Great omentum plasty--original method of treatment of the septic complications of hip and pelvis surgery.

UNLABELLED: The septic complications after hip arthroplasty are extremely severe due to frequent chronicity and prosthesis looseness, despite the expensive long-term antibiotic treatment. Starting from the well-know function of the greater omentum to isolate any septic intraperitoneal processes (an "extended lymph node"), we initiated a surgical technique which uses the greater omentum in the treatment of septic complications after hip surgery. METHOD: The technique consist in mobilisation of the greater omentum along the right or left gastroepiploic artery according to the affected hip, and placing it in the septic area after passing it anterior or posterior of the inguinal ligament. Between 1997 and 2004 we performed this technique on 5 patients (4 men and 1 woman) with ages ranking between 24 and 47, which presented chronic infections after hip arthroplasty (4 cases) and after iliac bone resection-reconstruction for fibrosarcoma (1 case). RESULTS: The post-operatory evolution was favourable in all cases. In one case the local septic process pursued demanding a reintervention that revealed that the great omentum has been retracted from the hip area. In 4 cases the septic processes has withdraw spectacularly. CONCLUSIONS: The use of the greater omentum in the treatment of septic complications after hip and pelvic surgery represents in some cases the only effective solution. This technique requires a good collaboration between orthopaedic and general surgeons.

Long-term follow-up after intertrochanteric osteotomies for avascular necrosis of the femoral head.

Between 1978 to 1994, 110 osteotomies were performed in 94 patients. Fifty hips (40 patients) were included in this study. Six hips were in stage II avascular necrosis (Arlet-Ficat staging) and 44 hips were in stage III. In 14 patients an etiologic association was discovered, the remaining 26 were considered idiopathic. The postoperative assessment (Harris score) showed that there is no statistic differences between sexes. Results strongly depend on the amplitude of the necrotic (Kerboul) angle (p < 0.01), the preoperative mobility of the hip (p < 0.01), and age. The best postoperative results are usually obtained in young, active, patients with unilateral involvement, a necrotic angle of less than 200 degrees, a good preoperative range of hip motion, and in which the osteotomy is performed before the collapse of sequestrum.

Immunocytomorphological study on the pathogenesis of ankylosing spondylarthritis.

The present investigation is based on the cytomorphological, histopathological (HE, VG, PAS-Alcian, Safranin 0, Gömöri), histoenzymological (acid phosphatase, chondroitinsulphatase, peroxidase) and immunological (rheumatoid factor (RF), circulating immune complexes (CIC), anticolagen II antibodies and C reactive protein (CRP) study on ankylosing spondylarthritis (2.5 cases). The synovial fluid (SF) synoviocytogram showed cytosis (6.067/mm3), with polynucleosis (65.19%) and ragocytosis (17.73%) as compared with the hydrarthrosie SF characterized by lymphocytosis (47%). Enzymological findings revealed phosphatasic and myeloperoxidasic activity in the ragocytary polymorphonuclear (PMNs) and mononuclear cells. Histopathologically, the severe forms of AS correlated with villous chronic synovitis, associated to processes of obliterating vascularitis, fibrosclerosis, necrosis and calcification of disintegrated synovial structures. The articular cartilage was severly damaged, while osseous necrobiosis was noted at the osteocartilaginous junction. Histoenzymologically, the chondrocytes and synovial macrophages showed lysosomal and oxidative enzymatic activity. Immunological assessments (72 sera and 25 synovial fluid samples) showed pathological values of circulating immune complexes, anticollagen antibodies and C reactive protein. Correlation of immunocytomorphological findings demonstrates the involvement of immunologic and enzymatic factors in the pathogenesis of AS.

Immunocytomorphopathological studies on the pathogenesis of rheumatoid arthritis.

