Pathoanatomical Changes Research Articles

The Compression Intensity Index: A practical anatomical estimate of the biomechanical risk for a deep tissue injury

Pressure-related deep tissue injury (DTI) is a severe form of pressure ulcer that initiates in compressed muscle tissues under bony prominences, and progresses superficially towards the skin. Patients with impaired motosensory capacities are at high risk of developing DTI. There is a critical medical need for developing risk assessment tools for DTI. A new anatomical index, the Compression Intensity Index: CII=(BW/Rt);[1/2], which depends on the body weight (BW), radius of curvature of the ischial tuberosities (R) and thickness of the underlying gluteus muscles (t), is suggested for approximating the loading intensity in muscle tissue during sitting in permanent wheelchair users, as part of a clinically-oriented risk assessment for DTI. Preliminary CII data were calculated for 6 healthy and 4 paraplegic subjects following MRI scans, and data were compared between the groups and with respect to a gold standard, being a previously developed subject-specific MRI-finite-element (MRI-FE) method of calculating muscle tissue stresses (Linder-Ganz et al., J. Biomech. 2007). Marked differences between the R and t parameters of the two groups caused the CII values of the paraplegics to be approximately 1.6-fold higher than for the healthy (p<0.001), thereby indicating on the sensitivity of this parameter to the pathoanatomical changes that occur in the buttocks with paraplegia. Data of CII correlated reasonably with the gold standard calculations of MRI-FE muscle stresses (correlation coefficient 0.65). Since CII measurements do not require highly-specialized biomechanical numerical analyses such as MRI-FE, CII has the potential to serve as a practical, quick, and cost-effective approximation of the loading intensity in muscles of wheelchair-bound or bedridden patients. Hence, CII measurements can be integrated into DTI-risk-assessment tools, the need of which is now being discussed intensively in the American and European Pressure Ulcer Advisory Panel meetings.

Magnetic resonance imaging in spinocerebellar ataxias

Magnetic resonance (MR) imaging is widely used to visualize atrophic processes that occur during the pathogenesis of spinocerebellar ataxias (SCAs). T1-weighted images are utilized to rate the atrophy of cerebellar vermis, cerebellar hemispheres, pons and midbrain. Signal changes in the basal ganglia and ponto-cerebellar fibers are evaluated by T2-weighted and proton density-weighted images. However, two-dimensional (2D) images do not allow a reliable quantification of the degree of atrophy. The latter is now possible through the application of three-dimensional (3D) true volumetric methods, which should be used for research purposes. Ideally, these methods should allow automated segmentation of contrast-defined boundaries by using region growing algorithms, which can be applied successfully in structures of the posterior fossa and basal ganglia. Thin slice thickness helps to minimize partial volume effects. Whereas volumetric approaches rely on predetermined anatomical boundaries, voxel-based morphometry has been developed to determine group differences between different types of SCA (cross-sectional studies) or within one SCA entity (longitudinal studies). We will review recent results and how these methods are currently used to (i) separate sporadic and dominantly inherited forms of cerebellar ataxias; (ii) identify specific SCA genotypes; (iii) correlate patho-anatomical changes with SCA disease symptoms or severity; and (iv) visualize and estimate the rate of progression in SCA.

Evaluation of Cardiac Function by Tissue Doppler Imaging in Children With Chronic Hepatitis

