scholarly journals Vascularized Osteochondral Grafts: Histologic Evaluation of Chondrocyte Viability with Viable Hyaline Nonfibrous Cartilage

2018 ◽  
Vol 11 (S 01) ◽  
pp. S26-S30
Author(s):  
Brian B. Freniere ◽  
Aviram M. Giladi ◽  
Matthew L. Iorio
Keyword(s):  
Intractable Pain ◽  
Proximal Pole ◽  
Femoral Trochlea ◽  
Chondrocyte Viability ◽  
Osteochondral Grafts ◽  
Histologic Evaluation ◽  
Pathologic Analysis ◽  
Biological Outcomes

AbstractVascularized osteochondral flaps are used for challenging arthroplasties of the upper extremity. Little has been described regarding the biological outcomes of these flaps, specifically regarding the structure of the cartilage. The authors present a case of a 31-year-old patient undergoing medial femoral trochlea flap for proximal scaphoid arthroplasty in the setting of proximal pole avascular necrosis. The patient sustained a fracture that was treated by a headless compression screw and demonstrated provisional radiographic healing, but at late follow-up he had new fragmentation of the proximal pole. The medial femoral trochlea flap that comprised the proximal pole of the reconstructed scaphoid was found to have viable chondrocytes and regularly oriented hyaline cartilage on pathologic analysis 1 year postoperatively. The patient initially had relief of wrist pain and return to work but ultimately developed intractable pain requiring scaphoidectomy and midcarpal arthrodesis. Despite the failure of the procedure, the presence of histologically normal cartilage and viable chondrocytes in a vascularized osteochondral flap offers encouragement that this technique may provide a durable long-term solution for articular reconstruction.

Treatment of Refractory Pain after Brachial Plexus Avulsion with Dorsal Root Entry Zone Lesions

Neurosurgery ◽  
2001 ◽  
Vol 48 (6) ◽  
pp. 1269-1277 ◽  
Author(s):  
Madjid Samii ◽  
Steffani Bear-Henney ◽  
Wolf Lüdemann ◽  
Marcos Tatagiba ◽  
Ulrike Blömer
Keyword(s):  
Brachial Plexus ◽  
Dorsal Root ◽  
Intractable Pain ◽  
Entry Zone ◽  
Dorsal Root Entry Zone ◽  
Root Entry Zone ◽  
Long Term Follow Up ◽  
Cervical Root

Abstract OBJECTIVE Significant numbers of patients experience intractable pain after brachial plexus root avulsions. Medications and surgical procedures such as amputation of the limb are often not successful in pain treatment. METHODS Forty-seven patients with intractable pain after traumatic cervical root avulsions were treated with dorsal root entry zone coagulation between 1980 and 1998. The dorsal root entry zone coagulation procedure was performed 4 months to 12 years after the trauma, and patients were monitored for up to 18 years (average follow-up period, 14 yr). RESULTS Immediately after surgery, 75% of patients experienced significant pain reduction; this value was reduced to 63% during long-term follow-up monitoring. Nine patients experienced major complications, including subdural hematomas (n = 2) and motor weakness of the lower limb (n = 7). Improved coagulation electrodes with thermistors that could produce smaller and more-accurate lesion sizes, which were introduced in 1989, significantly reduced the number of complications. CONCLUSION Central deafferentation pain that persists and becomes intractable among patients with traumatic cervical root avulsions has been difficult to treat in the past. Long-term follow-up monitoring of patients who underwent the dorsal root entry zone coagulation procedure in the cervical cord indicated that long-lasting satisfactory relief is possible for the majority of individuals, with acceptable morbidity rates.

