Areas Of Degeneration Research Articles

けい骨粗面前内方移動術後１５年を経過した膝蓋大腿関節症病変部の所見

A 51-year-old woman had undergone anteromedial displacement of tibial tuberosity for the patello-femoral (PF) osteoarthritis of her left knee. At the time of surgery, an extensive area with exposure of the subchondral bone had been found at both the lateral articular surface of the patella and the opposite lateral aspect of the sulcus. She later came back working as a farmer with no symptons postoperatively. At 15 years after surgery, she underwent arthroscopic examination for traumatic chondral injury of the lateral femoral condyle. Under arthroscopy, the previous cartilage degenerative area in the PF compartment was found to be covered uniformly by a white repartative tissue, without any exposure of the subchondral bone. The pathological finding of this reparative tissue showed the characteristic feature of the fibrocartilage that has combined properties of the cartilage and fibrous tissue.

Interstitial granulomatous dermatitis with plaques

Background: Interstitial granulomatous dermatitis is a histopathologic pattern with variable clinical appearance associated with autoimmune systemic diseases. The frequency of its different cutaneous expressions and its association with autoimmune diseases are not known. Objective: We describe the clinical, serologic, and histologic features in 17 patients with interstitial granulomatous dermatitis with a clinical presentation consisting of large erythematous plaques. Method: Skin biopsy specimens fulfilling criteria for diagnosis of interstitial granulomatous dermatitis were selected and correlated with the clinical and laboratory findings. Results: The study included 1 man and 16 women with multiple, asymptomatic, round to oval, erythematous plaques, most often on folds of the skin, in a bilateral and somewhat symmetric distribution. Most of patients had rheumatoid polyarthralgias along with various serologic abnormalities, often connected to collagen vascular diseases. Histologic examination disclosed a distinctive interstitial granulomatous dermatitis characterized by a diffuse infiltration of the interstitium by histiocytes with piecemeal fragmentation of collagen and formation of small granulomas around degenerative areas in concert with variable numbers of polymorphonuclear leukocytes sprinkled within the infiltrate. Churg-Strauss granulomas in miniature and flame figures were occasionally observed and indicated continued or increased activity of the associated autoimmune disease(s). Conclusions: Interstitial granulomatous dermatitis with plaques is a distinct entity with highly reproducible clinical and histopathologic features; recognition of these features identifies a patient who may have an underlying systemic autoimmune disorder. (J Am Acad Dermatol 2002;46:892-9.)

Endoscopic surgery in chronic achilles tendinopathies: A preliminary report

Purpose: The objective of this prospective study was to evaluate preliminary results of an endoscopic-assisted surgical technique for patients suffering from chronic Achilles tendinopathies. Type of Study: Case series. Methods: Endoscopic operations were performed on 7 consecutive patients involved in recreational sports suffering from chronic Achilles tendon (AT) lesions in whom conservative treatment had failed. Diagnoses included 2 patients with pure peritendinitis, 4 with peritendinitis and degenerative tendinosis, and 1 with a chronic partial tear. Patients were preoperatively and postoperatively evaluated at a mean follow-up period of 16 months (range, 6 to 27 months) with a 0-100 points rating system. All patients were studied preoperatively with magnetic resonance imaging (MRI) and 6 were re-evaluated with the same procedure after surgery. All surgical interventions were performed on an ambulatory basis and 5 under local anesthesia. The surgical endoscopic technique consisted of peritenon release and debridement in cases with pure peritendinitis. In addition, 2 longitudinal tenotomies were performed in cases with degenerative tendinosis or partial tears. Results: According to the scoring system used, all 7 patients had improved final outcome after surgery from a mean of 39 points preoperatively to 88 points postoperatively. The patient with an AT partial tear achieved the lowest score. The only complications were a minor hematoma and edema that resolved spontaneously. Postoperative MRI in patients with tendinosis failed to show evidence of degenerative areas. Conclusions: Endoscopic surgery may be a valid alternative to treat Achilles tendinopathies unresponsive to conservative treatment because of potential lower morbidity.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 3 (March), 2002: pp 298–303

