Humoral immune response against 38-kDa and 16-kDa mycobacterial antigens in bone and joint tuberculosis.

SETTING: The diagnosis of bone and joint tuberculosis (BTB) is difficult, and diagnostic delays often occur. A reliable serological test detecting anti-mycobacterial antibodies would thus be of some use in this form of the disease. OBJECTIVE: To evaluate the diagnostic accuracy of an assay detecting IgG against 38-kDa and 16-kDa recombinant mycobacterial antigens in BTB. MATERIALS AND METHODS: In a prospective study, serum samples from 124 subjects were examined: 30 BTB cases, 40 non-specific bone and joint infection patients (NSBI), 30 lung cancer patients (LC), and 24 healthy volunteers (HC). An ELISA-based test (Pathozyme TB complex plus) was used. RESULTS: The cut-off level was established at 150 U/ml according to receiver operating characteristic (ROC) curves. The quantified level of sensitivity of the test detecting BTB was 56%, at a specificity of 99%. The positive and negative predictive values were respectively 94% and 88%. Mean IgG level in the BTB group was 470 +/- 761 U/ml (mean +/- SD), and was significantly higher than the antibody level in the control groups (NSBI 58 +/- 42 U/ml, LC 43 +/- 38 U/ml, HC 40 +/- 29 U/ml). CONCLUSION: The test presents an acceptable level of sensitivity and very good specificity in the diagnosis of BTB, and can be used in combination with other methods to increase diagnostic accuracy in this disease.

Problems, progress, and late outcome from the treatment of septic loosening of hip arthroplasty.

Background. The goal of this research was to evaluate problems and progress in the treatment of septic loosening of total hip replacements. These complications are typically the result of unfamiliarity with the risk factors, technical errors during surgery, improper management by physicians, or other factors, sometimes difficult to ascertain. The bacteria which cause injections are identified, and the methods used to control and manage infections are described.
Material. The authors studied complicating infections in hip prostheses in 129 patients. This clinical material was divided into two groups: 31 patients with early infections and no indications of prosthesis loosening were assigned to Group I, while Group II included 98 patients with symptoms of late infection and signs of endoprosthesis loosening. Surgical treatment of early infection involved thorough debridement of the focus and many weeks of antibiotic therapy, both local and systemic.
Results. In 21 cases complete healing was obtained. Due to recurrence of the infection, removal of the endoprosthesis was necessary in 10 cases. For the 98 patients with late infection, healing of the infection was noted in75 joints (76%) following removal of the focus of injection along with the endoprosthesis and cement. Poor outcome as measured by pain and persistent fistulae, was obtained in 11 joints (11,5%). Only in 12 patients (12,5%) was the endoprosthesis implanted without recurrence of the infection, obtaining, a good treatment outcome.
Conclusions. The basic factors reducing the risk of causing septic loosening of the endoprosthesis are familiarity with the risk factors, the proper antibiotic prevention, the command of the requiste surgical skill and a high level of asepsis in the operating theater. The most commonly observed final outcome of treatment of the sequelae of septic loosening of the prosthesis is unstable pendent hip. Repeat implantation of an endoprosthesis can be considered in younger patient when healing of the infection has been confirmed clinically and biochemically.

[The Judet and Letournel classification of acetabular fractures]. / Klasyfikacja zlaman przezpanewkowych miednicy wedlug Judeta i Letournela.

Many classifications of acetabular fractures are to be found in literature. The fact that various orthopedic centres use different classifications makes an objective comparison of methods of treatment and their results difficult, if not impossible. The authors of the paper present the principles of the Judet and Letrournel classification of acetabular fractures. The Judet and Letournel classification is widely accepted and and used by many reknown orthopedic centres around the world. Polish literature lacks so far a satisfactory discussion about this issue.

The application of allogenic bone grafts for replantation of a hip prosthesis; an attempt at radiological evaluation of graft rebuilding.

UNLABELLED: An attempt at radiological estimation of remodelling of allogenic bone grafts used in reconstruction of bone stock in revision of hip arthroplasty. THE METHOD: x-ray pictures of the treated hips were taken immediately and at 3, 6 and 12 months after surgery. Changes of bone structure around the prosthesis were estimated. THE RESULTS: symptoms of remodelling (presence of newly formed bone trabecules between host bone and the grafts and in the surrounding area) were encountered at 3 to 6 months after reconstruction surgery. CONCLUSIONS: radiological estimation of bone remodelling remains subjective. Nevertheless it can help to determine bone graft rebuilding in revision surgery of the hip.

