Muscular Lesions Research Articles

Comment faire le diagnostic et mieux comprendre les myopathies inflammatoires ? L’utilité des auto-anticorps

The inflammatory myopathies are a group of quite proteiform, systemic auto-immune diseases which include polymyositis, dermatomyositis and inclusion body myopathies. To facilitate the diagnosis, classification criteria (Bohan and Peter, 1975) have been proposed, based essentially on clinical criteria. In addition, over the past fifteen years, auto-antibodies characterizing certain forms of inflammatory myopathy have been identified. One distinguishes schematically: auto-antibodies specific for myositis and auto-antibodies sometimes associated with myositis. Concerning the myositis specific auto-antibodies (MSA), schematically there are a dozen specificities which are classed according to the cellular distribution of the auto-antigen. The most characteristic are certainly the auto-antibodies directed against cytoplasmic antigens: the anti-tRNA synthetases (anti-Jo-1 (PL-1), anti-PL-7, PL-12, EJ, OJ, JS, KS, ZO, YRS), anti-SRP (signal recognition particle), anti-Mas and anti-KJ, anti-Fer (eEF1), anti-Wa and anti-CADM p140. Other auto-antibodies are directed against nuclear auto-antigens: the anti-Mi-2, anti-PMS (PMS1, PMS2) and related antibodies (MLH1, DNA PKcs…), anti-56 kDa, anti-MJ (NXP-2), anti-SAE and anti-p155/p140 (TIF-1γ). Concerning the auto-antibodies sometimes associated with myositis (myositis associated auto-antibodies or MAA), they can also be observed in other auto-immune diseases. These auto-antibodies are directed against nuclear or nucleolar auto-antigens: the anti-PM-Scl, anti-Ku, anti-RNP (U1 RNP and U2 RNP, U4/U6 RNP and U5 RNP), anti-Ro 52 kDa and more rarely, anti-Ro 60 kDa and anti-La. The auto-antibodies related to myositis are biological tools which are of interest in two main ways. They have allowed us to sort out the nosology of these inflammatory myopathies, in particular by defining anti-tRNA synthetase syndrome. It now remains to determine how they might be employed to complement the classical clinico-biological diagnostic criteria. In this perspective, it will be indispensable first of all to diffuse and standardize the methods of detection. The latter are at the moment very heterogeneous as they use techniques and above all antigenic preparations which are extremely diverse. These antibodies are also very interesting "physiopathological" tools to try to better understand myositis. The example of anti-tRNA synthetases is a particularly original model of auto-immunization, which allows one to establish a link between an initial, probably poorly specific muscular lesion and the appearance of auto-antibodies which maintain and aggravate the muscular disease.

Unusual Presentation of Urothelial Carcinoma of the Bladder With Noncontiguous Rectal and Diffuse Muscular Skeletal Metastases

AN 83-year-old man presented with frequent bowel movements and weight loss in the last 6 months. History was remarkable for hypertension and diabetes mellitus. Digital rectal examination revealed a tumor 3 cm from the anal verge, which was subsequently confirmed by rectoscopy. Biopsy revealed poorly differentiated carcinoma. The tumor cells stained strongly positive for CK7, weakly positive for CK20, and negative for CDX-2 and S-100. Therefore, primary adenocarcinoma of the colon was less likely and tumor growth of urothelial origin was suspected. Subsequent computerized tomography (CT) of the abdomen showed thickening of the right posterior wall of the bladder and noncontiguous circumferential thickening of the rectal wall (figs. 1 and 2). CT also revealed extensively infiltrative, strong enhancing lesions in multiple skeletal muscles, including bilateral psoas major, quadratus lumborum, iliacus, gluteus medius/minimus, obturator externus, quadratus femoris and adductor brevis/magnus. Cystoscopic biopsy of the bladder tumor confirmed high grade urothelial carcinoma. Ultrasound biopsy was performed for the skeletal muscle lesion and the result was consistent with metastatic urothelial carcinoma. The patient was treated with chemotherapy. Bladder urothelial carcinoma often metastasizes to regional lymph nodes, liver, lung and bone. The lower gastrointestinal tract is usually involved by direct tumor invasion. Noncontiguous rectal metastasis from urothelial carcinoma presenting as an annular rectal tumor is rare. 1 This case had concomitant diffuse skeletal muscle metastasis, which is an even rarer presentation of urothelial carcinoma. 2 Metastatic muscular lesions of urothelial carcinoma origin usually show low density and ring enhancement on CT. 3 However, in

