Mild Degenerative Changes Research Articles

Spontaneous Osteonecrosis as a Cause of Knee Pain in an Older Active Woman

The patient was a 63 year old woman with a chief complaint of worsening right knee pain, which began 6 weeks prior while walking down a steep incline. Prior to symptom onset, the patient ran 6.5 km daily. The patient’s symptoms initially presented as tightness in the posterior aspect of the knee, but changed to a constant varying ache along the medial aspect of the knee with occasional sharp pain during ambulation. The patient also reported night pain and as well as morning stiffness. Radiographic findings were significant for mild degenerative changes with minimal medial joint space narrowing for the right knee (Figure 1). The patient was treated with a corticosteroid injection, which only provided temporary minimal relief. Magnetic resonance imaging was subsequently ordered and revealed findings consistent with spontaneous osteonecrosis of the medial femoral condyle (Figure 2), which is a distinct form of osteonecrosis and usually demonstrates a subchondral fracture identifiable on magnetic resonance imaging. This can affect males or females but it more commonly affects older women and is typically characterized by the sudden onset of knee pain [1]. In general, the lesion is more commonly located in a femoral condyle and it is not usually associated with systemic disorders or previous corticosteroid therapy [1]. The patient attempted a course of conservative treatment including protected weightbearing with hyaluronic acid, and physical therapy. However, the patient did not respond to conservative management and is awaiting unicompartmental knee arthroplasty. Note: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the US Air Force or Department of Defense.

Results at 10-14years after microfracture treatment of articular cartilage defects in the knee.

To evaluate the long-term clinical outcome after microfracture treatment of focal chondral defects of the knee and to investigate possible early determinants of the outcome. A prospective cohort of 110 patients, treated with microfracture, was evaluated at a median of 12years (range 10-14) by Lysholm score, VAS of knee function and VAS of knee pain. Pre- and perioperative information was collected, and additional surgery to the same knee during the follow-up period was recorded. Analysis of variance and paired t test were used for comparison of the long-term data to results from the baseline examination and a former 5-year (midterm) follow-up evaluation. Forty-three patientsneeded additional surgery to the knee including seven knee replacements. Fifty had a poor long-term outcome-defined as a knee replacement surgery or Lysholm score below 64. A poor result was more common in subgroups with mild degenerative changes in the cartilage surrounding the treated defect, concurrent partial meniscectomy, poor baseline Lysholm score or long-standing knee symptoms. The Lysholm score, function VAS and pain VAS all significantly improved from the baseline values to the mean scores of 65 (SD 24), 65 (SD 24) and 31 (SD 24), respectively, at the long-term evaluation. The long-term scores did not differ significantly from the midterm scores. The outcome scores improved significantly from baseline to the long-term evaluation and were not different from the midterm outcome. Still, a normal knee function was generally not achieved, and many patients had further surgery. The results call for more research and, at present, caution in recommending microfracture in articular cartilage defects, especially in subgroups with worse prognosis. Case series, Level IV.

Does the subtalar joint compensate for ankle malalignment in end-stage ankle arthritis?

