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Sample records for ankylosis

  1. Temporomandibular ankylosis in the cat

    International Nuclear Information System (INIS)

    Ankylosis of the temporomandibular joint (TMJ) in the cat is an unusual complication of traumatic lesions involving articular (true ankylosis) or periarticular structures (false ankylosis). Seven cats with true ankylosis of the TMJ (four cases unilateral and three cases bilateral), of which previous trauma had been documented in five cases, were referred to the authors' clinic between September 1991 and October 1996. Radiographic assessment was performed in all cases, using dorsoventral and oblique projections. Five subjects underwent arthroplastic excision of the TMJ and, in the remaining two cases, stretching of the jaws was performed under general anaesthesia. The surgical outcome was satisfactory in all but one case, where partially decreased joint mobility was observed (follow-up time one to five years), but in the two cases where non-surgical treatment was carried out, recurrence of TMJ ankylosis was observed (follow-up time two to five months). In the authors' experience, surgery represents the treatment of choice for TMJ ankylosis in cats. Additional mandibular symphysiotomy can confirm the radiological findings in unilateral cases

  2. Bony ankylosis following thermal and electrical injury

    Energy Technology Data Exchange (ETDEWEB)

    Balen, P.F.; Helms, C.A. [Dept. of Radiology, Duke University Medical Center, Durham, NC (United States)

    2001-07-01

    Objective. Bony ankylosis has been described following trauma, paralysis, psoriasis, Reiter's syndrome, ankylosing spondylitis, juvenile chronic arthritis and rheumatoid arthritis. Reports of bony ankylosis following thermal and electrical injury are limited.Design and patients. Thirteen cases of burn-related joint ankylosis in four patients are presented.Conclusion. Patients with burns from thermal or electrical injury may develop bony ankylosis among other radiographic manifestations. This bony ankylosis may result either from bridging extra-articular heterotopic ossification with preservation of the underlying joint or from intra-articular fusion due to joint destruction. (orig.)

  3. Bony ankylosis following thermal and electrical injury

    International Nuclear Information System (INIS)

    Objective. Bony ankylosis has been described following trauma, paralysis, psoriasis, Reiter's syndrome, ankylosing spondylitis, juvenile chronic arthritis and rheumatoid arthritis. Reports of bony ankylosis following thermal and electrical injury are limited.Design and patients. Thirteen cases of burn-related joint ankylosis in four patients are presented.Conclusion. Patients with burns from thermal or electrical injury may develop bony ankylosis among other radiographic manifestations. This bony ankylosis may result either from bridging extra-articular heterotopic ossification with preservation of the underlying joint or from intra-articular fusion due to joint destruction. (orig.)

  4. Interposition arthroplasty in temporomandibular joint ankylosis

    OpenAIRE

    Ahmad, Q. G.; Siddiqui, R A; Khan, A H; S C Sharma

    2004-01-01

    We report a series of 60 cases of post- traumatic temporomandibular joint ankylosis that were treated at our unit from 1992 to 2002 by temporalis fascia flap interposition arthopiasty. Majority of these patients (21 patients, 35%) were in the age group of 15–20 years, with 39 males (65%) and 21 females (35%). The duration of ankylosis varied from 6 months to more than 4 years with 32 patients (54.32%) having a duration of 6 months to 2 years. 44 patients (73.33%) had unilateral white 16 patie...

  5. TEMPOROMANDIBULAR JOINT ANKYLOSIS: A CASE REPORT

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    Ankita

    2014-04-01

    Full Text Available Ankylosis is a Greek terminology meaning "stiff joint." It can be defined as "inability to open mouth due to either a fibrous or bony union between the head of the condyle and glenoid fossa."1 Temporomandibular joint (TMJ ankylosis is a disorder that leads to a restriction of the mouth opening from partial reduction to complete immobility of the jaw. It is most commonly associated with trauma (13-100%, local or systemic infection (0-53%, or systemic disease, such as ankylosing spondylitis, rheumatoid arthritis, or psoriasis.2, 3

  6. Surgical management of temporomandibular joint ankylosis.

    Science.gov (United States)

    Maki, Mohammed Hashim; Al-Assaf, Dhuha A

    2008-11-01

    Ankylosis of the temporomandibular joint (TMJ) is one of the causes of persistent and progressive limitation of mouth opening. It usually requires to be corrected surgically; an intervention not without complications. This study was conducted in a central surgical hospital in Iraq (Baghdad) in the era hallmarked by shortage of nearly all facilities needed to accomplish solutions for a surgical task. The surgical procedure is displayed along with modifications, complications, and follow-up protocol. Fifteen patients (21 joints) have been treated surgically for TMJ ankylosis of different severities. All patients were treated at the Department of Oral and Maxillofacial Surgery, Specialized Surgical Hospital-Baghdad Medical City, Iraq. The study was carried out in the period between 1998 and 2002 (inclusive). Patients' ages ranged between 4 and 52 years. In addition to the clinical diagnoses, further evaluation of the ankylosis area was assisted by the use of orthopantomography and spiral computerized scanning (axial, coronal sections, and three-dimensional views). Maximal incisal opening was registered before and after surgery for further follow-up evaluation. Al-Kayat and Bramely approach is advocated to expose the joint area. All 21 joints were operated through blind nasoendotracheal intubation general anesthesia. Computed tomography scans, wide exposures, aggressive resections, proper interposition materials, strict postoperative physiotherapy, and good family and patient compliance all may decrease the possibility of relapse and offer better results. Early management of TMJ ankylosis is important if more damage in orofacial structures and consolidation of bony union are to be avoided. PMID:19098556

  7. GAP ARTHROPLASTY IN TEMPOROMANDIBULAR JOINT ANKYLOSIS: A RETROSPECTIVE STUDY

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    Himanshu

    2015-03-01

    Full Text Available Temporomandibular joint (TMJ ankylosis is a disorder that leads to a restriction of the mouth opening from partial reduc tion to complete immobility of the jaw. The author retrospectively analyzed 20 patients with TMJ ankylosis which were treated by gap a rthroplasty in department of surgery, Government Medical Colleg e, Haldwani from March 2008 to J an 2015. Mean follow up was at least twenty - four months ( M inimum 24 and maximum 48 months. The purpose of this paper was to show that gap arthroplasty improve m outh opening when treating TMJ ankylosis. This was the first study in Kumaon region of U ttarakhand .

  8. Bilateral Scapulohumeral Ankylosis after Prolonged Mechanical Ventilation.

    Science.gov (United States)

    van Lotten, Manon L; Schreinemakers, J Rieneke; van Noort, Arthur; Rademakers, Maarten V

    2016-09-01

    This case demonstrates a rarely reported bilateral scapulohumeral bony ankylosis. A young woman developed extensive heterotopic ossifications (HOs) in both shoulder joints after being mechanically ventilated for several months at the intensive care unit in a comatose status. She presented with a severe movement restriction of both shoulder joints. Surgical resection of the bony bridges was performed in 2 separate sessions with a significant improvement of shoulder function afterwards. No postoperative complications, pain, or recurrence of HOs were noted at 1-year follow-up. Mechanical ventilation, immobilization, neuromuscular blockage, and prolonged sedation are known risk factors for the development of HOs in the shoulder joints. Relatively early surgical resection of the HOs can be performed safely in contrary to earlier belief. Afterwards, nonsteroidal anti-inflammatory drugs and/or radiation therapy can be possible treatment modalities to prevent recurrence of HOs. PMID:27583120

  9. Management of temporo-mandibular joint ankylosis in growing children

    OpenAIRE

    Shashikiran N; Reddy SV; Patil R; Yavagal G

    2005-01-01

    Although temporo-mandibular joint (TMJ) ankylosis is one of the most common pathologies afflicting the facial skeleton, it is also the most overlooked and under-managed problem in children. The TMJ forms the very cornerstone of cranio-facial integrity and hence its ankylosis in growing children adversely affects the growth and development of the jaws and occlusion. Impairment of speech, difficulty in mastication, poor oral hygiene, rampant caries and acute compromise of the airway pose a seve...

  10. CT imaging in the surgical treatment of one-sided extraarticular temporomandibular joint ankylosis

    International Nuclear Information System (INIS)

    Temporomandibular joint (TMJ) ankylosis is characterized by difficulty to open the mouth. The ankylosis may be articular when TJM is involved and extra-articular when other factors lead to a restriction of chewing movements without TJM involvement. Case report of one patient with unilateral ankylosis and his surgical planning through the tomography imaging. CT imaging helps preoperative planning because it can locate the exact point of injury and can make the difference between the true and false ankylosis of the TJM. (author)

  11. Ankylosing Spondylitis Associated With Bilateral TMJ Ankylosis

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    Song, Ju Seop; Koh, Kwang Joon [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Chonbuk National University, Iksan (Korea, Republic of)

    2000-09-15

    A 31-year-old male with severe limitation of mouth opening was referred to our department of Chonbuk National University Hospital. The physical status of the patient was hyposthenic. Extraoral examination showed no condylar movement of the both temporomandibular joints, no pain, no faical swelling or paresthesia. Intraoral examination showed several cervical caries on the upper anterior teeth, and gingival swelling on the whole dentition. Transcranial view showed no condylar movement, and narrowing of joint spaces. Chest P-A view showed straightening of thoracic, lumbar spine, and squaring of vertebrae of the same spines. Conventional lateral radiograph of cervical spine showed calcification of the intervertebral ligament. Computed tomograph showed extensive bone formation between temporal bone and the both condylar heads. Labortory findings showed positive reaction on HLA-B27 histocompatibility antigen and increased level of IgA, IgG, ESR. Based on the clinical, radiographic, and the labortary findings, final diagnosis was made as bony ankylosis of the both temporomandibular joints secondary to ankylosing spondylitis.

  12. Temporomandibular joint ankylosis in child: A case report

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    Rahul J Hegde

    2015-01-01

    Full Text Available Background: Ankylosis of the temporomandibular joint (TMJ is an intracapsular union of the disc-condyle complex to the temporal articular surface that restricts mandibular movements, including the fibrous adhesions or bony fusion between condyle, disc, glenoid fossa, and eminence. It is a serious and disabling condition that may cause problems in mastication, digestion, speech, appearance, and hygiene. Case Report: This report describes a case of a 12-year-old girl with inability to open her mouth, diagnosed with unilateral right bony TMJ ankylosis. The surgical approach consisted of gap arthroplasty with interpositional temporalis muscle flap followed by vigorous physiotherapy. Conclusion: The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. Its treatment includes the orthodontist, oral and maxillofacial surgeon, pediatric dentist, and psychologist and physical therapist as part of the healthcare team.

  13. Treatment of Post-Stroke Ankylosis by Warm-Needling

    Institute of Scientific and Technical Information of China (English)

    刘傲霜

    2004-01-01

    @@ Ankylosis is one of the post-stroke sequelae that hampers seriously the daily activities of the patients.Since 1996, the author has adopted warm needling for treatment of post-stroke ankylosis and obtained excellent therapeutic results. The statistical findings have shown that this therapeutic method can exert an important action in improving the joint spasm for patients with post-stroke sequelae. Especially, a better effect can be expected when it is used at the points of yin channels. A report follows.

  14. Congenital Temporomandibular Joint Ankylosis: Case Report and Literature Review

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    Ryan Chin Taw Cheong

    2016-01-01

    Full Text Available Congenital temporomandibular joint (TMJ ankylosis is an uncommon condition that presents itself at or soon after birth in the absence of acquired factors that could have contributed to the ankylosis such as infection and trauma. The experience of managing one such case is reported in light of a review of the literature on this condition. Key management principles include adequate removal of the ankylotic mass, costochondral grafting, and post-op physiotherapy. Most patients reported in the literature with the condition experienced relapse. This echoes our own experience where there was recurrence of the ankylosis. However, after removal of the ankylotic mass, the patient maintains a satisfactory maximal incisal opening (MIO till the present day. The additional challenges faced in the congenital form in addition to the already complex management of acquired paediatric temporomandibular joint ankylosis are (1 much earlier insult to the TMJ, (2 reduced opportunity for neuromuscular development of the muscles of mastication, and (3 reduced compliance with postoperative physiotherapy programmes due to the younger age of these patients.

  15. The management of traumatic ankylosis during orthodontics: a case report.

    LENUS (Irish Health Repository)

    McNamara, T G

    2000-01-01

    Dental ankylosis may be a significant complication in orthodontic clinical practice. This case report describes the management of a malocclusion, complicated by an ankylosed maxillary central incisor, which arose during orthodontic treatment, following an acute traumatic injury. The use of the ankylosed incisor in successfully managing the significant Class II division 1 malocclusion is described.

  16. Fibrous Ankylosis of the Temporomandibular Joint in a Young Child.

    Science.gov (United States)

    Figueiredo, Nigel R; Meena, Manoj; Dinkar, Ajit D; Khorate, Manisha M

    2015-01-01

    Temporomandibular joint (TMJ) ankylosis is an intracapsular union of the disccondyle complex to the temporal articular surface that restricts mandibular movements, including fibrous adhesions or bony fusion between the condyle, disc, glenoid fossa, and articular eminence. The leading causes include trauma and infection. It can be a serious and disabling condition that leads to difficulties in mastication, swallowing, speaking, esthetics and oral hygiene. Disturbances of facial and mandibular growth and acute compromise of the airway invariably result in physical and psychological disability. Treatment should be initiated as soon as the condition is recognized, with the main objective of re-establishing joint function and harmonious jaw function. The purpose of this report is to describe a case of unilateral fibrous ankylosis of the right TMJ in a three-year-old girl. PMID:26349799

  17. Management of temporo-mandibular joint ankylosis in growing children

    Directory of Open Access Journals (Sweden)

    Shashikiran N

    2005-03-01

    Full Text Available Although temporo-mandibular joint (TMJ ankylosis is one of the most common pathologies afflicting the facial skeleton, it is also the most overlooked and under-managed problem in children. The TMJ forms the very cornerstone of cranio-facial integrity and hence its ankylosis in growing children adversely affects the growth and development of the jaws and occlusion. Impairment of speech, difficulty in mastication, poor oral hygiene, rampant caries and acute compromise of the airway pose a severe psychologic burden on the tender minds of children. The aim of this article is to present an overview of efficient management strategies, based on a case report, so as to increase its awareness among all dental surgeons involved in the treatment of children.

  18. TMJ ANKYLOSIS: MANAGEMENT WITH RECONSTRUCTION AND INTERPOSITIONAL ARTHROPLASTY.

    Science.gov (United States)

    Madhumati, Singh; Shruthi, R; Mitul, Sojitra; Karan, Abhishek; Aziz, Abdul

    2015-01-01

    Temporomandibular joint (TMJ) ankylosis is a very desolating structural condition that involves fusion of the mandibular condyle to the base of the skull. It causes difficulty in mastication and breathing. Trauma and Infections are usually responsible. If trauma occurs in young age, it leads to disturbance in growth & facial asymmetry. Treatment of temporomandibular joint (TMJ) ankylosis usually requires adequate excision of the involved ankylotic block (arthroplasty) or interpositional arthroplasty using autogenous or alloplastic materials. Early mobilization, physiotherapy & strict follow up are essential to prevent postop adhesions. In our cases fascia lata was used as an interpositional grafting material. One case was treated by gap arthroplasty, second case by costochondral graft & third case was managed with titanium condylar prosthesis. PMID:27487617

  19. Cephalometric Craniofacial Characteristics in Patients with Temporomandibular Joint Ankylosis

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    Ellen Wen-Ching Ko

    2005-07-01

    Full Text Available Background: The sequelae of temporomanibular joint (TMJ ankylosis include limitationof jaw movement, interference of oral function and affects on the craniofacialgrowth. Analysis of the craniofacial form of TMJ ankylosis offers guidelinesfor managing this disease.Methods: Forty-five patients with intraarticular TMJ ankylosis were collected from thefiles at the Chang Gung Craniofacial Center. There were 21 male and 24female patients, aged 3 to 47 years. Thirty-seven patients were unilaterallyaffected and eight had bilateral involvement. Patients were grouped accordingto gender and age. Both the medical history and onset of the disease wereinvestigated in all patients. The pretreatment lateral cephalograms were usedfor analysis. The variables were compared with the Chinese norms with correspondingsex and age groups.Results: The etiology included 48.9% facial trauma history, 17.8% traumatic deliveryor birth injury, 15.6% middle ear or dental infection, 2.2% chronic arthritisand 15.6% unknown causes. The onset of mouth opening limitation wasunder 16 years of age. The average total mandibular length was less than thenorm by 30 mm. Each patient presented with a mandible that had backwardrotation with chin recession. Accentuated antegonial notch and inferiorlylocated condyle were observed on the affected side. The maxilla was shorterand the ANB was larger than the norm by 10° but the overbite and overjetwere within normal ranges.Conclusions: The facial growth was severely disturbed in terms of dimension, morphologyand direction of growth in patients with TMJ ankylosis. Better managementof mandibular fractures, good infection control and early treatment interventionare ways to reduce the influence on craniofacial growth.

  20. Spontaneous Knee Ankylosis through Heterotopic Ossification after Total Knee Arthroplasty

    OpenAIRE

    Samuel Boulezaz; Emmanuel Gibon; Philippe Loriaut; Laurent Casabianca; Romain Rousseau; Benjamin Dallaudiere; Hugues Pascal-Moussellard

    2016-01-01

    This paper reports on a case of total ankylosis of the knee after a cruciate-sacrificing cemented total knee arthroplasty (TKA). An 82-year-old female patient previously underwent primary TKA for osteoarthritis twenty years ago in our institution. She had recovered uneventfully and returned to her regular activities. There was no history of postsurgical trauma; however, she progressively lost knee range of motion. Radiographs revealed severe bridging heterotopic ossification.

  1. Spontaneous Knee Ankylosis through Heterotopic Ossification after Total Knee Arthroplasty

    Science.gov (United States)

    Boulezaz, Samuel; Gibon, Emmanuel; Loriaut, Philippe; Casabianca, Laurent; Rousseau, Romain; Dallaudiere, Benjamin; Pascal-Moussellard, Hugues

    2016-01-01

    This paper reports on a case of total ankylosis of the knee after a cruciate-sacrificing cemented total knee arthroplasty (TKA). An 82-year-old female patient previously underwent primary TKA for osteoarthritis twenty years ago in our institution. She had recovered uneventfully and returned to her regular activities. There was no history of postsurgical trauma; however, she progressively lost knee range of motion. Radiographs revealed severe bridging heterotopic ossification. PMID:27119034

  2. Modified Technique of Retrograde Intubation in TMJ Ankylosis

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    Shaila Kamat

    2008-01-01

    Full Text Available We are presenting a case report on the anaesthetic management of a case of ankylosis of temporomandibular joint for corrective surgery in a 7 year old child. Anticipated difficult airway in paediatric population has always been a perplexing problem, awake fibreoptic intubation almost impossible due to obvious difficulties with co-operation. Here we are describing a new approach to this problem, in which the patients were kept under GA with spontaneous ventilation while retrograde intubation was done quite comfortably by the conventional method.

  3. Temporomandibular joint ankylosis fixation technique with ultra thin silicon sheet

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    G S Kalra

    2011-01-01

    Full Text Available Background: Temporomandibular joint ankylosis is a highly distressing condition in which the joint space is obliterated by scar tissue and the patient has an inability to open the mouth. Different autogenous and alloplastic interposition materials have been used after the resection of the ankylotic bone to achieve desirable and long lasting results. The recurrence of disease is most distressing for both patients and surgeon. We have been using ultra thin silicon sheet as our preferred material for providing proper fixation and cover to the joint. We have been encouraged by good patient compliance, no implant extrusion and favourable outcome. Materials and Methods: The clinical study included 80 patients with temporomandibular joint ankylosis, treated between April 2001 and March 2009. In all patients, temporomandibular joint ankylosis had resulted following trauma. Diagnosis was based on clinical assessment supplemented by radiographic examination consisting of a panoramic radiograph, axial and coronal computer tomography. The technique of using ultra thin silicon sheet covering whole of the joint space fixed with non-absorbable nylon 3-0 suture both medially to medial pterygoid muscle and laterally to periosteum of zygomatic arch was employed in all patients. Results: A total of 80 patients were in this study (59 males and 21 females. The aetiology of temporomandibular joint ankylosis was post-traumatic in all cases. The patients′ age ranged from 5 to 45 years. The disease was unilateral in 61 cases and bilateral in 19 cases. Twelve patients, who had previous surgery done in the form of gap arthroplasty in 6 cases, costochondral graft in 4 cases and temporalis muscle in 2 cases, presented with recurrence on the same side. The pre-op inter-incisal mouth opening ranged from 4 to 12 mm. The intraoperative inter-incisal mouth opening ranged from 28 to 46 mm. An additional procedure was done in 13 patients, including placement of costochondral

  4. Zygomatico-coronoid ankylosis secondary to heterotopic bone formation: Combined treatment by surgery and radiation therapy

    International Nuclear Information System (INIS)

    Zygomatico-coronoid ankylosis is a rare, extra-articular form of ankylosis of the jaws. An unusual case is presented in which true bony zygomatico-coronoid ankylosis was produced by a mass of heterotopic bone. Surgical treatment consisted of an oblique ostectomy across the mandibular ascending ramus, with interposition of Silastic sheeting to form a pseudarthrosis. Since surgery is often the stimulus for this condition, 2000 rads were delivered to the surgical site postoperatively in order to inhibit recurrent heterotopic bone formation. The rationale and indications for this form of treatment are discussed. (orig.)

  5. Lateral Thigh Fascia Lata as Interpositional Graft for Temporomandibular Joint Ankylosis

    OpenAIRE

    Alemán, Ramón Manuel; Martínez, María Guadalupe

    2011-01-01

    Successful management of temporomandibular joint (TMJ) ankylosis depends on adequate gap arthroplasty and interpositional graft; the objective is to produce a functioning pseudoarthrosis that prevents reankylosis and provides adequate mobility. Several interpositional grafts have been used for the treatment of temporomandibular joint ankylosis such as indigenous pterygomasseteric sling, temporalis muscle/fascia, auricular cartilage, fat and dermis-fat. Lateral thigh fascia lata (LTFL) graft i...

  6. COMPARION OF GAP ARTHROPLASTY AND INTERPOSITIONAL GAP ARTHROPLASTY ON THE TEMPOROMANDIBULAR JOINT ANKYLOSIS

    OpenAIRE

    M. Ramezanian T. Yavary

    2006-01-01

    Temporomandibular joint ankylosis causes limitation in mouth opening and establishes severe deformity and asymmetry in patient’s face, especially in children. Surgery is the only treatment. This study was conducted to compare the effect of two surgical approaches, gap arthropasty and interpositional gap arthroplasty, on rate of maximum interincisal opening in temporomandibular joint ankylosis. We also evaluated the relapse rate of these two surgical approaches. A total of 48 patients were enr...

  7. Ankylosis of the temporomandibular joint and mandibular growth disturbance caused by neglected condylar fracture in childhood

    OpenAIRE

    Endrajana Endrajana

    2010-01-01

    Background: Fractures of the mandibular condyle may lead to complications such as disturbance of occlusal function, internal derangement of the joint, ankylosis and mandibular growth disturbance. When treating young patients with the history of mandible trauma, ankylosis of the temporomandibular joint and mandibular growth disturbance are two most important complications of condyle fracture that should be considered. Purpose: This case report attempts to emphasize the long term complication o...

  8. TMJ replacement utilizing patient-fitted TMJ TJR devices in a re-ankylosis child.

    Science.gov (United States)

    Cascone, Piero; Basile, Emanuela; Angeletti, Diletta; Vellone, Valentino; Ramieri, Valerio

    2016-04-01

    Temporomandibular joint (TMJ) ankylosis is a pathological condition characterized by articular bony or fibrous tissue fusion. TMJ ankylosis developing during childhood can lead to growth complications because of the loss of mandibular function. Hard and soft autogenous tissue grafting has been used for TMJ reconstruction in the growing patient. However, in cases where autogenous tissue grafts fail either due to unpredictable growth or ankylosis, total alloplastic temporomandibular joint replacement (TMJ TJR) can provide a viable option. The case of a 7-year old female suffering from recurrent bilateral TMJ ankylosis resulting from birth trauma, and with concomitant obstructive sleep apnea syndrome (OSAS) is presented. Due to prior surgical and autogenous graft failures, the decision was made to complete her joint reconstructions utilizing patient-fitted TMJ prostheses. Questions have been raised about the longevity of TMJ TJR devices as well as their lack of growth potential, but children with TMJ ankylosis do not have condyle-related growth potential and that replacing failed autogenous tissue graft material with more autogenous tissue will result in the same adverse outcomes. Therefore, in growing patients with recurrent TMJ ankylosis and/or failed autogenous tissue grafts, there may be a role for TMJ TJR. PMID:26920044

  9. CT imaging in the surgical treatment of one-sided extraarticular temporomandibular joint ankylosis; Uso da tomografia computadorizada no planejamento cirurgico da anquilose temporomandibular extra-articular unilateral

    Energy Technology Data Exchange (ETDEWEB)

    Villamizar, Lenin A.; Ghirelli, Carolina de Oliveira; Baroni, Carina Outi; Ferro, Daniel; Pinto, Ana Carolina Brandao de Campos Fonseca, E-mail: carinaouti@yahoo.com.br [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina Veterinaria e Zootecnia. Dept. de Cirurgia

    2012-07-01

    Temporomandibular joint (TMJ) ankylosis is characterized by difficulty to open the mouth. The ankylosis may be articular when TJM is involved and extra-articular when other factors lead to a restriction of chewing movements without TJM involvement. Case report of one patient with unilateral ankylosis and his surgical planning through the tomography imaging. CT imaging helps preoperative planning because it can locate the exact point of injury and can make the difference between the true and false ankylosis of the TJM. (author)

  10. Severe bony ankylosis of the temporomandibular joint on one side and contralateral adhesion: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Song, Ji Young [Dept. of Oral and Maxillofacial Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju (Korea, Republic of); Kim, Seong Gon; Choi, Hang Moon [School of Dentistry, Gangneung-Wonju National University, Gangneung (Korea, Republic of); Kim, Hyun Jung [Dept. of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju (Korea, Republic of)

    2015-06-15

    Bony fusion between the mandibular condyle and skull base involves temporomandibular joint (TMJ) bony ankylosis. This condition might originate from trauma, infection, or systemic disease. TMJ adhesion can develop after synovial damage. Both TMJ ankylosis and adhesion lead to functional impairment and pain. Here, we present a case of a 50-year-old female who had bony ankylosis of the right TMJ and adhesion of the left TMJ. She had otitis media in the right ear. A large mass in the right TMJ was observed on computed tomograph. Magnetic resonance image showed a large fused bone mass with normal bone marrow in the right TMJ and flattening of the condyle with a thin disk in the left TMJ. Gap arthroplasty with temporal fascia was performed on the right TMJ, and discectomy, high condylectomy, and coronoidectomy were performed on the left TMJ. During a 2-year follow-up after surgery, the patient had no recurrence.

  11. An unusual case of sub-condylar bilateral fracture and bilateral post-traumatic temporomandibular ankylosis.

    Science.gov (United States)

    Matteini, C; Belli, E

    2001-01-01

    A case of bilateral sub-condylar fracture with wide stump dislocation associated with a central facial trauma, fracture-intrusion of the rhino-orbital-maxillary complex and a parasymphyseal mandibular fracture, is reported. After surgery and inter-maxillary fixation an unusual temporo-mandibular ankylosis developed. Maximum mouth opening, lateral and protrusive movements were severely limited. Surgical treatment of ankylosis was requested and performed. The originality of this case lies in the atypical lateral dislocation of condylar neck fractured stumps to the zygomatic arches and in the later appearance of ankylosis between the glenoid fossa, zygomatic arch, condylar neck stump, and the condylar process displaced anteromedially. The ankylosed blocks were resected, displaced condyles were also removed due to the strong adhesion with the ankylotic tissue and the lack of any anatomical continuity or connection with the glenoid fossa. Functional therapy allowed the resolution of the functional limitation. PMID:11723434

  12. Severe bony ankylosis of the temporomandibular joint on one side and contralateral adhesion: A case report

    International Nuclear Information System (INIS)

    Bony fusion between the mandibular condyle and skull base involves temporomandibular joint (TMJ) bony ankylosis. This condition might originate from trauma, infection, or systemic disease. TMJ adhesion can develop after synovial damage. Both TMJ ankylosis and adhesion lead to functional impairment and pain. Here, we present a case of a 50-year-old female who had bony ankylosis of the right TMJ and adhesion of the left TMJ. She had otitis media in the right ear. A large mass in the right TMJ was observed on computed tomograph. Magnetic resonance image showed a large fused bone mass with normal bone marrow in the right TMJ and flattening of the condyle with a thin disk in the left TMJ. Gap arthroplasty with temporal fascia was performed on the right TMJ, and discectomy, high condylectomy, and coronoidectomy were performed on the left TMJ. During a 2-year follow-up after surgery, the patient had no recurrence

  13. Cervical ankylosis following Grisel's syndrome in a 14-year-old boy with infectious mononucleosis

    International Nuclear Information System (INIS)

    Non-traumatic atlanto-axial subluxation (Grisel's syndrome) is an uncommon complication of neck space infection or otolaryngologic procedures. It most frequently affects children, although it may occur in adults. We present a 14-year-old boy with Grisel's syndrome as a complication of infectious mononucleosis proceeding to cervical ankylosis. (orig.)

  14. Temporomandibular joint ankylosis: Case-series of two different surgical procedures

    Directory of Open Access Journals (Sweden)

    Gholamreza Shirani

    2014-01-01

    Full Text Available Introducation: The long-term outcome and clinical results of gaparthroplasty used for the treatment of condylar ankylosis of the mandible in children with application of postoperative activator appliances and costochondral rib graft are evaluated and compared. The purpose of this study was to compare the effect of gap arthroplasty and costochondral graft methods on reankylosis, a mount of mouth opening and growth. Materials and Methods: A non-randomized, retrospective clinical study of l0 cases (5-12 years old of condylar ankylosis of the mandible, surgically treated during a 10 year period from 2002 to 2012 was performed. Four patients were treated by condylectomy and interpositional flap, whereas six were treated by condylectomy and immediate costachondral rib grafts. The first group underwent long-term postoperative therapy using removable activator appliances. Casts, radiographs, photographs, and computed tomography (CT were used post surgically to evaluate rib graft, condylar growth and function, occlusion, facial, and condylar symmetry. Data were analyzed by SPSS 16 statistical software using Mann-Whitney, Paired T-test and Chi-square tests. Results: Children with long-standing condylar ankylosis of the mandible treated by condylectomy and interpositional flap showed more favorably when activators were used post-surgically. Conclusions: Gaparthroplasty with functional activator post-operatively can be considering for TMJ ankylosis.

  15. The characteristics of bony ankylosis of the facet joint of the upper cervical spine in rheumatoid arthritis patients

    OpenAIRE

    Iizuka, Haku; Nishinome, Masahiro; Sorimachi, Yasunori; Ara, Tsuyoshi; Nakajima, Takashi; Iizuka, Yoichi; Takagishi, Kenji

    2009-01-01

    This study investigated the bony ankylosis of the upper cervical spine facet joints in patients with a cervical spine involvement due to rheumatoid arthritis (RA) using computed tomography (CT) and then examined the characteristics of the patients showing such ankylosis. Forty-six consecutive patients who underwent surgical treatment for RA involving the cervical spine were reviewed. The radiographic diagnoses included atlanto-axial subluxation in 30 cases, vertical subluxation (VS) in 10 cas...

  16. Fluroscopic assisted airway intubation in temporomandibular joint ankylosis: A novel technique

    Directory of Open Access Journals (Sweden)

    Ibin Varughese

    2011-01-01

    Full Text Available Airway management is considered one of the most difficult and challenging procedures among the various anesthetic procedures. It becomes tougher when there is a diseased temporomandibular joint (TMJ due to inadequate mouth opening. In the current scenario there are only a few methods that ensure a safe, uneventful intubation in a TMJ ankylosis patient with a difficult airway. These include techniques ranging from minimally invasive techniques like blind nasal intubation, retrograde intubation using a guide wire, the latest technique of intubating with the help of a fiberoptic laryngoscope and the time tested tracheostomy. All these techniques have got their own disadvantages. So we report a case series of five patients with TMJ ankylosis who underwent fluoroscopic-assisted intubation for airway management. We found that this technique is 100% successful in managing the airway in these patients. To the best of our knowledge, this is the first case series detailing this novel technique in the entire English medical literature.

  17. Airway Management in a Mental Retardation Patient with Temporo-mandibular Joint Ankylosis

    Directory of Open Access Journals (Sweden)

    Rauf GÜL

    2012-01-01

    Full Text Available Temporo-mandibular joint (TMJ ankylosis makes it impossible orotracheal intubation for general anesthesia because of limited mouth opening. We applied a nasotracheal intubation via fiberoptic bronchoscopy (FOB guidance on a 36 years old mental retarded (MR patient with bilateral TMJ, having extremely limited mouth opening. As a result, nasotracheal intubation via FOB is reliable technique on even mental retarded patients with extremely limited opening.

  18. Severe proliferative congenital temporomandibular joint ankylosis: a proposed treatment protocol utilizing distraction osteogenesis.

    Science.gov (United States)

    Bartlett, Scott P; Reid, Russell R; Losee, Joseph E; Quinn, Peter D

    2006-05-01

    The classical treatment for temporomandibular joint (TMJ) ankylosis in children: 1) joint release; 2) arthroplasty; 3) reconstruction; and 4) postoperative physical therapy (PT), is often unsuccessful. Postoperative physical therapy is difficult in the young patient due to poor cooperation. Moreover, there is a subgroup of patients who have a refractory congenital proliferative bony process that is the cause of their disease. In these patients, a role for distraction osteogenesis (DO) has been defined. We present a series of young patients with congenital proliferative TMJ ankylosis. Some have failed classic treatment. In such cases, DO is used to expand the mandibular size and soft tissue matrix. This creates a static open bite, facilitates mid-facial growth, and avoids compromise of the airway, speech, nutrition, and oral hygiene. To maintain these objectives, mandibular DO may be repeated as the child matures. Once skeletal maturity is reached, DO is used to normalize occlusion and further expand the soft tissue envelope prior to definitive reconstruction and aggressive post-op PT. In seven patients, this protocol has been used. Five patients are currently in the active phase of growth and undergoing interim treatment with mandibular DO. Two patients have reached skeletal maturity and have completed the protocol of DO with definitive arthroplasty and reconstruction. DO is a valuable aid in the treatment of the problematic child with congenital proliferative TMJ ankylosis. Interim DO, prior to definitive arthroplasty and reconstruction, can provide a static open bite that prevents progressive deformity and its associated functional disturbances. PMID:16770209

  19. COMPARION OF GAP ARTHROPLASTY AND INTERPOSITIONAL GAP ARTHROPLASTY ON THE TEMPOROMANDIBULAR JOINT ANKYLOSIS

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    M. Ramezanian T. Yavary

    2006-11-01

    Full Text Available Temporomandibular joint ankylosis causes limitation in mouth opening and establishes severe deformity and asymmetry in patient’s face, especially in children. Surgery is the only treatment. This study was conducted to compare the effect of two surgical approaches, gap arthropasty and interpositional gap arthroplasty, on rate of maximum interincisal opening in temporomandibular joint ankylosis. We also evaluated the relapse rate of these two surgical approaches. A total of 48 patients were enrolled in this cross-sectional experimental study. Range of mouth opening was evaluated before and during and one year after surgery. All other related information was also recorded. Mean age of the study population was 19.5  8.9 years. Of those, 21 (41% were male and 27 (59% were female. For 26 patients (54.2% interpositional gap arthroplasty was accomplished and for 22 patients (45.8% gap arthropasty was performed. Mean range of mouth opening before and after surgery was 10.3  3.9 and 33.9  5.2 in interpositional gap arthroplasty, 8.7  4.9 and 32.1  7.8 in gap arthropasty, respectively. The results showed that the range of mouth opening significantly increases after ankylosis surgery in both surgical approaches but improvement was less in interpositional gap arthroplasty. In regards to recurrence, results of interpositional gap arthroplasty were superior to gap arthropasty.

  20. Ankylosis of the temporomandibular joint and mandibular growth disturbance caused by neglected condylar fracture in childhood

    Directory of Open Access Journals (Sweden)

    Endrajana Endrajana

    2010-06-01

    Full Text Available Background: Fractures of the mandibular condyle may lead to complications such as disturbance of occlusal function, internal derangement of the joint, ankylosis and mandibular growth disturbance. When treating young patients with the history of mandible trauma, ankylosis of the temporomandibular joint and mandibular growth disturbance are two most important complications of condyle fracture that should be considered. Purpose: This case report attempts to emphasize the long term complication of neglected condylar fracture in children i.e. ankylosis of the temporomandibular joint and subsequently lead to mandibular growth disturbance. Case: A case of right temporo-mandibular joint ankylosis and mandibular growth disturbance in a 28 years old male patient is presented. He had a history of trauma to the mandible after a traffic accident when he was 8 years old. Since then, he experienced difficulty in mouth opening which eventually developed into severe trismus. Case management: The case was treated surgically with gap and interpositional arthroplasty using Mersilen mesh™. Conclusion: Mandibular fractures involving temporomandibular joint in young children should be examined thoroughly and treated adequately in order to prevent ankylosis of the TMJ and the subsequent mandibular growth disturbance.Latar belakang: Fraktur pada kondilus mandibula dapat menyebabkan beberapa komplikasi berupa: gangguan oklusi, internal derangement sendi, ankilosis serta gangguan pertumbuhan mandibula. Pada perawatan penderita usia muda dengan riwayat trauma pada mandibula, perlu diwaspadai dua macam komplikasi akibat fraktur pada kondilus, yaitu ankilosis sendi temporo mandibula dan adanya gangguan pertumbuhan mandibula. Tujuan: Laporan kasus ini bertujuan untuk menekankan bahwa fraktur kondilus pada anak-anak yang tidak mendapatkan perawatan yang semestinya akan mengakibatkan komplikasi jangka panjang berupa ankilosis sendi temporomandibula yang diikuti dengan

  1. Cervical ankylosis following Grisel's syndrome in a 14-year-old boy with infectious mononucleosis

    Energy Technology Data Exchange (ETDEWEB)

    Haidar, Salwa; Armstrong, Derek [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, Ont. (Canada); Drake, James [Hospital for Sick Children, Department of Neurosurgery, Toronto (Canada)

    2005-03-01

    Non-traumatic atlanto-axial subluxation (Grisel's syndrome) is an uncommon complication of neck space infection or otolaryngologic procedures. It most frequently affects children, although it may occur in adults. We present a 14-year-old boy with Grisel's syndrome as a complication of infectious mononucleosis proceeding to cervical ankylosis. (orig.)

  2. Pseudoarthrosis and ankylosis of the vertebral spine without sacroiliitis associated with Takayasu's arteritis: review of the association

    Energy Technology Data Exchange (ETDEWEB)

    Schuetz, C.T.; Anderson, S.E. [Department of Diagnostic Radiology, University Hospital of Berne, Inselspital, 3010 Berne (Switzerland); Aeberli, D.; Oertle, S. [Department of Rheumatology, University Hospital of Berne, Inselspital, 3010 Berne (Switzerland)

    2002-09-01

    Pseudoarthrosis and ankylosis of the vertebral spine associated with Takayasu's arteritis is extremely rare. We present a patient with the entity who was HLA-B27 negative and had normal sacroiliac joints. The association between Takayasu's arteritis and ankylosing spondylitis appears real but seemingly rare. (orig.)

  3. Extraarticular bony ankylosis in a child with supracondylar fracture of humerus

    Institute of Scientific and Technical Information of China (English)

    Sameer Naranje; Ramprasad Kancherla; Arun Kannan; Rajesh Malhotra; Lalit Sharma; Sukesh Rao Sankineani

    2012-01-01

    Myositis ossificans is defined as formation of bone at the site of injured muscle.It is one of the rare complications of supracondylar fracture of humerus in children.Myositis mass usually develops on the anterior aspect in the brachialis muscle and produces restriction of range of motion,but complete ankylosis is rare.To the best of our knowledge,this is the first case to be reported in the literature as a consequence of myositis ossificans traumatica.In this case,a six-year-old child presented to the casualty department with pain in the right elbow after a fall on outstretched hand during play,After surgical excision through the anterior approach,the child had no symptoms referable to the elbow and a residual flexion deformity of 15 degrees with further painless flexion up to 100 degrees at last followup of one year after surgery.

