BACKGROUNDTherapeutic approaches for tracheal stenosis caused by the formation of exuberant granulation tissues usually include electrocautery, mechanical dilation, laser therapy, argon plasma coagulation (APC), cryotherapy and stent placement. However, restenosis after stent insertion remains a significant limitation. We examined the efficacy of three different approaches, including induction of mechanical lesions, APC performed with different powers or durations and cryotherapy, to identify the method that limited the formation of granulation tissue.

METHODSTwelve specially bred research mongrel dogs were divided into three groups. In group 1 (four dogs) mild (procedure 1; two dogs) or moderate (procedure 2; two dogs) damage was induced mechanically. Group 2 (six dogs) received APC at different powers or durations (procedure 3: 30 W, 1 cm/s; procedure 4: 30 W, 2 cm/s; procedure 5: 25 W, 3 cm/s). Group 3 (two dogs) received cryotherapy (procedure 6: two freeze-thaw cycles of 30 seconds). Uncovered self-expandable metallic stents were inserted in all dogs to maintain a continuous stimulus to the trachea mucosa. Dogs were monitored for 4 weeks and the relationship between granulation tissue proliferation and method used was analyzed.

RESULTSIn group 1, granulation tissue growth increased with more severe mechanical damage. The growth of granulation tissue in group 2 was more pronounced than in group 1, and both dogs in procedure 3 died because of severe stenosis. In this group, the formation of granulation tissue decreased with decreasing power and duration. In group 3, no obvious granulation tissue was found at week 4.

CONCLUSIONSLesions and stimuli from a foreign body (the stent) are two important factors that lead to overgrowth of granulation tissue. Thermal lesions, such as APC, seem to induce greater granulation tissue growth and cartilage damage compared with mechanical and cryotherapy lesions. Cryotherapy in combination with mechanical dilation may be a safe and effective treatment method for managing tracheal stenosis caused by the formation of granulation tissue.

Animals ; Bronchoscopy ; methods ; Cryotherapy ; Dogs ; Granulation Tissue ; pathology ; Laser Coagulation ; methods ; Stents ; Tracheal Stenosis ; therapy

STUDY DESIGN: A retrospective study. PURPOSE: To categorize the MR appearance of ischemic vertebral collapse and to correlate surgical and histologic findings. OVERVIEW OF LITERATURE: X-ray and MRI findings of delayed posttraumatic vertebral collapse shows several patterns. Histopathologic signs of osteonecrosis were present only in minor portion of cases sampled for biopsy of delayed post-traumatic vertebral collapse in the literature. METHODS: Twenty-one patients (22 vertebral bodies), with surgically and histopathologically proven ischemic vertebral collapse were included. The patients were examined with a 1.5 T MR imager. Spin echo T1- and T2-weighted images were obtained in axial and sagittal planes. Two experienced musculoskeletal radiologists, who reached consensus, evaluated the MR images. Then, MR-pathology correlations were made. RESULTS: Four different MR patterns were identified. Fluid patterns, were seen in 14% (3/22) of the affected vertebral bodies, and were characterized by hypo-intense signals on T1-weighted images, and hyper-intense signals, similar to water, on T2-weighted images. Extensive bone necrosis was predominant. Compression pattern, the most common pattern, found in 41% (9/22 vertebral bodies), was characterized by a marked decrease of anterior column height. Bone necrosis, granulation tissue, marrow fibrosis, and reactive new bone formation were found in relatively equal proportion. Granulation pattern, seen in 27% (6/22 vertebral bodies), was characterized by hypo-intense signals on T1-weighted images, and intermediate signals on T2-weighted images. Extensive granulation tissue was predominant. Mixed patterns were present in 18% (4/22), of the vertebral bodies. CONCLUSIONS: Awareness of histopathologic correlation of MR patterns in patients with delayed post-traumatic vertebral collapse may facilitate effective interpretation of clinical MR images of the spine.
Biopsy ; Bone Marrow ; Consensus ; Fibrosis ; Granulation Tissue ; Humans ; Magnetic Resonance Imaging ; Necrosis ; Osteogenesis ; Osteonecrosis ; Pathology ; Retrospective Studies ; Spine ; Water