Nicotinic acetylcholine receptor activation reduces skeletal muscle inflammation of mdx mice

Mdx mice develop an inflammatory myopathy characterized at different ages by myonecrosis with scattered inflammatory infiltrates followed by muscular regeneration and later persistent fibrosis. This work aimed to verify the putative anti-inflammatory role of nicotinic acetylcholine receptor (nAChR) in the mdx muscular lesion. Mitigation of myonecrosis and decreased TNFα production were accompanied by increased numbers of F4/80 macrophages expressing nAChRα7. In vivo treatment with nicotine attenuated muscular inflammation characterized by reduced metalloprotease MMP-9 activity, TNFα and NFkB content and increased muscular regeneration. Our data indicate that nAChR activation influences local inflammatory responses in the muscular lesion of mdx mice.

Vitamin E serum levels and bone mineral density in postmenopausal women

The potential muscle regeneration after nutritional dystrophy caused by high dietary DHA contents in fish and the physiological pathways involved are still unknown. To better understand this process, an experiment was conducted for 3 weeks in 14 day-old European sea bass larvae using different DHA ratios (1 or 5%). After this period, part of the larvae fed 5% DHA diet was switched to 1% DHA diet (“wash-out”) for another 2 weeks. Larvae fed 5% DHA diet showed altered oxidative status as indicated by the highest TBARS values, antioxidant enzymes (AOE) expression and incidence of muscular lesions. Accordingly, “washed-out” larvae showed lower dry weight and α-TOH content. IGF-I gene expression was elevated in 5% DHA larvae at 35 dph, suggesting increased muscle mitogenesis that was corroborated by the increase in myosin heavy chain expression. It can be concluded that high dietary DHA contents alter the oxidative status and cause muscular lesions in European sea bass larvae, with morphological and molecular aspects of mammalians muscular degenerative disease.

O14 Clinical applications of MRI in muscular dystrophy

In patients with neuro-muscular disorders, NMR imaging is useful to (1) assist diagnosis by identifying topographical patterns of muscle involvement and (2) determine muscular lesion progression in longitudinal studies. NMR investigations of animal models focus on this second objective and aim at characterizing precisely muscle degenerative and/or inflammatory changes during disease progression and at assessing muscle responses to treatment. Translational research benefits from the NMR indices of pathological features defined and validated in experimental models, and secondarily transferred to studies in humans. Another possibility with the NMR techniques is to take advantage of the non-invasive characterization of muscle in order to optimize therapeutic deliveries and select processes with minimal toxicity. Muscle trophicity and fatty degenerative changes can be precisely measured using 3D sequences, such as 3pt Dixon or selective excitation GE, which separate muscle tissue from fatty infiltration. Fibrosis can be determined using advanced quantification schemes, which compensate for signal distortions introduced by instrumental imperfections. Other approaches, from T1-rho or ultra-short TE sequences to Gd-molecules with high affinity for collagen, aim at a more direct visualisation of the fibrotic component. A quantitative evaluation of muscle inflammation/oedema can be achieved using T2 mapping. Sarcoplasmic membrane leakiness in models of dystrophinopathies can be assessed by time-course studies of muscle T1w signal enhancement after injection of Gd-chelates, possibly coupled to albumin. Phosphorus NMR spectroscopy might provide more specific indices of membrane integrity, which need to be validated versus histology and tested in pre-clinical therapeutic trials.