  4. Fat metaplasia and backfill are key intermediaries in the development of sacroiliac joint ankylosis in patients with ankylosing spondylitis

    DEFF Research Database (Denmark)

    Maksymowych, Walter P; Wichuk, Stephanie; Chiowchanwisawakit, Praveena;

    2014-01-01

    OBJECTIVE: Fat metaplasia in bone marrow on T1-weighted magnetic resonance imaging (MRI) scans may develop after resolution of inflammation in patients with ankylosing spondylitis (AS) and may predict new bone formation in the spine. Similar tissue, termed backfill, may also fill areas of excavated...... bone in the sacroiliac (SI) joints and may reflect resolution of inflammation and tissue repair at sites of erosions. The purpose of this study was to test our hypothesis that SI joint ankylosis develops following repair of erosions and that tissue characterized by fat metaplasia is a key intermediary...... step in this pathway. METHODS: We used the Spondyloarthritis Research Consortium of Canada (SPARCC) SI structural lesion score (SSS) method to assess fat metaplasia, erosions, backfill, and ankylosis on MRIs of the SI joints in 147 patients with AS monitored for 2 years. Univariate and multivariate...

  5. ANAESTHETIC MANAGEMENT OF A CASE OF TEMPOROMANDIBULAR JOINT ANKYLOSIS POSTED FOR BILATERAL BREAST SURGERY: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Athaluri Vishnu

    2014-07-01

    Full Text Available BACKGROUND: Temporomandibular joint (TMJ ankylosis is associated with partial or complete restriction of mouth opening and poses a significant problem to the anesthesiologist making the airway management very challenging. Alternative methods of securing the airway should be kept ready because conventional laryngoscopy and intubation are impossible. Thoracic epidural anesthesia (TEA is one of the options to avoid general anesthesia in this case. We aimed to manage a case of bilateral modified radical mastectomy with TMJ ankylosis solely under thoracic epidural anesthesia. METHODOLOGY: Female patient of 32 years of age, with bilateral TMJ ankylosis with no mouth opening was posted for bilateral breast surgery. Thoracic epidural was instituted at T4-T5 interspace and 18G epidural catheters was secured. Alternative airway management strategies were included in our plan if thoracic epidural fails. OBSERVATION: Adequate preparation of the patient, counseling about anesthetic plan of management, placement of epidural catheter by an experienced anesthesiologist helped in the successful management of this case. CONCLUSION: Regional anesthesia techniques are safer alternatives to provide intraoperative anesthesia with difficult airway for bilateral breast surgeries.

  6. Anquilosis mandibular: una frecuente secuela por Noma Mandibular ankylosis: a Noma frequent sequel

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    R. Fernández García-Guilarte

    2009-12-01

    Full Text Available Conocemos poco sobre el Noma o Enfermedad Cancrum Oris. Esta entidad afecta a niños con malnutrición crónica, poca higiene oral, poco desarrollo sanitario y enfermedades concurrentes debilitantes. Existe un consenso general sobre que el Noma empieza como una gingivitis; en su fase aguda, puede haber respuesta al tratamiento antibiótico, no obstante, las secuelas tras su curación incluyen daños estéticos y funcionales variables, que pueden requerir cirugía reconstructiva. Presentamos 3 casos de anquilosis mandibular que en el examen preoperatorio presentaron dimorfismo mandibular, fusión de hueso maxilar y mandibular y anquilosis de la articulación témporomandibular. La ortopantografía y la Tomografía Axial Computerizada (TAC fueron muy útiles en la planificación de la cirugía. El tratamiento quirúrgico consistió en todos los casos en la resección del hueso anquilótico y la reconstrucción con injerto condrocostal en uno de los casos. En el postoperatorio se siguió fisioterapia intensiva. Clínicamente todos los pacientes mostraron una gran mejoría en la masticación, la alimentación y el habla, obviamente debido a una buena oclusión. El problema más común fue la baja colaboración en la rehabilitación mandibular por parte de los pacientes.Little is known about Noma or Cancrum Oris Disease. This entity affects to children with chronic malnutrition, poor oral hygiene, poor environmental sanitation and debilitating concurrent illness. There is general consensus that noma starts as gingivitis. The acute stage responds readily to antibiotic treatment. The sequelae after healing include variable functional and aesthetic impairments, which require reconstructive surgery. We report 3 cases of mandibular ankylosis. Preoperative examination revealed mandibular dismorphism, fusion of maxilla and mandible and ankylosis of the temporomandibular joint. Orthopantography and Computed Thomography scan (TCS were very useful in planning

  7. Dexmedetomidine premedication for fiberoptic intubation in patients of temporomandibular joint ankylosis: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Kumkum Gupta

    2012-01-01

    Full Text Available Background : Fiberoptic intubation is the gold standard technique for difficult airway management in patients of temporomandibular joint. This study was aimed to evaluate the clinical efficacy and safety of dexmedetomidine as premedication with propofol infusion for fiberoptic intubation. Methods: Consent was obtained from 46 adult patients of temporomandibular joint ankylosis, scheduled for gap arthroplasty. They were enrolled for thisdouble-blind, randomized, prospective clinical trial with two treatment groups - Group D and Group P, of 23 patients each. Group D patients had received premedication of dexmedetomidine 1 μg/kg infused over 10 min followed by sedative propofol infusion and the control Group P patients were given only propofol infusion to achieve sedation. Condition achieved at endoscopy, intubating conditions, hemodynamic changes and postoperative events were evaluated as primary outcome. Results : The fiberoptic intubation was successful with satisfactory endoscopic and intubating condition in all patients. Dexmedetomidine premedication has provided satisfactory conditions for fiberoptic intubation and attenuated the hemodynamic response of fiberoptic intubation than the propofol group. Conclusion : Fiberoptic intubation was found to be easier with dexmedetomidine premedication along with sedative infusion of propofol with complete amnesia of the procedure, hemodynamic stability and preservation of patent airway.

  8. Rehabilitation treatment of ankylosis after relaxing and plastic operation of adhesion of knee extension apparatus%伸膝装置粘连松解成形术后康复治疗膝关节僵直

    Institute of Scientific and Technical Information of China (English)

    史桂秋; 尹中华

    2002-01-01

    Background:Ankylosis is the result of adhesion of knee extension apparatus that is often the complications of trauma of femoral shaft and knee .Because ankylosis will impair the flexion of knee joint,postoperational exercise is the key to rebuild flexing function of knee joint.

  9. Use of vascularised cartilage as an additional interposition in temporomandibular ankylosis surgery: Rationale, advantages and potential benefits

    Directory of Open Access Journals (Sweden)

    Jagannathan Mukund

    2008-01-01

    Full Text Available Context: Surgery for the release of temporomandibular joint (TMJ ankylosis is a commonly performed procedure. Various interposition materials have been tried with varying success rates. However, none of these procedures attempt to recreate the architecture of the joint as the glenoid surface is usually left raw. Aims: We aimed to use a vascularised cartilage flap and to line the raw surface of the bone to recreate the articular surface of the joint. Settings and Design: There is a rich blood supply in the region of the helical root, based on branches from the Superficial Temporal Artery (STA, which enables the harvest of vascularised cartilage from the helical root for use in the temporomandibular joint. Materials and Methods: Two cases, one adult and the other a child, of unilateral ankylosis were operated upon using this additional technique. The adult patient had a bony segment excised along with a vascularised cartilage flap for lining the glenoid. The child was managed with an interposition graft of costochondral cartilage following the release of the ankylosis, in addition to the vascularised cartilage flap for lining the glenoid. Results: The postoperative mouth opening was good in both the cases with significant reduction in pain. However, the long-term results of this procedure are yet to be ascertained. Conclusions: The vascularised cartilage flap as an additional interposition material in temporomandibular joint surgery enables early and painless mouth-opening with good short-term results. The potential applicability of this flap in various pathologies of the temporomandibular joint is enormous.

  10. Interposition arthroplasty in post-traumatic temporomandibular joint ankylosis: A retrospective study

    Directory of Open Access Journals (Sweden)

    Tripathy Satyaswarup

    2009-01-01

    Full Text Available Temporomandibular joint ankylosis which is most frequently caused by trauma, presents with restriction in mouth opening in early stages and if children are the victim and not treated early, it presents with growth retardation of the involved mandibular side. Various methods are available for surgical correction. We have reviewed our experience with the efficacy of different interpositional materials in post-traumatic cases in our set up with special reference to temporal fascia over last three years. Twenty seven patients with history of trauma, mostly fall from height, have been studied. They were evaluated clinically and by computed tomography (CT scan, orthopantogram and x- ray lateral oblique view. The most common age group was 10-15 years with mean 12.5 years and male to female ratio 1:2. Preoperative mouth opening (inter incisor distance was 1-2 mm in 17 cases and 2-4 mm in 10 cases. We have used temporalis fascia in nine, costochondral graft in seven, silastic sheets in five and T-plates in six cases. Post-operatively, adequate mouth opening of 30-50 mm was observed in six months follow-up and more than 50 mm at one year follow up in 21 cases out of which nine cases have interpositional material as temporalis fascia alone. The postoperative period was uneventful in all cases and none required re-operation for recurrences. We conclude that interpositional arthroplasty, especially with pedicled temporal fascia, is the best method to prevent recurrences and establish good mouth opening and full range of jaw movements.

  11. Application of the rapid prototyping technique to design a customized temporomandibular joint used to treat temporomandibular ankylosis

    Directory of Open Access Journals (Sweden)

    Chaware Suresh

    2009-01-01

    Full Text Available Anthropometric variations in humans make it difficult to replace a temporomandibular joint (TMJ, successfully using a standard "one-size-fits-all" prosthesis. The case report presents a unique concept of total TMJ replacement with customized and modified TMJ prosthesis, which is cost-effective and provides the best fit for the patient. The process involved in designing and modifications over the existing prosthesis are also described. A 12-year- old female who presented for treatment of left unilateral TMJ ankylosis underwent the surgery for total TMJ replacement. A three-dimensional computed tomography (CT scan suggested features of bony ankylosis of left TMJ. CT images were converted to a sterolithographic model using CAD software and a rapid prototyping machine. A process of rapid manufacturing was then used to manufacture the customized prosthesis. Postoperative recovery was uneventful, with an improvement in mouth opening of 3.5 cm and painless jaw movements. Three years postsurgery, the patient is pain-free, has a mouth opening of about 4.0 cm and enjoys a normal diet. The postoperative radiographs concur with the excellent clinical results. The use of CAD/CAM technique to design the custom-made prosthesis, using orthopaedically proven structural materials, significantly improves the predictability and success rates of TMJ replacement surgery.

  12. SMALLER SIZE LARYNGEAL MASK AIRWAY AND GUM ELASTIC BOUGIE COMBINATION IS A FAILSAFE TECHNIQUE FOR TRACHEAL INTUBATION IN A CHILD WITH TEMPOROMANDIBULAR JOINT ANKYLOSIS

    Directory of Open Access Journals (Sweden)

    Satyendra S.

    2014-10-01

    Full Text Available So many men’s, so many opinions are there for managing a difficult airway in a child with temporomandibular joint ankylosis (TMJA. It is an exceptionally challenging even in hands of experienced anesthesiologist. Success lies in doing ordinary things extraordinarily well. At times newer equipments and techniques turn out to be failure with uncooperative child. Here we present a case report of TMJA where successful intubation was possible in child with limited mouth opening with the aid of smaller size Laryngeal mask airway.

  13. Ultrathin Silicon Sheet in the Management of Unilateral Post-traumatic Temporo-Mandibuar Joint Ankylosis in Children: A Good Alternative to Conventional Techniques.

    Science.gov (United States)

    Aggarwal, Sushil Kumar; Ankur, Bhatnagar; Jain, R K

    2015-09-01

    We have described a new technique of using ultra-thin silicon sheet (0.2 mm) between two transected bony ends for temporo-mandibular joint (TMJ) ankylosis in children with advantages of short operative time, minimal foreign material insertion and faster recovery time post-operatively which makes our technique a good alternative to conventional techniques. Our study is a non-randomized prospective study conducted on 10 children aged between 4 and 15 years who presented to our tertiary care institute with severe trismus after traumatic injury and were willing to undergo this new technique. The main outcome measure taken into consideration was difference between pre-operative, intra-operative (on table) and post-operative mouth opening (minimum 2 years follow-up). The pre-operative mouth opening in our cases varied from 1 to 5 mm. The intra-operative mouth opening achieved ranged from 2.8 to 3.2 cm. The mouth opening was about more than 2.7 cm in all our cases at 2 years of follow-up. Our technique is a good alternative to conventional techniques used for TMJ ankylosis in children but few more randomized controlled trials are required to assess its effectiveness in comparison to conventional techniques and for universal adoption of this technique. PMID:26405658

  14. Experimental establishment of animal model of temporomandibular joint ankylosis secondary to condylar sagittal fracture%髁突矢状骨折继发颞下颌关节强直动物模型的建立

    Institute of Scientific and Technical Information of China (English)

    王霄; 张益; 李江明

    2011-01-01

    目的:建立髁突矢状骨折继发颞下颌关节强直动物模型,为进一步研究创伤性颞下颌关节强直发生机制提供实验载体.方法:小尾寒羊4只,双侧关节互为对照.实验侧通过手术造成髁突矢状骨折,破坏关节窝表面软骨,切除外侧1/2关节盘;对照侧仅造成髁突矢状骨折.术后6个月,通过CT检查和组织学观察评价实验侧颞下颌关节强直的形成.结果:4只小尾寒羊的实验侧关节均发生混合性强直,CT检查发现,关节结构消失,关节间隙变窄,周缘出现不规则增生或吸收,上、下关节面被若干上、下贯通的高密度影像所分隔,呈骨痂样改变.组织学观察可见,实验侧关节窝与髁突之间散在有骨与骨样的基质,部分区域可分辨出强直骨桥的形成.对照侧未出现强直迹象.结论:本研究中的动物实验重现了临床髁突矢状骨折继发颞下颌关节强直的发生过程,实验具有可重复性,可作为动物模型用于对创伤性关节强直的研究载体.%Objective: To experimentally develop an animal model of traumatic temporomandibular joint ankylosis secondary to condylar fracture in small Tail Han sheep. Methods: Four sheep were used to make sagittal fracture of condyles. The cartilage layer of articular surface was damaged and lateral half of articular disc was removed in the right side and conserved in the left side as a control. All animals were sacrificed at the end of 6 months postoperatively. CT observation and histological examination were carried out to evaluate the formation of ankylosed joints. Results: All of the animals showed a change of mixed ankylosis on the right sides. On the CT image, the joint space became narrow and the articular surfaces became irregular with high-density callus formation. Histological observation validated that the bone-like and the cartilage-like matrix scattered between the condyle and temporal fossa. The ankylosis bone bridge could be figured out in

  15. Prosthetic replacement of condylar head for management of traumatic temporomandibular joint ankylosis%髁突置换治疗创伤性颞下颌关节强直五例

    Institute of Scientific and Technical Information of China (English)

    安金刚; 张益; 何锦泉; 贺洋; 李江明

    2009-01-01

    Objective To preliminarily evaluate the method of using titanium condylar protheses in management of traumatic temporomandibular joint ankylosis.Methods Between August 2006 and April 2008,titanium condylar replacement was performed in 5 male patients.Preoperative CT datum of patient was obtained and a resin model was then produced and used as a reference to select a suitable titanium condyle for reconstruction of the joint.In the operation,the bony ankylosis was removed.According to the preoperation planning,the selected prosthesis was inserted and fixed to the distal mandibular segment.The results were assessed by means of examinations and measurements postoperatively and during follow-up.Results The 5 patients received alloplastic replacement of 6 condyles.Three patients were under follow-up and follow-up time ranged from 8 months to 2 years and 6 months.The mean mouth opening was 30 mm.Two patients had good occlusion and one patient developed a slight open bite.Conclusions Prosthetic condylar replacement can provide a choice for management of traumatic temporomandibular joint ankylosis.%目的 总结用人工髁突置换治疗创伤性颞下颌关节强直(temporomandibular joint ankylosis,TMJA)的临床效果.方法 2006年8月至2008年4月北京大学口腔医学院·口腔医院口腔颌面外科共5例创伤性TMJA患者接受人工髁突置换手术,患者均为男性.术前行CT检查后,用快速成形技术制作三维头模,在头模上模拟切除关节骨球、关节成形、选择适宜的人工髁突,术中依术前设计安放并固定人工髁突.术后1周和复查时评价手术效果.结果 5例共植入6侧人工髁突(1例为双侧).3例复查时间为术后8~30个月,另外2例失访.复查时张口度平均为30 mm,2例咬合关系良好,1例前牙区有约1 mm的开骀.结论 人工髁突置换可以作为创伤性TMJA手术治疗的方法之一,其临床效果还需进一步验证.

  16. Tooth ankylosis in deciduous teeth of children with cleft lip and/or palate Anquilose dentária na dentição decídua em crianças com fissura de lábio e/ou palato

    Directory of Open Access Journals (Sweden)

    Andreza Maria Fábio Aranha

    2004-12-01

    Full Text Available The present study aimed at evaluating the prevalence of tooth ankylosis in deciduous molars of Caucasian children with cleft lip and/or palate aged 5 to 12 years, of both genders. A total of 330 patients seen at the Hospital for Rehabilitation of Craniofacial Anomalies of the University of São Paulo for routine treatment were clinically evaluated. The prevalence of ankylosis was analyzed in relation to gender, age range (5-7, 8-10, 11-12 years, type of cleft, affected tooth and arch. The total group showed a prevalence of 18%, with no statistical difference between genders and among types of cleft; ankylosis was more often in the mandibular arch, lower first molars and among children in the age ranges 8-10 and 11-12 years. The results agreed with those observed in the related literature for patients without clefts, pointing out the absence of influence of the cleft on the prevalence of ankylosis. This reinforces the importance of early diagnosis of this anomaly and of the treatment of choice, which are similar in patients with or without clefts.Este estudo avaliou a prevalência de anquilose dentária em molares decíduos de portadores de fissura de lábio e/ou palato, brancos, de ambos os sexos, com idade entre 5 e 12 anos. Um total de 330 pacientes atendidos no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo para tratamento de rotina foi clinicamente avaliado. A prevalência de anquilose foi analisada em relação a gênero, idade (5-7; 8-10; 11-12 anos, tipo de fissura, dente e arco afetados. O grupo total demonstrou prevalência de 18%, sem diferença estatística entre gêneros e tipos de fissura, sendo mais acometido o arco mandibular, o primeiro molar inferior e as faixas etárias de 8 a 10 e de 11 a 12 anos. Os resultados estão de acordo com aqueles observados na literatura para pacientes sem fissuras, destacando a ausência da influência das fissuras na prevalência de anquilose. Isso reforça a

  17. Total knee arthroplasty for extension ankylosis of the knee:an analysis of 1 3 cases%膝关节置换治疗膝关节伸直位强直13例

    Institute of Scientific and Technical Information of China (English)

    张有伟; 郭礼跃

    2015-01-01

    Objective:To investigate the treatment method and curative effect of total knee arthroplasty for extension ankylosis of the knee. Methods:Total knee arthroplasty was performed to 13 patients with extension anky-losis of the knee from March 2008 to February 2014,including 6 male and 7 female patients with an average age of 41.4 years(36.0 -63.0 years),among whom 3 patients had rheumatoid arthritis and 10 patients had trauma around the knee joint. Before surgery,the range of motion was (0 ±0)°,the score of HSS and the Lysholm function score were(38 ±13.80)points and (15 ±13.29)points. Results:All of the 13 patients received total knee arthroplasty.The average follow-up was 48.7 months (9.0 -78.0 months). In the last follow-up,the range of motion was (96 ±12.17)°,the score of HSS and the Lysholm function score were (85 ±7.15)points and (82 ±6.94)points, indicating there were statistically significant differences before and after operation. The postoperative complications included patellar fracture in 1 patient,patellar tendon avulsion in 1 patient,part of incision necrosis in 2 patients and superficial infection in 1 patient. They were all cured after treatment,however,extension lag occurred in 3 pa-tients with degrees of 5°,10°and 15°respectively.Conclusion:Total knee arthroplasty for extension ankylosis of the knee can achieve satisfactory clinical results,but the operation is difficult and the chance of complications is high, and rehabilitation exercise is very important.%目的:探讨膝关节置换治疗膝关节伸直位强直的方法和疗效。方法:2008年3月至2014年2月,笔者采用膝关节置换治疗膝关节伸直位强直患者13例,男6例,女7例,平均年龄41.4岁(36.0~63.0岁),其中类风湿性关节炎3例,膝关节周围创伤10例;术前膝关节活动度(0±0)°,HSS评分(38±13.80)分,膝关节功能Lysholm评分(15±13.29)分。结果:全部病例行膝关节置换,平均随访48.7

  18. 髋关节强直人工关节置换术治疗分析%Experience of hip artificial joint replacement in the treatment of ankylosis of hip joint

    Institute of Scientific and Technical Information of China (English)

    冯国英; 王心宽; 张辉; 刘铁军

    2014-01-01

    Objective To investigate the clinical curative effect and the technique of hip artificial joint replacement in the treatment of ankylosis of hip joint.Methods A retrospective data of 19 patients with hip joint ankylosis operated by artificial joint replacement was reviewed between July 2010 and June 2013 in our hospital.The hipfusion due to ankylosing spondylitis was in 15 cases; congenital acetabular dysplasia and osteoarthritis were in 3 cases; ischemic necrosis of femoral head was in 1 case.The history of all the cases was 5-40 years in which 15 cases of hip joint was complete rigidity and no activity with hip 10 °-45 ° of adduction and flexion.The preoperative,intraoperative and postoperative data were summarized.Results Totally 19 cases were all followed up and the follow-up time was 0.5-3.5 years.All the patients had no complications after operation,such as nerve,vascular injury,acute pulmonary embolism,acute renal and heart failure,pulmonary infection and deep vein thrombosis.During the follow-up period,all the patients had no dislocation,loosening prosthesis and delayed infection.The postoperative activity of hip joint was significantly improved after operation.There were 3 cases (15.8%) of heterotopic ossification.Conclusions Artificial joint replacement is an ideal method in the treatment of hip joint ankylosis,which can significantly improve the joint function and the quality of life.Intraoperative technology directly affects the effect after operation.The lateral approach of hip joint has a lot of advantages and can effectively prevent the dislocation after artificial joint replacement.%目的 探讨髋关节强直人工关节置换手术的临床疗效和技术要点.方法 回顾性分析自2010年7月至2013年6月在北京市通州区中西医结合医院住院的19例髋关节强直患者经过人工关节置换手术后的临床资料.其中强直性脊柱炎髋关节融合15例,先天性髋臼发育不良伴骨性关节炎3

  19. 哈萨克医药马脂治疗SD大鼠踝关节僵硬的效果%Effect of Horse-fat of Kazakh-medicine on SD-rat Ankle-join Ankylosis

    Institute of Scientific and Technical Information of China (English)

    尹作祯; 江阿古丽·艾山; 海拉提·阿力地阿尔汗; 加莎热特·杰力勒; 杨广忠; 江安努尔·这依肯

    2011-01-01

    目的 研究马脂对创伤后制动继发踝关节僵硬后踝关节功能的效果.方法 将SD大鼠随机分成7 d、14 d、21 d三组,每组10只,各组分为用药组与功能锻炼组,每组各5只,用药后用量角器分别测定其踝关节活动度.结果 7 d组用药大鼠关节活动度与功能锻炼组比较,差异无统计学意义(P>0.05);14 d用药组活动度与功能锻炼组比较,差异有统计学意义(P<0.05);21 d用药组活动度与功能锻炼组比较,差异有统计学意义(P<0.05).结论 马脂经皮渗透治疗大鼠创伤后制动继发踝关节僵硬的作用明显优于对照组.%Objective To investigate the effect of horse-fat on ankle-join ankylosis secondary to immobilization following trauma. Methods All rat models were divided into three groups: 7-day group, 14-day group and 21-day group, ten rats each. These groups were further divided into two subgroups: control group and experimental group, 5 rats each. The protractor was used to determine ankle-joint range of motion of every group after medication. Results There was no difference between control group and experimental group in 7-day group but there were significant differences in the 14-day and the 21-day groups. Conclusion Horse-fat can improve the ankle-joint range of motion compared with control group.

  20. Analysis of the effect of short interval staged bilateral replacement in the treatment of ankylosing spondylitis combined with bilateral hip bony ankylosis%短间隔分期双侧置换治疗强直性脊柱炎伴双髋关节骨性强直的疗效分析

    Institute of Scientific and Technical Information of China (English)

    韩博闻; 殷力; 韩奇财; 娄超举; 李弘帅; 胡明鑫

    2015-01-01

    Objective To discuss the clinical effects of short interval staged bilateral replacement in the treatment of ankylo-sing spondylitis(AS)combined with bilateral hip bony ankylosis. Methods 21 cases(42 hips)of ankylosing spondylitis com-bined with bilateral hip bony ankylosis hospitalized from October of 2010 to October of 2014 were enrolled and received short in-terval(bilateral operation interval < 1 month)staged bilateral total hip arthroplasty. The Harris score,visual analogue score (VAS),total hip joint activity,short form health survey(SF - 36)were compared between pre - operation and the last follow -up,and the postoperative complications were observed. Results The Harris score,total hip joint activity and SF - 36 score on the last follow - up day were markedly increased than those before operation. The VAS score of the last follow - up day were markedly decreased than those before operation. 6 hips had mild heterotopic ossification,and 3 hips had femoral anterolateral in-termittent pain,but those had no obvious effect on the function. There were no femoral nerve injury. Conclusion SISBTHA can reconstruct the hip joint function,improve the quality of life,which is an effective and reliable method.%目的:探讨短间隔分期双侧置换治疗强直性脊柱炎(ankylosing spondylitis,AS)伴双髋关节骨性强直的临床疗效。方法回顾性研究2010年10月至2014年10月收治的21例(42髋)强直性脊柱炎双髋关节骨性强直患者,采用短间隔(双侧手术间隔<1个月)分期双侧人工全髋关节置换术(short interval staged bilateraltotal hip arthroplasty,SISBTHA)。比较患者术前及末次随访的 Harris 评分、疼痛视觉模拟评分(VAS)、髋关节总活动度、健康调查简表(SF -36),以及观察术后并发症发生情况。结果末次随访时 Harris 评分、髋关节总体活动度和 SF -36评分均较术前显著升高(P <0.05),VAS 评分较术前显著降低(P <0

  1. 人工全髋关节置换在骨性强直髋治疗中的临床及放射学评估%Clinical and radiographic evaluation for total hip arthroplasty in treatment of bony ankylosis of hips

    Institute of Scientific and Technical Information of China (English)

    冯卫; 刘建国; 齐欣; 李冬松; 杨晨; 李叔强; 付莉

    2012-01-01

    目的:对人工全髋关节置换(THA)在骨性强直髋治疗中的临床及放射学效果进行评估.方法:自2003年1月至2009年8月,20例(30髋)骨性强直的髋关节患者采用THA治疗,其中男12例,女8例;平均年龄36岁.术后临床随访根据Harris评分、患者疼痛缓解满意度、肢体长度差异、髋关节活动范围以及髋关节外展肌力进行评价.X线影像学随访包括对髋臼及股骨柄假体周围骨溶解、假体松动、透光线及异位骨化进行评价.术后平均随访时间为4年.结果:Harris评分由术前的平均(40.75±6.52)分提高至术后平均(86.40±5.42)分;邻近受累关节疼痛完全缓解13例,部分缓解7例;13例外展肌力量恢复满意,跛行症状明显缓解,肢体短缩下降至小于0.5 cm;髋关节活动范围较术前显著改善.放射学评估发现2例髋关节周围异位骨化,1例股骨假体周围透光线,无关节假体脱位及翻修的病例.结论:近期随访发现THA在治疗骨性强直的髋关节中可以获得满意的临床疗效,矫正髋关节畸形,恢复髋关节功能,减轻患髋邻近关节的疼痛,改善患者的生活质量.%Objective;To evaluate the clinical and radiographic effects of total hip arthroplasty (THA) in the treatment of bony ankylosis of hips. Methods: From January 2003 to August 2009,20 patients (30 hips) with bony ankylosis of hips were treated with THA. There were 12 males and 8 females,with an average age of 36 years old. After operation,the follow-up results were evaluated with clinical and radiographic criteria. The clinical follow-up results were evaluated with Harris score, satisfaction of pain relief, limb length discrepancy, ROM of hip and the strength of hip abductor. The X-ray imaging follow-up results were evaluated with acetabula and periprosthetic osteolysis, prosthesis loosening, radiolucent and hetcrotopic ossification. Re-SultS:The average following-up was 4 years. The mean preoperative Harris score was (40

  2. Anquilose intencional dos caninos decíduos como reforço de ancoragem para a tração reversa da maxila: estudo cefalométrico prospectivo Intentional ankylosis of the deciduous canines to enhance maxillary protraction: a prospective cephalometric analysis

    Directory of Open Access Journals (Sweden)

    Omar Gabriel da Silva Filho

    2006-12-01

    Full Text Available OBJETIVO: o presente trabalho de pesquisa analisou os efeitos da tração reversa da maxila associada à anquilose intencional dos caninos decíduos superiores, mediante o emprego da cefalometria. METODOLOGIA: o protocolo de tratamento incluiu: 1 anquilose intencional dos caninos decíduos superiores; 2 expansão rápida da maxila e 3 tração reversa da maxila, imediatamente após o término da fase ativa da expansão. A amostra foi composta de 18 crianças nos estágios de dentadura decídua e dentadura mista, com idade média inicial de 7 anos e 1 mês. O intervalo médio de tratamento com a tração reversa da maxila foi de 1 ano e 1 mês. As telerradiografias laterais foram obtidas na documentação inicial e após a correção da Classe III. RESULTADOS E CONCLUSÕES: os resultados demonstram que os ângulos representativos da convexidade facial, NAP e ANB, aumentaram de 0º para 6,6º e 3,5º, respectivamente. Isso significa dizer que a face transformou-se de reta ou côncava, peculiar na Classe III, para uma face convexa, característica de normalidade no estágio avaliado. Essa melhora na convexidade facial é atribuída ao avanço da maxila, registrado tanto na região alveolar (ângulo SNA e as distâncias Co-A e NPerp-A como na região basal (ângulo SN.ENA. A maxila deslocou-se para frente, enquanto a redução do ângulo SNB de 80,56º para 79,61º demonstrou um retroposicionamento mandibular. Além da mudança no sentido sagital, houve rotação da mandíbula no sentido horário, com aumento dos ângulos SN.GoGn e SN.Gn. Somado aos efeitos ortopédicos, houve inclinação vestibular dos incisivos superiores.AIM: the current article analyses the effects of maxillary protraction associated to the intentional ankylosis of the deciduous canines on the basis of cephalometric measurements. METHODS: the treatment protocol included: 1 intentional ankylosis of the upper deciduous canines; 2 rapid palatal expansion and 3 maxillary

  3. Case 229: Burn-related Global Ankylosis of Interphalangeal Joints with Associated Acroosteolysis.

    Science.gov (United States)

    Davis, Derik L; Resnik, Charles S

    2016-05-01

    History A 50-year-old woman presented with a 6-month history of polyarthralgia involving the left and right hands, wrists, elbows, ankles, and knees. Her pain was not associated with morning stiffness but did worsen over the course of the day. She denied experiencing fevers, chills, or mouth ulcers. She did not report paresthesias or blue discoloration of her fingers when they were exposed to cold. Her family history was remarkable for an aunt who died of systemic lupus erythematosus and for a brother with arthritis. Her medical history was remarkable for vitamin D deficiency, hypertension, and rehabilitation for burns. At clinical examination, she had mild tenderness to palpation of her joints, without associated erythema, swelling, or crepitus. Healed skin grafts were also noted. Blood chemistry tests revealed a rheumatoid factor of 8.5 IU/mL (normal range, 0-13.9 IU/mL), an erythrocyte sedimentation rate of 2 mm/hr (normal range, 0-40 mm/hr), and a C-reactive protein value of 0.4 mg/L (3.8 nmol/L) (normal range, 0-4.9 mg/L [0-46.7 nmol/L]). Antinuclear antibodies test results were negative. Radiography of the right and left hands was performed. PMID:27089192

  4. A CASE OF EXTRA ARTICULAR ANKYLOSIS OF HIP DUE TO HETEROTOPIC OSSIFICATION TREATED BY EXCISION OF BONE BLOCK

    Directory of Open Access Journals (Sweden)

    Srinivas

    2013-12-01

    Full Text Available Heterotrophic ossification (HO is the formation of lamellar bone in soft tissue. HO is a common complication in patients with spinal cord and head injury. HO is no trivial complication. A limitation of functional range of joint motion has serious consequences for the activities of daily living of people who are already severely incapacitated because of their original injury. Movement limitation of the hip joint is challenging to treat. Surgical excision of bone blo ck can be a formidable exercise , but will give gratifying results if done carefully.We report a case of HO involving left hip joint following head injury. A twenty - five year old male patient sustained head injury one and half year s ago. At that time there was no evidence of injury to hip joints. He was noted to have severe restriction of range of motion (ROM of left hip joint with a mass around the hip joint.Radiographs and 3D CT reconstruction revealed HO involving anterior , lateral , posterior and medial aspects of left hip joint ensheathing femoral neurovascular bundle with extra - articular HO. The joint space was well preserved. Blood investigations showed erythrocyte sedimentation rate (ESR alkaline phosphatase levels within normal limits.After complete evaluation , surgical excision of bone block was done and functional range of movements of left hip achieved. KEY WORDS : heterotrophic ossification , hip joint , spinal cord injury , head injury ; indomethacin ; BMP - bone morphogenic protein ; range of motion

  5. A CASE OF EXTRA ARTICULAR ANKYLOSIS OF HIP DUE TO HETEROTOPIC OSSIFICATION TREATED BY EXCISION OF BONE BLOCK

    OpenAIRE

    Srinivas,; Ramana; Harshad; Reddy; Guruvardhan; Kalyan

    2013-01-01

    Heterotrophic ossification (HO) is the formation of lamellar bone in soft tissue. HO is a common complication in patients with spinal cord and head injury. HO is no trivial complication. A limitation of functional range of joint motion has serious consequences for the activities of daily living of people who are already severely incapacitated because of their original injury. Movement limitation of the hip joint is challenging to treat....

  6. Anquilose temporomandibular bilateral: aspectos fonoaudiológicos e procedimentos clinidos Bilateral ankylosis of the temporomandibular joint: oral miofunctional aspects and clinical procedure

    OpenAIRE

    Silvana Regina Marzotto; Esther Mandelbaum Gonçalves Bianchini

    2007-01-01

    OBJETIVO: apresentar uma proposta terapêutica miofuncional orofacial, os procedimentos utilizados e resultados em caso de anquilose temporomandibular bilateral, buscando ressaltar a importância do trabalho interdisciplinar e a contribuição da fonoaudiologia para a reabilitação do sistema estomatognático nesses casos. MÉTODOS: relato de caso de paciente adulto, gênero masculino, encaminhado para avaliação e procedimentos fonoaudiológicos após três meses da realização de cirurgia articular, ten...

  7. The Use of a Bioadhesive (BioGlue®) Secured Conchal Graft and Mandibular Distraction Osteogenesis to Correct Pediatric Facial Asymmetry as Result of Unilateral Temporomandibular Joint Ankylosis

    OpenAIRE

    Muhammad, Joseph Kamal; Al Hashimi, Bader Abdulla; Al Mansoor, Abu Bakr; Ali, Iqbal

    2013-01-01

    The rehabilitation of children affected by early traumatic facial deformity is a challenge for both the craniofacial team and the child's family. Although the immediate goals of surgery are to restore both form and function, the psychological needs of the growing child must also be addressed. Early surgery may be required to assist integration of the child into the community and thereby avert both social isolation and stigmatization of the child. Timed correctly, such surgery has the potentia...

  8. Structural lesions detected by magnetic resonance imaging in the spine of patients with spondyloarthritis - definitions, assessment system, and reference image set

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Maksymowych, Walter P; Pedersen, Susanne J;

    2009-01-01

    representative examples of the individual pathologies, as well as borderline cases and important artefacts, were collected. RESULTS: The defined lesions were (a) Bone erosions, subdivided into corner and non-corner vertebral body erosions and facet joint erosions; (b) Focal fat infiltration at vertebral corners......; (c) Bone spurs, subdivided into corner and non-corner vertebral body spurs; and (d) Ankylosis, subdivided into corner and non-corner vertebral body ankylosis and facet joint ankylosis. All definitions were based on their appearance on sagittal T1-weighted MR images. Vertebral body structural lesions...

  9. Surgical treatment of temporomandibular joint ankyloses: meniscus conservation and relocation.

    Science.gov (United States)

    Rinna, Claudio; Reale, Gabriele; Calvani, Francesco; Cascone, Piero

    2013-03-01

    Ankylosis of the temporomandibular joint is a serious complication, mainly after trauma and local or systemic infection. In rare cases, ankylosis is associated with systemic disease such as ankylosing spondylitis, rheumatoid arthritis, and psoriasis. According to the functional restriction and the provoked disturbances of facial growth in the youth, an early and effective therapy is desirable. There is a wide variety of surgical approaches to temporomandibular joint ankylosis, ranging from chondro-osseous grafts to prothesis. In the article the authors present the clinical case of a 60-year-old patient who, at the age of 6, accidentally fell from a height of about 2 m. In 60 years old, after removing the temporomandibular ankylosis with surgical technique, patient showed a marked improvement of mandibular kinetics. PMID:23524812

  10. Failures in the treatment of pseudoarthroses; Problem niepowodzen w leczeniu stawow rzekomych

    Energy Technology Data Exchange (ETDEWEB)

    Konarski, K.; Piotrowski, W.; Trubisz, L.; Michalski, S. [Szpital im. J. Jonstona, Lublin (Poland)

    1993-12-31

    Failure analysis in the treatment of pseudoarthroses has been presented. It was noted that ankylosis within adjacent joints may lead to nonunion or refracture. Vascular disorders of various origins remain the dominant cause of failure. (author). 5 refs, 10 figs.

  11. 膝关节运动康复器与伸筋汤熏洗联合治疗股骨髁部骨折术后膝关节僵直的疗效观察%To Observe the Motion of Knee Joint Rehabilitation and Extensor Tendon Soup Fumigation Combined With Treatment of Femoral Condylar Fractures of Knee Ankylosis

    Institute of Scientific and Technical Information of China (English)

    赵明

    2015-01-01

    目的:探究股骨髁部骨折术后膝关节僵直采用膝关节运动康复器联合伸筋汤熏洗治疗的临床疗效。方法选取股骨髁部骨折术后膝关节僵直患者62例,随机分为对照组和观察组各31例,对照组采用膝关节运动康复器治疗,在此基础上,观察组采用伸筋汤熏洗治疗,比较其治疗效果。结果观察组患者治疗优良率高于对照组(P<0.05)。结论采用膝关节运动康复器与伸筋汤熏洗联合治疗股骨髁部骨折术后膝关节僵直,临床疗效显著。%ObjectiveTo explore clinical efficacy of femoral condylar fracture with postoperative stiffness of knee joint motion of knee joint rehabilitation combined with extensor tendon soup fumigation treatment.Methods 62 cases of knee joint stiffness in patients with femoral condylar fracture after operation, were randomly divided into control group and observation group with 31 cases in each group, the control group with rehabilitation treatment of knee joint motion, on the basis of this, the observation group with extensor tendon soup fumigation treatment. ResultsThe patients in the observation group was higher than the control group(P<0.05).Conclusion The knee joint rehabilitation and extension tendon soup fumigation treatment of femoral condylar fracture postoperative knee stiffness, clinical curative effect.

