Cartilage Necrosis Research Articles

Perichondritis of the larynx following radiation.

In a retrospective study of 348 patients receiving radiotherapy as the primary treatment for carcinoma involving the laryngeal region, perichondritis developed in 52--an incidence of 15%. Of these 52 cases of clinically diagnosed perichondritis, 50% had residual or recurrent carcinoma. A controversy exists regarding the value of frequent and multiple biopsies in these patients; disease will be missed if this is not done, but perichondritis and cartilage necrosis may result from infection introduced by repeated laryngeal manipulation. On the basis of this study the authors recommend an aggressive approach with close follow-up and multiple frequent biopsies as the data indicate an incidence of 50% recurrent or residual tumor when perichondritis is present.

Cartilage growth inhibition and necrosis in vitro caused by prostaglandin A1.

This paper details experiments using the Fell technique of organ culture of 8-day chick embryo femoral and tibial rudiments to test the effects of prostaglandin A1 (PGA1) on cartilage growth. Growth was studied during 8 days in vitro by measurement of rudiment length and wet and dry weight, and by histology. PGA1 inhibited explant growth in a dose-related manner. Linear growth was significantly decreased by 20 and 25 microgram/ml PGA1 at 2, 4, 6 and 8 days, and by 15 microgram/ml at 6 and 8 days. Linear growth was unaffected by 1 and 10 microgram/ml doses. Weight measurements were significantly reduced by 25 microgram/ml PGA1 (2, 4 and 8 days) and by 20 microgram/ml (8 days). Chondroblast degeneration was caused by doses of 15, 20 and 25 microgram/ml PGA1. Progressive degeneration was seen at the 25 microgram/ml concentration after 2 days in vitro. Cellular changes as early as 27 h in vitro were seen using electron microscopy. Tritiated thymidine autoradiography confirmed reduced chondroblast proliferation in the presence of PGA1 (25 microgram/ml). The mechanisms of prostaglandin-induced changes in embryonic cartilage remain uncertain. The possible role of intracellular cyclic nucleotides in the reaction is discussed.

Changes in the Capital Growth Plate and the Proximal Femoral Metaphysis in Legg-Calvé-Perthes Disease

Studies on about 350 hips treated during the years from 1946 to 1965 for Legg-Calvé-Perthes disease (LCPD) showed that metaphyseal changes regularly appear in this condition. When these changes are extreme, a step-like irregularity appears in the capital growth plate and the bony epiphysis adapts itself to the metaphyseal defect. This phenomenon of step-like progression of changes in the growth plate is seen in other conditions as a consequence of cartilage necrosis. When premature closure of the capital epiphyseal plate occurs in LCPD it may be followed by "overgrowth" of the greater trochanter and a positive Trendelenburg sign. This functional disability may be prevented by apophyseodesis of the greater trochanter if it is performed early enough.

Acute chondrolysis complicating slipped capital femoral epiphysis

Radiographs of 20 patients with acute chondrolysis complicating a slipped capital femoral epiphysis were reviewed with emphasis on the radiographic features and differential diagnosis. There was bilateral disease in five instances; radiographic follow-up ranged from 6 months to 5 years. The onset of chondrolysis occurred after surgery in 18 of the 25 abnormal hips. Acute necrosis of the articular cartilage is characterized radiographically by (1) persistent juxtaarticular osteoporosis; (2) progressive narrowing of all or a portion of the cartilage space; and (3) erosion of the subchondral cortices of the femoral head and acetabulum. The radiographic differential diagnosis varies with the stage of disease. The initial osteoporosis is indistinguishable from disuse. The rapid loss of the joint space, accompanied by destruction of the central portions of the subchondral bone, makes differentiation from postoperative infection a common problem. Late changes may resemble either degenerative joint disease or a chronic inflammatory arthritis. The accurate diagnosis of acute chondrolysis depends on correlation of the clinical history and radiographic findings.

Complications after cuneiform osteotomy for moderately or severely slipped capital femoral epiphysis.

Joint arthroplasty in general has experienced tremendous advances over the past few decades. Numerous improvements in implant design, instrumentation, anesthesia, surgical techniques, intraoperative navigation, and materials have occurred in hip and knee arthroplasty. Although elbow arthroplasty also has seen continual improvements, much remains to be accomplished before elbow arthroplasty can be recommended to patients with the same level of confidence as hip or knee arthroplasty.