Deregulated Expression of Cell Cycle–Associated Proteins in Solid Pseudopapillary Tumor of the Pancreas

Solid pseudopapillary tumor of the pancreas was studied in a 20-year-old woman and a 54-year-old woman. In the younger patient, the tumor had metastasized to the liver 8 years after distal pancreatectomy. In both neoplasms, the distinct histologic pattern of solid, pseudopapillary, and degenerative cystic areas was present. Analysis by means of immunohistochemistry revealed a diffuse expression for vimentin, neuron-specific enolase, and a focal positivity for α1-antitrypsin, whereas epithelial markers were negative in the tumor of the older patient and only focally expressed in the tumor of the younger patient. Immunohistochemical analysis of cell cycle–associated proteins provided an overexpression of cyclin D1 and cyclin D3 in both tumors, although to varying degrees. In addition, the cyclin-dependent kinase inhibitors p21, and to a lesser extent p27, were up-regulated just as mdm2. There was no accumulation of p53 protein, and Ki67-positive cells were extremely scarce. Analysis of the liver metastases showed an immunoreactive profile similar to that of the primary tumor. The results show a deregulation of the cell cycle with overexpression of cell cycle–activating proteins D1 and D3 and a probably counterbalancing up-regulation of the cyclin-dependent kinase inhibitors p21 and p27. The findings may explain the low pool of Ki67-reactive tumor cells and the generally good clinical outcome of these tumors. Whether a more profound dysbalance of the cell cycle regulation is responsible for the development of metastatic disease remains to be clarified.

The influence of hypoxia on the myocardium of experimentally diabetic rats with and without protection by Ginkgo biloba extract: III: Ultrastructural investigations on mitochondria

Completing our preceding ultrastructural studies on diabetes and additional acute hypoxia of rat myocardium and the protective effect of Ginkgo extract (EGb) we investigated specific ultrastructural-morphometric parameters of corresponding mitochondria. Aim of the study was to answer the question whether mitochondria of diabetic myocardium are more sensitive to hypoxia than in normal condition, and whether antioxidative protection by EGb is effective. Further we compared the ultrastructural reactions of mitochondria of different intracellular locations. Voluminal parameters of mitochondria indicated a moderate swelling after diabetes and a further slight swelling after additional hypoxia, which was slightly reduced after EGb pretreatment. Decrease of volume density of mitochondrial cristae was less expressed after diabetes and much stronger after additional hypoxia; slight protection by EGb was only visible after diabetes. Degenerative intramitochondrial areas increased significantly after diabetes and after hypoxia; EGb was protective only after additional hypoxia. The relative number of ATPase particles (F1-coupling factors) at the inner mitochondrial membranes was slightly but significantly reduced after diabetes and stronger reduced after additional hypoxia; only in the latter condition Ginkgo extract was slightly protective. The product of volume density of mitochondria x volume density of cristae x relative number of ATPase particles at the inner mitochondrial membrane (as structural equivalent of the myocardial capacity for ATP production) indicated better than single parameters the increasing mitochondrial damage after diabetes of 4 months duration and subsequent acute hypoxia of 20 min duration. After hypoxia this capacity amounted only to 46% of the normal and was improved by EGb to 53%.

内側型変形性膝関節症における外側半月板変性のＭＲＩによる検討

We examined the degeneration of the lateral meniscus (LM) by MRI in 47 knees with OA. The average age of the patients was 65.5 years (range from 47 to 90). They were divided into two groups radiographically by Kellgren classification: One group was classified as early stage, consisting of grades I and II, and the other as advanced stage, consisting of grades III and IV. There were 22 knees in the early stage, and 25 in the advanced stage. The MRI findings were evaluated according to Mink's classification. Grades 3A and 3B were regarded as significant degeneration.In the early stage, a significant degenerative area was observed in the anterior, middle, and posterior regions in LM at the rate of 18.2%, 9.1%, 13.6%, respectively in MRI. On the other hand, in the late stage, the degenerative area was observed in the anterior region at the highest rate of 48%; In the middle and posterior regions, the rate was 28% and 24%, respectively. The tendency for the anterior region in LM to degenerate more frequently in the late stage may be correlated with the loose attachment to the capsular ligament in the subpopliteal recess in the posterior region.

