Arthroscopic treatment of synovial osteochondromatosis of the elbow. Case report and literature review

AbstractSynovial osteochondromatosis is a benign proliferative disorder with metaplasia of the synovial membrane that affects the fibroblasts of the synovial joints, tendons and bursae. In literature, there are few descriptions of synovial osteochondromatosis of the elbow. The objective of this article was to report a case of synovial osteochondromatosis of the elbow in a patient aged 32, basketball athlete, in which surgical treatment was chosen because of the pain and functional limitation and stage of disease with multiple loose bodies. Patient 32, male, presented with pain and limitation of motion of the elbow. The range of passive motion was 100° of flexion and 30° extension. The range of active motion was 40–90°. Magnetic resonance observed many loose bodies mainly in the posterior compartment in the olecranon fossa plus some chondral lesions in the capitellum. The arthroscopic treatment was chosen with two anteriors portals (medial and lateral) and two posterior portals (standard posterior and posterolateral) for easing loose bodies and osteoplasty of the olecranon fossa. The visual analog scale pain was 9–3 and its arc of active motion was 110° to −20° of flexion and extension. On a scale of performance from Mayo Clinic patients was 65 points preoperatively to 90 postoperatively with 9 months follow-up and the patient was satisfied with the treatment outcome. Arthroscopic treatment of synovial osteochondromatosis of the elbow is an effective and safe therapeutic management with low morbidity and early return to activities

Arthroscopic treatment for chronic lateral epicondylitis

AbstractObjectiveTo report the clinical and functional results from arthroscopic release of the short radial extensor of the carpus (SREC) in patients with chronic lateral epicondylitis that was refractory to conservative treatment.MethodsOver the period from January 2012 to November 2013, 15 patients underwent arthroscopic treatment. The surgical technique used was the one described by Romeo and Cohen, based on anatomical studies on cadavers. The inclusion criteria were that the patients needed to present lateral epicondylitis and that conservative treatment (analgesics, anti-inflammatory agents, corticoid infiltration or physiotherapy) had failed over a period of more than six months. The patients were evaluated based on the elbow functional score of the Mayo Clinic, Nirschl's staging system and a visual analog scale (VAS) for pain.ResultsA total of 15 patients (9 men and 6 women) were included. The mean Mayo elbow functional score after the operation was 95 (ranging from 90 to 100). The pain VAS improved from a mean of 9.2 before the operation to 0.64 after the operation. On Nirschl's scale, the patients presented an improvement from a mean of 6.5 before the operation to approximately one. There were significant differences from before to after the surgery for the three functional scores used (p<0.01). No correlations were observed using the Spearman test between the results and age, gender, length of time with symptoms before the operation or injury mechanism (p>0.05).ConclusionArthroscopic treatment for lateral epicondylitis was shown to be a safe and effective therapeutic option when appropriately indicated and performed, in refractory cases of chronic lateral epicondylitis. It also allowed excellent viewing of the joint space for diagnosing and treating associated pathological conditions, with a minimally invasive procedure

HIV-1 Efficient Entry in Inner Foreskin Is Mediated by Elevated CCL5/RANTES that Recruits T Cells and Fuels Conjugate Formation with Langerhans Cells

Male circumcision reduces acquisition of HIV-1 by 60%. Hence, the foreskin is an HIV-1 entry portal during sexual transmission. We recently reported that efficient HIV-1 transmission occurs following 1 h of polarized exposure of the inner, but not outer, foreskin to HIV-1-infected cells, but not to cell-free virus. At this early time point, Langerhans cells (LCs) and T-cells within the inner foreskin epidermis are the first cells targeted by the virus. To gain in-depth insight into the molecular mechanisms governing inner foreskin HIV-1 entry, foreskin explants were inoculated with HIV-1-infeceted cells for 4 h. The chemokine/cytokine milieu secreted by the foreskin tissue, and resulting modifications in density and spatial distribution of T-cells and LCs, were then investigated. Our studies show that in the inner foreskin, inoculation with HIV-1-infected cells induces increased CCL5/RANTES (1.63-fold) and decreased CCL20/MIP-3-alpha (0.62-fold) secretion. Elevated CCL5/RANTES mediates recruitment of T-cells from the dermis into the epidermis, which is blocked by a neutralizing CCL5/RANTES Ab. In parallel, HIV-1-infected cells mediate a bi-phasic modification in the spatial distribution of epidermal LCs: attraction to the apical surface at 1 h, followed by migration back towards the basement membrane later on at 4 h, in correlation with reduced CCL20/MIP-3-alpha at this time point. T-cell recruitment fuels the continuous formation of LC-T-cell conjugates, permitting the transfer of HIV-1 captured by LCs. Together, these results reveal that HIV-1 induces a dynamic process of immune cells relocation in the inner foreskin that is associated with specific chemokines secretion, which favors efficient HIV-1 entry at this site

