursal fluid mucin test was more abnormal and the viscosity lower than that of joint fluid in traumatic arthritis. The bursal fluid total leukocyte count of septic bursitis was less than 20,000/mm3 in 8 of 13 cases but in only 1 of 21 synovial fluids from cases of septic arthritis (P = 0.005). In gouty bursitis the mean total leukocyte count of bursal fluid was 2800/mm3, compared with a mean synovial fluid total leukocyte count of 28,700 in gouty arthritis (P less than 0.02). These findings indicate that superficial bursae react less intensely than diarthrodial joints to specific disease stimuli and that a relatively low bursal fluid leukocyte count is often present in cases of septic and gouty bursitis.

Comparison of Nonseptic and Septic Bursitis Further Observations on the Treatment of Septic Bursitis

Of 30 cases of olecranon and prepatellar bursitis, ten were septic. Fever, tenderness, peribursal cellulitis, and skin involvement over the bursa were more common in the septic cases. A high leukocyte count, low bursal-to-serum glucose ratio, and positive Gram-stained smear of the bursal fluid distinguished septic from nonseptic bursitis. Rheumatoid arthritis and gout may be accompanied by nonseptic bursitis. Septic bursitis may be associated with a sympathetic sterile effusion in a neighboring joint or adjacent fascial space. The duration of antibiotic treatment necessary to sterilize bursal fluid was proportional to the length of time infection had been present. A prospective antibiotic program disclosed an average of 12 days for successful therapy. A bactericidal agent against penicillin-resistant Staphylococcus aureus is the drug of choice.

Acute gouty bursitis: report of 15 cases.

Fifteen cases of acute gouty bursitis were seen among 136 crystal-proved cases of gout. Bursal aspirate yielded yellow or pink fluid in 10, chalky white fluid in 1, and a small amount of bloody fluid in 4. Monosodium urate crystals were present in all. Bursal fluid leucocyte counts averaged 2.9 X 10(9)/1 compared with synovial fluid leucocyte counts that averaged 25.5 X 10(9)/1 in cases of articular gout (P less than 0.05). Gouty, septic, and idiopathic (traumatic) bursitis share clinical features, and detailed bursal fluid analysis is crucial for diagnosis.

The extra-articular deposition of fibrinogen antigenic material in patients with rheumatoid arthritis.

Experimental suction blisters were elicited on extensor and flexor sites or forearm skin of patients both with rheumatoid arthritis and without rheumatoid diseases. The blister fluid obtained was investigated, together with rheumatoid bursa fluid and rheumatoid noduli material by crossed and quantitative immunoelectrophoresis for fibrinogen antigenic material, plasminogen and inhibitors of fibrinolysis. In rheumatoid noduli and rheumatoid bursa fluid, fibrinogen degradation products identical with those previously described in rheumatoid synovial fluid and in bullous dermatosis were found (3, 14). On the other hand, no fibrinogen antigenic material was found in the experimental suction blisters. These results indicate that the fibrinogen degradation products in rheumatoid inflammatory exudate are probably not specific for a rheumatoid process, but rather part of a general mechanism in inflammation.

Septic bursitis in the prepatellar and olecranon bursae: an analysis of 25 cases.

Five cases of septic prepatellar and 20 cases of septic olecranon bursitis are reported. All were men, with a mean age of 47 years. Seventeen had a history of recent trauma to the affected limb or sustained pressure on knees or elbows, or both, required by certain occupations. Septic bursitis was not associated with septic arthritis and could be easily distinguished from it by the characteristic bursal swelling and joint examination. Septic bursitis was misdiagnosed as nonseptic bursitis in eight cases despite characterstic bursal fluid leukocytosis (greater than 1000 cells/mm3) and recovery of bacteria on culture. Staphylococcus aureus was identified in 22 cases; 76% were resistant to penicillin. Intravenous antibiotics and bursal fluid drainage were uniformly succesful. Oral antibiotic ttherapy was also successful unless the infection was extensive or there was underlying bursal disease. Early recognition, prompt therapy, and preventive measures are necessary to reduce the morbidity of septic bursitis.

Idiopathic or traumatic olecranon bursitis. Clinical features and bursal fluid analysis.

Thirty cases of idiopathic olecranon bursitis were studied. Most had previous local trauma. The process was unilateral and often associated with nontender pitting edema in cases of short duration. Ten patients exhibited a bony spur at the olecranon process, and amorphous calcific deposits were seen in 6. The bursal fluid was hemorrhagic with a xanthochromic supernatant, and the mucin clot test was poor or fair. Leukocyte count averaged 878/mm3, predominantly mononuclears. Many cells contained inclusion bodies. Glucose, total protein, and complement (C3) concentration averaged 80, 60, and 60% of the respective serum values.

The elemental composition of the environments of the gametes and preimplantation embryo during the initiation of pregnancy.

Micropuncture and electron probe microanalysis were used to determine the concentrations of Na, Cl, K, Ca, Mg, S and P in picoliter volumes of fluid in the microenvironments of male and female gametes and zygotes in the female genital tract of the mouse. Since ejaculation occurs directly into the lumen of the uterine cornua, post-coital uterine fluid is the first microenvironment of sperm following coitus. This fluid is characterized by a high concentration of K (32 mM) but low concentrations of Na (114 mM), Cl (115 mM) and Ca (1 mM), relative to mouse serum. Elemental analyses of the liquid ejaculate and proestrous uterine fluid demonstrate that the liquid ejaculate is the main modifier of proestrous uterine fluid in the formation of postcoital uterine fluid. In passing from postcoital uterine fluid to the ampulla, the site of fertilization, spermatozoa experience changes in the concentrations of only two elements: Cl and Ca significantly increase. Bursal sac fluid and oviducal fluids in the microenvironment of the mouse ova have unique compositions. Bursal sac fluid is lower in Ca, S and P than serum but slightly higher in K. Ampulla and isthmus fluids contain high concentrations of K (23-25 mM) but low concentrations of Ca (1.7-2.0mM). Analyses of proestrous ampulla fluid demonstrate that high K levels in the mouse oviduct are not due to cumulus cell degeneration, but probably originate from the oviducal epithelium.

Beta-galactosidase in rat ovarian bursa fluid at ovulation.

β-Galactosidase activity was assayed fluorometrically in the fluid which accumulates within the ovarian bursa of the rat at the time of ovulation. Its concentration there was found to be 7.5-fold greater than its concentration in plasma. The enzyme is a typical acid hydrolase, presumed to occur in lysosomes in cells of the ovarian follicle wall. Its accumulation in bursa fluid suggests that lysosomal enzymes may be released from follicle walls during ovulation and washed into the bursa by the exudation of fluid through the surface of follicles.

Sperm penetration of rat eggs in vitro after dissolution of zona pellucida by chymotrypsin.

SUCCESSFUL in vitro fertilization of mammalian eggs has been achieved in the rabbit and golden hamster1–4, but authentic reports of success for rat eggs are still lacking. In an attempt to fertilize rat eggs in vitro by the procedures of Yanagimachi and Chang3, we used various media with added heated rat serum, follicular, bursal or uterine fluid. After many trials, none of 844 eggs from seventy-six rats was found to have been penetrated, confirming Austin's early statement5. Various proteolytic enzymes were added to the medium to facilitate sperm penetration, and we found that, when the zona pellucida was dissolved, epididymal sperm as well as sperm recovered from the uterus could penetrate the vitelline surface, activate the eggs and lead to the formation of pronuclei. This communication reports the procedures and results of this experiment.