Pathoanatomic changes in cirrhosis result in impaired ventricular filling and diastolic dysfunction and were named as cirrhotic cardiomyopathy. However, cardiac functions have not been studied in patients with chronic hepatitis. We hypothesized that such patients might have subclinical ventricular dysfunction, detectable by tissue Doppler echocardiography and related to the severity of hepatic inflammation and fibrosis. We studied 63 clinically stable patients, 27 patients with mild chronic hepatitis (group 1), 22 patients with moderate chronic hepatitis (group 2) and 14 patients with severe chronic hepatitis (group 3) according to the scoring system of Knodell, and 36 age-matched healthy subjects. Patients with severe chronic hepatitis had impaired right ventricular diastolic function. The early diastolic velocity of the tricuspid valve annulus was lower in patients from group 3 than in healthy subjects (P < 0.001). Patients in group 3 had a greater isovolumic relaxation time (P < 0.001), indicating right ventricular diastolic dysfunction. Comparing group 3 with the healthy subjects, the ratio of peak early myocardial tissue velocity and peak late (or atrial) myocardial tissue velocity was significantly decreased (P < 0.001), at 1.4 (0.7) and 1.9 (0.7), respectively. There was also a slightly lower peak early myocardial tissue velocity and peak late (or atrial) myocardial tissue velocity ratio and a slightly longer isovolumic relaxation time in patients from group 2 than in healthy subjects (P < 0.05). We detected subclinical dysfunction of the right ventricle in children with chronic hepatitis in whom hepatic inflammation and fibrosis is prominent. Tissue Doppler echocardiography provides a quantifiable indicator useful for detection and monitoring of disease progression.

Chronic Obstructive Pulmonary Disease: Linking Outcomes and Pathobiology of Disease Modification

Recent guidelines define chronic obstructive pulmonary disease (COPD) as a preventable and treatable disease characterized by airflow limitation and systemic consequences. Airflow limitation in COPD worsens over years as assessed by the forced expiratory volume in one second (FEV(1)). Regardless, while it is likely that cardiovascular and other systemic components also worsen as COPD progresses, there are no accepted or validated outcomes to measure such pathophysiologic changes as they relate to COPD disease progression. It is clear that health status in COPD is more closely related to levels of patients' physical functional capacity than it is to changes in FEV(1). Furthermore, the relative contributions of pathoanatomic changes such as small airways fibrosis and pulmonary emphysema to declining airflow remain unknown. These features may even progress at different rates in the same individuals. Although stopping smoking is the only intervention shown to alter the relentless progression of COPD, the resultant slowing of FEV(1) decline takes several years to evince and requires at least 1,000 subjects to demonstrate annual therapeutic benefits of as little as 20 ml. The FEV(1) cannot distinguish between peribronchiolar fibrosis and emphysema and it is feasible that, as techniques are developed and validated, lung imaging methodologies may become important and sensitive outcomes measures of time- and age-dependent lung structural changes in COPD. The development of biomarkers of lung damage, pulmonary inflammation, and systemic disease will be essential to our further understanding of the natural history of COPD and the discovery of new, effective treatments for its progression.

Fish Health Management in Slovenia

Slovenian aquaculture system is quite specific because we have small water sources and small fish farm facilities, which is reflected also in the organisation of fish health management. In fish health management we pay close attention to the prevention of fish diseases. The technology of fish farming, fish handling and nutrition are controlled both, from the economic and fish welfare point of view. Brown trout, marble trout, lake trout, brook trout, huchen, grayling, common carp, nase and chub are bred for restocking. Besides fish production for restocking, rainbow trout and common carp are produced for human consumption. In the last 15 years the number of fish farms has considerably increased. In compliance with the National Programme financed by the Veterinary Administration of Slovenia of the Ministry for Agriculture, Food and Forestry, all hatcheries have to be examined to IHN and VHS viruses, all carp for restocking have to be examined to spring viraemia of carps and eritrodermatis. In Slovenia, whirling disease is also a notifiable disease and all trout fingerlings have to be examined on Myxobolus cerebralis. Other fish farms are examined according to the epizootiological situation or with regard to clinical and pathoanatomical changes presumptive of notifiable diseases.

Traumatic anterior shoulder dislocation

The purpose of this paper is to outline the present state of treatment for traumatic anterior shoulder dislocation. Pathoanatomic changes as well as intrinsic and extrinsic prognostic factors are discussed. Based on these, treatment options for first time traumatic dislocations and chronic posttraumatic instability are recommended.