Anatomical and safety considerations in establishing portals used for canine elbow arthroscopy

To describe the relationship of the major muscular, ligamentous and neurovascular structures in relation to standard medial elbow arthroscopic portals used in dogs, and to evaluate their potential iatrogenic lesions. Anatomical study using 20 canine cadaveric elbows. Arthroscopic explorations were performed using medial portals. Three 4 mm orthopaedic pins were introduced in place of the arthroscope, egress canula and instrumental portals. Limbs were dissected. Distances between pins and neurovascular structures were measured. Muscle, ligament and cartilage lesions were recorded. Minimal muscular lesions were observed. No ligament injury was evidenced. Superficial iatrogenic cartilage lesions were observed in three joints. The arthroscopic portal was 23.1 mm (range: 16 to 28.5 mm) caudal to the brachial artery, 21.0 mm (13-30.5 mm) caudal to the median nerve, and 4.0 mm (1-7 mm) cranial to the ulnar nerve. The instrumental portal was 16.3 (9-24 mm) caudal to the brachial artery, 13.5 mm (7-24.5 mm) caudal to the median nerve, and 11.8 (8-18 mm) cranial to the ulnar nerve. The egress portal was 21.4 mm (12-37 mm) caudal to the ulnar nerve. The study confirmed the safety of elbow medial arthroscopic portals. Care must be taken when placing the camera portal so as to avoid injury of the ulnar nerve. Should extensive intra-articular procedures be needed, manipulation of instruments should be done cautiously in the cranio-medial compartment of the joint due to the proximity of the median nerve to the capsule.

Physiopathologie des prolapsus génito-urinaires

The physiopathology of urogenital prolapse is multifactorial, a combination of the interaction between constitutional and acquired factors resulting in the weakening of perineal support. Genetic modifications contribute to the occurrence of prolapse (proof level 2). Differences relating to types of collagen and their proportions, the construction of smooth muscle fibres and nervous structures, have been described between women with and without prolapse. But the relationship of cause and effect is not always clear. It would appear that the reduction in the expression of the elastine gene and the perturbation of metabolism may be at the origin of the cause of a prolapse. However, the intense activity of tissue remodeling is probably the consequence of biomechanical pressure born by the prolapse. Muscular or neuropathic lesions of the levator ani have been widely researched and documented. In the case of prolapse, these were isolated exceptions and most often associated with dehiscence of support tissue.

Effects of Therapeutic Pulsed Ultrasound and Dimethylsulfoxide (DMSO) Phonophoresis on Parameters of Oxidative Stress in Traumatized Muscle

Many studies have demonstrated an increase in reactive oxygen species (ROS) and oxidative damage markers after muscle damage. Phonophoresis aims to achieve therapeutically relevant concentrations of the transdermally introduced drug in the tissues subjected to the procedure by the use ultrasound waves. The aim of the study was to evaluate the effects on the therapeutic pulsed ultrasound (TPU) together with gel-dimethylsulfoxide (DMSO) in the parameters of muscular damage and oxidative stress. Male Wistar rats were divided randomly into six groups ( n = 6): sham (uninjured muscle); muscle injury without treatment; muscle injury and treatment with gel-saline (0.9%); muscle injury and treatment with gel-DMSO (15 mg/kg); muscle injury and TPU plus gel-saline; and muscle injury and TPU plus gel-DMSO. Gastrocnemius injury was induced by a single impact blunt trauma. TPU (6 min duration, frequency of 1.0 MHz, intensity of 0.8 W/cm 2) was used 2, 12, 24, 48, 72, 96 and 120 h after muscle trauma. The CK and acid phosphatase activity in serum was used as an indicator of skeletal muscle injury. Superoxide anion, TBARS, protein carbonyls, superoxide dismutase (SOD) and catalase (CAT) activity was used as indicators of stress oxidative. Results showed that TPU and gel-DMSO improved muscle healing. Moreover, superoxide anion production, TBARS level and protein carbonyls levels, superoxide dismutase (SOD) and catalase (CAT) activity were all decreased in the group TPU plus gel-DMSO. Our results show that DMSO is effective in the reduction of the muscular lesion and in the oxidative stress after mechanical trauma only when used with TPU. (E-mail: silveira_paulo2004@yahoo.com.br)

The distribution and characterization of skeletal muscle lesions in dysferlin-deficient SJL and A/J mice

