An automatic method for bone histomorphometry: assessment with reference to usual static and dynamic parameters.

To perform a fast and reproducible analysis in bone histomorphometry, we developed an automatic method for calculating static and dynamic parameters. A color automatic image analyzer (SAMBA 200) was used to obtain the usual parameters of bone histomorphometry: bone volume (Cn-BV%TV), osteoid volume (Cn-OV%BV), and osteoid surface (Cn-OS%BS). A specialized algorithm was designed for calculation of the mineral apposition rate (MAR). Eroded surface (Cn-ES%BS) was read in a semiautomatic mode using a cursor. To validate this program, we input 30 samples from patients with bone disease (20 osteoporosis, 6 renal osteodystrophy, 2 osteomalacia, and 2 hyperparathyroidism) using manual and automatic modes. The results obtained showed a highly significant correlation with the usual manual method for all parameters: OS/BS, r = 0.93; OV/BV, r = 0.98; MAR, r = 0.90. With the automatic method, larger values were found for osteoid parameters and MAR and lower values for BV/TV. There were no statistical differences for OV/BV and MAR when compared to the reference manual method. This study establishes that automatic measurements of osteoid parameters and MAR can be performed by a fast analyzer with as good reproducibility and accuracy as the manual method.

Percutaneous intradiscal radio-frequency thermocoagulation. A cadaveric study.

STUDY DESIGN: This study examined the effect of radio-frequency thermocoagulation on cadaveric disc material. Radio-frequency lesions are induced to decompress the nerve root by coagulating the nucleus pulposus. OBJECTIVES: The purpose of this study was to assess the potential of the radio-frequency lesion technique for treating lumbar disc herniation percutaneously. The effect of radio-frequency thermocoagulation on cadaveric disc material was studied. SUMMARY OF BACKGROUND DATA: An intradiscal bipolar electrode is used for the thermocoagulation of the nucleus pulposus. METHODS: Lumbar discs of 27 adult cadavers were used for the experiments within 72 hours of donors' deaths. The physical and thermal parameters of intradiscal radio-frequency thermocoagulation were determined experimentally. Acute macroscopic and histologic changes before and after thermocoagulation were investigated. The temperature distribution of the tissue surrounding the disc was measured during the operation using thermocouples to evaluate potential heat damage. Also, computed tomography and magnetic resonance imaging of the disc were performed before and after thermocoagulation. RESULTS: Macroscopic observation showed that the lesion induced by radio-frequency thermocoagulation is homogeneous and intense without necrosis, and is limited to the nucleus pulposus. Histologically, the endplates and vertebral bodies were unaffected and an architectural disorganization of the stroma of the nucleus pulposus was seen. The temperature increase of the tissue surrounding the discs did not exceed 3-4 C. CONCLUSION: A bipolar electrode and a radio-frequency alternating current permits percutaneous intradiscal thermocoagulation for destruction of a portion of disc material in a cadaveric spine.

Bone metastases from a cerebral and sacral ependymoma. Report of a case.

A case of cerebral and sacral ependymoma revealed by cerebellar syndrome and sciatica in a 68-year-old man is reported. Bone metastases were diagnosed seven months after surgical excision of the brain tumor.

Intervertebral disk degeneration and herniation: the role of metalloproteinases and cytokines.

This article reviews the role of metabolic factors, including metalloproteinases and cytokines, in the occurrence of degenerative disk disease and disk herniation. Given that mechanical factors alone cannot cause disk degeneration, studies must explore metabolic, genetic, nutritional, and age-related factors. Zinc metalloproteinases exert particularly important effects, not only directly, but also indirectly through promotion of neovascularization. The production of these enzymes is dependent on a number of cytokines and on the cell changes they induce. This complex effect acts both on disk matrix degeneration and on the pain generated by contact between the protruding disk and the nerve roots. However, it can have a favorable effect by promoting resorption of the herniated disk. Available data on the role for mechanical factors on the disk chondrocyte metabolism and on metalloproteinase production show that mechanical and metabolic factors interact closely to produce disk disorders.

[Osteo-medullary metastases from cerebral glioblastoma]. / Métastases ostéo-médullaires d'un glioblastome cérébral.

A 55 year old female with a history of three different malignancies including a cerebral glioblastoma developed two bone metastases (in the spine and iliac crest). Histologic and immunohistochemical studies of biopsy specimens demonstrated the presence of glial fibrillary acidic protein, establishing that the bone tumors were metastases from the glioblastoma. Specific features of these rare metastases are discussed.

[Socioeconomic incidences and prognostic factors of low back pain caused by occupational injuries among the hospital personnel of Grenoble University Hospital Center]. / Incidences socio-économiques et facteurs pronostiques des lombalgies par accident du travail dans le personnel hospitalier du CHU de Grenoble.

