Nachum Halperin

Resurfacing of goat articular cartilage by chondrocytes derived from bone marrow.

The feasibility of using cartilaginous implants containing bone marrow derived chondrocytes in biological resurfacing procedures for correcting defects in articular cartilage was examined in goats. The experimental protocol included bone marrow aspiration, mesenchymal cell culturing, cell proliferation, favorable conditions inducing chondrogenic differentiation, and implantation of autogeneic and allogeneic cells. Autogeneic implant transplantations proved to be the best source for regeneration and repair of defective articular surfaces with use of densitometric computed image analysis of histochemical and immunohistochemical parameters on tissue sections. Allogeneic chondrocyte enriched cultures derived from bone marrow evoke a typical immune response in the host, expressed by the formation of fibrosis and progressive joint arthrosis. In the current study, a biological resurfacing procedure is described in detail for large mammals of similar weight and size as humans. Autogeneic mesenchymal cells derived from a bone marrow aspiration are the best cell source and when embedded in hyaluronic acid based adhesive glue make an excellent cartilaginous implant. The reparative regenerated cartilaginous tissue outcome within the defects appear different than neighboring normal articular cartilage shortly after surgery. Whether in the long term the cartilaginous remodeling process will shape the cartilage such that it more closely resembles the original articular cartilage is not known.

Regenerating hyaline cartilage in articular defects of old chickens using implants of embryonal chick chondrocytes embedded in a new natural delivery substance

SummaryPartial and full thickness defects were created mechanically in articular cartilage and subchondral bone of the tibiotarsal joint condyles of 3-year-old chickens. The wounds were then repaired using embryonal chick chondrocytes embedded in a new biocompatible, hyaluronic acid-based delivery substance. Controls were similarly operated on but received either no treatment or implants of the delivery substance only. Animals were killed from 1 week to 6 months postoperatively. Sections from the two groups were examined and compared macroscopically, histologically, and histochemically. Results of 6-month follow-up showed that only the defects of the experimental chickens were completely filled with reparative hyaline cartilage tissue, with no signs of inflammation or immunologic rejection. Initially the entire defect cavity, whether partial thickness or full thickness up to the deep regions in the subchondral bone, was filled with cartilaginous reparative tissue. Relatively rapid maturation occurred under the tidemark; chondrocytes hypertrophied, were invaded with vascular elements and ossified. In the superficial areas, the reparative tissue remained cartilaginous and matured as typical hyaline cartilage tissue. These results indicate that aged chicken cartilage and its accompanying thin and spongy osteoporotic bone offer a favorable host environment for embryonal cell implants.

Changes in proteoglycans of intervertebral disc in diabetic patients. A possible cause of increased back pain.

Study Design. Characterization of the analytic profile of proteoglycans in the intervertebral discs at L4‐L5 of nondiabetic (n = 5) and diabetic (n = 5) age‐matched subjects. The discs used were discarded material from operations. Objectives. To clarify the reason for the higher risk of disc prolapse in diabetic patients. Summary of Background Data. The pathogenesis of diabetes results from a combination of neurologic dysfunctions and a yet undefined metabolic failure, which leads to an abnormal proteoglycan profile. Methods. The following methods were used to determine the proteoglycan profile: the measurement of 35S‐sulfate uptake per gram wet tissue into sulfated glycosaminoglycan using fresh tissue explants; extraction of proteoglycans by 4 M guanidinium chloride containing protease inhibitors, with further purification by ultracentrifugation on cesium chloride buoyant density gradient under dissociative conditions; total uronic acid and protein contents in the various gradient fractions; assessing the length of sugar side chains of isolated 35 Sulfate‐glycosaminoglycan molecules by separation of the glycosaminoglycan molecules on a Sepharose 6B‐CL column; and paper chromatography of the final digest products of glycosaminoglycan molecules obtained by chondroitinase ABC, a glycosaminoglycan‐degrading enzyme. Results. The findings show that discs from normal nondiabetic subjects have 15 times the rate of 35Sulfate incorporation into glycosaminoglycan molecules than do discs of diabetic patients. The proteoglycans of diabetic patients are banded at a lower buoyant density, indicating a lowered glycosylation rate and a lower number of sugar side chains per core protein. In discs of diabetic patients, there is a slight increase in the chain length of chondroitin sulfate. Further analysis of the glycosaminoglycan chains showed a decreased amount of keratan sulfate, compared with that in nondiabetic subjects. However, the total uronic acid content of the disc tissues and the ratio of uronic acid to protein of each fraction were unchanged in diabetic patients versus that in control subjects. Conclusions. Discs in patients with diabetes have proteoglycans with lower buoyant density and substantially undersulfated glycosaminoglycan, which with the specific neurologic damage in these patients, might lead to increased susceptibility to disc prolapse.