The influence of hypoxia on the myocardium of experimentally diabetic rats with and without protection by Ginkgo biloba extract: I. Ultrastructural and biochemical investigations on cardiomyocytes

The influence of acute respiratoric hypoxia in streptozotocin-diabetic rats and protective effects of Ginkgo biloba extract (EGb 761)-pretreatment were investigated by the means of ultrastructural morphometry, biochemical parameters of oxidative stress and iNOS transcription and expression. Ultrastructural parameters revealed that acute hypoxia deteriorated the morphologic condition of the diabetic cardiomyocytes: volume fractions of sarcoplasm, t-tubules, mitochondria, cytoplasmic vacuoles, and degenerative intramitochondrial areas increased after hypoxia, those of myofibrils and mitochondrial cristae decreased. Since these alterations are more striking than after hypoxia of non-diabetic animals as demonstrated in preceding studies, we regard them as indicative for reduced hypoxia tolerance of the diabetic myocardium. EGb-treatment of the diabetic animals could improve the above mentioned parameters thus indicating a gradual improvement of the hypoxia tolerance. The biochemical parameters of oxidative stress (malondialdehyde, superoxide dismutase) were decreased after hypoxia in the diabetic myocardium but increased after EGb-pretreatment. The ultrastructural damage by hypoxia and its prevention by EGb should be regarded rather as a consequence of ATP--and energy deficiency and breakdown of membrane functions and--structure resp. as membrane stabilizing and enzyme-regulating effects of EGb than as radical-related events. The hypoxia-induced deprivation of creatine kinase activity of the diabetic myocardium was not prevented by EGb-treatment. Immunohistochemical demonstration of iNOS expression was strongest in the unprotected diabetic myocardium, absent after additional hypoxia and in the controls, and very weak in the protected hypoxic specimens. Transcription of iNOS as demonstrated by RT-PCR was present in few diabetic, some of the hypoxic diabetic, in most of the EGb-treated hypoxic diabetic, and in all control animals. EGb-treatment seems to improve the hypoxia tolerance of diabetic myocardium concerning ultratructural parameters. The partly conflicting immunohistochemical and biochemical results require further investigations.

The immunological microenvironment in the CNS: implications on neuronal cell death and survival.

Microenvironmental factors have a profound influence on resident cell populations and their ability to modulate an immune response. The unique central nervous system (CNS) microenvironment has important effects in this regard, resulting in the establishment of immune privilege. The immune response in the CNS is under tight control of bipolar regulatory mechanisms. Neurons have a suppressive potential, which prevents and limits the formation of inflammatory responses. In contrast, activated lymphocytes, which can invade the CNS, deposit potentially pro-inflammatory mediators. The balance between pro- and anti-inflammatory factors determines localization, intensity and course of immune responses in the brain. Thus, an overwhelming invasion of activated lymphocytes, which may have emerged from a recent anti-microbial immune response, may create inflammation in intact parts of the CNS. In contrast, in compromised brain areas, much weaker proinflammatory forces are required to create the same effect. Thus, in degenerative brain lesions, inflammatory infiltrates may be formed easily. Immune cell invasion and expression of immune effector molecules in degenerative CNS disease could exert a variety of actions on the neurons. In the first instance, activation of the local immune response could be harmful to resident brain cells, possibly resulting in neuronal cell death. Alternatively, immune cell-derived mediators could protect and support the regeneration of damaged neurons. Recently, it has been realized that normal inflammatory cells (lymphocytes and macrophages) produce neurotrophic factors. In addition, pro-inflammatory cytokines released by invading immune cells may have a role in neuroprotection. Infiltration of degenerative brain areas by inflammatory cells could thus reflect a beneficial process encouraging neuronal survival and local cell regeneration.

Repetitive coxsackievirus infection induces cardiac dilatation in post-myocarditic mice.

