Manga traqueal cartilaginosa. Reporte de dos casos / Tracheal cartilaginous sleeve. Report of two cases

La manga traqueal cartilaginosa es una malformación de la vía aérea donde no se distinguen anillos traqueales. Un segmento continuo de cartílago se extiende desde el cricoides, pudiendo llegar hasta los bronquios principales. Está asociada a síndromes de craneosinostosis con la mutación FGFR2, además de muertes prematuras por oclusión de la tráquea con tapones mucosos. Se presenta el curso clínico de pacientes portadores de manga traqueal cartilaginosa en el contexto de una malformación craneofacial. Caso 1. Masculino, al nacer hipoplasia del tercio medio facial. Polisomnografía: índice de apnea/hipopnea de 37,7/hr. Laringotraqueobroncoscopía (LTBC): tráquea sin anillos cartilaginosos desde cricoides hasta bronquios fuentes. Se indica traqueostomía. Caso 2. Masculino, al nacer cráneo en trébol. Poligrafía: Síndrome de apnea/hipopnea obstructiva del sueño (SAHOS) leve. Revisión vía aérea: desde subglotis hasta bronquios principales se extiende tráquea en manga. Se indica traqueostomía. En el contexto de una craneosinostosis en niños, especialmente con mutación FGFR2, creemos necesario realizar una LTBC en búsqueda de manga traqueal, ya que si es diagnosticada se debe recomendar traqueostomía, mejorando su expectativa de vida. Si la indicación de traqueostomía fuese por SAHOS, es obligatoria una LTBC preoperatoria, para evitar el no tener referencias anatómicas en el proceso.

A tracheal cartilaginous sleeve is a malformation of the airway in which the tracheal rings are indistinguishable. A continuous segment of cartilage extends from the cricoid, and it may reach all the way to the main bronchi. It is associated with various craniosynostosis syndromes with the FGFR2 mutation, in addition to premature deaths due to occlusions caused by mucus plugs in the trachea. Here we present the clinical course of patients who suffer from Tracheal Cartilaginous Sleeve in the context of a craniofacial malformation. First case. Male, presenting at birth a midfacial hypoplasia. Polysomnography: presents a 37,7/h index of apnea/hypopnea. Laryngotracheobronchoscopy (LTB): trachea is without cartilaginous rings from the cricoid to the main bronchi. A tracheostomy is indicated. Second case. Male, cloverleaf skull at birth. Polysomnography: Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) non-severe degree. Revision of the airway: the trachea in sleeve extends from the subglottis to the main bronchi. A tracheostomy is indicated. In the context of craniosynostosis in children, especially with FGFR2 mutation, we believe it is necessary to do an LTB in the search of a tracheal sleeve, since if it is diagnosed a tracheostomy must be indicated, to better the life expectancy of the patient. If the tracheostomy indication comes from an OSAHS, a preoperatory LTB is obligatory to avoid not having anatomical references during the procedure.

Fibrocartilaginous mesenchymoma: a clinicopathological analysis of four cases / 中华病理学杂志

Objective: To investigate the clinical, radiological, histological and molecular features and the differential diagnosis of fibrocartilaginous mesenchymoma (FM). Methods: Four cases of FM diagnosed in the Department of Pathology, the Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine from 2020 to 2022 were analyzed. Related literature was also reviewed. Results: Case 1 was a 10-year-old girl with bone destruction in the sacrum and L5 articular processes revealed by CT scan. Case 2 was a 7-year-old girl with an aggressive lesion in her right distal ulna. Case 3 was an 11-year-old boy with a lesion in the metaphysis of his left proximal tibia. Case 4 was an 11-year-old boy with bone destruction in the distal portion of a radius. Microscopically, the four tumors all consisted of numerous spindle cells, hyaline cartilage nodules, and bone trabeculae. The hypocellular to moderately cellular spindle cell component contained elongated cells with slightly hyperchromatic, mildly atypical nuclei arranged in bundles or intersecting fascicles. Benign-appearing cartilaginous nodules of various sizes and shapes were scattered throughout the tumors. There were areas mimicking epiphyseal growth-plate characterized by chondrocytes arranged in parallel columns and areas of enchondral ossification. The stroma was rich in mucus in case 1. Mutation of GNAS and IDH1/IDH2 and amplification of MDM2 gene were not found in any of the three tested cases. Conclusions: FM is very rare and tends to affect young patients. It most frequently occurs in the metaphysis of long tubular bones, followed by the iliac-pubic bones and vertebrae. FM is characterized by a mixed population of spindle cells, hyaline cartilage nodules and trabeculae of bone, without specific immunophenotypes and molecular alternations. As a borderline, locally aggressive neoplasm, surgical removal with a wide margin is generally the treatment of choice for FM.

