PubMed Health⌕ Search

Biomedical subjects

J A Pahle

Publications and source records attributed to J A Pahle.

At least 19 recordsLinked to original sources
PubMed1992

A prospective clinical five year follow up study after open synovectomy of the knee joint in patients with chronic inflammatory joint disease. The prognostic power of clinical, arthroscopic, histologic and immunohistologic variables.

Arthroscopy and clinical examination was performed on the knee joint of 26 patients with chronic inflammatory joint disease, before and at 6 and 12 months after open synovectomy. Biopsies were examined by histologic and immunohistologic methods. Clinically the patients improved until 6 months after synovectomy, and the improvement was maintained for 5 years. Patients with the best clinical function prior to synovectomy also had the best long term results (p = 0.024). The state of the cartilage was the best predicting variable with a significant prognostic power (p = 0.01). Thus patients with normal cartilage at the time of synovectomy had the best clinical score five years later. The patients with most resynovitis 12 months after surgery did less well at five year clinical follow up (p = 0.032) than those with little or no resynovitis. Absence or low number of IgA-positive plasma cells in the cellular infiltrate at 12 months after surgery correlated with a good clinical score five years after surgery (p = 0.036). This suggests that a high number of IgA-positive plasma cells may be indicative of a more aggressive, destructive disease.

Adolescent↗
PubMed1991

Evaluation of knee joint cartilages and menisci in patients with chronic inflammatory joint diseases. A prospective arthroscopic study before, six and twelve months after open synovectomy.

Destruction of joint cartilage is an important feature in chronic inflammatory joint diseases. This article considers the areas of the cartilages of the knee joint prone to destructive changes, pannus growth and marginal erosions, and the changes of pattern after open synovectomy. Twenty-eight patients with chronic inflammatory joint disease which gave indication for synovectomy of the knee joint had arthroscopy immediately before, 6 and 12 months after open synovectomy. A method of grading the changes of the cartilage, pannus growth, menisci and marginal erosions is described. There was an increase in cartilage pathology 12 months after synovectomy (p less than 0.001), particularly on the weight bearing areas of the femur and on the tibial condyles. No significant deterioration in areas with pathology at the time of synovectomy was found in the follow up. Pannus growth was particularly located to areas 2 and 4 on the femoral condyles. We conclude that cartilage destruction after synovectomy is more likely to be a result of osteoarthrosis than arthritic changes.

Arthritis↗
PubMed1991

Intraoperative autotransfusion in reconstructive hip joint surgery of patients with rheumatoid arthritis and ankylosing spondylitis.

The efficacy of a simple, low-cost device designed for intraoperative blood salvage and reinfusion, known as the Sorensen system, was studied during 24 hip joint operations in adult patients suffering from rheumatoid arthritis or ankylosing spondylitis. The total need for homologous blood was reduced to 28%, compared with a matched control group of patients who had previously undergone hip surgery by homologous blood replacement. In primary hip-replacement operations, the need for blood was met either completely by autotransfused blood or by the addition of 1 or 2 units of homologous blood. In revision arthroplasties, the maximal need for homologous blood was 6 units owing to a greater blood loss during operation. Postoperative changes in several hematologic variables measured were all very small. The autotransfusion system proved easy and safe to operate. No patients manifested complications. In our experience, the system may be considered an underutilized resource in rheumatological surgery.

Adolescent↗
PubMed1990

Arthroscopic evaluation of the synovial lining before and after open synovectomy of the knee joint in patients with chronic inflammatory joint diseases.