The pathogenesis of limb-girdle muscular dystrophy type 2B (LGMD2B) dysferlinopathy remains to be investigated. The distribution and characterization of skeletal muscle lesions were examined in two different LGMD2B mouse models, SJL and A/J mice (at 10 and 35 weeks old), in association with the endoplasmic reticulum (ER) stress. SJL mice showed an earlier age of onset and a faster progression of skeletal muscle lesions as compared with those of A/J mice; the sensitivity difference to muscular dystrophic lesions between SJL and A/J mice was observed in the lumbar muscles (particularly, lumbar longissimus and sublumbar muscles); the lesions seen mainly in SJL mice at 35 weeks old consisted of degeneration, necrosis, fatty infiltration, variation in muscle fiber size and atrophy in muscle fibers. Enzyme-histochemically, the fast-twitch muscle fiber was predominant for the degenerative changes seen in the rectus femoris and lateral longissimus muscles of SJL mice. Immunohistochemically, the main reactive cell type observed in and around degenerative and/or necrotic muscle fibers was macrophages, demonstrable with an anti-F4/80 antibody. Because the analyses of spliced XBP1 mRNA, a marker of ER stress, did not show the increased expression, it was considered that ER stress did not affect the progression of skeletal muscle lesions in SJL mice with the advanced stage of dysferlinopathy.

Edwardsiella tarda infection in Korean catfish, Silurus asotus, in a Korean fish farm

Mass mortality of Korean catfish, Silurus asotus, occurred in a culture farm situated in Jeollabukdo Province, Korea. The cumulative mortality rates reached up to 5% of the total fish in the farm per day. In clinical signs, the affected fish showed abdominal distension, vent protrusion, enteritis, liver congestion and abscess-like lesions in enlarged spleen and kidney. Histopathologically, in the liver, hepatocytes lost fat and underwent atrophy or necrosis. The spleen showed necrotized splenocytes and a haemorrhagic pulp. In the kidney, glomerular destruction, degeneration of renal tubular epithelial cell and haemorrhage were observed. However, necrotic muscular lesions were not observed. A pure bacterial isolate was obtained from the liver, spleen and kidney lesions of affected fish. Experimental infection of normal catfish with the isolate resulted in the development of clinical signs similar to those seen on the farm. The isolates were identified as Edwardsiella tarda through biochemical tests (99.4%) and analysis of bacterial genes (16S rDNA) sequences (98%). The bacteria possessed two virulent genes: sodB and katB genes. These results suggest that E. tarda can act as a pathogen of farmed catfish. This is the first report showing that E. tarda caused mortality in cultured Korean catfish.

Investigation into selenium requirement of growing turkeys offered a diet supplemented with two levels of vitamin E

To evaluate dietary selenium (Se) requirement in turkeys offered a diet supplemented with two levels of vitamin E (VE), 96 newly hatched male BIG 6 chicks (58.4 +/- 4.12 g) were divided into eight groups of 12 animals each and fed maize soya diets containing 0.05, 0.10, 0.20 and 0.30 mg Se/kg from sodium selenate in combination either with the natural VE content (approximately 10 IU/kg) or with a VE addition of 50 IU/kg. Animals from all the groups were highly performant and their final body weights (1746 +/- 190 g) after 35 days on experiment were not significantly different. According to its dietary supply, Se concentration in the liver and plasma increased dose dependently. Independent of dietary VE, the activities of GPx3 in plasma and of GPx1 in liver and breast muscle increased to a larger extent in turkeys supplemented with 0.10 and 0.20 mg Se/kg in relation to animals with low marginal Se supply (0.05 mg/kg). Supplementation of 0.30 mg Se/kg only slightly increased further selenoprotein activities. 2-Thiobarbituric acid reactive substances in the liver were strongly reduced by dietary VE, but not by Se. Plasma aspartate aminotransferase (AST) and creatine kinase (CK) activities did not show muscular lesions in none of the groups. Although there were no signs of muscular lesions even in turkeys with marginal Se and moderate VE supply, the activity of selenoproteins in various organs increased up to 0.30 mg Se/kg diet, independent of VE supply. It was concluded that for growing turkeys the Se supply should meet at least a level of 0.20 mg/kg diet as currently recommended by the National Research Council and Gesellschaft für Ernährungsphysiologie. Vitamin E addition confirmed the particular function of the vitamin as a lipid antioxidant and should be taken into consideration when diets with high PUFA concentrations are fed.

