Proximal row carpectomy for open fracture-dislocation of the carpus

A severe carpal fracture dislocation is described and the alternatives of management are discussed. A method of treatment, that is, proximal row carpectomy, is described based on a review of applicable literature.     

Review of the brachial plexus. Part II: Reconstruction after chronic upper plexus injuries

Chronic and complete, brachial plexus injuries are a burden for society and the patient. A literature review reveals the different options in treating upper plexus deficits. Analysis of early, and more recent, results is provided with an emphasis placed on the more reliable procedures to date.     

Interaction of clodronate with fibroblast growth factor 2 reduces FGF2-activity in endothelial cells

Stabilization of fibroblast growth factors from heat denaturation and proteolytic digestion by bound heparin and heparan sulphate proteoglycans is known for more than 20 years. Furthermore, ATP-binding to FGF2 also leads to stabilization of this growth factor as discovered recently. The physiological importance of this protection is not yet clear but has become the focal point of interest. In this study we used the method of stabilizing FGF2 from proteolytic degradation to identify some bisphosphonates, namely clodronate and etidronate, which interact with FGF2. These two bisphoshonates protect FGF2 from tryptic digestion in vitro. The circular dichroism spectrum of FGF2 incubated with clodronate was significantly shifted compared to the spectrum of non-treated FGF2 indicating a conformational change of the protein after clodronate-binding. Additionally, clodronate and etidronate at low μM concentrations induce a concentration-dependent reduction of FGF2-induced cell proliferation of human umbilical vein endothelial cells. In contrast, proliferation of these cells after addition of clodronate and etidronate without FGF2 was not influenced by these bisphosphonates. Furthermore, the intracellular signaling via ERK1/2 and AKT was inhibited by clodronate and the tube formation, indicating the beginning process of angiogenesis, was reduced. Our results show for the first time that bisphosphonates I) interact with FGF2, II) reduce FGF2-activity and III) decrease the angiogenic potential of this growth factor.     

Human immune cells' behavior and survival under bioenergetically restricted conditions in an in vitro fracture hematoma model

The initial inflammatory phase of bone fracture healing represents a critical step for the outcome of the healing process. However, both the mechanisms initiating this inflammatory phase and the function of immune cells present at the fracture site are poorly understood. In order to study the early events within a fracture hematoma, we established an in vitro fracture hematoma model: we cultured hematomas forming during an osteotomy (artificial bone fracture) of the femur during total hip arthroplasty (THA) in vitro under bioenergetically controlled conditions. This model allowed us to monitor immune cell populations, cell survival and cytokine expression during the early phase following a fracture. Moreover, this model enabled us to change the bioenergetical conditions in order to mimic the in vivo situation, which is assumed to be characterized by hypoxia and restricted amounts of nutrients. Using this model, we found that immune cells adapt to hypoxia via the expression of angiogenic factors, chemoattractants and pro-inflammatory molecules. In addition, combined restriction of oxygen and nutrient supply enhanced the selective survival of lymphocytes in comparison with that of myeloid derived cells (i.e., neutrophils). Of note, non-restricted bioenergetical conditions did not show any similar effects regarding cytokine expression and/or different survival rates of immune cell subsets. In conclusion, we found that the bioenergetical conditions are among the crucial factors inducing the initial inflammatory phase of fracture healing and are thus a critical step for influencing survival and function of immune cells in the early fracture hematoma.     

Awareness,concern, and communication between physicians and patients on bone health in cancer

Purpose

This study aims to explore physician–patient communications about bone metastases and cancer treatment-induced bone loss (CTIBL).

Methods

The study utilizes online survey of patients with breast cancer, prostate cancer, and multiple myeloma, and the physicians who treat them.

Results

Even though 69 and 48 % of patients with nonmetastatic breast and prostate cancer aware of treatment-induced bone loss, only 39 and 23 %, respectively, were concerned about bone loss. Yet, 62 and 71 % of oncologists treating breast and prostate cancer felt that their patients were concerned. Among patients with metastatic breast and prostate cancer, two thirds had not discussed treatment for bone metastases with their doctor; when discussed, 88 and 91 % of discussions were initiated by the doctor, usually prior to initiating treatment. Most myeloma patients (77 %) had discussed treatment options with their physicians; 99 % of hematologists reported discussing treatment of bone disease with patients.

Conclusions

Physicians are primary sources of information to patients regarding bone health. There is a gap between what physicians assume their patients know about bone health and the patients’ perceptions, presenting a need for systematic awareness and education.     

Review of the brachial plexus. Part I: Acute injuries

Acute injuries of the brachial plexus are open or closed, and occur by compression, traction, sharp laceration, or missile injuries. Following initial resuscitation, a proper evaluation and treatment plan must be formulated. A review of the literature showed an obvious trend away from conservative treatment of many brachial plexus lesion toward an early, aggressive surgical approach to these injuries. An extensive literature review also provided the opportunity to devise a rational classification of brachial plexus injuries, which allows for a treatment regimen that reflects the trend of the recent literature.     

Delayed diagnosis in non-union of the body of the hamate: a case report

Fractures of the body of the hamate are uncommon. We report a case with symptomatic non-union in which the diagnosis was not made until oblique pronated radiographs were taken.     

Reproduction Study of Dimethylacetamide following Inhalation in the Rat

Reproduction Study of Dimethylacetamide following Inhalationin the Rat. Ferenz, R. L., and Kennedy, G. L., Jr. (1986). Fundam.Appl Toxicol. 7, 132-137. Groups of 10 male and 20 female Crl:CD(SD)BRrats were exposed to vapors of dimethylacetamide (DMAC) at concentrationsof 0 (control), 30, 100, or 300 ppm. Exposures were conductedfor 6 hr/day, 5 days/week for 10 weeks (prebreeding), then 7days/week for 7 to 8 weeks (through breeding, gestation, andlactation). The exposure period was interrupted for female ratsbetween gestation Day 21 and postpartum Day 4. No compound-relatedeffects on body weight, survival, or clinical signs were detectedin parental rats. Liver weight to body weight ratios were increasedin groups where both males and females were exposed to 300 ppmbut not in groups where only males or only females were exposedto 300 ppm. No significant differences were observed betweencontrol and test rats with respect to mating performance, fertility,length of gestation, progeny numbers, structure, and viability.At 21 days postpartum, pups derived from matings involving exposureof both sexes to 300 ppm or exposure of parental females to300 ppm had lower body weights than did the controls. Grosspathologic examination of representative pups and evaluationof liver and gonad weight data did not reveal any DMAC-relatedchanges. It is concluded that reproduction in rats was not alteredby repeated inhalation exposure to up to 300 ppm DMAC.     

Sepsis due to an infected pseudocyst of hemophilia. A case report

A 42-year-old Factor-VIII-deficient hemophiliac developed an infected pseudocyst and subsequent clostridial sepsis. Wide surgical debridement and precise medical management provided for survival in this patient's case. The treatment of choice for this rarely encountered problem was radical excisional surgery along with antibiotics and replenishment of all necessary blood products.