The relation between mycarditis and dilated cardiomyopathy (DCM) is controversial. To clarify the pathogenic mechanism of these diseases, the present study examined the effect of repetitive inoculation with coxsackievirus B3 (CVB3) in post-myocarditic mice. Inbred 3-week-old A/J mice were inoculated intraperitoneally with CVB3 (Nancy strain; 2x10(4) plaque-forming units) and reinfected in the same manner with CVB3 at 40 weeks (3W+/40W+). All mice were killed at 42 weeks old. The weight of the hearts of the 3W+/40W+ group were significantly increased compared with those of the 3W-/40W+ group, and both the heart weight/body weight and lung weight/body weight ratios of the 3W+/40W+ group were also significantly increased over those of the 3W-/40W- group, although the levels of serum neutralizing antibody titers were significantly increased in the 3W+/40W+ group over the level of the other groups. No increase in inflammatory cell infiltration or fibrosis progression was observed in the 3W+/40W+ group relative to the 3W+/40W- group, but the second inoculation resulted in a significant left ventricular dilatation and in left and right ventricular free wall thinning (3.31+/-0.20 mm vs 2.61+/-0.19 mm, p<0.05; 0.54+/-0.09 mm vs 0.72+/-0.16 mm, p<0.05, respectively). The sarcomere length was also significantly increased in the 3W+/40W+ group compared with that of the other groups, as determined by electron microscopy. Degenerative or necrotic areas in the infected hearts were not stained with anti-mouse IgG antibody, but were stained, only in 3W+/40W+ mice, with anti-mouse IgM antibody. The concentrations of TNF-alpha in the hearts of the 3W+/40W+ group were increased significantly over those of the 3W+/40W- group. Repetitive CVB3 infection produced cardiac dilatation without inflammatory cell infiltration in post- myocarditic mice. Autoimmunity mediated by the circulation of certain antibodies (eg, antibodies against the CVB3 genome or a CVB3-related protein) may be part of the pathogenic mechanism for this phenomenon. Thus, repetitive virus infection might contribute to the pathogenesis of cardiac dilatation.

Solid and cystic tumorの1切除例

A 52-year-old Japanese female was pointed out a pancreas tumor at healthy check and admitted to our hospital for further diagnosis and treatment on May, 1996. No apparent abnormality was found at physical examinations. She had anemia (Hb 8.9g/dl) which was recovered before surgical operation. Other laboratory data such as blood chemistry, hormonal examinations and tumor markers were within normal limits. Abdominal ultrasound and endoscopic ultrasonography revealed an 4cm in size, which showed slightly hypoechoic internal echo and anechoic cystic area. Magnetic resonance cholangiopancreaticography (MRCP) revealed a high-intensity tumor which compressed extrahepatic distal bile duct and main pancreatic duct. Abdominal angiography showed a hypervascular tumor which was feeded by mainly inferior pancreaticoduodenal artery and partially anterior superior pancreaticoduodenal artery. And finally she was suspected solid and cystic tumor (SCT) or non-functional islet tumor and was removed the tumor which was 5.0×3.3×3.2cm in size with fibrous capsule. That tumor consisted of yellowish solid tumor with hemorrhage and degenerative cystic area. Microscopic examination showed cubic tumor cells with sheets, cystic and papillary formation. Immuno-histological staining for α1-antitrypsin and NSE were positive. And this tumor was diagnosed SCT histologically. 189 cases with SCT have been reported in Japan from 1979 to 1995 and we reviewed these cases.

Chromogranin A triggers a phenotypic transformation and the generation of nitric oxide in brain microglial cells.