Slipped Capital Femoral Epiphysis A Study of 68 Cases in the Eastern Half Area of Japan

Slipped capital femoral epiphysis is an uncommon disease among children in Japan. Eighty-one hips in 68 patients collected in the eastern half area of Japan were examined and studies in reference to the incidence, clinical characteristics, and results of treatment. The estimated yearly incidence rate in boys was 0.3 to 0.5 per 100,000 in the population between 10 and 14 years old. The higher incidence of boys (a 5.8 to 1 predilection for males) was characteristic. The disease was extremely rare in girls. Although Japanese children are generally neither as tall nor as heavy as Americans or Europeans, these patients were relatively taller and also much heavier than average. One of the reasons why children of Japan are not susceptible to slipped epiphysis may be explained by the Japanese physique. Satisfactory results were found in less than half the cases. Poor results were mainly caused by complications such as avascular necrosis and acute cartilage necrosis. The incidence of the latter complication was 20.7 per cent in 58 hips followed longer than a year and a half. The method of treatment seems not necessarily related to the development of chondrolysis. This complication is caused by an unknown genetic factor.

Malignant external otitis: A severe form of otitis in diabetic patients

Two cases of malignant external otitis are presented and the literature is reviewed. The disease seems to occur exclusively in elderly diabetic patients. Diagnosis is mostly a clinical one, and requires a high index of suspicion. The characteristic clinical manifestations are pain and severe tenderness of the tissues around the ear and mastoid, persistent drainage and the presence of granulation tissue at the junction of the osseus and cartilagenous portions of the external ear. Roentgenographic findings are not helpful in the early stages. The pathogenesis of this disease depends on the presence of clefts in the cartilage forming the floor of the external auditory canal at its junction with the osseus portion through which infection can spread from the external ear to the deep soft tissues. Serious and often fatal complications may ensue. The most common and earliest symptom to appear is facial nerve palsy. Pseudomonas aeruginosa has been isolated uniformly, in pure or mixed cultures. This entity, therefore, should be borne in mind whenever an elderly diabetic patient presents with external otitis not amenable to the usual methods of therapy. Ps. aeruginosa should be strongly suspected, and its isolation should prompt vigorous systemic treatment with gentamicin and carbenicillin before extensive necrosis of cartilage and bone takes place. Any delay in diagnosis and management will lead to serious and often fatal complications.

Fractures of the neck of the femur in childhood and adolescence

Twenty cases of fracture of the neck of the femur in children and adolescents below the age of 20 were reviewed. The most important single prognostic factor was the degree of displacement of the fracture at the time of injury. Undisplaced fractures, whether treated conservatively or by internal fixation, did well. Displaced fractures, however, always required internal fixation with thin pins after accurate correction of displacement. The various complications of this fracture in children are discussed. Acute necrosis of articular cartilage following this fracture in children is recorded for the first time in 2 cases.

MULTIPLE POSTINTUBATION COMPLICATIONS

Four cases of multiple postintubation laryngotracheal injuries are presented. They encompass a range of injury including isolated soft tissue damage to total necrosis of the cricotracheal cartilage...

Acute slipped capital femoral epiphysis.

Of 12 cases of acute slipping of the capital femoral epiphysis (representing 11 patients), results were satisfactory in nine cases and poor in three cases at follow-up (in two of the three cases with poor results, reduction was lost postoperatively). Five of nine patients with prodromal symptoms were seen by a physician but were undiagnosed or untreated before the acute slipping. An additional patient had roentgenographic evidence of an early (asymptomatic) slipping capital femoral epiphysis one year before the acute slipping. Preferred treatment is gentle manipulation and fixation with multiple threaded pins, followed by crutch walking for three to four months. Spica casting is not recommended because of an increased incidence of acute articular cartilage necrosis and the possibility of late recurrence of slipping.

The classic: Clinical and experimental observations about the etiology of arthritis deformans and especially the significance of the aseptic bone and cartilage necrosis.

The classic: Clinical and experimental observations about the etiology of arthritis deformans and especially the significance of the aseptic bone and cartilage necrosis.