Twenty-eight patients with chronic inflammatory joint diseases had arthroscopy immediately before synovectomy of the knee joint and 6 and 12 months postoperatively. In patients with moderate and/or severe synovitis of the knee joint all of the synovial membrane is involved in the disease process. Resynovitis (synovitis of the regenerated synovial membrane after synovectomy), however, is patchy and if biopsy should be indicated, arthroscopic guidance is advocated. Following synovectomy there is a recurrence of mild synovitis of varying degree in some cases with an increase in resynovitis between 6 and 12 months. The level of synovitis at 12 months was, however, markedly less than at synovectomy (p less than 0.01). Similar development was found both in histopathology and immunohistopathology after synovectomy. Arthroscopic examination of the synovial membrane in chronic inflammatory disease of the knee joints gives valuable information of the severity and the longitudinal changes of synovitis. A simple method of scoring is described and is imperative when comparing patients or groups of patients and when doing longitudinal arthroscopic studies. The method was used both at arthroscopy and at subsequent synovectomy giving a highly significant correlation (p less than 0.001).

Arthroscopy↗
PubMed1990

A three-year retrospective study of synovectomies in children.

The aim of this study was to evaluate the results of synovectomies in children with juvenile arthritis. Five hundred twenty-eight synovectomies and tenosynovectomies were performed over a period of 13 years. The patients were followed for one, two, three, five, and ten years postoperatively. The evaluation after three years was chosen as the basis for this article. One hundred twenty-five children with arthritis who were not evaluated three years postoperatively had less severe arthritis, both locally and generally, than the evaluated group of 389. The rate for good results and tolerability was high at one, two, and three years postoperatively but decreased with time; more patients went from good results to poor rather than vice versa. Global assessment, soft-tissue swelling, and limitation of movement seemed to be the best parameters for evaluating the results of synovectomies. It appears necessary to wait at least three years to evaluate the long-term effect of synovectomies.

Adolescent↗
PubMed1989

Cross-reactive epitope with Klebsiella pneumoniae nitrogenase in articular tissue of HLA-B27+ patients with ankylosing spondylitis.

Synovial tissues from patients with ankylosing spondylitis or reactive arthritis were examined by an immunoperoxidase technique, using antisera to synthetic peptides representing antigens shared between HLA-B27.1 and Klebsiella pneumoniae nitrogenase. With either antiserum, all HLA-B27+ patients with synovial inflammation showed strong immunoperoxidase staining in synovial lining cells, vascular endothelium, and infiltrating inflammatory cells. These findings indicate that antigens showing cross-reactivity between HLA-B27.1 and Klebsiella nitrogenase epitopes are strongly expressed within inflamed synovial tissues of HLA-B27+ patients.

Arthritis↗
PubMed1989

[Possibilities of current therapy of rheumatoid arthritis].

In cases of systemic diseases such as arthritis, the choice of surgical treatment places demands upon the physician. Any organ system may be involved; not only joints, but also the skin, bone marrow, kidneys, and the vascular or nervous systems. The cervical column is often affected; the elasticity of connective tissue is reduced, and osteoporosis is a predominant feature. The medication used is potent. Surgical treatment of arthritis is of two main categories: reconstructive surgery, which accounts for 60-80 per cent of cases; and synovectomy, for its inhibitory effect on joint destruction, which at most clinics is used in 20-40 per cent of cases.

Gout↗
PubMed1987

Comparison of synovectomy and no synovectomy in patients with juvenile rheumatoid arthritis. A 24-month controlled study.

Thirty patients with pauciarticular or polyarticular juvenile rheumatoid arthritis entered a randomized, 24-month, parallel trial of synovectomy (n = 15) versus no synovectomy (n = 15). The joints studied were 18 wrists, 8 ankles and 4 knees. The synovectomies were performed as radically as possible. Joint motion was slightly decreased in the operated joints, especially for passive movements during the first 6 months following surgery. Swelling and disease activity of the joints studied as well as subjective evaluation of joint pain improved in the synovectomy group compared with the non-synovectomy group. This improvement seemed to continue for at least 2 years.

Adolescent↗
PubMed1986

The value of arthroscopy in the diagnosis and treatment of patients with juvenile rheumatoid arthritis.