Vaccination Safety Update: Macrophagic Myofasciitis

We wish to raise awareness of the phenomenon of macrophagic myofasciitis (MMF), which does exist in Germany but has not received much attention. This phenomenon may develop after vaccination. MMF is an acquired inflammatory muscular lesion that manifests focally as round cells located in the perifascicular space while the remaining muscle fibers remain relatively intact. Histopathologically, MMF is characterized by macrophages that are positive for diastase resistant periodic acid-Schiff (PAS) and numerous CD8+ T cells. Tissue necrosis or giant cells are typically not detected. As an expression of lysosomal activity, the macrophages are strongly positive for acidic phosphatase and nonspecific esterase. Electron microscopic studies regularly show numerous needle-shaped structures within the lysosomes of these macrophages. By analyzing a tissue section—so called laser microprobe mass analysis (LAMMA)—the needle-shaped structures can be identified as aluminum hydroxide. In adults it is almost exclusively the left deltoid muscle (‘vaccination muscle’) that is affected, in children almost exclusively the quadriceps. Different working groups, mainly in France, postulate a causal association between MMF, aluminium hydroxide containing vaccines—for example, the hepatitis B, hepatitis A, tetanus toxoid vaccines and systemic clinical symptoms. The clinical spectrum, which may occur even up to 10 years after the vaccination, is unspecific and ranges from myalgias and arthralgias to increased fatigue (1, 2). A comprehensive epidemiological follow-up to establish a possible causal association between focal MMF lesions after vaccination, the use of aluminum hydroxide, and systemic clinical symptoms is required—which, as far as we know, has not been undertaken so far. However—and this is an important message—it is absolutely in no way our intention to question the need for the mentioned vaccinations.

Bloqueos diagnóstico-terapéuticos de carillas articulares cervicales

Cervical pain is experienced by 66% of adults during their lifetime and by 54% in the previous 6 months. Only 5% will experience intense chronic pain with functional disability. Eighty percent of cervical pain is produced by skeletal or muscular lesions as a result of disc and facet degeneration. External causative agents include trauma, overweight, occupational demands, stress, etc. Diagnosis of cervical pain is mainly based on physical examination and clinical findings. In cervical pain radiating to the neck, scapulohumeral girdle and upper right arm without a radicular pattern and positive examination of the facet joints, diagnostic-therapeutic facet joint blocks are indicated. The present article describes the anatomy of the cervical region. Knowledge of this region is essential to guarantee good results and to minimize risks. The indications and practical features of the technique are also discussed.

Evaluation of mitochondrial respiratory chain activity in muscle healing by low-level laser therapy

Background Recent studies demonstrate that low-level laser therapy (LLLT) modulates many biochemical processes, especially the decrease of muscle injures, the increase in mitochondrial respiration and ATP synthesis for accelerating the healing process. Objective In this work, we evaluated mitochondrial respiratory chain complexes I, II, III and IV and succinate dehydrogenase activities after traumatic muscular injury. Methods Male Wistar rats were randomly divided into three groups ( n = 6): sham (uninjured muscle), muscle injury without treatment, muscle injury with LLLT (AsGa) 5 J/cm 2. Gastrocnemius injury was induced by a single blunt-impact trauma. LLLT was used 2, 12, 24, 48, 72, 96, and 120 hours after muscle-trauma. Results Our results showed that the activities of complex II and succinate dehydrogenase after 5 days of muscular lesion were significantly increased when compared to the control group. Moreover, our results showed that LLLT significantly increased the activities of complexes I, II, III, IV and succinate dehydrogenase, when compared to the group of injured muscle without treatment. Conclusion These results suggest that the treatment with low-level laser may induce an increase in ATP synthesis, and that this may accelerate the muscle healing process.

Xeroradiography and soft tissue traumatology (author's transl)

A three-year experience concerning soft tissue pathology following orthopedic and sport lesions is presented. The possibilities of xeropneumoradiography in tendon lesions (Achilles, rectus, biceps, etc.), epicondylitis, muscular lesions, articular and meniscal lesions, are discussed. Many examples are presented which show the possibilities and the difficulties encountered in soft tissue pathology. The findings clearly show that the precise xeroradiographic images allow a diagnostic gain even when routinely used for orthopedics and traumatology.