Patients with ankle arthritis often present with concomitant hindfoot deformity, which may involve the tibiotalar and subtalar joints. However, the possible compensatory mechanisms of these two mechanically linked joints are not well known. In this study we sought to (1) compare ankle and hindfoot alignment of our study cohort with end-stage ankle arthritis with that of a control group; (2) explore the frequency of compensated malalignment between the tibiotalar and subtalar joints in our study cohort; and (3) assess the intraobserver and interobserver reliability of classification methods of hindfoot alignment used in this study. Between March 2006 and September 2013, we performed 419 ankle arthrodesis and ankle replacements (380 patients). In this study, we evaluated radiographs for 233 (56%) ankles (226 patients) which met the following inclusion criteria: (1) no prior subtalar arthrodesis; (2) no previously failed total ankle replacement or ankle arthrodesis; (3) with complete conventional radiographs (all three ankle views were required: mortise, lateral, and hindfoot alignment view). Ankle and hindfoot alignment was assessed by measurement of the medial distal tibial angle, tibial talar surface angle, talar tilting angle, tibiocalcaneal axis angle, and moment arm of calcaneus. The obtained values were compared with those observed in the control group of 60 ankles from 60 people. Only those without obvious degenerative changes of the tibiotalar and subtalar joints and without previous surgeries of the ankle or hindfoot were included in the control group. Demographic data for the patients with arthritis and the control group were comparable (sex, p=0.321; age, p=0.087). The frequency of compensated malalignment between the tibiotalar and subtalar joints, defined as tibiocalcaneal angle or moment arm of the calcaneus being greater or smaller than the same 95% CI statistical cutoffs from the control group, was tallied. All ankle radiographs were independently measured by two observers to determine the interobserver reliability. One of the observers evaluated all images twice to determine the intraobserver reliability. There were differences in medial distal tibial surface angle (86.6°±7.3° [95% CI, 66.3°-123.7°) versus 89.1°±2.9° [95% CI, 83.0°-96.3°], p<0.001), tibiotalar surface angle (84.9°±14.4° [95% CI, 45.3°-122.7°] versus 89.1°±2.9° [95% CI, 83.0°-96.3°], p<0.001), talar tilting angle (-1.7°±12.5° [95% CI, -41.3°-30.3°) versus 0.0°±0.0° [95% CI, 0.0°-0.0°], p=0.003), and tibiocalcaneal axis angle (-7.2°±13.1° [95% CI, -57°-33°) versus -2.7°±5.2° [95% CI, -13.3°-9.0°], p<0.001) between patients with ankle arthritis and the control group. Using the classification system based on the tibiocalcaneal angle, there were 62 (53%) and 22 (39%) compensated ankles in the varus and valgus groups, respectively. Using the classification system based on the moment arm of the calcaneus, there were 68 (58%) and 20 (35%) compensated ankles in the varus and valgus groups, respectively. For all conditions or methods of measurement, patients with no or mild degenerative change of the subtalar joint have a greater likelihood of compensating coronal plane deformity of the ankle with arthritis (p<0.001-p=0.032). The interobserver and intraobserver reliability for all radiographic measurements was good to excellent (the correlation coefficients range from 0.820 to 0.943). Substantial ankle malalignment, mostly varus deformity, is common in ankles with end-stage osteoarthritis. The subtalar joint often compensates for the malaligned ankle in static weightbearing. Level III, diagnostic study.

Microdiscectomy with and without insertion of interspinous device for herniated disc at the L5–S1 level

The role of interspinous devices (ISD) after lumbar herniated disc surgery for the prevention of postoperative back pain is controversial. The aim of this comparative prospective study was to determine outcomes in a selective cohort with L5–S1 disc herniation and degenerative disc changes after microdiscectomy with or without insertion of an ISD. One hundred and two consecutive patients underwent an L5–S1 microdiscectomy with or without implantation of an ISD. Group 1 consisted of 47 patients, with mild (n=22), moderate (n=14) or severe (n=11) degenerative disc changes who had microdiscectomy alone. Group 2 comprised 45 patients with similar types of disc changes who underwent microdiscectomy with an ISD implant. The Visual Analogue Scale (VAS) was used to grade low-back pain and postoperative clinical status was rated according to the modified MacNab criteria. Mean VAS score for low-back pain improved significantly at 1year follow-up from 7.3 at baseline to 2.75 (p<0.001) in Group 1 and from 6.7 to 1.5 (p=0.001) in Group 2. VAS score at 1year showed significant improvements in 21 Group 1 patients versus 30 Group 2 patients (p=0.001). Forty four percent of Group 1 patients and 80% of Group 2 patients showed improvement using the modified MacNab criteria. Patients in both groups reported significant improvement in sciatic pain and disability after microdiscectomy with or without an ISD implant. Patients with mild degenerative disc changes were more likely to achieve improvement of their low-back pain when treated with both microdiscectomy and ISD insertion.