Electrocoagulation and curettage for carcinoma involving the skin of the face, nose, eyelids and ears

Electrocoagulation and curettage has been criticized as inadequate therapy for skin carcinoma. This series of patients demonstrates the effectiveness of electrocoagulation and curettage in the treatment of carcinoma involving the skin of the head and face. From 1964 through 1968, 90 private patients with 128 skin cancers of the head and face were treated by electrocoagulation and curettage. Approximately 50% of these patients were more than 70 years old; 93% of the lesions were basal cell carcinomas and 39% involved the skin of the nose, eyelids, or ears. Forty-four per cent were at least 1 cm or greater in transverse diameter. Only one patient required hospitalization for this therapy, and all lesions were destroyed under local anesthesia. The average healing time was 5.1 weeks. There was neither morbidity nor mortality related to this therapy. All patients were personally followed from 2-7 years. Complete cure was observed in 93% of these lesions. The recurrence rate for 123 primary (previously untreated) skin cancers was 6.5%. Recurrence is first noticed on the scar created by the initial coagulation and is easily recoagulated. These data emphasize the simplicity and adequacy of this treatment modality. In addition, electrocoagulation and curettage is convenient, expeditious, and economical, important assets in these times of burgeoning hospital costs. It is well tolerated by cartilage, and cartilage necrosis has not been observed. Electrocoagulation is tissue-sparing—of great importance in the nose, eye, and ear areas. It avoids anesthetic risks, extensive surgical procedures, prolonged hospitalization, and multiple treatment visits. These considerations justify its use as the preferred therapy of skin cancer of the head and face.

Radiation necrosis of the larynx. Etiology and management.

The response of the larynx to radical doses of radiotherapy varies from mild erythema to severe inflammation with edema and induration, possibly leading to necrosis of cartilage. Necrosis is mediated by bacterial infection in traumatized tissue having greatly reduced healing power. This complication may be fatal, and if not, its treatment is difficult and lengthy. Possible etiologic factors discussed include short treatment times, large treatment fields, chronic respiratory tract infection, and generalized arteriosclerosis. Early cases may respond to medical treatment, but once cartilage necrosis has occurred, a laryngectomy is required. Excision of affected neck skin and wound closure at a later date is advocated in order to limit spread of infection.

Post-radiation perichondritis and cartilage necrosis of the larynx.

AbstractUnder certain circumstances laryngeal cartilage damage following radiation therapy can take place. Two cases of post‐radiation perichondritis with cartilage necrosis are reported, and the factors predisposing to its development, the methods of treatment, and the techniques of radiation therapy are discussed. The danger of repeated intralaryngeal manipulation in the radiation patient is stressed. The authors advise that T1N0 and T2N0 laryngeal lesion be treated with 6,000 rads over a three to five‐week period. Homogeneity is achieved in the treated volume by employing wedged filters. Surgery is advised in T3 or larger lesions usually after preoperative cobalt radiation.

Electrocoagulation and curettage for carcinoma involving the skin of the face, nose, eyelids, and ears.

Electrocoagulation and curettage has been criticized as inadequate therapy for skin carcinoma. This series of patients demonstrates the effectiveness of electrocoagulation and curettage in the treatment of carcinoma involving the skin of the head and face. From 1964 through 1968, 90 private patients with 128 skin cancers of the head and face were treated by electrocoagulation and curettage. Approximately 50% of these patients were more than 70 years old; 93% of the lesions were basal cell carcinomas and 39% involved the skin of the nose, eyelids, or ears. Forty-four per cent were at least 1 cm or greater in transverse diameter. Only one patient required hospitalization for this therapy, and all lesions were destroyed under local anesthesia. The average healing time was 5.1 weeks. There was neither morbidity nor mortality related to this therapy. All patients were personally followed from 2-7 years. Complete cure was observed in 93% of these lesions. The recurrence rate for 123 primary (previously untreated) skin cancers was 6.5%. Recurrence is first noticed on the scar created by the initial coagulation and is easily recoagulated. These data emphasize the simplicity and adequacy of this treatment modality. In addition, electrocoagulation and curettage is convenient, expeditious, and economical, important assets in these times of burgeoning hospital costs. It is well tolerated by cartilage, and cartilage necrosis has not been observed. Electrocoagulation is tissue-sparing—of great importance in the nose, eye, and ear areas. It avoids anesthetic risks, extensive surgical procedures, prolonged hospitalization, and multiple treatment visits. These considerations justify its use as the preferred therapy of skin cancer of the head and face.

