Osteochondral necrosis of the femoral condyles in Thoroughbred foals: eight cases (2008–2018)

2021 ◽  
pp. 1-9
Author(s):  
Jannah Pye ◽  
Mathieu Spriet ◽  
Penny Dow ◽  
Scott Katzman ◽  
Brian G. Murphy
Keyword(s):  
Bacterial Colonization ◽  
Femoral Condyle ◽  
Treatment Strategies ◽  
Disease Process ◽  
Polymorphonuclear Cells ◽  
Postmortem Ct ◽  
Presumptive Diagnosis ◽  
Cartilage Canals ◽  
Thoroughbred Foals ◽  
Femoral Condyles

Abstract OBJECTIVE To describe clinical, imaging, gross, and histopathological abnormalities associated with osteochondral necrosis of the femoral condyles in foals and identify features suggestive of a common pathogenesis. ANIMALS 8 Thoroughbred foals euthanized with a presumptive diagnosis of necrosis of the femoral condyles. PROCEDURES Postmortem CT was performed on all distal femoral epiphyseal samples. The articular epiphyseal cartilage complex (AECC) of affected distal femurs was examined grossly and histologically, focusing on lesions of interest identified on CT images. RESULTS 7 foals were between 9 and 23 days old at the time of euthanasia; 1 foal was 85 days old. Concurrent illness (neonatal maladjustment syndrome, neonatal isoerythrolysis, or infection such as enteritis and omphalitis) was diagnosed in 7 foals. The characteristic antemortem radiographic and postmortem CT finding was a crescent-shaped osteochondral flap displaced from the affected medial femoral condyle. Synovial fluid cytology from affected joints was either within normal limits or consistent with mild inflammation. Histologically, all lesions were characterized by osteochondral necrosis and detachment of the AECC. In 6 foals, polymorphonuclear cells were found within growth cartilage canals, representing septic cartilage canals. CLINICAL RELEVANCE Osteochondral necrosis was interpreted to be secondary to bacterial colonization of the distal femoral AECC, evidenced by septic cartilage canals identified in 6 of 8 foals. This uncommon condition was previously thought to arise from an ischemic event, but the disease process was not well understood. An improved understanding of the pathogenesis of osteochondral necrosis is the first step in formulating more successful preventative and treatment strategies.

scholarly journals COVID-19/SARS-CoV-2 Infection: Lysosomes and Lysosomotropism Implicate New Treatment Strategies and Personal Risks

2020 ◽  
Vol 21 (14) ◽  
pp. 4953 ◽  
Author(s):  
Markus Blaess ◽  
Lars Kaiser ◽  
Martin Sauer ◽  
René Csuk ◽  
Hans-Peter Deigner
Keyword(s):  
Viral Entry ◽  
Cathepsin L ◽  
Treatment Strategies ◽  
Disease Process ◽  
Host Cells ◽  
Cytokine Release ◽  
Early Administration ◽  
Lysosomal Ph ◽  
New Treatment ◽  
Exposure Prophylaxis

In line with SARS and MERS, the SARS-CoV-2/COVID-19 pandemic is one of the largest challenges in medicine and health care worldwide. SARS-CoV-2 infection/COVID-19 provides numerous therapeutic targets, each of them promising, but not leading to the success of therapy to date. Neither an antiviral nor an immunomodulatory therapy in patients with SARS-CoV-2 infection/COVID-19 or pre-exposure prophylaxis against SARS-CoV-2 has proved to be effective. In this review, we try to close the gap and point out the likely relationships among lysosomotropism, increasing lysosomal pH, SARS-CoV-2 infection, and disease process, and we deduce an approach for the treatment and prophylaxis of COVID-19, and cytokine release syndrome (CRS)/cytokine storm triggered by bacteria or viruses. Lysosomotropic compounds affect prominent inflammatory messengers (e.g., IL-1B, CCL4, CCL20, and IL-6), cathepsin-L-dependent viral entry of host cells, and products of lysosomal enzymes that promote endothelial stress response in systemic inflammation. As supported by recent clinical data, patients who have already taken lysosomotropic drugs for other pre-existing conditions likely benefit from this treatment in the COVID-19 pandemic. The early administration of a combination of antivirals such as remdesivir and lysosomotropic drugs, such as the antibiotics teicoplanin or dalbavancin, seems to be able to prevent SARS-CoV-2 infection and transition to COVID-19.