Thirty cases of rheumatoid arthritis were submitted to cytomorphological, histopathological (HE, VG, PAS Alcian, Gömöri, Safranine O), histoenzymological (Acid Phosphatase, chondroitin-sulphatase, Peroxidase) and immunological (rheumatoid factor (RF)) studies; circulating immune complexes, anti-collagen antibodies II, Reactive C protein (CRP), Complementary C3 fraction were also assessed. The synoviocytogram of the rheumatoid synovial fluid (SF) indicated a cytosis with polynucleosis and ragocytosis compared to the hydroarthrosic SF defined by lymphocytosis (47.8%). Enzymologically, especially for high titres of rheumatoid factor, a phosphatase and peroxidase activity was observed in polymorphonuclear cells of a ragocytary type and in phagocytic mononuclear cells. The severe forms of rheumatoid arthritis (RA) were correlated histopathologically with chronic villous synovitis associated with some processes of obliterant vascularitis, fibrosis and sclerosis. At the level of synovio-cartilage junction, fissures and a homogenization of the cartilaginous fundamental substance in the vicinity of disintegrated synovial structures were noticed. Histoenzymologically, a lysosomal and oxidative activity was found in chondrocytes and in synovial macrophages. Immunological assessments (73 serum and 60 synovial fluid samples) showed pathological values of circulating immune complexes, anti-collagen antibodies and C reactive protein. The complementary synovial depletion of the C3 fraction underlines the immune character of the rheumatoid synovitis. The immunocytomorphologic data correlation demonstrates the involvement of immunologic and enzymatic factors in the evolution of Rheumatoid Arthritis.

Histopathological and ultrastructural modifications of the arthrosis articular cartilage.

Thirty samples of articular cartilage taken during the operation from patients with incipient arthrosis, arthrosis with radiological modifications and arthrosis under study for Rheumatoid Arthritis (RA) were investigated using histopathological (HE, VG, PAS-Alcian, Gömöri, Safranine O) and electronmicroscopic techniques. The control material was made of posttraumatic cartilage (Moore prosthesis). Histopathologically, the incipient arthrosis cartilage had superficial exfoliations associated with reduced saframinophilic tinctorial perichondrocytic activity. The arthrosic cartilage with typical radiological modifications was individualized at the synovia-cartilage junction by villous aspects of the synovia associated with perichondrocytic gaps, reduction of safraninophilia and modifications of reticuline-collagenic network. The arthrosic cartilage under study for RA revealed destructive fibrous modifications of the synovia and severe affection of the articular cartilage at synovia-cartilage junction. Electronmicroscopically, the ultrastructural affection was minimum in the incipient arthrosis cartilage developing to chondrocytic degeneration in arthrosis with radiological correspondent. Both histopathological and ultrastructural data emphasize the fact that arthrosis is associated with synovitis following a primitive degenerative process similar to rheumathoid synovitis in arthrosis under study for RA.

Pathogenesis aspects of arthrosis in histopathological and electronmicroscopical studies of articular cartilage, correlated to some immunological parameters.

Twenty-five biopsies of arthrosic cartilage with radiological correspondence, arthro, sic cartilage under study for Rheumatoid Arthritis (RA) and posttrauma cartilage as control-were examined using histopathological (HE, VG, PAS-Alcian, Gömöri, Safranine O) and electronmicroscopical techniques. The arthrosic cartilage with radiological correspondence shows superficial and deep fissures, perichondrocytic gaps and modified reticulino-collagenic network at the histopathological examination. At the level of synovia-cartilage junction, we found some villous aspects of the synovia desquamating in the proximity of the affected cartilage. The investigated arthroses for RA presented some destructive fibrous modifications of the synovia similar to rheumatoid synovitis and associated with some dystrophic chondrocytic alterations. The ultrastructural affection was severe leading to cellular degeneration. The immunologically-studied arthroses for RA had seric pathologic values regarding: circulating immune complexes (CIC) (mean = 67.08 +/- 1.45 U), Ig.M(mean = 358 +/- 3.02 UI/ml) and anti collagen antibodies (mean = 409.9 +/- 0.42 U). The synovial depletion of complementary fraction C3(mean = 42.3-1 mg%) as against the normal seric level (mean = 63.07 +/- 0.49 mg%) suggests an immune synovitis. Correlation of immunomorphopathological data emphasize that arthrosis coexists with a secondary synovitis following a primitive degenerative process and allows arthroses under study for RA to be separated from other degenerative rheumatism diseases.

