Herniation Of Tissue Research Articles

腰椎椎間板ヘルニアに対する術後成績の検討

341 operated cases of lumbar disc hernia were analyzed. Cases of pure hernia were 87%, those with lumbar canal stenoses were 13%. The average age was 50.3 years-old and the male to female ratio was almost 2 to 1.The indication of surgery should be analyzed first, according to the patient's neurological status, complaints and the duration of leg pain. It also can be determined by examining the evidence of the findings of radiological images of neural compression. However, it may be also indicated, in consideration of the psychiatric aspects, excluding neurological degenerative diseases.In deciding the surgical plan, (whether it is limited to minimum surgery, or extended to the wide laminectomy), the surgeon should consider the following points; whether the patient is of working age or not, and whether his labor is physical work or not, for example.One of the other important points of surgical strategy is to make a change as promptly as possible from minimum laminotomy to the wide laminectomy, when the case of a large size hernia is accompanied with a severely narrow canal. This is in order to protect the nerve root, at the same time, as aiming for the maximum removal of the herniated tissue. Nevertheless, the rate of recurrence could not be decreased more than 2∼3%.The investigation of preoperative risk factors brings a decrease in the percentage of complications, such as, brain or heart vascular disorders, Exceptions would be postoperative infections or hematomas.

Inhibition of peridural fibrosis after laminectomy using biological sheet in rat model

OBJECTIVE: To investigate the use of a biological membrane composed by a decalcified bovine cortical osseous, in surgeries of spinal column in rats, to treat the osseous defect, minimizing or blocking the muscular tissue herniation into the rachidian channel, reducing the fibrous tissue formed at post-operative period and yet to evaluate the material biocompatibility […] Inhibition of peridural fibrosis after laminectomy using biological sheet in rat model (Abstract). Thesis. Sao Paulo, 2003

Pathology of space-occupying lesions of the CNS

The brain and spinal cord are enclosed by bone, hence expansion of their contents by a space-occupying lesion (SOL) leads to compression and distortion of the tissues of the CNS. Slowly enlarging SOLs can be accommodated by atrophy of adjacent brain or spinal tissue. More rapid enlargement causes a rise in pressure in the affected compartment from the normal level of < 2 kPa (< 15 mmHg), and herniation of the soft CNS tissue into adjacent compartments where the pressure is lower. This has potentially fatal consequences. There are several types of SOL within the CNS (Figure 1) and individual examples are discussed in this contribution.

Status of the internal orbit after reduction of zygomaticomaxillary complex fractures

Purpose We sought to determine the status of the internal orbit before and after reduction of zygomaticomaxillary complex (ZMC) fractures when treated without internal orbital reconstruction. Patients and methods We conducted a retrospective study of preoperative and postoperative computed tomography (CT) scans in 65 patients with unilateral ZMC fractures who were treated by reduction of the ZMC complex without internal orbital reconstruction. The size and location of the internal orbital defects, orbital soft tissue displacement, and orbital volume were assessed in the preoperative and postoperative CT scans. Results Reduction in the ZMC fractures was considered ideal in 58 of the 65 patients. Only minor malpositions occurred in the remaining 7 patients. The size of the internal orbital defects increased slightly with ZMC reduction but the internal orbital fractures were realigned, and few had increases in orbital volume or soft tissue sagging into the sinuses. Examination of follow-up CT scans in several patients taken weeks to months later showed that the residual defects became smaller and that none of these patients had an increase in orbital volume or soft tissue sagging. Conclusion The preoperative CT scan can be used to assess the amount of internal orbital disruption for purposes of developing a treatment plan in patients with ZMC fractures. When there is minimal or no soft tissue herniation and minimal disruption of the internal orbit, ZMC reduction is adequate treatment.