  12. A case of perosomus elumbis in a Holstein calf

    International Nuclear Information System (INIS)

    Perosomus elumbis is an occasionally found congenital anomaly of unknown etiology and is characterized by partial or complete agenesis of lumbar, sacral and coccygeal vertebrae and ankylosis of the hindlimbs. A 2-day-old female Holstein calf presented nearly normal forelimbs but flexure and ankylosis of the hindlimbs. The vertebrae and pelvic malformations and agenesis were radiographed and then necropsied. Mild ankylosis of the hindlimbs, absence of cauda equina, left scoliosis in state of fusion of T11 and T12 and complete fusion of L4 and L5, narrowed pelvic canal and misshapen ilium were confirmed. However, abnormal development or agenesis was not observed in the urogenital and intestinal system in this calf

  13. Transarticular invasion of the sacroiliac joints by malignant pelvic bone tumors

    International Nuclear Information System (INIS)

    To describe modes of transarticular invasion, with reference to the size and location of a tumor, the anatomic characteristics of invaded cartilage,and the existence of ankylosis in SI joint. Eleven histologically confirmed malignant pelvic bone tumors involving transarticular invasion of sacroiliac joints, were retrospectively analysed. Transarticular invasion of a joint was defined as involvement of its opposing bones. The anatomic site and size of the tumors were analysed, and invaded sacroiliac joint was divided into upper, middle and lower parts on the basis of the anatomic characteristics of the intervening cartilage: synovial hyaline or fibrous ligamentous. the existence of ankylosis was determined, and transarticular invasion directly across a joint was classified as direct invasion. Extension of tumors around a joint from its periphery to the opposing bone were considered as indirect invasion. All tumors were located near the sacroiliac joint, eight at the ilium and three at the sacrum. Six invasions were indirect and five were direct. Average tumor area was larger in indirect cases than in direct: 191.8 cm2 vs. 69.6 cm2. In all indirect invasions, a huge soft tissue mass abutted onto the peripheral portion of the sacroiliac joint. In five of six cases of indirect transarticular invasion, the upper part of the joint posteriorly located fibrous ligamentous cartilage. In the other, the lower part was invaded, and this involved a detour around the joint space, avoiding the invasion of intervening cartilage. Ankylosis occurred in one of the indirect cases. Among the five cases of direct invasion, there was invasion of the posteriorly located ligamentous fibrous cartilage in three without ankylosis. In the other two cases, involving ankylosis, the synovial hyaline cartilage was invaded directly at the lower part of the joint. Transarticular invasions of sacroiliac joint via fibrous cartilage are most common. Ankylosis of the sacroiliac joint facilitates hyaline

  14. Functional exercise after high temporomandibular joint plastic surgery%高位颞下颌关节成形术后的功能康复

    Institute of Scientific and Technical Information of China (English)

    洪霞; 羊玉荣; 赵丽

    2002-01-01

    Objective To investigate the impact of functional exercise following high temporomandibular joint plastic surgery on functional recovery.Methods High temporomandibular joint plastic surgery was performed on 31 patients suffered from temporomandibular ankylosis.Titanium fragment and pedicle fascia were inserted.Functional exercise as well as locally hot compress and healthy education were carried out after operation.Results 29 subjects showed favorable functional recovery.Results showed 2 subjects developed ankylosis again due to poor mouth opening training (2/31).Conclusion Functional exercise after high temporomandibular joint plastic surgery is effective for recovery of temporomandibular joint functional.

  15. Stress fracture of the clavicle associated with sternocostoclavicular hyperostosis

    International Nuclear Information System (INIS)

    We report a case of stress fracture of the clavicle associated with sternocostoclavicular hyperostosis. A 60-year-old man sustained a stress fracture of the right clavicle with no history of trauma. On radiography, hyperostosis of the anterior chest wall and ankylosis of the sternoclavicular joint were evident in addition to the fracture. Fracture healing was uneventful after 2.5 months. Ankylosis of the sternoclavicular joint may have caused increased stress at the midshaft of the clavicle by daily activity or minor trauma. Such a fracture is a rare complication of sternocostoclavicular hyperostosis. (orig.)

  16. Clinical Outcomes Study of the Nexel Total Elbow

    Science.gov (United States)

    2015-12-18

    Elbow Joint Destruction; Post-traumatic Lesions; Ankylosed Joints; Advanced Rheumatoid Arthritis; Joint Instability or Loss of Motion; Acute Comminuted Articular Fracture of Elbow Joint Surfaces; Bone Loss Contributing to Elbow Instability; Bilateral Ankylosis From Causes Other Than Active Sepsis; Post-traumatic, or Degenerative Arthritis With Incapacitating Pain

  17. 下肢骨折后膝关节的功能锻炼%Functional training of knee joint after fracture of lower limb

    Institute of Scientific and Technical Information of China (English)

    张超

    2003-01-01

    @@ BACKGROUND:In treatment of fracture of lower limb, clinical healing of fracture needs a long time after replace and immobilization. But clinical healing does not represent complete recovery of joint function.Knee ankylosis or stiffness could happen if not treated properly in this term.

  18. Actis Total Hip System 2 Year Follow-up

    Science.gov (United States)

    2016-08-09

    Osteoarthritis; Traumatic Arthritis; Rheumatoid Arthritis; Congenital Hip Dysplasia; Avascular Necrosis of the Femoral Head; Acute Traumatic Fracture of the Femoral Head or Neck; Certain Cases of Ankylosis; Non-union of Femoral Neck Fractures; Certain High Sub-Capital and Femoral Neck Fractures in the Elderly

  19. A novel nonsense mutation in the NOG gene causes familial NOG-related symphalangism spectrum disorder

    Science.gov (United States)

    Takano, Kenichi; Ogasawara, Noriko; Matsunaga, Tatsuo; Mutai, Hideki; Sakurai, Akihiro; Ishikawa, Aki; Himi, Tetsuo

    2016-01-01

    The human noggin (NOG) gene is responsible for a broad spectrum of clinical manifestations of NOG-related symphalangism spectrum disorder (NOG-SSD), which include proximal symphalangism, multiple synostoses, stapes ankylosis with broad thumbs (SABTT), tarsal–carpal coalition syndrome, and brachydactyly type B2. Some of these disorders exhibit phenotypes associated with congenital stapes ankylosis. In the present study, we describe a Japanese pedigree with dactylosymphysis and conductive hearing loss due to congenital stapes ankylosis. The range of motion in her elbow joint was also restricted. The family showed multiple clinical features and was diagnosed with SABTT. Sanger sequencing analysis of the NOG gene in the family members revealed a novel heterozygous nonsense mutation (c.397A>T; p.K133*). In the family, the prevalence of dactylosymphysis and hyperopia was 100% while that of stapes ankylosis was less than 100%. Stapes surgery using a CO2 laser led to a significant improvement of the conductive hearing loss. This novel mutation expands our understanding of NOG-SSD from clinical and genetic perspectives.

  20. On the biology of the bony otic capsule and the pathogenesis of otosclerosis

    DEFF Research Database (Denmark)

    Bloch, Sune Land

    2012-01-01

    In human otosclerosis, focal pathological bone remodeling occurs in significant amounts inside the normally anti-resorptive perilabyrinthine domain of the bony otic capsule. Otosclerosis causes hearing loss in 0.2-0.5% of the population by ankylosis of the footplate. The disease cannot be predict...... osteocyte survivors might distort the process and account for the otosclerotic morphology....

  1. 颞下颌关节强直模型的研究进展

    Institute of Scientific and Technical Information of China (English)

    顾云凯(综述); 满城(审校)

    2014-01-01

    Temporomandibular joint ankylosis is a kind of disease seriously af ecting jaw movements.In order to explore its pathogenesis and treatment,animal experiment has been widely applied in this field.In this paper,a brief review is given about the research advances on animal models of temporomandibular joint ankylosis .%颞下颌关节强直是一类严重影响口腔下颌运动的疾病。为了更好的探究其发病机制及治疗方法,动物实验已被广泛应用于研究。本文就各种颞下颌关节强直模型相关研究做一简要综述。

  2. Apicotomy: surgical management of maxillary dilacerated or ankylosed canines.

    Science.gov (United States)

    Araújo, Eustáquio A; Araújo, Cristiana V; Tanaka, Orlando M

    2013-12-01

    This clinical article reports a technique, apicotomy, for managing dilacerated or ankylosed canines. The records of 3 patients successfully treated with apicotomy are presented. Orthodontists observe clinically significant incidences of impacted maxillary canines in their daily practices. Several procedures have been described to bring an ankylosed, impacted tooth into occlusion. Luxation is the most widely used solution, but there are risks involved with that approach, and the success rate is low. Surgical repositioning has also been used, but morbidity is high, and the aggressiveness of the procedure might also contraindicate it. Ankylosis might be related to the anatomic position of the canine's root apex and its adjacent anatomic structures. Apicotomy is a guided fracture of a canine root apex, followed by its orthodontic traction. It is a conservative surgical alternative for treating impacted canines with dilacerations or apical root ankylosis. PMID:24286914

  3. Posttraumatic Temporomandibular Joint Disorders

    OpenAIRE

    Giannakopoulos, Helen E.; Quinn, Peter D.; Granquist, Eric; Chou, Joli C.

    2009-01-01

    The temporomandibular joint (TMJ) has many essential functions. None of its components are exempt from injury. Facial asymmetry, malocclusion, disturbances in growth, osteoarthritis, and ankylosis can manifest as complications from trauma to the TMJ. The goals of initial treatment include achievement of pretraumatic function, restoration of facial symmetry, and resolution of pain. These same objectives hold true for late repairs and reconstruction of the TMJ apparatus. Treatment is demanding,...

  4. Ankylosing Spondylitis: a Reflection and a Question

    Directory of Open Access Journals (Sweden)

    Annia Deysi Hernández Martín

    2014-07-01

    Full Text Available Ankylosing spondylitis is a chronic inflammatory disease that affects the synovial membrane, joint entheses and para-articular structures of the spine, including the sacroiliac joints and limbs. We present a case of ankylosing spondylitis that had evolved for 12 years despite the relatively early diagnosis and treatment, showing flexion deformity and limitation of spinal movements. On radiological examination an early evolution to ankylosis was observed, which motivated us to make a reflection and a question.

  5. Tumor necrosis factor inhibitor therapy but not standard therapy is associated with resolution of erosion in the sacroiliac joints of patients with axial spondyloarthritis

    OpenAIRE

    Pedersen, Susanne J; Wichuk, Stephanie; Chiowchanwisawakit, Praveena; Lambert, Robert G; Maksymowych, Walter P

    2014-01-01

    Introduction Radiography is an unreliable and insensitive tool for the assessment of structural lesions in the sacroiliac joints (SIJ). Magnetic resonance imaging (MRI) detects a wider spectrum of structural lesions but has undergone minimal validation in prospective studies. The Spondyloarthritis Research Consortium of Canada (SPARCC) MRI Sacroiliac Joint (SIJ) Structural Score (SSS) assesses a spectrum of structural lesions (erosion, fat metaplasia, backfill, ankylosis) and its potential to...

  6. Introduction of a Phe377del Mutation in ANK Creates a Mouse Model for Craniometaphyseal Dysplasia

    OpenAIRE

    Chen, I-Ping; Wang, Chiachien J.; Strecker, Sara; Koczon-Jaremko, Boguslawa; Boskey, Adele; Reichenberger, Ernst J.

    2009-01-01

    Craniometaphyseal dysplasia (CMD) is a monogenic human disorder characterized by thickening of craniofacial bones and flaring metaphyses of long bones. Mutations for autosomal dominant CMD have been identified in the progressive ankylosis gene ANKH. Previous studies of Ank loss-of-function models, Anknull/null and Ankank/ank mice, suggest that Ank plays a role in the regulation of bone mineralization. However, the mechanism for Ank mutations leading to CMD remains unknown. We generated the fi...

  7. A functional variant in ERAP1 predisposes to multiple sclerosis

    OpenAIRE

    Guerini, F R; Cagliani, R.; De Forni, D; C. Agliardi; Caputo, D.; A. Cassinotti; Galimberti, D.; Fenoglio, C; M. Biasin; R. Asselta; Scarpini, E.; Comi, G P; Bresolin, N.; M. S. Clerici; Sironi, M

    2012-01-01

    The ERAP1 gene encodes an aminopeptidase involved in antigen processing. A functional polymorphism in the gene (rs30187, Arg528Lys) associates with susceptibility to ankylosying spondylitis (AS), whereas a SNP in the interacting ERAP2 gene increases susceptibility to another inflammatory autoimmune disorder, Crohn's disease (CD). We analysed rs30187 in 572 Italian patients with CD and in 517 subjects suffering from multiple sclerosis (MS); for each cohort, an independent sex- and age-matched ...

  8. Cartilage in facet joints of patients with ankylosing spondylitis (AS) shows signs of cartilage degeneration rather than chondrocyte hypertrophy: implications for joint remodeling in AS

    OpenAIRE

    Bleil, Janine; Sieper, Joachim; Maier, Rene; Schlichting, Uwe; Hempfing, Axel; Syrbe, Uta; Appel, Heiner

    2015-01-01

    Introduction In ankylosing spondylitis (AS), joint remodeling leading to joint ankylosis involves cartilage fusion. Here, we analyzed whether chondrocyte hypertrophy is involved in cartilage fusion and subsequent joint remodeling in AS. Methods We assessed the expression of chondrocyte hypertrophy markers runt-related transcription factor 2 (Runx2), type X collagen (COL10), matrix metalloproteinase 13 (MMP13), osteocalcin and beta-catenin and the expression of positive bone morphogenic protei...

  9. HETEROTOPIC OSSIFICATION OF HIP IN A RARE CASE OF MOYAMOYA DISEASE: A RARE CASE REPORT

    OpenAIRE

    Anita; Dimple; Pratima; Ravi

    2015-01-01

    A case of extensive ossification around the left hip joint involving lesser trochanter of the femur leading to ankylosis of left hip joint in a 60 years male is being reported. The diagnosis of moyamoya disease was made , which is a rare form of occlusive cerebrovasc ular disorder. Occlusion of an artery may present with Transient Ischemic Attacks , headaches , stroke and seizures. Surgical management is the only option...

  10. Successful management of a cervical fracture in a patient with ankylosing spondylitis by a posterior approach

    Directory of Open Access Journals (Sweden)

    Neeraj Patni

    2015-01-01

    Full Text Available Patients with ankylosing spondylitis (AS are at an increased risk of spinal fractures due to the altered spinal biomechanics. Moreover, it is difficult to treat these fractures due to the combination of ankylosis and osteoporosis. We report successful management of a C6-C7 vertebral fracture in a patient with AS. The patient improved in his neurological status and a good fusion was seen at a follow-up of 24 months.

  11. Curcumin: an orally bioavailable blocker of TNF and other pro-inflammatory biomarkers

    OpenAIRE

    Aggarwal, Bharat B.; Gupta, Subash C.; Sung, Bokyung

    2013-01-01

    TNFs are major mediators of inflammation and inflammation-related diseases, hence, the United States Food and Drug Administration (FDA) has approved the use of blockers of the cytokine, TNF-α, for the treatment of osteoarthritis, inflammatory bowel disease, psoriasis and ankylosis. These drugs include the chimeric TNF antibody (infliximab), humanized TNF-α antibody (Humira) and soluble TNF receptor-II (Enbrel) and are associated with a total cumulative market value of more than $20 billion a ...

  12. Dexmedetomidine Use for Awake Nasotraceal Fiberoptic Intubation: A Case Report

    Directory of Open Access Journals (Sweden)

    Dilek Gunay Canpolat

    2013-10-01

    Full Text Available Awake fiberoptic nasotracheal intubation is usually performed in patients with an anticipated difficult airway. For patient comfort, it%u2019s important to provide adequate level of sedation. In this case, we discussed our experience with the literature about usage of dexmedetomidine in nasotracheal awake fiberoptic intubation for the expected difficult airway in a patient with bilateral temporomandibular joint ankylosis and limited mouth opening who was planned to deformity repair under general anesthesia.

  13. Pedigree analysis of Czech Holstein calves with schistosoma reflexum

    OpenAIRE

    Citek Jindrich

    2012-01-01

    Abstract Background Schistosoma reflexum (SR) is congenital syndrome briefly characterized by visceral eventration, severe dorsoflexion and ankylosis of the spine and arthrogryposis. A genetic etiology has been proposed, but conclusive evidence has not yet been provided. Methods Pedigree analysis was carried out in 29 cases of SR in Czech Holsteins and Holstein crosses. Genetic relationship was evaluated and inbreeding coefficients calculated. Pedigrees of 15 Czech Holsteins fathering non-SR ...

  14. [Current diagnosis and therapy of anterior mandibular fracture associated with condyle fractures].

    Science.gov (United States)

    Xu, Xiaofeng; Xu, Bing

    2014-04-01

    Anterior mandibular fracture, which includes symphyseal and parasymphyseal mandibular fractures, is one of the most common types of fracture in clinical work, and is usually associated with condyle fracture. This type of fracture predisposes the patients to facial widening, malocclusion, and ankylosis when not properly and timely treated because of the influence of its anatomic structure. This article reviews the characteristics, complication, diagnosis, and therapy of this type of fracture. PMID:24881222

  15. OPEN REDUCTION OF MANDIBULAR CONDYLE NECK FRACTURES: CASE REPORT AND LITERATURE REVIEW-Mandibular Kondil Boynu Kırıklarında Açık Redüksiyon: Olgu Raporu ve Kaynak Taraması

    OpenAIRE

    İŞLER, Sabri Cemil; CANSIZ, Erol; AKBAŞ, Emine; ÇEBİ, Zerrin

    2014-01-01

    ABSTRACTSince cases of mandibular condyle fractures may result in difficulty of recovery of functional and aesthetic disorders, their immobilization and reduction are very important. It may cause long-term complications as well as limited mandibular movement, pain, malocclusion, pathological changes in the TMJ, osteonecrozis, facial asymmetry, ankylosis, functional and growth disorders. Appropriatetreatment must enable the reconstruction of undamaged functional and natural form of mandibular ...

  16. Immunogenicity does not influence treatment with etanercept in patients with ankylosing spondylitis

    OpenAIRE

    Vries, de, P.M.; Horst-Bruinsma, van der, I.E.; Nurmohamed, M.T.; Aarden, L; Stapel, S.N.; Peters, M J L; Denderen, van, J.C.; Dijkmans, B A C; Wolbink, G

    2009-01-01

    Background: Immunogenicity, specifically the onset of antibodies against tumour necrosis factor (TNF) blocking agents, seems to play an important role in non-response to treatment with these drugs. Objectives: To assess the relation of clinical response of ankylosing spondylitis (AS) to etanercept with etanercept levels, and the presence of antibodies to etanercept. Methods: Patients with AS were treated with etanercept 25 mg twice weekly, according to the international Assessment in Ankylosi...

  17. Immunogenicity does not influence treatment with etanercept in patients with ankylosing spondylitis

    OpenAIRE

    Vries, de, P.M.; Horst-Bruinsma, van der, I.E.; Nurmohamed, M.T.; AARDEN, L. A.; Stapel, S.O.; Peters, M J L; Denderen, van, J.C.; Dijkmans, B A C; Wolbink, G.J.

    2009-01-01

    BACKGROUND: Immunogenicity, specifically the onset of antibodies against tumour necrosis factor (TNF) blocking agents, seems to play an important role in non-response to treatment with these drugs. OBJECTIVES: To assess the relation of clinical response of ankylosing spondylitis (AS) to etanercept with etanercept levels, and the presence of antibodies to etanercept. METHODS: Patients with AS were treated with etanercept 25 mg twice weekly, according to the international Assessment in Ankylosi...

  18. Perosomus elumbis in a day old udah neonate lamb in Sokoto, Nigeria

    Directory of Open Access Journals (Sweden)

    A. Bello

    2013-02-01

    Full Text Available Perosomus elumbis is a rare congenital anomaly of unknown aetiology. It is characterized by errors of morphogenesis resulting in multi-organs malformations that produce a deformity of the caudal one third of the foetus. Spinal and pelvic malformations are evident, structural anomalies such as arthrogryposis of the hind limbs, ankylosis of joints, with associated malformations of the musculature. This is a case of a new born Uda lamb, with the Chief complaint of inability to stand two hours after lambing. History revealed that the dam delivered them as twins, one of which was normal. On clinical examination the lamb was recumbent but alert. The fore limbs were well developed and appeared normal. The lumbo-sacral area was excessively narrow, with a skin fold attaching the crus (Tibia and Fibula. There was an ankylosis of the stifle and hock joint and were maintained in a flexed position. The response to pin prick on the hind limb was poor. However, both anal and vulval openings were patent. Radiography revealed hypoplasia of the lumbar vertebrae, pelvic girdle, the iliac wing, the ischium and the pubis. There is a convergence of the lschial arches towards the public symphisis; the wing of the ischium is absent bilaterally. There is an ankylosis of the stifle and tarsal joints in flexed position. However, all the bones of the hind limbs are present.

  19. Bone pathology inpsoriatic arthritis

    Directory of Open Access Journals (Sweden)

    V. V. Badokin

    2007-10-01

    Full Text Available Objective. To study different variants of osteolysis in pts with psoriatic arthritis (PA and to reveal their relationship with other clinico-radiological features of joint damage. Material and methods. 370 pts with definite PA having different variants of joint damage were included. Radiological examination of bones and joints (in some cases large picture frame was performed. Morphological evaluation of synovial biopsies was done in 34 pts with PA and 10 pts with rheumatoid arthritis (RA. Results. Different types of osteolysis were revealed in 80 (21,6% pts. Osteolytic variant of joint damage was present in 29 pts. 33 pts had acral, 48 — intra-articular osteolysis and 16 - true bone atrophy. Frequency and intensity of bone resorption were associated with severity of PA. Acral osteolysis correlated with arthritis of distal interphalangeal joints and onychodystrophy. Intra-articular osteolysis was most often present in distal interphalangeal joints of hands and metacarpophalangeal joints (39,6% and 41,7% respectively. Characteristic feature of PA was combination of prominent resorption with formation of bone ankylosis and periosteal reaction. Ankylosis was present in 33,3% of pts with intra-articular osteolysis and in 60% of pts with combination of different osteolysis variants. Systemic reaction of microcirculation in synovial biopsies was most prominent in osteolytic variant: marked thickening of capillary and venule basal membrane with high level of acid phosphatase, increased capillary and precapillary blood flow with stasis features, vascular lymphocyte and macrophage infiltration, productive vasculitis with annular wall thickening, thrombovasculitis and villi deep layer sclerosis. Conclusion. Different variants of osteolysis show bone involvement in PA. Acral and intra- articular osteolysis association with bone ankylosis and periostitis proves their common pathogenetic entity.

  20. Radiography of the spine and sacro-iliac joints in ankylosing spondylitis and psoriasis

    International Nuclear Information System (INIS)

    A grading system involving six stages of arthritis from grade O=normal joints to grade V=extensive bony ankylosis in the sacro-iliac joints and a scheme applicable for quantitative registration of the radiographic findings of the spine in ankylosing spondylitis (AS) are detailed. These radiographic grading systems were used in a study comprising 48 patients with psoriasis (group A), 19 patients with AS and psoriasis (group B), 103 patients with AS (group C) and 231 first-degree relatives of the patients belonging to groups B and C (group D). Radiographic abnormalities of the spine were found totally in 80 per cent of the patients belonging to groups B and C. In these groups sclerotic anterior borders of vertebrae (SABS) and/or straightened anterior surfaces of vertebrae were seen totally in 66 per cent. SABS were earlier findings than syndesmophyte formation which was found in 60 per cent of the patients belonging to groups B and C. Except for ankylosis of the apophyseal joints and ossified interspinous ligament most frequently found in the lower lumbar region in patients with duration of disease more than 20 years, all abnormalities of the spine were most frequent in the dorsolumbar junction. Grade V sacro-iliitis was associated with ankylosis of two or more segments of the spine. Such spinal changes were infrequently seen in patients with grade IV sacro-iliitis. This finding supports the previous notion that among patients fulfilling the criteria for AS, there is a group with a non-ankylosing disease. Thus two different subgroups of AS could be identified. Except for frequent unilateral sacro-iliitis and slight changes of the spine in group A no radiographic differences were found between the groups A, B and C. Sacro-iliitis was found in 22(9%) in group D, and 11 of those with sacro-iliitis had abnormalities of the spine compatible with AS. (orig.)

  1. Radiography of the spine and sacro-iliac joints in ankylosing spondylitis and psoriasis

    Energy Technology Data Exchange (ETDEWEB)

    Dale, K.; Vinje, O.

    A grading system involving six stages of arthritis from grade O=normal joints to grade V=extensive bony ankylosis in the sacro-iliac joints and a scheme applicable for quantitative registration of the radiographic findings of the spine in ankylosing spondylitis (AS) are detailed. These radiographic grading systems were used in a study comprising 48 patients with psoriasis (group A), 19 patients with AS and psoriasis (group B), 103 patients with AS (group C) and 231 first-degree relatives of the patients belonging to groups B and C (group D). Radiographic abnormalities of the spine were found totally in 80 per cent of the patients belonging to groups B and C. In these groups sclerotic anterior borders of vertebrae (SABS) and/or straightened anterior surfaces of vertebrae were seen totally in 66 per cent. SABS were earlier findings than syndesmophyte formation which was found in 60 per cent of the patients belonging to groups B and C. Except for ankylosis of the apophyseal joints and ossified interspinous ligament most frequently found in the lower lumbar region in patients with duration of disease more than 20 years, all abnormalities of the spine were most frequent in the dorsolumbar junction. Grade V sacro-iliitis was associated with ankylosis of two or more segments of the spine. Such spinal changes were infrequently seen in patients with grade IV sacro-iliitis. This finding supports the previous notion that among patients fulfilling the criteria for AS, there is a group with a non-ankylosing disease. Thus two different subgroups of AS could be identified. Except for frequent unilateral sacro-iliitis and slight changes of the spine in group A no radiographic differences were found between the groups A, B and C. Sacro-iliitis was found in 22(9%) in group D, and 11 of those with sacro-iliitis had abnormalities of the spine compatible with AS. (orig.).

  2. Posttraumatic temporomandibular joint disorders.

    Science.gov (United States)

    Giannakopoulos, Helen E; Quinn, Peter D; Granquist, Eric; Chou, Joli C

    2009-05-01

    The temporomandibular joint (TMJ) has many essential functions. None of its components are exempt from injury. Facial asymmetry, malocclusion, disturbances in growth, osteoarthritis, and ankylosis can manifest as complications from trauma to the TMJ. The goals of initial treatment include achievement of pretraumatic function, restoration of facial symmetry, and resolution of pain. These same objectives hold true for late repairs and reconstruction of the TMJ apparatus. Treatment is demanding, and with opposing approaches. The following article explores various treatment options for problems presenting as a result of a history of trauma to the TMJ. PMID:22110802

  3. THE RHEUMATOID HAND (Part I

    Directory of Open Access Journals (Sweden)

    Yuri Aleksandrovich Olyunin

    2009-12-01

    Progression of RA leads to articular cartilage and bone destruction and ligament and tendon damage over time. Incompetence of the ligamentous apparatus may cause dorsal subluxation of the radius. In late RA, bone erosions are detectable in practically all patients. This is the most characteristic X-ray symptom of polyarthritis. Extensive and multiple destructive changes in the joints are accompanied by the development of their multiple subluxations, dislocations, and contractures. In addition to destructive changes in the joints, most deformities are associated with their tendinous and liga-mentous looseness and ruptures and with the rearrangement of normal muscle tension around one joint or more. Articular ankylosis occurs in late RA

  4. Experimental joint immobilization in guinea pigs. Effects on the knee joint

    Science.gov (United States)

    Marcondesdesouza, J. P.; Machado, F. F.; Sesso, A.; Valeri, V.

    1980-01-01

    In young and adult guinea pigs, the aftermath experimentally induced by the immobilization of the knee joint in hyperextended forced position was studied. Joint immobilization which varied from one to nine weeks was attained by plaster. Eighty knee joints were examined macro and microscopically. Findings included: (1) muscular hypotrophy and joint stiffness in all animals, directly proportional to the length of immobilization; (2) haemoarthrosis in the first week; (3) intra-articular fibrous tissue proliferation ending up with fibrous ankylosis; (4) hyaline articular cartilage erosions; (5) various degrees of destructive menisci changes. A tentative explanation of the fibrous tissue proliferation and of the cartilage changes is offered.

  5. [Textual research on "Chigu Decoction" in Wooden Slips from the Site of the Ancient People's Dike in Zhangjiajie].

    Science.gov (United States)

    Ding, Yuan; Zhang, Ru-Qing

    2011-07-01

    In 1987, wooden slips named Zhi Chigu Fang (Chigu Decoction) were discovered on the site of the Ancient People's Dike in Zhangjiajie, Hunan Province. 15 drugs with dosage were listed on the front of the wooden slip and processing on the reverse side. Though there are two academic opinions about Chigu Decoction neither of them is convincing. Zhi means treatment and Chigu is the name of an ancient exogenous febrile disease with the symptoms of aversion to cold, fever, headache and neck pain, ankylosis, cough and asthma or cold pain in the gastric area and diarrhea. Chi is a descriptive word describing the appearance of exogenous febrile fever. PMID:22169493

  6. Imaging the spine in arthritis-a pictorial review

    DEFF Research Database (Denmark)

    Jurik, Anne Grethe

    2011-01-01

    radiographic features of spinal changes in RA and SpA in addition to the advantages of MRI and CT, respectively. RA changes are usually located in the cervical spine and can result in serious joint instability. Subluxation is diagnosed by radiography, but supplementary MRI and/or CT is always indicated to...... vertebral squaring and condensation of vertebral corners, in later stages by slim ossifications between vertebral bodies, vertebral fusion, arthritis/ankylosis of apophyseal joints and ligamentous ossification causing spinal stiffness. The imaging features of the other forms of SpA can vary, but voluminous...

  7. ANALYSIS OF STRUCTURAL CHANGES OF THE TEMPOROMANDIBULAR JOINT ACCORDING TO THREE-DIMENSIONAL COMPUTED TOMOGRAPHY

    OpenAIRE

    Marugina Tatyana Leonidovna; Kan Vsevolod Vladimirovich; Fedotov Vadim Valentinovich; Zagorodnih Yekaterina Sergeyevna

    2012-01-01

    The algorithm of the research of the structural changes of the temporomandibular joint was based on comparative analysis of the history/anamnesis, clinical picture and the results of a three-dimensional computed tomography. It was found that among 235 patients who referred to the clinic the largest share of pathological TMJ dysfunction accounts is for the joint - 65.5% of cases, 24.5% of cases - arthrosis, arthritis, 8.8% - arthrosis and 1.2%, - ankylosis, respectively. When patients refer wi...

  8. 股骨髁上骨折应用L形加压钢板内固定后的早期康复治疗%The early rehabilitation intervention after internal fixation English Column with L-shaped compression armor plate for supracondylar fracture of femur

    Institute of Scientific and Technical Information of China (English)

    岳红卫; 李国顺

    2002-01-01

    Background: The thickness and width of L shaped armor plate can antagonize muscle traction with the ability of anti inflecting, anti torsion and anti shearing force, which overcomes the weakness of common armor plate and osseous pin that have weaker fixation force and need external fixation. The fixation can satisfy the request of early functional training. And the functional training can be performed on the continuous passive movement (CPM) instrument 1 week after operation to prevent adhesion of knee joint, elasticity losing in soft tissue around joint, ankylosis, osteoporosis and osteoarthritis.

  9. Management of a Severely Submerged Primary Molar: A Case Report

    Directory of Open Access Journals (Sweden)

    Iman Parisay

    2013-01-01

    Full Text Available Ankylosis is a condition frequently associated with primary molars, wherein the ankylosed primary teeth remain in a fixed position, while the adjacent teeth continue to erupt, moving occlusally. In this case report, a five-year-old boy, who had a retained and submerged left lower second primary molar, was presented. Luxation of ankylosed primary molar was considered as a treatment approach. After four months, the tooth erupted to the occlusal level, and there was evidence of further development of a permanent successor in radiographic evaluation. After one year, tooth mobility, bone formation, and development of a permanent successor were in good condition.

  10. Martin-Gruher anastomosis:a case report and review of the literature%正中神经与尺神经交通支1例报告及文献回顾

    Institute of Scientific and Technical Information of China (English)

    潘伟波; 陈海啸; 梁军波; 叶招明

    2011-01-01

    Objective:To investigate therapeutic effects of mini-incision assisted by arthroscope for the treatment of ankylosis of knee. Methods: From July 2007 to August 2009,18 patients with ankylosis of knee were treated with mini-incision assisted by arthroscope. Among the patients, 15 patients were male and 3 patients were female,ranging in age from 27 to 56 years, with an average of 33.6 years. Before operation, 5 patients had comminuted fractures in the distal end of femur (including 1 patient with open fracture),9 patients had comminuted fractures of tibial plateau,2 patients had comminuted fractures of patella, 1 patient had comminuted fractures of patella combined with comminuted fracture of capitulum fibulae and injuries of complex structure at lateral knee,and 1 patient had floating knee. The duration between the primary operation and the arthrolysis ranged from 6 to 31 months (averaged, 10.6 months). The therapeutic effects were evaluated according to Judet criteria. Results : All the patients were followed up,and the duration ranged from 3 to 25 months (averaged, 11.4 months). All the patients had incision healing at the first stage without infection,wound dehiscence and liquifaction necrosis. The preoperative knee flexed motion ranged from 30° to 80° ,with a mean of(44.72±l 1.60)° ;and postoperative knee flexed range of motion improved to an average of (109.17±10.31)° (ranged,95° to 135°). According to Judet evaluation, 16 patients got an excellent result,2 good. Conclusion:Treatment of ankylosis of the knee through a mini-incision assisted by arthroscope has advantages such as reducing the complications of incision on knee, little trauma and early recovery, which is a good operative mode to treat ankylosis of the knee after operation or trauma.%@@ 肘关节水平的尺神经损伤,常导致患者手内在肌的功能障碍.笔者遇到1例肘部尺神经沟内尺神经完全断裂的患者,手内在肌无明显功能障碍,后经肌电图检查证实

  11. Thoracic sinuses in HIV a diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Pai V

    2003-03-01

    Full Text Available A male aged 57 years with multiple discharging sinuses on both sides of chest, multiple ulcers on the back, painful ankylosis of right shoulder since 2 months. Chest examination showed reduced expansion and decreased breath sounds on right side. Large boggy swelling on right hemithorax with multiple discharging sinuses was seen. VDRL was reactive in high dilutions and he was also ELISA - HIV positive. X-ray of chest showed few opacities in right lung field. A provisional diagnosis of Gumma - Syphilis/Tuberculous was considered. Sensorineural deafness was also present.

  12. Thoracic sinuses in HIV a diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Pai V

    2003-01-01

    Full Text Available A male aged 57 years with multiple discharging sinuses on both sides of chest, multiple ulcers on the back, painful ankylosis of right shoulder since 2 months. Chest examination showed reduced expansion and decreased breath sounds on right side. Large boggy swelling on right hemithorax with multiple discharging sinuses was seen. VDRL was reactive in high dilutions and he was also ELISA - HIV positive. X-ray of chest showed few opacities in right lung field. A provisional diagnosis of Gumma - Syphilis/Tuberculous was considered. Sensorineural deafness was also present.

  13. Roentgenological differential diagnosis in diseases of the sacroiliac joints

    International Nuclear Information System (INIS)

    Conventional diagnostic radiology lends itself to the diagnosis of diseases of the sacroiliac joints and tomography in the dorsal position is useful in the identification of discrete changes. Processes of either an inflammatory or a degenerative etiology can be differentiated roentgenologically. Inflammatory disorders can be defined and differentiated to some extent radiomorphologically; this requires to analyse the dimension and temporal sequence of reaction forms of the sacroiliac joints - destruction, sklerosis, ankylosis. The 'colourful picture' is characteristic of morbus Bechterew; however, it is no exclusive proof since a number of other disorders cause similar changes. (orig.)

  14. Roentgenological differential diagnosis in diseases of the sacroiliac joints

    Energy Technology Data Exchange (ETDEWEB)

    Erlemann, R.; Peters, P.E.

    1985-12-01

    Conventional diagnostic radiology lends itself to the diagnosis of diseases of the sacroiliac joints and tomography in the dorsal position is useful in the identification of discrete changes. Processes of either an inflammatory or a degenerative etiology can be differentiated roentgenologically. Inflammatory disorders can be defined and differentiated to some extent radiomorphologically; this requires to analyse the dimension and temporal sequence of reaction forms of the sacroiliac joints - destruction, sklerosis, ankylosis. The 'colourful picture' is characteristic of morbus Bechterew; however, it is no exclusive proof since a number of other disorders cause similar changes.

  15. Osteoarthrosis of the Antebrachiocarpal Joint of 7 Riding Horses

    Directory of Open Access Journals (Sweden)

    Ekman S

    2001-12-01

    Full Text Available Osteoarthrosis (OA of the antebrachiocarpal joint from 7 riding horses is described. The horses were old mares and developed severe OA, with ankylosis in some of the joints. The lesions were bilateral, and the owners noticed the lameness in a late event. The cause of severe OA in these mares is not clear. The fact that OA was bilateral indicates that a single traumatic injury is unlikely as an etiologic factor. Considering the severe joint lesions it took long time before the horse-owners noticed the lameness. It is discussed if the threshold of pain is higher in the antebrachiocarpal joint compared with the middle carpal joint.

  16. Alveolar process fractures in the permanent dentition. Part 2. The risk of healing complications in teeth involved in an alveolar process fracture

    DEFF Research Database (Denmark)

    Lauridsen, Eva; Gerds, Thomas; Andreasen, Jens Ove

    2015-01-01

    AIM: To analyze the risk of pulp canal obliteration (PCO), pulp necrosis (PN), repair-related resorption (RRR), infection-related resorption (IRR), ankylosis-related resorption (ARR), marginal bone loss (MBL), and tooth loss (TL) for teeth involved in an alveolar process fracture and to identify...... possible risk factors. MATERIAL AND METHOD: A total of 91 patients with 223 traumatized teeth. STATISTICS: The risks of PCO, PN, RRR, IRR, ARR, MBL, and TL were analyzed separately for teeth with immature and mature root development using Kaplan-Meier and Aalen-Johansen methods. Possible risk factors for...

  17. Mutation Detection in Activin A Receptor, Type I (ACVR1) Gene in Fibrodysplasia Ossificans Progressiva in An Iranian Family

    OpenAIRE

    Ziba Morovvati; Saeid Morovvati; Gholamhossein Alishiri; Seyed Hossein Moosavi; Reza Ranjbar; Yaser Bolouki Moghaddam

    2014-01-01

    Fibrodysplasia Ossificans Progressiva (FOP, MIM 135100) is a rare genetic disease that is often inherited sporadically in an autosomal dominant pattern. The disease manifests in early life with malformed great toes and, its episodic and progressive bone formation in skeletal muscle after trauma is led to extra-articular ankylosis. In this study, a 17 year-old affected girl born to a father with chemical injury due to exposure to Mustard gas during the Iran-Iraq war, and her first degree relat...

  18. [Decoronation: treatment protocol for ankylotic root resorption as a consequence of dental trauma].