There are several reports on the intervertebral vacuum phenomenon since Maldague s report in 1978. This disease is, however, considered as uncommon and miscellaneous entity. We performed retrospective review of 27 collapsed vertebral bodies of 21 osteoporotic patients to define the clinical, radiological and pathological characteristics of intravertebral vacuum phenomenon. Simple radiographs and MRIs were reviewed and the pathological findings from 6 specimens were matched with MRI. Intravertebral air shadows were shown in all cases either on A-P or lateral view, more definite on extension lateral views. Basically, it was considered as a burst fracture with loss of anterior and middle column height. The extent of collapse could be classified as complete or incomplete and the shape of spinal canal intrusion as bulging or local beak type. 12 cases of MRI findings were classified in to three types by T1, T2 and gadolinium enhancement patterns. The extent of spinal canal intrusion was less then 50% in all cases but neurolgic deficits were examined in 10 cases. Pathologically, necrotic trabeculae with fibrous granulation tissue was mixed with reactive new bone and callus formation in some area. This phenomenon is considered not so uncommon, which can be noticed easily in lateral flexion/extension view. Basically, this is a burst fracture with nonunion from ischemic necrosis and neurologic status should be carefully obserued.
Animals ; Beak ; Bony Callus ; Gadolinium ; Granulation Tissue ; Humans ; Magnetic Resonance Imaging ; Necrosis ; Pathology ; Retrospective Studies ; Spinal Canal ; Vacuum*

The pathologic spectrums of the tennis elbow are varies as lateral epicondylitis, degenerative partial tear of extensor tendon origin, annular ligament lesion, synovial fringe between radio-capitellar joint, bursitis and posterior interosseous nerve pathology. So it is difficult to perform separate treatments for each different pathologic conditions. Conservative treatments for the tennis elbow are consisted of rest, immobilization, non-steroidal anti-inflammatory drugs (NSAID), and local injection of the steroid. Usual success rates of the conservative treatment have been reported approximately more than 90%. Several methods of surgical treatm nt of the resistant tennis elbow have been reported. Authors performed surgical treatment for twelve cases of the resistant tennis elbow from Jan. 1989 to Jan. 1994. Authors modified the Nirschl's technique; flap retraction of the extensor carpi radilais brevis (ECRB) and common extensor tendon to expose the radio-capitellar joint and no reattachment of detached tendons to the lateral epicondyle and side-to-side suture with maximal stretching of the ECRB tendon. Identified pathologic conditions were the degenerative partial tear and friable granulation tissues at the ECRB origin, sclerosis of the lateral epicondyle (ten cases), synovial fringe bewteen the radio-capitellar joint (two cases). In one case, authors couldn't find any abnormal pathologic conditions. Microscopic examinations (two cases) showed angioblastic proliferation, fibrosis, degeneration of the collagen fiber. Among these patients, eleven patients were industrial worker (eight painter, two welder and one carpenter). They have something in common with using hammer mainly. The hammering might be a possible cause of the tennis elbow. After the surgery, the functional recoveries were satisfactory. The final results were four excellent (33.3%) and good (66.6%) by Nirsh & ettrone grading system. The time required to return to the original job were varied from one month to eight months (average 4.3 months).
Bursitis ; Collagen ; Elbow ; Fibrosis ; Granulation Tissue ; Humans ; Immobilization ; Joints ; Ligaments ; Pathology ; Sclerosis ; Sutures ; Tendons ; Tennis Elbow* ; Tennis*

Idiopathic retroperitoneal fibrosis (IRF) is a rare human disease characterized by non-neoplastic fibroblastic proliferation associated with chronic inflammatory cells; its pathogenesis is obscure. We undertook an immunohistochemical study for the expression of HLA-DR antigens and other immune-related markers by retroperitoneal proliferating fibroblasts and inflammatory cells from 2 IRF patients. Patterns of immunoreactivity were compared with those expressed by human nodular fasciitis (NF) and granulation tissue. In IRF, most fibroblasts immunostained strongly for HLA-DR antigens, whereas fibroblasts in NF and granulation tissue did, not immunostain at all. The fibroblasts did not immunostain for interleukin 2 receptor, C3b receptor, CD-4, CD-8, or Leu-M1 in any of the tissue studied. Most macrophages and lymphocytes in IRF and NF immunostained Strangly for HLA-DR antigens. In IRF, the CD-4 and CD-8 immunostained T-lymphocytes appeared equally distributed. The expression of HLA-DR antigens by fibroblasts in IRF indicates that this rare disease may indeed be an immune-associated hypersensitivity disorder.
Adult ; Aged ; MH - ; Biological Markers ; Fasciitis/pathology ; Fibroblasts/*immunology/pathology ; Granulation Tissue/pathology ; HLA-DR Antigens/*analysis ; Humans ; Male ; Middle Aged ; Retroperitoneal Fibrosis/*immunology/pathology