Efficiency of using green algae as biological controllers against toxic algal taxa in cultured Nile tilapia Oreochromis niloticus, based on histopathological examinations

The incidence of harmful cyanobacterial blooms in surface waters has increased in frequency and outbreaks have become more severe. This research aimed at studying the effect of a culture of two green algal species as biological control of the growth of toxic blue-green algae. Nile tilapia of an initial mean weight of 55 g fish−1 (SE 5) were used for each of four treatments in triplicate. All algal seedings were done at 4 × 103 cells ml−1. Treatment I (untreated) served as a control, Treatment II was seeded with Microcystis aeruginosa, Treatment III was seeded with green algae Chlorella ellipsoidea and Scenedesmus bijuga, and Treatment IV was seeded with a mixture of M. aeruginosa and C. ellipsoidea and S. bijuga. After 10 days, Treatment IV showed 3.4% viable cell survival, compared to 35% and 55% in Treatments II and III, respectively. Histopathological examination revealed mild degenerative changes and focal necrosis, as well as a depletion of haematopoietic tissues in Treatment IV compared to Treatment II. These findings suggest the efficacy of C. ellipsoidea and S. bijuga in controlling the growth of M. aeruginosa and minimising its side effects on cultured Nile tilapia.

Three-dimensional characterization of in vivo intervertebral disc degeneration using EPIC-μCT

Small animal models are commonly employed to study progression of and potential treatment techniques for degenerative disc disease (DDD), but assessment using conventional imaging techniques is challenging due to resolution. The objective of this study was to employ equilibrium partitioning of an ionic contrast agent micro computed tomography (EPIC - μCT) to map three-dimensional (3D) degenerative changes in the rabbit intervertebral disc (IVD). Invivo degeneration was induced surgically in 12 New Zealand White rabbits via percutaneous annular puncture and percutaneous nucleotomy. IVDs were harvested after 3 and 6 weeks. EPIC-μCT imaging was performed on fresh, IVDs before and after formalin fixation, and 3DIVD volumes were segmented. IVDs were histologically stained with Safranin-O/Fast-Green and Hematoxylin & Eosin (H&E). EPIC-μCT attenuation and 3D morphological measurements were assessed in healthy and degenerate IVDs and compared to qualitative grading and disc height measurement from histology. EPIC-μCT caused pronounced contrast enhancement of the IVD. Annular puncture and nucleotomy produced mild and severe degenerative changes, respectively. IVD attenuation following contrast enhancement increased significantly in nucleotomized discs at 3 and 6 weeks. IVD attenuation correlated significantly with histologic score and disc height measurements. Disc height decreased most extensively in the posterior and lateral aspects of the IVD. 3D morphological measurements correlated strongly to IVD attenuation and were more sensitive to degenerative changes than histologic measurements. Formalin fixation reduced the attenuation of IVDs by ∼10%. EPIC-μCT is sensitive to invivo DDD induced by nucleotomy and provides a high resolution 3D method for mapping degenerative changes in rabbit IVDs.

A 76-Year-Old Man With Anemia, Bone Pain, and Progressive Dyspnea

A 76-year-old man presented with left-sided hip pain radiating to the leg and foot for 4 weeks. He was a former smoker. The patient's medical history included coronary artery disease, benign prostatic hypertrophy, and mild chronic renal impairment (serum creatinine, 1.5 mg/dL). Other previous blood chemistry tests and chest radiographs obtained 6 months earlier were unremarkable. The plain radiographs of the lumbosacral spine revealed only mild degenerative changes.

Treatment of Recurrent Coxofemoral Joint Luxation by Total Hip Replacement in a Dog

A 7-year-old, intact female Golden Retriever weighing 38 ㎏ was referred for left coxofemoral joint luxation. On physical examination, pain and crepitus were noted atthe left hip joint during joint extension. Radiological examination revealed coxofemoral joint luxation and mild degenerative bone changes in the left hip joint. We performed minimally invasive arthroscopy-assisted reduction with TightRope ® as a treatment option; however, the left coxofemoral joint was reluxated after one month postoperatively. We performed cementless total hip replacement (THR) of the luxated left coxofemoral joint. At tenmonths after surgery, the dog could sit, stand, walk normally and jump comfortably without lameness. The thigh girth measurement of the operated limb was 108.6% of the contralateral limb. Based on the present case, THR can be a successful treatment for coxofemoral joint luxation in dogs with failed coxofemoral joint reduction.