Thyroiditis in Children

1989 ◽  
Vol 11 (6) ◽  
pp. 184-191
Author(s):  
Laura K. Bachrach ◽  
Thomas P. Foley
Keyword(s):  
Thyroid Gland ◽  
Sick Child ◽  
Treatment Strategies ◽  
Disease Process ◽  
Feedback System ◽  
Diagnostic Techniques ◽  
Thyroid Stimulating Hormone ◽  
Endocrine Disorders ◽  
Asymptomatic Child ◽  
Hormone Production

Thyroiditis ranks with diabetes as the most common of the endocrine disorders of childhood. The term encompasses all forms of thyroid gland inflammation and infection, although chronic lymphocytic thynoiditis is overwhelmingly the most frequent. Thyroiditis may appear as a mass in the neck of an asymptomatic child or it may be a painful, erythematous goiter in a sick child. The affected thyroid gland may be small on large, with varying degrees of dysfunction. Most commonly, thyroiditis causes euthyroid function, although the disease process can result in transient or permanent thyroid dysfunction. The causes of thyroiditis in childhood, as well as the less common thyroid disorders in the differential diagnosis of goiter, are listed in Table 1. Thyroid physiology and pathophysiology will be discussed briefly to explain the rationale for diagnostic studies and treatment strategies. The more recent diagnostic techniques and therapeutic controversies regarding thyroiditis will be included. The goal is to provide the clinician with renewed awareness of this most common pediatric problem. THYROID PHYSIOLOGY Thyroid hormone production is regulated by a classical negative feedback system (Fig 1). Hypothalamic thyrotropin-releasing hormone (TRH) stimulates the synthesis and secretion of thyroid-stimulating hormone (TSH) from the pituitary. TSH, in turn, stimulates production and release of thyroxine (T4) and triiodothyronine (T3).

Avascular necrosis

2013 ◽  
pp. 1266-1273
Author(s):  
Stefan Rehart ◽  
Martina Henniger
Keyword(s):  
Avascular Necrosis ◽  
Femoral Condyle ◽  
Clinical Signs ◽  
Disease Process ◽  
Core Decompression ◽  
Underlying Disease ◽  
Classification Systems ◽  
Circulatory Disorder ◽  
Ischaemic Necrosis ◽  
Important Disease

Avascular necrosis (AVN) represents an important disease process of the cartilage-bone complex, which can occur at any age. According to aetiology one may discriminate between rare idiopathic avascular necroses and more common forms that occur as an effect of the underlying disease or rather the therapy, the secondary avascular necroses. Pathophysiologically it is assumed that a circulatory disorder leads to an ischaemic necrosis of bone, bone marrow, and adjunct cartilage. Sites of the human skeleton with predilection to AVN are the femoral head, humeral head, femoral condyle, proximal tibia, and ossicles of the foot and hand. Clinical signs are unspecific, but in the region of the load-bearing lower extremities pain occurs usually early. Plain radiographs, MRI, and sometimes also skeletal scintigraphy are used for diagnosis and staging. Usually 4-5 stages are distinguished; there are extra classification systems for individual entities. Spontaneous healing in terms of a return to normal without further damage can be found in small, circumscribed areas, but the bigger and the nearer the joint the more unlikely this is. Depending on region, stage of disease, age of the patient, concomitant diseases and cause, several conservative and surgical therapies may be applied. Conservative treatments include exoneration and relief of the extremity, physiotherapy, and if necessary medical treatment. The need for surgical intervention becomes more likely as AVN increases in size and gets closer to the joint. Surgical therapies include core decompression, revascularizing techniques, vascular bone transplant, corrective/transposition osteotomy, arthrodesis/joint reinforcement, or joint replacement.

scholarly journals ARTICULAR CARTILAGE THICKNESS OF THE PEDIATRIC KNEE: IMPLICATIONS FOR CARTILAGE IMPLANTATIONS

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0018
Author(s):  
Audrey Rustad ◽  
Nicolas G. Anchustegui ◽  
Stockton Troyer ◽  
Cooper Shea ◽  
Aleksei Dingel ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Ct Images ◽  
Cartilage Thickness ◽  
Coronal Plane ◽  
Average Thickness ◽  
Text Figure ◽  
Pediatric Knee ◽  
Femoral Condyles