    Science.gov (United States)

    Lin, S; Fuss, Z; Wigler, R; Karawani, M; Ashkenazi, M

    2013-10-01

    Severe dental traumatic injuries, such as the complete displacement of a tooth from its socket (Avulsion) or the displacement of a tooth within its socket (Intrusive Luxation), may result in extensive injury to the root surface. As a result, the root surface injury heals without cementum and there is fusion between the alveolar bone and the exposed dentin or anorganic exposed cementum, without any attachment apparatus between them. This phenomenon is known as "dento-alveolar ankylosis" and is accompanied by ankylotic resorption of the root. In a process that results subsequent to the ankylosis, the root surface resorbs, and this is part of the remodeling of the alveolar bone (ankylotic resorption). When the traumatic injury occurs at a young age, lateral and apical growth of the alveolar bone continues without continued physiological eruption of the tooth. As a result, the position of the ankylotic tooth does not change, and with time thetooth appears infra-occluded resulting in severe esthetic and functional consequences. Extraction of the ankylotic tooth is difficult and sometimes even impossible due to the rigid fusion between the bone and the tooth. In addition, attempted extraction of the ankylotic tooth may lead to fracture of the buccal plate and resorption of the alveolar bone. Retention of the ankylotic tooth may lead to damage in bone deposition in the verticaldimension, leading to difficulties in future prosthodonticrehabilitation, research-based information has been incorporated PMID:24660573

  19. [Results of plate osteosynthesis in comminuted fracture of the olecranon].

    Science.gov (United States)

    König, S; Kilga, M; Kwasny, O

    1990-05-01

    Comminuted fractures of the olecranon are an absolute indication for operative treatment. Adequate therapy is only possible when open reduction and plating are performed. In the last 20 years, 31 of our patients, i.e. 0.0001% of all patients treated for injuries, had this type of olecranon fracture, and in 25 follow-up examination was possible. The fracture type was classified according to the ASIF system. The range of motion, i.e., extension, flexion, pro- and supination, and pain, physical strength and rehabilitation were classified according to our own system. In cases with concomitant fracture of the radial head, reconstruction is necessary to provide adequate axial movement and strength in the forearm. Brief plaster fixation after the operation makes it possible to restrict the development of ankylosis in the elbow joint. The results were excellent in 10 patients, good in 5 patients, fair in 4 and poor in 6 patients. In 3 patients, i.e. 10% ankylosis was present in the elbow joint; this was considered to constitute an indication for arthroplasty, which gave a better postoperative range of motion. PMID:2356478

  20. Vertebral deformities in hatchery-reared and wild-caught juvenile Japanese flounder, Paralichthys olivaceus

    Science.gov (United States)

    Lü, Hongjian; Zhang, Xiumei; Fu, Mei; Xi, Dan; Su, Shengqi; Yao, Weizhi

    2015-01-01

    The present study compared vertebral deformities of hatchery-reared and wild-caught juvenile Japanese flounder, Paralichthys olivaceus. A total of 362 hatchery-reared flounder (total length 122.5-155.8 mm) were collected from three commercial hatcheries located in Yantai, East China, and 89 wild fish (total length 124.7-161.3 mm) were caught off Yangma Island near Yantai City (37°27'N, 121°36'E). All the fish were dissected, photographed, and images of the axial skeleton were examined for vertebral deformities. Compared with wild-caught flounder in which no deformed vertebrae were detected, 48 (13.3%) hatcheryreared fish had deformed vertebrae. The deformities were classified as compression, compression-ankylosis, and dislocation-ankylosis. The vertebral deformities were mainly localized between post-cranial vertebra 1 and 3, with vertebrae number 1 as the most commonly deformed. The causative factors leading to vertebral deformities in reared Japanese flounder may be related to unfavorable temperature conditions, inflammation, damage, or rupture to the intervertebral ligaments under rearing conditions. Furthermore, no significant difference in the total number of vertebral bodies was observed between wild-caught (38.8±0.4) and hatchery-reared flounder (38.1±0.9) ( P>0.05). However, the number of vertebral bodies of hatchery-reared and wild-caught flounder ranged from 35 to 39 and from 38 to 39, respectively.

  1. Pre-arthroplasty simultaneous maxillomandibular distraction osteogenesis for the correction of post-ankylotic dentofacial deformities.

    Science.gov (United States)

    Mehrotra, D; Vishwakarma, K; Chellapa, A L; Mahajan, N

    2016-07-01

    The aim of this study was to evaluate the hard and soft tissue changes after pre-arthroplasty simultaneous maxillomandibular distraction osteogenesis for the correction of post-ankylotic dentofacial deformities. This prospective study included 10 patients with unilateral temporomandibular joint (TMJ) ankylosis who presented with a facial deformity and a maxillary cant. Informed patient consent was obtained for participation. Simultaneous maxillomandibular distraction was planned based on clinical and radiographic examinations. A horizontal mandibular osteotomy was performed in the ramus and the distractor device was fixed. A bilateral Le Fort I osteotomy was then performed and a four-hole straight plate was fixed on the contralateral zygomatic buttress to act as a fulcrum. After a latency period of 5 days, the distractor was activated twice daily by 0.5mm until the required vertical lengthening was achieved. Intermaxillary fixation was maintained during the entire distraction period. After a consolidation period of 8-12 weeks, the distractor was removed. The TMJ ankylosis was released and a temporal fascia interpositional arthroplasty was performed as second surgery, along with a genioplasty if needed. All patients were followed up for a period of 12-24 months. A marked improvement in the facial asymmetry was noted in all cases. The occlusal cant and mandibular retrusion improved satisfactorily, and the average postoperative inter-incisal opening was 35.6mm. Pre-arthroplasty simultaneous maxillomandibular distraction offers a good treatment outcome, as it allows improvements in facial aesthetics as well as function. PMID:26780926

  2. Hyperplastic conditions of the mandibular condyles

    Energy Technology Data Exchange (ETDEWEB)

    Nah, Kyung Soo [Pusan National University College of Medicine, Busan (Korea, Republic of)

    2003-12-15

    To evaluate the clinical and radiographic features of unilateral hyperplastic mandibular condyles for some useful preliminary diagnostic recommendations. Clinical records, radiographs and histologic diagnoses of 35 cases with asymmetric mandibular condyles due to apparent unilateral condylar hyperplasia were evaluated retrospectively. Among 35 cases, 28 were true hyperplastic conditions of condyles whereas the remaining 7 were unilateral internal derangement occurring on the short side. 17 of the 28 hyperplastic condyles showed a mass or irregular radiographic shadow with histologic diagnosis including osteochondroma and osteoma. Only 5 of these cases showed facial asymmetry. 2 out of ths 17 cases showed hyperplastic round shaped irregular condyles consistent with ankylosis and their histologic diagnoses were osteochondromas. 11 of the 28 cases showed smooth enlargement of condylar head with elongation of the neck causing facial asymmetry, but histologic diagnoses were not available because the surgical operation conserved the condyles. The hyperplastic conditions of the mandibular condyles include not only true hyperplasia, osteochondroma, osteoma, and ankylosis, but also unilateral internal derangement occurring on the short side.

  3. Indications and results of a radium-224 (thorium x) therapy of ankylosing spondylitis (Sp.a.)

    International Nuclear Information System (INIS)

    224Ra treatment of ankylosing spondylitis with 1 i.v. injection of 28 μCi 224Ra per week and a total of 10 injections is indicated only for stages II and III of the disease if the inflammation of the small vertebral joints and iliosacral grooves are resistant to therapy and if the progressive ankylosis of the vertebral column can be proved by radiography and scintiscanning. It should not be applied, in general, during stage I, where only ilisacral arthritis can be diagnosed in the iliosacral grooves, and in stage IV, full-scale osseous ankylosis of the vertebral column with or without involvement of the extremity joints. Due to the antiosteoblastic action of the α radiation of 224Ra and the antiphlogistic action of the β and γ radiation released during the radioactive decay of 224Ra daughter products, the pain during stages II and III of a.sp. is greatly alleviated, and intensive gymnastic and balneological treatment during the 10 weeks' stay in hospital is made possible. Malignant bone tumours have never been observed so far, although the period of observation has been as long as 29 years in some cases. Even in those patients who died of tumours of the soft tissue, the rate was only 14% compared to the 20% rate in the normal population. (orig./MG)

  4. The biomechanical role of periodontal ligament in bonded and replanted vertically fractured teeth under cyclic biting forces

    Institute of Scientific and Technical Information of China (English)

    Ya-Nan Zhu; Wei-Dong Yang; Paul V Abbott; Nicolas Martin; Wen-Jia Wei; Jing-Jing Li; Zhi Chen; Wen-Mei Wang

    2015-01-01

    After teeth are replanted, there are two possible healing responses:periodontal ligament healing or ankylosis with subsequent replacement resorption. The purpose of this study was to compare the fatigue resistance of vertically fractured teeth after bonding the fragments under conditions simulating both healing modes. Thirty-two human premolars were vertically fractured and the fragments were bonded together with Super-Bond C&B. They were then randomly distributed into four groups (BP, CP, CA, BA). The BP and CP groups were used to investigate the periodontal ligament healing mode whilst the BA and CA groups simulated ankylosis. All teeth had root canal treatment performed. Metal crowns were constructed for the CP and CA groups. The BP and BA groups only had composite resin restorations in the access cavities. All specimens were subjected to a 260 N load at 4 Hz until failure of the bond or until 23106 cycles had been reached if no fracture occurred. Cracks were detected by stereomicroscope imaging and also assessed via dye penetration tests. Finally, interfaces of the resin luting agent were examined by scanning electron microscope. The results confirmed that the fatigue resistance was higher in the groups with simulated periodontal ligament healing. Periodontal reattachment showed important biomechanical role in bonded and replanted vertically fractured teeth.

  5. Functional appliance treatment for bilateral condylar fracture in a pediatric patient.

    Science.gov (United States)

    Medina, Aida Carolina

    2009-01-01

    Trauma to the mandible may cause condylar fracture (CF). The prevalence of CF in children is low and treatment must focus on possible long-term effects on the growing facial skeleton and soft tissues. Consequences may include functional disturbances, facial asymmetry, mandibular retrusion, temporomandibular joint dysfunction and ankylosis. Conservative treatment, including close observation, soft diet, physiotherapy, and functional appliances, is advised in most cases. The purpose of this report was to describe the case of a pediatric female patient with bilateral condylar fracture. Treatment consisted of physiotherapy and hybrid functional appliances. Satisfactory remodeling of both condyles occurred and normal occlusion and jaw movements were obtained. Close monitoring will continue throughout the 6-year follow-up period and completion of growth. The conservative treatment approach proved successful in this case. PMID:19947140

  6. Limitation of Mandibular Movement: A Rare Case Report of Unilateral Zygomatico-Coronoid Interference

    Science.gov (United States)

    Akhlaghi, Fahimeh; Esmaeelinejad, Mohammad

    2016-01-01

    Introduction: Zygomatico-coronoid interference is a rare type of mandibular extracapsular ankylosis. There is a lack of information on the treatment of these cases in the literature. Condylectomy and coronoidectomy are not always the best options for the treatment of limitations in mandibular movement. Case Presentation: A 51-year-old woman presented with mouth-opening limitation due to zygomatic bone displacement and interference with the coronoid process. The treatment plan was bilateral coronoidectomy through an intraoral approach and osteotomy of the right zygomatic arch through an extraoral incision. The patient was able to open her mouth to approximately 40 mm after surgery. The patient underwent physiotherapy during follow-up appointments. There was no relapse after three months of follow-up. Conclusions: This study shows that simultaneous arch osteotomy and coronoidectomy may be an appropriate treatment procedure for zygomatico-coronoid interference.

  7. The unerupted maxillary canine - a post-surgical review.

    LENUS (Irish Health Repository)

    O'Dowling, Ian

    2009-10-01

    The orthodontic records of 685 patients referred for surgical exposure of an unerupted impacted maxillary canine tooth were examined. The condition was more common among females than males, slightly less than 2:1. The impacted teeth had a palatal-labial ratio of 3:1. All of the teeth were exposed using the open surgical technique and in 98% of cases the tooth erupted and was orthodontically aligned. In 2% of cases ankylosis occurred and the teeth were subsequently extracted. The presence of peg-shaped lateral incisors associated with the impacted maxillary canine tooth was 3.4% of the total number of impacted teeth and congenital absence was found in 1.7% of impacted teeth.

  8. A MODIFIED TECHNIQUE OF RETROGRADE INTUBATION IN A DIFFICULT INTUBATION CASE

    Directory of Open Access Journals (Sweden)

    Murthy

    2014-08-01

    Full Text Available Anaesthesiologists will be facing difficult intubating conditions, anticipated or unanticipated, quite frequently, whenever they anaesthetize patients with facio- maxillary injuries, temporo mandibular joint ankylosis, obesity, pregnancy, congenital air-way abnormalities, etc. A large number of aids are available now for intubating in such difficult situations and a lot of techniques have been described in literature for giving anaesthesia for such patients. (1 Use of Bullard laryngoscope in difficult air-way situation was described by Dullenkopf et al 2003, (2 Lighted Wand by Agro et al 2004, (3 Shikani flexible seeing stylet by Agro et al 2005(4 Blind nasal intubation, L M A, Fiber optic laryngoscope by Levitan et al1999. (5 Glydoscope by Lim et al 2005(6 . In this case report, we have given one more alternate solution for this problem

  9. New treatment option for an incomplete vertical root fracture--a preliminary case report.

    Science.gov (United States)

    Hadrossek, Paul Henryk; Dammaschke, Till

    2014-01-01

    Instead of extraction this case report presents an alternative treatment option for a maxillary incisor with a vertical root fracture (VRF) causing pain in a 78-year-old patient. After retreatment of the existing root canal filling the tooth was stabilized with a dentine adhesive and a composite restoration. Then the tooth was extracted, the VRF gap enlarged with a small diamond bur and the existing retrograde root canal filling removed. The enlarged fracture line and the retrograde preparation were filled with a calcium-silicate-cement (Biodentine). Afterwards the tooth was replanted and a titanium trauma splint was applied for 12d. A 24 months clinical and radiological follow-up showed an asymptomatic tooth, reduction of the periodontal probing depths from 7 mm prior to treatment to 3 mm and gingival reattachment in the area of the fracture with no sign of ankylosis. Hence, the treatment of VRF with Biodentine seems to be a possible and promising option. PMID:24670232

  10. The natural history of ankylosing spondylitis in the 21st century

    Directory of Open Access Journals (Sweden)

    C. Campana

    2011-06-01

    Full Text Available Ankylosing spondylitis (AS is a chronic inflammatory disease that affects the axial skeleton and evolves in stiffnes followed by ankylosis and disability. However, it may be difficult to exactly establish the natural history of the disease and the influence of risk factors of progression, since most patients are treated with various pharmacologic or non-pharmacologic agents, which may potentially influence the natural progression of the disease. In this context, we report here a very interesting case of a 40 year old man, presented to our outpatient clinic, 28 years after the onset of AS. Previously for personal reasons, did not choose not to undergo any treatment. This case allows us to evaluate the natural radiological progression of the disease and the influence of predictive risk factors.

  11. The role of radiotherapy in the treatment of desmoid tumours

    International Nuclear Information System (INIS)

    From 1974 to 1983 in the Netherlands Cancer Institute, 21 patients with desmoid tumours were treated with radiation therapy. Nineteen patients were irradiated postoperatively (11 patients had micro- or macroscopic residual disease, 8 patients treated for recurrent disease had narrow surgical margins), 2 patients with inoperable tumours were treated with radiation alone. The entire involved muscle received a dose of 40 Gy, while a boost of 20 Gy was delivered to the tumour bed. Local control was achieved in 19 out of 21 patients, with an actuarial 5 year disease-free survival of 90%. No relation could be found between the amount of tumour present and local control. With careful set-up of treatment fields and long-term physical therapy, complications like fibrosis, ankylosis and oedema could be minimised. These excellent results with radiotherapy for minimal residual tumour, or even for macroscopic tumour, makes mutilating surgery unnecessary. (Auth.)

  12. Periodontal healing complications following concussion and subluxation injuries in the permanent dentition: a longitudinal cohort study

    DEFF Research Database (Denmark)

    Hermann, Nuno Vibe; Lauridsen, Eva; Ahrensburg, Søren Steno; Gerds, Thomas Alexander; Andreasen, Jens Ove

    2012-01-01

    Purpose The purpose of the study was to analyze the risk of periodontal ligament (PDL) healing complications following concussion and subluxation injuries in the permanent dentition. Material and method A total 469 permanent teeth (358 patients) with concussion and 404 permanent teeth with......-related resorption (ankylosis), marginal bone loss, and tooth loss were analyzed with the Kaplan–Meier method. Results Concussion: In teeth with immature root development, no healing complications were observed. For teeth with mature root development, the risk of repair related resorption after 3 years was 3.2% (95...... among teeth with concussion. Subluxation: In teeth with immature root development, the risk of infection-related resorption after 3 years was 1.7% [95% confidence interval (CI): 0–3.8%]. Infection-related resorption occurred significantly more often in teeth with concomitant crown fracture (P = 0...

  13. Surgery of temporomandibular joint under local anaesthesia

    Directory of Open Access Journals (Sweden)

    Gajiwala Kalpesh

    2008-01-01

    Full Text Available Temporomandibular joint ankylosis is a debilitating disorder arising from an inability to open the mouth. This leads to poor nutrition, poor dental hygiene, and stunted growth. Anaesthesia, especially general anaesthesia, is very difficult to administer. There is a lack of direct visualization of the vocal cords, tongue fall following relaxation, and an already narrowed passage due to a small mandible, which makes even the blind nasal intubation difficult. There are various techniques described in literature to overcome these challenges, failing which, one needs to do tracheostomy. All the risks of difficult intubation and general anaesthesia can be avoided if the surgery is done under local anaesthesia. A simple but effective method of successful local anaesthesia is described, which allows successful temporomandibular joint reconstruction.

  14. A Literature Review of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis: Perioperative Considerations and Outcome.

    Science.gov (United States)

    Putnis, S E; Wartemberg, G K; Khan, W S; Agarwal, S

    2015-01-01

    Ankylosing spondylitis is a spondyloarthropathy affecting the sacro-iliac joints with subsequent progression to the spine and the hip joints. The hip joints are affected by synovitis, enthesial inflammation, involvement of medullary bone, progressive degeneration and secondary osteoarthritis. Clinical presentation is usually in the form of pain and stiffness progressing to disabling fixed flexion contractures and in some instances, complete ankylosis. Hip arthroplasty should be considered for hip pain, postural and functional disability, or pain in adjacent joints due to hip stiffness. We conducted a literature review to determine peri-operative considerations and outcome in ankylosing spondylitis patients undergoing hip arthroplasty. In this review, we have discussed pre-operative surgical planning, thromboprophylaxis, anaesthetic considerations and heterotopic ossification. Outcomes of arthroplasty include range of movement, pain relief, survivorship and complications. PMID:26587066

  15. HETEROTOPIC OSSIFICATION OF HIP IN A RARE CASE OF MOYAMOYA DISEASE: A RARE CASE REPORT

    Directory of Open Access Journals (Sweden)

    Anita

    2015-04-01

    Full Text Available A case of extensive ossification around the left hip joint involving lesser trochanter of the femur leading to ankylosis of left hip joint in a 60 years male is being reported. The diagnosis of moyamoya disease was made , which is a rare form of occlusive cerebrovasc ular disorder. Occlusion of an artery may present with Transient Ischemic Attacks , headaches , stroke and seizures. Surgical management is the only option in these cases. This 60 years male had an acute onset hemiplegia 4 ½ years back and at present came wit h complaints of pain and swelling over the left hip. Surgical excision was done and histopathological examination revealed extensive ossification of skeletal muscle. A diagnosis of Moyamoya disease complicated with heterotopic ossification was made. There was no recurrence after 8 months of follow up.

  16. Radium-226-induced dental disease in Beagles: a radiographic study

    International Nuclear Information System (INIS)

    Evaluation of dental radiographs made at necropsy and during the life of the dogs clearly shows age dependent changes within the control dogs. Periodontal diseases, loss of lamina dura, root ankylosis, and loss of pulp cavity were all commonly noted. Tooth loss and dental caries were rare in the control dogs. In injected Beagles loss of lamina dura was noted earlier and was dose dependent. Tooth loss and dental carried increased with dose level and appeared earlier. Tooth loss was common by 1600-1800 days of age while dental caries were common in almost all dogs by 1600-1800 days of age in the R40 level. Dental caries was the most accurate indication of the level of 226Ra toxicity. 18 reference, 1 table

  17. Maxillo-dental lesions produced in cats, after gamma and fast neutron irradiation. Radiographical and microradiographical study

    International Nuclear Information System (INIS)

    Gamma doses of 50 Gy, in 5 fractions over 29 days, induce severe modifications of the irradiated jaw in the cat, as shown by radiographical and microradiographical techniques. Four out 5 animals could survive up to one year; a fifth one died as a consequence of osteoradionecrosis. In addition, 2 animals, on which a tooth extraction was performed, died from osteoradionecrosis (role of trauma). Similar irradiations were performed with fast neutrons d(50) + Be at a total dose of 16.1 Gy in 5 fractions over 29 days. The ratio 50 Gy/16.1 Gy = 3.1 is the CNPF adopted for neutrontherapy applications at Louvain-la-Neuve. This irradiation was well tolerated by 7/7 animals. Only alveolodental ankylosis was observed in 3 cases, as well as a slight reduction in bone vitality in the dorsal part of the jaw. An eighth animal died from osteoradionecrosis induced by tooth extraction

  18. Total reconstruction of the temporomandibular joint. Up to 8 years of follow-up of patients treated with Biomet(®) total joint prostheses.

    Science.gov (United States)

    Westermark, A

    2010-10-01

    12 patients underwent temporomandibular joint (TMJ) reconstruction with Biomet total joint prostheses. Indications for TMJ reconstruction included ankylosis, rheumatoid arthritis, degenerative joint disease and condylar resorption. Five patients had unilateral procedures, seven had bilateral. The follow-up ranged between 2 and 8 years. Amongst the ankylotic patients the mean jaw-opening capacity increased from 3.8mm preoperatively to 30.2mm 1 year after surgery, and in most of those patients the opening capacity remained stable over the years. The other patients maintained a mean opening capacity of more than 35 mm. Joint related pain and interference with eating were eliminated after TMJ reconstruction. There were no permanent facial nerve disturbance, no postoperative infections and no device related complications. The outcome supports prosthetic TMJ reconstruction as a useful treatment modality in patients with advanced TMJ disease. PMID:20594807

  19. Treatment of inflammatory root resorption using mineral trioxide aggregate: A case report

    Directory of Open Access Journals (Sweden)

    Roohollah Sharifi

    2014-01-01

    Full Text Available Introduction: This report presents a case to show inflammatory root resorption can be successfully treated by using mineral trioxide aggregate (MTA. Case Report: A central maxillary incisor of an eight-year-old boy was avulsed associated with crown fracture secondary to a fall. The tooth was stored in ice. Early attempts at pulpal revascularization of the replanted tooth proved unsuccessful. To stop inflammatory root resorption, long-term calcium hydroxide therapy was employed. Despite the use of calcium hydroxide, resorption continued. Subsequent to the failure of that treatment, MTA was used as a root canal filling material. At 20-month follow-up, the tooth was asymptomatic and had clinical signs of ankylosis but external inflammatory root resorption had stopped. Discussion: MTA may be considered as an alternative option for the treatment of continuous external inflammatory root resorption.

  20. Bilateral Mandibular Torus and an Ankylosed Third Molar: A Case Report

    Directory of Open Access Journals (Sweden)

    Hasan Onur Şimşek

    2016-04-01

    Full Text Available Environmental factors, genetic heritage, increased biting function and nutrition are some of the reason for intraoral exostosis to get developed. Torus mandibularis is one of the types of exostosis in the oral region, which is unilaterally or bilaterally located in the lingual aspect of the body of the mandible above the mylohyoid line. There is usually no need for biopsy for the diagnosis of tori. In symptomatic cases, excision is the treatment of choice. In this paper, a 65-year-old man with a wide bilateral mandibular torus and an ankylosed mandibular right third molar tooth with mucosal retention is presented and general information was given about tori. In relation with this case, it was thought that dental ankylosis and tori may occur together because of similar etiological factors.

  1. Radiological residua of healed diabetic arthropathies

    Energy Technology Data Exchange (ETDEWEB)

    Reinhardt, K.

    1981-12-01

    Diabetic arthropathy is a relatively rare manifestation of neuropathic disease, occurring in fewer than 5% of cases. Abnormalities of this type are confined largely to the small joints of the feet, although the larger joints of the lower limbs and the spine occasionally are affected. Some lesions, particularly in the feet, repair spontaneously, leaving radiological residua sufficiently characteristic to prompt suspicion of an unrecognised diabetic state. These include deformity of the head of the second metatarsal (akin to a Freiberg lesion), shortening of the great toe, painless deforming arthrosis of the knee, and ankylosis of interphalangeal joints. In the presence of these signs the patient should be interrogated concerning diabetes and blood sugar estimates, with provocation if necessary, obtained. Should such a diagnosis be sustained, appropriate protective measures may be undertaken to avoid a relapse of the arthropathy.

  2. Tumor necrosis factor inhibitor therapy but not standard therapy is associated with resolution of erosion in the sacroiliac joints of patients with axial spondyloarthritis

    DEFF Research Database (Denmark)

    Pedersen, Susanne J; Wichuk, Stephanie; Chiowchanwisawakit, Praveena; Lambert, Robert G; Maksymowych, Walter P

    2014-01-01

    INTRODUCTION: Radiography is an unreliable and insensitive tool for the assessment of structural lesions in the sacroiliac joints (SIJ). Magnetic resonance imaging (MRI) detects a wider spectrum of structural lesions but has undergone minimal validation in prospective studies. The Spondyloarthritis...... Research Consortium of Canada (SPARCC) MRI Sacroiliac Joint (SIJ) Structural Score (SSS) assesses a spectrum of structural lesions (erosion, fat metaplasia, backfill, ankylosis) and its potential to discriminate between therapies requires evaluation. METHODS: The SSS score assesses five consecutive coronal...... (ANOVA), discrimination was assessed using Guyatt's effect size, and treatment group differences were assessed using t-tests and the Mann-Whitney test. We identified baseline demographic and structural damage variables associated with change in SSS score by univariate analysis and analyzed the effect of...

  3. Management of the temporomandibular joint in rheumatoid disorders.

    Science.gov (United States)

    Sidebottom, A J; Salha, R

    2013-04-01

    This article summarises the rheumatoid diseases that particularly affect the temporomandibular joint (TMJ): psoriatic arthropathy, ankylosing spondylitis, and rheumatoid arthritis. Management is by a joint approach between rheumatologists and maxillofacial surgeons with a specific interest in diseases of the TMJ who give early surgical advice. Steroid injections, whilst useful in the short term, are not useful for long term or repeated treatment, and may lead to collapse of the joint and development of a deformed anterior open bite. These disorders should be managed primarily using standard conservative regimens, and failure to respond should lead to diagnostic or therapeutic arthroscopy and appropriate surgical treatment. When ankylosis develops or the joint collapses, a replacement joint should be considered and patients should be referred to an appropriately trained surgeon. PMID:22658606

  4. Imaging of connective tissue diseases of the head and neck.

    Science.gov (United States)

    Abdel Razek, Ahmed Abdel Khalek

    2016-06-01

    We review the imaging appearance of connective tissue diseases of the head and neck. Bilateral sialadenitis and dacryoadenitis are seen in Sjögren's syndrome; ankylosis of the temporo-mandibular joint with sclerosis of the crico-arytenoid joint are reported in rheumatoid arthritis and lupus panniculitis with atypical infection are reported in patients with systemic lupus erythematosus. Relapsing polychondritis shows subglottic stenosis, prominent ear and saddle nose; progressive systemic sclerosis shows osteolysis of the mandible, fibrosis of the masseter muscle with calcinosis of the subcutaneous tissue and dermatomyositis/polymyositis shows condylar erosions and autoimmune thyroiditis. Vascular thrombosis is reported in antiphospholipid antibodies syndrome; cervical lymphadenopathy is seen in adult-onset Still's disease, and neuropathy with thyroiditis reported in mixed connective tissue disorder. Imaging is important to detect associated malignancy with connective tissue disorders. Correlation of the imaging findings with demographic data and clinical findings are important for the diagnosis of connective tissue disorders. PMID:26988082

  5. The radiological residua of healed diabetic arthropathies

    International Nuclear Information System (INIS)

    Diabetic arthropathy is a relatively rare manifestation of neuropathic disease, occurring in fewer than 5% of cases. Abnormalities of this type are confined largely to the small joints of the feet, although the larger joints of the lower limbs and the spine occasionally are affected. Some lesions, particularly in the feet, repair spontaneously, leaving radiological residua sufficiently characteristic to prompt suspicion of an unrecognised diabetic state. These include deformity of the head of the second metatarsal (akin to a Freiberg lesion), shortening of the great toe, painless deforming arthrosis of the knee, and ankylosis of interphalangeal joints. In the presence of these signs the patient should be interrogated concerning diabetes and blood sugar estimates, with provocation if necessary, obtained. Should such a diagnosis be sustained, appropriate protective measures may be undertaken to avoid a relapse of the arthropathy. (orig.)

  6. Treatment of a Vertical Root Fracture Using Dual-Curing Resin Cement: A Case Report

    Directory of Open Access Journals (Sweden)

    Nima Moradi Majd

    2012-01-01

    Full Text Available Introduction. Vertical root fracture (VRF is one of the most frustrating complications of root canal treatment. The prognosis of the root with VRF is poor therefore tooth extraction and root amputation are usually the only treatment options. However, bonding of the fracture line with adhesive resin cement during the intentional replantation procedure was recently suggested as an alternative to tooth extraction. Methods. A vertically fractured left maxillary incisor was carefully extracted, fracture line was treated with adhesive resin cement, a retrograde cavity was produced and filled with calcium-enriched mixture (CEM cement, and tooth was replanted. Results. After 12 months the tooth was asymptomatic. The size of periapical radiolucency was noticeably reduced and there was no clinical sign of ankylosis. Conclusion. Using adhesive resin cement to bond the fracture lines extraorally in roots with VRF and intentional replantation of the reconstructed teeth could be considered as an alternative to tooth extraction, especially for anterior teeth.

  7. The treatment of condylar fractures: to open or not to open? A critical review of this controversy

    Directory of Open Access Journals (Sweden)

    Renato VALIATI, Danilo IBRAHIM, Marcelo Emir Requia ABREU, Claiton HEITZ, Rogério Belle de OLIVEIRA, Rogério Miranda PAGNONCELLI, Daniela Nascimento SILVA

    2008-01-01

    Full Text Available The treatment of condylar process fractures has generated a great deal of discussion and controversy in oral and maxillofacial trauma and there are many different methods to treat this injury. For each type of condylar fracture, the techniques must be chosen taking into consideration the presence of teeth, fracture height, patient's adaptation, patient's masticatory system, disturbance of occlusal function, deviation of the mandible, internal derangements of the temporomandibular Joint (TMJ and ankylosis of the joint with resultant inability to move the jaw, all of which are sequelae of this injury. Many surgeons seem to favor closed treatment with maxillomandibular fixation (MMF, but in recent years, open treatment of condylar fractures with rigid internal fixation (RIF has become more common. The objective of this review was to evaluate the main variables that determine the choice of method for treatment of condylar fractures: open or closed, pointing out their indications, contra-indications, advantages and disadvantages.

  8. Patterns of radiographic damage to cervical spine in polyarticular juvenile idiopathic arthritis patients presenting to tertiary care hospital in pakistan

    International Nuclear Information System (INIS)

    Objective: To see the radiographic cervical spine damage in polyarticular juvenile idiopathic arthritis (PJIA) coming to a tertiary care hospital in Islamabad, Pakistan. Study Design: Cross-sectional descriptive study. Place and Duration of Study: The study was conducted in department of Rheumatology at Pakistan Institute of Medical Sciences from Jun 2013 to Dec 2013. Subjects and Methods: A total of 50 patients of PJIA coming to Rheumatology Outpatient Department were recruited in the study after informed consent. Radiographs of cervical spine were performed for each patient in antero-posterior, lateral with flexion and extension and open-mouth views. Radiographs were reviewed for the following eatures: loss of cervical lordosis, odontoid process erosion, anterior atlantoaxial subluxation, C1-C2 arthritis, atlantoaxial impaction, inflammation of disc, apophyseal joint arthritis, anterior ankylosis, apophyseal joint ankylosis, anterior and posterior subaxial subluxation and growth disturbances. Data was analysed using SPSS version 18. Results: Out of the total 50 patients, 28 (56%) were females while 22 (44%) were males. The mean duration of pJIA was 5.54 +- 3.28 years. Radiological cervical spine involvement was seen in 52% patients. The most common structural lesions were anterior atlantoaxial subluxation (30%), C1-C2 arthritis (22%) erosion of the odontoid process (18%), and apophyseal joint arthritis (16%). Loss of cervical lordosis was found in 7(14%) patients. There was no growth disturbances observed in vertebra. Conclusion: Cervical spine involvement is common in patients of PJIA. It is mostly asymptomatic, so routine cervical spine radiographs in all patients suffering from PJIA is recommended. (author)

  9. Achondroplasia manifesting as enchondromatosis and ossification of the spinal ligaments: a case report

    Directory of Open Access Journals (Sweden)

    Al Kaissi Ali

    2008-08-01

    Full Text Available Abstract Introduction A girl presented with achondroplasia manifested as mild knee pain associated with stiffness of her back. A skeletal survey showed enchondroma-like metaphyseal dysplasia and ossification of the spinal ligaments. Magnetic resonance imaging of the spine further clarified the pathological composites. Case presentation A 7-year-old girl presented with the classical phenotypic features of achondroplasia. Radiographic documentation showed the co-existence of metaphyseal enchondromatosis and development of spinal bony ankylosis. Magnetic resonance imaging showed extensive ossification of the anterior and posterior spinal ligaments. Additional features revealed by magnetic resonance imaging included calcification of the peripheral vertebral bodies associated with anterior end-plate irregularities. Conclusion Enchondromas are metabolically active and may continue to grow and evolve throughout the patient's lifetime; thus, progressive calcification over a period of years is not unusual. Ossification of the spinal ligaments has a specific site of predilection and often occurs in combination with senile ankylosing vertebral hyperostosis. Nevertheless, ossification of the spinal ligaments has been encountered in children with syndromic malformation complex. It is a multifactorial disease in which complex genetic and environmental factors interact, potentially leading to chronic pressure on the spinal cord and nerve roots with subsequent development of myeloradiculopathy. Our patient presented with a combination of achondroplasia, enchondroma-like metaphyseal dysplasia and calcification of the spinal ligaments. We suggest that the development of heterotopic bone formation along the spinal ligaments had occurred through an abnormal ossified enchondral mechanism. We postulate that ossification of the spinal ligaments and metaphyseal enchondromatous changes are related to each other and represent impaired terminal differentiation of

  10. Optimizing the MRI protocol of the sacroiliac joints in Spondyloarthritis: which para-axial sequence should be used?

    Energy Technology Data Exchange (ETDEWEB)

    Giraudo, Chiara; Weber, Michael; Platzgummer, Hannes; Kainberger, Franz; Schueller-Weidekamm, Claudia [Medical University of Vienna, Vienna General Hospital, Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging und Image-guided Therapy, Vienna (Austria); Magnaldi, Silvia [Fondazione Poliambulanza Istituto Ospedaliero, Dipartimento di Radiologia e Diagnostica per Immagini, Brescia (Italy); Puchner, Antonia [Medical University of Vienna, Vienna General Hospital, Division of Rheumatology, Department of Internal Medicine III, Vienna (Austria)

    2016-01-15

    To assess the diagnostic value of para-axial T2w-TSE (paT2) and fat-suppressed proton density (paPD-FS) MRI sequences for the evaluation of the sacroiliac joint (SIJ) of patients with axial Spondylarthritis (SpA). One hundred and six patients with clinical findings suggestive of SpA underwent an MR protocol of the SIJ with additional paPD-FS (41 patients) and paT2 (105 patients). Acute (bone marrow oedema [BME], enthesitis, capsulitis, synovitis) and chronic findings (erosions, ankylosis) were assessed by paPD-FS and compared with the gold standard post-contrast sequences, whereas chronic features (because of the lack of fat suppression) were evaluated on paT2 and compared with pcT1. paPD-FS demonstrated high sensitivity (98.9 %) and specificity (99.1 %) for BME; sensitivity and specificity for synovitis and enthesitis were 100 %; 85.7 % and 100 %, respectively, for capsulitis. paPD-FS and paT2 showed 100 % sensitivity and specificity for ankylosis; for erosions, paT2 demonstrated 85.3 % sensitivity and 100 % specificity, whereas paPD-FS, respectively, 98 % and 100 %. PaT2 and paPD-FS provided precious information enabling an accurate interpretation of the heterogeneous findings of SpA. paPD-FS showed good results in detecting acute and chronic lesions and its inclusion in a routine MR examination of the SIJ could increase the diagnostic performance of a pre-contrast protocol. (orig.)

  11. Management of facial asymmetry due to overgrowing costochondral graft: A case report.

    Science.gov (United States)

    Razzak, Arif; Ahmed, Nabeela; Sidebottom, Andrew

    2016-01-01

    Costochondral grafts are used to replace the mandibular condyle in cases of TMJ ankylosis, and are generally viewed as a gold standard for autogenous reconstruction of the mandibular condyle (Güven, 2000; Posnick and Goldstein, 1993 [1,2]). We report a case where overgrowth of costochondral grafts is seen, resulting in asymmetric mandibular growth and dentofacial asymmetry (Posnick and Goldstein, 1993 [2]). A 17 year old male patient presented with an existing costochondral graft performed due to TMJ ankylosis during childhood. He fell from a height at the age of 4, and was lost to follow up through non-attendance until the age of 9, when he presented with a progressive reduction in maximal incisal opening (MIO). At this stage his maximal incisal opening was noted to be 11mm, and the CT showed a grossly deformed ankylosed left TMJ. This post traumatic ankyloses was managed with gap arthroplasty and costochondral graft reconstruction. This immediately improved his MIO to 22mm and at 1 year follow up was noted to be 30mm. At age 12 he was noted to have a clinically obvious overgrowth of the left ramus of the mandible, and deviation of the chin point to the right. MIO remained at 38mm. He declined orthognathic surgery and represented 2 years later requesting treatment without orthodontic intervention for his facial asymmetry. He subsequently underwent a Le Fort 1 impaction osteotomy, right BSSO and left condylar ostectomy, coronoidectomy and left lower border mandibulectomy. Regrowth of the CCG occurred during the 6 months of follow up. This case illustrates the problems that can occur after condylar trauma. It also highlights issues with costochondral grafts which can continue to grow. PMID:27475115

  12. Evaluation of two formulations containing mineral trioxide aggregate on delayed tooth replantation: relevance of RANKL/RANK/OPG system.