THE SPORT HABIT DURING YOUNGER AGE MAY BRING GOOD EFFECT FOR LOCOMOTORY SYSTEM AND FUNCTION. —FROM PERIODIC MEDICAL CHECKUP ON FORMER JAPANESE OLYMPIAN AT 1964—

BackgroundIn Japan, which is always the top-ranked life expectancy in the world, the healthcare issues for elderly people transitions from internal; cancer, cardiovascular and cerebrovascular disease to motor system and...

Adolescent cervical disc degeneration in MRI does not predict adult headache or neck pain: A 5-year follow-up of adolescents with and without headache

The impact of early degenerative changes of the cervical spine on pain in adulthood is unknown. The objective was to determine whether degeneration in adolescence predicts headache or neck pain in young adulthood. As part of a follow-up of schoolchildren with and without headache, 17-year-old adolescents with headache at least three times a month (N = 47) and adolescents with no headache (N = 22) participated in a magnetic resonance imaging (MRI) study of the cervical spine. The same adolescents were re-examined by phone interview at the age of 22 years (N = 60/69, 87%). Mild disc degeneration at the age of 17 years was common, but was not associated with either frequent or intensive headache or neck pain at the age of 22 years. Conclusion: Mild degenerative changes of the cervical spine in 17-year-old adolescents cannot be regarded as a cause of future headache or neck pain.

Haemato-biochemical and pathological changes in 7.5% karanj cake (Pongamia glabra) toxicity and its amelioration in broiler chickens

The present experiment was undertaken to study the effect of dietary incorporation of 7.5% expeller karanj cake (EKC) in partial replacement of soybean meal and its amelioration with 1.5% NaOH (w/w) and 0.1% activated charcoal, in order to find out the suitability of its inclusion in poultry ration. The chicks were divided into 5 treatment groups and each group was further replicated to 3 of 6 chicks each. G-1 birds were fed with basal diet as such and G-2 was maintained on 7.5% raw expeller karanj cake incorporated basal diet, and G-3 was fed on 7.5% EKC along with charcoal, while G-4 and G-5 were provided with 1.5% NaOH (w/w) treated EKC alone and in combination with 0.1% activated charcoal in basal diet for 42 days, respectively. An improvement in respect of body weights, feed consumption and feed conversion ratio was observed in G3, 4 and 5 as compared to G2. Haematological profile revealed significant (P < 0.05) reduction of TEC, PCV, Hb and TLC values in G-2 with respect to other groups. The serum biochemical profile revealed significant reduction in protein profile, cholesterol levels and a significant (P < 0.05) increase in creatinine, AST, glucose and A/G ratio in G-2 birds in comparison to other groups. The gross and histopathological changes in G-2 birds comprised of marked congestion and enlargement of liver with marked central venous congestion and mild degenerative changes (hydropic degeneration). Kidneys exhibited gross changes like enlargement and marked congestion which were correlated with marked intertubular haemorrhages, congestion and severe degenerative changes. Bursa and spleen showed slight reduction in size and histopathological sections revealed mild to moderate depletion of lymphocytes in the respective organs. The gross and histopathological changes of the ameliorative groups G-4 and G-5 were mild type in comparison to moderate changes exhibited by G-3 birds. It is concluded that alkali treatment (1.5% NaoH w/w) alone or in combination with activated charcoal was more effective, in comparison to activated charcoal alone, in counteracting the toxicity of karanj cake.

Evaluation of Antioxidant Activity and Acute Toxicity of Clausena excavata Leaves Extract.