Herniated and Spondylotic Intervertebral Discs of the Human Cervical Spine: Histological and Immunohistochemical Observations

We investigated the histological and immunohistochemical changes within and around the cervical intervertebral discs in symptomatic myeloradiculopathy and myelopathy patients. A total of 163 cervical intervertebral discs, 100 herniated discs and 63 spondylotic discs, were harvested en bloc during anterior decompressive surgeries and histological examination was performed, focusing on nucleus pulposus, annulus fibrosus, cartilaginous endplate, and ligamentous enthesis. There was a close relationship between MRI grade and histological degenerative changes. Histological features of the herniated intervertebral discs were the presence of granulation tissue, newly-developed blood vessels and infiltration of CD68-positive cells, which surrounded the herniated tissue in the outer layer of the annulus fibrosus. Marked vascular invasion was detected in 67% of herniated discs and 54% of spondylotic discs. Immunohistochemically, chondrocytes positive for matrix metalloproteinase (MMP)-3, tumor necrosis factor (TNF)-α, basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) were detected in both herniated and spondylotic discs. Our results indicate that the neoangiogenesis process is associated with overexpression of bFGF and VEGF, and suggest that intervertebral disc degradation is enhanced by macrophage infiltration, which is regulated by MMP-3 and TNF-α. The expression of these proteins may be enhanced by the tear of annulus fibrosus.

Combination of transconjunctival and endonasal-transantral approach in the repair of blowout fractures involving the orbital floor

In the repair of orbital blowout fractures through eyelid or conjunctival incision, it is difficult to see the posterior edge of the fracture and the condition of the herniated tissue before reduction of the orbital contents. Prolapsed orbital tissue or infraorbital nerve and vessels may therefore be damaged in the reduction. The recently advocated combination of traditional transconjunctival approach and endoscopic transantral approach allows reduction and reconstruction under clear endoscopic vision without a facial skin incision. We modified this technique to make it less invasive and applied it to the repair of orbital blowout fractures involving the orbital floor. The use of a 70-degree straight endoscope through an enlarged ostium as for functional sinus surgery allowed clear sight of the roof of the antrum. During the repair of the orbital floor through a transconjunctival approach, reduction and reconstruction was assisted from the antrum. Twelve cases of fresh blowout fractures were treated with this approach. There were seven male and five female patients. Mean age was 23.5 years. Causes of injuries were fights, motor vehicle or bicycle accidents, and sports. Patients with concomitant fractures involving the orbital rim were excluded. Persistent diplopia was present in eight cases and enophthalmos of more than 2 mm was detected in five cases preoperatively. The average intervals from injury to surgery was 22.8 days. Exploration, reduction and reconstruction of the orbital floor fractures were precisely performed with this procedure. Large orbital floor defects were reconstructed with silicone sheets, thin iliac bone grafts or nasal septal cartilage. In all eight cases that showed diplopia, ocular movement recovered and symptomatic diplopia disappeared after surgery. Enophthalmos of more than 2 mm was also improved in all five cases. One early case showed temporary entropion. Transient numbness of the cheek appeared in five cases and temporary maxillary sinusitis recovered in one case. Postoperative infection was not observed. This method provides visualisation of posterior edge of the fracture and the condition of herniated orbital contents before initiation of reduction. Dual manipulation by two surgeons is also possible in reduction and reconstruction of the orbital floor.

Transdiaphragmatic liver herniation mimicking pulmonary nodule

Transdiaphragmatic herniation of liver tissue can rarely mimic intrapulmonary masses and is almost exclusively diagnosed as incidental finding during surgery. In a 77-year-old female smoker referred for work-up bullous pemphigoid, a potentially paraneoplastic condition, chest radiography demonstrated a right-sided supradiaphragmatic lung nodule. Transdiaphragmatic liver herniation was diagnosed prospectively by computed tomography (CT) and percutaneous lung biopsy and subsequently confirmed by surgery. Solid intrathoracic masses demonstrating isodense enhancement to liver tissue in CT suggest presence of ectopic liver tissue or herniated liver. We suggest that CT combined with percutaneous biopsy can be sufficient to establish diagnosis and to exclude a malignant condition.