[Pain as an important symptom in trauma, diseases and movement disorders]. / Ból--wazny objaw w urazach, chorobach i znieksztalceniach narzadu ruchu.

The author shows the importance of pain in motion organ diseases. He pointed out numerous orthopaedic conditions, such as inborn luxation of the hip joint, scoliosis, spondylolisthesis, at the preliminary stage of procedure, produce no pain. There are also diseases such as Perthes disease or osteoporosis, whose pain are untypical and appear at the moment of the fracture of the bone trabecules. Transitory pains are very often downplayed by patients and physicians, which may lead to serious mistakes in diagnosis.

[30 years experience in articular fractures of the calcaneus bone]. / 30 lat doswiadczen dotyczacych leczenia 150 stawowych zlaman kosci pietowych.

Results of 150 (123 in males, 27 in females) articular fractures of the calcaneus treated by various methods over period of 30 years have been evaluated. Mean age of the patients was 43 years. Minimum follow-up was 18 months. An analysis of the material indicates the need for reduction in every case. Westhues method is suitable for tongue type fracture, joint depression type should be managed by Palmer's method. Best results have been achieved after K-wire fixation of the reduced fracture and early mobilization. In fractures with no displacement or with a minor one functional treatment led to good results also. Unreduced fractures gave poor results; pain below lateral ankle was produced by compression of peroneal tendons with deformed calcaneus. Seventy per cent of the results were rated good, 15% fair and 15% poor.

Tumour necrosis factor-alpha selectivity modulates expression of collagen genes in rat granulation tissue.

OBJECTIVE: To study the effects of tumour necrosis factor-alpha (TNF-alpha) on granulation tissue in rats. DESIGN: Animal experiment. SETTING: University Hospital, Finland. MATERIAL: 48 rats in 6 groups. INTERVENTIONS: The test implants were treated with either a single or daily injections of 200 ng of TNF-alpha. The samples were collected 4 and/or 7 days postoperatively. MAIN OUTCOME MEASURES: Pro alpha 1 (I) and pro alpha 1 (III) collagen mRNA concentrations, hydroxyproline, nitrogen, uronic acids, and hexosamine content of the sponge; and ingrowth of new granulation tissue into the sponge. RESULTS: A single application of TNF-alpha resulted in no significant differences between the groups. After daily applications of TNF-alpha the accumulation of collagen hydroxyproline and volume of ingrowth of granulation tissue were significantly lower than in the controls. After 7 days there were significant reductions in the concentrations of RNA-ribose, nitrogen, and uronic acids. Daily injections of TNF-alpha reduced pro alpha 1 (I) collagen mRNA concentrations but those of pro alpha 1 (III) collagen mRNA levels were not lowered to the same extent. CONCLUSION: Repeated application of TNF-alpha was required to reduce the synthesis of collagen. This down-regulation was selective as pro alpha 1 (I) collagen mRNA concentrations were lowered more than those of pro alpha 1 (III) collagen mRNA.

The effects of interleukin-1 and prostaglandin E2 on accumulation of collagen and steady-state levels of pro alpha 1(I) collagen messenger RNA in experimental granulation tissue in rats.

The effects of human interleukin 1 beta (IL-1 beta) and prostaglandin E2 (PGE2) on experimental granulation tissue in rats and on granulation tissue cells in culture were studied. IL-1 beta and PGE2 were injected into subcutaneously implanted sponges during the first 3 days after implantation. The rate of collagen synthesis in fibroblasts was measured as synthesis of protein-bound 3H-hydroxyproline. The steady-state levels of pro alpha 1(I) and pro alpha 1(III) collagen chain mRNAs were estimated by Northern transfer analyses. By 7 days postoperatively IL-1 beta had decreased the hydroxyproline content of granulation tissue. PGE2 decreased non-significantly the amounts of hydroxyproline, but the steady-state levels of pro alpha 1(I) and pro alpha 1(III) collagen chain mRNAs were slightly elevated. In IL-1 beta-treated fibroblast cultures collagen production decreased by 15% and following PGE2 treatment by 34% compared with the controls. The latter effect could be abolished by indomethacin. Indomethacin alone stimulated collagen production by 40%. In vivo IL-1 decreases the formation of normal granulation tissue. This effect may be partly due to stimulation of secretion of PGE2.

The effect of tumor necrosis factor-alpha on wound healing. An experimental study.