Clausena excavata (Lour.), locally known as “Kemantu hitam,” is a common plant in Malaysian folklore medicine. This study evaluated the antioxidant properties of the solvent extracts of C. excavata leaves and determined the acute toxicity of methanolic extract C. excavata (MECE) leaves in Sprague-Dawley rats. Harvested leaves were dried and subjected to solvent extraction using petroleum ether, chloroform, ethyl acetate and methanol in succession. The antioxidant activity of each extract was determined using the ferric-reducing antioxidant power (FRAP) and 2,2-diphenyl-1-picryl dihydrazyl (DPPH) radical scavenging activity. The total phenolic content (TPC) and total flavonoids content (TFC) were estimated by Folin-Ciocalteu and ethanolic aluminium chloride method, respectively. The chloroform extract was found to be highest in flavonoid content, while the methanolic extract showed the highest TPC and antioxidant activity. There was no mortality in rats treated with MECE leaves even at a high dose of 5000 mg/kg body weight. However, the MECE leaves produced mild to moderate pathological changes in the liver and kidneys, shown by mild degenerative changes and leucocyte infiltration. The extract did not affect the haematological parameters or relative weights of the liver or kidneys. Overall, the MECE leaves have potent antioxidant activity and are presumed safe to be used orally as health-promoting product at low to moderate doses.

Pathology of acute oral toxicity of sodium fluoride in Wistar rats

Toxicopathological effects of sodium fluoride (NaF) with acute toxic dose were studied in female Wistar rats. The acute toxic dose of NaF was determined by approximate lethal dose (ALD) method. The ALD for NaF was found to be 253.125 mg/kg body weight, orally in female Wistar rats. The rat showed signs of depression, prostration, piloerection, scant droppings, profuse salivation, initial colourless lacrimation followed by chromodacryorrhoea, dyspnoea, passage of dark reddish -black pasty faeces, gasping, cyanotic paws, hunched posture, soiled perineum and loss of reflexes. The rat died after 8 hours of oral NaF administration. The pathomorphological changes observed at necropsy were those of generalized congestion in vital organs i.e., liver, heart, kidneys, spleen and brain along with frothy catarrhal gastritis. Apart from haemorrhages and congestion in liver, lungs, kidneys and heart, the histopathological lesions represented degenerative and necrotic changes and dilated sinusoids in liver, degeneration and necrosis of tubular epithelium and glomeruli in kidneys, severe degenerative and necrotic changes in cardiac muscles, severe lymphocytolysis in the Malpighian corpuscles in spleen, thickening of interalveolar septa in lungs and mild degenerative and necrotic changes in neurons of brain.

Elastin content is high in the canine cruciate ligament and is associated with degeneration

Cruciate ligaments (CLs) are primary stabilisers of the knee joint and canine cranial cruciate ligament disease (CCLD) and rupture is a common injury. Elastin fibres, composed of an elastin core and fibrillin containing microfibrils, are traditionally considered minor components of the ligament extracellular matrix (ECM). However, their content and distribution in CLs is unknown. The purposes of this study were to determine the elastin content of canine CLs and to ascertain its relationship to other biochemical components and histological architecture.Macroscopically normal CLs were harvested from Greyhounds (n=11), a breed with a low risk of CCLD. Elastin, collagen and sulfated glycosaminoglycan content were measured and histological scoring systems were developed to quantify ECM changes using a modified Vasseur score (mVS) and oxytalan fibre (bundles of microfibrils) staining. Elastin contents were 9.86±3.97% dry weight in the cranial CL and 10.79±4.37% in the caudal CL, respectively, and did not alter with advancing histological degeneration. All CLs demonstrated mild degenerative changes, with an average mVS score of 11.9±3.3 (maximum 24). Increasing degeneration of the ligament ECM showed a positive correlation (r=0.690, P<0.001) with increased oxytalan fibre staining within the ECM.Elastin is an abundant protein in CLs forming a greater proportion of the ligament ECM than previously reported. The appearance of oxytalan fibres in degenerative CL ECM may reflect an adaptive or reparative response to normal or increased loads. This finding is important for future therapeutic or ligament replacement strategies associated with cranial CL injury.

