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Every fibrous structure of ten wrists of fresh cadavers has been the object of an elastometric study. The opposite wrists have been studied surgically and then histologically with the optical microscope. Comparison between the two shows a close relationship between the mechanical features and the morphology of the bundles, which proved also to be perfectly measurable. It also displays the great differences between ligaments and tendons. Histological study of the tendons and ligaments of four other wrists subjected to manoeuvres of axial loading, rupture and bending, reinforces these statements. The therapeutic consequences are considered. [ABSTRACT FROM PUBLISHER]

Background: ReGeneraTing Agents (RGTAs) are biodegradable polymers engineered to mimic heparan-sulfate in the extracellular matrix of damaged tissue. RGTAs improve tissue healing in several animal models by stabilizing and protecting heparin-binding growth factors and matrix proteins. RGTA restores the normal matrix architecture and supports tissue regeneration. In this study, the authors evaluated the effects of RGTA on epidermal repair and dermal remodeling in a rat burn model., Methods: Deep second-degree burns were induced in 156 hairless rats, of which half (n = 78) received topical and intramuscular RGTA immediately after the burn followed by intramuscular RGTA weekly for 1 month. The controls (n = 78) received saline according to the same protocol. Rats were killed starting on each day of the first week and on days 14, 28, 60, 120, 240, and 365. The burns were evaluated by photography, histology, and immunohistochemistry., Results: Coagulation necrosis involved the entire epidermis and superficial adnexa. Compared with the controls, speed of epidermal repair, as assessed between days 3 and 7 based on cell-layer number and anticytokeratin-14 staining, was faster in the RGTA group; and the zone of stasis, as assessed based on secondary vascular lesions in the dermis, was smaller. On day 7, reepithelialization was complete in both groups. On days 14 and 28, the remodeled dermal zone was smaller in the RGTA group., Conclusion: RGTA accelerated epidermal repair and protected the dermis from secondary effects of heat as quantified by zone-of-stasis size and extent of dermal remodeling.

Purpose of the Study: We looked for the anatomic origin and mechanism of constitution of the so-called "ganglions" of the wrist., Material and Methods: Fifty-nine formations considered to be synovial ganglions were dissected and removed according to the same protocol by the same surgeon. Eleven were re-examined by a pathologist. All ganglions were extra-articular but had intra- and extra-capsular components. The extra-capsular part was the clinically palpable main cyst. The intra-capsular part was composed of the cystic stalk and its base of implantation. An intra-capsular stalk was present in 58 cases. The stalk was situated between the joint synovium and the capsula which it perforated at a weak point between two ligaments, forming a collar before expanding outwardly. Based on our findings, we propose a topographical systematization and natural history of ganglions of the wrist., Results: The stalk's implantation base was always located on bone and found in the intermediate area of Colomniati and Soubbotine, which lies outside the articular cartilage between the synovium and the ligamentous capsula. This area is exposed to mechanical stress initiating histological degenerative lesions, particularly mucoid degeneration. At the radiocarpal joint, the stalk's base of implantation was located at the distal end of the lateral dorsal or volar edge of the lunate bone or at the corresponding part of the scaphoid. The collar of the proximal ganglions was situated between the dorsal radiocarpal and transverse scaphotriquetral ligament. The collar of distal dorsal ganglions was situated between the transverse scaphotriquetral and the trapezotriquetral ligament. The collar of the lateral ganglions was situated between the lateral collateral and the transverse ligament. The collar of the volar ganglions was situated between the stylocarpal ligament and the radiolunotriquetral ligament, or between the different stylocarpal ligaments. At the level of the scaphotrapezal joint, the stalk's base of implantation was located near the collateral edge of the distal surface of the joint with the collar between the distal scaphoidal ligaments. The palmar cysts exhibited a collar between the stylocarpal ligaments and the radiolunotriquetral ligament or between the different stylocarpal ligaments., Discussion: At pathology examination, the lesions were not found to be different from those observed in other connective tissues exposed to overuse or repeated microtrauma (sports, occupational exposure). Anatomic conditions inside the joint capsula excluded extension of the mucoid degeneration transversally. The only issue was through the capsula, allowing the mucus enclosed in the connective tissue fibers to form the main cyst., Conclusion: Knowledge of these different processes enabled a topographical systematization useful for complete surgical or arthroscopic removal of the ganglion. Complete resection would prevent recurrence.

