Experimental studies prove that these different pathological conditions use common enzymatic pathways leading muscle atrophy. In every catabolic conditions where there is proteolyses’s increase, this one happens in association with up-regulation of two specific genes of skeletal muscle atrophy. These genes, MuRf1 (muscle ring finger-1) and MAFbx (muscle atrophy F-box), encode ubiquitin ligases. These ligases bind and mediate ubiquitination of myofibrillar proteins for subsequent degradation during muscle atrophy. The aim of our study is to obtain a better understanding of human muscle physiopathology in atrophy by use of histochemistry and immunolocalisation of MuRF-1 and MAFbx.
The demonstration that the muscle-specific proteins MAFbx and MuRF1 are upregulated in multiple pathological conditions of skeletal muscle atrophy it is critical to continue studying the cellular pathways to discover promising targets for the development of effective new treatments for skeletal muscle disease.
Many surgical techniques based on a distal osteotomy are used for the treatment of the symptomatic hallux valgus. We review the results of percutaneous distal osteotomy retrospectively. Between 1998 and 2003, 52 patients were operated on using a distal osteotomy for symptomatic hallux valgus. We investigated 35 females and nine males for a mean follow-up time of 4.6 years. We performed a percutaneous distal osteotomy (PDO) with a 2-mm Kirschner wire. Radiological analysis consisted of measuring the hallux valgus angle (HV) and the angle between the first and the second metatarsal (M). Clinical evaluation was performed with the AOFAS scale. Good bony contact was achieved and all the osteotomies united and no aseptic necrosis was found. According to the questionnaire, the pre-operative AOFAS score was 44.3 and 92.5 at the follow-up examination. Radiological analysis showed that the pre-operative HV angle was 13.7° and 9.8° at follow-up. The pre-operative M angle was 24.1° and 13.6° at follow-up. The PDO technique gives good results at a mean follow-up of 4.6 years. The positive aspects of this technique are: short surgical time, low incidence of complications and high patient compliance. A single 2-mm Kirschner wire is enough to achieve adequate stabilisation of the osteotomy, is less expensive than other surgical instruments for hallux valgus and is very easy to remove.
Primary synovial chondromatosis (PSC) is a rare benign disorder characterised by development of foci of cartilage in the synovial membrane of the joint, bursa or tendon sheath that was first described by Reichel in 1900. The disorder has traditionally been considered as a metaplastic condition, but was recently assoicated with structural chromosomal abnormalities, suggesting a neoplastic origin. The aim of the present study was to evaluate the clinical, arthroscopic and histopathological aspects of PSC involving both the glenohumeral joint and tendon sheath of the biceps. An 18-year-old, right-hand dominant boy presented with right shoulder pain. There was no history of trauma. Pain began in his shoulder about 1 year prior to his clinical visit. Physical examination revealed an active range of motion of the affected side measuring 90 ° of abduction and 150° of forward flexion; internal rotation to the greater trochanter of the hip and external rotation were slightly limited. Plain radiographs revealed multiple calcific nodules in the right glenohumeral joint, the subcoracoid recess, and anterior to the humeral head. There appeared to be mild degenerative changes in the gleno-humeral joint. Magnetic resonance imaging was performed to assess the location of the loose bodies and evaluate intra-articular degenerative changes. It demonstrated multiple loose bodies within the glenohumeral joint, the proximal tendon sheath of the biceps, and also in the subscapularis bursa. There was irregularity involving the anterior aspect of the humeral head consistent with erosive changes. The patient underwent arthroscopic surgery to remove the loose bodies, arthroscopic partial synovectomy and decompression of the biceps tendon sheath, with removal of multiple loose bodies. For partial synovectomy a motorized suction-cutting device alternated between anterior and posterior portals. The biceps tendon was identified through an anterior deltopectoral incision and multiple loose bodies were removed from within the tendon sheath. Specimens for histological analyses were stained with haematoxylineosin (H&
E) and safranin-O. Polyclonal anti-type II collagen was used at 1:100 dilution for immunohistological analyses At 2–year follow-up examination the patient was asymptomatic and there was no clinical or radiographic evidence of recurrence. Lobulated areas of hyaline cartilage just below the synovial surface were easily identified. Chondrocytes were clustered together in nests and were not uniformly distributed throughout the ground substance. Safranin-O staining showed evident meta-chromasia of the cartilaginous matrix. Immunolabelling for type II collagen was observed in cartilaginous areas with marked cytoplasmic staining. We believe that arthroscopy is an easy and safe method for the management of this disorder and that the support of an experienced pathologist is necessary to avoid differential diagnostic problems with the uncommon malignant transformation.