Detection of Toxic Effects of Clostridial Crude Toxin in Experimental Rats

The present study was conducted for the detection of toxic effects of clostridial crude toxin in experimental rats. The crude toxin of Clostridium perfringens was prepared and the rats were injected intraperitoneally (IP) 0.5 ml, 1.0 ml and 2.0 ml of crude toxin. The rats were observed for 24 hrs. The crude toxin inoculated rats showed the dose dependent clinical signs; depression, rough hair coat, respiratory distress, diarrhea and rapid heart beats, whereas PBS inoculated rats did not show any clinical sings. Necropsy changes were variable however, highly dilated and distended whole intestine with blood stained semifluid contents and gas along with congestion in all the affected rats were found dose dependently. Liver, lung and kidney were congested, hemorrhagic and swollen. More or less hydrothorax was seen during the postmortem of all affected rats. The peritoneal fat was frequently congested in all affected rats. Histopathological changes in intestine (0.5 ml inoculated rats) involved congestion, slightly swollen goblet cells and hemorrhages. The most severe lesions comprised of profuse hemorrhages in the mucosa and submucosa with complete necrosis, desquamation and intense leukocytic infiltration in 2 ml inoculated rats. Affected liver (1 ml inoculated rats) exhibited engorgement of central veins, sinusoidal spaces with blood and fatty change. The hepatocytes revealed swelling, granulation and vacuolation of cell cytoplasm, extensive hemorrhage and congestion were seen in 2 ml toxin inoculated rats. Congestion and sometimes extravasation were observed in the subepicardial region of heart. The myocardium revealed mild degenerative changes in the form of granularity of myocardial fiber. In lungs there was congestion, hemorrhage and leukocytes infiltration in the interstitial spaces around the bronchioles in both 1 and 2 ml toxin inoculated rats. Affected kidneys of different doses of crude toxin showed hemorrhage, congestion and inflammatory cells dose dependently. From the above findings, it may be concluded that clostridial crude toxin induced clinical signs, gross and histopathological lesions dose dependently in experimental rats.DOI: http://dx.doi.org/10.3329/pa.v21i1-2.16753 Progress. Agric. 21(1 &amp; 2): 65 - 72, 2010

에탄올 투여 랫트에서 인진쑥 열수 추출물이 간 독성 저하에 미치는 영향

본 연구는 에탄올을 투여한 랫트에서 인진쑥 열수 추출물이 간 기능 개선 및 혈청지질의 변화에 미치는 효과를 검증하고 향후 간 기능개선 건강기능식품 개발 원료로써의 가능성을 확인하고자 하였다. 인진쑥 열수 추출물을 알코올로 간 독성유발한 실험쥐에게 경구투여한 후 정상식이군, 양성대조군, 에탄올 투여군, 인진쑥 열수 추출물 저농도(200 mg/kg BW) 및 고농도(400 mg/kg BW) 투여군으로 나눠 실험하였다. 실험 결과 실험기간 동안 실험동물의 체중 증가량 및 간 무게 변화에는 통계적으로 처리군 간 유의적인 차이는 없었다. 실험종료 후 혈청과 간 조직을 사용하여 분석한 결과, 간 기능의 주요 지표인 AST, ALT 및 GGT 효소 활성측정 결과 정상식이군에 비해 알코올 투여군에서 각 효소활성이 유의하게 증가하였으며, LDH의 경우 정상식이군에 비해 증가하는 것으로 나타났으나 처리군 간 유의성은 없었다. 인진쑥 열수 추출물 저농도 투여군의 경우 ALT 및 GGT활성이 대조군에 비해 유의하게 감소하였으며, 고농도 투여군에서는 AST 및 LDH 활성도 유의하게 감소함을 알 수 있었다. 또한 에탄올을 단독 투여한 처리군의 경우 정상식이군에 비하여 중성지방 함량이 유의하게 증가하였으며, HDL-콜레스테롤 함량이 유의하게 감소하는 것으로 나타났다. 인진쑥 열수 추출물 투여군에서는 중성지방 함량이 대조군에 비하여 유의하게 감소하였으며, HDL-콜레스테롤의 경우 함량이 유의하게 증가하는 것으로 나타났다. 간 조직에서 항산화효소 활성 및 과산화지질 함량을 알아보고자 SOD 활성 측정 결과 에탄올을 단독 투여한 대조군에서는 정상식이군과 비교하여 SOD 활성이 유의하게 감소하였으며, 인진쑥 열수 추출물 투여군에서는 SOD 활성이 유의하게 증가함을 알 수 있었다. 간 조직 내 과산화지질의 분해산물인 malondialdehyde(MDA) 함량을 측정한 결과 에탄올을 단독투여한 대조군에서 MDA 함량이 가장 높게 나타났고 인진쑥 열수 추출물 투여군에서 MDA 함량이 감소하는 것으로 나타났다. 간 조직 염색결과 알코올을 투여한 대조군에서 미세공포와 풍선모양세포변성이 중심정맥 주변이 미약하게 관찰되었으며, 인진쑥 추출물을 처리한 경우에는 거의 정상군와 유사한 정상 간 조직 형태를 보였다. 이상의 결과로 보아 인진쑥 열수 추출물이 rat의 간 기능개선 및 혈청의 지질대사를 개선하고 항산화효소의 활성을 증가시켜 알코올 섭취로 인한 간 손상을 완화시키는데 효과적일 것으로 사료되며, 향후 간 기능 개선 개별인정형 건강기능식품 소재로 활용 가능할 것으로 사료된다.