Chromogranin A is an ubiquitous 48,000 mol. wt secretory protein stored and released from many neuroendocrine cells and neurons. In human brain, chromogranin A is a common feature of regions that are known to be affected by various neurodegenerative pathologies such as Alzheimer's, Parkinson's and Pick's diseases. Brain degenerative areas are generally infiltrated by activated microglial cells, the resident macrophage cell population within the central nervous system. Here, we report that both recombinant human chromogranin A and chromogranin A purified from bovine chromaffin granules trigger drastic morphological changes in rat microglial cells maintained in culture. Microglial cells exposed to chromogranin A adopted a flattened amoeboid shape and, this change was associated with an accumulation of actin in the subplasmalemmal region, as observed by immunocytochemistry and confocal laser microscopy. In single microglial cells loaded with indo-1, chromogranin A elicited a rapid and transient increase in [Ca2+]i which preceded the reorganization of actin cytoskeleton. The activity of nitric oxide synthase was estimated by measuring the accumulation of nitrite in the culture medium. Both recombinant human chromogranin A and bovine chromogranin A triggered an important accumulation of nitrite comparable to that induced by lipopolysaccharide, a well-known activator of microglia. The effect of chromogranin A was dose dependent, inhibited by N omega-nitro-L-arginine methyl ester, a competitive inhibitor of nitric oxide synthase, and by cycloheximide, an inhibitor of protein synthesis. These findings suggest that chromogranin A induces an activated phenotype of microglia, and thus may have a role in the pathogenesis of neuronal degeneration in the brain.

MR imaging of meniscal allografts: correlation with clinical and arthroscopic outcomes.

To correlate magnetic resonance (MR) imaging findings after meniscal transplantation with those at clinical, arthroscopic, and histologic examination. Twenty-four patients (29 menisci) underwent MR imaging after meniscal transplantation. Nineteen patients underwent arthroscopy, and the peripheral capsular attachment, degenerative areas, or both were sampled for biopsy. MR findings were correlated with those at clinical, arthroscopic, and histologic examination. MR imaging enabled accurate assessment of allograft attachments. Fragmentation and frank extrusion were associated with full-thickness chondral loss. Allograft degeneration, indicated by an increase in signal intensity, was seen with moderate and severe chondral wear. Clinical results were worse with meniscal extrusion, with complaints of locking. Patients with mild fragmentation reported pain without locking. Histologic examination of excised allografts revealed myxomatous degeneration without immunologic reaction. MR imaging can help assess allograft placement and articular cartilage and enable differentiation of fragmentation from extrusion. Preoperative assessment of articular cartilage is important to identify patients who may be at risk for failure.

Decreased food efficiency ratio, growth retardation and changes in liver fatty acid composition in rats consuming thermally oxidized and polymerized sunflower oil used for frying

Changes in food intake, body weight, liver weight, hepatosomatic index and hepatic fatty acid composition were studied in growing male Wistar rats fed a diet containing sunflower oil that had been used repeatedly for frying. During a period of 27 days, the animals were fed semi-synthetic diets containing either 15% used oil with 19.1% polar material (group 2) or 15% unused oil with 5.1% polar material (group 1). Although food intake was similar in both experimental groups, final body weight, body weight gain, food efficiency ratio and protein efficiency ratio were significantly lower in group 2. The increase of the hepatosomatic index in rats of group 2 seems related to a higher ingestion of potential toxic components (dimers and polymers of triglycerides and oxidized triglycerides) by this group. The livers of nine out of the 10 animals studied also showed moderate fibrotic degenerative areas with severe vacuolization, together with regenerative areas containing eosinophilic binuclear hepatocytes. In addition, livers of group 2 animals showed a 12% higher content of arachidonic acid. Data suggest that higher arachidonic acid levels would be needed for regeneration to palliate liver injury. These data suggest that frying sunflower oil is potentially toxic; assessment of risk is therefore necessary for frying fats with a high polar content.

Resorption of unemitted gametes in Lithognathus mormyrus (Sparidae, Teleostei): a possible synergic action of somatic and immune cells

The resorption of unemitted gametes during the post-spawning period of the male and female reproductive cycles in Lithognathus mormyrus was studied by histochemical, histological and cytological methods. The resorption of residual spermatozoa involved the phagocytotic activity of Sertoli cells bounding the seminiferous cysts of spermatozoa, and those associated with spermatogonia lining the lobular lumen. Spermatozoa remaining in the sperm duct were phagocytozed by the lining epithelial cells. Eosinophilic granulocytes and macrophages were identified in the vicinity of residual spermatozoa. The remnants of oocytes underwent an atretic phenomenon in which follicle cells were firstly involved, inducing a progressive fragmentation of the oocyte cytoplasm. Subsequently, eosinophilic granulocytes invaded oocyte degenerative areas and clung to the remaining vitelline inclusions ensuring their biotransformation into waste products (brown bodies). The analogy of the resorption processes of both male and female unemitted gametes during the post-spawning period of natural reproductive cycle, involving first the enveloping somatic cells and then immune cells, is emphasized.

