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1.
Clin J Pain ; 21(2): 185-9, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-15722813

RESUMEN

A 28-year-old man presented with a clinical picture suggestive of complex regional pain syndrome type I following a blow to the thenar eminence and thumb. Symptoms, including swelling of the hand and distal forearm, progressed until an amputation was carried out to rid the patient of an unendurable painful and nonfunctioning wrist and hand. The histologic evaluation of the amputation specimen showed: 1) dermal edema, perivascular dermatitis, and epidermal hyperkeratosis; 2) subcutaneous chronic inflammation with subtotal replacement of the adipose lobules by fibrous tissue associated with thickening of the muscular fascia, implying the fasciitis-panniculitis reaction pattern; 3) atrophy, degeneration, necrosis, and focal calcifications of the skeletal muscles; 4) phlebosclerosis, phlebectasias and lymphocytic arteritis; and 5) increased cortical porosity of the bones. It seems that the pathogenetic process underlying the fasciitis-panniculitis syndrome may rarely manifest as a complex regional pain syndrome-like disorder.


Asunto(s)
Brazo/cirugía , Errores Diagnósticos , Fascitis Necrotizante/patología , Fascitis Necrotizante/cirugía , Paniculitis/patología , Paniculitis/cirugía , Distrofia Simpática Refleja/diagnóstico , Distrofia Simpática Refleja/cirugía , Adulto , Brazo/patología , Diagnóstico Diferencial , Fascitis Necrotizante/diagnóstico , Humanos , Masculino , Paniculitis/diagnóstico
2.
Exp Mol Pathol ; 77(2): 145-8, 2004 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-15351238

RESUMEN

The expedited revascularization of the rats' avascular, necrotic femoral heads suggests the operation of angiogenic factor(s). The blood circulation of the epiphysis was interrupted by cutting the cervical periosteum and the ligamentum teres of rats' femoral heads. Three days postoperatively, the marrow was necrotic. Seven days postoperatively, the subchondral bony plate and trabecular bone were necrotic as well. The joint capsule was distended by myriad, so-called synovial fibroblasts, all of which were virtually immunoreactive with an antibody to vascular endothelial growth factor. The expression of this factor in the synovial membrane of non-operated rats was limited to preexisting blood vessels. Revascularization of necrotic, avascular femoral heads makes up the essential step in the chain of events terminating in the repair processes, that is, resorption of the necrotic debris and its substitution by newly formed bony and hematopoietic-fatty tissues. Synthesis and release of excessive amounts of vascular endothelial growth factor by these fibroblasts explain the lively angiogenesis in the necrotic intertrabecular spaces of the femoral heads.


Asunto(s)
Médula Ósea/patología , Cabeza Femoral/irrigación sanguínea , Fibroblastos/metabolismo , Osteonecrosis/patología , Factor A de Crecimiento Endotelial Vascular/metabolismo , Animales , Cabeza Femoral/patología , Fibroblastos/inmunología , Masculino , Necrosis , Ratas , Ratas Sprague-Dawley , Flujo Sanguíneo Regional , Membrana Sinovial/irrigación sanguínea , Membrana Sinovial/metabolismo , Membrana Sinovial/patología
3.
Med Hypotheses ; 62(6): 958-65, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15142657