Unusual solid ganglia of the anterior cruciate ligament mimicking lateral meniscal tears

Previous investigators have reported incidental findings and symptomatic cases of cystic ganglia on the anterior cruciate ligament (ACL) that were mucinous degeneration or herniation of the synovial tissue through a defect. However, we report 2 cases of grossly solid ganglia of the ACL those mimicked lateral meniscal tears. A literature search found no previous report of them. We discuss the possibility of their pathogenesis and treatment.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 2 (February), 2003: pp E14–E14

Fractura evolutiva de cráneo en la infancia. Presentación de 12 casos

Growing skull fractures (GSF) are rare complications of head injury (HI) in childhood. This entity consists of a skull fracture with an underlying dural tear that courses with a progressive enlargement of the fracture to produce a cranial defect. The pathophysiology and some aspects of its management are still controversial. In this review we present 12 patients diagnosedd and treated for a GSF at our institution between 1980 and 2002. 11 patients were under the age of 3 years and one patient was 5 years old at the moment of HI. The most common cause of injury was a fall from height. In the initial plain x-rayfilms, 11 patients showed a diastatic skull fracture and one patient only had a linear fracture. At this time, CT scan showed cortical contussion underlying the fracture in every case. The mean time between injury and presentation of GSF was 11.6 weeks. Diagnosis was made by palpation of the cranial defect and confirmed with skull x-rayfilms. The most frecuent location of GSF was in the parietal region. Associated lesions like hydrocephalus, encephalomalacia, lepto-menigeal cysts, brain tissue herniation and ipsilateral ventricular dilatation, were found in the preoperative CT or MRI. All patients underwent a dural repair with pericranium or fascia lata. The cranial defect was covered with local calvarial bone fragments in every case. Only one patient needed a cranioplasty with titanium mesh. Every child with a skull fracture must be followed until the fracture heals. Patients under the age of 3 years with a diastatic fracture and a dural tear, demostrated by TC or MRI, are more prone to develop GSF. In these cases, early repair must be adviced in order to prevent progressive brain damage.

Predictability of donor lamellar graft diameter and thickness in an artificial anterior chamber system.

To identify factors affecting the predictability and report results of donor lamellar graft diameter and thickness in an artificial anterior chamber obtained with a microkeratome. Lamellar lenticules were obtained from 25 human corneoscleral rims mounted in an artificial anterior chamber. Lenticules measuring 9 mm were attempted at two thicknesses (250 microm and 350 microm heads). Intrachamber pressure of 65 mm Hg was confirmed with Barraquer tonometry. Keratometry, pachymetry, limbal white-to-white, and qualitative mires with the diameter applanation lens were evaluated as possible factors predictive of lenticule diameter and thickness. Diameters and thicknesses were measured with calipers and pachymetry, respectively. RESULTS Ninety-two percent (23/25 lenticules; 14/15 in 250 microm, 9/10 in 350 microm) were +/- 0.25 mm of the intended diameter and 76% (19/25 lenticules; 12/15 in 250 microm, 7/10 in 350 microm) were within +/- 100 microm of the intended thickness. Ovoid applanation mires with the diameter applanation lens represented tissue herniation within the artificial anterior chamber and led to ovoid lenticules (2/25). Lenticules of 9 mm +/-0.25mm in diameter were highly reproducible with proper corneoscleral rim seating. Intrachamber pressure confirmed with Barraquer tonometry is important in obtaining lenticules of consistent diameter and adequate thickness. Ovoid applanation mires may herald improper corneoscleral rim seating and result in a similarly shaped lenticule. A 2 mm or greater corneoscleral rim is recommended to prevent tissue herniation within the artificial anterior chamber used in this study.

Sphenoid encephaloceles: disease management and identification of lesions within the lateral recess of the sphenoid sinus.

