Isolated radial shaft fractures are more common than Galeazzi fractures

PURPOSE: In contrast to isolated diaphyseal fractures of the ulna (so-called night-stick fractures), isolated fractures of the radial diaphysis generally are expected to have associated injury of the distal radioulnar joint (DRUJ), the so-called Galeazzi fracture. This study retrospectively reviewed isolated fractures of the radial diaphysis in a large cohort of patients to determine how often such fractures occur without DRUJ injury METHODS: Thirty-six patients with fracture of the radius without fracture of the ulna were followed up for at least 6 months after injury. Injury of the DRUJ was defined as more than 5 mm of ulnar-positive variance on radiographs taken before any manipulative or surgical reduction. All of the fractures were treated with plate and screw fixation (8 with autogenous bone grafting) and all healed. Patients with DRUJ injury had either temporary pinning or immobilization of the DRUJ or surgical fixation of a large ulnar styloid fracture. Patients without DRUJ injury were mobilized within 2 weeks. RESULTS: Nine patients had dislocation of the DRUJ, 4 with large ulnar styloid fractures. Among the remaining 27 patients 1 had displacement of the proximal radioulnar joint noted after surgery, leading to a secondary procedure for radial head resection. The functional results were satisfactory or excellent in all but 2 patients with functional limitations related to central nervous system injury. No patient had DRUJ dysfunction at the final follow-up evaluation. CONCLUSIONS: Isolated fractures of the radial diaphysis are more common than true Galeazzi fractures. Surgeons should take great care not to overlook injury to the distal or proximal radioulnar joint in association with isolated diaphyseal fractures of the radius; however, fractures without identifiable radioulnar disruption can be treated without specific treatment of the DRUJ and with immediate mobilization. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.     

Microcatheter Looping to Facilitate Aneurysm Selection in Coil Embolization of Paraclinoid Aneurysms

ObjectiveDescribed herein is a microcatheter looping technique to facilitate aneurysm selection in paraclinoid aneurysms, which remains to be technically challenging due to the inherent complexity of regional anatomy.ResultsThrough this looping technique, a total of 59 paraclinoid aneurysms were successfully treated. After aneurysm selection as described, single microcatheter technique (n = 25) was most commonly used to facilitate coiling, followed by balloon protection (n = 21), stent protection (n = 7), multiple microcatheters (n = 3), and stent/balloon combination (n = 3). Satisfactory aneurysmal occlusion was achieved through coil embolization in 44 lesions (74.6%). During follow-up of 53 patients (mean interval, 10.9 ± 5.9 months), only one instance (1.9%) of major recanalization was observed. There were no complications related to microcatheter looping.ConclusionThis microcatheter looping method facilitates safe and effective positioning of microcatheter into domes of paraclinoid aneurysms during coil embolization when other traditional microcatheter selection methods otherwise fail.     

Production of Altered Cell Foci by 3-Methylcholanthrene in Mouse Cells Infected with AKR Leukemia Virus

This report describes altered cell foci observed 9-14 days after treatment with 3-methylcholanthrene of mouse-embryo tissue cultures that had previously been infected with wild-type AKR (RNA tumor) virus. The foci consisted of randomly oriented, piled-up, spindle-shaped cells. When heavily stained with Giemsa, the colonies of transformed cells were grossly visible and countable. Under the same experimental conditions, such changes of morphology were not detectable in the uninfected cells treated with 3-methylcholanthrene or in untreated cells infected with virus. The procedure may provide a rapid, quantitative test system for measurement of the oncogenic potential of certain carcinogens. As in similar previous studies in rat and hamster cells, the results suggest that the infectious, but nontransforming, RNA tumor viruses provided nascent oncogenic information, which when activated by 3-methylcholanthrene served as the specific genetic determinants of transformation.     

Radiofrequency thermal ablation of liver tumors.

Chemotherapy and radiation therapy are ineffective against primary and secondary malignant hepatic tumors. Surgical resection has been considered the only potentially curative option, but few patients with hepatic tumors are candidates for surgery. Recent results suggest that radiofrequency thermal ablation may be an effective, minimally invasive technique for treating malignant hepatic tumors. Sonography is the primary technique for guiding percutaneous ablative procedures. We review the current research and clinical experience with radiofrequency thermal ablation for treating malignant hepatic tumors.     