The inflammatory phase in wound healing is considered to be a preparatory process for the formation of new tissue. A monocyte-derived cytokine, tumor necrosis factor-alpha (TNF-alpha), is a highly conserved molecule known to play a major role in the pathogenesis of gram-negative shock. Besides this, previous experimental studies show that TNF-alpha may have either a beneficial or detrimental role in wound healing. The purpose of the present study was to examine the effects of TNF-alpha on developing granulation tissue in rats as well as on rat and human granulation tissue cells in culture. Subcutaneously implanted cylindrical hollow sponges were used for studying the effects of locally applied TNF-alpha on granulation tissue in rats. These implants were treated either on the day of implantation or for the first 4 or 7 days after implantation with a solution containing various amounts of TNF-alpha while the control implants were treated correspondingly with the carrier solution only. The analyses of the granulation tissue were carried out 4, 7, 14 and 21 days after implantation. In the histological specimen these sponges were cut into small pieces and stained with Weigert van Gieson to visualize collagen. The amount of granulation tissue grown into the sponge was calculated from the cross section of every sponge. For the cell culture studies fibroblasts were released from human and rat granulation tissue which was cut into small pieces and digested by collagenase and DNase in Hank's balanced salt solution. The cells were exposed to 1, 10, or 100 ng/ml of TNF-alpha and the rate of collagen synthesis was measured as synthesis of protein-bound 3H-hydroxyproline. The number of cells in the culture dishes was counted with Bürger's hemocytometer after detaching the cells with trypsin treatment. As interleukin-1 (IL-1) and TNF-alpha overlap in many of their functions, the effects of lipopolysaccharide (LPS), human interleukin 1 beta (IL-1) and prostaglandin E2 (PGE2) on experimental granulation tissue in rats as well as on rat granulation tissue cells in culture were studied with the same method. After a single application of TNF-alpha into the sponge, no essential differences between the groups were detected. However, after daily applications of TNF-alpha for 4 days, an inhibitory effect on tissue repair was observed after 4 and 7 days. Collagen formation, indicated by the hydroxyproline content of the sponge, was significantly lower in the group treated with TNF-alpha than in the controls. This effect was not observed after 14 or 21 days. These findings were confirmed in the histological samples. In the cultures of rat granulation tissue fibroblasts TNF-alpha decreased 3H-hydroxyproline production to about 75% of that in the controls and it had also a decreasing effect on pro alpha 1(I) and pro alpha 1(III) collagen mRNA levels maximally by 67% and 77% of the control level, respectively. In the cultures of human granulation tissue fibroblasts a similar inhibiting effect on the production of collagen was seen. TNF-alpha decreased the production of 3H-hydroxyproline to 56% of the control value with a dose of 100 ng/ml. Similarly, IL-1 beta decreased hydroxyproline content of granulation tissue seven days postoperatively and PGE2 decreased nonsignificantly the amounts of hydroxyproline but the steady-state levels of pro alpha 1(I) and pro alpha 1(III) collagen chain mRNAs were slightly elevated. In the IL-1 beta-treated fibroblast cultures collagen production decreased by 15% compared with that of the controls. PGE2 decreased collagen production by 34% of that in the controls. This effect could be abolished with indomethacin. Indomethacin alone stimulated collagen production by 40%. In vivo IL-1 decreases the formation of normal granulation tissue. This effect may be partly due to IL-1 stimulated secretion of PGE2.

Tumor necrosis factor-alpha inhibits collagen synthesis in human and rat granulation tissue fibroblasts.

The purpose of the study was to examine the effects of tumor necrosis factor-alpha (TNF-alpha) on collagen gene expression in rat and human granulation tissue fibroblast cultures. The cells were exposed to 0.1, 1, 10, or 100 ng/ml of TNF-alpha, and the rate of collagen synthesis was measured as synthesis of protein-bound 3H-hydroxy-proline. Total cellular RNA was isolated from fibroblasts, and measurements of specific cellular RNAs from fibroblasts were performed by Northern blot hybridizations using 32P-labeled cDNA probes. In cultures of rat granulation tissue fibroblasts TNF-alpha decreased 3H-hydroxyproline production to about 75% of that in controls and it also decreased pro alpha 1(I) and pro alpha 1(III) collagen mRNA levels, maximally to 33% and 23% of the control levels, respectively. In cultures of human granulation tissue fibroblasts a similar inhibiting effect in the production of collagen was seen. TNF-alpha decreased the production of 3H-hydroxyproline to 56% of the control value with a dose of 100 ng/ml also having an inhibiting effect on pro alpha 1(I) collagen mRNA levels of up to 43% of the control level. However, no effect was seen on pro alpha 1(III) collagen mRNA levels.

[A case of Phalen-Dickson syndrome]. / Przypadek zespolu Phalena i Dicksona.