Long-Term Follow-Up Study after Pulvinotomy for Intractable Pain

1980 ◽  
Vol 43 (3-5) ◽  
pp. 128-132 ◽  
Author(s):  
N. Yoshii ◽  
T. Mizokami ◽  
T. Ushikubo ◽  
T. Kuramitsu ◽  
S. Fukuda
Keyword(s):  
Intractable Pain ◽  
Follow Up Study ◽  
Long Term Follow Up

scholarly journals Mosaic arthroplasty of the medial femoral condyle in horses — An experimental study

2014 ◽  
Vol 62 (2) ◽  
pp. 155-168 ◽  
Author(s):  
Gábor Bodó ◽  
Gábor Vásárhelyi ◽  
László Hangody ◽  
László Módis
Keyword(s):  
Hyaline Cartilage ◽  
Femoral Condyle ◽  
Weight Bearing ◽  
Medial Femoral Condyle ◽  
The Other ◽  
Bearing Surface ◽  
Femoral Trochlea ◽  
Osteochondral Grafts ◽  
Mosaic Arthroplasty

One Arabian and 5 Hungarian half-bred horses were used to study the macroscopic and microscopic survival of autologous osteochondral grafts in the weight-bearing surface of the medial femoral condyle (MFC). Grafts were harvested from the cranial surface of the medial femoral trochlea (MFT) under arthroscopic control. Three of them were transplanted into the weight-bearing surface of the contralateral MFC using an arthrotomy approach. Three months later this transplantation procedure was repeated on the opposite stifle joints in the same animals, but at that time transplantation was performed arthroscopically. Follow-up arthroscopy was carried out 12 months after the first operations, and biopsies were taken from both the recipient and the donor sites for histological examination. During follow-up arthroscopy, the transplanted areas looked congruent and smooth. Microscopically, the characteristics of hyaline cartilage were present in 5 out of the 10 biopsies examined; however, in the other half of biopsies glycosaminoglycan (GAG) loss and change in the architecture of the transplanted cartilage was observed. In a 16-year-old horse, all grafts broke during harvesting, and thus transplantation was not performed. No radiological signs of osteoarthritic changes were detected 9 to 12 months after the operations in the donor and recipient joints. Clinically, no lameness or effusion was present three months after the transplantations.

Long-term Intraventricular Infusion of Morphine for Intractable Pain in Cancer of the Head and Neck

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 404-408 ◽  
Author(s):  
Gary C. Dennis ◽  
Robert L. DeWitty
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Intractable Pain ◽  
Intraventricular Administration ◽  
Narcotic Analgesics ◽  
Pump Failure ◽  
Intraventricular Infusion

Abstract The authors' experience with seven patients with intractable pain that was treated by continuous intraventricular infusion of morphine through an implanted Infusaid pump is reported. The pain was caused by head and neck cancer in six patients and was associated with postpolio syndrome in one. The average follow-up was 7 months. Pain was effectively managed through intraventricular administration of a combination of morphine and mild oral narcotic analgesics. Complications included one case of transient respiratory depression, one pump pocket infection, and one pump failure. The morphine dose required to maintain analgesia increased over time in all patients treated. This is a safe and effective method of pain management in patients with head and neck cancer. It is useful as well in patients who have intractable pain that cannot be managed through an intrathecal route because of a contraindication to lumbar puncture or an inaccessible subarachnoid space.

Long-Term Follow-up of Recurrent Laryngeal Nerve Avulsion for the Treatment of Spastic Dysphonia

1996 ◽  
Vol 105 (8) ◽  
pp. 592-601 ◽  
Author(s):  
Brian S. Jewett ◽  
R. E. Stone ◽  
Donald T. Weed ◽  
Cheryl Rainey ◽  
Robert H. Ossoff ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Nerve Stump ◽  
Self Assessment ◽  
Long Term Follow Up ◽  
Histologic Evaluation ◽  
Distal Nerve ◽  
Medialization Laryngoplasty

