Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0003090 (arthrodesis)
 8,374 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eight male DBA/1J mice immunized twice by intradermal injection of type II collagen were autopsied 12 weeks after the first immunization and analyzed for anti-type II collagen antibody level, and the limb joints were examined radiologically and histopathologically. Clinical onset of swelling and erythema in the limb joints occurred about 5 weeks after the first immunization and deformity of the limbs was observed in a few animals about 5 weeks later. Although there were marked individual differences, serum anti-type II collagen antibody levels were elevated in all animals. Histopathologically, the changes were similar to those seen in human rheumatoid arthritis and were characterized by proliferation of synovial lining cells, formation of granulation tissue with destruction of cartilage and subchondral bone, and ankylosis. Systematic examination of various joints of the fore- and hind-limbs revealed definitely that the sequence of arthritic lesions was not uniform. The knee joint was involved most frequently, but smaller joints such as the phalangeal joints were involved less frequently but exhibited severe changes. The significance of histopathological examinations in the evaluation of effects of anti-rheumatic drugs was discussed with reference to this model.
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PMID:[Histopathological study of arthritic lesions induced by immunization with type II collagen in DBA/1J mouse]. 230 92

Four patients whose rheumatoid arthritis (RA) was complicated by staphylococcal arthritis were identified. All patients had active, long-standing disease with destructive changes. Affected joints included hip (two patients), knee (one patient), and shoulder (one patient). Pain and loss of motion in the affected joint were prominent, but toxic features of pyogenic infections--hectic fever, chills, sweats, local warmth, or erythema--were conspicuously absent. Two patients had moderate fever and three patients had mild leukocytosis. No patient was leukopenic. When present, fever was attributed to infected decubiti or urinary tract infection and treated with antibiotics. Therapy with corticosteroids and nonsteroidal antiinflammatory drugs (NSAIDs) probably masked symptoms and delayed the correct diagnosis. Purulent synovial effusions were discovered serendipitously--during arthrography (knee), attempted Girdlestone procedure (hip), and aspiration prior to steroid injection (shoulder). Sepsis was included in the preoperative diagnoses only once (hip). Prior instrumentation (aspiration or injection) of the affected joint was not a feature in any patients, although one patient had undergone insertion of a knee prosthesis one year prior to sepsis. Infectious organisms were Staphylococcus aureus in three patients and Staphylococcus epidermidis in one. Severe sequelae ensued in three of four patients: death from recurrent sepsis (one patient), loss of prosthesis leading to knee arthrodesis (one patient), and protracted sepsis with additional pyarthrosis (one patient). The only patient to regain preseptic joint function (shoulder) had not been on long-standing corticosteroids. Pyarthrosis must be considered in RA patients with unusually painful or stiff joints even in the absence of toxic symptoms.
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PMID:Unrecognized staphylococcal pyarthrosis with rheumatoid arthritis. 408 87

The authors have treated 9 cases of streptococcal gangrene of the limbs. They describe the clinical features:local oedema, erythema, and cyanotic spots. In 7 of the cases the infected general condition was very severe. At operation, the subcutaneous soft tissues were grey-green without pus. The authors have reviewed the literature and consider that treatment should be based on early excision of the skin and subcutaneous tissues. Antibiotics are of great help but are not sufficient by themselves. Nine patients reached a stable state but sequelae have been severe with one disarticulation of the shoulder, one ankylosis of the wrist, one ankylosis of the knee and one generalised stiffness of the hand. Only five patients have been completely cured.
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PMID:[Streptococcal gangrene. A report on 9 cases (author's transl)]. 645 11