Cuff Tear Arthropathy

Visotsky, Jeffrey L. MD; Basamania, Carl MD; Seebauer, Ludwig MD; Rockwood, Charles A. MD; Jensen, Kirk L. MD Author Information

Upper thoracic-spine disc degeneration in patients with cervical pain.

To study the relationship of upper thoracic spine degenerative disc contour changes on MR imaging in patients with neck pain. The relation between upper thoracic and cervical spine degenerative disc disease is not well established. One hundred and fifty-six patients referred with cervical pain were studied. There were 73 women and 77 men with a mean age of 48.6 +/- 14.6 years (range, 19 to 83 years). All MR studies were performed with a large 23-cm FOV covering at least from the body of T4 to the clivus. Discs were coded as normal, protrusion/bulge or extrusion. Degenerative thoracic disc contour changes were observed in 13.4% of patients with cervical pain. T2-3 was the most commonly affected level of the upper thoracic spine, with 15 bulge/protrusions and one extrusion. Upper degenerative thoracic disc contour changes presented in older patients than the cervical levels (Student-Newman-Keuls test, P < 0.001). Degenerative disc contour changes at the C7-T1, T1-2, T2-3 and T3-4 levels were significantly correlated ( P = 0.001), but unrelated to any other disc disease, patient's gender or age. Degenerative cervical disc disease was closely related together ( P < 0.001), but not with any thoracic disc. A statistically significant relation was found within the upper thoracic discs, reflecting common pathoanatomical changes. The absence of relation to cervical segments is probably due to differences in their pathomechanisms.

The aging spine

The aging spine

Anatomy of the glenoid labrum

Most instabilities or pain syndromes are associated with injuries or morphologic changes in the glenoid labrum complex or long head of the biceps tendon origin. The first anatomic descriptions go back to Fick in 1910 and since then many authors have described the anatomy of these structures. It was Snyder who introduced the term SLAP lesions, classifying superior, anterior, posterior labrum changes into four grades. It is still unclear whether all of the described and arthroscopically observed changes are due to a post-traumatic, acquired lesion or whether anatomic variations can be present as well. In order to elucidate this problem, 36 cadaver shoulder joints were inspected macroscopically and sectioned for microscopic evaluation. Here the glenoid could be divided into an superior and an anterior- superior area demonstrating a wide variety of morphologic labral glenoid changes, while the dorsal and inferior sectors of the glenoid showed a relatively uniform anatomy of a firm labrum-glenoid bond. Four types of biceps tendon attachments could be identified similar to the description given by Vangsness. In addition, a variety of anterior-superior changes could be found. The sublabral hole as described by Esch in the clinical setting was found to be a physiologic variant. Precise knowledge of the anatomic morphology of the normal glenoid in its variations seems to be necessary to understand variants and allow for distinguishing between physiologic anatomic variants and pathoanatomic changes in imaging and the clinical setting.

Kernicterus: Past, Present, and Future

The concept of a relationship between severe neonatal hyperbilirubinemia and kernicterus evolved slowly. Jaundice was recognized in ancient as well as biblical times as a manifestation of disease. However, according to Louis K. Diamond (Fig. 1), who reviewed the history of neonatal jaundice, (1) the first record concerning jaundice of the newborn appears to be by Barthomomaeus Metlinger in 1473 in his book Ein Regiment der Jungen Kinder . The occurrence of jaundice shortly after birth as well as some suggestions for homeopathic treatment were mentioned by Michael Ettmuller in his 1708 treatise “De Infantum Morbis.” (1) An early description of icterus neonatorum was published in 1742 in London by John Burton in his treatise “A Full View of All the Diseases Incident to Children.” He suggested that “jaundice generally yields to any gentle purgative.” (1) This same approach was used by Condie in 1853 in Philadelphia. (2) At that time, he wrote that icterus neonatorum seemed to be “connected with the want of a free evacuation of meconium.” He suggested the use of castor oil or a small measure of calomel or rhubarb. It is interesting that he noted that the jaundice was known at times to be accompanied by a “good deal of drowsiness.” There were several publications in France concerning neonatal jaundice in the late eighteenth and early nineteenth centuries, the most significant of which, according to Thor Hansen, (3) was the thesis submitted by Jacques Francois Hervieux and defended by him for his M.D. degree at the University of Paris in 1847. The thesis was entitled “De l’ictere des nouveau-nes” (On the jaundice of newborns). Thor Hansen, to whom we are grateful for having reviewed the original French thesis, pointed out that the introductory section of the Hervieux thesis contains a valuable review of works by …