Background: While access to pediatric tissue for cartilage conditions is limited, recent research on the use of pediatric cartilage tissue for implantation has shown promising results. These pediatric grafts may include bulk osteochondral allografts, morselized cartilage, or cellular manipulation products. The purpose of this study was to evaluate the parameters of cartilage thickness in different regions of the pediatric knee from a larger pediatric knee specimen research database. Methods: CT Scans of 12 skeletally immature knees ranging from ages 7 to 11 were evaluated. Cartilage thickness measurements were taking in the following regions: 1. Femoral Condyles - Cahill Zones 1, 2, 4, and 5 (Fig. 1) on coronal plane CT images, the region of greatest cartilage thickness on medial and lateral femoral condyles using coronal plane CT images, and Cahill Zones A, B, and C on sagittal plane CT images (Fig. 2). 2. Tibial Plateau – the region of greatest cartilage thickness identified on the medial and lateral sides of the tibial plateau using coronal plane CT images (Fig. 1). 3. Patella – the region of greatest cartilage thickness identified on axial and sagittal CT images (Fig. 3 and 4). Results: The cartilage on the medial femoral condyle had an average thickness of 4.86 mm ± 0.61 mm at its thickest point and the cartilage on lateral femoral condyle had an average thickness of 3.71 mm ± 0.52 mm at its thickest point. The cartilage on the medial tibial plateau had an average thickness of 2.80 mm ± 0.26 mm at its thickest point and the cartilage on the lateral tibial plateau had an average thickness of 3.29 mm ± 0.45 mm at its thickets point. The cartilage on the midpoints of Cahill zones 1, 2, 3, and 4 had an average thickness of 2.93 mm ± 0.62 mm, 3.42 mm ± 0.66 mm, 2.81 mm ± 0.46 mm, and 3.30 mm ± 0.73 mm respectively. The cartilage on the midpoints of Cahill zones A, B, and C had an average thickness of 3.81 mm ± 0.68 mm, 4.40 mm ± 0.49 mm, and 3.82 mm ± 0.68 mm respectively. The cartilage at its thickest point on the patella had an average thickness of 4.53 mm ± 0.38 mm from an axial view and 4.40 mm ± 0.49 mm from a sagittal view (Fig. 5 and 6). Conclusion: Pediatric knees demonstrate relatively thick cartilage regions in multiple zone of the knee, compared with adult specimens. Increasing access to and use of this tissue for cartilage grafts, non-manipulated tissue, and manipulated tissue offer significant opportunity to address cartilage loss. Osteochondral allograft procedures may benefit from access to such tissue, with relatively high volume and thickness of normal articular cartilage. [Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text]

Cytomegalovirus after Kidney Transplantation: A Case Review

2005 ◽  
Vol 15 (2) ◽  
pp. 157-160
Author(s):  
Carol A. Lawson
Keyword(s):  
Kidney Transplantation ◽  
Organ Transplant ◽  
Treatment Strategies ◽  
Disease Process ◽  
Lymphoproliferative Disease ◽  
Diagnostic Methods ◽  
Solid Organ ◽  
Case Review ◽  
Posttransplant Lymphoproliferative Disease ◽  
Living Related

Cytomegalovirus is the most common infectious complication in solid-organ transplant recipients. Despite the frequency of the problem, no commonly accepted approach to cytomegalovirus prophylaxis and treatment exists. Because cytomegalovirus may lead to the modulation of the immune system sometimes causing opportunistic superinfections, allograft injury, acute rejection, chronic rejection, and development of posttransplant lymphoproliferative disease, transplant coordinators require knowledge of the disease, diagnostic methods, and treatment and prophylaxis strategies. This case study reviews a high-risk cytomegalovirus transplant recipient after living-related kidney transplantation. In addition to a review of the pathophysiology of the disease process, patient, family, and nursing staff education, and cultural and psychosocial aspects of cytomegalovirus, prophylaxis, diagnosis, treatment strategies as well as role of the transplant coordinator, will be discussed.

scholarly journals Complement Inhibition as a Proposed Neuroprotective Strategy following Cardiac Arrest

2009 ◽  
Vol 2009 ◽  
pp. 1-7 ◽  
Author(s):  
Brad E. Zacharia ◽  
Zachary L. Hickman ◽  
Bartosz T. Grobelny ◽  
Peter A. DeRosa ◽  
Andrew F. Ducruet ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ischemia Reperfusion ◽  
Critical Role ◽  
Treatment Strategies ◽  
Disease Process ◽  
Global Cerebral Ischemia ◽  
Neurological Injury ◽  
Successful Resuscitation ◽  
Complement Inhibition ◽  
Neuroprotective Strategy

Out-of-hospital cardiac arrest (OHCA) is a devastating disease process with neurological injury accounting for a disproportionate amount of the morbidity and mortality following return of spontaneous circulation. A dearth of effective treatment strategies exists for global cerebral ischemia-reperfusion (GCI/R) injury following successful resuscitation from OHCA. Emerging preclinical as well as recent human clinical evidence suggests that activation of the complement cascade plays a critical role in the pathogenesis of GCI/R injury following OHCA. In addition, it is well established that complement inhibition improves outcome in both global and focal models of brain ischemia. Due to the profound impact of GCI/R injury following OHCA, and the relative lack of effective neuroprotective strategies for this pathologic process, complement inhibition provides an exciting opportunity to augment existing treatments to improve patient outcomes. To this end, this paper will explore the pathophysiology of complement-mediated GCI/R injury following OHCA.