Thirty-seven patients who were three to sixteen years old were managed with immobilization in a halo vest between 1987 and 1993. Twenty-four patients (65 per cent) had the halo vest applied in conjunction with operative arthrodesis of the cervical spine; the remaining thirteen patients (35 per cent) had the halo vest applied to immobilize the cervical spine after trauma. Complications occurred in twenty-five patients (68 per cent). Pin-site infections were the most common complications, developing in twenty-two patients. Grade-II infections (purulent drainage) developed more frequently in children who were eleven years old or more: they were identified in five of fourteen such patients, compared with two of twenty-three patients who were ten years old or less. There was a tendency toward more grade-I infections (non-purulent drainage, with or without erythema) and loosening of the pins in the children who were ten years old or less: eleven of twenty-three such patients had each of those complications, compared with four of fourteen children who were eleven years old or more. Both loosening and infection occurred more frequently at the anterior pin sites. Other complications included one dural penetration, one transient injury of the supraorbital nerve, and three pin-site scars that were considered by the family to be objectionable. There were no complications related to the vest part of the halo vest. Younger patients who had a halo construct with more than four pins (multiple-pin constructs) had a similar rate of complications compared with patients who were managed with a standard four-pin halo construct.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Complications in children managed with immobilization in a halo vest. 767 88

We report on two patients with linear scleroderma (a form of localised scleroderma) and their orthopaedic problems such as shortening of the limbs and contractions of the joints. The disease is very rare but easy to diagnose by its typical lesions of the skin (band like lesions with ivory like induration and hyper- or hypopigmentation; a peripheral erythema appears as a lilac ring). In the orthopedic management it is very important to follow the patient carefully during the period of growth for good planning of the conservative (physiotherapy and orthosis) and operative therapy, which in one of our patients consisted in repeated corrections as partial arthrodesis of the foot and osteotomies of the leg.
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PMID:[Linear scleroderma. Report of 2 cases with a review of the disease entity]. 788 9

Seven patients with nonbraceable, neuropathic ankle joints have been successfully treated by tibiocalcaneal arthrodesis utilizing an adolescent condylar blade plate, large cannulated AO screws, and a special cancellous allograft mixture. All patients had fragmentation and partial resorption of the talus. This procedure was considered as an alternative to below-knee amputation. Goals were limb salvage and limited community ambulation. Criteria for proceeding with the fusion were a commitment by the patient to 6 to 8 months of nonweightbearing ambulation, a biopsy and culture of the talus revealing no evidence of infection, and a nonbraceable deformity of the foot and ankle that would otherwise require amputation. A toe-level Doppler index or a transcutaneous oxygen index of greater than 0.45 was required. All patients were treated initially in a total contact cast or bivalved total contact ankle-foot orthosis (AFO) until wounds and swelling were controlled and there was no erythema. Presence of an ulcer did not preclude surgery. The arthrodesis used a combination of 7.0-mm AO cannulated screws and an adolescent condylar blade plate. A special preparation of fresh-frozen, irradiated, cancellous allograft mixed with tobramycin and vancomycin powder was used. All ankles fused solidly in an average of 5.2 months. No infectious complications were encountered. Two patients developed a stress fracture of the tibia at the proximal aspect of the blade plate before use of a bivalved AFO. These healed with nonoperative treatment in 6 weeks. All patients were satisfied with their result at their latest follow-up (average 26.9 months).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Tibiocalcaneal arthrodesis for nonbraceable neuropathic ankle deformity. 795 69

Septic arthritis of the temporomandibular joint (TMJ) has a high morbidity, is infrequently reported, and has been described almost exclusively in adults. We present two cases of septic arthritis of the TMJ that occurred in children after minor blunt trauma. Literature related to septic arthritis of the TMJ was reviewed, and a composite list of cases was constructed. The most common causes were various infections of the head and neck, rheumatic joint disease, and iatrogenesis. Pathogens may gain access to the TMJ by several routes. Patients typically present with an acute, tender, monarticular arthritis with associated swelling and erythema. Malaise, nausea, and vomiting may also be present. Traumatic effusions, fractures, and neoplasms may present in a similar fashion, and mimic TMJ septic arthritis. Staphylococcus aureus is the most commonly reported pathogen and often causes permanent joint damage. Aspiration and analysis of joint fluid, as well as blood chemistry, imaging studies, and clinical impression, may assist in the diagnosis. Timely diagnosis and treatment are essential for a successful outcome; therapy should include antimicrobial agents, adequate drainage, and resting of the joint. Complications include spread of infection, postinfectious bony changes, and fibrous (or bony) ankylosis of the temporomandibular joint.
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PMID:Septic arthritis of the temporomandibular joint: review of the literature and report of two cases in children. 824 70

