Granulomatosis with polyangiitis according to geographic origin and ethnicity: clinical-biological presentation and outcome in a French population.

Objectives: Granulomatosis with polyangiitis (GPA) mainly affects white Europeans, but rarely GPA may also affect non-Europeans. This study aimed to describe GPA clinical-biological presentation and outcome in black sub-Saharan Africans and Afro-Caribbeans and in North Africans. Methods: Among 914 GPA patients included in the French Vasculitis Study Group database, geographic origin and ethnicity were known for 760. Clinical-biological presentations and outcomes of white Europeans vs black sub-Saharans and Afro-Caribbeans and vs North Africans were analysed. Results: Among the 760 patients, 689 (91%) were white Europeans, 33 (4.3%) were North Africans and 22 (2.9%) were sub-Saharans (n = 8) or Afro-Caribbeans (French West Indies, n = 14). Black sub-Saharans and Afro-Caribbeans, compared with white Europeans, were significantly younger at GPA diagnosis (P = 0.003), had more frequent central nervous system involvement (P = 0.02), subglottic stenosis (P = 0.002) and pachymeningitis (P = 0.009), and tended to have more frequent chondritis and retroorbital tumour. Median serum creatinine levels and Birmingham Vasculitis Activity Score were significantly lower in sub-Saharans and Afro-Caribbeans (P = 0.002 and P = 0.003, respectively). In contrast, in comparison with white Europeans, North Africans had only less frequent arthralgias (P = 0.004). Time to relapse was shorter for black sub-Saharans and Afro-Caribbeans compared with white Europeans [adjusted HR = 1.96 (95% CI: 1.09, 3.51) (P = 0.02)], and did not differ for North Africans. In contrast, overall survival was not significantly different according to ethnicity. Conclusion: Our findings indicated different GPA clinical presentations in white Europeans and sub-Saharans and Afro-Caribbeans, with black patients having more frequent severe granulomatous manifestations. In addition, time to relapse was significantly shorter for black sub-Saharans and Afro-Caribbeans compared with white Europeans.

Changes in the T2 relaxation value of the tibiofemoral articular cartilage about 6 months after anterior cruciate ligament reconstruction using the double-bundle technique.

OBJECTIVE: To evaluate T2 relaxation values (T2RVs) of knee joint cartilage after double-bundle anterior cruciate ligament reconstruction (DB-ACLR) in a 6-month follow-up and to correlate changes between T2RVs with meniscal status and clinical findings. METHODS: 27 patients who underwent DB-ACLR and MRI before and 6 months after surgery, and 27 control subjects were enrolled. We compared T2RVs of the control vs pre-operative MR and pre-operative vs post-operative MR using 28 subcompartments, including superficial and deep layers. Correlations between T2RV changes with meniscal status and clinical data were examined. RESULTS: The pre-operative T2RV was significantly higher than that of the control group in the medial tibia (posterior-superficial), posterior medial femur (superficial) and posterior lateral femur (superficial and deep). The post-operative T2RV was significantly higher than that of pre-operative T2RV in the posterior medial femur (superficial), medial tibia (anterior-deep and central-deep), lateral femur (anterior-deep, anterior-superficial and central-superficial) and posterior medial femur (deep). Moderate positive correlations between pre-operative and post-operative T2RV changes were found at the posterior medial femur (interval between injury and MR examination, and instability) and posterior lateral femur (Lysholm score). CONCLUSION: Patients with anterior cruciate ligament injury followed by DB-ACLR presented short-term subcompartment T2RV changes at the medial femur, lateral femur and medial tibia. Meniscal status did not affect T2RV; however, clinical findings influenced T2RV at the posterior grooves of the medial and lateral femoral condyles. ADVANCES IN KNOWLEDGE: Patients submitted to DB-ACLR presented T2RV changes in both femoral and medial tibial condyles 6 months after the surgery, affecting not just the weight-bearing areas, but also the less-weight-bearing areas.

Tratamento dos defeitos osteocondrais do joelho / Treatment of the knee osteochondral defects

Os defeitos osteocondrais do joelho acometem toda a espessura da cartilagem e são geralmente de origem traumática, podendo ocorrer isoladamente ou em conjunto com lesões ligamentares ou meniscais. O diagnóstico definitivo geralmente é feito por ressonância magnética, apesar da história e exame físico darem indícios do diagnóstico. As lesões osteocondrais sintomáticas necessitam de tratamento cirúrgico e a escolha da técnica cirúrgica depende de alguns fatores como tamanho da lesão, local da lesão, atividade e idade do paciente. Técnicas, como abrasão e drilling são pouco usadas atualmente. A microfratura é largamente usada e geralmente é a primeira escolha no tratamento de defeitos osteocondrais de 1 a 2,5 cm2. A mosaicoplastia também pode ser usada para lesões desta magnitude, mas em pacientes mais ativos que necessitam um retorno mais rápido às atividades esportivas. Pode também ser usadas em defeitos maiores, porém o transplante autólogo de condrócitos (TAC) aparece como uma boa opção para lesões maiores. A primeira geração do TAC transplanta condrócitos os quais ficam contidos no defeito devido a uma cobertura de periósteo, já a segunda geração de TAC apresenta os condrócitos embebidos em uma matriz e evita o uso da cobertura com periósteo. O transplante alógeno osteocondral também é uma opção para defeitos maiores que 4 cm2. Novas tecnologias estão sendo desenvolvidas, porém ainda sem aplicabilidade clínica.

