RESUMO
A surgical procedure has been devised to prevent scapular winging and to increase shoulder abduction in facioscapulohumeral muscular dystrophy. The operation improves the limited shoulder abduction and scapular winging caused by the loss of scapular fixation to the thoracic cage, while passive abduction at the glenohumeral joint remains normal. Preventing scapular malrotation by eliminating scapulothoracic motion increases shoulder abduction. This is achieved by fastening the scapula to several underlying ribs with fascia. The operation has resulted in a 37 per cent increase in abduction, increased shoulder strength and endurance, and the prevention of scapular winging.
Assuntos
Fáscia , Úmero , Distrofias Musculares/cirurgia , Costelas/cirurgia , Escápula/cirurgia , Adulto , Humanos , Artropatias/prevenção & controle , Masculino , Métodos , Articulação do OmbroRESUMO
The clinical signs and symptoms of the most common muscular dystrophies are presented. Plans for treatment and genetic counseling are outlined. A new operation for correction of scapular winging is described with illustrative cases.
Assuntos
Distrofias Musculares/diagnóstico , Distrofias Musculares/terapia , Criança , Creatina Quinase/sangue , Aconselhamento Genético , Humanos , Distrofias Musculares/classificação , Distrofias Musculares/enzimologia , Distrofias Musculares/genética , Costelas/cirurgia , Escápula/cirurgia , Fusão Vertebral , Ossos do Tarso , Tendões/cirurgiaRESUMO
The morphologic and biochemical events during fracture callus cartilage differentiation and calcification are presented. 1. Histologic studies have demonstrated that unimmobilized fractures heal through endochondral ossification. 2. Biochemical studies have demonstrated an increase in the activities of alkaline phosphatase, enzymes involved with aerobic glucose metabolism, and lysosomal enzymes and a decrease in activities of enzymes involved with glycogen synthesis and anaerobic glycolysis. Hexosamines and hydroxyproline show a net decrease with cartilage differentiation. 3. Electron microscopic studies have demonstrated the intracellular origin and aggregation of collagen molecules, the cellular origin of matrix vesicles, and the early sites of calcification in the fracture callus.
Assuntos
Calo Ósseo/ultraestrutura , Calcificação Fisiológica , Cartilagem/ultraestrutura , Fraturas Ósseas/patologia , Cicatrização , Fosfatase Alcalina/metabolismo , Regeneração Óssea , Cartilagem/metabolismo , Humanos , Microscopia Eletrônica , Microscopia Eletrônica de Varredura , Fosfatos/metabolismo , Proteínas/metabolismoRESUMO
Differentiation and calcification of cartilage of a fracture callus morphologically, ultrastructurally, and histochemically resembles cartilage of growing epiphyseal plate. The fracture callus includes the various cartilage cell types found in the epiphyseal plate. Proliferating and hypertrophic cartilage had higher activities of cytochrome oxidase, alkaline phosphatase and glutamate aspartate transaminase than fibrocartilage. Enzymes controlling glycogen synthesis and glycolysis had higher levels of activity in fibrocartilage than in hypertrophic cartilage. Lysosomal enzymes, catalase, 6-phospho-gluconic acid and glucose 6-phosphate dehydrogenase were uniformly distributed. Alkaline phosphatase was associated with extracellular vesicles found in hypertrophic cartilage. EM dense granules were found in mitochondria in hypertrophic cartilage. There was an increase of total lipids in hypertropic and calcified cartilage as compared to resting cartilage.
Assuntos
Calo Ósseo/enzimologia , Calcinose/enzimologia , Cartilagem Articular/enzimologia , Fraturas Ósseas/enzimologia , Azul Alciano , Fosfatase Alcalina/metabolismo , Animais , Calo Ósseo/patologia , Cartilagem Articular/patologia , Diferenciação Celular , Divisão Celular , Citrato (si)-Sintase/metabolismo , Complexo IV da Cadeia de Transporte de Elétrons/metabolismo , Fraturas Ósseas/patologia , Glicogênio/biossíntese , Glicogênio Sintase/metabolismo , Masculino , Microscopia Eletrônica , Nucleotidiltransferases/metabolismo , Ácido Periódico , Fosfofrutoquinase-1/metabolismo , Coelhos , Bases de Schiff , Coloração e RotulagemRESUMO
An in vitro model has been devised to study the differentiation and calcification of fibrocartilage from fracture calluses. Morphological and biochemical studies substantiating cartilage metaplasia in vitro are presented. A role that such a model may play in the study of cartilage calcification is suggested.
Assuntos
Calo Ósseo/patologia , Cartilagem/patologia , Cicatrização , Fosfatase Alcalina , Animais , Calo Ósseo/enzimologia , Calo Ósseo/metabolismo , Calcificação Fisiológica , Cartilagem/enzimologia , Cartilagem/metabolismo , Diferenciação Celular , Técnicas de Cultura , Fíbula/lesões , Fraturas Fechadas , Masculino , Modelos Biológicos , Coelhos , Fraturas da TíbiaRESUMO
The differentiation and calcification of fracture callus cartilage studied by light microscopy resembles that of the epiphyseal plate cartilage. In this study, a correlation between the ultrastructural cytology and the chemical composition of the various cartilage types found in fracture callus was attempted. Fibrocartilage cells were very active with profuse secretion of collagen into the matrix. Collagen fibres were observed in close proximity to the cell membrane. Cells from hypertrophic and calcifying cartilage showed progressive degeneration while their mitochondria contain dense osmiophilic granules. Mitochondria granules were occasionally seen in fibrocartilage cells. The intercellular matrix of hypertrophic and calcifying cartilage showed needle-shaped crystals quite often arranged as a cluster in a radiated pattern. Chemical analyses of the various types of cartilage found in fracture callus demonstrated the presence of a high molecular weight bound phosphate and an increase of sialic acid in the differentiated types of cartilage.