1/21. Polyester fibre prosthetic anterior cruciate ligament implant rupture: necrosis of ingrown connective tissue.AIMS: To describe the histopathological and microanalytical features in seven cases of ruptured Apex(R) polyester (Terylene(R)) fibre anterior cruciate ligament prosthesis. methods AND RESULTS: Transmitted and polarized light microscopy was performed in all cases; one case was investigated by immunohistochemistry, transmission electron microscopy and scanning electron microscopy, with backscatter and X-ray detectors for elemental microanalysis. For comparison we also studied synovial biopsy material and unused polyester fibres. In the excised ligaments there was much ingrowth of fibrous tissue accompanying a florid giant cell reaction to the individual intact polyester fibres throughout the ligaments. phagocytosis of particles of prosthesis-derived material was demonstrated and a striking finding was of necrosis of the ingrown connective tissue in the central portions of the ligaments. Hyalinized areas and 'neoligament growth' were less striking. A consistent finding in the polyester fibres was of small particles containing antimony, used as a catalyst in the manufacturing process. CONCLUSIONS: The pattern of reaction to the prosthetic material and the presence of necrosis differ from previous descriptions in animal and human explants of this and other prosthesis types. The mechanical effect of the necrosis is unlikely to be of significance with this ligament, which is load-bearing ab initio.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/21. Late operative site pain with isola posterior instrumentation requiring implant removal: infection or metal reaction?OBJECTIVES: To elucidate the cause of late operative site pain in six cases of scoliosis managed with Isola posterior instrumentation that required removal of the implants. METHOD: Microbiologic examination of wound swabs and enriched culture of operative tissue specimens was undertaken in all cases. Histologic study of the peri-implant membranes also was conducted. RESULTS: The presentation in all cases was similar: back pain appearing between 12-20 months after surgery, followed by a local wound swelling leading to a wound sinus. In only one of these cases was the discharge positive for bacterial growth. Implant removal was curative. Histologic examination of tissue specimens revealed a neutrophil-rich granulation tissue reaction suggestive of an infective etiology despite the failure to isolate organisms. Within the granulation tissue was metallic debris that varied from very sparse to abundant from fretting at the distal cross-connector junctions. A review of recent literature describing similar problems suggests that late onset spinal pain is a real entity and a major cause of implant removal. CONCLUSIONS: On reviewing the evidence for an infective etiology versus a metallurgic reaction etiology for these cases of late onset spinal pain, it was concluded that a subacute low-grade implant infection was the main cause. Histologic findings would seem to confirm low-grade infection. There may be more than one causative factor for late operative site pain, as it is possible that fretting at cross connection junctions may provide the environment for the incubation of dormant or inactive microbes.- - - - - - - - - - ranking = 0.0084958197658861keywords = membrane (Clic here for more details about this article) |
3/21. Synovitic cyclops syndrome caused by a Kennedy ligament augmentation device.The cyclops lesion at the tibial attachment of the reconstructed ligament has been known to cause loss of knee extension. We present a case of knee extension loss because of a cyclops lesion caused by Kennedy ligament augmentation device synovitis at 10 years after ACL reconstruction in a 33-year-old man.- - - - - - - - - - ranking = 0.6keywords = ligament (Clic here for more details about this article) |
4/21. Intracarpal synovitis related to Dacron interposition after trapeziectomy: a report of three cases.To prevent the mechanical consequences of trapeziectomy, interposition devices are promoted, such a Dacron spacer. We report three cases of osteolysis and synovitis related to the use of such a device. This phenomenon occurred 4 months after insertion and required revision surgery after 9 months of follow-up because of pain and extensive osteolysis of the carpal bones. Revision consisted of an extended synovectomy, removal of the broken Dacron followed by a ligamentoplasty using the Flexor Carpi Radialis. Two years after revision surgery the result was satisfactory, with no recurrence of pain or osteolysis. The Dacron device did not demonstrate improvement in clinical results after short-term follow-up when compared to conventional ligamentoplasty. We recommend cautious use of the Dacron device at trapeziectomy and attention must be paid to follow up of the patient.- - - - - - - - - - ranking = 0.2keywords = ligament (Clic here for more details about this article) |
