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Purpose: The combination of a facet fracture and a contralateral facet dislocation at the same intervertebral level of the cervical spine (a fracture and contralateral dislocation of the twin facet joints) has not been described in detail. The aims of this study are to report a series of 11 patients with this injury, to clarify the clinical features and to discuss its pathomechanism.Methods: Among 251 patients with lower cervical spine fractures and/or dislocations surgically treated, 11 (9 males and 2 females, averaged age, 52 years) had this kind of injury. Medical charts and medical images were reviewed retrospectively.Results: Injury levels were C4-5, C5-6 and C6-7 in 1, 4 and 6 patients, respectively. A fracture was found at the superior facet in 6, and at the inferior facet in 5. The anterior displacement of the vertebral body ranged from 7 to 19 mm. The unilateral horizontal facet appearance on an anteroposterior radiograph and the triple image on a CT composed of a separated fracture fragment, the base of the fractured facet, and the neighboring non-fractured facet were characteristic. All patients had neurological deficits from Frankel A to D, and were surgically treated by posterior fusion using wire or cable, or combined anterior and posterior spinal fusion.Conclusions: The fracture and contralateral dislocation of the twin facet joints can cause severe neurological deficits because of its gross anterior displacement. Its plausible pathomechanism is extension force exerted to the cervical spine when it is maximally bent laterally. [ABSTRACT FROM AUTHOR]

Study design:Prospective multicenter study.Objective:To clarify the significance of intramedullary Gd-DTPA enhancement in cervical myelopathy, the prevalence, morphologic features, clinical relevance and postoperative change were investigated.Setting:Four hospitals in Japan.Methods:A total of 683 patients with cervical myelopathy who underwent decompressive surgery were consecutively examined. T1, 2 and Gd-DTPA-enhanced MRI were taken before surgery. Fifty consecutive cases without intramedullary enhancement were allocated in the non-enhancement group. The following variables were investigated: prevalence of the enhancement, the morphologic feature, the relationship between the enhancement and T2 high-intensity areas, the change of the Japanese Orthopedic Association (JOA) score for cervical myelopathy and the change of the enhancement after surgery.Results:Intramedullary enhancement was observed in 50 cases (7.3%). The enhancements were observed between the most severely compressed disc and the cranial half of the lower vertebral body. On axial images, they were observed at the posterior or posterolateral periphery of the spinal cord. Enhancement areas were observed within T2 high-intensity areas and smaller than them. The preoperative JOA score was 9.8±2.8 points in the enhancement group and 9.8±3.3 points in the non-enhancement group (NS). The postoperative JOA score was 12.7±2.9 points in the enhancement group and 14.2±2.4 in the non-enhancement group (P=0.006). Intramedullary enhancement disappeared in 60% of the patients 1 year after surgery.Conclusion:Intramedullary enhancement indicated not the severity of preoperative symptoms, but a sign of a worse prognosis. [ABSTRACT FROM AUTHOR]

Background: Patients with crowned dens syndrome typically present with severe neck pain and have calcium deposits around the odontoid process of the axis on radiographs. To our knowledge, the cases of only thirty-five patients have been reported in the English-language literature and the clinical features remain unclear. The purposes of this study were to examine the clinical features of crowned dens syndrome, determine treatment outcomes, and propose diagnostic criteria.Methods: Forty patients with severe neck pain had calcium deposition around the odontoid process on computed tomography scans, and they were thus diagnosed as having crowned dens syndrome. Data were collected in relation to these patients, including the date of onset of neck pain, the presence of inflammatory indicators (increased body temperature, C-reactive protein levels, and white blood-cell count), and treatment outcomes.Results: The male-to-female ratio was 0.6, and two-thirds of the patients were more than seventy years of age. All patients had markedly restricted neck motion, particularly in rotation, and all had one or more positive inflammatory indicators. Calcium deposition was detected in all areas around the odontoid process, but chiefly behind the process. Pain was typically relieved by nonsteroidal anti-inflammatory drugs, prednisolone, or both. A combination of both appeared to be the most effective.Conclusions: We believe that crowned dens syndrome is more common than previously recognized, especially in elderly patients. It is diagnosed on the basis of acute and severe neck pain; marked restriction of neck motion, particularly in rotation; the presence of inflammatory indicators, such as an elevated C-reactive protein level; calcium deposition around the odontoid process detected by computed tomography; no history of trauma; and the exclusion of other inflammatory diseases and tumors. Prednisolone and nonsteroidal anti-inflammatory drugs in combination are the recommended treatment for symptom relief. [ABSTRACT FROM AUTHOR]