Local application of steroids following lumbar discectomy.

In this prospective randomized clinical study, the effectiveness of epidural steroids to reduce pain following lumbar disc surgery was assessed. Sixty-one patients undergoing lumbar discectomy were included. They were assigned randomly to receive, immediately after removal of the disc, either 80 mg methylprednisolone acetate (Depomedrol) or the same amount (2 mL) of saline. Both were soaked in 2.5 × 2.5 cm of collagen absorbable hemostat (Instat) that was left on the decompressed nerve root. All discs were removed in the same way via unilateral flavectomy. The patients were asked to grade the pain intensity daily in the first 2 weeks and 1 year after surgery. Pain intensity was evaluated by the visual analog scale from 0 to 10, zero being no pain and 10 being the most severe pain. Statistically significant back pain relief was observed on postoperative days 1, 2, 6, and 14 in the study group (the group that received steroids). No difference between the two groups was found 1 year after surgery or when leg pain was compared. No side effects that could be related to the steroids were observed.

Non-specific back pain in children and adolescents: a prospective study until maturity.

Fifty-eight children with non-specific back pain lasting for at least 3 months were included in this prospective study. Not included were children with radicular pain or with abnormal findings on clinical examination, radiography, bone scan, computed tomography or magnetic resonance imaging. They were all re-examined after skeletal maturity, on average 7.6 years later. Thirty-one children had pain in the lumbar spine, 20 in the thoracic region and seven over the entire spine. Sixty-two percent of the children were still in pain at follow-up. Female sex and pain in the thoracic region were associated with an increased risk of the pain remaining chronic.

The Treatment of Carpal Tunnel Syndrome Caused by Hypertrophied Lumbrical Muscles: Case Reports

Three cases of manual workers suffering from carpal tunnel syndrome caused by a hypertrophied lumbrical muscle are presented. Results of auxiliary diagnostic tests are presented and the differential diagnosis is discussed. We conclude that release of the transverse carpal ligament should be accompanied by release or excision of the muscle belly to obtain permanent cure.

Multicentric giant-cell reparative granuloma. A case in the foot.

A case of multicentric giant-cell reparative granuloma in the foot of a 17-year-old boy is reported. Initially, there was a calcaneal lesion and 6 months later, three additional lesions in the forefoot. The calcaneal lesion was treated by curettage and bone grafting, and those in the forefoot by wide excision. The patient has now been free of disease for 18 months.

Pigmented Villonodular Synovitis of the Talus in a Child

An unusual case of localized pigmented villonodular synovitis of the ankle joint in a 3-year-old boy is described. The child was brought to the hospital because of abrupt onset of pain and joint effusion. A soft tissue mass eroding the talar dome was seen in roentgenograms. Exact diagnosis was established by excisional biopsy. Curettage of the lesion resulted in healing without recurrence at 10-year follow-up examination.

Painless root compression following disc extrusion

SummaryThree cases of painless root compression following disc extrusion are reported. Each patient showed the typical course of disease with the neurological deficit appearing at the same time as the sciatic pain disappeared. At operation the nucleus pulposus was found in the spinal canal. It is suggested that disappearance of the pain is related to the perforation of the anulus fibrosus and posterior longitudinal ligament by the nucleus pulposus. The operative findings justified early operation in these patients, and prompt surgery is recommended for similar cases.ZusammenfassungEs wird über 3 Fälle von schmerzloser Nervenwurzelkompresson berichtet, die im Anschluß an einen Einbruch von Bandscheibengewebe in den Rückenmarkkanal auftrat. Jeder Patient zeigte den gleichen, typischen Krankheitsverlauf: Mit dem Auftreten der neurologischen Ausfälle verschwanden zum gleichen Zeitpunkt die Ischiasschmerzen. Bei der Operation fand sich Gewebe des Nucleus pulposus im Spinalkanal. Es wird angenommen, daß das Verschwinden der Schmerzen mit der Perforation des Anulus fibrosus und des hinteren Längsbandes durch den Nucleus pulposus zusammenhängt. Die intraoperativen Befunde rechtfertigen bei solchen Patienten ein frühes operatives Vorgehen. Für ähnliche Fälle wird deshalb ein sofortiges chirurgisches Vorgehen empfohlen.

Devascularization of the anterior cruciate ligament by synovial stripping in rabbits. An experimental model.

In rabbits, synovial stripping of the anterior cruciate ligament was performed, and histologic and mechanical changes were followed up to 2 months. The operation did not immediately affect the strength of the ligament or its histological structure. However, a gradual deterioration of mechanical properties, associated with collagen necrosis and an ineffectual reparative response, was evident. Thus, synovial stripping of the ligament with the attendant concomitant devascularization leads to ligamentary insufficiency despite the lack of structural damage to the ligament by the contusion itself.