Jagoda Ravlić-Gulan

Femoral anteversion related to side differences in hip rotation. Passive rotation in 1,140 children aged 8-9 years.

We assessed whether the range of passive hip motion is reliable for predicting abnormal femoral anteversion. We measured the passive medial and lateral rotation in extension in both hips of 1,140 children between 8 and 9 years of age. The children were divided into 3 groups: group 1: difference between lateral and medial rotation less than 10 degrees; group 2: medial rotation more than 10 degrees greater than the lateral; group 3: lateral rotation more than 10 degrees greater than the medial. Group 1 comprised 90% of the children, whereas 8% belonged to group 2 and 2% to group 3. The angle of femoral neck anteversion was measured in 57 children from the first group, in 67 from the second and in 24 children from the third group, using biplane radiography. The mean anteversion angles in the 3 groups were 24 degrees, 36 degrees and 14 degrees, respectively. To predict an abnormally high anteversion angle (above mean +2SD), the difference between medial and lateral rotation must be 45 degrees or more, whereas an abnormally low anteversion angle (lower than mean -2SD) could be predicted when the lateral rotation was at least 50 degrees higher than the medial rotation.

Rapid Recurrence of a Giant Popliteal Cyst in a Patient With Rheumatoid Arthritis

Despite increasing knowledge of etiopathogenesis, therapy, and recurrence rate of popliteal cysts, they nevertheless occasionally represent clinical problems. We report the case of a 58-year-old rheumatoid arthritis patient in whom a giant recurrent cyst developed very shortly after primary excision. Reports of such large popliteal cysts are rare and very few cases were reported in rheumatoid arthritis patients. Moreover, no such giant recurrent cysts formed so shortly after primary excision. Thus, its occurrence may be partially ascribed to the specific dynamics of fluid flows caused by the absence of a valve-like mechanism. With regard to treatment, it appears that synovectomy may reduce the production of synovial fluid, but reinforcement of the thin tissue with capsuloplasty may also be important. Immobilization is necessary so that initiation of the healing process is not disturbed.

On the Role of T Lymphocytes in Stimulation of Humoral Immunity Induced by Peptidoglycan–Monomer Linked with Zinc

Effects of peptidoglycan linked with zinc (PGM–Zn) were investigated on plaque–forming cell (PFC) generation to sheep red blood cell (SRBC) and SRBC–unrelated antibody production in primary and secondary immune response in mice depleted in vivo of CD4+ and/or CD8+ T lymphocytes. PGM–Zn in nondepleted mice stimulated the PFC generation and IgM or IgG and IgG1 production in primary and secondary reaction. Single depletion of CD4 or CD8+ T cells did not change this ability. The effects of PGM–Zn after CD8+ depletion were even greater than those in nondepleted mice. Depletion of both T cell subsets, however, completely abrogated immunostimulatory effects of PGM on PFC generation (primary and secondary response), as well as on primary SRBC–unrelated antibody production, leaving only the increase of IgG in secondary response unchanged. Immunostimulatory effects and isotype switching to IgG1 and IgG2a correlated with the changes in splenic CD4+, CD8+, CD5+ cells, pointing to the regulatory role of these cells and/or their cytokines in PGM–Zn–induced immunostimulation. Altogether the data suggest that PGM–Zn may potentiate the costimulatory signals coming from activated T cells and act on B cells without the T cell help.

Immunoregulating effects of peptidoglycan monomer linked with zinc in adult mice.

Since it is well known that both zinc ions and bacterial immunostimulants influence the function of the immune system, in the present study we investigated the immunomodulating activity of a new analog of peptidoglycan monomer (PGM), in which the basic molecule was linked to zinc (PGM-Zn). Its effects in BALB/c mice, aged 10-12 months, were compared with the effects of equimolar doses of PGM and ZnCl2. The treatment lasted 26 days (one i.p. injection every fifth day). The results showed that PGM-Zn may markedly enhance antibody production to sheep red blood cells, as well as spontaneous and concanavalin A (ConA)-induced blastogenesis. The generation of plaque-forming cells in individual mouse was positively correlated with the expression of class II antigens in the liver and negatively correlated with the total quantity of hepatic proteins. PGM-Zn also induced the appearance of peritoneal macrophages, which in cocultures with syngeneic splenocytes were less able to enhance the spontaneous, and particularly the ConA-induced blastic transformation. The enhancing activities of PGM-Zn were in some respects more closely correlated with the action of PGM, whereas the induction of suppressive macrophages resembled more the activity of ZnCl2. The data emphasize that PGM-Zn may both stimulate and inhibit immunoregulative pathways by mechanisms which are not identical to those of PGM or ZnCl2.

Salmonella typhimurium osteomyelitis of the femur in patient with Crohn's disease

ZusammenfassungOsteomyelitis ist eine durch infektiöse Organismen ausgelöste Entzündung des Knochens. Wir stellen in der folgenden Fallbeschreibung den ersten Fall einer Osteomyelitis des distalen Femurs vor, die durch Salmonella typhimurium bei einem Patienten mit Morbus Crohn ausgelöst wurde. Die Infektion wurde durch eine Kombination von antibiotischer und chirurgischer Therapie erfolgreich behandelt.SummaryOsteomyelitis is an inflammation of the bone caused by infecting organisms. We present here the first case of osteomyelitis of the distal femur caused by Salmonella typhimurium in a patient with Crohns disease. The infection was successfully treated with a combination of antibiotics and surgical treatment.

Immunoprotective Properties of Peptidoglycan Monomer Linked with Zinc in Cholestatic Jaundice

Background: Previously it was shown that a new immunostimulator, peptidoglycan monomer linked with zinc (PGM-Zn), might have immunocorrective and hepatotropic effects. Owing to this in the present study we investigated its effects on jaundice-induced immunodysfunction, which might be responsible for serious peri- and postoperative complications in biliary obstruction. Methods: In vivo effects of PGM-Zn were analyzed in mice subjected to common bile duct ligation (CBDL), where we estimated phenotypic profile and cell cycle of thymocytes, splenocytes and phagocytic function of peritoneal macrophages. In vitro effects of PGM-Zn were evaluated on blastogenesis of human peripheral blood mononuclear cells (PBMNC), obtained from healthy donors and stimulated with anti-CD3 monoclonal antibody and/or PMA, in the presence or absence of jaundice serum obtained from patients with biliary calculosis. Results and Discussion: Jaundice induced marked disarrangement of lymphatic homeostasis, which at several points might be blocked by PGM-Zn. In mice it delayed the CBDL-induced decline of CD4+ CD8+ thymocytes, decreased the proportion of CD8+ T cells, and increased the percentage of CD4– CD8– thymocytes, augmenting simultaneously the proportion of thymic cells in S and G2 + M phase of cycle. Similar hyperplastic reaction with increased percentage of CD4+, Ig+ and CD5+ cells was noticed in the spleen, together with the enhanced phagocytic ability of peritoneal macrophages. In human PBMNC jaundice reduced the percentages of CD3, CD5, CD4, CD8 and HLA-DR-expressing cells and increased the proportion of CD25 and perforin-positive lymphocytes. PGM-Zn given in vitro was able to abrogate the antiproliferative activity of jaundice serum on PMA and anti-CD3 + PMA-induced blastogenesis.