    Science.gov (United States)

    Vogt, Beatriz Farias; Souza, Carlos Eduardo Chrzanowski Pereira; Silva, Daniela Nascimento; Etges, Adriana; Campos, Maria Martha

    2016-05-01

    This study aimed to evaluate the effects of White MTA (WMTA) and MTA Fillapex(®) on root resorption, when used for root canal filling, in a rat model of delayed tooth replantation, with special focus on the RANKL/RANK/OPG system. Maxillary right central incisors of male rats were extracted (total N = 48), and exposed to dry environment for 30 min. The animals were allocated into four groups: (1) WMTA; (2) MTA Fillapex; (3) Calcium hydroxide; (4) Negative control. After periodontal ligament removal, root canals were filled with the corresponding material and replanted. After 10 and 60 days, qualitative and semi-quantitative histological and immunohistochemical analyses were carried out. Analysis of variance (ANOVA) with Tukey's post hoc adjustment was used, at 10 and 60 days, to compare the experimental groups in terms of the inflammatory scores and in terms of the changes in OPG, RANK and RANKL. Both WMTA and MTA Fillapex groups displayed inflammatory and replacement resorption, with the presence of dento-alveolar ankylosis, similarly to that observed for calcium hydroxide, in either 10 or 60 days. Notably, a slight increase of the inflammatory process was observed in both MTA groups. Quantitatively, inflammation score analysis showed a significant difference between the calcium hydroxide and the control group at 10 days. On 60 days, dento-alveolar ankylosis was found significantly increased in the MTA Fillapex, in comparison to the control group (p cement presented an outcome comparable to that seen for calcium hydroxide. MTA cements might present some advantages when considering no need of frequent changes, although the effects of MTA cements in dental avulsion still require further investigation. PMID:25895663

  13. The genetic basis of ankylosing spondylitis: new insights into disease pathogenesis

    Directory of Open Access Journals (Sweden)

    Tsui FW

    2014-05-01

    Full Text Available Florence WL Tsui,1,2 Hing Wo Tsui,1 Ali Akram,1,3 Nigil Haroon,1–3 Robert D Inman1–3 1Genetics and Development Division, Toronto Western Research Institute, University Health Network, 2Department of Immunology, 3Institute of Medical Science, University of Toronto, Toronto, ON, Canada Abstract: Ankylosing spondylitis (AS is a complex disease involving multiple risk factors, both genetic and environmental. AS patients are predominantly young men, and the disease is characterized by inflammation and ankylosis, mainly at the cartilage–bone interface and enthesis. HLA-B27 has been known to be the major AS-susceptibility gene for more than 40 years. Despite advances made in the past few years, progress in the search for non-human leukocyte antigen susceptibility genes has been hampered by the heterogeneity of the disease. Compared to other complex diseases, such as inflammatory bowel disease (IBD, fewer susceptibility loci have been identified in AS. Furthermore, non-major histocompatibility-complex susceptibility loci discovered, such as ERAP1 and IL23R, are likely contributors to joint inflammation. Identification and confirmation of functional variants remains a significant challenge of investigations involving genome-wide association studies (GWAS. It remains unclear why none of the AS-susceptibility genes identified in GWAS appear to be directly involved in the ankylosing process. Numerous reviews have recently been published on the genetics of AS. Therefore, aside from a brief summary of what AS GWAS has successfully achieved thus far, this review will focus on directions that could address unanswered questions raised by GWAS. Keywords: ankylosing spondylitis, genome-wide association studies, risk loci, ankylosis, joint and gut inflammation, clinical subsets

  14. Spinal arthritis and physical stress at Bronze Age Harappa.

    Science.gov (United States)

    Lovell, N C

    1994-02-01

    This study examines joint changes in the vertebral skeleton in human remains excavated in 1987 and 1988 at Bronze Age Harappa, an urban center of the Indus Valley civilization. The sample consists of 23 complete skeletons from primary burial context, the partial remains of more than 69 other individuals, and hundreds of skeletal elements from secondary context, totalling 3,084 vertebral joint margins and articular surfaces. Marginal bone proliferation, pitting of articular surfaces, eburnation, and ankylosis were scored macroscopically for vertebral body margins and surfaces and posterior apophyseal facet joints. Marginal lipping is far more prevalent on the vertebral bodies than on the apophyseal facets and surface pitting is also more frequent on vertebral bodies although its expression is relatively low overall. Cervical vertebrae in this sample exhibit the same amount of marginal new bone and much more surface pitting of the vertebral bodies than do either thoracic or lumbar vertebrae; the cervical segment also exhibits the most severe expressions of both types of lesions. In addition, although the frequencies of cervical and lumbar posterior facet involvement are similar, the cervical facets exhibit much more severe lipping as well as the only cases of eburnation and ankylosis. Pitting of the posterior facets is most common in the lumbar segment, but the cervical examples are the only severe cases. It is proposed that the severe joint changes in the cervical spine result from trauma, perhaps accumulated microtrauma from activity stresses. There are no age or sex associated patterns in the frequency of arthritis although this result may be influenced by the small proportions of the total sample for which age and sex could be determined. PMID:8147433

  15. Avaliação radiográfica e de função de vôo após fixação de osteotomias distais do úmero em pombas (Columba livia, com modelo de fixador externo articulado Radiologic and flight function evaluation after fixation of distal humeral osteotomies in pigeons, with model of articulated external fixator

    Directory of Open Access Journals (Sweden)

    Vanessa C.M. Ferraz

    2008-08-01

    viabilidade de músculos e tendões, e assim, garantindo a capacidade de vôo das aves tratadas, sendo um método adequado para a reparação de fraturas distais de úmero em aves quando se pretende a reabilitação destes animais.The treatment of distal humeral fractures in birds is very difficult, technically and for consolidation and maintenance of normal function of the wing, because theses bones are pneumatic, and its cortices very thin. The ankylosis of the humerus-radius-ulnar joint with external fixator is unviable for birds intended for rehabilitation and release. In all animals, the experimental fixator was placed over the humerus, with its articulation over the humerus-radial-ulnar joint e the extension of the fixator was placed over the ulna. The animals were divided in two groups: bilateral surgeries with ankylosis in one wing (static wing and maintenance of the joint function in the other (dynamic wing (Group 1, and unilateral surgery, with maintenance of the joint function (dynamic wing (Group 2. The bonny callus was evaluated with radiographs: post-surgical, at 3, 6 and 9 weeks. The birds in Group 2 were evaluated as of their flight abilities between 11 and 15 weeks after surgery. The wing amplitude and humeral length was evaluated in all animals, after euthanasia. At 6 weeks, all the animals in Group 2, that underwent unilateral surgery, without ankylosis, and four animals in Group 1, that underwent bilateral surgeries: ankylosis of one elbow (static wing and not of the other (dynamic wing, presented radiographic and clinical consolidation of the fractures. Two animals in Group 1 only presented consolidation of the dynamic wing at 9 weeks and of the static wing at 12 weeks. All the animals in Group 2 presented adequate flight capacity, in at least 13 weeks after surgery. There are few published papers on bird osteosynthesis, and therefore we studied the use of articulated external fixator for the stabilization of distal humeral fractures, avoiding ankylosis

  16. Arthrogryposis multiplex congenita - a rare congenital stiff joints syndrome

    Directory of Open Access Journals (Sweden)

    Velisavljev-Filipović Gordana

    2006-01-01

    Full Text Available Introduction: Arthrogryposis multiplex congenita is not a disease but a term describing multiple congenital contractures. Etiological factors include neurological and primary myogenic diseases. This rare syndrome is present at birth and is characterized by reduced mobility of many joints. The contractures involve two or more joints with ankylosis. The accompanying musculature is hypoplastic, but multiple pterygia are also present. Arthrogryposis multiplex congenita is a heterogeneous group of disorders with the incidence rate of 6.2/100000 liveborn infants. The true incidence cannot be established, because many cases result in spontaneous miscarriages or stillbirth. More than 90% of cases are associated with birth defects. The cause of this syndrome is unknown. Many forms are not hereditary, though there are hereditary forms as well. Case report. This paper presents a case with arthrogryposis multiplex congenita. The pregnancy was not controlled regularly. During the pregnancy, oligohydramnion was detected. Due to contractures, labor ended is cesarean section. The child was born in the 34th week of gestation. Flexion and extension joint contractures were observed. Active and passive mobility of the afflicted joints was reduced. There was a limited motor function in the shoulder, elbow and wrist joints with a slight internal rotation of the shoulder joint and lower arm joints during pronation. The hips were subluxated; the feet were in equinovarus position and the fingers in ulnar deviation with partial syndactyly of the 4th and 5th fingers on the left hand. The infant had abnormal dermatoglyphics. The neck was short, and the 2nd and 3rd cervical vertebrae were fused. There was also a slight left-sided thoracic scoliosis. Trismus was present due to the existing ankylosis of the temporomandibular joint. The karyotype was normal. The serum creatinine phosphokinase was slightly elevated. The electromyographic picture indicate non-specific signs of

  17. MR imaging features of foot involvement in ankylosing spondylitis

    International Nuclear Information System (INIS)

    Objective: To determine alterations of the soft tissue, tendon, cartilage, joint space, and bone of the foot using magnetic resonance (MR) imaging in ankylosing spondylitis (AS) patients. Materials and Method: Clinical and MR examination of the foot was performed in 23 AS patients (46 feet). Ten asymptomatic volunteers (20 feet) were studied on MR imaging, as a control group. MR imaging protocol included; T1-weighted spin-echo, T2-weighted fast-field echo (FFE) and fat-suppressed short tau inversion recovery (STIR) sequences in sagittal, sagittal oblique, and coronal planes using a head coil. Specifically, we examined: bone erosions, tendinitis (acute and chronic), para-articular enthesophyte, joint effusion, plantar fasciitis, joint space narrowing, soft tissue edema, bone marrow edema, enthesopathy in the Achilles tendon and plantar fascia attachment, subchondral signal intensity abnormalities (edema and sclerosis), tenosynovitis, retrocalcaneal bursitis, subchondral cysts, subchondral fissures, and bony ankylosis. Midfoot, hindfoot, and ankle were included in examined anatomic regions. Results: Clinical signs and symptoms (pain and swelling) due to foot involvement were present in 3 (13%) of the patients while frequency of involvement was 21 (91%) with MR imaging assessment. The MR imaging findings were bone erosions (65%), Achilles tendinitis (acute and chronic) (61%), para-articular enthesophyte (48%), joint effusion (43%), plantar fasciitis (40%), joint space narrowing (40%), subchondral sclerosis (35%), soft tissue edema (30%), bone marrow edema (30%), enthesopathy of the Achilles attachment (30%), subchondral edema (26%), enthesopathy in the plantar fascia attachment (22%), retrocalcaneal bursitis (22%), subchondral cysts (17%), subchondral fissures (17%), tendinitis and enthesopathy of the plantar ligament (13%), and bony ankylosis (9%). The most common involved anatomical region was the hindfoot (83%) following by midfoot (69% ) and ankle (22

  18. MR imaging features of foot involvement in ankylosing spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Erdem, C. Zuhal E-mail: sunarerdem@yahoo.com; Sarikaya, Selda; Erdem, L. Oktay; Ozdolap, Senay; Gundogdu, Sadi

    2005-01-01

    Objective: To determine alterations of the soft tissue, tendon, cartilage, joint space, and bone of the foot using magnetic resonance (MR) imaging in ankylosing spondylitis (AS) patients. Materials and Method: Clinical and MR examination of the foot was performed in 23 AS patients (46 feet). Ten asymptomatic volunteers (20 feet) were studied on MR imaging, as a control group. MR imaging protocol included; T1-weighted spin-echo, T2-weighted fast-field echo (FFE) and fat-suppressed short tau inversion recovery (STIR) sequences in sagittal, sagittal oblique, and coronal planes using a head coil. Specifically, we examined: bone erosions, tendinitis (acute and chronic), para-articular enthesophyte, joint effusion, plantar fasciitis, joint space narrowing, soft tissue edema, bone marrow edema, enthesopathy in the Achilles tendon and plantar fascia attachment, subchondral signal intensity abnormalities (edema and sclerosis), tenosynovitis, retrocalcaneal bursitis, subchondral cysts, subchondral fissures, and bony ankylosis. Midfoot, hindfoot, and ankle were included in examined anatomic regions. Results: Clinical signs and symptoms (pain and swelling) due to foot involvement were present in 3 (13%) of the patients while frequency of involvement was 21 (91%) with MR imaging assessment. The MR imaging findings were bone erosions (65%), Achilles tendinitis (acute and chronic) (61%), para-articular enthesophyte (48%), joint effusion (43%), plantar fasciitis (40%), joint space narrowing (40%), subchondral sclerosis (35%), soft tissue edema (30%), bone marrow edema (30%), enthesopathy of the Achilles attachment (30%), subchondral edema (26%), enthesopathy in the plantar fascia attachment (22%), retrocalcaneal bursitis (22%), subchondral cysts (17%), subchondral fissures (17%), tendinitis and enthesopathy of the plantar ligament (13%), and bony ankylosis (9%). The most common involved anatomical region was the hindfoot (83%) following by midfoot (69% ) and ankle (22

  19. 下颌骨髁状突骨折56例疗效分析%Retrospective study of treatments for 56 condylar fractures

    Institute of Scientific and Technical Information of China (English)

    曲昌锋; 郭哲; 陆平; 周晓南; 汪崇

    2012-01-01

    [ Objective] To investigate the treatments and curative effects for different types of condylar fractures. [ Methods] There were 56 condylar fractures presented with expectant treatments, condylar removal, arthroplasty, rigid fixation and evaluated the clinical effects. [Results] The curative effects were satisfactory but some patients suffered with complications such as injury of facial nerve, limitation of mouth opening, ankylosis of temporo - mandibular joint and absorption of condyle. [ Conclusion ] Miniplate rigid fixation based on anatomical reduction is an effective procedure in treating condylar neck and subcondylar fractures. Post - mandibular approach could significantly reduce the probability of facial nerve injury. Ankylosis of temporo - mandibular joint could happen if the serious dislocation of articular disc and comminuted fractures of condyle head.%[目的]探讨不同类型髁状突骨折的治疗方法和临床效果.[方法]回顾性分析大连市中心医院56例髁状突骨折病例,分别采用保守治疗及髁状突摘除、关节成形和小型钛板坚固内固定,并评价其临床效果.[结果]随访47例,所有病例均一期愈合,无感染,无涎瘘.但部分病例出现面神经损伤(5例)、张口受限(3例)、颞下颌关节强直(1例)、髁状突吸收(2例)等并发症.[结论]切开复位及小型钛板坚固内固定是治疗髁颈和髁颈下骨折的有效方法,但应保留翼外肌附着.经颌后区入路可明显降低面神经损伤的几率.囊内粉碎性骨折和髁状突骨折伴关节盘明显移位如处理不当易发生颞下颌关节强直.

  20. Unusual radiographic changes of a gout patient

    International Nuclear Information System (INIS)

    Background. Gout is a metabolic disorder that results in hyperuricemia and accumulation of uric acid crystals (urats) in tissues, especially joint cartilage. The gouty arthritis presents as acute attacks of arthritis leading eventually to chronic gouty arthritis. In 80% of cases it first occurs in the matatarsophalangeal (MTP) joint of the great toe and is more frequent in male population. Case report. We present a case of unusual radiographic changes accompanying gouty arthritis. A 63 year old female complained about swelling of the first MTP joint on the right, right knee, about stiffness of feet and hands' digits and about backache. First symptoms started to appear 30 years ago. In the time of examination radiographs displayed degenerative changes of the majority of presented joints, bilateral sacroiliitis and osseous ankylosis of both insteps. Microscopic examination showed urate crystals in the samples of the synovial fluid aspirated from the knee. The histological findings of the synovial tissue after the synovectomy were also in favour of gouty arthritis. Conclusions. Radiographs are the most important imaging modality in the diagnostic process of gout. However, radiographic differential diagnosis can be difficult, since the findings overlap with other conditions which cause arthritis and osteoarthritis especially in longstanding gout, elderly patients and females. The diagnosis must be often confirmed with the help of laboratory and histological findings. (author)

  1. Calcium hydroxide mixed with camphoric p-monochlorophenol or chlorhexidine in delayed tooth replantation.

    Science.gov (United States)

    Trevisan, Carolina Lunardelli; Panzarini, Sônia Regina; Brandini, Daniela Atili; Poi, Wilson Roberto; Luvizuto, Eloá Rodrigues; Dos Santos, Cláudia Letícia Vendrame; Saito, Célia Tomiko Hamada Matida

    2011-11-01

    This study evaluated the repair process after delayed replantation of rat teeth, using calcium hydroxide (Ca(OH)2) mixed with camphorated p-monochlorophenol (CMCP), chlorhexidine 2% (CHX), or saline as temporary root canal dressing to prevent and/or control inflammatory radicular resorption. Thirty Wistar rats (Rattus norvegicus albinos) had their right upper incisor extracted, which was bench-dried for 60 minutes. The dental papilla, the enamel organ, the dental pulp, and the periodontal ligament were removed. The teeth were immersed in 2% acidulated-phosphate sodium fluoride solution for 10 minutes. The root canals were dried with absorbent paper cones and divided into 3 groups of 10 animals according to root canal dressing used: group 1: Ca(OH)2 + saline, group 2: Ca(OH)2 + CMCP, and group 3: Ca(OH)2 + CHX 2%. Before replanting, the teeth sockets were irrigated with saline. Histological analysis revealed the presence of inflammatory resorption, replacement resorption, and ankylosis in all 3 groups. Statistical analysis showed a significant difference between group 3 and the other groups. The use of Ca(OH)2 mixed with CMCP or CHX did not show an advantage over the use of Ca(OH)2 mixed with saline in preventing and/or controlling inflammatory resorption in delayed replantation of rat teeth. PMID:22067873

  2. Treatment of root surface in delayed tooth replantation: a review of literature.

    Science.gov (United States)

    Panzarini, Sônia Regina; Gulinelli, Jéssica Lemos; Poi, Wilson Roberto; Sonoda, Celso Koogi; Pedrini, Denise; Brandini, Daniela Atili

    2008-06-01

    The time elapsed between a trauma and tooth replantation usually ranges from 1 to 4 h. The chances of root surface damage are higher when tooth replantation is not performed immediately or if the avulsed tooth is not stored in an adequate medium. This invariably leads to necrosis of pulp tissue, periodontal ligament cells and cementum, thus increasing the possibility of root resorption, which is the main cause of loss of replanted teeth. This paper presents a comprehensive review of literature on root surface treatments performed in cases of delayed tooth replantation with necrotic cemental periodontal ligament. Journal articles retrieved from PubMed/MedLine, Bireme and Scielo databases were reviewed. It was observed that, when there are no periodontal ligament remnants and contamination is under control, replacement resorption and ankylosis are the best results and that, although these events will end up leading to tooth loss, this will happen slowly with no loss of the alveolar ridge height, which is important for future prosthesis planning. PMID:18410388

  3. Pfeiffer syndrome

    Directory of Open Access Journals (Sweden)

    Fryns Jean-Pierre

    2006-06-01

    Full Text Available Abstract Pfeiffer syndrome is a rare autosomal dominantly inherited disorder that associates craniosynostosis, broad and deviated thumbs and big toes, and partial syndactyly on hands and feet. Hydrocephaly may be found occasionally, along with severe ocular proptosis, ankylosed elbows, abnormal viscera, and slow development. Based on the severity of the phenotype, Pfeiffer syndrome is divided into three clinical subtypes. Type 1 "classic" Pfeiffer syndrome involves individuals with mild manifestations including brachycephaly, midface hypoplasia and finger and toe abnormalities; it is associated with normal intelligence and generally good outcome. Type 2 consists of cloverleaf skull, extreme proptosis, finger and toe abnormalities, elbow ankylosis or synostosis, developmental delay and neurological complications. Type 3 is similar to type 2 but without a cloverleaf skull. Clinical overlap between the three types may occur. Pfeiffer syndrome affects about 1 in 100,000 individuals. The disorder can be caused by mutations in the fibroblast growth factor receptor genes FGFR-1 or FGFR-2. Pfeiffer syndrome can be diagnosed prenatally by sonography showing craniosynostosis, hypertelorism with proptosis, and broad thumb, or molecularly if it concerns a recurrence and the causative mutation was found. Molecular genetic testing is important to confirm the diagnosis. Management includes multiple-staged surgery of craniosynostosis. Midfacial surgery is performed to reduce the exophthalmos and the midfacial hypoplasia.

  4. Computer-assisted surgical planning and intraoperative navigation in the treatment of condylar osteochondroma.

    Science.gov (United States)

    Yu, H B; Li, B; Zhang, L; Shen, S G; Wang, X D

    2015-01-01

    Mandibular condylar osteochondroma (OC) results in asymmetric prognathism with facial morphology and functional disturbances. The aim of this study was to explore the feasibility of computer-assisted surgical planning combined with intraoperative navigation in the treatment of condylar OC. Five patients with mandibular condylar OC were enrolled in this study. Surgical planning and simulation was performed based on a computed tomography reconstruction model using SurgiCase software. Under the guidance of navigation, a condylar OC resection and conservative condylectomy was carried out via intraoral approach. Simultaneous orthognathic surgery was used to correct the facial asymmetry and malocclusion. All patients healed uneventfully. No facial nerve injury or salivary fistula occurred. Facial symmetry and morphology were greatly improved and stable occlusion was obtained in all cases. Good matching between preoperative planning and postoperative results was achieved. Patients showed no signs of recurrence or temporomandibular joint ankylosis during follow-up of 12-30 months. Computer-assisted surgical planning and intraoperative navigation is a valuable option in the treatment of mandibular condylar OC. PMID:25442742

  5. Endoscope-assisted conservative condylectomy in the treatment of condylar osteochondroma through an intraoral approach.

    Science.gov (United States)

    Yu, H B; Sun, H; Li, B; Zhao, Z L; Zhang, L; Shen, S G; Wang, X D

    2013-12-01

    Mandibular condylar osteochondroma (OC) can result in morphological and functional disturbances, including facial asymmetry and temporomandibular joint (TMJ) dysfunction. The aim of this study was to explore the feasibility of endoscope-assisted tumour resection and conservative condylectomy via an intraoral approach. Seven patients with condylar OC were enrolled in this study. Endoscope-assisted tumour resection and conservative condylectomy were achieved intraorally, and no conventional extraoral incision was needed. Direct vision of the magnified and illuminated operative field was realized with the assistance of an endoscope. No facial nerve injury or salivary fistula occurred in any patient. Stable occlusion was realized through postoperative orthodontic treatment. The patients showed no signs of tumour recurrence or TMJ ankylosis during follow-up (range 18-43 months). Endoscope-assisted condylar OC resection and conservative condylectomy via intraoral approach offers great advantages with no significant complications compared with conventional extraoral incisions. The endoscope provides us with a valuable treatment option for this potentially complicated procedure. PMID:23790807

  6. [Immediate and long-term results of surgical treatment of patients for traumatic mandibular fracture].

    Science.gov (United States)

    Kopchak, A V

    2014-01-01

    The analysis of immediate and long-term results of the surgical treatment of 286 patients, operated for traumatic mandibular fractures in the Department of Oral and Maxillofacial Surgery, National O. O. Bogomolets Medical University. In 67% of patients the anatomical shape of the bone was adequately restored. The presence of residual displacements in other cases was determined by the fracture type and localization, the technical complexity of the surgical intervention, lack of fixation rigidity under certain functional load conditions. In long terms of observation the infection and inflammatory complications were observed in 13.4% of patients, delayed unition and non-unition of bone fragments occurred--in 4.7%, arthosis with persistent dysfunction of the temporomandibular joint--in 6.7%, fibrous ankylosis--in 1.3%. Secondary displacement of fragments was observed in 23.5% of patients due to insufficient stiffness and reliaability of the bone-fixatorsystem. The non-precise reposition of fragments and secondary displacements in the early and late postoperative period were the main cause of occlusal disturbances of various severities, noted in 28% of operated patients, limitation of mouth opening (10%), TMJ disorders and changes in masticatory stereotype (33%), the sensation of pain and discomfort in tough food chewing (35%). A statistical analysis of the effectiveness of different osteosynthesis methods depending on the type and localization of the fracture was carried out and recommendations for usage of fixation devices in clinical practice were given. PMID:24923155

  7. The temporomandibular joint

    International Nuclear Information System (INIS)

    Whilst the temporomandibular joint is in many ways unique, it is subject to all the diseases and disorders found in joints in other parts of the human skeleton. By far the most common disorder is injury, followed by arthropathy, acute and chronic dislocations, ankylosis, and in rare instances, neoplasms. The diagnosis and management of the temporomandibular joint are the primary responsibility of the oral surgeon. Nevertheless, this anatomical region is an area in which the cooperation of medical and dental disciplines may be required for the satisfactory conclusion of treatment. The more so when the disease process involves either associated psychosomatic illness or malignancy. The mainstay of the diagnosis is a careful radiological examination of the joint. There exists a delicate relationship between the dentition, the muscles of mastication, and the temporomandibular articulation, which is controlled by arthrokinetic reflex activity of the branches of the 5th cranial nerve. Imbalance between one or more of the components of this integrated system frequently leads to disturbances in function. Pain-dysfunction disorders constitute the larger part of temporomandibular joint disturbances generally encountered

  8. Roentgenographic study of the temporomandibular joint in rheumatoid arthritis

    International Nuclear Information System (INIS)

    For the study of the temporomandibular joint in rheumatoid arthritis 30 patients were selected who were diagnosis as rheumatoid arthritis through the clinical, radiographic examination and laboratory finding. Temporoman dibular joint involvement was evaluated through the clinical, radiographic examination. The results were as follows; 1. TMJ was involved in 15 patients of 30 patients with rheumatoid arthritis. (50% involvement). 2. Duration of rheumatoid arthritis was more longer in patients with TMJ involvement than in patients without TMJ involvement. 3. Osseous changes in TMJ were in order of frequency erosion, flattening, osteophyte, sclerosis, deformity, and most common involved site was mandibular condyle. 4. Most common positional change of condyle was forward position in centric occlusion, and restricted movement of condyle in 1 inch mouth opening. 5. TMJ involvement of rheumatoid arthritis was almost bilateral. 6. Main symptoms of TMJ were pain, stiffness, tenderness, limitation of mouth opening, crepitation. 7. There was not the case of ankylosis. 8. There was statistically insignificant correlation between mandibular deviation and TMJ involvement, but some cases showed severe deviation on mouth opening.

  9. Pedigree analysis of Czech Holstein calves with schistosoma reflexum

    Directory of Open Access Journals (Sweden)

    Citek Jindrich

    2012-04-01

    Full Text Available Abstract Background Schistosoma reflexum (SR is congenital syndrome briefly characterized by visceral eventration, severe dorsoflexion and ankylosis of the spine and arthrogryposis. A genetic etiology has been proposed, but conclusive evidence has not yet been provided. Methods Pedigree analysis was carried out in 29 cases of SR in Czech Holsteins and Holstein crosses. Genetic relationship was evaluated and inbreeding coefficients calculated. Pedigrees of 15 Czech Holsteins fathering non-SR affected calves were used for comparison. Results Twenty-one cases occurred in one pedigree founded by three sires while three SR calves occurred in another pedigree with a common grandfather. The sex ratio between affected males and females was 11:6. Affected calves shared common ancestors different from those shared by the unaffected calves. The inbreeding coefficient in the SR affected calves was not increased compared to unaffected calves. Conclusions The findings are consistent with SR being inherited autosomal recessively. Further studies are however needed to confirm this and therefore a breeding trial is recommended where a suspected heterozygous sire is mated to closely related females.

  10. Molecular mechanisms of bone formation in spondyloarthritis.

    Science.gov (United States)

    González-Chávez, Susana Aideé; Quiñonez-Flores, Celia María; Pacheco-Tena, César

    2016-07-01

    Spondyloarthritis comprise a group of inflammatory rheumatic diseases characterized by its association to HLA-B27 and the presence of arthritis and enthesitis. The pathogenesis involves both an inflammatory process and new bone formation, which eventually lead to ankylosis of the spine. To date, the intrinsic mechanisms of the pathogenic process have not been fully elucidated, and our progress is remarkable in the identification of therapeutic targets to achieve the control of the inflammatory process, yet our ability to inhibit the excessive bone formation is still insufficient. The study of new bone formation in spondyloarthritis has been mostly conducted in animal models of the disease and only few experiments have been done using human biopsies. The deregulation and overexpression of molecules involved in the osteogenesis process have been observed in bone cells, mesenchymal cells, and fibroblasts. The signaling associated to the excessive bone formation is congruent with those involved in the physiological processes of bone remodeling. Bone morphogenetic proteins and Wnt pathways have been found deregulated in this disease; however, the cause for uncontrolled stimulation remains unknown. Mechanical stress appears to play an important role in the pathological osteogenesis process; nevertheless, the association of other important factors, such as the presence of HLA-B27 and environmental factors, remains uncertain. The present review summarizes the experimental findings that describe the signaling pathways involved in the new bone formation process in spondyloarthritis in animal models and in human biopsies. The role of mechanical stress as the trigger of these pathways is also reviewed. PMID:26838262

  11. Talonavicular joint abnormalities and walking ability of patients with rheumatoid arthritis.

    Directory of Open Access Journals (Sweden)

    Miyamoto N

    2004-04-01

    Full Text Available Rheumatoid arthritis (RA is often associated with deformities of the feet, and foot pain often arises in the talonavicular joint of patients with RA. The object of this study was to assess the relationship between magnetic resonance imaging (MRI findings of the talonavicular joint and walking ability. The subjects were 35 RA patients (10 feet in 5 males and 56 feet in 30 females aged 34-87 years (mean: 70 years +/- 12.1, with a disease duration from 1-54 years (mean: 14 years +/- 12.1. MRI findings were classified as follows: Grade 1, almost normal; Grade 2, early articular destruction; Grade 3, moderate articular destruction; Grade 4, severe articular destruction; and Grade 5, bony ankylosis dislocation. Walking ability was classified into one of 9 categories ranging from normal gait to bedridden status according to the system of Fujibayashi. As the grade of MRI images became higher the walking ability decreased, and these parameters showed a correlation by Spearman's rank correlation coefficient analysis (P = 0.003. Thus, in the present cohort group of patients with RA, the deterioration of walking ability increased with the severity of destruction of the talonavicular joint.

  12. General anesthesia in fibrodysplasia ossificans progressive: a case report and clinical review.

    Science.gov (United States)

    Liu, Jin-Xing; Hu, Rong; Sun, Yu; Jiang, Hong

    2014-01-01

    Fibrodysplasia ossificans progressiva (FOP) is a rare and devastating genetic disorder of connective tissue characterized by heterotopic bone formation and progressive musculoskeletal disability. Soft-tissue trauma may exacerbate this condition and lead to further ossification. We described the anesthetic and perioperative management of a 23-year-old male with FOP scheduled for dental extraction requiring general anesthesia. Preoperative examination revealed multisystem involvement including cranial and cervical ankylosis and severe restrictive lung disease. Nasal fiber-optic endotracheal intubation was chosen in our patient. Anesthesia was maintained with total intravenous anesthesia and ventilation was controlled throughout the surgery. Endotracheal tube was remained for mechanical ventilation until the second postoperative day and aggressive respiratory physiotherapy was performed after extubation. Additionally, extreme caution was taken to a femoral vascular access and an arterial catheter. Positioning of the patient was meticulous and air warming blanket was used to minimize soft tissue trauma. No significant documented intraoperative and postoperative adverse events appeared attributable to the anesthesia. PMID:24995115

  13. Hereditary bone dysplasia with pathological fractures and nodal osteoarthropathy

    Energy Technology Data Exchange (ETDEWEB)

    Arendse, Regan [University of Stellenbosch, Department of Medicine, Tygerberg Hospital, Stellenbosch (South Africa); University of Cape Town, Division of Rheumatology, Groote Schuur Hospital, Cape Town (South Africa); Brink, Paul [University of Stellenbosch, Department of Medicine, Tygerberg Hospital, Stellenbosch (South Africa); Beighton, Peter [University of Cape Town, Division of Human Genetics, Faculty of Health Sciences, Cape Town (South Africa)

    2009-12-15

    A father and daughter both had multiple pathological fractures and nodal osteoarthropathy. The father, aged 50 years, had at least 20 healed fractures of the axial and appendicular skeleton, sustained by minor trauma over his 50-year lifespan, many of which had been surgically fixed prior to his first presentation to us. Fractures of the clavicles, thoracic cage and long bones of the arms and legs, had healed with malalignment and deformity. Healed fractures were complicated by ankylosis of the cervical vertebrae and both elbows. He also had osteoarthritis of the hands, with exuberant osteophytosis, and profound perceptive deafness. His general health was good, his intellect and facies were normal, and his sclerae were white. The daughter, aged 27 years, had sustained at least seven fractures of the axial and appendicular skeleton following trivial injuries, in distribution similar to those of the father. She had also experienced painful swelling of the fingers, which preceded progressive development of nodal osteoarthropathy. Her hearing was normal. In both individuals, biochemical and immunological investigations yielded normal results. It was not possible for molecular studies to be undertaken. Pedigree data were consistent with autosomal dominant transmission, and this disorder appeared to be a previously undocumented heritable skeletal dysplasia. (orig.)

  14. [Tuberculosis cutis luposa gigantea with Mycobacterium bovis detection].

    Science.gov (United States)

    Bonnekoh, B; Schütt-Gerowitt, H; Thiele, B; Mahrle, G

    1990-10-01

    In an 80-year-old woman, retired farmworker, we observed lupus vulgaris extending over more than half of her leg. The extreme size of the affected area made us talk of a giant form in this case. Bacteriological investigation revealed Mycobacterium bovis. The minimal amount of tuberculin required to induce a positive intradermal reaction was 10 IU (GT Behring). Another case with similar dimensions (reported by Christiansen in 1967) had been caused by Mycobacterium avium and developed over a period of at least 5 years. The vast cutaneous affection of our patient, in contrast, had developed within only one year, starting from a brownish macula of the size of a palm on her upper leg. This macula - presumably the manifestation of quiescent lupus vulgaris - had not changed for more than 40 years. This late exacerbation of post-primary tuberculosis might have been favored by the patient's reduced immunologic resistance on account of her advanced age. In addition, local cofactors - namely ankylosis of her knee and contact eczematous dermatitis - have to be considered. In accordance with the resistogram, the disease responded to monotherapy with isoniazide. PMID:2291294

  15. Overexpression of Shox2 Leads to Congenital Dysplasia of the Temporomandibular Joint in Mice

    Directory of Open Access Journals (Sweden)

    Xihai Li

    2014-07-01

    Full Text Available Our previous study reported that inactivation of Shox2 led to dysplasia and ankylosis of the temporomandibular joint (TMJ, and that replacing Shox2 with human Shox partially rescued the phenotype with a prematurely worn out articular disc. However, the mechanisms of Shox2 activity in TMJ development remain to be elucidated. In this study, we investigated the molecular and cellular basis for the congenital dysplasia of TMJ in Wnt1-Cre; pMes-stop Shox2 mice. We found that condyle and glenoid fossa dysplasia occurs primarily in the second week after the birth. The dysplastic TMJ of Wnt1-Cre; pMes-stop Shox2 mice exhibits a loss of Collagen type I, Collagen type II, Ihh and Gli2. In situ zymography and immunohistochemistry further demonstrate an up-regulation of matrix metalloproteinases (MMPs, MMP9 and MMP13, accompanied by a significantly increased cell apoptosis. In addition, the cell proliferation and expressions of Sox9, Runx2 and Ihh are no different in the embryonic TMJ between the wild type and mutant mice. Our results show that overexpression of Shox2 leads to the loss of extracellular matrix and the increase of cell apoptosis in TMJ dysplasia by up-regulating MMPs and down-regulating the Ihh signaling pathway.

  16. The genetic basis of ankylosing spondylitis: new insights into disease pathogenesis.

    Science.gov (United States)

    Tsui, Florence Wl; Tsui, Hing Wo; Akram, Ali; Haroon, Nigil; Inman, Robert D

    2014-01-01

    Ankylosing spondylitis (AS) is a complex disease involving multiple risk factors, both genetic and environmental. AS patients are predominantly young men, and the disease is characterized by inflammation and ankylosis, mainly at the cartilage-bone interface and enthesis. HLA-B27 has been known to be the major AS-susceptibility gene for more than 40 years. Despite advances made in the past few years, progress in the search for non-human leukocyte antigen susceptibility genes has been hampered by the heterogeneity of the disease. Compared to other complex diseases, such as inflammatory bowel disease (IBD), fewer susceptibility loci have been identified in AS. Furthermore, non-major histocompatibility-complex susceptibility loci discovered, such as ERAP1 and IL23R, are likely contributors to joint inflammation. Identification and confirmation of functional variants remains a significant challenge of investigations involving genome-wide association studies (GWAS). It remains unclear why none of the AS-susceptibility genes identified in GWAS appear to be directly involved in the ankylosing process. Numerous reviews have recently been published on the genetics of AS. Therefore, aside from a brief summary of what AS GWAS has successfully achieved thus far, this review will focus on directions that could address unanswered questions raised by GWAS. PMID:24971029

  17. A clinical perspective on common forms of acquired heterotopic ossification

    Energy Technology Data Exchange (ETDEWEB)

    Garland, D.E. (Rancho Los Amigos Medical Center, Downey, CA (USA))

    1991-02-01

    The clinical courses of heterotopic ossification (HO) as a consequence of trauma and central nervous system insults have many similarities as well as dissimilarities. Detection is commonly noted at two months. The incidence of clinically significant HO is 10%-20%. Approximately 10% of the HO is massive and causes severe restriction in joint motion or ankylosis. The most common sign and symptom are decreased range of motion and pain. The locations are the proximal limbs and joints. Sites of HO about a joint may vary according to the etiology of the HO. Roentgenographic evolution of HO occurs during a six-month period in the majority of patients. Treatment modalities include diphosphonates, indomethacin, radiation, range of motion exercises, and surgical excision. Surgical timing differs according to etiology: traumatic HO may be resected at six months; spinal cord injury HO is excised at one year; and traumatic brain injury HO is removed at 1.5 years. A small number of patients have progression of HO with medicinal treatment and recurrence after resection. The patients seem recalcitrant to present treatment methods regardless of the HO etiology. 117 refs.

  18. Tooth Germ-Like Construct Transplantation for Whole-Tooth Regeneration: An In Vivo Study in the Miniature Pig.

    Science.gov (United States)

    Yang, Kai-Chiang; Kitamura, Yutaka; Wu, Chang-Chin; Chang, Hao-Hueng; Ling, Thai-Yen; Kuo, Tzong-Fu

    2016-04-01

    The purpose of this study was to demonstrate the feasibility of whole-tooth regeneration using a tooth germ-like construct. Dental pulp from upper incisors, canines, premolars, and molars were extracted from sexually mature miniature pigs. Pulp tissues were cultured and expanded in vitro to obtain dental pulp stem cells (DPSCs), and cells were differentiated into odontoblasts and osteoblasts. Epithelial cells were isolated from gingival epithelium. The epithelial cells, odontoblasts, and osteoblasts were seeded onto the surface, upper, and lower layers, respectively, of a bioactive scaffold. The lower first and second molar tooth germs were removed bilaterally and the layered cell/scaffold constructs were transplanted to the mandibular alveolar socket of a pig. At 13.5 months postimplantation, seven of eight pigs developed two teeth with crown, root, and pulp structures. Enamel-like tissues, dentin, cementum, odontoblasts, and periodontal tissues were found upon histological inspection. The regenerated tooth expressed dentin matrix protein-1 and osteopontin. All pigs had regenerated molar teeth regardless of the original tooth used to procure the DPSCs. Pigs that had tooth germs removed or who received empty scaffolds did not develop teeth. Although periodontal ligaments were generated, ankylosis was found in some animals. This study revealed that implantation of a tooth germ-like structure generated a complete tooth with a high success rate. The implant location may influence the morphology of the regenerated tooth. PMID:26582651

  19. [Intravenous regional sympathetic block with guanethidine. Retrospective study of 251 blocks of the upper limb in 68 patients].

    Science.gov (United States)

    Egloff, D V; Piaget, F

    1989-01-01

    68 patients have been treated by regional intravenous blocks with guanethidine. 251 blocks have been realized. The majority of the patients received 3 blocks of one week. Some of them got a second series of 3 blocks after a minimum interval of one month. The study included 3 groups of patients. The first group showed 12 patients in the first stage of Sudeck; the second group 22 patients in the second stage. The third group included 34 patients for which the indication to blockade had been a chronic painful stage (19 cases), an ankylosis (8 cases), a Dupuytren post-traumatic contracture (3 cases) a stage before the operation predisposing to dystrophy reflex (3 cases) and one case of hyperhidrosis of the hand. Considering the three groups it can be stated that the first one responded the best to the treatment with a success in 80% of the cases. This success confirms the necessity of intervening as soon as possible in case of an algoneurodystrophy. The third group reveals that this therapeutical method can be useful in other situations than the dystrophy reflexes. The indication herewith is more founded on a possible sympathetic origin of the troubles as on the comportment psycho-affective of the patient. PMID:2481373

  20. Roentgenographic study of the temporomandibular joint in rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Ho Jung; You, Dong Soo [Department of Oral Radiology, College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    1984-11-15

    For the study of the temporomandibular joint in rheumatoid arthritis 30 patients were selected who were diagnosis as rheumatoid arthritis through the clinical, radiographic examination and laboratory finding. Temporoman dibular joint involvement was evaluated through the clinical, radiographic examination. The results were as follows; 1. TMJ was involved in 15 patients of 30 patients with rheumatoid arthritis. (50% involvement). 2. Duration of rheumatoid arthritis was more longer in patients with TMJ involvement than in patients without TMJ involvement. 3. Osseous changes in TMJ were in order of frequency erosion, flattening, osteophyte, sclerosis, deformity, and most common involved site was mandibular condyle. 4. Most common positional change of condyle was forward position in centric occlusion, and restricted movement of condyle in 1 inch mouth opening. 5. TMJ involvement of rheumatoid arthritis was almost bilateral. 6. Main symptoms of TMJ were pain, stiffness, tenderness, limitation of mouth opening, crepitation. 7. There was not the case of ankylosis. 8. There was statistically insignificant correlation between mandibular deviation and TMJ involvement, but some cases showed severe deviation on mouth opening.