A case of dysplastic spondylolisthesis with a complete slipping of the L5 vertebrae accompanied by neurological disorders and characteristic contracture of hamstrings (Tight Hamstrings Syndrome) has been described. This disease entity, described in literature, has a name of Phalen-Dickson Syndrome. Neurological disorders were caused by compression of radices at the level of the slipping. Surgical treatment were: laminectomy of the arcus of L5, decompression of the compressed radices with postero-lateral fusion of the L5-S1 segment without reduction of the slipping. The final, functional and radiological results were good.

[Treatment without plaster cast of intra-articular fractures of calcaneus united by means of a kirschner wire bundle]. / Bezgipsowe leczenie stawowych zlaman kosci pietowej zespolonej wiazka drutów Kirschnera.

A treatment without plaster cast is presented of intra-articular fractures of calcaneus. In nine patients after fracture reduction by the Westhues method or by operation, the fragments were united by means of divergent bundle of Kirschner wires, introduced from the side of calcaneal tuber. The obtained stabilization made possible an early rehabilitation treatment. In no case a secondary displacement of fragments occurred after removal of uniting wires. Poor result was noted only after surgical treatment complicated with osteitis.

[Evaluation of remote results in 80 intra-articular calcaneal fractures treated by various methods]. / Ocena odleglych wyników 80 stawowych zlaman kosci pietowej leczonych róznymi sposobami.

The studies were done in 69 patients in whom 80 intra-articular calcaneus fractures were diagnosed of tongue or crush type. In the analysis of the remote results a subjective three-grade evaluation of the results was used as reported by the patients. The good results in 60% were closely related to the reconstruction of the shape of the calcaneus and its articular surface with simultaneous restoration of functional fitness of the foot. It was found that the fractures of tongue type were to be reduced by the Westhues method, while the crush fractures were to be treated surgically or functionally. Poor results were observed in all fractures not reduced and not immobilised additionally in plaster casts.

[Mechanism of articular fracture of the calcaneus in experimental, pathological, roentgenographic and computerized tomography examination]. / Mechanizm stawowych zlaman kosci pietowej w badaniach doswiadczalnych, anatomopatologicznych oraz w obrazach rentgenowskich i w tomografii komputerowej.

The experiments on amputated extremities, pathological examination as well as plain and computerized radiology confirmed existence of two basic types of calcaneal articular fractures: tongue type and crush type. An accurate anatomy of the experimentally fractured os calcis could be restored only after Westhues. An articular surface in crush fracture could be restored only in open arthrotomy. Computerized tomography revealed the type of the fracture and the degree of calcaneal destruction very precisely but was of no practical value in the treatment of the os calcis fractures.

[Surgical treatment of familial hypophosphatemic rickets]. / Operacyjne leczenie krzywic hipofosfatemicznych rodzinnych.

In 20 children with tibial and femoral bones deformities due to hypophosphatemic rickets a corrective osteotomy/osteoclasis at 2 or 4 sites was performed. Both preoperative and postoperative pharmacological treatment was introduced. Good results were achieved in 13 cases, satisfactory an 4 and bad in 3 cases.

Tumor necrosis factor alpha inhibits wound healing in the rat.

This work was undertaken to study the effects of tumor necrosis factor-alpha (TNF-alpha/cachectin) on developing granulation tissue in rats. Cylindrical hollow sponge implants were used as an inductive matrix for the growth of granulation tissue. In the two test groups the implants were injected daily for 4 days with a solution containing either 50 or 200 ng of TNF-alpha, while the implants of the control group were treated correspondingly with phosphate-buffered saline solution only. Analyses of granulation tissue and would fluid in the sponge implants were carried out 7, 14 and 21 days after implantation. In histological specimens the ingrowth rate of granulation tissue into the sponge was significantly lower after 7 days in the group treated with 200 ng of TNF-alpha. No such an effect was observed after 14 or 21 days. After 7 days, the mean amounts of nucleic acids reflecting cellularity in the granulation tissue decreased dose-dependently, but nonsignificantly, in the groups treated with TNF-alpha. Simultaneously, the accumulation of collagen hydroxyproline of the sponge was significantly lower in the group treated with 200 ng of TNF-alpha than in the controls (-30%, one-way analysis of variance). This effect was not observed after 14 or 21 days. No significant differences were detected in the amounts of nitrogen, hexosamines and uronic acids between the groups, reflecting unchanged accumulation of glycosaminoglycans in the developing granulation tissue.(ABSTRACT TRUNCATED AT 250 WORDS)