5/21. Pigmented-membrane formation on acrylic intraocular lenses after phacoemulsification.PURPOSE: To report the formation of pigmented membranes on acrylic intraocular lenses (IOLs) after phacoemulsification and to determine the clinical characteristics of these pigmented membranes. DESIGN: Observational case series. methods: Four eyes of three patients were found to have pigmented membranes on their acrylic IOLs (Sensar AR40). Their medical records were reviewed. RESULTS: The pigmented membranes were observed at 4- to 9-month intervals after phacoemulsification. Their best-corrected Snellen visual acuity (BCVA) decreased by more than 2 lines, ranging from 20/63 to 20/40. After Nd:YAG laser treatment, BCVA improved 2 to 4 lines. At 5- to 12-week intervals after Nd:YAG laser treatment, recurrences of the pigmented membranes were observed with decreased BCVA. CONCLUSIONS: We have observed visually significant, recurrent, pigmented membrane formation in eyes implanted with Sensar AR40 acrylic IOLs. To the best of our knowledge, pigmented membranes on acrylic IOLs have not been described previously.- - - - - - - - - - ranking = 0.093454017424748keywords = membrane (Clic here for more details about this article) |
6/21. Multinucleated foreign body giant cells in placental membrane.We report the pathologic finding of a multinucleated foreign body giant cell reaction to squames and fetal hair in the placental membranes in a 37-week 1-day intrauterine gestation. This reaction appeared to have developed in association with repeated intrauterine procedures performed in the third trimester, including cordocentesis for fetal blood sampling, intrauterine blood transfusion, and amnioreduction for polyhydramnios. This type of reaction most likely was directed to prolonged amniotic fluid leakage that occurred spontaneously or after intrauterine procedures in the second half of the second trimester and the third trimester. Careful examination of the placental membranes and recognition of the foreign body giant cell reaction may provide etiologic insight in cases of unexplained oligohydramnios.- - - - - - - - - - ranking = 0.050974918595317keywords = membrane (Clic here for more details about this article) |
7/21. False magnetic resonance imaging persistence of a biodegradable anterior cruciate ligament interference screw with chronic inflammation after 4 years in vivo.Surgeons should be aware that the degradation kinetics of biodegradable implants likely influence the rate of osseous integration, and depend on numerous factors such as polymer weight, crystallinity, and stereocopolymer ratio. We present a case of inflammatory reaction at a polylactide tibial interference screw site more than 4 years after primary anterior cruciate ligament (ACL) reconstruction. This inflammation was presumptively treated as an infection with surgical irrigation and debridement. Preoperatively, the screw was clearly delineated by magnetic resonance imaging (MRI), yet was grossly absent at surgery. Postoperative MRI confirmed thorough debridement and complete absence of the screw. This report shows that not only can a late inflammatory reaction occur, after up to 4 years in vivo, but that the MRI may show a persistent screw despite significant biodegradation. False MRI-persistent screws should be considered when critically reviewing studies that use MRI in the methods for evaluating biodegradable implants. More importantly, false MRI-persistent screws may have significant ramifications when planning revision surgery after primary ACL reconstruction having used interference screws that can degrade over several years.- - - - - - - - - - ranking = 0.5keywords = ligament (Clic here for more details about this article) |
8/21. Long-term corneal retention of a plant foreign body.A fragment of sunflower stalk had been retained in the cornea of a 71-year-old man for 58 years. During initial healing of the wound, which included formation of a retrocorneal membrane over the foreign body in the anterior chamber, there was probably loss of endothelial cells. This probably predisposed the cornea to the endothelial decompensation that occurred following cataract extraction and implant of an intraocular lens 56 years after the foreign body first appeared in the cornea.- - - - - - - - - - ranking = 0.0084958197658861keywords = membrane (Clic here for more details about this article) |
9/21. Reactive membrane on a foldable silicone lens implant in the posterior chamber of a human eye.A foldable silicone posterior chamber intraocular lens implant caused irritation and glaucoma postoperatively in the eye of a diabetic patient who subsequently was treated with steroids and a laser capsulotomy. Because the lens implant was loose in the capsular bag and caused considerable glare, it was removed about 4 months after placement. Pathologic study revealed the entire surface of the implant to be covered by a continuous and firmly adherent protein membrane with excrescences and of irregular thickness. Sessile macrophages found on the membrane were not firmly attached.- - - - - - - - - - ranking = 0.050974918595317keywords = membrane (Clic here for more details about this article) |
10/21. Multinucleated giant cells on Bruch's membrane late in recurrent retinal and subretinal hemorrhaging.Two cases with a history of recurrent subretinal hemorrhaging are reported. Multinucleated giant cells of macrophage origin were demonstrated on Bruch's membrane in a few stages of their functions of phagocytosis of old blood and storage of blood remnants. Their classification as foreign-body giant cells fails to recognize the important purification, disposal and storage functions of these cells in situations with extensive intraocular hemorrhage, exudation or necrosis.- - - - - - - - - - ranking = 0.042479098829431keywords = membrane (Clic here for more details about this article) |
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