Surgical repair of the distal biceps brachii tendon: a comparative study of three surgical fixation techniques.

PURPOSE: Several fixation techniques exist to repair the distal biceps brachii tendon. We aimed to evaluate the clinical and functional outcomes after distal biceps tendon repair using three different fixation techniques. METHODS: A total of 54 patients were included in the study and were available for follow-up (mean, 30.7 months; SD 18.6). Surgery was performed using a single-incision approach with Corkscrews or Mitek suture anchors or with a two-incision exposure using transosseous sutures. The patients were evaluated with range of motion (ROM) measurements for flection/extension and pronation/supination as well as Disabilities of Arm Shoulder and Hand (DASH) scores. Furthermore, the duration of surgery and the length of hospital stay as well as the complication rate were analyzed. RESULTS: Fifty-four out of 73 patients were available after a mean follow-up time of 30.7 months (SD 18.6) for clinical evaluation. There was no statistical significant difference between the three groups comparing the mean DASH score, the length of hospital stay, the duration of surgery, or the ROM. The most common complication was neurapraxia, with 6 cases. All 3 reruptures were registered in the Mitek anchors group. Two patients in the Mitek anchors group required an open arthrolysis due to stiffness of the elbow. CONCLUSIONS: In summary, we achieved good clinical and functional results after surgical repair of the distal biceps tendon using Corkscrews, Mitek anchors, or transosseous sutures. The results conferred by Corkscrews were comparable to the other techniques, justifying their use.

Aneurysmal bone cyst of the spine in an adolescent: a case report.

Aneurysmal bone cysts are often localized in long bones of the lower extremity and are characterized by aggressive expansion with local destruction of bone. We present the case of a 14-year-old female patient with a two weeks history of low dorsal pain. Computerized tomography (CT) scan of the spine showed local destruction of the 10th thoracic vertebra and magnetic resonance imaging (MRI) revealed a 50 percent compression of the spinal cord. The partly septated and partly solid cystic tumour in the 10th thoracic vertebra was resected and a dorsal spondylodesis stabilised the thoracic spine. Aneurysmal bone cyst should be considered in the differential diagnosis of unspecific pain of the spine. Follow-up examinations after three, five and twelve months did not show signs of recurrence.

Osteogenic differentiation of human mesenchymal stromal cells is promoted by a leukocytes containing fibrin matrix.

PURPOSE: Mesenchymal stem cells (multipotent human mesenchymal stromal cells, MSC) are currently the most promising cell type for regenerative medicine. For a clinical approach, it is necessary to develop and establish methods for expansion, differentiation, and delivery. METHODS: A completely autologous plasma clot containing peripheral blood mononuclear cells (PBMC) was tested for the osteopromotive activity towards expanded human mesenchymal stem cells in vitro. The plasma clot was prepared from anticoagulated blood plasma after addition of isolated leukocytes and calcium chloride. Plasma clots after the gelation were added to subconfluently growing MSC or used in a transwell system. Cell proliferation, the activity of alkaline phosphatase, the release of osteoprotegerin, C-terminal procollagen peptide, as well as osteocalcin, the analysis of matrix mineralization as well as bone nodule formation were analyzed up to 3 weeks. RESULTS: In contrast to plasma clots with no exogenously added leukocytes, the presence of PBMC within the plasma clot significantly promoted osteogenic differentiation of MSC correlated to the time period of incubation. Proliferation of MSC was decreased at maximal mineralization time points. In addition, the osteopromotive activity was identified as soluble factor/factors by transwell assay system. There was a decrease in osteoprotegerin when the cells were cultured in the presence of plasma clots compared to control cell cultures without plasma clots. The osteocalcin expression was continuously higher after culture in the presence of plasma clots and significantly higher after 2- and 3-week after culture in the presence of leukocyte-containing plasma clots compared to 1-week cell culture. Differences in the concentration of the C-terminal procollagen peptide were not measured. CONCLUSIONS: The direct inoculation of an autologous mononuclear cell fraction (which contains leukocytes and MSC), e.g., isolated from a bone marrow aspirate or a different source into an autologous plasma gel, may be a further new strategy for bone fracture therapy.

Microvascular response to calcium phosphate bone substitutes: an intravital microscopy analysis.