Encephaloceles usually involve herniation of frontal lobe tissue through an anterior cranial fossa defect into the ethmoid sinus or nasal cavity. Encephaloceles can also result from temporal lobe herniation through a middle fossa defect into the sphenoid sinus. Within the sphenoid, encephaloceles are thought to occur most commonly in the central or midline aspect of the sinus. Lateral sphenoid encephaloceles, especially within the lateral aspect of the sphenoid sinus when the sphenoid sinus has pneumatized extensively into the pterygoid recess, are considered exceedingly rare. The objectives of the study were to review our experience with sphenoid encephaloceles to understand the relative frequency and the locations in which they occur within the sphenoid sinus and to report our experience in caring for patients with this condition. Retrospective review. Retrospective review of patient records and operative reports from 1991 to 2000. RESULTS Twelve patients were treated for intrasphenoid encephaloceles during a 10-year period. Eight patients had lesions located in the lateral recess of the sphenoid sinus. Surgical repair was undertaken in all 12 cases using endoscopic techniques. In 11 of 12 cases, the repair was successful with follow-up times of 12 to 69 months (mean follow-up, 31.9 mo). Temporal lobe encephaloceles in the lateral sphenoid sinus have been reported rarely in the literature. Careful preoperative evaluation and localization of the sphenoid defect are critical for the selection of the optimal surgical approach for repair of the skull base defect. Our 10-year experience represents the largest group of patients treated endoscopically for intrasphenoid encephaloceles reported to date.

Spatial and temporal localization of transforming growth factor-beta, fibroblast growth factor-2, and osteonectin, and identification of cells expressing alpha-smooth muscle actin in the injured anulus fibrosus: implications for extracellular matrix repair.

The spatial and temporal localization of fibroblast growth factor-2, transforming growth factor-beta, osteonectin, and alpha-smooth muscle cell actin in the injured anulus fibrosus was investigated. To assess the involvement of fibroblast growth factor-2, transforming growth factor-beta, osteonectin, and alpha-smooth muscle cell actin in anulus fibrosus repair. Fibroblast growth factor-2 and transforming growth factor-beta have been localized to disc herniation tissue, and alpha-smooth muscle cell actin has been identified in a number of mesenchymal cell types, but their roles have not been evaluated in repair processes in the experimentally injured anulus fibrosus. For this study, 32 two adult merinos received a 4-mm deep standard annular incision in their L1L2 and L3L4 discs (lesion group). A similar number of sham-surgery animals served as control subjects. Osteonectin, fibroblast growth factor-2, transforming growth factor-beta, and alpha-smooth muscle cell actin were immunolocalized in sagittal disc sections 3, 6, 12, and 26 months after the operation. Selected specimens also were stained with hematoxylin and eosin, Masson-trichrome, toluidine blue, and picrosirius red. Early focal depletion of proteoglycan was evident in the anulus fibrosus and reorganization of outer annular lamellas 3 to 6 months after the operation. Blood vessel ingrowth and fibroblast infiltration from the outer anulus fibrosus along the plane of the annular defect were maximal 12 months after the operation. Focal upregulation in alpha-smooth muscle cell actin expression was evident with maximal staining in the 12-month lesion samples near infiltrating blood vessels at the lesion site, and also in cells well away from these vessels. Some of the anulus fibrosus cells of the sham sections also stained positively for alpha-smooth muscle cell actin, but this staining was significantly less than in the lesion samples. Staining for fibroblast growth factor-2, transforming growth factor-beta, and osteonectin was strongly localized to blood vessels and cells in the vicinity of the annular lesion. It was maximal 12 months after the operation and diminished by 26 months after the operation. Osteonectin expression also was significantly elevated in outer anulus fibrosus cells distant from the lesion site and its associated blood vessels. In the sham discs, immunoreactivity to fibroblast growth factor-2, transforming growth factor-beta, osteonectin, and alpha-smooth muscle cell actin was confined to sparsely distributed cells in the anulus fibrosus. No matrix staining was observed. Immunoreactivity for the noted agents was strongly associated with regions of the annular lesions undergoing matrix reorganization consistent with an active repair response. This response extended as far as the middle third of the anulus fibrosus, which also demarcated the extent of blood vessel ingrowth and cellular infiltration in this model. The alpha-smooth muscle cell actin expression suggested an active involvement of myofibroblasts in the anulus fibrosus repair processes.