Adolescent ; Brain ; pathology ; Brain Diseases ; diagnosis ; pathology ; Child ; Diagnosis, Differential ; Female ; Granulation Tissue ; pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Retrospective Studies

OBJECTIVE: To evaluate the fixation strength and tissue reaction of the glue fixation and self-stabilizing leg fixation methods and to compare the results with those of the conventional tagging suture fixation method. MATER AND METHODS: Twelve healthy rabbits were selected and three different methods of implanting the port chamber were employed on the back of each rabbit. A total of thirty six port chambers were implanted with these three different methods, viz. the glue fixation method using tissue adhesive, the self-stabilizing leg method using a self-expandable stabilizing leg, and the suture fixation method. The fixation strength and the gross and histopathologic changes of each fixation method were evaluated at three days, one week, two weeks and four weeks after port implantation. RESULTS: The glue fixation method showed a good fixation strength, which was similar to that of the tagging suture method (p=0.3486). Five of the six ports (83%) implanted with the glue fixation method which were examined after two weeks showed cracks on the external surface, but this had no adverse effects on their function. A large amount of granulation tissue reaction was found at the bottom of the chamber (p=0.0025). The fixation with the self-stabilizing leg showed relatively lower fixation strength (p=0.0043), but no turning-over of the chamber occurred. The fixation strength improved with time after the first week, and minimal granulation tissue reaction was observed with this method. CONCLUSION: The glue fixation method exhibited equal fixation strength compared to the suture fixation, but showed cracking and a large amount of granulation tissue, whereas the fixation with a self-stabilizing leg showed weaker fixation strength.
Alloys ; Animals ; Capillaries/cytology/metabolism/pathology ; Cell Proliferation ; Device Removal ; Enbucrilate/therapeutic use ; *External Fixators ; Fibroblasts/metabolism/pathology ; Granulation Tissue/blood supply/metabolism/pathology ; *Implants, Experimental ; Models, Animal ; Rabbits ; Sutures/*utilization ; Time Factors ; Tissue Adhesives/*therapeutic use

PURPOSE: To compare the MR imaging findings of experimentally induced pyogenic arthritis of rabbit knees with the corresponding histopathologic findings. MATERIALS AND METHODS: Infection was induced in 20 rabbit knees by direct intra-articular injection of Staphylococcus aureus. The animals were divided into four groups of five rabbits each, and spin-echo sagittal T1-and T2-weighted images were obtained 3 days, 1 week, 2 weeks, and 4 weeks, respectively, after staphylococcal inoculation. MR-pathologic correlation was performed, with emphasis on intra-and extra-articular soft tissue lesion characteristics. Soft tissue lesion signal intensity (SI) was classified as low, iso, or high on the basis of that of muscle, and high SI was further subdivided into three categories. RESULTS: At T2-weighted imaging, all soft tissue lesions showed high SI. Pathologic examination revealed the presence of inflammatory cell infiltration (n=2), abscess (n=1), granulation tissue (n=3), fibrosis (n=11), edema (n=4), congestion (n=9), and joint fluid (n=11). Except for the abscess, these lesions were irregular in shape and had variable SI (grade 1-3) and at T2WI could not, therefore, be differentiated. In nine kness, extraarticular soft-tissue lesions were demonstrated at T2WI and correlated with infectious soft tissue lesions such as inflammatory cell infiltration, abscess, granulation tissues and fibrosis; and non-infectious reactive soft tissue changes such as edema and congestion. CONCLUSION: In pyogenic arthritis, the MR imaging features of soft tissue lesions varied and were nonspecific, depending on the histopathologic abnormalities observed. Our results indicate that in assessing the extent of pyogenic arthritis with MR imaging, caution is required.
Abscess ; Animals ; Arthritis* ; Arthritis, Infectious ; Edema ; Estrogens, Conjugated (USP) ; Fibrosis ; Granulation Tissue ; Injections, Intra-Articular ; Joints ; Knee* ; Magnetic Resonance Imaging* ; Pathology* ; Rabbits ; Staphylococcus aureus

BACKGROUNDCurrently available silicone and metallic stents for tracheal stenosis are associated with many problems. Granulation proliferation is one of the main complications. The present study aimed to evaluate the efficacy of paclitaxel drug-eluting tracheal stent in reducing granulation tissue formation in a canine model, as well as the pharmacokinetic features and safety profiles of the coated drug.