Long-term follow-up of 3 to 7 years is reported on 18 patients who had undergone recurrent laryngeal nerve avulsion (RLNA) for the treatment of adductor spastic dysphonia (SD). Data on neural regrowth after previous recurrent laryngeal nerve section (RLNS) are presented in 2 of these 18 patients. We introduced RLNA as a modification of standard RLNS to prevent neural regrowth to the hemiparalyzed larynx and subsequent recurrence of SD. We have treated a total of 22 patients with RLNA, and now report a 3- to 7-year follow-up on 18 of these 22 patients. Resolution of symptoms was determined by routine follow-up assessment, perceptual voice analysis, and patient self-assessment Sixteen of 18, or 89%, had no recurrence of spasms at 3 years after RLNA as determined at routine follow-up. Two of the 16 later developed spasms after medialization laryngoplasty for treatment of weak voice persistent after the avulsion. This yielded a total of 14 of 18, or 78%, who were unanimously judged by four speech pathologists to have no recurrence of SD at the longer follow-up period of 3 to 7 years. Two of these 4 patients were judged by all four analysts to have frequent, short spasms. The other 2 were judged by two of four analysts to have seldom, short spasms. Three of 18 patients presented with recurrent SD after previous RLNS. At the time of subsequent RLNA, each patient had evidence of neural regrowth at the distal nerve stump as demonstrated by intraoperative electromyography and histologic evaluation of the distal nerve stump. One remained free of SD following RLNA, 1 was free of spasms at 4 years after revision avulsion but developed spasms after medialization laryngoplasty, and the final patient developed spasms 3.75 years after revision RLNA. Medialization laryngoplasty with Silastic silicone rubber was performed in 6 of 18, with correction of postoperative breathiness in all 6, but with recurrence of spasm in 3. Spasms resolved in 1 of these with downsizing of the implant. We conclude that RLNA represents a useful treatment in the management of SD in patients not tolerant of botulinum toxin injections.

A prospective long-term follow-up of dorsal root ganglion stimulation for the management of chronic intractable pain

Pain ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sam Eldabe ◽  
Sue Copley ◽  
Ashish Gulve ◽  
Ganesan Baranidharan ◽  
Beatrice Bretherton ◽  
...  
Keyword(s):  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Intractable Pain ◽  
Long Term Follow Up

Stereotactic Radiosurgery for the Treatment of Chronic Intractable Pain: A Systematic Review

2017 ◽  
Vol 13 (5) ◽  
pp. 543-551 ◽  
Author(s):  
Dustin G. Roberts ◽  
Nader Pouratian
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Stereotactic Radiosurgery ◽  
Clinical Success ◽  
Controlled Vocabulary ◽  
Intractable Pain ◽  
Patients With Cancer ◽  
Short And Long Term

Abstract BACKGROUND: Since the advent of neuromodulation, the role and efficacy of stereotactic radiosurgery (SRS) for chronic pain has not been carefully scrutinized. OBJECTIVE: To perform a systematic review to evaluate the clinical efficacy, both short- and long-term, of SRS for the treatment of chronic intractable pain. METHODS: A systematic search in PubMed, Web of Science, and PsycINFO was performed using keywords and controlled vocabulary. The search included peer-reviewed articles reporting clinical outcomes of SRS for chronic pain with a minimum 3-mo follow-up for nonmalignant and 1 mo for malignant pain. RESULTS: Six articles (113 patients) were evaluated on the basis of radiation target (thalamus vs pituitary) and pain etiology (malignant vs nonmalignant). Across studies, at least 35% of patients were reported to have lasting significant pain relief. By cohort, clinical success was achieved in 51% of pituitary SRS, at least 23% of thalamic SRS, 39% of nonmalignant, and at least 33% of malignant pain patients. Adverse events were noted in 21% of patients; the majority related to hormonal deficits from pituitary SRS. CONCLUSION: Despite decreased utilization, SRS is effective for select patients with chronic pain and is associated with an acceptable complication rate. Pituitary SRS is superior in patients with cancer-related pain (87% success), while thalamic SRS is superior in patients with nonmalignant pain (65% success). Because reports of SRS for pain largely stem from a period before the common use of neuromodulatory and intrathecal therapies, the efficacy in patients who fail such therapies remains unclear and requires further characterization.

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