Nigrostriatal damage after systemic rotenone and/or lipopolysaccharide and the effect of cannabis

In this study, we compared the effects of systemic rotenone, lipopolysaccharide (LPS), or both rotenone and LPS on oxidative stress and nigrostriatal cell damage in mice. We further investigated the therapeutic potential of cannabis in these rodent models of Parkinson's disease. Rotenone (1.5 mg/kg, subcutaneously, three times per week), LPS (0.2 mg/kg, intraperitoneally, daily), or LPS plus rotenone was given alone or in combination with cannabis (20 mg/kg, expressed as Δ9-tetrahydrocannabinol, subcutaneously daily) for 2 weeks. Mice were tested for behavioral changes on the 14th day after different treatments. Biochemical markers of oxidative stress such as malondialdehyde (MDA), reduced glutathione (GSH), nitric oxide (nitrite), paraoxonase 1 (PON1) activity as well as monoamine neurotransmitters in the brain were determined. Histopathology, tyrosine hydroxylase immunoreactivity (TH-ir), inducible nitric oxide synthase (iNOS), and caspase-3 immunohistochemistry were also performed. Either rotenone or LPS injection was followed by increased MDA and decreased GSH in the cortex, striatum, and the rest of the brain (subcortex). There was increased nitrite and decreased PON1 activity in the cortex and subcortex. The increase in nitrite by combined LPS–rotenone in the cortex was significantly higher than that caused only LPS. In the subcortex, nitrite was significantly increased compared with either agent alone. The biochemical changes induced by rotenone, LPS, or rotenone + LPS were reduced, but not prevented by cannabis. In the striatum, the administration of only cannabis induced mild degenerative changes with shrunken neurons and pyknotic nuclei, a slight decrease in TH-ir, and mild iNOS and caspase-3 immunoreactivities. LPS injection was followed by pyknotic and apoptotic nuclei and perinuclear cytoplasmic vacuoles and decreased TH-ir with mild iNOS and caspase-3 immunoreactivities. Meanwhile, marked striatal neurodegeneration was observed after rotenone with shrunken and distorted neurons, pericellular haloes, inflammation, and hemorrhage. Markedly decreased TH-ir and increased iNOS and caspase-3 immunoreactivities were observed. The loss of pigmented neurons, the decrease of TH-ir, and the increase in both iNOS and caspase-3 immunoreactivities were markedly increased by administering both rotenone and LPS. The administration of cannabis did not reduce nigrostriatal damage due to rotenone, LPS, or rotenone + LPS, although an improvement in striatal TH-ir was observed. Thus, (1) systemic rotenone or LPS increased oxidative and nitrosative stress in brain and (2) induced nigrostriatal neuronal damage; (3) the effect was not limited to the striatum but involved other areas such as the cerebral cortex and hippocampus; (4) the neuronal damage caused by rotenone was increased in the presence of systemic inflammation; (5) rotenone induced caspase-3-mediated apoptosis; (6) cannabis reduced brain oxidative stress but failed to alleviate nigrostriatal damage due to rotenone, LPS, or rotenone + LPS; and (7) cannabis increased TH immnunostaining in the striatum after rotenone, LPS, or rotenone + LPS. This effect of cannabis does not appear to reflect a neuroprotective effect and might be due to increased striatal dopamine levels by cannabis.