  1. Hereditary bone dysplasia with pathological fractures and nodal osteoarthropathy

    International Nuclear Information System (INIS)

    A father and daughter both had multiple pathological fractures and nodal osteoarthropathy. The father, aged 50 years, had at least 20 healed fractures of the axial and appendicular skeleton, sustained by minor trauma over his 50-year lifespan, many of which had been surgically fixed prior to his first presentation to us. Fractures of the clavicles, thoracic cage and long bones of the arms and legs, had healed with malalignment and deformity. Healed fractures were complicated by ankylosis of the cervical vertebrae and both elbows. He also had osteoarthritis of the hands, with exuberant osteophytosis, and profound perceptive deafness. His general health was good, his intellect and facies were normal, and his sclerae were white. The daughter, aged 27 years, had sustained at least seven fractures of the axial and appendicular skeleton following trivial injuries, in distribution similar to those of the father. She had also experienced painful swelling of the fingers, which preceded progressive development of nodal osteoarthropathy. Her hearing was normal. In both individuals, biochemical and immunological investigations yielded normal results. It was not possible for molecular studies to be undertaken. Pedigree data were consistent with autosomal dominant transmission, and this disorder appeared to be a previously undocumented heritable skeletal dysplasia. (orig.)

  2. Diagnostic imaging of sacroiliac joints and the spine in the course of spondyloarthropathies

    International Nuclear Information System (INIS)

    Spondyloarthropathies belong to a group of rheumatic diseases, in which inflammatory changes affect mainly the sacroiliac joints, spine, peripheral joints, tendon, ligaments and capsule attachments (entheses). This group includes 6 entities: ankylosing spondylitis, arthritis associated with inflammatory bowel disease, reactive arthritis, undifferentiated spondyloarthropathy, psoriatic arthritis and juvenile spondyloarthropathy. In 2009, ASAS (Assessment in SpondyloArthritis international Society) association, published classification criteria for spondyloarthropathies, which propose standardization of clinical-diagnostic approach in the case of sacroiliitis, spondylitis and arthritis. Radiological diagnosis of inflammatory changes of sacroiliac joints is based on a 4 step radiographic grading method from 1966. According to modified New York criteria, the diagnosis of ankylosing spondylitis is made based on the presence of advanced lesions, sacroiliitis of at least 2 grade bilaterally or 3–4 unilaterally. In case of other types of spondyloarthropathies diagnosis is made based on presence of at least grade 1 changes. In MRI, active inflammation of sacroiliac joints is indicated by the presence of subchondral bone marrow edema, synovitis, bursitis, or enthesitis. ASAS discusses only the classic form of axial spondyloarthropathies, which is ankylosing spondylitis. To quantify radiological inflammatory changes in the course of the disease, Stoke Ankylosing spondylitis classification Spinal Score (SASSS) is recommended. The signs of inflammation and scarrying of the spinal cord in the course of ankylosing spondylitis, present in MRI include: bone marrow edema, sclerosis, fat metaplasia, formation of syndesmophytes, and ankylosis

  3. Arthroscopic tibiotalar and subtalar joint arthrodesis.

    Science.gov (United States)

    Roussignol, X

    2016-02-01

    Arthroscopy has become indispensable for performing tibiotalar and subtalar arthrodesis. Now in 2015, it is the gold-standard surgical technique, and open surgery is reserved only for cases in which arthroscopy is contraindicated: material ablation after consolidation failure, osteophytes precluding a work chamber, excentric talus, severe malunion, bone defect requiring grafting, associated midfoot deformity, etc. The first reports of arthroscopic tibiotalar and subtalar arthrodesis date from the early 1990s. Consolidation rates were comparable to open surgery, but with significantly fewer postoperative complications: infection, skin necrosis, etc. Arthroscopy was for many years reserved to moderate deformity, with frontal or sagittal deviation less than 10°. The recent literature, however, seems to extend indications, the only restriction being the surgeon's experience. Tibiotalar arthrodesis on a posterior arthroscopic approach remains little used. And yet the posterior work chamber is much larger, and initial series showed consolidation rates similar to those of an anterior approach. The surgical technique for posterior tibiotalar arthrodesis was described by Van Dijk et al., initially using a posterior para-Achilles approach. This may be hampered by posterior osteophytes or ankylosis of the subtalar joint line (revision of non-consolidated arthrodesis, sequelae of calcaneal thalamus fracture) and is now used only by foot and ankle specialists. Posterior double tibiotalar-subtalar arthrodesis, described by Devos Bevernage et al., is facilitated by transplantar calcaneo-talo-tibial intramedullary nailing. PMID:26797006

  4. Fibroblast-Like Synoviocytes Induce Calcium Mineral Formation and Deposition

    Directory of Open Access Journals (Sweden)

    Yubo Sun

    2014-01-01

    Full Text Available Calcium crystals are present in the synovial fluid of 65%–100% patients with osteoarthritis (OA and 20%–39% patients with rheumatoid arthritis (RA. This study sought to investigate the role of fibroblast-like synoviocytes (FLSs in calcium mineral formation. We found that numerous genes classified in the biomineral formation process, including bone gamma-carboxyglutamate (gla protein/osteocalcin, runt-related transcription factor 2, ankylosis progressive homolog, and parathyroid hormone-like hormone, were differentially expressed in the OA and RA FLSs. Calcium deposits were detected in FLSs cultured in regular medium in the presence of ATP and FLSs cultured in chondrogenesis medium in the absence of ATP. More calcium minerals were deposited in the cultures of OA FLSs than in the cultures of RA FLSs. Examination of the micromass stained with nonaqueous alcoholic eosin indicated the presence of birefringent crystals. Phosphocitrate inhibited the OA FLSs-mediated calcium mineral deposition. These findings together suggest that OA FLSs are not passive bystanders but are active players in the pathological calcification process occurring in OA and that potential calcification stimuli for OA FLSs-mediated calcium deposition include ATP and certain unidentified differentiation-inducing factor(s. The OA FLSs-mediated pathological calcification process is a valid target for the development of disease-modifying drug for OA therapy.

  5. Treatment of Necrotic Calcified Tooth Using Intentional Replantation Procedure

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    Nima Moradi Majd

    2014-01-01

    Full Text Available Introduction. If the teeth are impacted by a chronic irritant, the pulp space possibly will undergo calcific changes that may impede access opening during root canal treatment. In such cases that conventional endodontic treatment is impossible or impractical, intentional replantation may be considered as a last solution to preserve the tooth. Methods. After failing to perform conventional root canal therapy for a necrotic calcified right mandibular second premolar, the tooth was gently extracted. The root apex was resected and the root end cavity was prepared and filled with calcium enriched mixture (CEM cement. Then, the extracted tooth was replanted in its original position. Results. After a year the tooth was asymptomatic, and the size of periapical radiolucency was remarkably reduced and no clinical sign of ankylosis was observed. Conclusion. Intentional replantation of the necrotic calcified teeth could be considered as an alternative to teeth extraction, especially for the single-rooted teeth and when nonsurgical and surgical endodontic procedures seem impossible.

  6. Fragility Fractures in Patients with Psoriatic Arthritis.

    Science.gov (United States)

    Del Puente, Antonio; Esposito, Antonella; Costa, Luisa; Benigno, Carla; Del Puente, Aurora; Foglia, Francesca; Oriente, Alfonso; Bottiglieri, Paolo; Caso, Francesco; Scarpa, Raffaele

    2015-11-01

    Psoriatic arthritis (PsA) can have peculiar effects on bone, including mechanisms of bone loss such as erosions, but also of bone formation, such as ankylosis or periostitis. The aim of the present study was to describe the prevalence of fractures in patients with PsA as compared to healthy controls and to investigate determinants of fractures among cases. For both cases and controls, radiographs were read to identify vertebral fractures (VF), and the presence of femoral neck or other nonvertebral fractures was obtained from patients' medical history. The prevalence of fragility fractures on radiographic readings did not differ between cases and controls. The number of subjects showing a VF was 33 (36%) among PsA patients and 36 (36%) among controls, with a prevalence of severe VF of 8% among cases and 4% among controls. Controlling for covariates in a logistic model, the only variables showing a significant correlation with the presence of nonvertebral fractures (NVF) were disease duration (p=0.02), age (p=0.03), and bone mineral density at femoral neck (inverse correlation, p=0.04). Fractures should be carefully considered when evaluating the global picture of the patient with PsA for their contribution to the "fragility" profile. PMID:26523054

  7. Profunda Femoris Artery Perforator Propeller Flap: A Valid Method to Cover Complicated Ischiatic Pressure Sores.

    Science.gov (United States)

    Scalise, Alessandro; Tartaglione, Caterina; Bolletta, Elisa; Pierangeli, Marina; Di Benedetto, Giovanni

    2015-08-01

    We report the case of a 50-year-old paraplegic man with a complicated grade III/IV ischiatic pressure sore treated with a propeller flap based on the first perforator of the profunda femoris artery. Our aim was to surgically reconstruct an ischiatic pressure sore in a patient with ankylosis using a fasciocutaneous perforator propeller flap obtained from the posterior region of the thigh. Our decision to perform a profunda femoris artery perforator propeller flap reconstruction was mainly due to the anatomical contiguity of the flap with the site of the lesion and the good quality of the skin harvested from the posterior region of the thigh. The use of the perforator fasciocutaneous flap represents a muscle-sparing technique, providing a better long-term result in surgical reconstruction. The choice of the 180-degree propeller flap was due to its ability to provide a good repair of the pressure ulcer and to pass over the ischiatic prominence in the patient in the forced decubitus position. The operatory course did not present any kind of complication. Using this reconstructive treatment, we have obtained complete coverage of the ischiatic pressure sore. PMID:26495200

  8. Occult radiological effects of lipomatosis of the lumbosacral plexus

    Energy Technology Data Exchange (ETDEWEB)

    Mahan, Mark A. [Barrow Neurological Institute, Phoenix, AZ (United States); Howe, B.M.; Amrami, Kimberly K. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Spinner, Robert J. [Mayo Clinic, Department of Neurosurgery, Rochester, MN (United States); Mayo Clinic, Department of Orthopedics, Rochester, MN (United States); Mayo Clinic, Rochester, MN (United States)

    2014-07-15

    Lipomatosis of nerve (LN) is a condition of massive peripheral nerve enlargement frequently associated with hypertrophy within the distribution of the nerve, and most commonly affecting the distal limbs. We sought to understand if LN of the lumbosacral plexus would be associated with the trophic effects of LN on surrounding tissue within the pelvis, which may be clinically occult, but present on MRI. Fifty-one cases of LN, confirmed by pathology or pathognomonic appearance on MRI, were reviewed. Patients with LN of the sciatic nerve were investigated for radiological signs suggestive of overgrowth. Five patients had involvement of the sciatic nerve, 4 of whom had MR imaging of the pelvis. Three patients had LN involving the lumbosacral plexus, and one patient had isolated involvement of the sciatic nerve. All patients with involvement of the lumbosacral plexus demonstrated previously unrecognized evidence of nerve territory overgrowth in the pelvis, including: LN, profound adipose proliferation, muscle atrophy and fatty infiltration, and bone hypertrophy and ankylosis. The patient with LN involving the intrapelvic sciatic nerve, but not the lumbosacral plexus did not demonstrate any radiological evidence of pelvic overgrowth. LN is broader in anatomical reach than previously understood. Proximal plexal innervation may be involved, with a consequent effect on axial skeleton and intrapelvic structures. (orig.)

  9. Extensive heterotopic ossification in patient with tubercular meningitis

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    Vijai Prakash Sharma

    2014-01-01

    Full Text Available Tubercular meningitis is a severe form of central nervous system tuberculosis with high morbidity and mortality. Apart from neurological deficits, musculoskeletal involvement is also seen in very few cases in the form of heterotopic ossification around immobile joints. A 35-year-old male case of tubercular meningitis with left hemiparesis presented with multiple joint restriction of range of motion. On clinical examination, palpable firm masses around multiple joints with painful restriction of movements were seen. X-ray films of multiple joints revealed heterotopic ossification over left shoulder, hip and knee joint with bony ankylosis of left hip and soft tissue contractures. Very few reports have been published in the literature for association of heterotopic ossification with tubercular meningitis with such extensive joint involvement which compels us to report this clinical association of tubercular meningitis. This report is intended to create caution among physicians and other caregivers for this debilitating complication of tubercular meningitis and in face of high prevalence of tuberculosis and tubercular meningitis, employ methods to prevent and treat.

  10. Enduring fluoride health hazard for the Vesuvius area population: the case of AD 79 Herculaneum.

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    Pierpaolo Petrone

    Full Text Available BACKGROUND: The study of ancient skeletal pathologies can be adopted as a key tool in assessing and tracing several diseases from past to present times. Skeletal fluorosis, a chronic metabolic bone and joint disease causing excessive ossification and joint ankylosis, has been only rarely considered in differential diagnoses of palaeopathological lesions. Even today its early stages are misdiagnosed in endemic areas. METHODOLOGY/PRINCIPAL FINDINGS: Endemic fluorosis induced by high concentrations of fluoride in water and soils is a major health problem in several countries, particularly in volcanic areas. Here we describe for the first time the features of endemic fluorosis in the Herculaneum victims of the 79 AD eruption, resulting from long-term exposure to high levels of environmental fluoride which still occur today. CONCLUSIONS/SIGNIFICANCE: Our observations on morphological, radiological, histological and chemical skeletal and dental features of this ancient population now suggest that in this area fluorosis was already endemic in Roman times. This evidence merged with currently available epidemiologic data reveal for the Vesuvius area population a permanent fluoride health hazard, whose public health and socio-economic impact is currently underestimated. The present guidelines for fluoridated tap water might be reconsidered accordingly, particularly around Mt Vesuvius and in other fluoride hazard areas with high natural fluoride levels.

  11. Fluorosis

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    Fallahian F. MD- Internist

    2003-07-01

    Full Text Available The health of habitants, living in un-fluoridated drinking water areas, can be endangered"nthrough fluoride intake from food, beverages, tooth paste and dentistry products. Fluoride is used in"nmouthwash, toothpaste, juice fruits, conserved foods and Teflon dishes. Water exposure to fluoride"noccurs through fertilizers, aluminum industries, insecticides, pesticides, herbicides and fungicides used"nfor fruits and vegetables which ultimately lead to environmental fluoride pollution. Some side effects."ncaused by chronic fluoride intake are as follows: decrease of hemoglobin concentration, gastrointestinal"ndisorders, and tooth loss at young age, osteofluorosis, hip fracture among aged people, osteosclerosis,"nosteoporosis, special forms of arthritis and joint ankylosis, metaphysial osteomalacia, mottling and weak"nstructure of tooth, insulin secretion and glucose tolerance test disorders, decrease of urine concentration,"nimmune system disorders, genetic defects and cancer, learning disabilities and IQ(intelligence quotient"ndeficits and thyroid dysfunction The present article was to investigate the side effect of excessive"nfluoride intake and to discuss different preventive and diagnostic ways.

  12. Psoriatic arthritis: imaging techniques

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    E. Lubrano

    2012-06-01

    Full Text Available Imaging techniques to assess psoriatic arthritis (PsA include radiography, ultrasonography (US, magnetic resonance imaging (MRI, computed tomography (CT and bone scintigraphy. The radiographic hallmark of PsA is the combination of destructive changes (joint erosions, tuft resorption, osteolysis with bone proliferation (including periarticular and shaft periostitis, ankylosis, spur formation and non-marginal syndesmophytes. US has an increasing important role in the evaluation of PsA. In fact, power Doppler US is useful mainly for its ability to assess musculoskeletal (joints, tendons, entheses and cutaneous (skin and nails involvement, to monitor efficacy of therapy and to guide steroid injections at the level of inflamed joints, tendon sheaths and entheses. MRI allows direct visualization of inflammation in peripheral and axial joints, and peripheral and axial entheses, and has dramatically improved the possibilities for early diagnosis and objective monitoring of the disease process in PsA. MRI has allowed explaining the relationships among enthesitis, synovitis and osteitis in PsA, supporting a SpA pattern of inflammation where enthesitis is the primary target of inflammation. CT has little role in assessment of peripheral joints, but it may be useful in assessing elements of spine disease. CT accuracy is similar to MRI in assessment of erosions in sacroiliac joint involvement, but CT is not as effective in detecting synovial inflammation. Bone scintigraphy lacks specificity and is now supplanted with US and MRI techniques.

  13. The contemporary imaging methods of arthritis of the knee: algorithm of radiological examination

    International Nuclear Information System (INIS)

    Arthritis is a common term used for over 50 different joint diseases. Arthritis of the knee from the data of traumatologists takes about 16-22% of all arthritis. The precise diagnosis in early stage is very important to prevent such severe complications of arthritis as ankylosis and others because certain problems require immediate attention and prompt treatment. The aim of the study was to create an algorithm for precise diagnosis of arthritis in early stage taking in account clinics, possible cause of the arthritis and potentialities and informatively of the new radiological equipment. There were analysed 43 conventional radiograms, 10 ultra sonograms, 5 computer tomograms, 3 magnetic resonance and 7 radionuclide images of the patients with different stages and causes of the arthritis of the knee. The findings were correlated with literature data. From data of the study authors conclude that in the early stage of the arthritis the conventional radiology findings can be negative. If arthritis goes with excess fluid or cysts in the joint and also in paediatric praxis it might be more convenient to start examinations with ultrasonography. If there is clinical suspicion of bone marrow, tendon or cartilage structures involvement must be used magnetic resonance. To detect more precise destructive cavities or localisation of squirmiest the computer tomography should be performed. According to analysis for precise early radiological diagnosis and for follow up of the arthritis of the knee its treatment, authors made up algorithm for the patients with arthritis of the knee depending of the clinics and radiological findings

  14. Detectability for Nondeterministic Discrete Event Systems and Its Applications in Medical Diagnosis

    Institute of Scientific and Technical Information of China (English)

    舒少龙; 林峰

    2008-01-01

    In this paper,we extend our previous results on detectability to nondeterministic discrete event systems.Many practical systems are nondeterministic,especially those in biomedicine.Disease models of patients are usually nondeterministic because hardly anything is deterministic in biological systems.The goal is to determine or estimate the current and subsequent states of a system based on a sequence of observations when the initial state of the system is unknown.We say that a system is detectable if one can determine its state after observing some outputs.The observation includes partial event observation and/or partial state observation.We define four types of detectabilities:strong detectability,(weak) detectability,strong periodic detectability,and (weak) periodic detectability.We derive necessary and sufficient conditions for these detectabilities.These conditions can be checked by constructing an observer,which models the estimation of states under different observation.Furthermore,we apply the results to medical diagnosis by considering a realistic example of diagnosing whether a patient suffers from one of the following five similar diseases:(1) rheumatoid arthritis,(2) rheumatic arthritis,(3) systemic lupus eruthematosus,(4) bony ankylosis,or (5) spondylitis ankylopoietica.

  15. Spine imaging after lumbar disc replacement: pitfalls and current recommendations

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    Sandén Bengt

    2009-07-01

    Full Text Available Abstract Background Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI. Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures. Methods Possible complications of lumbar total disc replacement (TDR are reviewed from the available literature and imaging recommendations given with regard to implant type. Two illustrative cases are presented in figures. Results Access-related complications, infections, implant wear, loosening or fracture, polyethylene inlay dislodgement, facet joint hypertrophy, central stenosis, and ankylosis of the operated segment can be visualised both in titanium and stainless steel implants, but require different imaging modalities due to magnetic artifacts in MRI. Conclusion Alternative radiographic procedures should be considered when evaluating patients following TDR. Postoperative complications following lumbar TDR including spinal stenosis causing radiculopathy and implant loosening can be visualised by myelography and radionucleotide techniques as an adjunct to plain film radiographs. Even in the presence of massive stainless steel TDR implants lumbar radicular stenosis and implant loosening can be visualised if myelography and radionuclide techniques are applied.

  16. [Chronic prostatitis and Bechterew's disease].

    Science.gov (United States)

    Kohlicek, J; Svec, V

    1977-11-01

    A group of patients between 35 and 65 years old with chronic prostatitis were examined for the presence of Becherew's disease. In this connection the New York and Roman criterions for morbus Bechterew were applied. There were found one ankyosing spondylarthritis, one ankylosis of the sacroiliac joint, and 11 times a tentative sacroileitis were stated. Altogether the proved and tentative findings were only 3.68 per cent of all examinations. In our countries the morbus Bechterew is found in 0,21 per cent of the normal population. So the protion of the Bechterew's disease in patients with chronic prostatitis is indeed a little higher than average, but not so frequent as often pretended in recent times. After a second series 58 patients being treated because of Bechterew's disease of different stages and different terms were examined for the possibility of a simultaneously elapsing chronic prostatitis. A chronic prostatitis was found in 38 per cent of these patients which correspondents to the incidence published in literature for the medium-age manhood. Nobody of the test persons had complaints on the part of the urologenital tract. PMID:602457

  17. Magnetic resonance imaging of sacroiliitis in patients with spondyloarthritis. Correlation with anatomy and histology

    Energy Technology Data Exchange (ETDEWEB)

    Hermann, K.G.A. [Charite Medical School, Campus Mitte, Berlin (Germany). Dept. of Radiology; Bollow, M. [Augusta Hospital, Bochum (Germany). Dept. of Diagnostic and Interventional Radiology and Nuclear Medicine

    2014-03-15

    Magnetic resonance imaging (MRI) of the sacroiliac joints (SIJs) has become established as a valuable modality for the early diagnosis of sacroiliitis in patients with inconclusive radiographic findings. Positive MRI findings have the same significance as a positive test for HLA-B27. Sacroiliitis is one of the key features of axial spondyloarthritis (SpA) in the classification proposed by the Assessments in Ankylosing Spondylitis (ASAS) group. Early signs of sacroiliitis include enthesitis of articular fibrocartilage, capsulitis, and osteitis. In more advanced disease, structural (chronic) lesions will be visible, including periarticular fatty deposition, erosions, subchondral sclerosis, and transarticular bone buds and bridges. In this article we describe magnetic resonance (MR) findings and provide histologic biopsy specimens of the respective disease stages. The predominant histologic feature of early and active sacroiliitis is the destruction of cartilage and bone by proliferations consisting of fibroblasts and fibrocytes, T-cells, and macrophages. Advanced sacroiliitis is characterized by new bone formation with enclosed cartilaginous islands and residual cellular infiltrations, which may ultimately lead to complete ankylosis. Knowledge of the morphologic appearance of the sacroiliac joints and their abnormal microscopic and gross anatomy is helpful in correctly interpreting MR findings. (orig.)

  18. A functional variant in ERAP1 predisposes to multiple sclerosis.

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    Franca Rosa Guerini

    Full Text Available The ERAP1 gene encodes an aminopeptidase involved in antigen processing. A functional polymorphism in the gene (rs30187, Arg528Lys associates with susceptibility to ankylosying spondylitis (AS, whereas a SNP in the interacting ERAP2 gene increases susceptibility to another inflammatory autoimmune disorder, Crohn's disease (CD. We analysed rs30187 in 572 Italian patients with CD and in 517 subjects suffering from multiple sclerosis (MS; for each cohort, an independent sex- and age-matched control group was genotyped. The frequency of the 528Arg allele was significantly higher in both disease cohorts compared to the respective control population (for CD, OR = 1.20 95%CI: 1.01-1.43, p = 0.036; for RRMS, OR = 1.26; 95%CI: 1.04-1.51, p = 0.01. Meta-analysis with the Wellcome Trust Cases Control Consortium GWAS data confirmed the association with MS (p(meta = 0.005, but not with CD. In AS, the rs30187 variant has a predisposing effect only in an HLA-B27 allelic background. It remains to be evaluated whether interaction between ERAP1 and distinct HLA class I alleles also affects the predisposition to MS, and explains the failure to provide definitive evidence for a role of rs30187 in CD. Results herein support the emerging concept that a subset of master-regulatory genes underlay the pathogenesis of autoimmunity.

  19. Increased risk of temporomandibular joint closed lock: a case-control study of ANKH polymorphisms.

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    Boyen Huang

    Full Text Available OBJECTIVES: This study aimed to carry out a histological examination of the temporomandibular joint (TMJ in ank mutant mice and to identify polymorphisms of the human ANKH gene in order to establish the relationship between the type of temporomandibular disorders (TMD and ANKH polymorphisms. MATERIALS AND METHODS: Specimens from the TMJ of ank mutant and wild-type mice were inspected with a haematoxylin and eosin staining method. A sample of 55 TMD patients were selected. Each was examined with standard clinical procedures and genotyping techniques. RESULTS: The major histological finding in ank mutant mice was joint space narrowing. Within TMD patients, closed lock was more prevalent among ANKH-OR homozygotes (p = 0.011, OR = 7.7, 95% CI 1.6-36.5 and the elder (p = 0.005, OR = 2.4, 95% CI 1.3-4.3. CONCLUSIONS: Fibrous ankylosis was identified in the TMJ of ank mutant mice. In the human sample, ANKH-OR polymorphism was found to be a genetic marker associated with TMJ closed lock. Future investigations correlating genetic polymorphism to TMD are indicated.

  20. Signs and Symptoms of Temporomandibular Joint Disorders Related to the Degree of Mouth Opening and Hearing Loss

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    Kanavaros Panagiotis

    2011-05-01

    Full Text Available Abstract Background The temporomandibular joint is a unique bi-condylar joint involved in mastication and speech. Temporomandibular joint disorders (TMD have a range of symptoms, including aural symptoms, and are present in approximately 75% of normal populations. The present study examined the relationship between signs and symptoms of TMD and mouth opening, gender, joint and aural symptoms, and hearing loss. Methods The study involved 464 healthy Greek university students (156 men and 308 women with a mean age of 19.6 years. Age, gender and maximum mouth opening was recorded. Mouth opening was measured using Vernier calipers. An anamnestic questionnaire was used to stratify the subjects into four groups based on TMD severity. Aural symptoms and an audiogram were recorded for each subject too. Data were analyzed using multifactor ANOVA, chi-square, t-test, Mann-Whitney and Kruskal-Wallis tests. Results The overall incidence of TMD signs and symptoms was 73.3%. The incidence and severity was greater in females than males (p-value 0.0001 Conclusions TMD signs and symptoms were more common and severe in females than males. TMD severity is correlated with the degree of mouth opening and the number of aural symptoms. The absence or presence of mild TMD are associated with normal audiograms while moderate and severe TMD are related to hearing loss in median and low tones respectively. Bruxism, joint ankylosis, joint pain and ear itching were more common in TMD than non-TMD patients.

  1. Psoriatic arthritis as a distinct disease entity

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    Leung Y

    2007-01-01

    Full Text Available Psoriatic arthritis (PsA is a chronic systemic inflammatory disease characterized by joint inflammation associated with cutaneous psoriasis. For many years, the amount of attention directed to PsA had been less than that for various other arthropathies. With the advances in understanding its pathogensis, it is now recognized as a distinct disease entity with characteristic features. Psoriatic arthritis has a greater tendency towards asymmetric oligoarticular involvement, distal interphalangeal involvement and spondylitis. Associated features such as enthesitis and dactylitis are more common. Specific radiological features include ankylosis and bone resorption. With the availability of potent new therapeutic agents for psoriasis and PsA, interest in research and clinical care for these conditions has been reinvigorated. Anti-TNF therapy has achieved encouraging efficacy in both the joints and skin disease, improving function and quality of life and inhibiting radiological progression measured in patients with PsA and psoriasis. Biologic agents may have the potential in addressing the unmet medical need in patients with PsA.

  2. Efficacy and safety of adalimumab in ankylosing spondylitis

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    Mounach A

    2014-08-01

    Full Text Available Aziza Mounach, Abdellah El MaghraouiRheumatology Department, Military Hospital Mohammed V, Rabat, MoroccoAbstract: Ankylosing spondylitis (AS is the most common and most severe subtype of spondyloarthritis. It also may be an outcome of any of the other spondyloarthritis subtypes. AS preferentially affects the sacroiliac joints and the tip of the column, with a tendency to later ankylosis. Peripheral joints, enthesis, and other extra-articular involvement may be observed. Tumor necrosis factor (TNF inhibitors are now well-established, effective drugs in the treatment of AS symptoms. Adalimumab, which is a fully human monoclonal antibody that binds to and neutralizes TNF, has demonstrated efficacy in treating AS symptoms, including axial involvement, peripheral arthritis, enthesitis, uveitis, gut involvement, and psoriasis. Furthermore, adalimumab has showed an overall acceptable safety profile. In this paper, we review the efficacy and safety profile of adalimumab in the treatment of AS, and discuss its differences from the other anti-TNF drugs reported in the literature.Keywords: ankylosing spondylitis, spondyloarthritis, adalimumab, tumor necrosis factor-α

  3. Current diagnosis and therapy of anterior mandibular fracture associated with condyle fractures%下颌骨前段骨折伴发髁突骨折的诊治现状

    Institute of Scientific and Technical Information of China (English)

    徐晓峰; 徐兵

    2014-01-01

    下颌骨前段骨折(包括正中联合及旁正中的骨折)是下颌骨骨折最常见的类型之一,且常常与髁突骨折同时发生。受解剖因素的影响,这类骨折一旦处理不当容易出现包括面下部增宽,咬合紊乱,甚至关节强直等多种并发症。本文就这类骨折的特点、常见并发症、诊断方法以及治疗过程中应注意的问题作一综述。%Anterior mandibular fracture, which includes symphyseal and parasymphyseal mandibular fractures, is one of the most common types of fracture in clinical work, and is usually associated with condyle fracture. This type of fracture predisposes the patients to facial widening, malocclusion, and ankylosis when not properly and timely treated because of the influence of its anatomic structure. This article reviews the characteristics, complication, diagnosis, and therapy of this type of fracture.

  4. Description of spinal findings and determining the MR positive spondylitis

    International Nuclear Information System (INIS)

    Full text: Spondyloarthritis (SpA) is an umbrella term applied to a family of rheumatic diseases that have both features in common with, as well as being distinct from, other inflammatory arthritides, particularly rheumatoid arthritis (RA). Recently, the ASAS working group established classification criteria to distinguish 2 broad categories of SpA: peripheral SpA and axSpA (Rudwaleit, 2011; Rudwaleit, 2010; Rudwaleit, 2009c). This division is based on the body part predominantly involved in the inflammatory process and those areas of the body that may respond similarly well to medication. Therefore, peripheral SpA includes diseases affecting mainly peripheral joints, such as reactive arthritis and psoriatic arthritis (PsA), whereas axSpA comprises those diseases with mainly axial involvement (sacroiliac joints and spine), including ankylosing spondylitis (AS) and nonradiographic axSpA (nr-axSpA). Patients with AS have definitive evidence of structural changes in the sacroiliac joint (sacroiliitis) on x-ray, fulfilling the Modified New York classification criteria (mNY-positive) (van der linden, 1984), whereas in those with nr-axSpA structural changes on conventional radiographs do not meet the mNy criteria (mNY-negative) (Rudwaleit, 2005; Dougados, 1991). Axial SpA is a chronic inflammatory disease that impacts a substantial proportion of the population. Limited evidence exists regarding the exact prevalence of axSpA. In the US, however, recent data suggest that the prevalence is similar to that of RA (axSpA: 0.7% to 1.4%; RA: 0.5% to 1.0%) (Reveille; 2012; Myasoedova, 2010; Helmick, 2008). In patients with axSpA, the disease typically originates in the sacroiliac joints, then progresses to the spine. In the sacroiliac joints and the spine, active inflammation results in erosions, sclerosis, and fatty lesions. However, the most characteristic feature is new bone formation leading to ankylosis of the sacroiliac joints and syndesmophytes attached to the vertebral

  5. 严重僵硬型颈椎后凸畸形的手术入路选择%Surgical approach of severe fixed cervical kyphosis

    Institute of Scientific and Technical Information of China (English)

    李方财; 陈其昕; 陈维善

    2015-01-01

    Objective To investigate the radiographic features and surgical approach of severe fixed cervical kyphosis.Methods Seventeen cases of severe fixed cervical kyphosis from January 2007 to January 2012 were studied retrospectively.There were 8 males and 9 females,with an average age of 49.7 years.The etiologies were 3 cases of infection,3 cases of degeneration,3 cases of neurofibromatosis,3 cases of prior laminectomy,2 cases of idiopathic,2 cases of trauma and 1 case of neuromuscular disease.The average length of kyphosis was 4.3 ± 1.2 segments.All patients complained of severe neck pain (visual analogue scale,VAS,7.6±1.5) or progressive cervical kyphosis.There were 4 cases with myelopathy,2 with radiculopathy,3 with difficulty of forward gaze and 1 with difficulty of swallowing.All patients were underwent dynamic flexion-extension radiographs and traction views.CT scans were carried out to identify the sites of fixed kyphosis.Continuous traction was performed after general anesthesia,and the surgical approach was decided according to spinal cord compression,length of kyphosis and the cause of fixed kyphosis.Surgical outcomes were assessed in terms of correction of Cobb angle and Odom criteria.Results All patients were followed-up for 2 to 5 years.According to the CT scans,the sites of fixed kyphosis were identified:anterior bony ankylosis in 7 cases,posterior in 6 cases and both anterior and posterior in 4 cases.The surgical approach were as following:anterior only in 4 cases,posterior only in 2 cases,anterior-posterior in 5 cases,posterior-anterior in 3 cases,anterior-posterior-anterior in 1 case and posterior-anterior-posterior in 2 cases.The Cobb angle was corrected from 49.3°± 14.6° preoperation to 2.1 °±6.8° at the latest follow-up,with an average correction of 47.2°.According to Odom criteria,there were 7 excellent outcome,8 good,2 fair and none poor outcome.Revision surgery was performed in 1 case due to proximal junctional kyphosis.At the latest

  6. The value of {sup 99m}Tc-HDP scan in the diagnosis of tibial avascular necrosis caused by thermal injury: a case with multi-image correlation analysis

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee [Sung-Ae General Hospital, Seoul (Korea, Republic of)

    2007-10-15

    Basic pathology in thermal injury is coagulative soft tissue necorsis that may occasionally be complicated by infection and later by scarring and vascular changes. Radiological features were discussed in detail by Resnick. The early changes consist of soft tissue defect, porosis and periostitis and the late changes include osteophytosis, periarticular calcification or ossification and arthropathy with ankylosis. Acromutilation can occur when small bones of the hand and foot are burned and scarred. This communication describes {sup 99m}Tc-HDP pnhole bone scan manifestations of thermal bone injuries observed in a case of skin-bone burns of the mid-tibial shaft that was complicated by infection, soft tissue scarring and osteonecrosis. Patient was a 49-year-old female thermal burn involving a mid-tibial shaft segment along with overlying skin. The injury was accidental to medullary rimming to fit intramedullary nail to fix fracture. The heat produced during drilling spread to burn the pretibial skin that is sparse in subcutaneous buffer tissue and vessels. The soft tissue burn was infected and healed by repeated skin grafts and scar over a period of 2 years. Concomitantly, the underlying bone was infected locally and treated but ensued in osteonecrosis that was accompanied by osteolysis. Indeed. pinhole {sup 99m}Tc-HDP scan played a unique role in this case in detecting that live lateral cortex had sustained the large dead bone that involved the main volume of the mid-tibial shaft. Importantly, the scan could confirm live cortex to have sustained dead bone uncollapsed. Anatomical and metabolic data gained from bone scanning prompted us to systematically scrutinize radiograph and CT to specifically identify the preserved lateral cortex. As mentioned the existence of healthy cortex is biomechanically and tactically vital to surgically replace and restore the devitalized bone.

  7. Magnetic resonance imaging features of hip disorders in an Egyptian pediatric population

    Directory of Open Access Journals (Sweden)

    Y. Ragab

    2015-09-01

    Full Text Available Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to assess the role of magnetic resonance imaging (MRI in the evaluation of non-traumatic hip disorders in a series of Egyptian patients and to review the literature on the most common hip conditions. Seventy two consecutive patients [40 males (55.6% and 32 females (44.4] with acute onset of hip complaints unrelated to trauma or falls were recruited. All patients underwent an initial full clinical assessment and blood tests as well as contrast enhanced MRI of both hips. The most common diagnosis in this group of Egyptian patients was transient synovitis in 29 (40.3% cases, followed by seronegative enthesopathy and arthropathy syndrome in 8 (11.1%, septic arthritis in 10 (13.9%, tuberculous arthritis in 4 (5.6%, sickle-cell disease in 7 (9.7%, complicated with septic arthritis in 3 (4.2%, transient bone marrow edema (BME in 3 (4.2%, osteomyelitis in 2 (2.8%, osteosarcoma in 2 (2.8%, sciatic nerve injury in 1 (1.4%, leukemia with BME in 1 (1.4%, coxa vara of both hips and L5/S1 facet joint ankylosis in 1 (1.4%, and a benign bone cyst in 1 (1.4%. MRI studies showed hip effusion in a total of 51 patients (70.8%, joint space narrowing in 9 (12.5%, and BME in 15(20.8%. MRI is a sensitive tool for assessing hip disorders in a pediatric population and can play an important role in both diagnosis and management of different hip disorders, irrespective of the underlying pathology.

  8. Magnetic resonance imaging features of hip disorders in an Egyptian pediatric population.

    Science.gov (United States)

    Ragab, Y; Nabih, M; Aly, I; Kamal, A; Abd-Allah, M A; El-Refai, R; Emad, Y; El-Naggar, A; El-Shaarawy, N; Rasker, J J

    2015-01-01

    Hip disorders in a pediatric population are a diagnostic challenge. The aim of the study is to assess the role of magnetic resonance imaging (MRI) in the evaluation of non-traumatic hip disorders in a series of Egyptian patients and to review the literature on the most common hip conditions. Seventy two consecutive patients [40 males (55.6%) and 32 females (44.4)] with acute onset of hip complaints unrelated to trauma or falls were recruited. All patients underwent an initial full clinical assessment and blood tests as well as contrast enhanced MRI of both hips. The most common diagnosis in this group of Egyptian patients was transient synovitis in 29 (40.3%) cases, followed by seronegative enthesopathy and arthropathy syndrome in 8 (11.1%), septic arthritis in 10 (13.9%), tuberculous arthritis in 4 (5.6%), sickle-cell disease in 7 (9.7%), complicated with septic arthritis in 3 (4.2%), transient bone marrow edema (BME) in 3 (4.2%), osteomyelitis in 2 (2.8%), osteosarcoma in 2 (2.8%), sciatic nerve injury in 1 (1.4%), leukemia with BME in 1 (1.4%), coxa vara of both hips and L5/S1 facet joint ankylosis in 1 (1.4%), and a benign bone cyst in 1 (1.4%). MRI studies showed hip effusion in a total of 51 patients (70.8%), joint space narrowing in 9 (12.5%), and BME in 15(20.8%). MRI is a sensitive tool for assessing hip disorders in a pediatric population and can play an important role in both diagnosis and management of different hip disorders, irrespective of the underlying pathology. PMID:26492965

  9. Magnetic resonance imaging for ankylosing spondylitis

    International Nuclear Information System (INIS)

    Ankylosing spondylitis (AS) is the prototypical form of the spondyloarthropathies, which at a prevalence of 2% is among the most frequent rheumatic diseases. Spondyloarthropathy comprises the following five disorders: AS, reactive arthritis, psoriatic arthritis, enteropathic arthritis in Crohn's disease, and ulcerosing colitis as well as undifferentiated spondyloarthropathy. In 99% of the patients with AS initial abnormal findings affect the sacroiliac joints. The radiographic changes required for diagnosing AS occur as late as 5-9 years after the onset of clinical symptoms. MRI of the sacroiliac joints reliably demonstrates both chronic inflammatory changes (erosions, sclerotic changes, bone bridges) and acute inflammatory changes (synovitis, capsulitis, osteitis) and allows for grading the chronicity and acuity of such changes. Enthesitis of the interosseous ligaments of the retroarticular space is a manifestation of AS. Spondylodiscitis (Andersson 1937) may occur as an inflammatory or non-inflammatory process (transdiscal fatigue fracture). Inflammations of the facet and costospinal joints developing into ankylosis are typical of AS. Changes of the vertebral bodies occur as anterior (Romanus 1952), posterior, and marginal spondylitis. All forms of spondyloarthropathies are furthermore characterized by asymmetrical synovitis of the large joints, particularly of the legs (gonarthritis, coxitis, tarsitis, peripheral oligoarthritis), rheumatic fibroosteitis (pelvic enthesitis, rheumatic calcaneopathy), and peri- and synchrondritis of the public symphisis and sternal synchondrosis. Since early inflammatory changes of the spinal column and of the extravertebral localizations in AS are demonstrated by MRI before they become apparent on radiographs, and thereby the diagnostic gap could be closed, the early use of MRI for diagnostic and follow-up is commendable, when new therapeutical options like the so-called 'biologicals' are employed. (orig.)