We report a case of endometriosis in the right inguinal region, attached to the right round ligament in a 28-year-old woman. At the age of 20, laparoscopic left ovarian cystectomy and pelvic adhesiolysis for endometriosis was carried out. She noticed a right tender groin mass 7 months previously, and the tumour size fluctuated with the menstrual cycle. A poorly circumscribed elastic hard mass, measuring 3 cm in diameter, was palpated in her right inguinal region. Magnetic resonance imaging showed a 2.5 cm × 2.5 cm mass in the right inguinal canal and a 5.4 cm × 6.8 cm mass was seen in the left ovary. The mass enlarged during menstruation. The groin mass was removed, in addition to carrying out laparoscopic ovarian cystectomy. At operation, the groin mass was found to be in continuity with the round ligament of extraperitoneal portion. Histological diagnosis of endometriosis was made in both ovarian and inguinal tumours. After surgery, the pain disappeared completely. Worth mentioning is that MRI clearly showed the change of tumour size depending on the menstrual cycle, which aided in arriving at the correct diagnosis of endometriosis in an unusual location. [ABSTRACT FROM AUTHOR]

Background It is well known that anterior cruciate ligament (ACL) injuries are commoner in female athletes. Accordingly, we hypothesized that serum estrogen may play some role in this sex difference. We evaluated the relationship between serum estrogen levels and the mechanical properties of the ACL in rabbits. Animals and methods In 40 ovariectomized rabbits, the serum estrogen levels (SEL) were controlled by intramuscular injection of 17[beta]-estradiol. The mean SEL in each rabbit was defined as the average of 5 determinations done at 1, 2, 3, 4 and 5 weeks after ovariectomy. The animals were divided into 4 groups according to the dose of estradiol administered (low, medium, high and control: L, M, H and C, respectively) and into 2 groups according to the mean SEL (high-SEL group and low-SEL group). The medial portions of ACL attached to both femur and tibia harvested at 5 weeks after ovariectomy were examined mechanically. Results The mean serum estrogen levels in groups C, L, M and H were 37, 50, 60 and 231 pg/mL. Statistically significant differences in the mean serum estrogen levels were seen among the 4 groups, except between groups L and M. Statistically significant differences were found between groups M and H in both the ultimate tensile stress and linear stiffness. In the comparison between 2 groups using the mean SEL value, both ultimate tensile stress and linear stiffness were lower in the high-SEL group. In all animals, a positive correlation was found between ultimate tensile stress and linear stiffness. Interpretation Our findings suggest that high SEL might be one of the factors in the multifactorial pathogenesis of ACL rupture. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate whether the abnormal expression of matrix metalloproteinases (MMPs) 3, 9, and 13 and ADAMTS-4 by human osteoarthritic (OA) chondrocytes is associated with epigenetic 'unsilencing.' METHODS: Cartilage was obtained from the femoral heads of 16 patients with OA and 10 control patients with femoral neck fracture. Chondrocytes with abnormal enzyme expression were immunolocalized. DNA was extracted, and the methylation status of the promoter regions of MMPs 3, 9, and 13 and ADAMTS-4 was analyzed with methylation-sensitive restriction enzymes, followed by polymerase chain reaction amplification. RESULTS: Very few chondrocytes from control cartilage expressed the degrading enzymes, whereas all clonal chondrocytes from late-stage OA cartilage were immunopositive. The overall percentage of non-methylated sites was increased in OA patients (48.6%) compared with controls (20.1%): 20% versus 4% for MMP-13, 81% versus 47% for MMP-9, 57% versus 30% for MMP-3, and 48% versus 0% for ADAMTS-4. Not all CpG sites were equally susceptible to loss of methylation. Some sites were uniformly methylated, whereas in others, methylation was generally absent. For each enzyme, there was 1 specific CpG site where the demethylation in OA patients was significantly higher than that in controls: at -110 for MMP-13, -36 for MMP-9, -635 for MMP-3, and -753 for ADAMTS-4. CONCLUSION: This study provides the first evidence that altered synthesis of cartilage-degrading enzymes by late-stage OA chondrocytes may have resulted from epigenetic changes in the methylation status of CpG sites in the promoter regions of these enzymes. These changes, which are clonally transmitted to daughter cells, may contribute to the development of OA. [ABSTRACT FROM AUTHOR]