Sustained decrease in brain regional blood flow after microsphere embolism in rats.

An experimental model that induces sustained ischemia and infarction may provide useful information relevant to prevention of the development of ischemic brain disease. The purpose of the present study was to elucidate the pathophysiological consequences of cerebral blood flow under sustained cerebral ischemia or oligemia and infarction in rats after microsphere embolism. We injected 900 microspheres (48 microns in diameter) into the right internal carotid artery of 146 rats and determined the time course of changes in blood flow of the cerebral cortex, striatum, and hippocampus of both hemispheres by the hydrogen clearance method for a period of 28 days after the operation. Infarct area was determined by triphenyltetrazolium chloride staining and hematoxylin and eosin staining methods. Cortical and striatal blood flow of the right hemisphere of microsphere-injected rats was significantly decreased after the embolism, and this was sustained throughout the experiment. Hippocampal blood flow of the microsphere-injected hemisphere was also decreased on days 1 and 3 but tended to return toward control levels thereafter. In the left hemisphere, reduction in regional blood flow was detected in the cortex and hippocampus on day 1 and the striatum on day 3. A triphenyltetrazolium chloride-unstained area had developed by day 3 after the embolism. The extent of the area was similar to that on days 7 and 28. Microscopic examination revealed degenerative areas scattered mainly in the parietotemporal cortex, corpus callosum, hippocampus, thalamus, and lenticular nucleus of the embolized hemisphere, demonstrating the induction of widespread necrosis after embolism. Microsphere embolism resulted in a sustained decrease in regional blood flow and production of cerebral infarction in the brain regions of the microsphere-injected hemisphere.

A new instrument for pulmonary resection: the bipolar Nd-YAG laser dissector.

A bipolar Nd-YAG laser dissector was developed to quickly dissect or resect organs, and the possibility of laser pulmonary dissection without scissors and ligation threads was studied experimentally. Pulmonary tissue was completely and easily divided using a bipolar laser handpiece, and the dissected edge was perfectly sealed. Leakage of air and blood from the edge was not induced and no additional stitching was required. Histological examination of the dissected edge revealed tissue remodeling after laser irradiation. The formation of amorphous layers, including vacuoles, was peculiar to the fusion-coagulation area, and alveolar atelectasis and capillary obstructions were characteristic of the degenerative area. When tissue dissection was performed by laser vaporazation, tissue remodeling seemed to be the most important factor in the prevention of leakage. In conclusion, we can effectively and quickly resect pulmonary tissue using the bipolar Nd-YAG laser dissector without scissors and without ligation threads.

Autopsy report of HTLV-I-associated myelopathy presenting with ALS-like manifestations

We report an autopsy case of HTLV-I-associated myelopathy (HAM) showing clinical features indistinguishable from amyotrophic lateral selerosis (ALS). A Japanese man developed bulbar palsy and generalized neurogenic muscular atrophy with symmetrical hyperreflexia at the age of 57 and died 4.5 years after the onset. He had an increased titer of anti-HTLV-I antibodies in serum and CSF. At autopsy, the leptomeninges were thickened and infiltrated with inflammatory cells. The brain and spinal cord were atrophic. The pyramidal tracts and anterior horn cells of spinal cord were severely degenerated but degenerative changes were also found in the basal ganglia, thalamus, brainstem tegmentum, and the dorsal columns of spinal cord. In all degenerative areas, prominent infiltrations of inflammatory cells were found. The present case indicates that HAM may produce clinical features indistinguishable from ALS.