OBJECTIVES: The purpose was to evaluate inflammatory and microcirculatory reactions after implantation of various calcium phosphate bone substitutes in an in vivo model. METHODS: Calcium phosphate-based bone substitutes were implanted in dorsal skinfold chambers of mice. Intravital fluorescence microscopy was performed to measure inflammatory and microcirculatory reactions based on functional vessel density (FVD), capillary leakage, and relative white blood cell velocity (rWBCV). RESULTS: An increase of FVD was observed in all groups and the capillary leakage grew with a level of significance (p < 0.001). The fraction of rolling and sticking leukocytes (rWBCV) was highest at the beginning of the trial and decreased during the course. CONCLUSIONS: There are differences in microvascular soft tissue reactions between various calcium phosphate bone substitutes, but inflammatory reactions were moderate, and the results revealed no reasons which explain the sporadic failure of the tested substances under clinical conditions.

Systemic IL-17 after severe injuries.

IL-17 is a cytokine produced by a newly identified T-cell subpopulation (THl7/THIL-17). It is a central mediator in inflammatory processes that connects T-cell stimulation with neutrophil mobilization. The role of IL-17 in the immune dysfunction after polytrauma is still not clarified. In a retrospective study, the systemic concentration of IL-17 and IL-6 of 71 polytraumatized patients were analyzed daily by enzyme-linked immunosorbent assay. The patients' collective consist of 55 men and 16 women (43 +/- 16 years; injury severity score, 33 +/- 13). In only 6% of the patients, an increase in systemic IL-17 was detected. In most patients (94%), no systemic IL-17 was detectable or the IL-17 concentrations in plasma were in the range of the healthy donor group. To identify a possible role of systemic IL-17 in the posttraumatic phase, the patients were divided into two groups. Group A (47 men, 15 women) consists of patients with IL-17 concentrations in the range of normal healthy donors. Group B (8 men, 1 woman) consists of patients with elevated (>45 pg ml(-1) on at least 3 consecutive days) systemic IL-17 concentrations. Three patients in group B showed highly increased systemic IL-17 concentrations (median, >200 pg mL(-1)). These patients were male and showed all blunt chest and abdominal trauma with lung contusion and pneumohemothorax. However, there was no conformity in other injury patterns, injury severity score, age, outcome, intensive care period, or clinical complications. After a period of 4 years, we were able to obtain a new blood sample from one patient with high IL-17 level. The systemic IL-17 value of this former patient was now less than the detection limit. However, stimulation of peripheral blood mononuclear cells from thlise patient revealed elevated numbers of cells with the capacity to produce IL-17 as determined by enzyme-linked immuno spot assay and flow cytometry compared with peripheral blood mononuclear cells obtained from current polytrauma patients and healthy donors. In conclusion, IL-17 is not suitable as a pathophysiological or predictive marker after polytrauma. Whether highly increased systemic IL-17 concentrations detected in single patients are due to individually increased numbers of TH17 cells as we have demonstrated with one rerecruited patient has to be further analyzed.

Elevated systemic interleukin-18 in multiple injured patients is not related to clinical outcome.

Interleukin-18 (IL-18) is a pleiotropic proinflammatory cytokine with the ability to induce interferon-gamma production in T-helper cells type 1 and natural killer cells. To investigate the role of IL-18 after severe trauma we measured plasma levels of IL-18 in 229 multiple injured patients [mean age of 39 +/- 16 (range 11-81) years, injury severity score (ISS) of 31 +/- 10 (range 16-66) points; 55 women and 174 men] and correlated these with demographics, clinical course, and routine laboratory parameters. IL-18 plasma levels were significantly increased in polytraumatized patients compared to healthy donors (p < 0.001). Survivors presented significantly (p < 0.05) higher IL-18 plasma median values (n = 193, median 98 pg/mL) compared to nonsurvivors (n = 36, median 63 pg/mL). Patients >60 years old (n = 35) had significantly lower plasma levels of IL-18 (median 45 pg/mL) compared to younger ones (n = 194, median 92 pg/mL). In the subgroup of nonsurvivors (n = 12) elderly patients had the lowest plasma levels of IL-18 (median 45 pg/mL). Patients with an ISS >25 had significant higher IL-18 plasma levels compared to the group with an ISS

Polypoid pleomorphic sarcoma of the colon.

In contrast to common colonic epithelial neoplasms, polypoid mesenchymal tumors of the colon are extremely rare. The majority of uncommon gastrointestinal mesenchymal tumors are associated with the so-called gastrointestinal stromal tumors (GIST). We present a case of a rare colonic pleomorphic sarcoma, macroscopically mimicking a common epithelial colonic polyp, which did not match the criteria of GIST. In this case report we discuss the clinical and pathological characteristics of a rare polypoid-shaped, pleomorphic colonic sarcoma and refer a mark-off to other rare mesenchymal neoplasms of the gut.