  10. Central role of pyrophosphate in acellular cementum formation.

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    Brian L Foster

    Full Text Available BACKGROUND: Inorganic pyrophosphate (PP(i is a physiologic inhibitor of hydroxyapatite mineral precipitation involved in regulating mineralized tissue development and pathologic calcification. Local levels of PP(i are controlled by antagonistic functions of factors that decrease PP(i and promote mineralization (tissue-nonspecific alkaline phosphatase, Alpl/TNAP, and those that increase local PP(i and restrict mineralization (progressive ankylosis protein, ANK; ectonucleotide pyrophosphatase phosphodiesterase-1, NPP1. The cementum enveloping the tooth root is essential for tooth function by providing attachment to the surrounding bone via the nonmineralized periodontal ligament. At present, the developmental regulation of cementum remains poorly understood, hampering efforts for regeneration. To elucidate the role of PP(i in cementum formation, we analyzed root development in knock-out ((-/- mice featuring PP(i dysregulation. RESULTS: Excess PP(i in the Alpl(-/- mouse inhibited cementum formation, causing root detachment consistent with premature tooth loss in the human condition hypophosphatasia, though cementoblast phenotype was unperturbed. Deficient PP(i in both Ank and Enpp1(-/- mice significantly increased cementum apposition and overall thickness more than 12-fold vs. controls, while dentin and cellular cementum were unaltered. Though PP(i regulators are widely expressed, cementoblasts selectively expressed greater ANK and NPP1 along the root surface, and dramatically increased ANK or NPP1 in models of reduced PP(i output, in compensatory fashion. In vitro mechanistic studies confirmed that under low PP(i mineralizing conditions, cementoblasts increased Ank (5-fold and Enpp1 (20-fold, while increasing PP(i inhibited mineralization and associated increases in Ank and Enpp1 mRNA. CONCLUSIONS: Results from these studies demonstrate a novel developmental regulation of acellular cementum, wherein cementoblasts tune cementogenesis by modulating

  11. Effects of concomitant use of fibroblast growth factor (FGF)-2 with beta-tricalcium phosphate ({beta}-TCP) on the beagle dog 1-wall periodontal defect model

    Energy Technology Data Exchange (ETDEWEB)

    Anzai, Jun, E-mail: anzai_jun@kaken.co.jp [Pharmacology Department, Central Research Laboratories, Kaken Pharmaceutical Co., Ltd., 14, Shinomiya, Minamigawara-cho, Yamashina-ku, Kyoto 607-8042 (Japan); Department of Periodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871 (Japan); Kitamura, Masahiro, E-mail: kitamura@dent.osaka-u.ac.jp [Department of Periodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871 (Japan); Nozaki, Takenori, E-mail: tnozaki@dent.osaka-u.ac.jp [Department of Periodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871 (Japan); Nagayasu, Toshie, E-mail: nagayasu_toshie@kaken.co.jp [Pharmacology Department, Central Research Laboratories, Kaken Pharmaceutical Co., Ltd., 14, Shinomiya, Minamigawara-cho, Yamashina-ku, Kyoto 607-8042 (Japan); Terashima, Akio, E-mail: terashima_akio@kaken.co.jp [Pharmacology Department, Central Research Laboratories, Kaken Pharmaceutical Co., Ltd., 14, Shinomiya, Minamigawara-cho, Yamashina-ku, Kyoto 607-8042 (Japan); Asano, Taiji, E-mail: asano_taiji@kaken.co.jp [Pharmacology Department, Central Research Laboratories, Kaken Pharmaceutical Co., Ltd., 14, Shinomiya, Minamigawara-cho, Yamashina-ku, Kyoto 607-8042 (Japan); Murakami, Shinya, E-mail: ipshinya@dent.osaka-u.ac.jp [Department of Periodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871 (Japan)

    2010-12-17

    Research highlights: {yields} Concomitant use of FGF-2 and {beta}-TCP (an osteo-conductive scaffold) significantly promotes periodontal regeneration in the severe periodontitis model (1-wall defect model) of beagle dog. {yields} FGF-2 enhanced new bone formation via {beta}-TCP at the defects. {yields} In particular, FGF-2 dramatically regenerated new periodontal ligament and cementum formations at the defects, that is one of the most important healing outcomes during the process of periodontal regeneration. {yields} Epithelial downgrowth (undesirable wound healing) was decreased by administration of FGF-2. {yields} This manuscript indicates for the first time that concomitant use of FGF-2 and {beta}-TCP is efficacious in regenerating periodontal tissue following severe destruction of the tissue by progression of periodontitis. -- Abstract: The effects of concomitant use of fibroblast growth factor-2 (FGF-2) and beta-tricalcium phosphate ({beta}-TCP) on periodontal regeneration were investigated in the beagle dog 1-wall periodontal defect model. One-wall periodontal defects were created in the mesial portion of both sides of the mandibular first molars, and 0.3% FGF-2 plus {beta}-TCP or {beta}-TCP alone was administered. Radiographic evaluation was performed at 0, 3, and 6 weeks. At 6 weeks, the periodontium with the defect site was removed and histologically analyzed. Radiographic findings showed that co-administration of FGF-2 significantly increased bone mineral contents of the defect sites compared with {beta}-TCP alone. Histologic analysis revealed that the length of the regenerated periodontal ligament, the cementum, distance to the junctional epithelium, new bone height, and area of newly formed bone were significantly increased in the FGF-2 group. No abnormal inflammatory response or ankylosis was observed in either group. These findings indicate the efficacy of concomitant use of FGF-2 and {beta}-TCP as an osteoconductive material for periodontal

  12. A review of the Liverpool elbow prosthesis from 1974 to 1982.

    Science.gov (United States)

    Soni, R K; Cavendish, M E

    1984-03-01

    Eighty elbows in 65 patients with an average age of 57 years have had two-part non-constrained Liverpool elbow arthroplasties performed since 1974. Fifty-five had rheumatoid arthritis, eight osteoarthritis or ankylosis secondary to injury, one osteochondritis dissecans and one pyknodysostosis. The average preoperative range of movement was 42 degrees to 112 degrees with 47 degrees of pronation and 42 degrees of supination. There was significant gain in the arc of movements at follow-up: 32 degrees in the extension-flexion range (average range 32 degrees to 134 degrees of flexion) and 42 degrees in forearm rotation (average pronation 69 degrees and supination 62 degrees). Before operation severe pain was the predominating symptom in 43 elbows (53.8%) but after replacement there was only moderate pain in five elbows (6.2%). The results were excellent in 42 (52.5%), good in 15 (18.7%), fair in 9 (11.3%) and unsatisfactory or poor in 14 (17.5%). Eight elbows required revision of the arthroplasty: three were post-traumatic, disorganised or osteoarthritic joints, three rheumatoid and both elbows in the patient with pyknodysostosis. Loosening of the prosthesis (particularly the humeral component) was the common factor necessitating revision. Of six rheumatoid elbows needing removal of the implant, four had deep infection, one had a dislodged humeral component as a result of injury and in one a divided olecranon had developed non-union. Rheumatoid elbows benefited more than post-traumatic arthritic elbows from the operation. (ABSTRACT TRUNCATED AT 250 WORDS) PMID:6707062

  13. Long-Term Symptoms Onset and Heterotopic Bone Formation around a Total Temporomandibular Joint Prosthesis: a Case Report

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    Luca Guarda-Nardini

    2014-04-01

    Full Text Available Background: The literature on total alloplastic temporomandibular joint (TMJ reconstructions is encouraging, and studies on total alloplastic TMJ replacements outcomes showed acceptable improvements in terms of both pain levels and jaw function. Nevertheless, some adverse events, such as heterotopic bone formation around the implanted prosthesis, may occur. In consideration of that, the present manuscript describes a case of heterotopic bone formation around a total temporomandibular joint prosthesis, which occurred several years after the implant. Methods: The present manuscript describes a case of heterotopic bone formation around a total TMJ prosthesis, which occurred several years after the implant in patients, who previously underwent multiple failed TMJ surgeries. Results: Ten years after the surgical TMJ replacement to solve an ankylotic bone block, the patient came to our attention again referring a progressive limitation in mouth opening. A computerized tomography showed evidence of marked heterotopic bone formation in the medial aspects of the joint, where a new-born ankylotic block occupied most part of the gap created by resecting the coronoid process at the time of the TMJ prosthesis insertion. Conclusions: Despite this adverse event has been sometimes described in the literature, this is the first case in which its occurrence happened several years after the temporomandibular joint replacement. It can be suggested that an accurate assessment of pre-operative risk factors for re-ankylosis (e.g., patients with multiple failed temporomandibular joint surgeries and within-intervention prevention (e.g., strategies to keep the bone interfaces around the implant separated should be better standardized and define in future studies.

  14. The value of 99mTc-HDP scan in the diagnosis of tibial avascular necrosis caused by thermal injury: a case with multi-image correlation analysis

    International Nuclear Information System (INIS)

    Basic pathology in thermal injury is coagulative soft tissue necorsis that may occasionally be complicated by infection and later by scarring and vascular changes. Radiological features were discussed in detail by Resnick. The early changes consist of soft tissue defect, porosis and periostitis and the late changes include osteophytosis, periarticular calcification or ossification and arthropathy with ankylosis. Acromutilation can occur when small bones of the hand and foot are burned and scarred. This communication describes 99mTc-HDP pnhole bone scan manifestations of thermal bone injuries observed in a case of skin-bone burns of the mid-tibial shaft that was complicated by infection, soft tissue scarring and osteonecrosis. Patient was a 49-year-old female thermal burn involving a mid-tibial shaft segment along with overlying skin. The injury was accidental to medullary rimming to fit intramedullary nail to fix fracture. The heat produced during drilling spread to burn the pretibial skin that is sparse in subcutaneous buffer tissue and vessels. The soft tissue burn was infected and healed by repeated skin grafts and scar over a period of 2 years. Concomitantly, the underlying bone was infected locally and treated but ensued in osteonecrosis that was accompanied by osteolysis. Indeed. pinhole 99mTc-HDP scan played a unique role in this case in detecting that live lateral cortex had sustained the large dead bone that involved the main volume of the mid-tibial shaft. Importantly, the scan could confirm live cortex to have sustained dead bone uncollapsed. Anatomical and metabolic data gained from bone scanning prompted us to systematically scrutinize radiograph and CT to specifically identify the preserved lateral cortex. As mentioned the existence of healthy cortex is biomechanically and tactically vital to surgically replace and restore the devitalized bone

  15. Effects of concomitant use of fibroblast growth factor (FGF)-2 with beta-tricalcium phosphate (β-TCP) on the beagle dog 1-wall periodontal defect model

    International Nuclear Information System (INIS)

    Research highlights: → Concomitant use of FGF-2 and β-TCP (an osteo-conductive scaffold) significantly promotes periodontal regeneration in the severe periodontitis model (1-wall defect model) of beagle dog. → FGF-2 enhanced new bone formation via β-TCP at the defects. → In particular, FGF-2 dramatically regenerated new periodontal ligament and cementum formations at the defects, that is one of the most important healing outcomes during the process of periodontal regeneration. → Epithelial downgrowth (undesirable wound healing) was decreased by administration of FGF-2. → This manuscript indicates for the first time that concomitant use of FGF-2 and β-TCP is efficacious in regenerating periodontal tissue following severe destruction of the tissue by progression of periodontitis. -- Abstract: The effects of concomitant use of fibroblast growth factor-2 (FGF-2) and beta-tricalcium phosphate (β-TCP) on periodontal regeneration were investigated in the beagle dog 1-wall periodontal defect model. One-wall periodontal defects were created in the mesial portion of both sides of the mandibular first molars, and 0.3% FGF-2 plus β-TCP or β-TCP alone was administered. Radiographic evaluation was performed at 0, 3, and 6 weeks. At 6 weeks, the periodontium with the defect site was removed and histologically analyzed. Radiographic findings showed that co-administration of FGF-2 significantly increased bone mineral contents of the defect sites compared with β-TCP alone. Histologic analysis revealed that the length of the regenerated periodontal ligament, the cementum, distance to the junctional epithelium, new bone height, and area of newly formed bone were significantly increased in the FGF-2 group. No abnormal inflammatory response or ankylosis was observed in either group. These findings indicate the efficacy of concomitant use of FGF-2 and β-TCP as an osteoconductive material for periodontal regeneration following severe destruction by progressive

  16. Analysis of meniscal degeneration and meniscal gene expression

    Directory of Open Access Journals (Sweden)

    Norton James H

    2010-01-01

    Full Text Available Abstract Background Menisci play a vital role in load transmission, shock absorption and joint stability. There is increasing evidence suggesting that OA menisci may not merely be bystanders in the disease process of OA. This study sought: 1 to determine the prevalence of meniscal degeneration in OA patients, and 2 to examine gene expression in OA meniscal cells compared to normal meniscal cells. Methods Studies were approved by our human subjects Institutional Review Board. Menisci and articular cartilage were collected during joint replacement surgery for OA patients and lower limb amputation surgery for osteosarcoma patients (normal control specimens, and graded. Meniscal cells were prepared from these meniscal tissues and expanded in monolayer culture. Differential gene expression in OA meniscal cells and normal meniscal cells was examined using Affymetrix microarray and real time RT-PCR. Results The grades of meniscal degeneration correlated with the grades of articular cartilage degeneration (r = 0.672; P HLA-DPA1, integrin, beta 2 (ITGB2, ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1, ankylosis, progressive homolog (ANKH and fibroblast growth factor 7 (FGF7, were expressed at significantly higher levels in OA meniscal cells compared to normal meniscal cells. Importantly, many of the genes that have been shown to be differentially expressed in other OA cell types/tissues, including ADAM metallopeptidase with thrombospondin type 1 motif 5 (ADAMTS5 and prostaglandin E synthase (PTGES, were found to be expressed at significantly higher levels in OA meniscal cells. This consistency suggests that many of the genes detected in our study are disease-specific. Conclusion Our findings suggest that OA is a whole joint disease. Meniscal cells may play an active role in the development of OA. Investigation of the gene expression profiles of OA meniscal cells may reveal new therapeutic targets for OA therapy and also may uncover novel

  17. Influence of 60Co irradiation on the mandible of adult rabbit

    International Nuclear Information System (INIS)

    This study was performed in order to observe the effect of 60Co γ-ray irradiation (5000, 8000 and 10000R) on rabbits' mandible, for as long as possible, approximately 18 months. Radiographical and histopathological studies were done after irradiation. The upper anterior teeth of all experimental animals showed elongation, lateral flection and diasthema. The lower anterior teeth showed shortening or disappearance of the crowns and resorption of the root apex in all. These teeth were lost eventually. Molar teeth disclosed shortening of crowns and irregular and partial loss on the surface of the dentine. Pulp chambers were extremely narrowed. These changes were most conspicuous in the 10,000R irradiation group. Mandibular fractures occurred in 13 cases, which include 3 cases with 5,000R, 4 cases with 8,000R and 6 cases with 10,000R. The alveolar bones were resorped, and were replaced with mandibular bone trabeculae. Various types of ankylosis of root surface and mandibulars were seen. These changes were more frequently noted in the molar regions that the anterior regions and in the groups with higher doses and longer days after irradiation. Bone trabeculae and cortex of the mandibles were resorped in the 3 irradiation groups in the early stage, but regeneration and thickening of the bones occured later. The usual case was that the anterior bone marrow became more gelatinous and the molar marrow became more fibrous. Hyperemia and abscess formation were recognized in some cases. Although in the molar regions these pathological changes were conspicuous in proportion to the amount of dose, in the anterior regions, the same changes were more conspicuous in the 5,000R irradiation group than in the 8,000R group. (J.P.N.)

  18. Identification of the inorganic pyrophosphate metabolizing, ATP substituting pathway in mammalian spermatozoa.

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    Young-Joo Yi

    Full Text Available Inorganic pyrophosphate (PPi is generated by ATP hydrolysis in the cells and also present in extracellular matrix, cartilage and bodily fluids. Fueling an alternative pathway for energy production in cells, PPi is hydrolyzed by inorganic pyrophosphatase (PPA1 in a highly exergonic reaction that can under certain conditions substitute for ATP-derived energy. Recombinant PPA1 is used for energy-regeneration in the cell-free systems used to study the zymology of ATP-dependent ubiquitin-proteasome system, including the role of sperm-borne proteasomes in mammalian fertilization. Inspired by an observation of reduced in vitro fertilization (IVF rates in the presence of external, recombinant PPA1, this study reveals, for the first time, the presence of PPi, PPA1 and PPi transporter, progressive ankylosis protein ANKH in mammalian spermatozoa. Addition of PPi during porcine IVF increased fertilization rates significantly and in a dose-dependent manner. Fluorometric assay detected high levels of PPi in porcine seminal plasma, oviductal fluid and spermatozoa. Immunofluorescence detected PPA1 in the postacrosomal sheath (PAS and connecting piece of boar spermatozoa; ANKH was present in the sperm head PAS and equatorial segment. Both ANKH and PPA1 were also detected in human and mouse spermatozoa, and in porcine spermatids. Higher proteasomal-proteolytic activity, indispensable for fertilization, was measured in spermatozoa preserved with PPi. The identification of an alternative, PPi dependent pathway for ATP production in spermatozoa elevates our understanding of sperm physiology and sets the stage for the improvement of semen extenders, storage media and IVF media for animal biotechnology and human assisted reproductive therapies.

  19. Update on calcium pyrophosphate deposition.

    Science.gov (United States)

    Abhishek, Abhishek; Doherty, Michael

    2016-01-01

    Calcium pyrophosphate crystal deposition (CPPD) associates with ageing, osteoarthritis (OA), uncommon metabolic diseases, mutations and polymorphisms in the ankylosis human gene (ANKH). CPPD is frequently polyarticular, occurs due to a generalised articular predisposition, and the association between CPPD and OA is joint specific, for example CPPD associates with knee OA, but not with hip OA. Other recently identified associations include knee malalignment (knee CC), low cortical BMD and soft-tissue calcification. CPPD is generally asymptomatic. A recent study reported that knees with OA plus CC at the index joint, or at distant joints (in absence of index joint CC), were more likely to have attrition. CPPD can cause acute CPP crystal arthritis, chronic CPP crystal inflammatory arthritis, and is frequently present in joints with OA. Joint aspiration remains the gold standard for diagnosing CPPD, although other promising techniques are emerging. Patients with polyarticular or young onset CPPD should be screened for underlying metabolic abnormalities, however, such testing can be unrewarding. The treatment of CPPD is symptomatic. Acute CPP crystal arthritis is treated with rest, local application of ice-packs, joint aspiration, colchicine and/or intra-articular corticosteroid injection (once infection is excluded). Colchicine, low-dose corticosteroids, hydroxychloroquine and radiosynovectomy are recommended for the treatment of chronic or recurrent acute CPP crystal arthritis. Recent RCTs did not confirm any benefit from methotrexate, and although there is increasing interest in the use of anti-IL1 agents for acute or chronic CPP crystal arthritis, their efficacy has not been formally examined. Unlike gout, currently there are no treatments to eliminate CPP crystal deposits. PMID:27586801

  20. Indications and outcome of mandibular condylar and ramus surgeries

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    Babatunde O Akinbami

    2014-01-01

    Full Text Available Background: Different surgical procedures are utilized for treatment of various diseases of the posterior mandible depending on the type of disease, site, duration and age of the patient. A thorough knowledge of the anatomical relations of structures and adequate surgical skills are needed to minimize complications. The purpose of this study was to evaluate the indications and outcome of surgical techniques for diseases affecting the condyle and ramus of the mandibles. Patients and Methods: Data were retrieved from the case files of patients who had surgeries for diseases involving the ramus/condylar area of the mandible. The diagnosis/indications for surgery, procedure and postoperative outcomes were documented. Outcomes assessed were related to mouth opening, esthetics (appearance of scar and jaw symmetry and function (occlusion, Jaw movements. Complications such as nerve dysfunction were documented. Paresthesia was tested by simple tactile stimulations. Results: There were a total of 27 procedures done either on the condyle or ramus in 23 (100% patients between May 2006 and October, 2013. 16 procedures were done for tumors in 16 (69.6% patients, 14 (60.9% patients had Ameloblastoma, 1 (4.3% had central neurofibroma and one had keratocystic odontogenic tumor, two procedures for unilateral condylar fractures in 2 (8.6% patients, five procedures for ankylosis in 3 (13.0% patients and four procedures were done for dislocation in 2 (8.6% patients. There was no permanent nerve dysfunction; mouth opening, jaw movements and mastication were remarkably satisfactory. Conclusion: Esthetic and functional outcome were quite satisfactory when compared with the preoperative status.

  1. Evaluation of the topical effect of alendronate on the root surface of extracted and replanted teeth. Microscopic analysis on rats' teeth.

    Science.gov (United States)

    Lustosa-Pereira, Adriana; Garcia, Roberto Brandão; de Moraes, Ivaldo Gomes; Bernardineli, Norberti; Bramante, Clovis Monteiro; Bortoluzzi, Eduardo Antunes

    2006-02-01

    The treatment of choice for tooth avulsion is replantation. The ideal replantation should be realized as quickly as possible, or at least, the avulsed tooth should be kept in an adequate solution to preserve the periodontal ligament attached to the root. If that is not possible, treatment of the radicular surface should be done in order to prevent radicular resorption. The purpose of this study was to test sodium alendronate as a substance for topical treatment of the radicular surface of avulsed teeth in an attempt to prevent the occurrence of dental resorptions. Fifty-four rat maxillary right central incisors were extracted and replanted. Group I--extra-alveolar dry period of 15 min, intracanal dressing with calcium hydroxide (CALEN, S.S. White, Artigos Dentários LTDA, Rio de Janeiro, Brazil) and replantation; Groups II and III - extra-alveolar dry periods of 30 and 60 min, respectively, immersion in 1% sodium hypochlorite for 30 min for removal of the periodontal ligament, washing in saline solution for 5 min, and treatment of the radicular surface with 3.2 mg/l sodium alendronate solution for 10 min. Intracanal dressing with calcium hydroxide and replantation followed. At 15, 60, and 90 days post-reimplantation, the animals were killed and the samples obtained and processed for microscopic analysis. The results indicated that sodium alendronate was able to reduce the incidence of radicular resorption, but not of dental ankylosis. No significant differences were observed regarding variations in the extra-alveolar periods among the groups. PMID:16422756

  2. Surgical outcome after spinal fractures in patients with ankylosing spondylitis

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    Brilakis Emmanuel

    2009-08-01

    Full Text Available Abstract Background Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine. The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned. Methods Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge. Results Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries. Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement

  3. The Results of Fetal Chondrocytes Transplantation in Patients with Rheumatoid Arthritis

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    Natalya Krivoruchko

    2014-12-01

    .03. Furthermore, patients in the second group had 2.7 times higher risk of ankylosis compared to the first group. We did not observe any complications of fetal chondrocytes transplantation.Conclusions. Application of fetal chondrocytes therapy had the desired clinical effect, which was confirmed by reduction of the RA activity and decrease of cartilage and bone destruction. 

  4. Diversas modalidades de intervención temprana de caninos ectópicos.

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    Carlos Astorga

    2012-12-01

    Full Text Available RESUMEN La impactación del canino permanente se encuentra a menudo en la práctica ortodóncica y su etiología se asocia a factores locales de espacio y genéticos. El no intervenir a tiempo trae como consecuencia la reabsorción de raíces de dientes vecinos, desarrollo de quistes, anquilosis y necesidad de tratamientos ortodóncicos complejos y costosos. El objetivo de esta revisión fue recoger las distintas modalidades publicadas en los últimos años para prevenir este fenómeno. Son cuatro las más importantes: Intervención solo basadas en extracciones, extracción de caninos temporales más contención (arco de tracción cervical, intervención activa en dentición mixta tardía, intervención activa en dentición mixta temprana. Estos distintos tipos de intervención muestran un mayor porcentaje de éxito eruptivo del canino permanente maxilar (80 - 97%. La extracción del canino temporal sigue siendo un método efectivo para evitar la impactación palatina del canino, cuya tasa de éxito se vería aumentada sí además se complementa con otro método interceptivo . ABSTRACT Maxillary canine impactation is often encountered in orthodontic clinical practice and the aetiology is associated to genetic factors as well as local space factors. If preventive treatment is not started in ectopic maxillary canines, some possible consequences may occur, such as resorption of the roots of the neighboring permanent teeth, cysts, ankylosis and expensive surgical and orthodontic treatment. The aim of this review was to preset several early treatment modalities for ectopic maxillary canines based on recent scientific evidence. Four are the most important: Only extractions intervention, extraction of deciduous canines with cervical pull headgear, active intervention in late mixed dentition and active intervention in early mixed dentition. These different modalities showed a greater increasing the rate of normal eruption of ectopic canines ( 80- 97

  5. A PROSPECTIVE STUDY TO ASSESS EFFICACY OF DIRECTLY OBSERVED TREATMENT SHORT - COURSE INTERMITTENT REGIME IN DIFFERENT STAGES OF SPINAL TUBERCULOSIS

    Directory of Open Access Journals (Sweden)

    Manoj Kumar

    2015-02-01

    Full Text Available STUDY DESIGN: A Prospective non - randomised study . INTRODUCTION: Management of Tuberculosis spine still possesses many challenges. Availability of anti - tubercular drugs has changed the outcome. However, present recommendation by the WHO of Directly Observed Treatment Short - course (DOTS has sound scientific basis, but the optimum duration is still controversial. We conducted a prospective study on a consecutive series of patients with spinal tuberculosis treated with Category I Revised National Tuberculosis Control Programme (RNTCP regime based on DOTS strategy from June 2012 to Sep 2014 to evaluate the efficacy and come to conclusion regarding optimum duration of treatment. MATERIALS AND METHODS: A prospective study of 30 consecutive patients of spinal tuberculosis treated with Category I RNTCP based on DOTS strategy. All the patients were followed for minimum of 2 year. Surgical intervention was done in patients presenting with significant neurological deficits. Patients diagnosed clinicoradiologically and histopathologically (n=3 were enrolled in the study. Outcome was graded into excelle nt, good, fair and poor based on clinical, laboratory including return of ESR to normal and correction of lymphocytosis and radiological outcome showing - return to normal bone density and sclerosis, bony ankylosis and disappearance of marrow edema on MRI. RESULTS: In 30 cases, 63.4% (n=19 were males and 36.7% (n=11 were females. 10% (n=3 were with pre - destructive lesion, 53.3% (n=16 were in the early destructive phase, 30% (n=9 with mild angular kyphosis and 6.67% (n=2 with moderate angular kyphosis. Outcome of our study were excellent in 46.67% (n=14, good in 36.67% (n=11, fair in 10% (n=3 and poor in 6.67% (n=2. Duration to cure spinal TB 6 months 30% (n=9, 9 months 56.67% (n=17 and 12months 13.33% (n=4. CONCLUSIONS: Outcome of our study were excellent in 46.67% (n=14, good in 36.67% (n=11, fair in 10% (n=3 and poor in 6.67% (n=2. The duration of

  6. Autocrine stimulation of osteoblast activity by Wnt5a in response to TNF-α in human mesenchymal stem cells

    International Nuclear Information System (INIS)

    Highlights: ► Ankylosing spondylitis (AS) leads to bone fusions and ankylosis. ► TNF-α stimulates osteoblasts through growth factors in AS. ► We compare the involvement of canonical vs non-canonical Wnt signaling. ► Canonical Wnt signaling is not involved in TNF-α effects in differentiating hMSCs. ► TNF-α stimulates osteoblasts through Wnt5a autocrine secretion in hMSCs. -- Abstract: Although anti-tumor necrosis factor (TNF)-α treatments efficiently block inflammation in ankylosing spondylitis (AS), they are inefficient to prevent excessive bone formation. In AS, ossification seems more prone to develop in sites where inflammation has resolved following anti-TNF therapy, suggesting that TNF-α indirectly stimulates ossification. In this context, our objectives were to determine and compare the involvement of Wnt proteins, which are potent growth factors of bone formation, in the effects of TNF-α on osteoblast function. In human mesenchymal stem cells (MSCs), TNF-α significantly increased the levels of Wnt10b and Wnt5a. Associated with this effect, TNF-α stimulated tissue-non specific alkaline phosphatase (TNAP) and mineralization. This effect was mimicked by activation of the canonical β-catenin pathway with either anti-Dkk1 antibodies, lithium chloride (LiCl) or SB216763. TNF-α reduced, and activation of β-catenin had little effect on expression of osteocalcin, a late marker of osteoblast differentiation. Surprisingly, TNF-α failed to stabilize β-catenin and Dkk1 did not inhibit TNF-α effects. In fact, Dkk1 expression was also enhanced in response to TNF-α, perhaps explaining why canonical signaling by Wnt10b was not activated by TNF-α. However, we found that Wnt5a also stimulated TNAP in MSCs cultured in osteogenic conditions, and increased the levels of inflammatory markers such as COX-2. Interestingly, treatment with anti-Wnt5a antibodies reduced endogenous TNAP expression and activity. Collectively, these data suggest that increased

  7. Kaks luustikku Tartu toomkirikust: arheoloogia ja osteoloogia andmed / Two skeletons from the Tartu Cathedral Cemetery: archaeological and osteological data

    Directory of Open Access Journals (Sweden)

    Martin Malve

    2011-01-01

    from slight forms of various spinal diseases, which include Schmorl’s nodes, spondyloarthrosis, and spondylosis. The fourth and fifth cervical vertebrae had ankylosis, the cause of which is unknown. Signs of osteoartrosis, a joint disease, were also noticed. Traumas recorded in the skeleton include a healed fracture of a rib and vertebral compression. The man’s head was decapitated with a sharp blade between the sixth and seventh cervical vertebrae (fig. 7.

  8. Autocrine stimulation of osteoblast activity by Wnt5a in response to TNF-α in human mesenchymal stem cells

    Energy Technology Data Exchange (ETDEWEB)

    Briolay, A. [ICBMS, UMR CNRS 5246, University of Lyon 1, Bâtiment Raulin, 43 Bd du 11 novembre 1918, 69622 Villeurbanne Cedex (France); Lencel, P. [Physiopathology of Inflammatory Bone Diseases, EA4490, ULCO. Quai Masset, Bassin Napoléon BP120, 62327 Boulogne/Mer (France); Bessueille, L. [ICBMS, UMR CNRS 5246, University of Lyon 1, Bâtiment Raulin, 43 Bd du 11 novembre 1918, 69622 Villeurbanne Cedex (France); Caverzasio, J. [Service of Bone Diseases, Department of Internal Medicine Specialties, University Hospital of Geneva, CH-1211 Geneva 14 (Switzerland); Buchet, R. [ICBMS, UMR CNRS 5246, University of Lyon 1, Bâtiment Raulin, 43 Bd du 11 novembre 1918, 69622 Villeurbanne Cedex (France); Magne, D., E-mail: david.magne@univ-lyon1.fr [ICBMS, UMR CNRS 5246, University of Lyon 1, Bâtiment Raulin, 43 Bd du 11 novembre 1918, 69622 Villeurbanne Cedex (France)

    2013-01-18

    Highlights: ► Ankylosing spondylitis (AS) leads to bone fusions and ankylosis. ► TNF-α stimulates osteoblasts through growth factors in AS. ► We compare the involvement of canonical vs non-canonical Wnt signaling. ► Canonical Wnt signaling is not involved in TNF-α effects in differentiating hMSCs. ► TNF-α stimulates osteoblasts through Wnt5a autocrine secretion in hMSCs. -- Abstract: Although anti-tumor necrosis factor (TNF)-α treatments efficiently block inflammation in ankylosing spondylitis (AS), they are inefficient to prevent excessive bone formation. In AS, ossification seems more prone to develop in sites where inflammation has resolved following anti-TNF therapy, suggesting that TNF-α indirectly stimulates ossification. In this context, our objectives were to determine and compare the involvement of Wnt proteins, which are potent growth factors of bone formation, in the effects of TNF-α on osteoblast function. In human mesenchymal stem cells (MSCs), TNF-α significantly increased the levels of Wnt10b and Wnt5a. Associated with this effect, TNF-α stimulated tissue-non specific alkaline phosphatase (TNAP) and mineralization. This effect was mimicked by activation of the canonical β-catenin pathway with either anti-Dkk1 antibodies, lithium chloride (LiCl) or SB216763. TNF-α reduced, and activation of β-catenin had little effect on expression of osteocalcin, a late marker of osteoblast differentiation. Surprisingly, TNF-α failed to stabilize β-catenin and Dkk1 did not inhibit TNF-α effects. In fact, Dkk1 expression was also enhanced in response to TNF-α, perhaps explaining why canonical signaling by Wnt10b was not activated by TNF-α. However, we found that Wnt5a also stimulated TNAP in MSCs cultured in osteogenic conditions, and increased the levels of inflammatory markers such as COX-2. Interestingly, treatment with anti-Wnt5a antibodies reduced endogenous TNAP expression and activity. Collectively, these data suggest that increased

  9. ANKYLOSING SPONDYLITIS IN THE VOLGA BULGARIA

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    D. I. Abdulganieva

    2015-09-01

    Full Text Available There is much evidence that ankylosing spondylitis (AS is a disease that is also much older than early human civilizations and man as a whole. Until now, the Russia's earliest (14th c ntury archaeological finding of such a patient remains a Volga Bulgaria inhabitant suffering with AS during his life. In the Republic of Tatarstan, at the site of an ancient Bulgar settlement appearing in the early ninth century, archaeologists have discovered an unusual grave: the deceased sitting with his back against the western wall of a tomb pitand having a bronze crosslet under his fingers. According to a historical source, it was the way of burying Christian hierarchs as pastors sitting on the altar and anticipating the great assize during which the destinies of human souls should be ruled. Anthropological analysis showed that the bones belonged to a 35–45-year-old man who was 158–163 cm tall. During the examination of the remains,attention was called to the following features of the spinal structure: ankylosis of the inferior cervical and superior thoracic vertebrae (СV–ThI and inferior thoracic and lumbar spine (ThIV–LII predominantly due to ossification of the anterior longitudinal ligament. Facet vertebral joints and costotransverse joints were also ankylosed at the same levels. The man's neck was fixed in a bent-over position with the head down, the chin touching the breast bone – the socalled soliciting posture. By and large, the vertebral changes are characteristic of late (X-ray stage III spondylitis. Spinal and pelvic photos and X-films are given for demonstration. The studies conducted by historical scientists and forensic medical experts suggest that the found remains are most likely to belong to Christian Theodore nicknamed Jerusaleman, also further known as Holy Theodore philosopher Kamsky (Bulgarian, who was mentioned in the Nikon chronicle in 1323.

  10. 微型钛板植入体可坚强内固定修复下颌骨骨折%Mini-titanium plate implant can enhance internal fixation for mandibular fracture

    Institute of Scientific and Technical Information of China (English)

    姚红磊; 纳应坤; 陈涌; 刘华

    2012-01-01

    背景:下颌骨折越来越多的采用口内切开小型钛板张力带内固定治疗,那么微小型钛板在颌骨骨折中起怎样的作用?目的:评价下颌骨骨折骨缺损重建微型钛板坚固内固定的重要性.方法:以 "钛板,下颌骨,骨折,坚固内固定"为关键词.采用计算机检索1995-01/2011-10 PubMed数据库,维普数据库有关坚固内固定技术在下颌骨骨折中的临床应用的文章.排除重复研究,以20篇为重点进行探讨.结果与结论:采用钛板在下颌角上缘张力带内固定辅以颌间固定治疗下颌角骨折,临床操作简单,易掌握,缩短颌间固定的时间,固定稳固性有了可靠的保证,创伤较小,患者能早期张口训练,避免关节强直.有利于内固定后骨折愈合及恢复正常咬合关系.%BACKGROUND: Intraoral incision and mini-plate fixation as tension band have been used to treat for mandibular fracture. The effect of mini-plate has not been fully investigated. OBJECTIVE: To assess the importance of mini-plate fixation during bone defect reconstruction following mandibular fracture. METHODS: With “titanium plate, mandible, fracture, and rigid internal fixation” as key words, a computer-based online search of PubMed and VIP database was performed for articles published between January 1995 and October 2011 related to clinical application of rigid internal fixation in mandibular fracture. Repetitive articles were excluded, and 20 were included and further discussed. RESULTS AND CONCLUSION: Titanium plate has been used as tension band in the superior margin of the mandibular angle, assisted with intermaxillary fixation to treat mandibular angle fracture. This method is simple, convenient, and can shorten duration for intermaxillary fixation, ensuring stability of the fixation. In addition, the incision is minimal, allowing early mouth open training and preventing ankylosis. This method benefits fracture healing and recovery of normal occluding relation

  11. 单螺钉内固定法在髁突矢状骨折治疗中的应用%Clinical comparsion of single screw-fixation treatment and conservative treatment in sagittal fracture of the madibular condyle

    Institute of Scientific and Technical Information of China (English)

    李健; 张智星; 柳江太; 邓末宏; 龙星

    2014-01-01

    目的:探讨单螺钉内固定治疗下颌骨髁突矢状骨折的临床效果和应用价值。方法:对27例髁突矢状骨折病例进行回顾研究,根据治疗方式分为单螺钉内固定组和保守治疗组,比较术后3个月两组患者术后并发症、咬合关系、最大开口度、颞下颌关节功能障碍指数(DI)和肌肉压痛指数(PI)等情况,进行统计学分析。结果:单螺钉内固定组术后未出现关节区疼痛、张口受限和关节强直等严重并发症,DI和PI各指标均优于保守治疗组,两组的差异具有显著统计学意义。结论:单螺钉内固定手术方法是一种行之有效的髁突矢状骨折治疗手段,疗效确切。%Objective:To compare the effects of single screw-fixation treatment and conservative treatment in sagittal fracture of the madibular condyle(SFMC). Method:Patients with SFMC were single-screw fixation(SSF) group and the con-servative treatment (CON) group. Index,such as occlusion, maximum opening,and function of temporomandibular joint, were recorded and analyzed. Result:All patients in the SSF group had favorable results,including good occlusion,satisfying function and without serious complications or ankylosis,etc. Conclusion:Single screw-fixation surgery is an effective treat-ment used in sagittal fracture of the mandibular condyle.

  12. Reconstrucción de la articulación temporomandibular postraumática con prótesis a medida: Planificación quirúrgica virtual Post-traumatic reconstruction with custom prosthesis of the temporomandibular joint: Computerized surgical planning

    Directory of Open Access Journals (Sweden)

    Aitor García Sánchez

    2011-06-01

    surgical execution of three cases of bilateral articular ankylosis (6 joints is presented with simulation of osteotomies, maxillomandibular movements and custom total alloplastic prosthesis design for the temporomandibular joint. Conclusions: A comprehensive approach to articular biomechanics, intermaxillary relations and dental occlusion is necessary to obtain predictable and satisfactory results. Computer modeling and the use of custom alloplastic devices allows exact, safe total articular reconstruction.