2D- and 3D-based measurements of orbital floor fractures from CT scans

Objective: Two methods for area and volume calculation of the orbit were evaluated following blow-out fractures of the orbital floor using computed tomography (CT) scans. Material and Methods: Isolated blow-out fractures of the orbital floor in human cadavers were simulated by fracturing the orbital floor and placing a defined volume of silicone within each defect. The area of fracture and the volume of silicone simulating herniated periorbital tissue were evaluated in 16 orbits by the use of a three-dimensional (3D) CT-based software package (Analyze ®; Mayo Clinic, Rochester, MN, USA) and software based on two-dimensional (2D) coronal CT scans. Both methods were compared with direct anatomical measurements and evaluated with Lin's concordance coefficient ( ρ c ). Results: Between-method concordance of area and volume calculation were ρ c =0.962, and 0.872 for the 3D-CT-based method, and 0.981 and 0.952 for the 2D-CT method, respectively. The time allocated for measurement was significantly longer for the 3D-CT than for the 2D-CT method ( p<0.001). Conclusion: Calculations of blow-out fractures of the orbital floor by 3D-CT and 2D-CT method are accurate for assessing the area of fracture and the volume of herniated tissue. Lesser processing time and simple usage favour the 2D-CT-based calculation method. Copyright 2002 European Association for Cranio-Maxillofacial Surgery. Published by Elsevier Science Ltd. All rights reserved.

Effect of perforations in burr hole covers on cranial bone regeneration in rabbits

The reconstruction of bone defects is a significant problem in cranio-maxillofacial surgery. In an effort to avoid the known disadvantages of autogenous bone grafting, alternatives have been investigated. Bone substitute materials, degradable or nondegradable, aim at facilitating bone regeneration, while they take over load-bearing functions for a period of time. In this study, the healing of cranial defects in rabbits was assessed using polylactide guiding covers with and without perforations. Bilateral circular cranial defects were produced in 16 New Zealand white rabbits. The defects were covered with extruded and laser cut polylactide burr hole covers, each animal receiving a perforated burr hole cover on one side and a nonperforated one on the contralateral side. Bone seeking fluorochromes were administered at regular intervals. After an observation period of 8 weeks the amount of bone regeneration in the area of the defects was quantified from contact radiographs, and the dynamics of bone formation were assessed by fluorescence microscopy. Stained sections were used to analyze morphologic differences. No signs of adverse tissue reactions or osteolysis were observed. A bone-guiding function was observed for both covers with or without perforations. Intracranial tissue herniation into the defect hindered the regeneration process. Wide intraindividual and interindividual variation became apparent and average defect filling was only 40% within the 8-week observation period. In this model the perforated covers offered no advantage over nonperforated covers. It can be concluded from this study, that the use of external burr hole covers alone does not guarantee a full thickness regeneration of the cranial defect, but it provides a guiding function for promotion of structured bone regeneration.

Critical Care Management of Increased Intracranial Pressure

Increased intracranial pressure (ICP) is a pathologic state common to a variety of serious neurologic conditions, all of which are characterized by the addition of volume to the intracranial vault. Hence all ICP therapies are directed toward reducing intracranial volume. Elevated ICP can lead to brain damage or death by two principle mechanisms: (1) global hypoxic-ischemic injury, which results from reduction of cerebral perfusion pressure (CPP) and cerebral blood flow, and (2) mechanical compression, displacement, and herniation of brain tissue, which results from mass effect associated with compartmentalized ICP gradients. In unmonitored patients with acute neurologic deterioration, head elevation (30 degrees), hyperventilation (pCO2 26-30 mmHg), and mannitol (1.0-1.5 g/kg) can lower ICP within minutes. Fluid-coupled ventricular catheters and intraparenchymal pressure transducers are the most accurate and reliable devices for measuring ICP in the intensive care unit (ICU) setting. In a monitored patient, treatment of critical ICP elevation (&gt;20 mmHg) should proceed in the following steps: (1) consideration of repeat computed tomography (CT) scanning or consideration of definitive neurosurgical intervention, (2) intravenous sedation to attain a quiet, motionless state, (3) optimization of CPP to levels between 70 and 110 mmHg, (4) osmotherapy with mannitol or hypertonic saline, (5) hyperventilation (pCO2 26-30 mmHg), (6) high-dose pentobarbital therapy, and (7) systemic cooling to attain moderate hypothermia (32-33°C). Placement of an ICP monitor and use of a stepwise treatment algorithm are both essential for managing ICP effectively in the ICU setting.