RESUMEN

An impeded blood flow through the femoral head is incriminated in the etiopathogenesis of osteonecrosis of the femoral head. The disorder is either primary (idiopathic avascular osteonecrosis) or secondary to one condition or another, say, corticosteroid medication, fracture of the neck, coagulation defects, physical or thermal damage, storage disorders, alcoholism, and infectious, autoimmune as also marrow infiltrating diseases. In the wake of the necrosis, several mediators are released in increased amounts, prime among which is the vascular endothelial growth factor. The intermediates recruit endothelial progenitor cells, macrophages, osteoclasts, fibroblasts, and osteoblasts, which, pervading throughout the necrotic areas, initiate the reparative processes. The dead, soft and hard tissular debris is substituted by fibrous - later on by hematopoietic-fatty tissue - and bone. The newly formed, appositional and intramembranous bone is deficient in its mechanical properties. The ordinary load-carrying functions suffice to deform these weakened femoral heads so that osteoarthritic changes develop. Considering contemporary assumptions of the causes of osteonecrosis, oxygenation, revascularization, and core decompression are the realistic therapeutic interventions. Necrosis of rats' femoral heads is studied as a model of osteonecrosis in both adults and children. In view of rodents' lifelong persisting physeal cartilage, vascular deprivation-induced osteonecrosis in rats mimics children's Perthes disease. The experimental model, which is well suited to test treatment modalities, has been used to investigate the effects of exposure to hyperbaric oxygen with and without non-weight bearing, medication of enoxaparin, and creation of an intraosseous conduit on the remodeling of the avascular necrotic femoral head. Intriguingly, the shape of treated rats' femoral heads is disfigured to a greater degree than that of untreated animals. This is most likely due to the reduced yield strength and elastic modulus as well as the raised strain-to-failure of the recently formed bone making up the post-necrotic femoral heads. It follows that expedited osteogenesis is, counter intuition, detrimental to maintaining the hemispherical shape of the femoral head, and thus to an articulation with congruent load-bearing surfaces. If this is indeed the case, the remodeling of the necrotic femoral head should be delayed, rather than sped up, as the present day paradigm would have it. Bearing in mind that the dead osseous structures keep their mechanical attributes for quite a while, a slowed down new bone formation would favor the gradual replacement of the necrotic by living bone. Therefore, management of the adult patients with osteonecrosis and children with Perthes disease should focus on a slowly progressive substitution so that the decline of the bone's mechanical properties is kept to a minimum. One viable therapeutic mode is a medication of inhibitors of the vascular endothelial growth factor.


Asunto(s)
Cabeza Femoral/patología , Osteonecrosis/patología , Animales , Cartílago/anatomía & histología , Cartílago/patología , Cabeza Femoral/anatomía & histología , Humanos , Modelos Biológicos , Modelos Teóricos , Necrosis , Neovascularización Patológica , Osteonecrosis/terapia , Ratas
4.
J Comp Pathol ; 129(2-3): 235-9, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12921731

RESUMEN

The femoral heads of 15 rats were studied histologically 3 months after the induction of ischaemic necrosis by incising the cervical periosteum and cutting the ligamentum teres. The epiphyses consisted of immature disorganized subchondral and trabecular bone. The inter-trabecular spaces contained fibrous or haematopoietic tissue. Residual necrotic bone was rare. There was marked osteoblastic and osteoclastic activity. The articular aspect of the heads showed a spectrum of changes, ranging from cartilaginous degeneration with fibrillation and loss of glycosaminoglycans to an eburnated and polished bony surface. In seven rats, transphyseal bridges connected the epiphyseal and metaphyseal bony trabeculae to each other. It is suggested that the postnecrotic reparative processes, including the resorption of the necrotic debris and its replacement by newly formed, weak bone, led to an osteoarthritis-like disorder. This healing pattern of the necrotic femoral head was reminiscent of the progressive remodelling that occurs in rings in femoral capital osteonecrosis of adult human patients and in Perthes's disease of children.


Asunto(s)
Remodelación Ósea , Modelos Animales de Enfermedad , Necrosis de la Cabeza Femoral/patología , Osteoartritis de la Cadera/patología , Animales , Epífisis/patología , Necrosis de la Cabeza Femoral/complicaciones , Enfermedad de Legg-Calve-Perthes/patología , Ligamentos Articulares/lesiones , Ligamentos Articulares/cirugía , Masculino , Osteoartritis de la Cadera/etiología , Ratas , Ratas Sprague-Dawley , Cicatrización de Heridas
5.
Vet Pathol ; 40(4): 345-54, 2003 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-12824505