ADAM2 Interactions with Mouse Eggs and Cell Lines Expressing α4/α9 (ITGA4/ITGA9) Integrins: Implications for Integrin-Based Adhesion and Fertilization

Integrins are heterodimeric cell adhesion molecules, with 18 α (ITGA) and eight β (ITGB) subunits forming 24 heterodimers classified into five families. Certain integrins, especially the α(4)/α(9) (ITGA4/ITGA9) family, interact with members of the ADAM (a disintegrin and metalloprotease) family. ADAM2 is among the better characterized and also of interest because of its role in sperm function. Having shown that ITGA9 on mouse eggs participates in mouse sperm-egg interactions, we sought to characterize ITGA4/ITGA9-ADAM2 interactions.An anti-β(1)/ITGB1 function-blocking antibody that reduces sperm-egg binding significantly inhibited ADAM2 binding to mouse eggs. Analysis of integrin subunit expression indicates that mouse eggs could express at least ten different integrins, five in the RGD-binding family, two in the laminin-binding family, two in the collagen-binding family, and ITGA9-ITGB1. Adhesion assays to characterize ADAM2 interactions with ITGA4/ITGA9 family members produced the surprising result that RPMI 8866 cell adhesion to ADAM2 was inhibited by an anti-ITGA9 antibody, noteworthy because ITGA9 has only been reported to dimerize with ITGB1, and RPMI 8866 cells lack detectable ITGB1. Antibody and siRNA studies demonstrate that ITGB7 is the β subunit contributing to RPMI 8866 adhesion to ADAM2.These data indicate that a novel integrin α-β combination, ITGA9-ITGB7 (α(9)β(7)), in RPMI 8866 cells functions as a binding partner for ADAM2. ITGA9 had previously only been reported to dimerize with ITGB1. Although ITGA9-ITGB7 is unlikely to be a widely expressed integrin and appears to be the result of "compensatory dimerization" occurring in the context of little/no ITGB1 expression, the data indicate that ITGA9-ITGB7 functions as an ADAM binding partner in certain cellular contexts, with implications for mammalian fertilization and integrin function

Efeito de iscas formicidas granuladas sobre a biodiversidade de mirmecofauna não alvo em serapilheira de eucalipto

The effect of systematic use of granulated bait for leaf-cutting ants control was assessed on a community of non-target ants in eucalyptus in the municipality of Vera, Mato Grosso State, Brazil. The ants were collected using the Winkler extractors, in 50 samples of 1 m2 of litter in each stage: eight days before the distribution of baits, eight days after the distribution of baits and subsequently each month, totaling 13 collections. Each sample were taken at distances of 50 meters from each other. Copies of ants were assembled via dry, labeled and identified in genus and species level. The analysis of the residual effect was conducted by comparing the number of individuals and species over the months. A total of 273 ants were distributed into nine genera, four subfamilies  and 13 species. It was found that diversity index at the end of the study period did not return to initial levels observed before treatment with the ant, suggesting that the active ingredient in bait alters the patterns of diversity pre-existing, causing adverse impact on non-target myrmecofauna. This is the first work in this region and serves as support for future studies on ant diversity in leaf litter of Eucalyptus.Avaliou-se o efeito do uso sistemático de iscas granuladas destinadas ao controle de formigas cortadeiras sobre a comunidade de formigas não-alvo da serapilheira em eucaliptais do município de Vera, Mato Grosso.  As formigas foram coletadas, usando o método de extrator de Winkler, em 50 amostras de 1m² de serapilheira, em cada uma das fases: oito dias antes da distribuição das iscas, oito dias depois da distribuição das iscas e posteriormente a cada mês, totalizando 13 coletas. Cada amostra teve distância mínima de 50 m uma da outra. Os exemplares de formicídeos foram montados via seco, etiquetados e identificados em nível de gênero e de espécie. A análise do efeito residual foi realizada pelo comparativo do número de indivíduos e espécies ao longo dos meses. Um total de 273 formigas foi distribuído entre nove gêneros, quatro subfamílias e treze espécies. Constatou-se que o índice de diversidade ao final do período de estudo não voltou aos níveis iniciais encontrados antes do tratamento com o formicida, sugerindo que o princípio ativo da isca formicida altera os padrões de diversidade pré-existentes, causando impacto negativo na mirmecofauna não alvo.   Este é o primeiro trabalho realizado na região e serve como subsídio para trabalhos futuros sobre diversidade de formigas em serapilheira de eucaliptos. Effect of formicid granulated baits on non-target antsbiodiversity in eucalyptus plantations litterAbstractThe effect of systematic use of granulated bait for leaf-cutting ants control was assessed on acommunity of non-target ants in eucalyptus in the municipality of Vera, Mato Grosso State, Brazil.The ants were collected using the Winkler extractors, in 50 samples of 1 m2 of litter in each stage:eight days before the distribution of baits, eight days after the distribution of baits and subsequentlyeach month, totaling 13 collections. Each sample were taken at distances of 50 meters from eachother. Copies of ants were assembled via dry, labeled and identified in genus and species level.The analysis of the residual effect was conducted by comparing the number of individuals andspecies over the months. A total of 273 ants were distributed into nine genera, four subfamilies and13 species. It was found that diversity index at the end of the study period did not return to initiallevels observed before treatment with the ant, suggesting that the active ingredient in bait altersthe patterns of diversity pre-existing, causing adverse impact on non-target myrmecofauna. Thisis the first work in this region and serves as support for future studies on ant diversity in leaf litter ofEucalyptus