Critical Care Management of Increased Intracranial Pressure

Increased intracranial pressure (ICP) is a pathologic state common to a variety of serious neurologic conditions, all of which are characterized by the addition of volume to the intracranial vault. Hence all ICP therapies are directed toward reducing intracranial volume. Elevated ICP can lead to brain damage or death by two principle mechanisms: (1) global hypoxic-ischemic injury, which results from reduction of cerebral perfusion pressure (CPP) and cerebral blood flow, and (2) mechanical compression, displacement, and herniation of brain tissue, which results from mass effect associated with compartmentalized ICP gradients. In unmonitored patients with acute neurologic deterioration, head elevation (30 degrees), hyperventilation (pCO2 26-30 mmHg), and mannitol (1.0-1.5 g/kg) can lower ICP within minutes. Fluid-coupled ventricular catheters and intraparenchymal pressure transducers are the most accurate and reliable devices for measuring ICP in the intensive care unit (ICU) setting. In a monitored patient...

Cytokines and growth factors in the protruded intervertebral disc of the lumbar spine.

Nerve root irritation induced by factors produced by the intervertebral disc may play a crucial role in the pathophysiology of sciatic pain production. In this study we used immunohistochemistry to investigate the presence of transforming growth factor-beta1 (TGF-beta1), insulin-like growth factor-1 (IGF-1), interleukin-6 (IL-6), IL-6-receptor (IL-6R) and fibronectin in lumbar disc bioptic specimens from 30 patients with disc herniation (protrusion type). Chondrocytes of herniated discs stained positive for TGF-beta1, IGF-1, IL-6 and fibronectin. We demonstrated for the first time the presence of IL-6-R in the chondrocytes of herniated tissue. Specimens from autoptic healthy tissue were used as controls. In these sections no immunoreaction for TGF-beta1, IL-6, or IL-6R was found, while they expressed IGF-1 and fibronectin, but in lower quantities than herniated discs. These results demonstrated the production of factors such as TGF-beta1, IGF-1, IL-6, IL-6R and fibronectin at the site of lumbar disc herniation.

前頭蓋底外傷により引き起こされた脳内気脳症の1例

A case of intracerebral pneumocephalus due to head injury is reported and reports of this rare state are reviewed. These cases are relatively rare and only 13 cases including the present case have been reported to date. In this case, magnetic resonance imaging (MRI) clearly demonstrated not only the accumulation of air but also the herniation of brain tissue through fracture into the frontal sinus. Surgery for repairing the skull base fracture led to successful recovery without complications such as meningitis or delayed brain abscess. The diagnostic evaluations and surgical treatments of these cases are discussed.

Pathology of Idiopathic Encephaloceles into the Middle Ear

Meningoencephalic herniations into the middle ear and mastoid are rare and histologic information has been supplied only in few reports. Sections from two idiopathic encephaloceles were compared with those from encephaloceles associated with previous trauma, infection or surgery described in the literature. In the idiopathic encephaloceles, the herniated tissue consisted of cortical neural tissue with degenerative changes and gliosis like that described in cases with a history of chronic infection, previous surgery or trauma, but no inflammatory cells were present.

Barotraumatic blowout fracture of the orbit

We report a rare case of a barotraumatic blowout fracture of the orbit. A 32-year-old woman presented with sudden swelling of the right orbital region after vigorous nose blowing. Computed tomography scan revealed a blowout fracture of the medial wall of the right orbit with orbital emphysema and herniation of the orbital soft tissue. She was treated with prednisolone and an antibiotic, and did not show diplopia or visual disturbance. Three different theories have so far been proposed to explain the mechanism of blowout fractures, globe-to-wall contact theory, hydraulic theory, and bone conduction theory. The present case indicates that blowout fractures of the orbit can be induced solely by a sudden change of pressure, thereby suggesting the validity of the hydraulic theory.