Low back pain is generally believed to be common among hospital employees. This cross-sectional, retrospective study was carried out to determine the annual incidence of low back pain ascribable to occupational injuries in hospital employees and to evaluate factors influencing the prognosis of these injuries. In 1989, 70 employees working at the Grenoble Teaching Hospital (GTH) reported an occupational injury responsible for low back pain. Each of these employees filled out an epidemiological questionnaire during a routine evaluation by a rheumatologist. Overall annual incidence of occupational injuries with subsequent low back pain was 1.9% among GTH employees. Higher incidences were seen among employees whose occupations involved patient transfer, as well as among nursing assistants. Activities associated with an increased risk of low back pain included handling of patients or objects and work requiring prolonged periods in uncomfortable positions or in the standing position. A previous history of low back disease and a longer period of time in the current work were also associated with an increased risk of low back pain. Characteristic clinical profiles of patients with low back pain subsequent to occupational injury were determined by occupation and type of hospital department. The analysis of long-duration absence from work and long-term consequences on career confirmed the significant adverse socioeconomic impact of these injuries.

Why the back of the child?

An international congress about "the back of children and teenagers and the prevention of backache" was held in March 1999 in Grenoble (France). Beside specific low back pain following progressive and growth diseases, special attention was paid to non-specific low back pain (LBP). Some epidemiological data show a high incidence of LBP during and after the rapid growth phase, with the concomitant possibility of continued or recurrent evolution. MRI studies reveal frequent signs of disc degeneration: they start after the growth phase, spread during adolescence and are often correlated with backache. An immunohistological study seems to confirm the presence of degenerative-type alterations and changes in collagen in the vertebral plates and nucleus of juvenile spine. These data must be confirmed, and their relation to natural history and prognosis of juvenile LBP have to be clarified by longitudinal studies.

[Hypophosphatemic vitamin D resistant osteomalacia with parathyroid adenoma (author's transl)]. / Ostéomalacie hypophosphorémique vitamino-résistante avec adénome parathyroïdien.

The authors report a new case of parathyroid adenoma associated with hypophosphatemic vitamin D resistant osteomalacia. These troubles were simultaneously found. Major and isolated phosphate tubular loss was improved neither by parathyroidectomy nor vitamin D or 25 OHD therapy. On the contrary 25 OHD associated with oral phosphate intake was clinically, radiologically and histologically efficient. The actual pathogenic concepts about this affection are reviewed.

Multicentric reticulohistiocytosis: a case with enhanced interleukin-1, prostaglandin E2 and interleukin-2 secretion.

We describe a 47-year-old woman with multicentric reticulohistiocytosis. While the disease was in remission without therapy, interleukin-1 and prostaglandin E2 secretions by adherent cells was increased as well as interleukin-2 secretion by peripheral mononuclear cells. This suggests that macrophages play an essential role in the pathogenesis of this disease.

[Misleading pains in the lower limbs of rheumatologic origin]. / Les douleurs trompeuses des membres inférieurs d'origine rhumatologique.

Pain in the lower limbs related to rheumatic disease may be the source of diagnostic difficulties when it presents in the guise of pseudo-vascular manifestations. A narrow spinal canal and atypical neuralgia may present a very misleading clinical picture. Similarly, traumatic muscular pathology and bone trauma and tumours may also be misleading. A popliteal cyst and reflex sympathetic dystrophy may simulate venous disorders. Iatrogenic disease, particularly complications of anticoagulant treatment also need to be recognized.

[Spinal biomechanics and the sitting position]. / Biomécanique rachidienne et station assise.

Our study was conducted in two stages. In a first stage, elaboration of a reliable biomechanical model for the lumbar spine, permitting to calculate for each lumbar level, for a definite posture and a given patient, the normal and tangential forces as well as the overall stresses applied to the disc, and represented by the intradiscal pressure of the nucleus pulposus and the overall stresses in the annulus fibers. This biomechanical model was constructed with the help of radiographs and formulas of forces and moments balance in comparison with a reference axis system. This biomechanical model was then used to compare stresses on the disc in various sitting positions, in order to determine an ergonomic adaptation of the sitting position at work.

Rheumatic manifestations at presentation of Hodgkin's disease and non-Hodgkin's malignant lymphoma. A national survey of one hundred forty-six patients.

The authors report the findings of a national survey conducted at the request of the French Society for Rheumatology to list the rheumatic manifestations that can be inaugural in Hodgkin's disease or non-Hodgkin's malignant lymphoma. This was an exploratory, retrospective, descriptive study of 146 patients from 22 rheumatology departments. A number of clinical features (young male, nocturnal sweats, generalized pruritus, protracted fever, central or peripheral lymphadenopathy) and laboratory test abnormalities (evidence of severe inflammation) considerably increased the likelihood of Hodgkin's disease rather than malignant lymphoma. The diagnosis of bony involvement requires multidisciplinary studies of tumor specimens.