Capsular Adhesions Research Articles

The Temporomandibular Joint

MRI is the procedure of choice for diagnosing most internal derangements. MRI provides images that not only demonstrate bony detail but show excellent representation of soft tissues in both anatomic and semifunctional relationships. MRI does not use ionizing radiation and has no known adverse effects. Multiplanar imaging allows a three-dimensional analysis of the TMJ, providing a more complete assessment of the condyle, articular disc, fossa relationships. Whenever capsular adhesions or disc perforations are suspected and are not demonstrated with MRI, then arthrography should be performed.

Significance of fibrin/fibrinogen related antigen in glomeruli in children with IgA nephropathy.

AbstractThe relationship between the deposition of fibrin/fibrinogen related antigen (FRA) and morphologic findings in glomeruli was investigated in 59 children with IgA nephropathy. After treatment of renal biopsy sections with monochloroacetic acid (MCA) solution, MCA‐insoluble FRA, suggesting cross‐linked fibrin, was observed within the capillary walls, the mesangium and/or the sclerotic area in children with severe proliferative lesions, such as segmental sclerosis, capsular adhesions or crescent formation. Mesangial deposits of FRA were confined to electron‐dense deposits, and the MCA‐soluble FRA did not seem to be closely related to glomerular damage. FRA deposits within crescents may consist of MCA‐soluble FRA.

Experimental autoimmune glomerulonephritis in chickens: I. Influence of source of antigen, dose and adjuvant.

Autoimmune glomerulonephritis was induced in chickens by immunization with human, bovine, turkey or chicken glomeruli in CFA. The influence of dose and of the pertussis vaccine was evaluated in two other separate experiments. The highest incidence of glomerulonephritis was observed in chickens immunized with human glomeruli, followed in descending order by bovine, chicken and turkey glomeruli. Capsular adhesions were seen in the last three groups. Epithelial crescents were seen only in the group immunized with chicken glomeruli. Interstitial lymphocytic infiltration was seen in 54% and 71% of chickens immunized with bovine and chicken glomeruli, respectively. The severity of the disease increased with time and the number of immunizations. IgG deposits on the GBM were seen in 92% (22/24), 54% (13/24), 50% (12/24) and 33% (8/24) of animals immunized with human, bovine, turkey and chicken glomeruli, respectively. Severity of disease was directly related to the amount of glomeruli injected. However, IgG deposits showed an inverse correlation with antigen dose. The disease was always less severe in chickens immunized with bovine glomeruli-CFA plus pertussis, as compared to bovine glomeruli-CFA immunized chickens. These studies demonstrate that the type of GBM antigen and immunization method play a significant role in the resultant histologic lesions in this model, and define conditions for optimal production of disease.

1552 CLINICAL AND HISTOLOGICAL SPECTRUM OF IgA NEPHROPATHY IN CHILDREN AND ADOLESCENTS

Since 1972, significant mesangial IgA deposition was detected in 19 patients (16 male, 3 female), undergoing renal biopsy for recurrent gross hematuria (n=15) or asymptomatic urinary abnormalities (n=4). The mean age of diagnosis was 13.5 yrs (range8-18 yrs). Significant proteinuria (> 4mg/M2/hr was detected in 11 patients (x=24.3mg/M2/hr); 8 of these 11 patients had at least one episode of gross hematuria. Glomerular filtration rate (GFR) was normal at the time of diagnosis in all patients. Three patients had reversible reduction in GFR of 20-64% during episodes of gross hematuria. No patients had experienced hypertension. Histopathology varied from completely normal (n=3) to focal and segmental proliferative glomerulonephritis. Capsular adhesions of sclerosed segments were seen in 6 patients and organizing crescents in 2 patients. Six patients had global sclerosis- Immunofluorescence studies revealed C3 in 15 patients, IgG in 8 pts., and IgM in 5 pts. Follow-up in 11 pts. (x=3 yrs), has shown persistence of the clinical pattern, urinary abnormalities and maintenance of GFR Therefore, IgA nephropathy appears to have a more benign histopathology in children and adolescents.

Glomerulonephritis associated with (infected) ventriculo-atrial shunt.

Diffuse glomerulonephritis with the nephrotic syndrome was observed in two patients aged 3 years 8 months and 27 years, both of whom had ventriculo-atrial shunts. Removal of the shunts resulted in marked improvement in the first and complete recovery in the second patient. Serum β1C-globulin concentrations were initially low and returned to normal values. Cultures taken from cerebrospinal fluid and valve grew Staphylococcus albus in the pediatric patient and were negative in the adult patient. Initial renal biopsies obtained immediately before shunt removal showed diffuse intra- and extracapillary glomerulonephritis type III (crescent formation in over 90 percent of the glomeruli) in the first patient, and diffuse intracapillary proliferative and exudative glomerulonephritis in the second patient. Repeat biopsies were performed, on the first patient 22 months, and on the second patient 7 months after shunt removal. In the first patient, half of the glomeruli were sclerosed, and the others exhibited slight mesangial proliferation with some capsular adhesions. The repeat renal biopsy from the adult patient showed mesangial proliferation with lobulation. Immunofluorescence studies in both patients revealed positive staining in a coarsely granular pattern against IgG, IgM, and β1C globulin. On electron microscopy, subendothelial deposits were still visible in the second biopsies of both patients. Glomerulonephritis associated with infected ventriculo-atrial shunt is probably mediated by antigen-antibody complexes. Recovery is possible in spite of severe renal lesions since the antigen can be eliminated at once by removal of the shunt.