The effect of prenatal exposure to 1800 MHz electromagnetic field on calcineurin and bone development in rats

PURPOSE: To investigated the effects of exposure to an 1800 MHz electromagnetic field (EMF) on bone development during the prenatal period in rats. METHODS: Pregnant rats in the experimental group were exposed to radiation for six, 12, and 24 hours daily for 20 days. No radiation was given to the pregnant rats in the control group. We distributed the newborn rats into four groups according to prenatal EMF exposure as follows: Group 1 was not exposed to EMF; groups 2, 3, and 4 were exposed to EMF for six, 12, and 24 hours a day, respectively. The rats were evaluated at the end of the 60th day following birth. RESULTS: Increasing the duration of EMF exposure during the prenatal period resulted in a significant reduction of resting cartilage levels and a significant increase in the number of apoptotic chondrocytes and myocytes. There was also a reduction in calcineurin activities in both bone and muscle tissues. We observed that the development of the femur, tibia, and ulna were negatively affected, especially with a daily EMF exposure of 24 hours. CONCLUSION: Bone and muscle tissue development was negatively affected due to prenatal exposure to 1800 MHz radiofrequency electromagnetic field.

Correlation between age and general morphology of transverse section of cartilago costalis / 法医学杂志

OBJECTIVE@#To study the correlation between age and general morphology of transverse section of cartilago costalis and its forensic significance.@*METHODS@#Eighty-six corpses' cartilago costalis from the routine postmortem examination were collected and the morphological features of their transverse section were observed.@*RESULTS@#With the increased age, there were regular changes in the color, structure, and material of the general morphology of transverse section of cartilago costalis. But the changes were not affected by gender.@*CONCLUSION@#The good correlation between general morphology of transverse section of cartilago costalis and age can be used to estimate age of the deceased rapidly.

Cartilaginous melanoma: case report and review of the literature / Melanoma cartilagíneo: caso clínico e revisão da literatura

Malignant melanoma can present a variety of histopathological patterns. Cartilaginous change in the absence of osteogenic differentiation is extremely rare in malignant melanoma, being among the least frequent of the wide range of melanoma histologic patterns. We report a case of a 47-year-old woman with a subungual nodule on her right great toe for many years. Histopathological examination of the lesion led to a diagnosis of malignant melanoma with cartilaginous differentiation devoid of concomitant osseous areas. It would appear that this unusual form of melanoma has a predilection for acral location, particularly the subungual region. Malignant melanoma with chondroid stroma should therefore be considered in the differential diagnosis of cartilaginous lesions of the toes and fingers. Careful examination of the overlying epidermis and identification of an in situ component of melanoma may be necessary in order to establish the correct diagnosis.

O melanoma maligno pode apresentar uma grande variedade de padrões histopatológicos. A presença de diferenciação cartilagínea, na ausência de diferenciação osteogénica, é extremamente rara no melanoma maligno. O melanoma cartilagíneo está entre os padrões histológicos menos frequentes. Relatamos um caso de uma doente do sexo feminino de 47 anos de idade com um nódulo subungueal no 1º dedo do pé direito com muitos anos de evolução. O exame histopatológico da lesão revelou melanoma cartilagíneo, sem áreas de diferenciação osteogénica. Esta variante de melanoma parece ter predileção pela extremidades, sobretudo pela região subungueal. Assim, o melanoma maligno com diferenciação condróide, deve ser tido em consideração no diagnóstico diferencial de lesões acrais cartilagíneas. A observação cuidadosa da epiderme e a identificação de um componente do melanoma in situ podem ser necessários para estabelecer um diagnóstico correto.

Effect of ofloxacin on the cartilage of the knee joint of juvenile rats

Ofloxacin is one of fluoroquinolones derivatives, which has a broad spectrum bacterial activity. It is contraindicated in children and adolescents because of its potential chondotoxicity in juveniles. However, fluoroquinolones continue to be prescribed as a drug of choice for treatment of some life threatening diseases in pediatrics. This study was conducted to examine the effect of ofloxacin on cartilage of juvenile rats by light and electron microscopes. Twenty newborn albino rats were treated with an oral dose of 900 mg/kg/day of ofloxacin for 28 days. The animals were sacrificed after the completion of the administration and the knee joints were prepared for light and electron microscopic examination. Morphometric study and statistical analysis of the results were also performed. The lesions were demonstrated in the articular cartilage of all the animals. Fissures, chondrtocyte clusters and wide area of matrix devoid of cells in the intermediate zone were observed. The surface of the premature articular cartilage of the femur was irregular. The matrix of the articular cartilage showed less staining with toluidine blue and masson trichrome. Electron microscopic results showed separation between chondrocyte cell membrane and the matrix. The chondrocytes were necrotic with pyknotic nuclei and vacuolation of their cytoplasm. There were electron dense aggregates on the cell membrane and inside the cells. The thickness of the premature articular cartilage and epiphyseal plate cartilage were significantly decreased. The numbers of chondrocytes of the premature articular cartilage and epiphyseal plate cartilage were significantly decreased. The numbers of chondrocytes of the premature articular cartilage and epiphyseal plate cartilage were significantly decreased