Arthroscopy of 49 knee joints in patients with juvenile rheumatoid arthritis (JRA) or suspected JRA is described. A large number of patients had a monoarticular involvement with a difficult differential diagnostic problem. Arthroscopy gave important additional diagnostic information. Arthroscopy gives accurate information regarding cartilage destruction and severity of synovitis. In some patients with JRA arthroscopy was a final tool in deciding whether or not to do a synovectomy. Arthroscopy is a safe examination which gives important additional diagnostic information in patients with JRA.

Adolescent↗
PubMed1985

Shoulder synovectomy.

The technique and results of synovectomy of the shoulder joint in rheumatoid arthritis with a mean follow up time of 5.3 years (1-16 years) is described. The original method included resection of acromion after loosening of the deltoid muscle and splitting of the rotator cuff. Since 1981 the simpler approach of Neer without resection of acromion has been used (for synovectomy as well as for prosthetic replacement) with an easier postoperative management and equally good results. Only in 6 of 54 shoulders a total replacement prosthesis has been inserted later, an indication of the lasting good effect of synovectomy, even in advanced cases where an additional debridement was necessary. The best results are obtained in early cases. Radiographic changes are late, indications should be based more on clinical findings. Access to good training facilities is mandatory.

Acromion↗
PubMed1985

Shoulder replacement arthroplasty.

Since 1973 64 shoulders in 56 patients have had a prosthetic replacement at the Oslo Sanitetsforening Rheumatism Hospital, the semi-constrained prosthesis of Lettin/Stanmore was used in 13 cases, the non-constrained prosthesis of Engelbrecht/St. Georg in 10 cases and Neer's type II prosthesis in 41 cases. An evaluation of the results is given. The minimal muscular loosening recommended by Neer is facilitating the postoperative training. The best results regarding function and pain reduction have been obtained by the Neer prosthesis, but the lack of cranial support ("fornix humeri") and the ovalization of the head seem to be responsible for some cases of upward migration of the head of the prosthesis. The ideal prosthesis should be non-constrained and come with different lengths of the neck and at least in two sizes of the head and several sizes of the stem. The glenoid socket should provide a cranial support facilitating the centering. Special problems are met with in juvenile rheumatoid arthritis. A best possible reconstruction of the rotator cuff and the deltoid is mandatory, requiring good technical skill.

Adult↗
PubMed1982

Quantitation of cells secreting immunoglobulins after elution from rheumatoid synovial tissue.

Mononuclear cells (MNC) eluted from rheumatoid synovial tissue of 16 patients with rheumatoid arthritis were examined for immunoglobulin-secreting cells (ISC). Immediately after elution and separation synovial tissue MNC contained considerable numbers of ISC. IgG and IgA ISC were more abundant than IgM ISC. At the same time there were low numbers of ISC in blood. Synovial tissue ISC were lost during incubation with pokeweek mitogen (PWM), possibly because tissue MNC were already maximally triggered in vivo. This was in contrast to blood MNC, in which the number of ISC increased significantly during incubation with PWM.

Antibody-Producing Cells↗
PubMed1981

Inflammatory synovial tissue mononuclear cells release leucocyte migration inhibition factor in antigen- and mitogen-free cultures.

The presence of leucocyte migration inhibition factor (LIF) in supernatants from apparently antigen- and mitogen-free cultures of mononuclear cells (MNC) was studied. MNC were eluted from inflamed synovial tissue or isolated from blood. Untreated supernatants, supernatants in which any LIF had been inactivated, and culture medium were compared in their ability to affect the migration of homologous polymorphonuclear leucocytes. LIF was released by synovial tissue MNC from all of the 9 patients studied, consisting of 5 patients with rheumatoid arthritis, 2 with psoriatic arthropathy, and 2 with juvenile rheumatoid arthritis. Blood MNC of the patients and of 8 healthy blood donors did not release LIF. When synovial tissue MNC supernatants from 2 patients were examined, LIF activity increased as time of incubation was extended. In at least 2 synovial tissue MNC supernatants in which LIF had been inactivated a migration enhancement activity was revealed.

Adult↗