METHODSEight beagles were randomly divided into a control group (bare-metal stent group, n = 4) and an experimental group (paclitaxel-eluting stent group, n = 4). The observation period was 5 months. One beagle in both groups was sacrificed at the end of the 1st and 3rd months, respectively. The last two beagles in both groups were sacrificed at the end of 5th month. The proliferation of granulation tissue and changes in tracheal mucosa were compared between the two groups. Blood routine and liver and kidney function were monitored to evaluate the safety of the paclitaxel-eluting stent. The elution method and high-performance liquid chromatography were used to characterize the rate of in vivo release of paclitaxel from the stent.

RESULTSCompared with the control group, the proliferation of granulation tissue in the experimental group was significantly reduced. The drug release of paclitaxel-eluting stent was the fastest in the 1st month after implantation (up to 70.9%). Then, the release slowed down gradually. By the 5th month, the release reached up to 98.5%. During the observation period, a high concentration of the drug in the trachea (in the stented and adjacent unstented areas) and lung tissue was not noted, and the blood test showed no side effect.

CONCLUSIONSThe paclitaxel-eluting stent could safely reduce the granulation tissue formation after stent implantation in vivo, suggesting that the paclitaxel-eluting tracheal stent might be considered for potential use in humans in the future.

Animals ; Bronchoscopy ; Disease Models, Animal ; Dogs ; Drug-Eluting Stents ; Granulation Tissue ; drug effects ; Microscopy, Electron, Scanning ; Paclitaxel ; therapeutic use ; Trachea ; pathology ; Tracheal Stenosis ; drug therapy ; surgery

BACKGROUND AND OBJECTIVES: Canal wall down technique when used for treating chronic otitis media including cholesteatoma may secure better operation field and remove the lesion more easily, but may result in a problematic mastoid cavity, compared to canal wall up technique. To combine the advantages of both techniques, the concept of canal wall down technique with canal wall reconstruction has been studied. We removed the posterior bony wall for the good exposure of the pathology in the middle ear, and reconstructed the posterior wall using a silastic device called OCS (open & close technique with silastics). Alloplastic materials, cartilage, and bone have been used for the reconstruction of the wall and silicone for medical use have been proven to be safe. The purpose of this study is to report the results of a new surgical technique of canal wall reconstruction using silastics. SUBJECTS AND METHODS: Retrospective review was performed on the thirty-one patients undergoing open & close technique with silastics, OCS, from 2003 to 2005. All cases had large defect of posterior wall and scutum with cholesteatoma, and 70-80% defect of the wall was noted in 2 cases. This technique is characterized by partial canal wall down mastoidectomy for exposure and eradication of diseases, followed by immediate canal wall reconstruction using silastic sheets or C-shaped silastic devices, and supported with posterior auricular periosteal flap. RESULTS: During the average follow-up of 14 months, there was no recurrent or residual choesteatoma. Anatomic integrity of the posterior canal wall was obtained in 30 (96.8%) of 31 patients. The pinpoint perforation of posterior canal wall was observed in 4 patients and treated with temporalis fascia graft. Removal of the silastics was necessary for only one patient because of purulent otorrhea and granulation tissue formation. CONCLUSION: Canal wall reconstruction using silastics has been performed successfully without a major complication. Although long-term study in larger series of patients is required to further evaluate the efficacy of this technique, we consider this technique to be a satisfactory procedure in chronic otitis media surgery.
Cartilage ; Cholesteatoma ; Ear Canal ; Ear, Middle ; Fascia ; Follow-Up Studies ; Granulation Tissue ; Humans ; Mastoid ; Otitis Media* ; Otitis* ; Pathology ; Retrospective Studies ; Silicones ; Transplants