Tratamento cirúrgico das lesões osteocondrais do joelho com mosaicoplastia / Surgical treatment of osteochondral lesions of the knee with mosaicplasty

OBJETIVO: Avaliação dos resultados funcionais da técnica de mosaicoplastia em joelhos de pacientes com lesão osteocondral. MÉTODOS: No período de agosto de 1999 a março de 2005, 27 pacientes foram submetidos à mosaicoplastia do joelho. Vinte e um eram do sexo masculino e seis, do feminino. A idade variou de 16 a 64 anos (média de 38,1 anos). Dezessete lesões eram do lado direito e 10, do esquerdo. Em relação à localização da lesão, quatro (15 por cento) situaram-se no côndilo femoral lateral, 18 (66,5 por cento) no côndilo femoral medial e 5 (18,5 por cento) na patela. O tamanho das lesões variou de 1 a 8cm² (média de 2,7cm²). Os pacientes operados foram avaliados no pré e pós-operatórios pela escala funcional de Lysholm, com seguimento médio de 2,5 anos. RESULTADOS: O pré-operatório teve uma média de 62,7 pontos e o pós-operatório uma média de 95,4 pontos. Os pacientes submetidos à mosaicoplastia no côndilo femoral lateral apresentaram, no pré-operatório, a média de pontos de 51,5 pontos e, no pós-operatório, média de 100 pontos. No côndilo femoral medial a média no pré-operatório foi de 64,1 pontos e, no pós-operatório, de 95,4 pontos. Com relação à patela, a média do pré-operatório foi de 66,4 pontos e, do pós-operatório, de 92 pontos. CONCLUSÃO: A mosaicoplastia mostrou-se uma boa alternativa no tratamento das lesões osteocondrais do joelho. Entretanto, apresentou melhor evolução nas lesões dos côndilos femorais em relação às localizadas na patela.

OBJECTIVE: To evaluate the functional results of mosaicplasty in knees of patients with osteochondral lesion. METHODS: Between August 1999 and March 2005, twenty-seven patients were submitted to mosaicplasty on the knee. Twenty-one were male and six female. The patients' ages ranged from 16 to 64 years (average 38.1 years). Seventeen lesions were located on the right knee and ten on the left one. The lesion was located on the lateral condyle in 4 patients (15 percent), on the medial condyle in 18 patients (66.5 percent) and on the patella in 5 patients (18.5 percent). The lesion sizes varied from 1 to 8 cm² (average 2.7 cm²). The patients operated on were evaluated before and after surgery by the functional Lysholm scale, with an average follow-up of 2.5 years. RESULTS: In the preoperative evaluation, the average was 62.7 points, evolving to 95.4 points in the postoperative evaluation. The patients submitted to mosaicplasty in the lateral condyle presented an average of 51.5 points before surgery, evolving to 100 points after surgery. The patients submitted to mosaicplasty in the medial condyle had presented average of 64.1 points before surgery, evolving to 95.4 points after surgery. The patients submitted to mosaicplasty on the patella presented average of 66.4 points before surgery, evolving to 92 points in the postoperative evaluation. CONCLUSION: Mosaicplasty proved to be a good alternative for the treatment of chondral and osteochondral lesions of the knee, showing better evolution in lesions located on the femoral condyles than in lesions located on the patella.

Association of synovitis versus cartilage loss with pain severity and functional limitations in primary knee osteoarthritis: clinical and MRI study

This study aimed at examining the association of MRI detected synovitis versus cartilage defects with knee pain severity and functional limitations in patients with primary knee OA. Twenty with symptomatic primary knee OA [aged 32 to 56 years] fulfilling the American College of Rheumatology criteria of idiopathic OA of the knee. The severity of knee pain was evaluated by visual analogue scale [VAS]. Also pain severity impact on patient's global activity of daily living was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] fur pain scale. Scoring of OA impact on Patient's functional status was determined by Lequesne's functional index. Knee MRI was acquired to identify synoviaI changes and cartilage defects. Correlations between knee pain and functional measures with synovial and cartilage abnormalities scores were carried out. Twenty seven knees had evidence of synovitis in the scored sites. Synovitis correlated significantly with pain severity and limitations in functional activities. Total cartilage loss correlated with higher pain scores and higher Lequesne's index. Total and regional synovitis scores correlated significantly with total and compartmental cartilage scores. Osteoarthritic synovitis correlates with knee pain severity and functional limitations. Also, the degree of synovitis is associated with cartilage loss. Magnetic resonance imaging is beneficial in scoring synovitis and cartilage loss of OA

Relapsing polychondritis: a rare disease of multisystem involvement.