Histopathological and histoenzimological investigations of the rheumatoid articular cartilage.

Twenty seven biopsies of articular cartilage taken intraoperatively from patients with Rheumatoid arthritis (RA) and from control patients with traumas were examined using histopathological techniques (HE, VG, PAS-Alcian, Gömöri, Safranine 0) and histoenzymological techniques (Acid phosphatase-lysomal marker, Chondroitinsulphatase, Peroxidase). Histopathologically, the rheumatoid articular cartilage appears with superficial and deep cartilaginous fissures, frequent perichondrocytic gaps associated with modification of the tinctorial activity. At the pannus synovia-cartilage junction we found invasive and destructive synovial inflammatory infiltrates penetrating and eroding the cartilage. Histoenzymologically, the rheumatoid chondrocytes have a high lysosomal potential (phosphatasic, chondroitinsulphatasic) and highly oxidative potential (peroxidasic) specific for lesion modifications.

Aspects of ankylosing spondylarthritis immunopathogenesis correlated with some immunoseric- and synovial parameters in the investigation of histopathological and electronmicroscopic alterations of the articular cartilage correlated with some immunoseric and synovial parameters.

Eighteen biopsies of articular cartilage taken intraoperatory from patients with Ankylosing Spondylarthritis (AS) and from others with traumatisms (controls) were investigated using histopathological (HE, VG, PAS-Alcian, Gömöri, Safranin 0), electronmicroscopic and histoenzymamologic techniques. Histopathologically, the synovitis in AS is characterized by abundant synovia lymphoplasmocytic infiltrates associated with aspects of vascular hyperplasia and fibrosis. At the pannus synovia-cartilage junction we found the invasive synovia lymphoplasmocytic infiltrates. The proteoglycan (PG) depletion is confirmed histopathologically by diminishing the Safranin 0 staining, then ultrastructurally by the existence of collagen revealing areas, whereas biochemically, by the presence of glycosaminoglycans (GAG) in serum and synovial fluid (SF). The morphological data were related to some immunological parameters involved in pathogenesis. In this way, we found pathological values of the immune circulating complexes (ICC) (serum, mean = 73.5 U; SF mean = 81.80 U) and of anti Collagen II antibodies (serum mean = 410 U; SF mean = 436 U). The reactive protein C acting in the phase (CRP) showed high pathological values both in serum (mean = 5.01 mg%) and in SF (mean = 3.6 mg%) of the patients with AS, emphasizing the inflammatory characteristics of the rheumatic disease. The presence of ICC, anticollagen II antibodies and GAS as well in synovia suggests that the inflammatory articulation in AS is a local potential antigen of collagen and proteoglycan nature.

Aspects of immunopathogenesis of rheumatoid arthritis correlated with some immunological parameters in histopathological and electronmicroscopical investigations of the articular cartilage.

The histopathological (H. E., V. G., PAS-Alcian, Safranine 0, Gömöri) and electron-microscopical investigations were carried out on twenty samples of articular cartilage taken during operations from patients with Rheumatoid Arthritis (R. A.) and from others with traumatism, as controls. Histopathologically, the rheumatoid synovial membrane is characterized by synovitis with abundant perivascular lymphoplasmocytic infiltrates. At the pannus synovia-cartilage junction we found the invasive and destructive inflammatory infiltrates penetrating and eroding the cartilage. The histopathological characteristics of the rheumatoid articular cartilage lie in alteration of tinctorial activity, affection of reticuline collagen network and the presence of superficial and deep cartilaginous fissures. The histopathological alterations were confirmed ultrastructurally. Immunologically we found pathological serum values regarding the immune circulating complexes (I. C. C.) (mean = 104 +/- 1.04 U), anticollagen II antibodies (mean = 538 +/- 5 U), reactive Protein C (mean = 16.75 +/- 1.95 mg%) and orosomucoid (mean = 151.1 +/- 4.91 mg%), in seropositive R. A. The corroboration of histopathological, electronmicroscopical and immunological data show the inflammatory and autoimmune feature of this rheumatic disease.

