A cohort study linked increased mortality in patients treated surgically for Dupuytren's contracture

OBJECTIVE: Dupuytren's contracture (DC) is a fibromatous disease of the palmar fascia of unknown etiology. The objective of this study was to assess whether individuals treated for DC exhibited an altered standardized mortality ratio. STUDY DESIGN AND SETTING: A total of 16,517 patients operated on for DC between 1965 and 1995 were identified by the Swedish Inpatient Register. For the 7,579 patients who had died during that period, cause of death was obtained from the Swedish Death Register. RESULTS: There was an overall increased mortality (standardized mortality ratio [SMR]=1.06), inversely related to age and significant for both sexes, in patients under 70 years of age. The risk estimate was highest for endocrine diseases (highest value in patients 40-49 years of age at surgery; SMR=2.82), gastrointestinal diseases (highest value in those 40-49 years of age at surgery; SMR=2.69), accidents (highest value in those 30-39 years of age at surgery; SMR=2.40), and respiratory diseases (highest value in those 50-59 years of age at surgery; SMR=1.61). There was also an increased SMR for cardiovascular diseases in patients 40-59 years of age more than 10 years after surgery (highest value in those 40-49 years of age at surgery; SMR=1.65). CONCLUSION: The most probable mechanism for the increased mortality is related to smoking and other lifestyle factors.     

Menière's disease — Roentgenologic diagnosis

Summary Radiologic diagnosis in Menière's disease should not be based on the vestibular aqueducts tomographic reproducibility. Instead, valuable preoperative information should be given about the size and location of the aqueducts external aperture in relation to the posterior and lateral semicircular canals. In saccotomy the semicircular canals are landmarks for identification of the endolymphatic sac. The periaqueductal pneumatization is demonstrated to be partly decisive for the vestibular aqueducts gross morphology.In Menière's disease either a sparse or a total lack of periaqueductal pneumatization is observed in most of all cases. The development of peri- and infralabyrinthine pneumatization is also decisive for the position of the foveate impression, which houses the extraosseous part of the endolymphatic sac. Its location and size can be evaluated by tomographic characterization of the vestibular aqueducts external aperture.     

Reconstruction of critical-size mandibular defects in immunoincompetent rats with human adipose-derived stromal cells

In patients with bony defects, autologous bone grafts are the “gold standard” for reconstruction. In children, autologous bone harvesting is limited but tissue engineering offers an alternative. Next to bone marrow, adipose tissue is a source of mesenchymal stromal cells, and adipose-derived stromal cells (ADSC) can differentiate into osteocytes.The aim of this study was to evaluate the efficacy of bioactive implants (ADSC in fibrin glue) for repair of critical-size mandibular defects in athymic rats.Human adult ADSC embedded in fibrin glue were implanted into a critical-size defect in the rat mandible and their efficacy was compared to those of protected bone healing (pbh), autologous bone graft, and an empty defect. The newly formed bone was quantified using high-resolution flat-panel volumetric CT (fpvCT) during different observation times. After eight weeks, the specimens were assessed histologically and by micro-computed tomography (μ-CT).The radiographic examination demonstrated a significantly higher level of ossified defect area in the ADSC side compared with the pbh side. The autologous bone graft side showed significantly enhanced bone formation compared to the empty defect. The histological findings in the specimens with ADSC showed bony bridging of the defect. ADSC were capable of defect reconstruction under our experimental conditions.     

Investigation of temporal bone anatomy by plastic moulding and cryomicrotomy

To increase our understanding of the complex topographic relations between temporal bone structures and to facilitate the interpretation of their radiographic images, two techniques were developed. Plastic moulding of temporal bone specimens using polyester resin and silicone rubber substances providing detailed information and a three-dimensional survey of the structures. Carefully macerated temporal bone specimens are filled with plastic material under vacuum and the bone is then dissolved. The preparations, freed from irrelevant structures and embellished, allow metric evaluation of the different structures and their topographic relations. Automatic serial cryomicrotomy of fresh, deep-frozen temporal bones, using a commercial sledge-cryomicrotome. Photography of the cut surfaces of the specimen, usually at distance of 0.25 to 0.50 mm, allows natural-colour reproduction of minute detail, e.g. the melanin cell area in the cochlea, the smallest vessels on the ossicular surfaces, and the origin of the cochlear aqueduct at the basal turn of the cochlea. By correlating the photographs with images from the corresponding tomographic planes accurate information is obtained for interpretation of the radiographic images. A combination of the two techniques facilitates a detailed study and is a valuable aid in the teaching of temporal bone anatomy.     

Effects of a high jugular fossa and jugular bulb diverticulum on the inner ear. A clinical and radiologic investigation

From a series of patients undergoing routine radiographic examination, 112 temporal bones with a high jugular fossa were selected. Among these, 43 jugular bulb diverticula were found. The structures affected by a high fossa or diverticulum were recorded and correlated to the clinical symptoms of the patient. The vestibule was suspected to be affected in five patients. Two of these patients had tinnitus and vertigo, and three had hearing loss. In one of the latter the hearing loss was most marked in the supine position. The cochlea was close to the fossa in three patients, all of whom had tinnitus. Four patients had a defect of the posterior semicircular canal. One of them lost his hearing after a severe fit of coughing, became unsteady and showed signs of a fistula. The internal acoustic meatus and the mastoid portion of the facial canal were affected in two and four patients, respectively, who had no recorded symptoms. Twelve of 34 patients with Menière's disease and a high jugular fossa on the side of the diseased ear had a dehiscence of the vestibular aqueduct caused by the fossa or diverticulum, compared with nine of 58 patients in the unselected material. For comparison and demonstration of topographic relationships, 58 casts of unselected radiographed temporal bone specimens with high jugular fossae or diverticula were investigated. In patients with a high jugular fossa or jugular bulb diverticulum, tomographic assessment may be of value.     

Activation markers of connective tissue in Dupuytren's contracture: relation to postoperative outcome.

We investigated 103 consecutive patients operated on for Dupuytren's contracture (DC) to find out the relation between the expression of activation markers of connective tissue in surgical specimens obtained prospectively and recurrence of disease. The history of the disease and present state of the operated hand were obtained a mean of 4 years (range 2.5-6) after the latest operation. Immunohistochemical staining for anticollagen type IV, integrin alpha5, laminin, smooth muscle beta-actin, procollagen type I, and desmin was evaluated. Almost half of the patients noticed recurrences during the study period, one fifth within six months of operation. No differences in the expression of any of the markers investigated were found, either earlier or later than six months postoperatively, in patients with or without recurrent bending. Furthermore, there were no associations between sex, age at onset, number of operations, heredity, diabetes mellitus, or drugs taken for cardiovascular disease, and the expression of any of the immunohistochemical markers. The individual characteristics that place a person at high risk are not obviously related to ongoing production of connective tissue at the time of operation or to connective tissue activity in its conventionally-used sense.     

Multiple brown tumours of the upper extremity in a patient with secondary hyperparathyroidism as a result of chronic renal failure

A man with chronic renal failure was referred to the hand clinic because of massive osteolytic tumours in his right arm. Secondary hyperparathyroidism and brown tumours were suggested, and he was treated by subtotal parathyroidectomy. Rapid reduction of the vast tumours was noted postoperatively.