Essential hypertension (EH) is thought to be a polygenic disease. Several candidate genes of this disease have been investigated in studies using polymorphic genetic markers, but some studies have failed to show any association of EH with these genes. In this experiment, we used microsatellite markers on chromosome 1, and performed an association study between EH and control subjects. Genomic DNA was amplified with fluorescently labelled primers from the Applied Biosystems PRISM linkage mapping set HD-5 comprising 63 highly polymorphic microsatellite markers with an average spacing of 4.5?cM. We isolated three loci showing significant differences: D1S507, D1S2713 and D1S2842. The P-values of the allele with the greatest post hoc contributions in D1S507, D1S2713 and D1S2842 were 0.0008, 0.0062 and 0.0084, respectively. All these values were significant after Bonferroni correction. Furthermore, we found that the three microsatellite alleles were associated with the levels of systolic blood pressure. These data suggest that there are at least the three susceptibility loci for EH on chromosome 1, and that a case-control study using microsatellite markers on genomewide basis is a useful method for isolating the susceptibility loci of multifactorial disorders.Journal of Human Hypertension (2004) 18, 823-828. doi:10.1038/sj.jhh.1001740 Published online 10 June 2004 [ABSTRACT FROM AUTHOR]

An unusual case of endometriosis involving the right round ligament in a 40-yearold woman is presented. After giving birth to two children, she first noticed a tender mass in the right groin at the age of 36. It didn't change in size but pain appeared at the age of 38, disturbing her daily life. A poorly circumscribed elastic hard mass, measuring 3cm in diameter, was palpable in her right inguinal region. Magnetic resonance imaging demonstrated a 2×3 cm mass in the right inguinal canal. At operation, a mass was found to be in continuity with the round ligament at the inguinal canal. Histological diagnosis was endometriosis. After operation, she was completely relieved of pain. It is important to include endometriosis in the differential diagnosis for painful inguinal masses in women of childbearing age. [ABSTRACT FROM AUTHOR]

Reports on the case of a 55-year-old female diagnosed with extraskeletal osteosarcoma arising in the buttock. Medical history; Initial diagnosis; Treatment and chemotherapy.

The effects of architectural differences on the strength of cancellous bone of the vertebral body have not been clarified. This study was aimed at determining the influence of trabecular domain factor (TDF), a new histomorphometric parameter, on the maximum compressive strength (MCS) in vertebral cancellous bone. TDF is a variation coefficient representing the ratio dispersion of the area of each trabecula (Sd) to the area of its domain (D). A Voronoi diagram was used to determine trabecular domains. The materials comprised 35 lumbar vertebral bodies obtained at autopsy from 35 subjects aged 25-83 years. A mechanical test sample (12 x 12 x 16 mm) was cut out from each right half, and two large, undecalcified, horizontal sections from each left half. The fields (144 mm2 x 2) for image analyses were symmetrical with those for mechanical test samples in the other half of the same vertebral body. Bone volume (BV/TV), Sd, and D were semiautomatically measured. BV/TV correlated negatively with TDF (r = -0.73). Multiple regression analysis revealed the contributions of BV/TV (partial r = 0.75, p < 0.001) and TDF (partial r = -0.42, p < 0.02) to MCS. The model with BV/TV and TDF predicted MCS, 1.50 +0.15 BV/TV -0.03 TDF, more accurately (R2 = 0.83) than that with BV/TV alone (r2 = 0.79). We conclude that the bone volume primarily contributes to the MCS of vertebral cancellous bones but that the influence of TDF on the fragility becomes increasingly important as the bone volume decreases. [ABSTRACT FROM AUTHOR]

Sizable glomus tumors with cystic changes in the ankle are extremely uncommon. This paper describes painless glomus tumors with cystic changes arising in the ankle of a 22-year-old woman. At the age of 14, a painless mass was noticed on the lateral side of the left ankle, and at age 21, another mass appeared on the medial side of the same ankle. Magnetic resonance imaging (MRI) and computed tomography (CT) scanning revealed 4.5 x 4.0 cm and 2.0 x 2.0 cm sized masses on the medial side and a 3.0 x 4.0 cm sized cystic mass on the lateral side of the ankle. The tumors were removed en bloc. Microscopically, the tumor consisted of perivascularly arranged cells with punched-out, round, and regular nuclei. Immunohistochemically, the tumor cells expressed SMA and HHF-35, indicating smooth muscle cell characters. The patient had no recurrence at 2 years after surgery. [ABSTRACT FROM AUTHOR]

We report two cases of intraosseous lipoma arising in the calcaneus of a 36-year-old and a 22-year-old women complaining of heel pain. Plain radiographs and computed tomography scans revealed cystic lesions in the calcaneus triangle. On magnetic resonance images, the lesions had high signal intensities on both T1-weighted and T2-weighted images, corresponding to adipose tissue. Histological examination revealed mature fat cells with small bone fragments. Curettage and bone grafting were performed. There was no recurrence identified on plain radiographs 2 years following the surgery. [ABSTRACT FROM AUTHOR]