AB1100 A case of frozen hip – a diagnosis we should consider more often?

BackgroundAdhesive Capsulitis of the hip or “frozen hip” is not a diagnosis well documented in rheumatological textbooks or literature. There are only a few isolated case reports of adhesive capsulitis...

Coronal Shear Fracture of the Humeral Trochlea

To review records of 5 patients with anterior coronal trochlear fractures. Four men and one woman aged 25 to 46 (mean, 34) years underwent cancellous screw (n=3) or Kirschner wire (n=2) fixation for anterior coronal fractures of the humeral trochlea after falling on a flexed elbow. Patients were operated on through a medial approach. Three patients who had a large osteochondral fragment underwent fixation using 4-mm AO partially threaded cancellous screws. Two patients who had a small un-amenable osteochondral fragment (with articular cartilage damage) underwent fixation using Kirschner wires. Patients were evaluated using the Mayo Elbow Performance Index (MEPI) based on pain, arc of motion, stability, and functional disability. The mean time from injury to surgery was 7 (range, 5-10) days. The mean follow-up period was 2.7 years. No patient had any wound-related problems, postoperative neurovascular compromise, or avascular necrosis. Radiographic union was noted after a mean of 14 weeks. Outcome was excellent in 4 patients and good in one. The mean arc of flexion-extension was 101º and the mean arc of supination-pronation was 130º. The mean MEPI was 92. The MEPI was relatively low in the 2 patients with a small osteochondral fragment who underwent Kirschner wire fixation. One patient with articular cartilage damage developed mild degenerative changes and had to change his occupation. The remaining 4 patients were pain-free and had returned to their occupations within 4 months. Open reduction and screw fixation restores articular congruency and enables early mobilisation. Small coronal shear fractures of the trochlea not amenable to screw fixation should be fixed with Kirschner wires.

Combined Trochleoplasty and Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocations in Severe Trochlear Dysplasia

Background: Trochlear dysplasia is an important etiological factor for the development of patellofemoral instability. Because a dislocation of the patella as a result of trochlear dysplasia results in a traumatic disruption of the medial patellofemoral ligament (MPFL), a combined trochleoplasty and patellofemoral ligament reconstruction appears to be the most appropriate procedure to treat patients with severe trochlear dysplasia. Hypothesis: Combined trochleoplasty and anatomic reconstruction of the MPFL will prevent redislocations of the patella and will lead to improved knee function. Study Design: Case series; Level of evidence, 3. Methods: Twenty-three consecutive patients (26 knees) with patellofemoral instability and severe trochlear dysplasia underwent combined trochleoplasty and anatomic reconstruction of the MPFL. Preoperative radiographic examination included anteroposterior and lateral views to assess patella alta. Magnetic resonance imaging was performed to evaluate trochlear dysplasia and the tibial tubercle–trochlear groove (TT-TG) distance. Evaluations included the detection of cartilage injuries, preoperative and postoperative physical examinations, and scores for the visual analog scale (VAS), Kujala knee function, International Knee Documentation Committee (IKDC), activity rating scale (ARS), and Tegner activity scale. Results: The mean age at the time of operation was 19.2 years (range, 15.4-23.6 years). The mean follow-up after operation was 2.5 years after surgery (range, 2.0-3.5 years). No recurrent dislocation occurred postoperatively. Kujala scores improved from 79 to 96, IKDC scores from 74 to 90, and VAS scores from 3 to 1. All improvements were highly statistically significant (P < .01). The activity level according to the Tegner activity scale and the ARS decreased but was not statistically significant (P = .06 and P = .21, respectively). There were 95.7% of the patients who were satisfied or very satisfied with the procedure. Conclusion: Combined anatomic reconstruction of the MPFL and trochleoplasty reliably improved the stability of the patellofemoral joint in patients with severe trochlear dysplasia and no or mild degenerative changes. In addition, the described procedure showed significant improvement of knee function and good patient satisfaction without any episode of redislocations of the patella.