Relapsing Polychondritis (RP) is a rare connective tissue disease of unclear pathogenesis and may present with multisystem involvement. In this report we describe a case of Relapsing Polychondritis, a rare autoimmune disease of varied presentation, course, and response to therapy.

Correlation between cartilage defects as detected with MRI and x-ray spiking of tibial tubercles in osteoarthritis knees

To ascertain whether spiking of the tibial tubercles is associated with cartilage defects as detected by magnetic resonance imaging [MRI] in osteoarthritis [OA] of the knee joint patients. The study was performed on 76 knees of 47 patients with symptomatic tibiofemoral joint [TFJ] OA and 31 apparently normal knees of 16 volunteers as a control group. Angulation of the tip of the medial and lateral tubercles and the height of the tubercles above the tibial plateau were measured on a standard anteroposterior radiograph of the knee joint. Cartilage defects in the tibiofemoral joint were determined with MRI examination. The lengthening and sharpening of the angles of the tubercles were significantly more prominent in patients than controls. A strong association was found between angulation [if less than 70[0]] and especially the height [if more than 0.16] of the medial tibial spike and MRI-detected cartilage defects in the medial tibiofemoral compartment. The predictive value of the spiking of tibial tubercles for MRI-detected cartilage defects in TFJ was related to the degree and size of spiking. The presence of tibial spiking itself may not be a reliable sign of early OA

Efeito antiinflamatório da lama negra de Peruibe em diferentes modelos experimentais de artrite / Evaluation of the anti-inflammatory effects of mud therapy (Peruibe, Brasil) on different experimental models of arthritis

Investigar a eficácia da lama negra brasileira como tratamento para inflamação em modelos experimentais de artrite. O efeito antiinflamatório de aplicações de lama foi comparado ao tratamento com água aquecida e ausência de tratamento em modelos experimentais de artrite e osteoartrite induzidas em coelhos e em ratos, visando parâmetros inflamatórios e cartilagem. O tratamento com lama melhorou a infiltração de leucócitos e exerceu um efeito protetor parcial na sinóvia e cartilagem. Nossos resultados sugerem que a lama brasileira apresenta efeito antiinflamatório e pode ser útil como um método complementar ao tratamento de pacientes com doenças articulares crônicas / Investigate the effectiveness of a Brazilian black mud as treatment for inflammation in experimental models of arthritis. Effects of mud applications was compared with warm water and no treatment in experimental models of arthritis and osteoarthritis induced in rabbits and in rats, regarding inflammatory parameters and cartilage. Treatment with mud impaired leukocyte infiltration which was followed by a partial protective effect on synovium and cartilage. Our results show that Brazilian mud presents an anti-inflammatory effect and can be useful as a complementary approach to treat patients with chronicle articular diseases...

Estudo epidemiológico das alterações estruturais da cavidade nasal associadas à síndrome da apnéia e hipopnéia obstrutiva do sono (SAHOS) / Epidemiological analysis of structural alterations of the nasal cavity associated with obstructive sleep apnea syndrome (OSA)

OBJETIVO: Mostrar que alterações estruturais da cavidade nasal, como desvio do septo do nariz e a hipertrofia dos cornetos inferiores, são altamente incidentes em pacientes com síndrome da apnéia e hipopnéia do sono e devem ser abordados associados aos procedimentos específicos da síndrome. FORMA DE ESTUDO: Clínico retrospectivo. CASUíSTICA E MÉTODO: Realizamos um estudo retrospectivo em 200 pacientes, 196 homens e 4 mulheres, atendidos no ambulatório de otorrinolaringologia do Hospital Prof. Edmundo Vasconcelos e Unidade Paulista de Otorrinolaringologia, todos com controle polissonográfico, exame físico otorrinolaringológico, endoscópico e o tratamento cirúrgico com procedimentos nasais e faríngeos. RESULTADOS: Todos tiveram procedimento cirúrgico faríngeo: uvulopalatofaringoplastia ou uvulopalatoplastia, e no nariz: 176 septoplastias com turbinectomia parcial (88 por cento) e 24 turbinectomias isoladas (12 por cento), com resultados satisfatórios. CONCLUSÃO: Podemos concluir que as alterações estruturais da cavidade nasal têm alta incidência nos pacientes com SAHOS.