Primary malignant melanoma of the cervical spinal nerve root

The authors report on a case of primary malignant melanoma of the 7th cervical spinal nerve root in a 45-year-old woman. Neuro-radiological features of this extra-dural mass were suggestive of a nerve sheath tumor. The lesion underwent total gross resection through the anterolateral approach. The patient's postoperative course was uneventful. Histopathological investigation confirmed malignant melanoma. There was no evidence of tumor recurrence or other melanotic lesions on regular follow-up examinations until the postoperative eighth month. When treating a common, benign-looking lesion of the cervical spinal nerve root, surgeons should be aware of the potential to encounter such a malignant tumor.     

Fryns syndrome phenotype caused by chromosome microdeletions at 15q26.2 and 8p23.1

Background: Fryns syndrome (FS) is the commonest autosomal recessive syndrome in which congenital diaphragmatic hernia (CDH) is a cardinal feature. It has been estimated that 10% of patients with CDH have FS. The autosomal recessive inheritance in FS contrasts with the sporadic inheritance for the majority of patients with CDH and renders the correct diagnosis critical for accurate genetic counselling. The cause of FS is unknown. Methods: We have used array comparative genomic hybridisation (array CGH) to screen patients who have CDH and additional phenotypic anomalies consistent with FS for cryptic chromosome aberrations. Results: We present three probands who were previously diagnosed with FS who had submicroscopic chromosome deletions detected by array CGH after normal karyotyping with G-banded chromosome analysis. Two female infants were found to have microdeletions involving chromosome band 15q26.2 and one male had a deletion of chromosome band 8p23.1. Conclusions: We conclude that phenotypes similar to FS can be caused by submicroscopic chromosome deletions and that high resolution karyotyping, including array CGH if possible, should be performed prior to the diagnosis of FS to provide an accurate recurrence risk in patients with CDH and physical anomalies consistent with FS.     

Prevalence of primary immunodeficiency in Korea

This study represents the first epidemiological study based on the national registry of primary immunodeficiencies (PID) in Korea. Patient data were collected from 23 major hospitals. A total of 152 patients with PID (under 19 yr of age), who were observed from 2001 to 2005, have been entered in this registry. The period prevalence of PID in Korea in 2005 is 11.25 per million children. The following frequencies were found: antibody deficiencies, 53.3% (n = 81), phagocytic disorders, 28.9% (n = 44); combined immunodeficiencies, 13.2% (n = 20); and T cell deficiencies, 4.6% (n = 7). Congenital agammaglobulinemia (n = 21) and selective IgA deficiency (n = 21) were the most frequently reported antibody deficiency. Other reported deficiencies were common variable immunodeficiencies (n = 16), X-linked agammaglobulinemia (n = 15), IgG subclass deficiency (n = 4). Phagocytic disorder was mostly chronic granulomatous disease. A small number of patients with Wiskott-Aldrich syndrome, hyper-IgE syndrome, and severe combined immunodeficiency were also registered. Overall, the most common first manifestation was pneumonia. This study provides data that permit a more accurate estimation PID patients in Korea.     

Unrelated bone marrow transplantation with a reduced toxicity myeloablative conditioning regimen in Wiskott-Aldrich syndrome

Wiskott-Aldrich syndrome (WAS) is an X-linked congenital immune-deficiency syndrome, and bone marrow transplantation (BMT) has become a curative modality. However, the transplant with the alternative donor needed more intensive conditioning with increased treatment-related toxicities. Recently, fludarabine-based reduced toxicity myeloablative conditioning regimens have been developed for adult myeloid malignancies with promising results of good engraftment and low treatment-related toxicities. To increase the engraftment potential without serious complications, a boy with WAS received successful unrelated BMT with a reduced toxicity myeloablative conditioning regimen composed of fludarabine (40 mg/m2) on days -8, -7, -6, -5, -4, -3), busulfan (0.8 mg/kg i. v. q 6 hr on days -6, -5, -4, -3), and thymoglobulin (2.5 mg/kg on days -4, -3, -2). This novel conditioning regimen could improve the outcome of allogeneic transplantation for other non-malignant diseases such as congenital immune-deficiency syndromes or metabolic storage diseases.