Sporotrichal arthritis is a rare disease, with only 51 cases reported in the English literature. Thirteen patients with sporotrichal arthritis have been treated at Wichita area hospitals since 1979. Most of the patients were middle aged men. Significant alcohol intake was noted in 77% of the patients. There were 17 joints involved in the cases, including 10 knees, three interphalangeal joints, one elbow, one midtarsal, one intercarpal, and one metatarsophalangeal joint. The typical appearance was an afebrile patient with a mildly swollen warm joint without erythema. The leukocyte counts were normal in 85% of patients, and the erythrocyte sedimentation rates were elevated in 100%. The patients had various treatments and responses. Response rates included intravenous amphotericin B (16%), ketoconazole (40%), and arthrodesis (100%). Sporotrichal arthritis may be more common than previously thought. It should be considered early in the differential diagnosis of monoarthritis.
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PMID:Sporotrichal arthritis in south central Kansas. 957 29

Using the murine model of type II collagen-induced arthritis (CIA), we studied its evolution over time by histopathological, immunohistochemical and clinical evaluations. The first clinical symptoms appeared 28 days post-inoculation (dpi), with bovine type II collagen, with an average arthritic index of 1.00 +/- 0.48 corresponding to erythema of the articulation. The disease progressed, and by 70 dpi showed an average arthritic index of 3.83 +/- 0.27 corresponding to edema and maximum deformation, with ankylosis. Computed morphometry demonstrated that, in comparison to controls, the induction of CIA, produces a significant and increasing accumulation of inflammatory cells, fibrosis (p < 0.0001) and cartilage destruction (p = 0.0029). Likewise, the area of von Willebrand factor (vWF) immunostaining, as an indicator of endothelial proliferation, increased significantly from 28 dpi (p < 0.0001), in CIA mice compared to controls. However, the effective synovial vascularization, calculated as the synovial vascular bed area index, significantly increased by 42 dpi (p = 0.0014). This indicates that the activation and proliferation of endothelium becomes significant before an effective vascularization area is formed. The apoptosis index was also an earlier indicator of cartilage damage, becoming significant from 28 dpi in comparison to controls (p < 0.0001). Finally, it was observed that the increase in the arthritic index showed a strong correlation with the increase in both angiogenesis (r = 0.95; p = 0.0021) and apoptosis (r = 0.90; p = 0.0015). In conclusion, a robust correlation between synovial membrane inflammation, angiogenesis and chondrocyte apoptosis, with respect to the increase in the clinical severity of CIA, has been demonstrated by a quantitative computer-assisted immunomorphometric analysis.
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PMID:Inflammation, synovial angiogenesis and chondroid apoptosis in the evolution of type II collagen-induced arthritis. 1782 80

Inflammatory or erosive are terms used interchangeably to define a clinical subset of osteoarthritis of the hand (HOA), targeting interphalangeal joints and characterised by an abrupt onset, marked pain and functional impairment, inflammatory symptoms and signs, including stiffness, soft tissue swelling, erythema, paraesthesiae, mildly elevated C-reactive protein and a worse outcome than non-erosive HOA. This subset is defined radiographically by subchondral erosion, cortical destruction and subsequent reparative change, which may include bony ankylosis. Although the presence of both clinical and radiographic aspects are very suggestive for the diagnosis in most cases, doubts have been recently raised from some studies which, by means of sensitive imaging techniques such as magnetic resonance imaging (MRI) and sonography, had found erosive changes in most patients with HOA, including those without signs of erosions at conventional radiography. However, many findings suggest that subjects with erosive HOA exhibit more inflammatory features than those with non-erosive HOA in different ways, including clinical, laboratory and sonographic aspects. Thus, it is probably preferable to use the double term inflammatory/erosive to better define this particular subset of HOA.
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PMID:Inflammatory osteoarthritis of the hand. 2053 65


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