Clinicopathological studies on solid and cystic tumors of the pancreas

Three cases of pancreatic tumor in two females (case 1, case 3) and one male (case 2) were reported. Macroscopically cases 1 and 3, which were surrounded by a thick fibrous capsule, developed toward the outside of the pancreas and the cut surface showed mainly cystic degenerative areas filled with necrotic and hemorrhagic materials. In contrast with these two cases, case 2 was buried in the pancreatic tissue and the cut surface showed cystic degenerative areas in its center with a thick fibrous capsule and tumor cell nests invading beyond the capsule to the parenchyma of the pancreas. Microscopically each tumor was identical. The solid areas on the periphery were composed of sheets of polygonal uniform cells subdivided by delicate fibrovascular stalks. Near the degenerative areas, tumor cells lay on a delicate fibrovascular core in one or two layers, with pseudopapillary patterns. Mitotic figures were very rare. All three cases demonstrated immunoreactivity for alpha-1-antitrypsin, but not for islet hormones, tumor markers nor neuron-specific enolase. Although electronmicroscopically, zymogen granules were detected in cases 2 and 3, and annulate lamellae in cases 1 and 3, ductal cell character features were not so developed. From the above, these tumors were diagnosed as solid and cystic tumors of the pancreas. Furthermore, it was suggested that they differentiated in the direction of acinar cells.

Der therapieresistente Fersenschmerz - eine Operationsindikation der Sporttraumatologie

Posterior heel pain can be caused by inflammation or pathology of the achilles tendon, the tendon sheath, the retrocalcaneal and subcutaneous tendoachilles bursa, can be caused by osteophytes or stress fracture of the os calcis and by rheumatoid or metabolic diseases. The majority of patients can be treated successful nonoperatively; however, there is a small group of patients who are refractory to nonoperative managements. In the years 1984 to 422 patients with posterior heel pain were treated conservatively, 26 of these patients were refractory to that management. There were 9 cases of achilles tendinitis and/or tenosynovitis, 7 cases of bursitis, 3 cases of osteophyte of the os calcis. In 7 cases there was seen a combination of these three diseases. The following operative procedures were performed: discision of the tendon sheath, excision of thickened parts by inflammation, excision of degenerative and necrotic pain-producing areas in the achilles tendon, excision of bursa and ostectomy of osteophyte at the posterior-superior angle of the os calcis. The mean follow-up was 2.7 years (range, 1/2 to 5 years). Overall there were 79% good results. In our opinion cases of posterior heel pain refractory to non-operative treatment are an indication of sports surgery, especially in patients who like to continue sports without pain.

Ｎｄ‐ＹＡＧレーザー照射の舌組織に与える影響

Recently, the Nd-YAG laser has been widely applied for head and neck surgery. This medical instrument provides several advantages, including hemostatic efficacy and cutting capability which are dependent on manipulation. The purpose of this study is to discuss the clinical application of Nd-YAG laser in the field of oropharyngeal surgery. For this reason, the canine tongue is used in this study. After irradiation by Nd-YAG laser, observations were performed on histological findings, measurement of tissue temperature and changes in blood vessels. The results obtained are as follows: 1) Irreversible tissue changes were found in the center of the irradiated area, with other tissue degeneration occurring in the surrounding areas. 2) Within the coagulated degenerative area, blood vessels were completely embolized. 3) Temperature measurements revealed that there were minimal effects on the surrounding tissues. 4) The coagulated degenerative area was replaced by granulation tissue subsequently occurring after wound healing. 5) The Nd-YAG laser was useful for oral and paranasal surgery, because these diseases are localized in the cavity. 6) Non-contact type Nd-YAG laser was indicated for vaporization of the lesions and was particularly useful for vaporizing superficial benign lesions. In this case, close range, low power vaporization is recommended. Conversely, vaporization for hemangioma and/or malignant lesions were most effective with high power irradiation. 7) Contact type Nd-YAG laser might be suitable for cutting and excision of lesions, but careful attention must be given determining the safety margin for application in malignant lesions, because tissue degeneration when using contact type Nd-YAG laser is less reactive than in non-contact type.