Background: Lipodystrophy is a major side-effect of antiretroviral therapy but its pathophysiology remains elusive. In-vitro studies show that HIV-1-protease inhibitors affect adipocyte differentiation at an early step involving sterol-regulatory-element-binding-protein-1 (SREBP1), but in-vivo studies are lacking., Methods: We compared fat morphology and mRNA and protein expression of major adipocyte differentiation markers and cytokines in subcutaneous abdominal adipose tissue from 26 HIV-1-infected patients who developed peripheral lipoatrophy while on protease inhibitors and from 18 HIV-1-seronegative healthy controls., Findings: Patients' fat contained a higher proportion of small adipocytes than control fat, together with lower mRNA concentrations of the adipogenic differentiation factors CCAAT-enhancer binding protein (C/EBP) beta and alpha, peroxisome proliferator-activated receptor (PPAR) gamma, and the 1c isoform of SREBP1, with a median decrease of 93% in the latter. The SREBP1 protein concentration was increased 2.6-fold, whereas the PPARgamma protein concentration was decreased by 70%. The expression of adipocyte-specific markers, including leptin, was lower in fat from patients than in fat from controls, whereas expression of tumour necrosis factor (TNF) alpha was higher and correlated negatively with the expression of SREBP1c and downstream adipogenic factors. SREBP1c mRNA concentrations correlated negatively, and TNFalpha mRNA concentrations positively, with glycaemia and insulin resistance, but did not correlate with lipid variables., Interpretation: The altered differentiation status of peripheral adipocytes in HIV-1-infected patients with antiretroviral-induced lipoatrophy is associated with greatly reduced SREBP1c expression. Since the differentiation factor SREBP1 is rapidly targeted by protease inhibitors in vitro, our results suggest that SREBP1c could be an important mediator of peripheral lipoatrophy in this setting, leading to metabolic alterations such as insulin resistance.

Aim: The aim of the study was to test the hypothesis that some patients with functional diarrhea could actually suffer from a mild clinical pattern of collagenous or lymphocytic colitis., Patients and Methods: Twenty consecutive patients with chronic diarrhea were included in the study if the colonic mucosa appeared normal during colonoscopy. From multiple colonic biopsies were established a conventional histological diagnosis and a quantitative histological diagnosis. This latter diagnosis was based on the semiquantitative evaluation of epithelial morphological alterations and lamina propria monocellular infiltration, and on the determination of both intraepithelial lymphocyte count and subepithelial collagen layer thickness. Multiple colonic biopsies from 12 control patients without diarrhea were analyzed according to the same protocol., Results: Among the 20 patients with diarrhea, the quantitative diagnosis of collagenous colitis was made in 3 patients (thickness of the collagen band between 11 and 26 microns) and the diagnosis of lymphocytic colitis in one (21% of intraepithelial lymphocytes). The percentage of intraepithelial lymphocytes did not differ between the 16 remaining patients and the controls (12 +/- 5% and 9 +/- 4%, respectively). Similarly, the score of surface epithelial damage and the score of lamina propria infiltration in patients with diarrhea (1.2 +/- 1.0 et 1.7 +/- 1.5) were not different from the values in the control group (1.3 +/- 1.3 et 1.5 +/- 1.2). The mean fecal weight in patients with diarrhea but without colitis was 161 +/- 130 g/d. All the values of fecal weight were below 300 g/d, except in one patient with a past history of truncular vagotomy., Conclusions: These results suggest that most of the patients with functional diarrhea do not suffer from mild clinical patterns of collagenous or lymphocytic colitis.

We report six cases of toxic megacolon in patients with human immunodeficiency virus (HIV). One case, at an early stage of HIV infection, mimicked a severe attack of Crohn's disease, with a negative search for infectious agents. Subtotal colectomy was successfully performed with an uneventful postoperative course. The five other cases concerned patients with acquired immunodeficiency syndrome at a late stage of immunodeficiency. They were related to Clostridium difficile or cytomegalovirus (CMV) intestinal infection in two and three patients, respectively. One case of CMV colitis presented macroscopically and histologically as pseudomembranous colitis. Emergency subtotal colectomy, performed in the first four patients with acquired immunodeficiency syndrome was followed by a fatal postoperative outcome. The last patient treated conservatively by colonoscopic decompression, in association with anti-CMV therapy, had a favorable short-term outcome. From the experience of our series and data from the literature, we discuss the best diagnostic and therapeutic approach to toxic megacolon in patients with HIV.

After resecting the lateral collateral ligament of the knee in 56 male mature rats, the authors replaced it by an autogenous transplant of the same size, made of fascia lata, ligament or patellar tendon. The authors then studied this transplant after an evolution of 2 days to 5 1/2 months. This lapse of time can be divided into three stages: an initial stage (first week), marked by transplant necrosis and acute inflammation--an early stage (from the second to the fourth week), which shows the migration of the cells from the host to the transplant and the rebuilding of collagen fibers. Tissues with a loose, extensible, but weak texture, such as the fascia lata, are totally colonized by the fibroblasts. Tissues with a dense, strong, but less extensible texture, as the patellar tendon, are soon destroyed and recolonized at the periphery, whereas their center is destroyed and recolonized by fibroblasts later and more irregularly--a late phase of consolidation (from the second to the fifth month), which shows the rebuilding of a dense collagen network and its reorientation. In fascia lata transplants, this new collagen is homogeneous and is made of parallel bundles. In tendon transplants, the network is not homogeneous. It has a persistent nodular aspect at the periphery and well-oriented bundles, separated by calcified or granulomatous foci at the center. In the case of ligament transplants, the new collagen network shows an intermediate aspect between the two described above. The weakest regular connective tissues are the best for ligamentoplasties, and tendons are the worst.

