Early histologic changes in lower lumbar discs and facet joints and their correlation.

Biomechanical and histologic studies have highlighted the close functional relationship between lumbar discs and their associated facet joints, and it is conceivable that their degenerative changes are interdependent. However, separation of cause from effect remains controversial. Hitherto, no study in humans has correlated the changes histologically. The present study assessed histologic changes in lower lumbar discs and their associated facet joints in patients under the age of 40 years using classification systems developed for this investigation. A specific objective was to correlate changes in discs and facet joints. Data from 15 lower lumbar spine specimens were obtained. Three parasagittal sections per disc and one section per facet joint were graded histologically. The results were correlated with age, within the functional spinal unit (FSU), and with the adjacent level. Histologic changes were found in discs and facet joints from all FSUs. There was no correlation between the age of the subject and the degree of degeneration of the disc or facet joints at either level. The extent of disc degeneration at L4/5 correlated significantly with changes at L5/S1 (P < 0.01). There was no correlation between changes in discs and the associated facet joints at either level. The results of the study showed that microscopic changes are seen in the disc and facet joints from an early age and can be quite marked in some individuals before the age of 40 years. A correlation of degenerative changes within the FSU could not be established.

Quantitative assessment of angiogenesis and osteogenesis after transplantation of bone: comparison of isograft and allograft bone in mice.

We performed a vital microscopic study in mice bearing dorsal skinfold chambers to characterize microvascular perfusion and leukocyte/endothelium interaction and their effects on elongation and mineralization of neonatal isograft and allograft bone. Isograft (C57/BL to C57/BL) and allograft bone (C57/ BL to BALB/C) revascularized simultaneously. However, vascular perfusion and density were lower in allograft bone than in isograft bone. Leukocyte/endothelium interaction was the same in isograft and allograft bones. Revascularization was not detected in allograft bone transplanted to presensitized recipients. Moreover, in preexisting vessels at the transplantation site, leukocyte/endothelium interaction was altered in allograft bone of presensitized recipients, despite a normal systemic leukocyte count. Femoral growth resulting from thickening of both epiphyses did not differ between experimental groups, however, mineralization occurred in isograft bone only. Isograft bone was histologically intact, allograft bone hypovital and allograft bone in presensitized recipients necrotic 12 days after implantation. Our findings suggest that graft incorporation or rejection is mediated by the microvasculature and that presensitizing of recipients accelerates rejection of allograft bone.

Five-year audit of ambulatory 24-hour esophageal pH-manometry in clinical practice.

BACKGROUND: Esophageal function testing was developed to aid diagnosis in patients with negative endoscopy. Although combined 24-h esophageal pH-manometry is now commercially available, its routine clinical effectiveness has not yet been studied. METHODS: From 1992 to 1996 we evaluated 303 consecutive patients who were first-time referrals to our unit for 24-h esophageal pH-manometry. The referral indications were gastroesophageal reflux disease, 47.2%; dysphagia, 18.5%; non-cardiac chest pain, 14.9%; connective tissue disease, 13.2%; and symptomatic patients after antireflux surgery, 6.3%. RESULTS: Overall, esophageal function testing altered the diagnosis of 44% of the patients, confirmed it in 38%, and specifically changed the management of 66%. The final clinical 'diagnosis' was reflux disease, 54% (32% with non-specific esophageal motility disorder); connective tissue disease, 9.9%; achalasia, 9.6%; other specific esophageal motility disorders, 3.3%; non-specific esophageal motility disorders, 6.9%; and normal, 16.2%. The cost per testing was estimated to be US$305 and per change in management US$465. CONCLUSION: Combined 24-h pH-manometry has been shown to be a useful and cost-effective test for the management of selected patients in whom the primary investigation was insufficient.

Splenic infarction complicating ligation of a gastroduodenal artery aneurysm.

BACKGROUND: Aneurysms of visceral arteries are rare, but may lead to dramatic situations of intraabdominal or retroperitoneal hemorrhage in case of rupture. CASE REPORT: We report the case of a 72-year-old patient who developed a hemorrhagic shock following a total hip replacement due to the rupture of an aneurysm of the gastroduodenal artery. Angiography also demonstrated a high-grade stenosis of the celiac trunk. The ruptured aneurysm was ligated as a live-saving procedure, but due to the stenosis in the celiac trunk the patient developed a splenic infarction followed by partial tissue liquefication. This was treated conservatively and after 3 months, the computed tomography showed an atrophic residual spleen. SUMMARY: Diagnostic and therapeutic approaches to visceral vascular aneurysms are discussed including the potential complications of splenic infarction.

The relationship between height, shape and histological changes in early degeneration of the lower lumbar discs.

The influence of aging and early degenerative changes on intervertebral disc height is controversial. It has been claimed that with aging, narrowing of the disc is inevitable, but this is not confirmed by some published radiological investigations. The present study analysed the height and shape of intervertebral discs from subjects younger than 40 years, and correlated the findings with histological alterations, which were assessed using a grading system. Discs from the L4/5 level (n = 13) and the L5/S1 level (n = 10) were included. Degenerative changes tended to increase with age, specifically at the L4/5 level. There was a weak trend towards decreased disc height with increasing degenerative changes, but no significant correlation could be found. Disc shape was more convex in the frontal than the sagittal plane. It is concluded that early histological changes do not significantly influence intervertebral disc height. More pronounced loss of disc height may be seen in advanced degenerative changes or in elderly subjects.

Calcium pyrophosphate dihydrate deposition in degenerate lumbar discs.

Calcium pyrophosphate dihydrate (CPPD) crystal deposition in lumbar intervertebral discs has been described, but its clinical significance remains unclear. The present study analyzed histological sections of lumbar discs that were obtained from patients undergoing anterior lumbar interbody fusion. Immunohistological staining was undertaken to identify neural elements and blood vessels. Patients with CPPD deposition were compared with a group without CPPD deposition undergoing the same operation. CPPD was found in 15.7% of investigated patients (12.6% of analyzed discs). Deposits were found in areas of the annulus and nucleus showing advanced degeneration. Two patterns were identified: one comprised sharply demarcated rounded deposits, while the other showed diffuse deposition of crystals. There was no association with ingrowth of vascular or neural tissue. Clinical data did not differ significantly in the two groups of patients. However, in all patients with CPPD deposition there was a history of trauma, previous surgery, or both. Isolated CPPD deposition in lumbar intervertebral discs appears to be an incidental finding that is not related to systemic diseases or general arthropathies.