Desordens Musculo-Esqueléticas Relacionadas com o Exercício Profissional da Medicina Dentária

While working in Dentistry, we often see ourselves in incorrect work positions, which may cause muscular and joint lesions that, in a chronic way, will later be of major importance in professionals’ lives.In this paper, we aim to alert Dentists (and other health care professionals) to bad postures, the consequent pathologies that may affect them (mostly known as “Work Related muscular-skeletal disorders”), and their prevention, correction and compensation. Images were used to complement all the revised literature.

Fast and slow myosins as markers of muscle injury

Objective: The diagnosis of muscular lesions suffered by athletes is usually made by clinical criteria combined with imaging of the lesion (ultrasonography and/or magnetic resonance) and blood tests to detect...

Prevalence and patterns of soft tissue metastasis: detection with true whole-body F-18 FDG PET/CT

BackgroundThe aim of this retrospective study was to report the prevalence and patterns of soft tissue (ST) metastasis detected with true whole-body (TWB) F-18 FDG PET/CT acquired from the top of the skull through the bottom of the feet and to compare such findings to that of the typically acquired skull-base to upper-thigh, thus limited whole-body (LWB) field of view (FOV).MethodsTWB FDG-PET/CT scans were performed in 500 consecutive cancer patients. Suspected ST metastasis was verified by correlation with surgical pathology, other imaging modalities, or clinical follow-up.ResultsNine out of 500 patients (1.8 %) had ST metastasis with a prevalence of 4/41 (9.8%) for melanoma, 2/60 (3.3%) for lung carcinoma, 2/88 (2.3%) for lymphoma and 1/13 (77%) for esophageal cancer. Those nine patients had a total of 41 ST lesions: 22 lesions within and 19 outside of LWB FOV. Of those 41 lesions, 19 (46%) were subcutaneous and 22 (54%) were muscular lesions. The presence of ST metastasis neither changed the staging nor the treatment in any of these patients. However, the ST lesions provided a biopsy site in 4 of the 9 patients (44%). Seven out of nine studied patients died of their disease within 1–22 months after ST metastasis was diagnosed.ConclusionThe detection of ST metastasis may have prognostic implications, provide more accessible biopsy sites and help avoid invasive procedures. A LWB scanning may underestimate the true extent of ST metastasis since a significant percentage of ST metastasis (46%) occurred outside the typical LWB FOV.

Lésions musculo-aponévrotiques et tendineuses. Classification–explorations radiologiques

The aim of this paper is to remind the classifications of sport-related myofascial and myotendinous lesions and to discuss the place of medical imaging (MRI and sonography). Muscular lesions are divided in extrinsic and intrinsic ones, whether they result from a direct impact or a brutal contraction or extension. O'Donoghue classification evaluates injury severity. Myofascial lesions may be peri-muscular, inter-muscular or intra-muscular. In tendinous lesions, we distinguish tendinosis, longitudinal intra-tendinous tears, partial and full-thickness tears. They occur from several origins: overuse tendinopathy, brutal pulling, direct impact, paratendinopathy by repetitive frictions or snapping. Medical imaging provides differential and positive diagnosis as well as injury severity, allowing evaluation of sports intermission. It allows evaluation of healing (doppler sonography and post-Gadolinium MR imaging). Doppler sonography performed by musculoskeletal radiologists has become more and more efficient and sufficient in a lot of cases. MR imaging is used in first or second intent, especially in professional sports and in serious conditions. It remains more accurate in small acute lesions, and in complex lesions, which are not rare in sport-related injuries.

Pathologie des adducteurs chez le rugbyman. Démembrement et conduite thérapeutique

The pathology of the adductor tendons is dreaded by rugbymen because it is invalidating in displacements and for the drop-play. An anatomical and physiological recall makes it possible to individualize three muscular "curtains" in the internal compartment of the thigh. The lesional diagnosis is made by the clinical examination and the MRI. The local treatment allows the healing of the muscular or tendinous lesion. Then the well targeted stretching of the injured muscle guarantees a flexible cicatrization without remaining pain. With each muscular group corresponds a specific stretching.