Establishing novel mutation subtypes in peritoneal carcinomatosis of appendiceal origin.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 200-200
Author(s):  
Mary Garland-Kledzik ◽  
Anthony Joseph Scholer ◽  
Adam Khader ◽  
Juan Santamaria-Barria ◽  
Javier Orozco ◽  
...  
Keyword(s):  
Novel Mutation ◽  
Treatment Strategies ◽  
Disease Process ◽  
Optimal Number ◽  
Test Results ◽  
Appendiceal Cancer ◽  
Factorization Algorithm ◽  
Prospective Comparison ◽  
Non Negative Matrix Factorization

200 Background: Appendiceal cancer (AC) is a rare disease process with complex treatment strategies. The objective of this study was to identify mutation-based genetic subtypes that may differ from the current histological classification, compare genetic make-up of primaries and metastases, and to find novel targetable alterations. Methods: The analysis involved the curation and normalization of mutation panels from adenocarcinoma and mucinous adenocarcinoma (n = 196) stored in the AACR GENIE Database v6.0. Genes mutated in less than two patients and tumors profiled with incomplete mutation panels were excluded from the study. The optimal number of AC subtypes was established using the Non-negative Matrix Factorization algorithm. Statistical comparisons of mutation frequencies were performed by using the Pearson’s χ2 test. Results: AC patients were stratified into five mutation subtypes. AC0 had no mutations in the 41 genes in the study. The most frequently mutated genes varied between the subtypes. AC1: KRAS (91.9%) and GNAS (77.4%); AC2: KRAS (52.5%), APC (32.5%), and GNAS (30%); AC3: KMT2D (38.7%), TP53 (38.7%), KRAS (35.5%), EP300 (22.6%); and AC4: TP53 (97.2%), KRAS (77.8%), and SMAD4 (36.1%). Additionally, AC3 was less likely to be mucinous (22.6% v 50.0-74.2%, p < 0.001) and had a higher mutation frequency (3.6 v 0-3.1, p < 0.001). There were no differences between primaries and metastases (p = 0.35). Conclusions: Characterization of these subtypes suggest a need for molecular rather than anatomic staging for AC. Histone regulation by KMT2D and EP300 may be considered for targeted therapy for patients with AC3. A prospective comparison of subtype prognosis and response to surgery and adjuvant treatment is needed.

Load-Bearing at the Meniscofemoral Joint: An in vitro Study in the Canine Knee

2011 ◽  
Vol 1 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Pier Francesco Indelli ◽  
John A Szivek ◽  
Andrew Schnepp ◽  
William A Grana
Keyword(s):  
Contact Stress ◽  
Contact Area ◽  
Knee Flexion ◽  
Femoral Condyle ◽  
Testing Machine ◽  
Partial Meniscectomy ◽  
Clinical Value ◽  
Contact Areas ◽  
Local Contact ◽  
Femoral Condyles

ABSTRACT Background The role of the menisci on tibial load transmission and stress distribution has been extensively studied, but few studies have focused on the meniscofemoral joint during physiologic weightbearing. The objective of this study was to determine the contact areas and local contact stresses at the meniscofemoral interface during physiologic range of motion and axial-loading in the canine knee and to determine the influence of a partial or total meniscectomy. Methods Both fresh-frozen knees of 3 hound-type canines were tested in a universal testing machine configured for an axial-load of 90-120 N. Measurement of the contact area and the local contact stress were done at three different knee angles (30; 50; 70) and with both menisci intact, after partial meniscectomy, and after total meniscectomy. Pressure distribution was estimated by using pressure sensitive film inserted above the menisci. Results After partial meniscectomy, contact areas at 50° of knee flexion decreased approximately 25% on both femoral condyles, and local contact stress increased 30% on the medial femoral condyle but remained unchanged on the lateral. After total meniscectomy, contact areas at 50° of knee flexion decreased approximately 75% on both femoral condyles, and local contact stress increased approximately 60% on the medial compartment and 100% on the lateral compartment. Conclusions These data suggest that a conservative partial meniscectomy leaves the meniscus with an inferior weight distribution function; decreasing, but not canceling the protection on the femoral hyaline cartilage. A dramatic decrease of contact area followed by an increase of local contact stress was noted after a total meniscectomy. The clinical value of this study is to emphasize the biomechanical value of surgical procedures addressing the repair of damaged menisci.

