A new classification of glenoid bone loss to help plan the implantation of a glenoid component before revision arthroplasty of the shoulder.

AIMS: Glenoid bone loss can be a challenging problem when revising a shoulder arthroplasty. Precise pre-operative planning based on plain radiographs or CT scans is essential. We have investigated a new radiological classification system to describe the degree of medialisation of the bony glenoid and that will indicate the amount of bone potentially available for supporting a glenoid component. It depends on the relationship between the most medial part of the articular surface of the glenoid with the base of the coracoid process and the spinoglenoid notch: it classifies the degree of bone loss into three types. It also attempts to predict the type of glenoid reconstruction that may be possible (impaction bone grafting, structural grafting or simple non-augmented arthroplasty) and gives guidance about whether a pre-operative CT scan is indicated. PATIENTS AND METHODS: Inter-method reliability between plain radiographs and CT scans was assessed retrospectively by three independent observers using data from 39 randomly selected patients. Inter-observer reliability and test-retest reliability was tested on the same cohort using Cohen's kappa statistics. Correlation of the type of glenoid with the Constant score and its pain component was analysed using the Kruskal-Wallis method on data from 128 patients. Anatomical studies of the scapula were reviewed to explain the findings. RESULTS: Excellent inter-method reliability, inter-observer and test-retest reliability were seen. The system did not correlate with the Constant score, but correlated well with its pain component. TAKE HOME MESSAGE: Our system of classification is a helpful guide to the degree of glenoid bone loss when embarking on revision shoulder arthroplasty.

The biological response to a failed extra-articular polyester ligament used for AC Joint reconstruction at the shoulder girdle: a retrieval analysis of five cases.

The LockDown device (previously called Surgilig) is a braided polyester mesh which is mostly used to reconstruct the dislocated acromioclavicular joint. More than 11,000 have been implanted worldwide. Little is known about the tissue reaction to the device nor to its wear products when implanted in an extra-articular site in humans. This is of importance as an adverse immunological reaction could result in osteolysis or damage to the local tissues, thereby affecting the longevity of the implant. We analysed the histology of five LockDown implants retrieved from five patients over the last seven years by one of the senior authors. Routine analysis was carried out in all five cases and immunohistochemistry in one. The LockDown device acts as a scaffold for connective tissue which forms an investing fibrous pseudoligament. The immunological response at the histological level seems favourable with a limited histiocytic and giant cell response to micron-sized wear particles. The connective tissue envelope around the implant is less organised than a native ligament.

Examination of gastroesophageal reflux by transabdominal ultrasound: can a slow, trickling form of reflux be responsible for reflux esophagitis?

BACKGROUND: Ultrasound can visualize significant portions of the upper and lower esophagus; it is without any instrumental interference in real conditions and displays events in motion. PURPOSE: To study the events that occur during swallowing and gastroesophageal reflux. PATIENTS AND METHODS: Group 1 comprised 25 patients with retrosternal complaints, selected for esophageal surface ultrasonography for endoscopic signs of esophagitis. Group 2 comprised 25 patients who underwent initial transabdominal ultrasonography. For 3 to 6 h before ultrasonography, nothing was given by mouth to the 50 patients labelled as having gastroesophageal reflux disease (GERD). Ultrasonography was then performed for 15 to 20 mins after drinking one mouthful of water or tea, or swallowing some saliva to provoke reflux. The events were recorded on videotape rolls. Endoscopy was carried out in all 50 cases; in 46 cases (21 and 25 from groups 1 and 2, respectively), gastric acidity and bacteriology were subsequently examined (test meal). Manometry and pH were not measured to avoid provocation of reflux by the instruments. Thirty patients without any esophageal complaints or signs of esophagitis (though suffering from gastric and duodenal diseases) were designated as the control group (group 3). The available results were compared. RESULTS: In 32 of 46 patients diagnosed with GERD (69.5% in groups 1 and 2), a special kind of reflux was observed by ultrasonography: a slow, trickling reflux of the gastric content was seen, mostly after swallowing. A fast clearance followed four to six episodes of the trickling reflux, only after an interval of 0.5 to 2 mins. Only fast refluxes and immediate clearance were observed in the control group. CONCLUSIONS: The observations above may indicate a special form of gastroesophageal reflux, namely, a slow, trickling form of it. It can be responsible for the development of GERD. Fast reflux and immediate clearance are common; however, this special trickling form was observed only in GERD patients. This may explain a number of often contradictory measurements and can make the effect of cisapride more understandable. A test meal is always necessary to distinguish a bilious reflux from an acidic one, because only the latter may require aggressive antacidic treatment.

