On vertebral body growth.

We have studied development of vertebral bodies with special regard to the area of contact of the vertebral body with the intervertebral disc. We have investigated complete serial sections of fetuses of the 2nd to 3rd month of intrauterine life, microscopic preparations from children, adolescents and young adults. The results of our studies and deductions from our findings are as follows: 1. Cartilaginous plates on contact surfaces of vertebral bodies with intervertebral discs are genetically parts of vertebral bodies, not of the discs. 2. During ontogenesis and growth period of life typical growth (epiphyseal) cartilages with all layers described on growth cartilages of long bones are formed on the surface of these cartilaginous plates facing the vertebral bodies. 3. From the point of view of its growth, the vertebral body should be considered to be a long bone. 4. Unlike other long bones of the skeleton, vertebral body epiphyses never ossify, and after the end of the growth period of life they are reduced into thin plates of hyaline cartilage which are situated between vertebral body and intervertebral disc. 5. We assume nucleus pulposus is not a persistent residuum of notochord. 6. According to our findings the link of sacral vertebral segments is from the very beginning of development typical synchondrosis with bipolar physes without formation of primordium of intervertebral disc.

[Degenerative changes in intervertebral disks]. / Regresívní zmeny v meziobratlových ploténkách.

A histotopographic study of lumbar spine was made in 27 deceased of the age of 2 to 85 years lacking of any spinal clinical symptomatology. Regressive changes were found in all the intervertebral disks except in infants. A central necrosis was present in 26 cases and pericentral striped necrosis in 19 cases. Other disks showed consequences of necrosis--vascularization, scarring, regenerative proliferation of chondrocytes, ganglion type cavities. A concept of disk lesion as a trigger of further spinal lesions was supported by frequent regressive changes of the disks. Schmorl's (internal) nodes were found in 35 cases, quite often in young persons without clinical symptomatology. The amount of glycosaminoglycans during the disk regression was detected by Safranin O-Fast Green stain with ambiguous results. A hypothetical spontaneous vanishing of the nucleus pulposus in accordance with the age was a topic of discussion. Protrusions of the disks into the spinal canal were not found. Initial osteophytes at ventral margins of vertebral bodies were identified in 49 cases, at dorsal margins in only 3 cases.

Radiological picture of juvenile rheumatoid arthritis.

Basing on the results of radiological, clinical and laboratory examinations of 200 children with juvenile rheumatoid arthritis, we tried to obtain a comprehensive picture of radiological changes in the joints, the spine and the remaining skeleton caused by JRA. The bulk of data was obtained in the period between 1954 and 1972, but for some of the patients, our follow-up continued until 1987. Our main interest were differences in morphological changes caused by JRA and adult RA. We described initial changes and their progress in childhood, adolescence and adulthood, drawing attention to fundamental differences in radiological changes and their progress in patients with an onset of disease in the first half of childhood (up to the age of 8) and in those with an onset in the second half of childhood, where these changes were similar already to those caused by adult RA. Juvenile rheumatoid arthritis affects mainly skeletal growth by either retarding or accelerating various ossification processes. The skeleton of children has a great regenerative capacity, but this, on the other hand, supports various disturbances of growth brought forth by disease. This, apparently, account for differences of changes in the skeleton of the joints observed in JRA patients during childhood and adulthood. Whenever a case is suspected of JRA, a radiological examination of the joints involved ought to be complemented by a radiological examination of the hands because most of our radiographs showed structural changes in the hands. Particular attention should also be given to the knees and hips of children with active disease over a period of 3-6 years. Synostosis of arches and joints of the cervical spine, a typical feature of JRA, was observed in 20-25% of former JRA patients. Synostoses occurred either in the individual segments or in the whole cervical spine, but were never absent at the level of vertebral bodies C2-C3. There were neither objective nor subjective complaints.

Enthesopathy of the hip joint.

Morphologically, enthesopathy appears as dystrophic calcification or ossification of tendon insertion. In the study of the initial stages of arthrosis on necroptic material roentgenologically 158 and of these histologically 62 hip joints were investigated. A typical picture of so-called non-inflammatory enthesopathy was present in thirteen cases on the major and in three cases on the minor trochanter. Histologically, we observed enthesopathy-like changes, but to a much lesser extent in the insertions of the articular capsule. These pictures which on the X-ray resembled initial osteophytes were found seven times on the head of the femur and fourteen times on the edge of the joint acetabulum. There was no correlation to osteoarthrosis.

[Evaluation of activity and the electron microscope picture in Paget's disease]. / Beitrag zur Aktivitätsbeurteilung und zum elektronenoptischen Bild der Pagetschen Krankheit.

Thirteen patients with Paget's disease followed-up for prolonged periods of time were subjected to a series of biological tests and to studies of radionuclides incorporation into skeletal tissues. Bone alkaline phosphatase showed an osteoblastic activity, and tartarate -resistant acid phosphatases an osteoclastic function. Hydroxyproline in urine corresponded to the osteoclastic destruction. The X-ray pattern did not agree necessarily with the local metabolic bone activity of phosphates ( 99mTechnetium pyrophosphate), or of glycoproteins (85Sr). The use of scanning was recommended for studies of local activity and to correlate the results obtained with the clinical and biochemical syndromology . The electronoptic pattern was similar to that observed in inclusions of the paramyxovirus or papova virus. The problems associated with the differential diagnosis were discussed.

[Osteophytes of the femur head]. / Osteofyty hlavice femuru.

The shape and size of osteophytes were studied in different parts of the head of femur (mediodistal, proximal and lateral, central). There was not found any dependence of osteophytes on the basic disease of joint which produced arthrosis. Osteophytes developed from the subchondral cortical lamella, most often at the margin of the joint cartilage. Original corticalis and joint cartilage persisted nearly always at least in remnants under mediodistal osteophyte. On the other hand, original corticalis and cartilage were found under proximal and lateral osteophytes rather exceptionally.

Donor specific suppressor cells in association with rejection of a renal allograft.

Details are presented of three aspects of immunological monitoring in a single instance of severe irreversible rejection of a renal allograft. Rejection is associated with strong evidence of lymphocyte mediated cytotoxicity (LMC). During this period reduced responsiveness of recipient cells to stimulation in vitro by donor cells is observed; this is more reduced than is responsiveness to random cells. Donor-specific suppressor cells also develop, as detected in two systems. It is postulated that the data are evidence that competition exists between different agressive and suppressive subpopulation of recipient lymphocytes.

[Arthrotic manifestations on the patella in the x-ray and microscopy pictures]. / Artrotické projevy na patele v rentgenovém a mikroskopickém obraze.

40 patellae of different age groups were examined by X-ray and histology. X-ray changes found in the cartilage, corticalis and cancellous bone were in full agreement with histological findings. However, more than a quarter of the patellae were found to be affected by microscopic fibrillation of the surface of the cartilage without any demonstrable changes in the cartilage proper. In all those cases except one, however, roentgenograms helped to detect changes in the corticalis or also cancellous boneof the lamellae such as are associated with bone reconstruction, mostly in the form of subchondral bone lamella dilatation and of the thickening of adjacent cancellous bone trabeculae.