RESUMEN

Animal models of osteonecrosis of the femoral head are indispensable to the understanding of successful treatment modalities for avascular necrosis of the femoral head in adults and in children with Legg-Calvé-Perthes disease. Many of these models adequately reflect the current "vascular deprivation" theory regarding the etiology of the disease. In addition to spontaneous occurrence, surgical- and corticosteroid-induced models are suitable, common experimental ones. Osteonecrosis of spontaneously hypertensive rats appears to be due to defective bone formation and compression of the arteries entering the femoral head at its lateral facets by daily weight-bearing loads. Successful modeling of surgical-induced femoral capital necrosis can be a challenge in animals with a dual epiphyseal blood supply. High doses of corticosteroids are a pivotal risk factor in the development of osteonecrosis. The pathogenesis of corticosteroid-induced osteonecrosis likely resides in reduced blood flow. Steroids may reduce blood flow by numerous mechanisms, including marrow adipocytic hypertrophy leading to sinusoidal compression, venous stasis and, eventually, obstruction of the arteries, and arterial occlusion by fat emboli and lipid-loaded fibrin-platelet thrombi. Other, less common varieties of osteonecrosis include those secondary to endotoxin-induced disseminated intravascular coagulation, immune reactions, immoderately low or high temperatures, and high-impact-related injuries. Common to these diverse forms of osteonecrosis are fibrin thrombi clogging arterioles and small arteries.


Asunto(s)
Modelos Animales de Enfermedad , Necrosis de la Cabeza Femoral/patología , Necrosis de la Cabeza Femoral/veterinaria , Animales , Necrosis de la Cabeza Femoral/etiología , Necrosis de la Cabeza Femoral/inmunología , Humanos
7.
Exp Mol Pathol ; 71(3): 256-64, 2001 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-11733951

RESUMEN

Osteonecrosis of rat femoral heads was induced by stripping the periosteum of the neck and cutting the ligamentum teres. The epiphyseal marrow and bone were necrotic on the 5th postoperative day. Specimens obtained 18 and 36 days postoperatively showed fibrous and hematopoietic-fatty tissue in the intertrabecular spaces, osteoclastic bone resorption, osteogenesis, and degeneration of the joint cartilage. Morphometrically, the means of the height-to-length ratios of the control, 6-day, 18-day, and 36-day femoral heads were 0.26, 0.28, 0.48, and 0.29, respectively. The shape factor of the femoral heads of the control rats was higher than 0.81 in 80% of the cases, while those of rats killed on the 6th, 18th, and 36th postoperative day were higher than 0.81 in 65, 60, and 50% of cases, respectively. Statistically, the means of the height-to-length ratios and the values of the shape factors of the femoral heads of the rats killed 18 days postoperatively differed significantly from those of the other three groups of rats. The quantitatively gauged data of the remodeled epiphyses negate the authors' subjective impression concerning early flattening of the femoral heads after surgically produced osteonecrosis.


Asunto(s)
Cabeza Femoral/patología , Osteonecrosis/patología , Animales , Remodelación Ósea , Modelos Animales de Enfermedad , Cabeza Femoral/cirugía , Estudios de Seguimiento , Procesamiento de Imagen Asistido por Computador , Masculino , Osteonecrosis/cirugía , Ratas , Ratas Sprague-Dawley
9.
Artículo en Inglés | MEDLINE | ID: mdl-11713430

RESUMEN

A 52-year-old patient underwent excision of a parotid lump which was fond to consist of a Warthin's tumor coexistent with a lymph node involved in dermatopathic lymphadenopathy. A preoperative fine-needle aspiration specimen contained brown pigment-granule-laden macrophages within the background of many lymphocytes. Failure to correctly diagnose the parotid tumor was likely due to a sampling error.