scholarly journals Intra-Articular Injection of Alginate-Microencapsulated Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Osteoarthritis in Rabbits

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Seongjae Choi ◽  
Jun-Hyung Kim ◽  
Jeongho Ha ◽  
Bo-Ing Jeong ◽  
Yun Chan Jung ◽  
...  
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Adipose Tissue ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Cartilage Damage ◽  
Rabbit Model ◽  
Cartilage Degradation ◽  
Research Society ◽  
Femoral Condyles

We investigated the effects of intra-articular injections of alginate-microencapsulated adipose tissue-derived mesenchymal stem cells (ASCs) during osteoarthritis (OA) development in a rabbit model of anterior cruciate ligament transection (ACLT). We induced OA in mature New Zealand white rabbits by bilateral ACLT. Stifle joints were categorised into four groups according to intra-articular injection materials. Alginate microbeads and microencapsulated ASCs were prepared using the vibrational nozzle technology. Two weeks after ACLT, the rabbits received three consecutive weekly intra-articular injections of 0.9% NaCl, alginate microbeads, ASCs, or microencapsulated ASCs, into each joint. Nine weeks after ACLT, we euthanised the rabbits and collected bilateral femoral condyles for macroscopic, histological, and immunohistochemical analyses. Macroscopic evaluation using the modified OA Research Society International (OARSI) score and total cartilage damage score showed that cartilage degradation on the femoral condyle was relatively low in the microencapsulated-ASC group. Histological analysis of the lateral femoral condyles indicated that microencapsulated ASCs had significant chondroprotective effects. Immunohistochemically, the expression of MMP-13 after the articular cartilage damage was relatively low in the microencapsulated-ASC-treated stifle joints. During the development of experimental OA, as compared to ASCs alone, intra-articular injection of microencapsulated ASCs significantly decreased the progression and extent of OA.

Osteochondral Allograft Donor-Host Matching by the Femoral Condyle Radius of Curvature

2016 ◽  
Vol 45 (2) ◽  
pp. 403-409 ◽  
Author(s):  
Derek T. Bernstein ◽  
Craig A. O’Neill ◽  
Ryan S. Kim ◽  
Hugh L. Jones ◽  
Philip C. Noble ◽  
...  
Keyword(s):  
Conventional Method ◽  
Articular Surface ◽  
Femoral Condyle ◽  
Osteochondral Allograft ◽  
Radius Of Curvature ◽  
Surface Geometry ◽  
Match Rate ◽  
Matching Criteria ◽  
Matching Techniques ◽  
Femoral Condyles

Background: Conventional osteochondral allograft (OCA) matching, requiring orthotopic, size-matched condyles, and narrow surgical time windows often prohibit timely transplantation. Hypothesis: The femoral condyle radius of curvature (RoC) is an appropriate, isolated criterion for donor-host matching in fresh OCAs, potentially enhancing matching efficiency when compared with conventional matching techniques. Study Design: Descriptive laboratory study. Methods: In part 1 of this study, 3-dimensional digital reconstructions of 14 randomly selected, cadaveric distal femoral hemicondyles were performed. Each condyle was divided into anterior, middle, and posterior zones. A virtual best-fit grid was applied to each, and each zone’s sagittal- and coronal-plane RoCs were determined. Seven nonorthotopic OCA transplantations were performed based on RoC matching with 1-mm tolerance, and the preoperative and postoperative surface geometry were quantified to assess the accuracy of articular surface restoration. Of note, each donor-host pair did not match by the conventional method. In part 2 of this study, 12 cadaveric distal femora were categorized by size and digitized in the aforementioned manner. Simulated circular defects measuring 20, 25, and 30 mm in diameter were introduced into each zone. OCA matches were determined based on donor and host RoCs, and the total number of potential matches (of 71 total comparisons) was recorded as a percentage for each simulated defect. Finally, the results of RoC matching were compared with the conventional method for simulated defects in all zones of both the medial and lateral femoral condyles. Results: Part 1: The mean surface deviation after OCA transplantation was −0.09 mm, with a mean maximum protrusion at any point of 0.59 mm. Part 2: Using the RoC, 20-mm defects had a 100% chance of being matched. Defects of 25 and 30 mm had a 91% and 64% chance of being matched, respectively. Compared with the conventional method, the RoC method yielded a 3.2-fold greater match rate for lesions of the medial and lateral femoral condyles ( P = .02). Conclusion: This investigation shows that femoral condyle RoCs in the sagittal and coronal planes may be useful, alternative matching criteria, expanding on current standards. Clinical Relevance: These matching criteria may increase the number of available matches, reduce wait times for patients, and reduce the number of wasted grafts.

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