Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
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The rat C5/6 facet joint is innervated multisegmentally from the C3 to the T3 dorsal root ganglia. Sensory fibers from the C3, C4, and C7-T3 dorsal root ganglia were reported to be innervated nonsegmentally through the paravertebral sympathetic trunks, while those from the C5 and C6 dorsal root ganglia were reported to segmentally innervate the C5/6 facet joint. The presence of calcitonin gene-related peptide-immunoreactive nerve fibers has been proved in the facet joints, but their ratios have not been studied. ⋯ Of the fluoro-gold-labeled neurons, the ratios of calcitonin gene-related peptide-immunoreactive C3, C4, C45 C6, C7, C8, T1, T2, and T3 dorsal root ganglion neurons were 30%, 22%, 43%, 47%, 21%, 19%, 25%, 36%, and 40%, respectively. The ratios of calcitonin gene-related peptide-immunoreactive neurons in the C5 and C6 dorsal root ganglia were significantly higher than those in the C3, C4, C7, and C8 dorsal root ganglia. In the physiological condition in rats, the neurons of the C5 and C6 dorsal root ganglia may have a more significant role in pain sensation of the facets than other dorsal root ganglion neurons.
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This study was designed to determine the prognostic factors in unilateral lumbar radiculopathy due to herniated nucleus pulposus (HNP); this was done by prospectively investigating the clinical course of consecutive patients with HNP. The study population consisted of 131 patients who complained primarily of unilateral leg pain, and who were examined by magnetic resonance imaging (MRI) to establish a definite diagnosis. Patients with a questionable diagnosis were excluded. ⋯ The type of HNP and the result of the initial assessment were correlated with outcome at the times of both follow-ups, but the significance of these correlations had decreased at the second follow-up. In conclusion, initial assessment and type of HNP on MRI are major prognostic factors. However, the conventional manner of treatment selection is inadequate for the appropriate management of lumbar disc herniation.
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Although the overall results of treatment of Ewing's tumors have improved, patients with high-risk factors, including metastatic disease at diagnosis, bulky primary tumors, axial sites, and age >15 years, continue to have poor prognoses. The effects of high-dose chemotherapy and autologous peripheral blood stem-cell transplantation on high-risk Ewing's tumor patients have been reported. In most of these studies, conditioning and high-dose regimens varied among patients. ⋯ The high-dose regimen and transplantation were feasible and well tolerated. The poor prognoses of high-risk Ewing's tumor patients may be improved by high-dose chemotherapy with peripheral blood stem cell transplantation. However, the real impact of the therapy on the clinical outcome of patients with high-risk Ewing's tumors should be evaluated in a prospective, randomized study.
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Case Reports
Rapidly growing fibro-osseous pseudotumor of the digits mimicking extraskeletal osteosarcoma.
Fibro-osseous pseudotumor of the digits is a rare benign lesion characterized histopathologically by a fibroblastic proliferation with foci of osseous differentiation. We report a case of fibro-osseous pseudotumor of the digits with a rapidly growing lesion in a 30-year-old woman. Because of its rapid growth and aggressive histopathological appearance, this lesion can be mistaken for a malignant neoplasm such as extraskeletal or parosteal osteosarcoma, despite its benign clinical behavior. For a soft tissue mass in the digit with a clinicopathological feature of pseudomalignancy, the clinician should consider fibro-osseous pseudotumor of the digits as a possible diagnosis, thereby avoiding inappropriately aggressive surgery.
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We investigated the regenerative capacity of motor nerves repaired by end-to-side or end-to-end neurorrhaphy, using choline-acetyltransferase (ChAT) activity measurement or histological analysis. The right medial gastrocnemius nerves (MGNs) of 62 male Fisher strain rats were transected and divided into three groups. In group 1, the distal ends of the MGN were coapted to the side of the lateral gastrocnemius nerve, using a Y-shaped silicone tube in end-to-side neurorrhaphy. ⋯ Axonal regeneration of MGN and the recovery of MGM to nearly normal histology and weight were observed in groups 1 and 2 3 months postoperatively. Although there were no significant differences in ChAT values between groups 1 and 2, the values were significantly larger than that of group 3 3 months postoperatively. These findings suggested that end-to-side neurorrhaphy would be an alternative treatment for peripheral nerve injury in certain clinical situations.