Asunto(s)
Adenolinfoma/patología , Adenolinfoma/cirugía , Errores Diagnósticos , Enfermedades Linfáticas/patología , Enfermedades Linfáticas/cirugía , Neoplasias de la Parótida/patología , Neoplasias de la Parótida/cirugía , Biopsia con Aguja , Femenino , Humanos , Persona de Mediana Edad
10.
Eur J Gastroenterol Hepatol ; 13(10): 1265-8, 2001 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-11711789

RESUMEN

Gastrointestinal autonomic nerve (GAN) tumours form a distinct subcategory of gastrointestinal stromal tumours, and are thought to originate from the enteric autonomic plexus. To date, a total of 45 cases have been documented in the literature; a few of these cases were associated with neurofibromatosis type 1 (NF-1). Bowel perforation due to other gastrointestinal stromal tumours has been reported only twice, but never in association with a GAN tumour. We describe a 40-year-old woman with NF-1 who had bowel perforation due to a GAN tumour. The patient underwent radical surgical resection and remained tumour free for at least 4 years, which may indicate a good prognosis.


Asunto(s)
Enfermedades del Sistema Nervioso Autónomo/complicaciones , Perforación Intestinal/etiología , Neurofibromatosis 1/complicaciones , Neoplasias del Sistema Nervioso Periférico/complicaciones , Adulto , Enfermedades del Sistema Nervioso Autónomo/cirugía , Femenino , Humanos , Perforación Intestinal/diagnóstico , Perforación Intestinal/cirugía , Neurofibromatosis 1/cirugía , Neoplasias del Sistema Nervioso Periférico/cirugía , Pronóstico
11.
Angiology ; 52(9): 641-4, 2001 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-11570664

RESUMEN

An elderly patient with paraneoplastic cutaneous leukocytoclastic vasculitis (CLV) leading to the discovery of an as-yet asymptomatic, potentially surgically curable squamous cell carcinoma of the lung is presented. This type of vasculitis has not been previously described in association with this type of lung cancer. Since vasculitic paraneoplastic syndromes, including CLV, may develop before the clinical presentation of malignant tumors, the present case and others previously reported strongly suggest that in apparently idiopathic CLV, patients should be evaluated for the presence of occult malignancy that could be curable by early detection.


Asunto(s)
Carcinoma de Células Escamosas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Síndromes Paraneoplásicos , Enfermedades de la Piel/etiología , Vasculitis Leucocitoclástica Cutánea/etiología , Anciano , Carcinoma de Células Escamosas/complicaciones , Humanos , Neoplasias Pulmonares/complicaciones , Masculino
12.
J Pediatr Orthop B ; 10(3): 214-8, 2001 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-11497365

RESUMEN

In view of the lifelong persistence of the physis, the femoral head of rats may serve to model Perthes disease and slipped capital femoral epiphysis. To produce osteonecrosis, the blood supply of one femoral head of 133, 6-month-old animals was severed by circumferentially incising the periosteum of the neck and cutting the ligamentum teres. The rats were killed 7 days to 90 days postoperatively. Associated with resorption of the necrotic bone and marrow, remodeling of the epiphysis was characterized by an ingrowth of vascularized fibrous tissue, formation of new bone and some cartilage, architectural deformation and flattening of the head. In 22 of 83 rats killed 30 days or more postoperatively, gaps in the continuity of the physeal cartilage were occupied by osseous bridges, connecting newly formed epiphyseal bony trabeculae with either the preexisting or newly formed metaphyseal osseous trabeculae. This healing mode may follow ischemic death of physeal chondrocytes or be owing to another mechanism, e.g., release of mediatory substances of inflammation. These findings raise the possibility that fixation of the healing epiphysis of a child's previously necrotic femoral head to the metaphysis occurs by transphyseal osseous growth in cases in which the physis is involved in the necrotic process.