Concomitant lower thoracic spine disc disease in lumbar spine MR imaging studies.

Our objective was to study the coexistence of lower thoracic-spine disc changes in patients with low back pain using a large field of view (FOV) in lumbar spine MR imaging. One hundred fifty patients with low back pain were referred to an MR examination. All patients were studied with a large FOV (27 cm), covering from the coccyx to at least the body of T11. Discs were coded as normal, protrusion, and extrusion (either epiphyseal or intervertebral). The relationship between disc disease and level was established with the Pearson chi(2) test. The T11-12 was the most commonly affected level of the lower thoracic spine with 58 disc cases rated as abnormal. Abnormalities of T11-12 and T12-L1 discs were significantly related only to L1-L2 disease ( p=0.001 and p=0.004, respectively) but unrelated to other disc disease, patient's gender, and age. No correlation was found between other discs. Magnetic resonance imaging of the lumbar spine can detect a great amount of lower thoracic disease, although its clinical significance remains unknown. A statistically significant relation was found within the thoracolumbar junctional region (T11-L2), reflecting common pathoanatomical changes. The absence of relation with lower lumbar spine discs is probably due to differences in their pathomechanisms.

Pathoanatomical Changes of the Brachial Plexus and of C5-C6 Following Whiplash-Type Injury:

Pathoanatomical Changes of the Brachial Plexus and of C5-C6 Following Whiplash-Type Injury:

Pathoanatomical Changes of the Brachial Plexus and of C5-C6 Following Whiplash-Type Injury

Study Design and Method Case report.Summary of Background Data. Persistent neck pain and bizarre cranial symptoms are common sequelae of whiplash-type injuries. Since soft tissue injuries of the neck are rarely fatal, only few pathoanatomical studies of such injuries have been conducted. We report on a man who had been extensively investigated after a whiplash injury sustained in a traffic accident. He died at the age of 42 of a heart attack 12 years after the injury. The cervical spine was examined in great detail by cryosectioning and the brachial plexa were examined microscopically.Results There were marked isolated degenerative changes in the C5-C6 segment such as disc degeneration, uncovertebral osteophytosis, and zygapophyseal joint osteoarthrosis with subluxation, including degeneration of the meniscoid folds. Contralateral to the C5-C6 changes, and consistent with symptoms and clinical signs, there were marked fibrotic perineural adherences in the brachial plexus.Conclusions The findings might explain the development of chronic symptoms.

Glenohumeral joint. Anatomical aspects and implications for prosthesis design

Knowledge of normal anatomy and kinematics of the glenohumeral joint as well as analysis of the pathoanatomic changes that occur during the course of the disease is the condition for successful patient management. This review article critically discusses the most relevant geometrical variables. Systematically, normal anatomy, pathologic anatomy, and the implications for prosthetic design and implantation are presented. The most important aspects concerning the size and shape of the glenoid, the inclination of the articular surface in the horizontal and frontal planes, as well as the geometry of the scapular neck are discussed. The accumulated knowledge is of immediate practical use and might stimulate researchers and manufacturers to develop more adequate glenoid components.

Magnetic resonance imaging appearances of different discovertebral lesions.

