Tendon tissue sampling

Mechanical load is regarded as the most important etiologic factor in cumulative trauma disorders affecting human tendons. At present there is limited knowledge concerning adaptation and the influence of training on human tendon tissue and the time process of developing a chronic tendon disorder. Tendon tissue samples and data concerning tendon pathology and repair have been derived from biopsies removed during surgery for rupture or pain conditions and from autopsy material. The ultrasound-guided percutaneous core biopsy technique provides the possibility to obtain tendon tissue from human Achilles and patellar tendon with limited discomfort for the individual. The specimens can be used for diagnostic purposes or for research and have the potential to highlight novel knowledge in, for example, the early stages of painful human tendon disorders. The fact that the procedure is invasive is a limitation. Autopsy material has limitations regarding poor information on case history, post mortem alterations and legal regulations on the use of tissue for medical purposes. The inflammatory process quickly affects ruptured tendons. The subcutaneous tendons that sustain a rupture are commonly characterized by degenerative alterations. Many tendon ruptures are treated with surgery, facilitating easy access to biopsy material. In summary, tendon tissue sampling in humans has obvious limitations. The recently described use of the core biopsy technique in human tendon research and diagnosis gives potential for new knowledge concerning human tendon adaptation, repair and disease.     

Observer reliability in the arthroscopic classification of osteoarthritis of the knee

We studied 19 videotaped knee arthroscopies in 19 patients with mild to moderate osteoarthritis (OA) of the knee in order to compare the intraobserver and interobserver reliability and the patterns of disagreement between four orthopaedic surgeons. The classifications of OA of Collins, Outerbridge and the French Society of Arthroscopy were used. Intraobserver and interobserver agreements using kappa measures were 0.42 to 0.66 and 0.43 to 0.49, respectively. Only 6% to 8% of paired intraobserver classifications differed by more than one category. Observer-specific disagreement was evident both within and between observers. A small, but significant, occasional variation was also seen. Although reliability may improve by an analysis of disagreement, it appears that the arthroscopic grading of early osteoarthritic lesions is inexact.     

Calf muscle function after Achilles tendon rupture. A prospective, randomised study comparing surgical and non-surgical treatment

In a prospective, randomised, multicentre study, 112 patients with Achilles tendon rupture (ATR) were allocated to surgical treatment (n=59), followed by early functional rehabilitation using a brace, and non-surgical treatment (n=53), i.e. eight weeks of plaster treatment. In this study, the results of the isokinetic muscle strength evaluation are presented for contractions in both the concentric and the eccentric mode, plantar flexion and dorsiflexion, two angular velocities and three different positions of the subject. The heel-raise test for endurance, maximum calf circumference and tendon width were also evaluated. The re-rupture rate was 20.8% in the non-surgically-treated group and 1.7% in the surgically-treated group. No significant differences were found between the treatment groups in terms of the isokinetic strength measurements and the endurance test among the patients who did not sustain a re-rupture. If a re-rupture is avoided, both surgical and non-surgical treatment for ATR produce good functional outcome; however, the muscle function was not restored after two years in either group.     

Achilles tendinopathy: some aspects of basic science and clinical management

Achilles tendinopathy is prevalent and potentially incapacitating in athletes involved in running sports. It is a degenerative, not an inflammatory, condition. Most patients respond to conservative measures if the condition is recognised early. Surgery usually involves removal of adhesions and degenerated areas and decompression of the tendon by tenotomy or measures that influence the local circulation.     

S-100 protein in carcinoid tumours of appendix

Summary Serotonin (5-HT)-like immunoreactive nerve fibers were investigated in gut tissue obtained from seven Japanese children with Hirschsprung's disease. In the control untreated tissues, 5-HT-like immunoreactive fibers were observed neither in the normoganglionic nor in the aganglionic regions. After pargyline treatment, 5-HT-positive neuropils were consistently detected in association with the myenteric plexus in the normoganglionic segment, while in the aganglionic segment immunoreactive fibers could not be demonstrated through the entire layer of the bowel tissue. The occurence of 5-HT-like immunoreactive neuropils by pargyline treatment strongly suggests that the infant bowel is innervated with serotoninergic elements. After treatment with 5-hydroxy-l-tryptophan (5-HTP), the immunoreactive neuropils were localized in the myenteric and submucous plexuses of the normoganglionic segment. On the other hand, another type of 5-HT-positive fibers was characteristically demonstrated in aganglionic segments following the drug treatment; moderate numbers of 5-HT-like immunoreactive fibers appeared in the intermuscular zone and within the circular and longitudinal muscle layers. Several 5-HT-positive fibers were present in the hypertrophic nerve bundles seen in a diseased bowel. A possible origin of this type of 5-HT-positive nerve fibers was discussed.     

Tendon injury and repair after core biopsies in chronic Achilles tendinosis evaluated by serial magnetic resonance imaging

Objective: To evaluate the morphological response and healing process after transverse ultrasound guided core biopsies in chronic Achilles tendinosis using serial magnetic resonance imaging (MRI) over a period of one year.

Methods: The study included 10 patients. Six had five transverse core biopsies and were longitudinally evaluated by MRI before the biopsies and then after one week, three months, seven months, and one year. These patients started a three month eccentric training programme one to two weeks after the biopsy. Four "non-biopsied" and untreated patients were used for comparison. The clinical outcome was categorised according to the level of pain and performance.

Results: The MRI one week after the biopsies showed an increase in tendon volume (T1-WI) and mean signal intensity (PD-WI) of 29% and 30% (p = 0.04). During follow up, tendon volume and mean signal intensity gradually decreased. One year after the biopsy, the tendon volume had decreased by 20% and the intratendinous signal by 28% compared with the index MRI (p = 0.04). The untreated patients showed an increase in both tendon volume (39%, p = 0.06) and intratendinous signal (37%, p = 0.14) at the one year follow up. After one year, pain and performance had improved in the treated patients but not the untreated patients.

Conclusion: Five transverse ultrasound guided core biopsies induced a lesion in the diseased Achilles tendon. Alterations during healing such as tendon size and intratendinous signal intensity could be evaluated by MRI. The tendon alterations had decreased one year after the core biopsies.

     

Pharmacokinetics of remoxipride controlled release and immediate release capsules in schizophrenic patients

Single dose and steady-state pharmacokinetics of remoxipride, a new antipsychotic drug, were compared after administration of a controlled release capsule (CR) and an immediate release capsule (IR), both 200 mg and administered b.i.d. Thirteen patients with chronic schizophrenia entered the double-blind 6-week crossover study. Seven were evaluable for investigation of steady-state pharmacokinetics. Fluctuations in plasma remoxipride concentrations decreased considerably after remoxipride CR compared with the IR formulation. The plasma peak concentrations were significantly decreased and the trough values were increased after the CR formulation, although the average concentrations at steady-state were similar. The two formulations were bioequivalent regarding the amount of remoxipride absorbed after repeated dosing. Five out of 13 patients withdrew prematurely from the study because of ineffectiveness or refusal of treatment. Both formulations were well tolerated.