Primary peritoneal adenosarcoma with stromal overgrowth and fetal type cartilage: a case report and literature review.

Primary peritoneal adenosarcoma with sarcomatous overgrowth and fetal-type cartilage presented in a 48-year-old female patient is described. The tumor seems likely to have derived from the pelvic peritoneum, wheareas the uterus, ovaries and tubes were uninvolved. It was composed of benign-appearing glands and a sarcomatous component showing cartilaginous differentiation. The extrauterine adenosarcomas were reported in other sites, e.g. cervix, ovary, fallopian tube, bladder, and peritoneum. This case was the ninth case of the primary peritoneal adenosarcoma in the English literature and the first report in Thailand.

Effects of cigarette smoke on the Meckel's cartilage of rat fetus: morphologic, morphometric and stereologic study

O objetivo deste estudo foi investigar os efeitos da fumaça de cigarros sobre o desenvolvimento da cartilagem mandibular (cartilagem de Meckel) do embrião de rato. Quando inalado por ratas Wistar, entre o 9º e o 12º dia de prenhez, a fumaça de cigarros (5/dia) provocou retardo do crescimento intrauterino, com fetos e placentas menores. Nos fetos do grupo experimental, o exame histopatológico revelou uma cartilagem de Meckel pouco desenvolvida, com condroblastos menores apresentando citoplasma escaso com núcleos mais pálidos, esféricos e centrais, assim como uma matrix cartilaginosa mais abundante. A análise morfométrica revelou que as lacunas da cartilagem de Meckel eram menores nos fetos do grupo experimental, não apresentando alteração significativa de sua forma. Os resultados sugeriram que a fumaça de cigarros inalada pelas ratas prenhes durante o período de organogênese induziu retardo tanto do crescimento quanto da diferenciação celular na cartilagem de Meckel dos fetos.

Tabla de valoración de la maduración esquelética según el signo de risser en individuos sanos de 10 a 20 años de edad / Table of valuation of the skeletal maturation according to the sign of risser in healthy individuals of 10 to 20 years of age

Se realizó un estudio clínico-radiográfico, transversal, comparativo, en 300 individuos sanos comprendidos entre de 10 y 20 años, de los dos sexos, del Instituto Fiscal de Educación Integrado "José Martí" y del Colegio Nacional Santiago de Guayaquil de la ciudad de Quito, entre enero y diciembre de 1996, con el propósito de elaborar una tabla de valoración ósea nacional, usando como referencia el signo de RISSER, (evolución de los centros secundarios de osificación de la cresta ilíaca). A cada uno de los sujetos de nuestro estudio se le realizó una radiografía anteroposterior de pelvis, y se analizaron las siguientes variables: peso, talla, edad, sexo y perímetro braquia para valorar el estado nutricional. Los sujetos fueron subdivididos en dos grupos de acuerdo al sexo: hombres y mujeres, y de acuerdo a la edad en subgrupos de 10 a 20 años con intervalos de 1 año. Se encontró que la maduración ósea según el signo de Risser se inicia más temprano en las mujeres. En los hombres existe una relación directa (correlación positiva r = 0.50) entre el aparecimiento del signo de Risser con las siguientes variables: perímetro braquial a los 16 años y con el peso y la talla a los 13 años; en las mujeres con talla a los 10 años y peso y perímetro braquial a los 13 años. En los hombres el signo de RISSER se inicia a los 13 años en un 6.67 por ciento y a los 19 años únicamente han completado la osificación el 46.67 por ciento, en las mujeres el 6.67 por ciento presentaron un RISSER 1 a los 10 años y completaron su osificación el 54.55 por ciento a los 19 años. Ninguno de los grupos presentó signos de desnutrición (Indice de Quetelet 0.17-0.22). Estos valores comparados con los de la literatura, nos indican que el desarrollo óseo en hombres y mujeres de Quito es notoriamente más tardía debido probablemente a factores nutricionales, climáticos, genéticos y étnicos...

Peripheral odontogenic fibroma with chondroid differentiation.

An unusual case of peripheral odontogenic fibroma, presenting as a swelling on gingiva involving hard palate in a 3-year-old female child, is described. Even with cellular stroma and unencapsulation these tumors behave in a benign fashion. To the best of our knowledge, cartilagenous differentiation of stroma as observed in this case has not been reported in English literature so far.