Tratamento artroscópico da osteocondromatose sinovial do cotovelo. Relato de caso e revisão da literatura

resumo A osteocondromatose sinovial é uma patologia proliferativa com metaplasia benigna da membrana sinovial que afeta os fibroblastos das articulações sinoviais, dos tendões e das bursas. Na literatura, existem poucas descrições de osteocondromatose sinovial do cotovelo. O objetivo deste artigo foi relatar um caso de osteocondromatose sinovial de cotovelo em um paciente de 32 anos, sexo masculino, atleta de basquete, no qual se optou pelo tratamento cirúrgico devido ao quadro clínico com dor e limitação funcional e ao estágio da doença com múltiplos corpos livres. Paciente apresentou dor e limitação do arco de movimento do cotovelo. O arco de movimento passivo era de 100° de flexão e -30° de extensão. Na resso nância magnética observaram-se diversos corpos livres, principalmente no compartimento posterior na fossa do olecrano, além de algumas lesões condrais no capítulo. Optou-se pelo tratamento artroscópico com a feitura de dois portais anteriores (medial e lateral) e dois pos teriores (posterior padrão e posterolateral) para remoção dos corpos livres e osteoplastia da fossa olecraniana. A escala visual analógica da dor foi de 9 para 3 e seu arco de movimento ativo foi para 110° de flexão e -20° de extensão. Na escala de desempenho da Clínica Mayo o paciente foi de 65 pontos no pré-operatório para 90 no pós-operatório com nove meses de seguimento e satisfeito com o resultado. O tratamento artroscópico da osteocondromatose sinovial do cotovelo mostra-se com uma opcão terapêutica eficaz e segura no manejo terapêutico dessa patologia, apresenta baixa morbidade e retorno precoce às atividades

Direct repair of chronic distal biceps tendon tears

ABSTRACT OBJECTIVE: To present the results from direct tendon repair using EndoButton and interference screws in patients with lesions of the distal biceps that had evolved over a period of more than 28 days. METHODS: Between January 2012 and November 2013, eleven patients (all male) with a torn distal biceps and a time interval between injury and surgery of more than 28 days were evaluated. The patients' mean age was 46 years and the most common mechanism of injury was eccentric loading with the elbow flexed and supinated. RESULTS: A subjective analysis on pain and function was conducted using a visual analog scale of pain (VAS) and the Mayo Elbow Performance Score (MEPS), before and after surgery. The VAS showed a decrease of 5 points to 0.8 points on average. The MEPS improved from 69.3 points before the operation to 97.5 points afterwards. The mean flexion was 133.1° on the operated side, versus 134.3°. The mean extension was -2.5° and 0° (operated side versus non-operated). Supination was 88.2° versus 89.5° and pronation was 82.5° versus 84.1°, comparing the operated side versus the non-operated side. Flexion and supination strengths were evaluated with the aid of a dynamometer, and the mean flexion and supination strengths were found to be respectively 78.57% and 89.65% of the strength of the non-operated limb. CONCLUSION: Use of the technique of direct tendon repair using EndoButton and interference screws was shown to be a safe and effective alternative for repairing chronic lesions of the distal biceps

Sternoclavicular dislocation: case report and surgical technique

Abstract Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the "figure of eight" technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified "figure of eight" and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our study presented a case of chronic anterior dislocation of the sternoclavicular joint that was successfully treated by using a modification of the "figure of eight" reconstruction technique. This technique was shown to be safe and effective, and it allowed the patient to fully return to his sports activities