Asunto(s)
Remodelación Ósea , Cartílago/patología , Modelos Animales de Enfermedad , Epífisis Desprendida/patología , Epífisis/patología , Necrosis de la Cabeza Femoral/patología , Enfermedad de Legg-Calve-Perthes/patología , Factores de Edad , Animales , Cartílago/fisiopatología , Niño , Condrocitos/patología , Condrocitos/fisiología , Epífisis/fisiopatología , Epífisis Desprendida/fisiopatología , Epífisis Desprendida/terapia , Femenino , Necrosis de la Cabeza Femoral/fisiopatología , Necrosis de la Cabeza Femoral/terapia , Humanos , Inflamación , Enfermedad de Legg-Calve-Perthes/fisiopatología , Enfermedad de Legg-Calve-Perthes/terapia , Masculino , Osteoblastos/patología , Osteoblastos/fisiología , Ratas , Ratas Sprague-Dawley , Factores de Tiempo
13.
Biochem Biophys Res Commun ; 284(2): 395-403, 2001 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-11394892

RESUMEN

Neuropilin-2 (np-2) is a receptor for semaphorin-3F (sema-3F) and semaphorin-3C (sema-3C). These semaphorins repel tips of growing axons that express np-2. In addition, np-2 functions as a receptor for heparin binding forms of the angiogenic factor vascular endothelial growth factor (VEGF) such as VEGF145 and VEGF165. We report that np-2 is strongly expressed in neuroendocrine cells located all along the human digestive tract. Confocal fluorescent microscopy revealed that np-2 is concentrated in vesicle-like structures located near the nucleus at the basolateral side of these cells. In the colon, the np-2-expressing subpopulation of neuroendocrine cell is almost identical with the serotonin-producing subpopulation of neuroendocrine cells. Gastrointestinal carcinoid tumors are digestive tract tumors that develop from neuroendocrine cells. Interestingly, most of the carcinoid tumors derived from the colon and the appendix did not contain np-2-producing cells. However, some carcinoid tumors derived from the small intestine and stomach did express low levels of np-2 in isolated foci of cells. By contrast, strong serotonin and chromogranin-A expression was observed in all of the carcinoid tumors that were examined. These results suggest that loss of np-2 expression may accompany tumor progression in carcinoid tumors.


Asunto(s)
Tumor Carcinoide/metabolismo , Neoplasias del Sistema Digestivo/metabolismo , Sistema Digestivo/metabolismo , Proteínas del Tejido Nervioso/biosíntesis , Sistemas Neurosecretores/metabolismo , Tumor Carcinoide/patología , Cromogranina A , Cromograninas/biosíntesis , Colon/citología , Colon/metabolismo , Vesículas Citoplasmáticas/metabolismo , Sistema Digestivo/citología , Neoplasias del Sistema Digestivo/patología , Técnica del Anticuerpo Fluorescente , Humanos , Inmunohistoquímica , Microscopía Confocal , Proteínas del Tejido Nervioso/genética , Neuropilina-1 , Sistemas Neurosecretores/citología , Especificidad de Órganos , ARN Mensajero/biosíntesis , Serotonina/biosíntesis
14.
Acta Orthop Belg ; 67(1): 42-8, 2001 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-11284270

RESUMEN

The patellae of 6 male and 2 female, 40 to 70 year-old individuals, who were healthy at the time of their violent death, were assessed by computer-assisted image analysis. The means of the bone density (percentage of bone in the respective field of interest) ranged from approximately 20% to approximately 30% in the central spongiotic zones, from approximately 40% to approximately 80% in the superior and inferior peripheral zones, and approximately 40% to approximately 60% in the subchondral zone. Bone densities were greatest in the lateral parts of the subchondral and spongiotic territories. The bony trabeculae were haphazardly distributed in the central spongiotic zones. They were commonly oriented vertically or parallel to the surface of the patella in the peripheral and subchondral zones. In conclusion, the histomorphometric data presented validate the rationale of reaming the articular aspect of the patella into a dome-shaped configuration with preservation of a circumferential bony bulwark in the preparation for the implantation of a thick polyethylene-based component with a concave undersurface.