Tissue engineering in musculoskeletal problems related to haemophilia.

This article is a review of how advances in tissue engineering can be applied to the musculoskeletal pathology of patients with haemophilia. This article will also explain the theory that the deterioration of joints in patients with haemophilia is due to biological and mechanical causes. Current concepts of tissue engineering would be to replace the degenerated and damaged tissue by live cells, using them as a biological implant. However, before these new technologies are applied, an appropriate control of their indication and results is required.

Alterações ilíacas que influenciam na condromalácia patelar / Iliac alterations that influence on chondromalacia of the patella

As alterações na cintura pélvica em especial no ilíaco tem sido amplamene relacionadas com as compressões patelares. Deste modo, a finalidade deste estudo é fazer uma revisão sobre os efeitos da anterioridade,posterioridade, abertura e fechamento do ilíaco e suas consequências sobre a articulação patelofemural, tal como as compressões. Observou-se que estando o ilíaco em alteração por um tempo relativamente grande levará a disfunções biomecânicas da patela, tendo como uma de suas consequências, a condromalácia patelar.

Chondromalacia induced by patellar subluxation: morphological and morphometrical aspects in rabbits.

The purpose of this study was to describe morphologically and quantify the changes of the articular cartilage in chondromalacia, concerning both the chondrocytes and extracellular matrix. Eight rabbits were submitted daily to patellar subluxation, causing chondromalacia after two weeks. The knee fragments obtained were processed by the standard methods. These experimental conditions caused degenerative alterations of the articular cartilage, varying from a slight decrease of proteoglycans, to fibrillations, clefts, and horizontal splitting. The results showed a significantly increase number of chondrocytes (p < 0,000139), although smaller in size (p < 0,000109). The immobilization for 2 weeks and the intermittent passive daily motion afterwards for a period of 2 weeks, was effective to cause patellar chrondomalacia in rabbits.

Condrolisis idiopática de la cadera: caso clínico / Idiopathic chondrolysis of the hip: case report

La condrolisis de la cadera es una entidad poco frecuente, de etiología desconocida. Descrita originalmente como secundaria a epifisiolisis, se asocia también a trauma severo, inmovilización prolongada, artritis reumatoídea monoarticular e infección. En 1971 Jones describe por primera vez casos de condrolisis no asociados a patologías conocidas, o condrolisis idiopática. Esta patología ha mostrado ser característica de adolescentes premenárquicas de 12 años en promedio. Se reporta el caso de un paciente de 23 años con cuadro de 10 meses de coxalgia, cojera y disminución del rango de movilidad articular. El laboratorio, la radiología y el estudio anatomopatológico fueron compatibles con condrolisis idiopática de la cadera. El tratamiento consistió en un reemplazo total no cementado de la cadera afectada. El score de Harris fue de 100 puntos tras 1 año de seguimiento. La importancia de este caso radica en lo infrecuente de esta patología, así como la inhabitual edad de presentación. Según nuestra revisión, este sería el tercer caso reportado de esta entidad en adultos

Condromalacia patelar: revisión / Chondromalacia patellae: review

Se presenta en este trabajo una revisión bibliográfica desde la historia hasta las tendencias actuales de enfoque en estudio y tratamiento de la condromalacia patelar. Se pone gran énfasis en el ordenamiento de conceptos fisiopatológicos y biomecánicos básicos, ambos asuntos de gran confusión y debate. Se discute acerca del estudio por imágenes y se trata de establecer una relación clínico etiológica. Se aclara el significado de algunos términos conflictivos y se sugiere una pauta a seguir en los exámenes y procedimientos a realizar en cada caso

Pericondrite supurativa do pavilhäo auricular / auricular suppurative perichondritis

A pericondrite do pavilhão auricular é uma infecção grave que pode comprometer toda a estrutura cartilaginosa e a pele circunjacente a esta estrutura. É uma entidade rara mesmo em cirurgias otológicas contaminadas e leva a uma considerável morbidade e alguma deformidade da orelha. É relatado o caso de um paciente com pancreatite crônica e diabetes mellitus insulino-dependente desconpensada e pericondrite rebelde à terapia clínica. A etiologia, patogênese, sintomas, diagnóstico e os princípios de tratamento desta rara afecção são apresentados.

Chondrolysis following slipped capital femoral epiphysis in Jamaica

We reviewed the cases of all patients with slipped capital femoral epiphysis at the University Hospital of the West Indies. Forty-seven hips in thirty-six Black patients were evaluated, and in 40 per cent of those hip chondrolysis developed. The appearance of roentgenographic changes of chondrolysis was predictable. There was a high percentage occuring within one year of diagnosis of slipped epihysis and within six months of closure of the proximal femoral growth plate. The persistent absence of motion in all planes following slipping of the capital femoral epiphysis was a constant finding in patients with chondolysis. This loss of motion can be diagnostic of impending chondrolysis and is usually present before the appearance of the roentgenographic changes. The microscopic changes suggest that the primary lesion is not necrosis of cartilage but a replacement of articular cartilage by pannus formation (Summary)