Histopathological and ultrastructural modifications of the articular cartilage in ankylosing spondylarthritis.

The present study aims to analyse the articular cartilage in Ankylosing, Spondylarthritis (AS) versus the normal cartilage (18 cases altogether) by histopathological (HE, VG, Pas-Alcian, Gömöri, Safranine O), electronmicroscopic and histoenzymological techniques starting from the finding that the articular exudate in this affection is characterized cytomorphologically by cytosis (6,100/mm3), with polynucleosis (61%) and ragocytosis (25%). Histopathologically, the articular cartilage in AS evinced an alteration of safraninophilic areas and pale zones located in the neighbourhood of synovial lymphoplasmocytic infiltrates, pointing to the depletion of proteoglycans. The cartilage-synovia interference areas are relevant for the invasive nature of the inflammatory infiltrates which erode the cartilage. The histopathological modifications were confirmed ultrastructurally by the existence of some extended areas of revealed collagen, indicative of proteoglycans depletion. Functionally, chondrocytes have a high oxidative potential expressed by the presence of the peroxisomes and the positive reaction of peroxidase (PO), located near the nuclear membrane and the rough endoplasmic reticulum. The corroboration of histopathological, ultrastructural and histoenzymological data shows the alteration of the articular cartilage in AS, expressed morphologically at the level of the chondrocytes and of their synthesis products, collagen and proteoglycans.

[Therapeutic management of fracture-induced osteitis]. / Atitudinea terapeutica în osteita fracturar.

Fractural osteitis is considered to be exclusively of external origin, being due either to accidental wounds, or to operatory wounds. The infection is usually either with a single strain of germs, or with a small number of strains, most frequently a staphylococcus strain with a necrototizing effect on the bone structure. The prophylaxis has a determinant role, and the authors stress the organisatory measures, as well as the medical attitudes that should prevail in the face of an open fracture. In the case of closed fractures that have been infected as a result of surgery the necessity for an "early reintervention" is stressed. Late postoperative osteitis may develop in a consolidated focus, and is called osteitis of the repaired bone. It may also develop as an osteoarthritis or, and this is more serious, as a suppurated pseudarthrosis. The therapeutic attitude depends on the condition, and may consist in the removal of the osteosynthesis material, removal of the sequestered bone tissue, a so-called: "mis-à-plat" of the cavity with muscular tissue and application of septopal pearls, or a two-stage spongious graft according to Papineau, under protection of the external fixation when the necessity arises.

[Paralytic scoliosis]. / Scoliozele paralitice.

The authors discuss the problems raised by paralytic scolioses. A total of 14 patients with this syndrome were operated, of which 13 with the instrumentation, and according to the procedure introduced by Harrington. The authors stress the pathophysiologic context which defines the surgical indications and the prognosis.

[Physiopathological bases of the treatment of fractures of the trochanteric process]. / Bazele fiziopatologice ale tratamentului fracturilor masivului trohanterian.

The proximal end of the human femur represents the result of a long, phylo- and ontogenetic evolutionary process. Its functional structure is determined by biomechamical stresses imposed by the necessities of locomotion and of the upright position, the principal role being that of gravitational pull and the resultant contraction of the two major muscular groups. The older classifications of the fractures of the trochanteral massif, based on anatomical description, is being replaced by the classification based on pathophysiological data, with therapeutic and prognostic value. The notion of instability sets the course in the field of therapeutical principles, of which the most important is, certainly, the refection of the major sustentation pillar--the internal or the calear-femural cortical.