Aetiological aspects of mandibular tooth agenesis--focusing on the role of nerve, oral mucosa, and supporting tissues.

The purpose of the present investigation was to consider possible aetiological aspects of mandibular tooth agenesis by comparing the pattern of mandibular molar and premolar agenesis with radiological evidence of the mandibular canal. Orthopantomograms from 33 children affected by agenesis of at least four premolar and/or molar teeth in the mandible were investigated. Three children were affected by ectodermal dysplasia. Two anthropological mandibles with absence of mandibular canals were included in the study for comparison. According to the investigation, agenesis should be divided into three groups, based on an analysis of agenesis location, the presence of nerve canals in the jaws, and finally, data on possible bone, skin and oral mucosa abnormalities. The three aetiological groups suggested are: agenesis related to nerve tissue, agenesis related to the oral epithelium, and agenesis related to the supporting tissue.

Idiopathic bone cavity on the posterior buccal surface of the mandible.

A cavity on the posterior buccal surface of four dry mandibles (n = 8282) is reported. The shape, size, unilaterality, and sex distribution of this phenomenon are similar to anterior and posterior idiopathic bone cavities (i.e., defects) on the lingual cortex. Posterior buccal mandibular defects differ from posterior lingual cavities in their unilateral occurrence and age distribution. The differential diagnosis for posterior buccal mandibular defects includes an anatomic variant, an aneurysmal erosion, erosion by a lymphoid nodule, and a neural neoplasm.

Sensitized immunochemical method for the specific detection of human haemoglobin in dried biological samples.

The authors describe a modified version of counterimmunoelectrophoresis of easy performance and high sensitivity. With this method human haemoglobin can easily and specifically be determined either in fresh or dried biological samples. Glutaraldehyde pretreatment of the samples results in the development of complexes with highly favourable electrophoretic mobility and precipitating capacity. By this chemical modification and use of a double set of samples with varying antigen-antibody proportion, the sensitivity of haemoglobin detection in erythrocyte-containing haemolysate and native blood was 300 ng/ml. The examination is easily performed, and without considerable outlay, even with conventional laboratory facilities. It is equally suitable for the detection of occult colorectal bleeding and for species-specific study of blood stains of unknown origin. The authors succeeded in identifying human haemoglobin even in a 42-month dried blood stain.

The problem of the bifid mandibular condyle.

In a survey of 1,882 prehistoric and historic skulls with 2,077 condyles, 7 double (bifid) mandibular condyles were found. One mandible with bilaterally bifid condyles is presented in detail. Possible causes and consequences of the anomaly are discussed. It is assumed that bifid mandibular condyles with anteroposteriorly situated heads are caused by early childhood fractures, whereas those with mediolaterally situated heads are caused by the persistence of connective tissue septa.

Accessory root formation on a lower medial incisor.

Accessory root formation on a lower medial incisor dating from the eighth century was observed. The accessory root consisted structurally of dentin (corresponding to the root of the tooth) covered with cement but had no radicular canal. It is therefore not a real supernumerary root. Postmortem deformation was excluded by examination of the alveolar bone. It must have been formed at the time of root development, through a lesion of Hertwig's sheath, as a result of a trauma.

Monoclonal cryoimmunoglobulinemia of IgG4 subclass specificity.

Authors demonstrated the prevalence of an unusual cryoimmunoglobulin with IgG4 subclass specificity in the blood of a patient with malignant lymphoproliferative disease. They provide the case history, results of immunochemical studies, and cytological and ultrastructural findings of the bone marrow.