Asunto(s)
Rótula/ultraestructura , Tomografía Computarizada por Rayos X , Adulto , Anciano , Artroplastia de Reemplazo de Rodilla/métodos , Densidad Ósea , Cadáver , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteotomía/métodos , Rótula/cirugía , Valores de Referencia
15.
Undersea Hyperb Med ; 28(4): 187-94, 2001.
Artículo en Inglés | MEDLINE | ID: mdl-12153146

RESUMEN

We examined the role of hyperbaric oxygenation (HBO2) combined with non-weight bearing (NWB) in the treatment of vascular deprivation-induced osteonecrosis of the femoral head in the rat. Group 1 included 16 rats treated by a combination of NWB and HBO2. Twenty animals treated by NWB alone (group 2), and 18 rats which received no treatment (group 3), served as the control groups. Maximal benefit of HBO2 was observed on Day 30 of the study. The femoral heads were less deformed in group 1 animals (P = 0.07). Preservation of the femoral heads was observed in a larger proportion of the HBO2-treated animals (P = 0.06). A smaller proportion of high-grade new bone formation was observed, and more animals demonstrated well-regenerated hematopoietic tissue (P = 0.08). The tendency for less deformation of the femoral head in the HBO2-treated group might be a predictor of better function of the hipjoint.


Asunto(s)
Necrosis de la Cabeza Femoral/terapia , Oxigenoterapia Hiperbárica , Animales , Terapia Combinada , Fémur/irrigación sanguínea , Necrosis de la Cabeza Femoral/etiología , Necrosis de la Cabeza Femoral/patología , Masculino , Ratas , Ratas Sprague-Dawley , Soporte de Peso
16.
Arch Orthop Trauma Surg ; 120(9): 502-7, 2000.
Artículo en Inglés | MEDLINE | ID: mdl-11011668

RESUMEN

Analysis of retrieved woven carbon filamentous pads, used for resurfacing of the patellar joint surface, disclosed a 4-zonal organizational pattern. Zone 1, facing the articular cavity, was devoid of carbon filaments and consisted of fibrous tissue. Foreign body granulation tissue and fibrous tissue occupied about one-third and approximately 50%-60% of the interfilamentous space in zones 2 and 3, respectively. Carbon filaments formed 2%-9% of zone 2 and 14%-16% of zone 3. An interfacial membrane-like zone 4 separated the carbon filamentous pads from a trabecular bony shell. The bone volume within the latter was approximately 25%. Given that the purpose of articular resurfacing with implants is repopulation of the defect by chondrocytes producing a cartilaginous matrix, the woven carbon filamentous pads did not fulfill this expectation. In an environment of an ongoing foreign body-induced granulomatous reaction, the stem cells permeating the interstices of the woven carbon filamentous pad are apparently incapable of maturing into highly differentiated cells (chondrocytes) synthesizing a highly complex (cartilaginous) matrix.


Asunto(s)
Compuestos Inorgánicos de Carbono , Rótula/patología , Adulto , Humanos
17.
J Cancer Res Clin Oncol ; 126(5): 285-90, 2000 May.
Artículo en Inglés | MEDLINE | ID: mdl-10815764

RESUMEN

PURPOSE: The aim of this work was to detect nuclear parameters related to the prognosis of patients with stage III, IV or DS neuroblastomas. METHODS: Histological sections of 25 operation specimens obtained from children with advanced-stage neuroblastomas were subjected to computer-assisted image analysis. Statistical relationships between nuclear descriptors of the tumor cells and patients' clinical outcome were determined. RESULTS: The coefficient of variability of the mean nuclear area the mean nuclear elongation factor, and the mean nuclear averaged Feret diameter of the neuroblastoma cells were ascertained to be discriminators separating high-grade from low-grade tumors. CONCLUSIONS: The histomorphometrically gauged nuclear parameters may help oncologists to assess the prognosis of patients with advanced-stage neuroblastoma.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales/mortalidad , Neoplasias de las Glándulas Suprarrenales/patología , Procesamiento de Imagen Asistido por Computador/normas , Neuroblastoma/mortalidad , Neuroblastoma/patología , Factores de Edad , Niño , Preescolar , Supervivencia sin Enfermedad , Femenino , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Humanos , Lactante , Recién Nacido , Israel/epidemiología , Modelos Logísticos , Masculino , Neoplasias del Mediastino/mortalidad , Neoplasias del Mediastino/patología , Neoplasias Pélvicas/mortalidad , Neoplasias Pélvicas/patología , Valor Predictivo de las Pruebas , Pronóstico , Neoplasias Retroperitoneales/mortalidad , Neoplasias Retroperitoneales/patología , Análisis de Supervivencia
19.
Am J Med Sci ; 318(5): 343-9, 1999 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-10555099