Magnetic resonance imaging (MRI) is not only an excellent imaging modality for the demonstration of morphological changes but is also capable of providing pathophysiological and pathoanatomic information about various spinal diseases. Different techniques offer opportunities to demonstrate the degree of water content, the vascularity of tissue components, the accumulation of fat, and new bone production. Thus MRI closely reflects the initial phase as well as the progression of pathoanatomic changes during the evolution of a disease. Due to the high sensitivity of MRI, abnormalities are often established at an early stage of discovertebral disease, when etiological diagnosis may be difficult. The specificity of MRI findings lags behind its sensitivity; similar changes can be demonstrated in etiologically different disease entities, which reflects the limited reactive possibilities of the osteoarticular system. In fact, the MRI morphological and signal intensity features of different discovertebral lesions are commonly determined more by their location and by the reactive capabilities of disc and bone than by their etiology. Early and exact MRI differentiation of various discovertebral lesions is of the utmost clinical importance for prompt institution of appropriate therapy.

Occurrence of Anguillicola crassus in the Water Reservoir Koryčany (Czech Republic) and its Influence on the Health Condition and Haematological Indices of Eels

Palikova M., S. Navratil: Occurrence of Anguillicola crassus in the Water Reservoir Koryaany (Czech Republic) and its Influence on the Health Condition and Haematological Indices of Eels. Acta Vet. Brno 2001, 70: 443-449. The occurrence of the nematode Anguillicola crassus in eels in the Water Reservoir Koryaany was studied from 1994 to 2000. In 1998 and 1999 the study was performed at more frequent intervals in order to evaluate possible seasonal changes of the disease and the influence of the parasite on the health condition of eels in this water reservoir. In all, 143 eels were sampled. Haematological examinations were performed using 46 specimens in 1999. Prevalence of nematodes showed seasonal dynamics and varied from 43 to 100%. Intensity of infection by young and adult nematodes in the swim bladder of eels varied from 1 to 66 specimens, with the mean being 6.6 nematodes per individual. Prevalence of larval stages in the swim bladder amounted from 38.5 to 100%. There were patho-anatomical changes in the swim bladder as well as in the ductus pneumaticus found. Severe damage to the swim bladder was observed especially during autumn months. No significant differences were found between infected and non-infected eels, or in dependence on the numbers of nematodes in the swim bladder with regards to the haematological parameters examined (i.e., hematocrit, red and white blood cell counts). The obtained values are also mentioned in relation to the date of sampling. There was a rise (p < 0.05 and p < 0.01) in the hematocrit value sampled on October 10, 1999 (0.29 L.L-1) in comparison to sampling on June 7, 1999 (0.25 L.L -1 ), September 16, 1999 (0.25 L.L -1 ) and June 30, 1999 (0.27 L.L -1 ), respectively. Red blood cells were significantly (p < 0.05 and p < 0.01) lowest on September 16, 1999 (1.04 T.L -1 ) as compared to sampling on June 7, 1999 (1.28 T.L -1 ), October 6, 1999 (1.24 T.L -1 ) and June 30, 1999 (1.41 T.L -1 ), respectively. White blood cell counts were lower (p < 0.05 and p < 0.01) on October 6, 1999 (27.6 G.L-1) as compared to values obtained on June 7, 1999 (56.2 G.L -1 ), and September 16, 1999 (41.2 G.L -1 ) and June 30, 1999 (39.0 G.L-1), respectively. Differential counts of white blood cells showed no significant changes. Infected as well as non-infected eels were characterised by lymphocytic type of blood (88.02 and 90.34 % of lymphocytes, 10.27 and 7.38 % of granulocytes, 0.52 and 0.94 % of monocytes, 1.17 and 1.34 % of blasts, respectively). Anguillicolosis under conditions of the Koryaany Water Reservoir did not cause mortality and clinical signs of the disease in the population of eels. Prevalence, intensity of infection, hematocrit, erythrocytes, leukocytes, differential leukocyte count

Salvage surgery for lateral tennis elbow.