Experimental nodular "diabetic-like" glomerulosclerosis in guinea pigs following long-acting, heterologous insulin immunization.

Renal lesions similar to Kimmelstiel-Wilson nephropathy have been found in guinea pigs immunized with long-acting heterologous insulin. — The animals were treated for periods ranging from 3 to 5 months, with monthly subcutaneous injections of highly purified bovine insulin in a mixture of lanolin and paraffin oil. — Kidney sections have been examined by means of light microscopy after standard and histochemical stainings, histoimmunological techniques and electron microscopy. — The following glomerular lesions have been detected : 1. PAS-positive hyaline nodules (55.5%); 2. Thickening of the basal membrane (100%); 3. aneurysmatic dilatation of the capillaries (88.8%); 4. diffuse glomerulosclerosis (61.1%); 5. increased number of mesangial cells (38.8%); 6. fibrinoid caps (44.4%); 7. capsular adhesions (33.3%). — Histo-chemical findings showed that there are differential characteristics between fibrinoid caps (exudative lesions) and hyaline nodular alterations: the former were rapidly digested by trypsin, whereas the nodules resisted the tryptic treatment for 6 h. — Histoimmunological staining of the lyophilized kidney sections with fluorescein-isothiocyanate-labelled anti-bovine insulin serum showed marked fluorescence of both the fibrinoid caps and hyaline nodules of the glomeruli, and also a less intense fluorescence of the basement membrane and of the intercapillary stroma. — Electron microscopy of the glomeruli demonstrated that the basal membrane was always irregularly thickened showing a patchy fibrillary structure, and that there were nodular areas and bands of “basal-membrane-like” material. Besides, dense osmiophilic deposits were noted in the mesangium. — It is concluded that insulin acting as an antigen brings about a nodular Kimmelstiel-Wilson-like nephropathy in experimental animals with normal or low blood sugar and lipids, through immunological mechanisms.

A study of 2,532 fractures in children

of the recent marked increase in the use of open reduction and internal fixation, it was believed that a study of this Iatter group wouId be a sobering inffuence and again re-emphasize the fact that “Fractures in chiIdren are different.“’ In this group of 2,058 patients there was a predominance of maIes, constituting 64.3 per cent of the total. The group sustained a total of 2,532 fractures, of which 2,093 or 82 per cent invoIved the Iong bones of the body. There were nine deaths (0.4 per cent), a11 of which were due to the severe craniocerebra1 injuries. The statistica anaIysis of this group is of particuIar interest because it is made up of patients treated in the emergency room as we11 as those admitted to the hospital; it therefore gives a reIiabIe picture of the frequency of invoIvement. The radius was the bone most commonIy fractured, being injured in 647 cases or 25.5 per cent (TabIe I.) BIount,’ Aitken,2 0deI13 and others have repeatedIy pointed out the factors which determine the principIes of fracture treated in chiIdren. Apposition and angulation, both of which are of prime importance in our concept of fracture treatment in the adult, are of much Iess significance in the chiId. The growth factor will equalize shortness due to overriding at the fracture site; and because the fracture itself acts as a stimuIus to bone growth, it is frequentIy advisabIe to have some overriding to compensate for an actual increase in the Iength of the fractured bone. This has been pointed out repeatedIy in fractures of the femur where a I cm. overlap gives the best resuhs. Angulation will aIso be corrected by the growth factor when the fracture is near the end of the bone and in the very young when anguIation is near the middIe. This of course does not mean that apposition, anguIation and aIignment shouId be completely negIected, for it is obvious that a perfect reduction in each of these spheres wiI1 result in hastened convaIescence and norma function. However, repeated manipuIation wiI1 onIy interfere with the tremendous potential for healing and for the correction of deformity which is present in this group of patients. Open reductions, except in a very specific group of cases, with the resuItant capsular adhesions and stiffness wiI1 more often produce an undesirabIe resuIt than wiI1 a poor closed reduction. However, in fractures with dispIacement invoIving the medial epicondyle of the humerus, the lateral condyle of the humerus and the radiaI neck, open reduction should be considered as the primary form of treatment to prevent marked deformity. Other operations except under individual circumstances are not justified. This is one group where you must treat the patient and not the x-ray. EpiphyseaI injuries can potentiaIIy cause growth arrest with resultant shortening. Because of this epiphysea1 injuries are often subjected to repeated manipulation which cause more damage than the original injury. Aitken2 states : “MaIposition of an epiphysis per se, is not a cause of deformity.” There are three