RESUMEN

BACKGROUND: Lymph node enlargement in patients with eosinophilic fasciitis is a rare occurrence and its clinical significance is unknown. METHODS: The literature and authors' registries were searched for eosinophilic fasciitis associated with lymphadenopathy. Clinical data, time sequence of appearance of either disorder, and pathological diagnoses were analyzed. RESULTS: Six patients presenting with eosinophilic fasciitis had a lymph-node-based lymphoma and 4 patients had a reactive lymphadenopathy. The patients with lymphoma were elderly and the subcutaneous induration preceded the lymphadenopathy by 2 to 36 months. The patients with eosinophilic fasciitis and reactive lymphadenopathy were young and the onset of subcutaneous induration and lymph node enlargement coincided with one another. Favorable response of the eosinophilic fasciitis to prednisone therapy was attained in 3 of 3 patients with reactive lymphadenopathy and in 4 of the 6 cases with lymphoma. CONCLUSIONS: Eosinophilic fasciitis is rarely associated with clinically significant lymph node enlargement. Subcutaneous induration preceding the lymphadenopathy by 6 months or more, especially in elderly patients, suggests an underlying lymphoma. A favorable response of the subcutaneous induration to prednisone treatment does not exclude the diagnosis of lymphoma; therefore, it does not supersede the need of a pathological evaluation. A lymph node biopsy is mandatory in all cases.


Asunto(s)
Eosinófilos , Fascitis/complicaciones , Enfermedades Linfáticas/etiología , Linfoma/complicaciones , Linfoma/diagnóstico , Adolescente , Adulto , Anciano , Fascitis/patología , Femenino , Humanos , Enfermedades Linfáticas/patología , Linfoma/patología , Masculino , Persona de Mediana Edad
20.
Pathol Res Pract ; 195(9): 637-47, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10507084

RESUMEN

The reparative processes following vascular deprivation-induced necrosis of the femoral head were studied histologically in rats sacrificed 2, 7, 14, 21, 42 and 92 days postoperatively. The blood supply was severed by incision of the periosteum at the neck of the femoral head and transection of the ligamentum teres. Granulation tissue and a well-vascularized fibrous tissue originating from the joint capsule invaded the necrotic marrow spaces. With progressive resorption of the necrotic tissues and osteoneogenesis, both appositional and intramembranous, within the fibrotic intertrabecular spaces, the remodeling process led to a shift of the normal spongy architecture of the femoral head to a compacta-like one. In a few cases, osseous bridges bisected a necrotic physeal cartilage at the latest time intervals. The remodeling was associated with flattening of the femoral heads as well as with degenerative, regenerative and reparative alterations of the articular cartilage. In one of the two femoral heads obtained three months postoperatively, cystic spaces developed in the fibrous subchondral zone. Our findings are consistent with the view that ineffective attempts at restoring the prenecrotic state of the femoral head by replacing the necrotic with viable tissue triggers the collapse of the femoral head. Thickening and condensation of the subchondral bone, leading to increased stiffness of the subchondral zone, result in the osteoarthritis-like disorder. Mimicking the well-known phases of human osteonecrosis, the model readily allows for preclinical studies of therapeutic regimens.


Asunto(s)
Cabeza Femoral/irrigación sanguínea , Enfermedad de Legg-Calve-Perthes/etiología , Osteoartritis/etiología , Animales , Remodelación Ósea , Cartílago Articular/patología , Modelos Animales de Enfermedad , Femenino , Enfermedad de Legg-Calve-Perthes/patología , Ligamentos Articulares/cirugía , Osteoartritis/patología , Ratas , Flujo Sanguíneo Regional , Procedimientos Quirúrgicos Vasculares
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