  13. Al-Aqeel Sewairi Syndrome, a new autosomal recessive disorder with multicentric osteolysis, nodulosis and arthropathy. The first genetic defect of matrix metalloproteinase 2 gene

    International Nuclear Information System (INIS)

    We report a distinctive autosomal recessive multicentric osteolysis in Saudi Arabian families with distal arthropathy of the metacarpal, metatarsal and interphalangeal joints, with ultimate progression to the proximal joints with decreased range of movements and deformities with ankylosis and generalized osteopenia. In addition, they had large, painful to touch palmar and plantar pads. Hirsutism and mild dysmorphic facial features including proptosis, a narrow nasal bridge, bulbous nose and micrognathia. Using a genome-wide search for microsatellite markers from 11 members of the family from the Armed Forces Hospital and King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia, localized the disease gene to chromosome 16q12-21. Haplotype analysis with additional markers narrowed the critical region to 1.2cM and identified the matrix metalloproteinase 2 (MMP-2), (gelatinase A, collagenase type IV, EC 3.4, 24,24) gene as a disease candidate at Mount Sinai School of Medicine, New York, United States of America in April 2000. Some affected individuals were homoallelic for a nonsense mutation (TCA>TAA) in codon 244 of exon 5, predicting the replacement of a tyrosine residue by a stop codon in the first fibronectin type II domain (Y244X). Other affected members had a missense mutation in exon 2 arginine 101-histidine (R101H) leading to no MMP-2 enzyme activity in serum or fibroblast or both of affected individuals. In other affected members, a non-pathogenic homoallelic GT transversion resulted in the substitution of an aspartate with a tyrosine residue in codon 210 of exon 4 (D210Y). The MMP-2-null mouse has no developmental defects, but are small, which may reflect genetic redundancy. The discovery that deficiency of this well-characterized gelatinase/collagenase results in an inherited form of an osteolytic and arthritic disorder provides an invaluable insights for the understanding of osteolysis and arthritis and is the first genetic

  14. The posttraumatic proximal cross-union of the forearm in childhood: what is recommended?

    Directory of Open Access Journals (Sweden)

    Marcel Dudda

    2013-06-01

    Full Text Available The posttraumatic proximal cross-union of the forearm in childhood is a rare complication after radial head, neck or proximal forearm fractures and elbow dislocations. There is no standardized treatment. Several surgical procedures with or without interposition techniques are described in the literature. The aim of this study was to analyze all children with cross-unions who underwent surgery over the last 15 years. From 1998 to 2013, 8 children with a posttraumatic proximal cross-union of the forearm (Type 3 according to Vince and Miller received surgical treatment with resection of the cross-union or radial head. Mean age at the time of initial trauma was 9.0±2.56 years (range 6-14 years, age at the time of surgery was 11.9±3.09 years (range 7-16 years. Mean time of resection of the cross-union was 23.2 months. Follow-up time was 10.6 months (range 1-36 months. Five patients had a resection of the cross-union without any interposition techniques, in 2 cases with an additional arthrolysis of the elbow. One patient had an interposition of a local fascia flap. In 2 cases, a primary excision of the radial head, six and seven years, respectively, after trauma, was performed. All patients, except one, had non-steroidal anti-inflammatory drugs therapy after surgery. A post-operative irradiation was performed in 3 cases. The mean postoperative range of motion for pronation/supination was 36/0/53°. Controversy remains about the best procedure to adopt for posttraumatic cross-union in childhood. After analysis of our data and the literature, we recommend the resection of the cross-union within 6-24 months of occurrence without necessarily using any interposition techniques. All patients reported an improvement with regard to ordinary activities. In cases of long-term cross-union for several years with ankylosis of the elbow and bony deformities of the proximal radius, an excision of the radial head as salvage procedure is recommended.

  15. Complex Fractures of the Facial Skeleton%颌面部多发骨折临床特点的探讨

    Institute of Scientific and Technical Information of China (English)

    管仪芳

    2013-01-01

    were single linear fracture,102 cases were multiple linear,46 cases were comminuted fractures.Among them,38 cases were associated with maxillary fracture,12 cases with zygoma fracture,13 cases with fracture of the nasal bone,48 cases with fractures of tympanic plate,10 cases with condylar fracture and retrodisplacement.There was significant difference between incidence of sagittal fracture of the condyle accompanying with anterior wall fracture of external auditory canal and that of other types (P<0.01),there was significant difference between incidence of mentum and condyle sagittal fracture accompanying with anterior wall fracture of external auditory canal and that of fracture of mentum or condylar process (P<0.01).3 cases complicated with obstruction of external auditory canal.2 cases resulted in ankylosis of the temporomandibular joint,3 cases occurred dislocation of temporomandibular joint.Conclusion:The mandibular fractures manifested as single linear fracture,multiple fracture and comminuted fracture,in association with fractures of other facial skeletons.The proportion of mandibular mentum and condyle sagittal fracture accompanying with fractures of anterior wall of external auditory canal was significantly increased.Attention should be paid on the prevention of complications as stenosis of external auditory canal,ankylosis and posterior dislocation of the temporomandibular joint.

  16. Progress of temporomandibular joint prosthesis%人工颞下颌关节的研究进展

    Institute of Scientific and Technical Information of China (English)

    孙荃; 李恺得; 刘磊

    2014-01-01

    颞下颌关节结构和功能的复杂性使得其重建成为外科医生所面临的最大挑战之一。人工颞下颌关节是颞下颌关节重建的重要方式之一,主要适用于颞下颌关节强直、无法复位固定的髁突粉碎性骨折、颞下颌关节肿瘤、晚期关节内紊乱及一些先天性颅面综合征等所致的颞下颌关节发育不良等。人工颞下颌关节旨在改善颞下颌关节的功能、减少疼痛并防止严重的并发症。在口腔颌面外科,人工颞下颌关节具有能模仿正常的解剖形态、与宿主贴合、不需另行取材、术后能立即进行功能训练等优点。假体材料在人工颞下颌关节的发展中起着至关重要的作用,优良的设计、牢靠的固定都是人工颞下颌关节能够行使其功能必不可少的条件,当然关节生物力学的研究也是必不可少的。随着材料学、关节生物力学及制作工艺等相关学科的飞速发展,人工颞下颌关节在关节假体的植入材料、假体的设计等方面取得了不少进展。随着人工颞下颌关节的发展,其应用也越来越广泛。本文对人工颞下颌关节的发展及其临床应用作一综述。%The anatomically and functionally complex nature of the temporomandibular joint (TMJ) makes its reconstruction one of the most challenging tasks faced by surgeons who operate in the head and neck. TMJ prosthesis is one of the important techniques in the reconstruction of TMJ. The main indications for TMJ prosthesis include ankylosis, fractures of condylar that can’t be fixed, trauma or tumor, end-stage TMJ disturbance, and TMJ dysplasia caused by Hallermann-Streiff syndrome. TMJ replacement aims to enhance the function of TMJ, alleviate pain, and prevent serious complications. TMJ prosthesis is advantageous in oral and maxillofacial surgery because it can imitate normal anatomic morphology and adhere to the host. Moreover, the use of other materials is no longer

  17. Association of therapeutic occasion, gross motor function grading and developmental level with gross motor functional recovery in children with cerebral palsy

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    BACKGROUND: The abnormal posture and motor pattern have not stabilized in children with cerebral palsy at early period, thus timely treatment can establish normal postural reflex and motor pattern, and prevent complications of muscle contracture, ankylosis, skeletal deformity, etc. The clinical factors affecting the rehabilitative efficacy of gross motor function in children with cerebral palsy should be observed.OBJECTIVE: To observe the effects of therapeutic occasion, grading of gross motor function and developmental level on the rehabilitative efficacy in children with cerebral palsy.DESIGN: A case-controlled analysis.SETTING: Qilu Children's Hospital of Shandong University.PARTICIPANTS: Totally 138 children with cerebral palsy, who were hospitalized for 12 months in the Rehabilitation Center of Qilu Children's Hospital, Shandong University, were selected from April 2004 to September 2006, and all the children were diagnosed to be accorded with the standard set by the national seminar on cerebral palsy in 2004. There were 97 males and 41 females, including 55 cases of 0 - 2 years old,47 cases of 2 - 4 years and 36 cases of 4 - 6 years. Informed contents were obtained from relatives of all the children.METHODS: ① Comprehensive rehabilitation treatment: Vojta method was to induce the children to turn over the body and crawl by stimulating reflective turn over and crawling on belly. Bobath method including trainings of head control, turning over body, keeping sitting position, keeping balance, crawling, keeping standing position, and walking, etc.; The children were massaged by using the maneuvers of push, press, rub,pull, wave, etc. according to the sites and types of palsy. Acupuncture was performed mainly at bilateral motor areas, the needle was retained for 1 hour per time, 6 days continuously every week, and followed by a 1-day interval. ② Prognosis assessment: The gross motor functional grading of the children with cerebral palsy at admission was

  18. Elbow interposition arthroplasty in children and adolescents: long-term follow-up.

    Science.gov (United States)

    Fernandez-Palazzi, Federico; Rodriguez, Janeth; Oliver, Guillermo

    2008-04-01

    A long-term follow-up was made of 12 elbows operated upon between 1971 and 1986, with more than 20 years' follow-up, in nine males and three females, age at the time of surgery between 10 and 19 years . Eight right and four left elbows were involved, and there were three aetiological causes. Seven cases were sequelae of elbow fractures, of which five were supracondylar and two were of the olecranon. There were four cases of juvenile rheumatoid arthritis and one was post-osteomyelitis. The surgical technique involved a modification made by Vainio of MacAusland's technique (wider resection of the osseous ends and total covering of the bloody surfaces) [5, 9]. After extirpating the tissue blocking the joint, we proceeded to remodel the distal humerus in a wide V shape, the proximal end of the ulnar and, if necessary, the radial head. The proximal end of the ulna was sectioned transversely. All surgery was carried out sub-periosteally. Then, an interposition material was placed in one piece and sutured over the distal humerus and cut ends of the ulna and radius. The articular ends were brought together, and the capsule was closed using equidistant stitching, as is the skin. A small compression bandage was applied, and the arm was immobilised with a collar and cuff sling, with the forearm flexed to slightly less than a right angle. In ten cases, the interposition material was fascia lata grafts; in one case, skin graft and in one case, Gelfoam graft. Early rehabilitation began when post-operative pain allowed. Follow-up ranged from 25 to 32 years. Pre-surgical movement ranged between 90 degrees and 120 degrees of flexion and 30 degrees and 90 degrees of extension. Post-operative range varied between 90 degrees and 150 degrees of flexion. The five cases of full pre-operative ankylosis achieved between 90 degrees and 150 degrees of flexion and between 0 degrees and 70 degrees of extension. The total range of motion at the latest follow-up varied from 35 degrees to 150

  19. 交锁髓内钉固定治疗胫骨干骨折的疗效观察

    Institute of Scientific and Technical Information of China (English)

    赵英杰; 张如国

    2013-01-01

    目的:探讨交锁髓内钉治疗胫骨干骨折的适应症及优点。方法:回顾性分析笔者所在医院2008年以来应用交锁髓内钉固定治疗60例胫骨干骨折患者,其中开放性骨折18例(GustiloⅠ度10例,Ⅱ度8例),闭合性骨折42例,采用Johner-wruh 评分评价其治疗效果。结果:术后所有患者均获得随访,骨折均获愈合,无断钉,无伤口感染和骨髓炎发生、未发生脂肪栓塞综合征、骨筋膜间室综合征、关节僵硬等并发症。本组病例平均愈合时间为6个月,根据Johner-wruh 评分:优50例,良7例,差3例,优良率95%。结论:交锁髓内钉内固定治疗胫骨干骨折有术式简单、手术损伤小、固定可靠、可早期功能锻炼、骨折愈合率高、并发症少等优点,可作为治疗胫骨干骨折较理想的固定方式。%Objective Explore into interlocking intramedullary nails in the treatment of tibial fracture dry indications and advantages. Methods The writer's hospital were retrospectively analyzed since 2008 in application of interlocking intramedullary nail fixed treatment sixty cases of tibial fractures were treated with dry, including open fractures and cases (Gustilo degrees of 10 cases, 8 cases), closed fracture 42 patients, the Johner - wruh score evaluate its therapeutic effect. Results All the patients were followed up for postoperative, fracture have been healing, no broken nail, no wound infection and osteomyelitis happen not happen fat embolism syndrome bone fascia compartment syndrome ankylosis complications, such as the average healing time, all the cases for 6 months, according to Johner-wruh rating:optimal fifty cases, good in 7 cases, difference in 3, was 95%. Conclusion Pay interlocking intramedullary nails in the treatment of tibial fractures fixed do a simple surgical operation injury small fixed reliable early functional exercise can fracture healing rate less complications advantages, such as a treatment for tibial

  20. Reimplante intencional en diente geminado con lesión endoperio tipo IV: Reporte de caso Intentional replantation gemina injured in tooth type IV endoperio: Case report

    Directory of Open Access Journals (Sweden)

    R.S. Rodríguez Rodríguez

    2012-10-01

    , persistent fistula, large periapical lesions, periodontal pocket, root anatomy of the tooth organ palate (palatine canal alleged and that the anatomy tooth is favorable to perform the procedure. The extraction and intentional replantation is the treatment in cases where the endodontic treatment fails and the anomaly dental periapical surgery also fail because only temporarily remove the lesion but not the cause it is the communication between the oral cavity and apical area. However, it is known that this treatment option can have risks and benefits, including tooth loss or possible ankylosis and with a success rate of 42.9%. The present case report describes the extraction and intentional replantation geminate tooth with a persistent periapical lesion of periodontal origin, with symptoms and fistula, after endodontic treatment complex, its evolution and success.

  1. All-arthroscopic rotator cuff repair versus mini-open for the treatment of rotator cuff injury:aMeta-analysis%全关节镜与小切口修复肩袖撕裂损伤的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    王毅; 赵其纯

    2016-01-01

    BACKGROUND:There are controversies about the efficacy of al-arthroscopic rotator cuff repairversus mini-open for the treatment of rotator cuff injury. OBJECTIVE:To evaluate the efficacy of al-arthroscopic rotator cuff repairversusmini-open for the treatment of rotator cuff injury by conducting a meta-analysis. METHODS:A computer-based online search was conducted in PubMed, Embase, Cochrane Library and CBM databases from January 1966 to November 2015 to screen the relevant articles usingthe key words of“rotator cuff, arthroscopy, mini-open”. Meta-analysis was performed using Revman5.3 software. RESULTS AND CONCLUSION:A total of 11 studies, including 6randomized controled trialsand 5 cohort studies,were selected. The meta-analysis results showed that there were no significant differences in the function and strength of the shoulder joint, pain, motor range, recurrence of rotator cuff avulsion, the incidence rate of ankylosis between both two groups (P> 0.05). These results suggest that the efficacy of al-arthroscopic rotator cuff repair does not differ from those of mini-open for the treatment of rotator cuff injury. However arthroscopic rotator cuff repair induces less soft tissue injury and early incision pain, but better function recovery.%背景:对于全关节镜及小切口两种修复式的疗效比较,国内外尚有许多争议。  目的:对全关节镜及小切口两种方法治疗肩袖损伤的疗效进行荟萃分析。  方法:以“肩袖”、“关节镜”、“小切口”为检索词,计算机检索1966年1月至2015年11月PubMed, Embase,Cochrane图书馆和CBM,搜集所有的有关论研究。筛选并提取数据,采用Revman5.3软件进行荟萃分析。  结果与结论:共纳入11例研究,其中6例随机对照研究,5例队列研究,荟萃分析显示这两组肩关节功能、疼痛、活动范围、肩袖再撕裂率、关节僵硬发生率以及肩关节力量差异均无显著性意义(P>0

  2. Storage media for avulsed teeth: a literature review.

    Science.gov (United States)

    Poi, Wilson Roberto; Sonoda, Celso Koogi; Martins, Christine Men; Melo, Moriel Evangelista; Pellizzer, Eduardo Pizza; de Mendonça, Marcos Rogério; Panzarini, Sônia Regina

    2013-01-01

    Dental avulsion is the most severe type of traumatic tooth injuries because it causes damage to several structures and results in the complete displacement of the tooth from its socket in the alveolar bone. The ideal situation is to replant an exarticulated tooth immediately after avulsion because the extraoral time is a determinant factor for treatment success and for a good prognosis. However, it is not always possible. The success of replantation depends on a number of factors that may contribute to accelerate or minimize the occurrence of root resorption or ankylosis, among which is the type and characteristics of the medium used for temporary storage during the time elapsed between avulsion and replantation. Maintaining the tooth in an adequate wet medium that can preserve, as longer as possible, the vitality of the periodontal ligament cells that remain on root surface is the key to success of replantation. Recent research has led to the development of storage media that produce conditions that closely resemble the original socket environment, with adequate osmolality (cell pressure), pH, nutritional metabolites and glucose, and thus create the best possible conditions for storage. Although these storage media can now be purchased in the form of retail products, the most common scenario is that such a product will not be readily available at the moment of the accident This paper reviews the literature on the different storage media that have been investigated for avulsed teeth based on full-length papers retrieved from PubMed/Medline, Lilacs, BBO and SciELO electronic databases using the key words 'storage medium', 'transportation medium', 'avulsion', 'tooth avulsion', 'replantation', 'tooth replantation', 'milk' and 'propolis'. After application of inclusion and exclusion criteria, 39 papers were selected and critically reviewed with respect to the characteristics, efficacy and ease of access of the storage medium. The review of the literature showed that a

  3. Stability of dual-incision double-plate fixation versus locking plate fixation for tibial plateau fracture%双切口双钢板及锁定钢板内固定修复胫骨平台骨折的稳定性比较

    Institute of Scientific and Technical Information of China (English)

    李世芳; 孙健; 周道政

    2014-01-01

    背景:Schazker Ⅴ、Ⅵ型骨折常造成交叉韧带、侧副韧带及半月板等部位的损伤,且塌陷移位严重,若仅采用一侧锁定钢板,则较难支撑及满意复位。目的:比较双切口双钢板内固定与膝前正中切口锁定钢板内固定修复Schatzker Ⅴ、Ⅵ型胫骨平台骨折后的效果及稳定性评价。方法:纳入76例Schazker Ⅴ、Ⅵ型胫骨平台骨折患者,分别采用锁定钢板内固定(n=38)和双切口双钢板内固定(n=38)进行治疗,通过X射线正、侧位片评估骨折复位及愈合情况,并对胫骨平台内翻角、胫骨平台内侧后倾角进行生物力学测试。结果与结论:双切口双钢板内固定组住院时间、内固定后开始负重时间显著少于锁定钢板内固定组(P0.05);关节强直、骨折延迟愈合、针道感染、骨折延迟愈合、膝内翻畸形多项并发症比较,双切口双钢板内固定组显著少于锁定钢板内固定组,差异均有显著性意义(P 0.05);双切口双钢板内固定组内固定后Rasmussen分级明显优于锁定钢板内固定组,差异均有显著性意义(P0.05). The number of complications, such as ankylosis, fracture delayed union, pin tract infection, delayed union, varus deformity, was significantly fewer in the dual-incision double-plate fixation group than in the locking plate fixation group (P0.05). Postoperative Rasmussen classification was significantly better in the dual-incision double-plate fixation group than in the locking plate fixation group (P<0.05). Experimental results indicated that the clinical efficacy of the dual-incision double-plate fixation is superior to that of the anterior cruciate midline incision locking plate fixation in the treatment of Schatzker V, VI type tibial plateau fractures. The dual-incision double-plate fixation has more biomechanical stability.

  4. HIPEROSTOSIS ESQUELÉTICA DIFUSA IDIOPÁTICA EN UNA COLECCIÓN OSTEOLÓGICA CONTEMPORÁNEA (LA PLATA, BUENOS AIRES, ARGENTINA / Difusse Idiopathic Skeletal Hyperostosis in a contemporary osteological collection (La Plata, Buenos Aires, Argentina

    Directory of Open Access Journals (Sweden)

    Marcos Plischuk

    2015-06-01

    Full Text Available La Hiperostosis Esquelética Difusa Idiopática (DISH es una enfermedad caracterizada por provocar anquilosis entre cuerpos vertebrales, sumada a la osificación masiva de ligamentos y tendones en el resto del sistema esqueletal. El objetivo del presente trabajo es establecer la prevalencia de DISH en una colección osteológica documentada contemporánea y discutir rasgos patognomónicos y factores de riesgo asociados. A fin de establecer un diagnóstico se relevó, en 100 individuos adultos, la formación de bloques óseos de al menos tres vertebras fusionadas por la osificación de ligamento vertebral anterior. Se consideró además que no estuvieran comprometidos los espacios intervertebrales y la articulación sacroilíaca. En la zona extra espinal se registraron como evidencia complementaria la presencia de entesopatías. Como resultado del análisis se observaron seis individuos con DISH, sin diferencias significativas entre ambos sexos. El segmento vertebral principalmente afectado fue el torácico, los espacios intervertebrales no se vieron comprometidos en ningún caso y la articulación sacroilíaca tampoco presentó señales de osificación patológica; a la vez que se relevaron numerosas entesopatías. Las prevalencias observadas se deberían a la avanzada edad de los individuos analizados y las características nutricionales de la población de referencia.  Abstract  The diffuse idiopathic skeletal hyperostosis (DISH is a disease characterized by vertebral ankylosis, with massive ligaments and tendons ossification in the rest of the skeletal system. The aim of this study is to establish the prevalence of DISH in a well-documented and contemporary osteological collection, and to discuss pathognomonic features and associated risk factors. In order to establish the diagnosis, we registered, in 100 adults, the formation of bone blocks, with at least three fused vertebrae by ossification of the anterior vertebral ligament. It was

  5. Tratamento ortodôntico em pacientes com dentes reimplantados após avulsão traumática: relato de caso Orthodontic treatment in patients with reimplanted teeth after traumatic avulsion: a case report

    Directory of Open Access Journals (Sweden)

    Simone Requião Thá Rocha

    2010-08-01

    Full Text Available INTRODUÇÃO: a alta prevalência de indivíduos com traumatismo dentário prévio ao tratamento ortodôntico justifica os cuidados a serem observados antes e durante o tratamento, considerando todas as implicações do movimento ortodôntico sobre os dentes traumatizados. Entre as lesões traumáticas dentárias, a avulsão com posterior reimplantação do dente é a que apresenta maior risco de complicações - como necrose pulpar, reabsorção radicular e anquilose -, sendo também a que inspira maiores cuidados pelo ortodontista. OBJETIVO: este trabalho busca, através do relato de um caso clínico, analisar as implicações do reimplante dentário após avulsão traumática, em pacientes que requerem tratamento ortodôntico. CONCLUSÕES: a movimentação ortodôntica de um dente reimplantado, após sua avulsão traumática, é possível desde que não ocorra qualquer sinal de anormalidade. Porém, dentes que sofrem anquilose não são passíveis de movimentação ortodôntica, mas devem ser preservados como mantenedores de espaço, até a reabsorção total da raiz, desde que não apresentem infraposição severa. Ocorrendo infraposição severa do dente anquilosado, é indicada a amputação da coroa e o sepultamento da raiz, como meio de favorecer a manutenção do osso alveolar na região, pois ocorrerá reabsorção por substituição da raiz sepultada, como ocorreu no caso clínico apresentado.INTRODUCTION: The high prevalence of individuals with dental trauma prior to orthodontic treatment justifies the precautions that should be followed before and during treatment, considering all possible effects of orthodontic movement on traumatized teeth. Among the major traumatic dental injuries, avulsion with subsequent tooth reimplantation entails a higher than average risk of complications, such as pulp necrosis, root resorption and ankylosis. Therefore, it gives orthodontists several reasons for concern. OBJECTIVE: This case report sought

  6. Magnetic resonance imaging for ankylosing spondylitis; Magnetresonanztomographie bei ankylosierender Spondylitis (Morbus Struempell-Marie-Bechterew)

    Energy Technology Data Exchange (ETDEWEB)

    Bollow, M. [Augusta-Kranken-Anstalt, Inst. fuer Radiologie, Bochum (Germany)

    2002-12-01

    Ankylosing spondylitis (AS) is the prototypical form of the spondyloarthropathies, which at a prevalence of 2% is among the most frequent rheumatic diseases. Spondyloarthropathy comprises the following five disorders: AS, reactive arthritis, psoriatic arthritis, enteropathic arthritis in Crohn's disease, and ulcerosing colitis as well as undifferentiated spondyloarthropathy. In 99% of the patients with AS initial abnormal findings affect the sacroiliac joints. The radiographic changes required for diagnosing AS occur as late as 5-9 years after the onset of clinical symptoms. MRI of the sacroiliac joints reliably demonstrates both chronic inflammatory changes (erosions, sclerotic changes, bone bridges) and acute inflammatory changes (synovitis, capsulitis, osteitis) and allows for grading the chronicity and acuity of such changes. Enthesitis of the interosseous ligaments of the retroarticular space is a manifestation of AS. Spondylodiscitis (Andersson 1937) may occur as an inflammatory or non-inflammatory process (transdiscal fatigue fracture). Inflammations of the facet and costospinal joints developing into ankylosis are typical of AS. Changes of the vertebral bodies occur as anterior (Romanus 1952), posterior, and marginal spondylitis. All forms of spondyloarthropathies are furthermore characterized by asymmetrical synovitis of the large joints, particularly of the legs (gonarthritis, coxitis, tarsitis, peripheral oligoarthritis), rheumatic fibroosteitis (pelvic enthesitis, rheumatic calcaneopathy), and peri- and synchrondritis of the public symphisis and sternal synchondrosis. Since early inflammatory changes of the spinal column and of the extravertebral localizations in AS are demonstrated by MRI before they become apparent on radiographs, and thereby the diagnostic gap could be closed, the early use of MRI for diagnostic and follow-up is commendable, when new therapeutical options like the so-called 'biologicals' are employed. (orig.) [German

  7. 全面部陈旧性骨折回顾性分析与临床分类研究%Delayed pan-facial fractures-injury patterns associated with deficient treatment results and clinical classification

    Institute of Scientific and Technical Information of China (English)

    张益

    2008-01-01

    Objective To analyze the injury patterns in pan-facial fractures(PFF) which potentially lead to deficient treatment outcomes and then to propose a clinical classification.Methods Thirty-nine patients,31 male and 8 female,with an average age of 33,treated from 1998 to 2007 in the Center of Maxillaofacial Trauma,Peking University School and Hospital of Stomatology,were included.Zygomatic complex,maxilla and mandible were involved in the extensive fracture concomitant with nosalorbital-ethmoid(NOE)fracture or not.All cases experienced a delay of over 4 weeks after iniury.An analysis was made to display the relationship between facial architecture demolition and disfigurement and disability.Treatment results were assessed with facial appearance,opening range,occlusion and regional deformities.The associated iniury patterns most frequently leading to deftcient outcomes were summarized as references to scheme a clinical classification.Resuits Facial deformities presented in 90% of the patients and mostly related to condylar fracture/dislocation and zygomatic complex fracture.Limited mouth opening occurred in 59% of patients and were caused most frequently by displacement of zygomatic complex and joint ankylosis.Malocclusion was found in 100% of cases and there were the associated optical signs in 46%.Thirty-nine cases were divided into two types.Zygomatic,maxillary and mandibular fractures all together constituted type Ⅰ,which accounted for 46% of patients.Type Ⅰ plus NOE fracture was type Ⅱ,which accounted for 54% of patients.Furthermore,A,B and C sub-types were recognized in corresponding to involvement of condylar dislocation/fracture and zygomatic complex fracture.In treatment outcomes,a difference between type Ⅰ and type Ⅱ fractures remained with NOE fractures.The outcomes of term "moderate"and"worse"in subtype C group were attributed to severe soft tissue injuries and trauma-induced ankylosis.Conclusions NOE fracture,condylar fracture and dislocation

  8. 一期全膝关节置换治疗陈旧性股骨髁骨折合并膝关节骨关节炎%One-stage total knee arthroplasty for old femoral condyle fractures combined with knee osteoarthritis

    Institute of Scientific and Technical Information of China (English)

    任姜栋; 张晓岗; 曹力; 郭文涛; 彭理斌

    2012-01-01

    目的 探讨陈旧性股骨髁骨折合并膝关节骨关节炎一期全膝关节置换(total knee arthroplasty,TKA)的可行性和疗效.方法 2003年1月至2010年12月对陈旧性股骨髁骨折合并膝关节骨关节炎患者11例行一期TKA手术,男4例,女7例;年龄38~77岁,平均58.3岁.股骨髁上骨折8例,髁间骨折3例.其中2例伴有膝纤维性强直及轻度肌肉萎缩,2例合并膝关节侧副韧带损伤,2例合并股骨髁上纤维性愈合,2例为感染性骨不愈合.结果 所有患者均获得随访,随访时间6~72个月,平均41.3个月.美国特种外科医院(The Hospital for Special Surgery,HSS)膝关节评分从术前平均(6.65±7.01)分(0~13分)提高至末次随访时平均(88.5±6.18)分(81~95分).膝关节活动度由术前平均32.7°±17.6°(0°~50°)提高至末次随访时平均101.3°±9.8°(85°~115°).活动度平均增加77.7°.1例患者术后6年出现感染,反复清创失败后行膝关节离断术.其余患者均无感染、假体松动、下肢深静脉血栓形成、膝关节不稳及双下肢不等长等并发症.结论 陈旧性股骨髁骨折合并膝关节骨关节炎的一期TKA手术难度大,合理的手术方案是手术成功的关键.术后短期随访效果良好.%Objective To investigate the feasibility and clinical effect of one-stage total knee arthroplasty for old femoral condyle fractures combined with knee osteoarthritis.Methods From January 2003 to December 2010,11 patients with old femoral condyle fracture combined with knee osteoarthritis,including 4males and 7 females,aged from 38 to 77 years (average,58.3 years),underwent one-stage total knee arthroplasty.There were 8 cases of supracondylar fracture,and 3 cases of intercondylar fracture.Moreover,there were 2 cases of knee fibrous ankylosis with mild amyotrophy,3 cases of collateral ligaments injury of the knee,2 cases of fibrous union,and 2 cases of infective nonunion.Results All patients were followed up for 6 to 72 months

  9. 前交叉韧带重建失败后的首次翻修%Primary revision after failure of anterior cruciate ligament reconstruction

    Institute of Scientific and Technical Information of China (English)

    孔颖; 王国栋; 张元民; 赵晓伟; 张玉革

    2014-01-01

    , invalid fixation, adhesion, compound ligament injuries, and ankylosis. The functional results and objective stability could be obtained through revision folowing anterior cruciate ligament reconstruction.%背景:前交叉韧带重建失败可由多种因素引起,需要进行翻修手术治疗。国内关于前交叉韧带翻修的报道较少。目的:分析前交叉韧带重建失败后行翻修治疗的主要原因、适应证、方法及效果。方法:前交叉韧带重建后失稳需要接受翻修患者30例,均在关节镜下行探查与翻修治疗。翻修后应用KT-2000、国际膝关节评分委员会评分标准(IKDC)、Lysholm及Tegner评分系统进行评价。结果与结论:30例患者中,初次手术选用自体骨-髌腱-骨移植物9例,自体半腱股薄肌腱14例,同种异体腘绳肌腱7例,翻修原因上、下两端骨道均偏前8例,上骨道偏前12例,下骨道偏前8例,其中1例合并关节强直;自体骨-髌腱-骨重建固定上骨道内骨块的挤压螺钉位置异常1例;内侧副韧带股骨止点撕脱骨折未予修复1例。翻修术中重建的前交叉韧带完全断裂和吸收12例,韧带有部分连接但已明显松弛失张力18例。无骨道骨质严重缺损,均一期行前交叉韧带翻修手术,重建移植物采用同侧腘绳肌腱(STG)10例,对侧腘绳肌腱14例,人工韧带6例。前交叉韧带翻修后KT-2000检查膝关节屈曲90°和30°平均差值,以及IKDC、Tegner和Lysholm评分均较翻修前有明显改善。前交叉韧带重建手术失败的原因较多,但主要与手术骨道位置异常、固定失效、复合韧带损伤处理不当、关节强直等有关。前交叉韧带翻修后膝关节的主观功能和客观稳定性可获得明显改善。

  10. Comparative evaluation of the efficacy of radiosynovectomy with conventional intra-articular therapy in rheumatoid arthritis and haemophilic arthropathy (CERAHA)

    International Nuclear Information System (INIS)

    Full text: The objective of this study is to determine the therapeutic efficacy of radiosynovectomy on rheumatoid and hemophilic arthropathy as compared to the usual intra-articular steroids on painful joints. Rheumatoid arthritis is a chronic, systemic and inflammatory disease that involves the joints and is quite disabling. It has a worldwide prevalence of 1%. Hemophilia is a congenital blood disease that produces abnormal bleeding at the musculoskeletal level. It is a sex-linked trait that cause coagulation defects brought about by lack of Factor Vlll for Hemophilia A and Factor lX for Hemophilia B. In this study, under the auspices of IAEA, we used Yttrium 90 colloids and Rhenium 188 intra-articularly in the knee in the experimental group and steroids on the control group. Radioactive colloids (beta radiation) create fibrosis of the hypertrophic and highly vascularized synovium. It leads to coagulation necrosis and sloughing of the cells, destroying diseased pannus and inflamed synovium with the hope that the regenerating synovium, after destruction, will be free of the disease. Included in this study were established cases of RA set by the American Rheumatoid Assn which are stage 1, 2, and 3 by Larsen classification, no ankylosis, non-responders for NSAIDS and DMARDS for at least 6 months and with their informed consent. For the hemophilic group, they should have at least 3 bleeding episodes for the last six months and at least with 30% coagulopathy at the time of the procedure. Exclusion criteria included being pregnant or lactating, with infection on site of injection, beyond stage 3 and presence Baker's cyst. Baseline radiography and two-phase bone scans were taken as well as repeating these procedures at 6 an 12 months post-treatment. There were 39 evaluable patients under the experimental group consisting of 18 RA patients (mostly females) and 21 HA patients (all males). Thirty-eight patients were given Yttrium-90 colloid with doses ranging from 60 Mbq to

  11. Dolor osteomuscular y reumatológico Osteomuscular and rheumatic pain

    Directory of Open Access Journals (Sweden)

    J. L. Rodríguez-Hernández

    2004-03-01

    spondylitis is a chronic systemic inflammatory disease that affects in particular the axial skeleton and rarely the peripheral joints. Most patients are HLA-B27 positive and may present family aggregation. Its onset occurs mainly at the end of the adolescence and most frequently in men. The treatment aims to maintain the spine mobility, in order to avoid ankylosis, pain and inflammation. Gout is a metabolic disease characterized by the deposition of urate monosodium crystals from over-saturated extracellular liquids. Its clinical manifestations range from acute gouty arthritis to intercritical gout and chronic tophaceous gout. The diagnosis is based on the examination of joint fluid. The treatment is based on colchicine, to which NSAIDs and occasionally corticoids or ACTH may be added. Musculotendinous pain syndromes occur at shoulder, elbow, wrist, hip, knee, ankle and foot level. They present local clinical manifestations and the treatment is based in local infiltrations, iontophoresis and sometimes TENS and ultrasounds. Myofascial pain syndrome is a regional pain condition that frequently affects the scapular and pelvic waist. It presents pain triggering points and muscular contracture. Treatment is focused on pain management, recovery of the muscular force and mobility. Fibromyalgia is a chronic generalized non-articular painful condition with predominance of muscular involvement and sensitivity in multiple predefined points. It is more frequently seen in middle-aged women. Its physiopathology is not clear. Low levels of tryptophan and a significant increase of the S/S type of the 5 HT transporting gene have been found. N-methyl-D-aspartate receptors seem also to be involved in this syndrome when they are activated and family aggregation has also been found, probably due to genetic predisposition. Its diagnosis is based on the criteria published by the American College of Rheumatology. This disease requires a pharmacological, physical and rehabilitative treatment, also

  12. An investigation of concerns of Chinese patients and their families before total knee arthroplasty%膝关节置换术前患者及家属关注问题调查

    Institute of Scientific and Technical Information of China (English)

    李杨; 蔡宏; 张克

    2013-01-01

    Objective To learn about the degree of concerns of Chinese patients and their family about the upcoming total knee arthroplasty ( TKA ), postoperative rehabilitation, expectation and other relevant diagnosis and treatment procedures. Methods 128 patients who were scheduled to undergo TKA and their family members were inquired about preoperative concerns with a 61-question questionnaire. The degree of concerns was assessed by assigning a score on a scale of 1-4 ( 1=not concerned, 2=somewhat concerned, 3=very concerned and 4=extremely concerned ). Collected data were then statistically analyzed. Results The mean score of the degree of concerns of all the patients about all the items was 3.11. The top 5 concerns of Chinese patients were the ability to walk with no difficulties postoperatively ( 3.78 ), surgeons’ experience ( 3.73 ), the risk of failure in the surgery ( 3.68 ), the lifespan of joint prostheses ( 3.63 ) and the ability to take care of oneself postoperatively ( 3.63 ). The mean score of the degree of concerns of their family members was 3.18. The top 5 concerns of family members were surgeons’ experience ( 3.86 ), the ability to walk with no difficulties postoperatively ( 3.82 ), the postoperative pain relief rate ( 3.74 ), the postoperative occurrence of ankylosis ( 3.72 ), pain existing or not after discharge ( 3.72 ). The patients under 65 years old were evidently more concerned about the 6 items than those aged greater than or equal to 65 years old, including the ability to look after children postoperatively, the ability to enjoy recreations postoperatively, the lifespan of joint prostheses, the ability to ride a bike postoperatively, the ability to lift weights postoperatively and the occurrence of fractures around artificial prostheses after TKA. The scores of the degree of concerns of elderly and young patients about the occurrence of anesthetic accident were 3.71 and 3.38 respectively ( P=0.036 ). The scores of the degree of concerns of

  13. 复杂肱骨远端骨折手术治疗的临床探讨%Clinical evaluation of operative treatment of complicated distal humerus fractures

    Institute of Scientific and Technical Information of China (English)

    赵龙; 宋有鑫; 崔成喜; 张宇轩; 张宝琦; 龚平; 武云鹤; 尚瑞松; 陈宾

    2014-01-01

    Background Distal humeral fracture is a severe damage around the elbow joint,and is often seen in young adults.It accounts for 2% of all adult fractures and about 50% of all humerus fractures.It′s one of the fractures that is difficult to deal with.The types of distal humeral fracture are divergent. Distal humerus fractures are often comminuted which make operative reduction difficult.Secondary loss of reduction and elbow ankylosis are common postoperative complications. All these difficulties make the distal humerus fracture one of the unresolved problems in fracture treatment.This study is to evaluate the clinical outcome of complex distal humeral fractures treated by operation.Methods (1)General data:twenty-four cases of operative treated distal humerus fractures in author′s hospital from January 2004 to December 2013 were included in this study.There were 1 5 males and 9 females,aging from 1 7 to 73,averaged 41.AO/OTA Classification:A3:9 cases;B1, B2:6 cases;C3:9 cases.Two cases were combined with nerve injury.Two cases had histories of high blood pressure and diabetes.(2 ) Operative method:The patient was placed in the supine position,and the elbow to be operated on was positioned at 90°of abduction and supported on a lucent operating table.A pneumatic tourniquet was placed as proximally as possible on the arm.With the elbow flexed at about 60°,the first incision was made about 7 cm proximal to the tip of the medial epicondyle.In the initial cases,the ulnar nerve was isolated,released from the ulnar nerve groove, and protected carefully.In later cases,the nerve was only exposed.The medial and anteromedial side of the distal humerus was exposed through the opening between the brachial muscle and the medial intermuscular septum.The common origin of the flexor muscles was partially dissected and reflected distally,leaving a 5-mm strut to be re-sutured in situ at completion of surgery.The anterior capsule was incised.The articular surface of the trochlea was