Skeletogenesis in insulin-treated chick embryos. II. Histochemical observations, with particular reference to the tibiotarsus.

AbstractChick embryos were exposed to a teratogenic dose of insulin at 5‐½ days of incubation, and the effects on the histochemistry of the developing tibiotarsus were studied until hatching. Tests for mucopolysaccharides, glycogen, calcium, and alkaline phosphatase were used. The matrices of intact cartilage revealed no changes in mucopolysaccharide staining. The major staining differences occurred in areas of cartilage necrosis and suggested loss of sulfate from the ground substance. Chondrocytes exhibited no consistent changes in glycogen content. However, in the premature secondary ossification centers that developed in proximal and distal epiphyses the chondrocytes showed an accumulation of glycogen just before full hypertrophy. Calcification, although initially delayed, was extensive and dystrophic calcification occurred in the necrotic areas. Alkaline phosphatase as usual was associated with ossification and in experimental tissues was associated with necrotic areas and the secondary ossification sites.

Skeletogenesis in insulin-treated chick embryos. I. Anatomical and histological observations, with particular reference to the tibiotarsus.

AbstractChick embryos were exposed to insulin early in development, and the gross and microscopic effects on endochondral ossification of the tibiotarsus were studied throughout the incubation period. The major anatomical effects were a generalized reduction in embryonic size, micromelia, and angulation of the tibiotarsus. There was a significant reduction in the growth rate of the tibiotarsus with some evidence of recovery toward the end of the incubation period. Histologically, the most striking feature of the tibiotarsus was degenerative necrosis of the epiphyseal cartilage. This involved all cartilage zones and was usually more pronounced in the proximal epiphyseal plate. The proliferative zone was compressed and poorly demarcated, and the usual arrangement of parallel rows of hypertrophic chondrocytes never resulted. Periosteal ossification, cartilage resorption, and marrow‐cavity formation were initially delayed but later progressed more rapidly than in the control tibiotarsi. Joint formation was impaired by the extension of necrotic areas and fibrous material across the joint space.

Chondrolysis Following Slipped Capital Femoral Epiphysis in Jamaica

1. We reviewed the cases of all patients with slipped capital femoral epiphysis at the University Hospital of West Indies. Forty-seven hips in thirty-six black patients were evaluated, and in 40 per cent of these hips chondrolysis developed. 2. The appearance of roentgenographic changes of chondrolysis was predictable. There was a very high percentage occurring within one year of diagnosis of slipped epiphysis and within six months of closure of the proxinial femoral growth plate. 3. The persistent absence of motion in all planes following slipping of the capital femoral epiphysis was a constant finding in patients with chondrolysis. This loss of motion can be diagnostic of impending chondrolysis and is usually present before the appearance of the roentgenographic changes. 4. The microscopic changes suggest that the primary lesion is not necrosis of cartilage but a replacement of articular cartilage by pannus formation.

Necrosis of articular cartilage after slipping of the capital femoral epiphysis: Report of six cases with recovery: H. G. Lowe. J. Bone Joint Surg. 52B:108–117 (February), 1970

Necrosis of articular cartilage after slipping of the capital femoral epiphysis: Report of six cases with recovery: H. G. Lowe. J. Bone Joint Surg. 52B:108–117 (February), 1970

NECROSIS OF ARTICULAR CARTILAGE AFTER SLIPPING OF THE CAPITAL FEMORAL EPIPHYSIS

1. Six cases of necrosis of articular cartilage complicating slipping of the upper femoral epiphysis are reviewed: histological examination in one case showed death of the superficial two-thirds of the articular cartilage, with survival of a layer of basal chondrocytes. In all six cases, after severe initial reduction of joint space as seen radiographically, there was gradual return of joint space, suggesting some regeneration of articular cartilage. The prognosis after cartilage necrosis is therefore not always so bad as has been supposed. 2. Various hypotheses concerning the cause of cartilage necrosis complicating slipped epiphysis are reviewed. The precise cause remains unknown, but there is substantial evidence against its being a consequence of ischaemia of the femoral head.