Eleven superficial aponeuroses have been examined in order to study their biomechanical and structural properties. Specimens were taken from 5 fresh cadavers, 3 males, 2 females with a mean age between 40 and 60 years. The study was done by two methods: biomechanical and histological. Aponeuroses can be classified in 2 biomechanical and histological groups that match perfectly. The first group has biomechanical and histological properties similar to those of tendons, and the second group similar to those of tendons, and the second group similar to those of ligaments. Ignoring the biomechanical and histological properties of tendons, ligaments and aponeuroses can be the cause of failure of a number of ligament and tendon plasties. The surgeon has an important role in choosing the transplants according to the histological properties (thickness, length of structures, bundle orientation) and biomechanical properties (solidity and extensibility).

We report a case of leiomyoma of the anal canal, a very rare benign tumour, which was followed up for more than 7 years. With only one exception (10 years), the 14 cases previously published were watched during a short period. This tumour is characterized by the lack of absolute pathological criteria of benignity, even in the total of operative specimens examined, and by a tendency to recurrence, perhaps due to an insufficient local excision. This simple surgical operation seems to be justified, provided the patient remains under close supervision during 5 to 10 years.

The volar fascicles of the interosseous muscles possess two separate components: the proximal and glenoidal one, the distal and aponeurotic other. The armature of the dorsal aponeurosis is constituted the deep, the central and the collateral expansions of the extensor digitorum muscles, and the interosseous muscles, whom are added the lumbrical muscles. The deep expansions are constant and are fixed respectively at the basis of the first phalanx. The central and the collateral expansions constitute equally the central and the collateral, then terminal tendons, which are respectively fixed at the basis of the second and at the third phalanx. The unitive structures: dossiere, triangular and retinacular ligaments are intricate with this of the armature and render jointly the whole. All the concerned fascicles have the mechanical and histological characteristics of the tendon.

The authors describe an original technique which makes it possible for them to determine during the operation whether conisation has been complete or incomplete. The tissue removed is examined during the operation colposcopically after it has been stained with an aqueous solution of toluidine colour blue. Pathological epithelium can be recognized easily and it is possible to measure the distance between the edge of this epithelium and the tissue that has been removed. If it is inadequate more can be cut out immediately. The distance should be at least 5 mm from the edge of the pathological epithelium.

A case of gastric tuberculosis associated with villous atrophy is reported in a sixty-three years old female. Fifteen years before she had a skin-disease whose histology was compatible with a dermatitis herpetiformis. Under treatment by gluten exclusion and anti-tuberculous drugs, a cure of gastric tuberculosis and a dramatic relapse of jejunal morphology were observed.

Acute toxoplasmosis was diagnosed in a Japanese woman aged 31 years after the discovery of a raised lysis titre and agglutinins resistant to 2-ME, as well as early increases in specific IgM followed later by increases in specific IgG. A high fever was present and signs of mainly distal polymyositis. The muscle lesion was confirmed by EMG examination. No increase in muscle enzyme levels was noted at any stage of the disease. Muscle biopsy demonstrated inflammatory lesions in interstitial tissue and perimysium, and, more particularly, segmental necrotizing arteritis in several arterioles. All the arteriolar lesions were at the same stage of development. After prednisolone (60 mg/day) had failed to produce improvement, spiramycin was given and caused apyrexia in 48 hours and definite disappearance of all muscle signs within several days. Recovery was complete and there was no return of symptoms 18 months later. The authors discuss the association of acute toxoplasmosis, polymyositis, and necrotizing vasculitis, and suggest a possible pathogenic role for the immune complexes deposited on the arterial walls.

Each fibrous structure of 10 wrists of fresh cadavers has been the subject of a study without preparation with the surgical microscope, then of an histological study. These have been compared with the elastometric study of the controlateral homologous structure. The diameter of the fascicles, the length and the amplitude of the undulations of the collagen fibers had shown particularly characteristic. The comparison between both series shows up the close relation between the mechanical properties and the architecture of the fascicles, which is also perfectly measurable. It shows up the big differences between ligaments and tendons. The histological study of the tendons and ligaments of 4 other wrists, submitted to manoeuvres of stretching, of rupture and of incurvation, reinforces these results. The therapeutic consequences are considered.

General notions of functional anatomy. Review of the literature concerning the elastometric study of tendons and of the ligaments, as well as the histologic study of the fibrous structures as a whole. It demonstrates the reliability of these methods and the interest of the tissular properties, showed up by the latter.

Each fibrous structure of the wrist has been studied by elastometric methods. These lead to a classification superposable to the functional classification. They show up the big mechanical differences between to tendons and but to ligaments. The former are 3 to 5 times as solid, but 3 to times less extensible than the latter. These are divided into 3 groups the more fragile as much as they are stretchable. The aponeuroses have their place between tendons and ligaments, but their properties are very closer to the latter.