We undertook a retrospective analysis of 34 patients (35 elbows) who had prior failed surgical intervention for lateral tennis elbow. Revision surgeries were performed between 1979 and 1994. Each patient's non-operative and operative history was recorded before our salvage revision surgery. At revision surgery, findings included residual tendinosis of the extensor carpi radialis brevis tendon in 34 of 35 elbows. In 27 elbows, the pathologic changes in the extensor carpi radialis brevis tendon had not been previously addressed at all, and in 7 elbows the damaged tissue had not been completely excised. Salvage surgery included excision of pathologic tissue in the extensor carpi radialis brevis tendon origin combined with excision of excessive scar tissue and repair of the extensor aponeurosis when necessary. Based on a 40-point functional rating scale proposed here, 83% of the elbows (29 of 35) had good or excellent results at an average followup of 64 months (range, 17 months to 17 years). To prevent failure of surgical treatment for tennis elbow, the pathologic tissue usually present in the extensor carpi radialis brevis tendon should be resected. Release operations, which weaken the extensor aponeurosis but fail to address the pathoanatomic changes, are not recommended.

Surgical Correction of Ruptured Aneurysm of the Sinus of Valsalva

Between January 1983 and December 1996, 108 patients with ruptured aneurysms of the sinus of Valsalva underwent surgical correction in Shanghai Chest Hospital. The aneurysms ruptured into the right ventricle in 91 patients, into the right atrium in 16, and into the left atrium in 1. The aneurysm originated from the right coronary sinus in 82 patients, from the noncoronary sinus in 25, and from the left coronary sinus in 1. Associated intracardiac defects included ventricular septal defect in 52, aortic valve insufficiency in 67, and patent ductus arteriosus in 2. A ruptured aneurysm of the sinus of Valsalva without aortic valve insufficiency was approached via the cardiac chamber into which it ruptured. When the aneurysm was associated with moderate or severe aortic valve insufficiency we preferred the transaortic approach for repair. The aneurysm was excised at its base and repaired with a Dacron patch regardless of the size of the base of the aneurysm. Active surgical management of aortic valve insufficiency was performed at the initial operation using valve suspension in 25 patients with moderate aortic valve insufficiency and replacement with a mechanical valve prosthesis in 6 cases of severe aortic insufficiency. The early mortality was 2.78%. The median follow-up period was 3.9 years. Of the 72 patients who were followed up, 67 are in New. York Heart Association functional class I or II and 5 are in class III or IV due to severe aortic valve insufficiency. Considering the pathoanatomic features and hemodynamic changes associated with ruptured aneurysms of the sinus of Valsalva in Oriental patients, we advocate repairing the defect with a patch in all cases and stress the importance of active surgical management for aortic valve insufficiency at the initial surgical correction.

Symptoms and pathological anatomy of the degenerative cervical spine

Clinical symptoms and patho-anatomic changes in cervical myelopathy due to spondylotic changes are described. The leading symptoms are numbness and clumsiness of upper and lower extremity, mostly combined with gait disturbances. Muscle wasting primarily on the upper extremity leads to the myelopathic hand. Cervical myelopathy can be classified into five main groups: 1. Spastic tetraparesis with numbness and hyperreflexivity of upper and lower extremity. The majority of patients present with the myelopathic hand. 2. Spastic paraparesis with lesion below C6. 3. Spastic tetraparesis, mild or moderate, with deltoid muscle paresis. 4. Amyotrophic myelopathic hand with mild long tract signs. 5. Central cord syndrome due to cervical spondylosis combined with trauma. From the therapeutic aspect, conservative treatment is often unsuccessful. It is important to relieve pressure on the spinal cord, and decompressive procedures, especially posterior laminoplasty techniques, are required. Earlier surgery provides better results.