Local Control of Soft Tissue and Bone Sarcomas.

Sarcomas of soft tissue and bone are mesenchymal malignancies that can arise in any anatomic location, most commonly the extremity, retroperitoneum, and trunk. Even for lower grade histologic subtypes, local recurrence can cause significant morbidity and even disease-related death. Although surgery remains the cornerstone of local control, perioperative radiation and systemic therapy are often important adjuvants. This review will summarize the current therapeutic approaches for local control of soft tissue and bone sarcomas.

The influence of electromagnetic radiation generated by a mobile phone on the skeletal system of rats.

The study was focused on the influence of electromagnetic field generated by mobile phone on the skeletal system of rats, assessed by measuring the macrometric parameters of bones, mechanical properties of long bones, calcium and phosphorus content in bones, and the concentration of osteogenesis (osteocalcin) and bone resorption (NTX, pyridinoline) markers in blood serum. The study was carried out on male rats divided into two groups: experimental group subjected to 28-day cycle of exposures in electromagnetic field of 900 MHz frequency generated by mobile phone and a control, sham-exposed one. The mobile phone-generated electromagnetic field did not influence the macrometric parameters of long bones and L4 vertebra, it altered mechanical properties of bones (stress and energy at maximum bending force, stress at fracture), it decreased the content of calcium in long bones and L4 vertebra, and it altered the concentration of osteogenesis and bone resorption markers in rats. On the basis of obtained results, it was concluded that electromagnetic field generated by 900 MHz mobile phone does not have a direct impact on macrometric parameters of bones; however, it alters the processes of bone mineralization and the intensity of bone turnover processes and thus influences the mechanical strength of bones.

A systematic review of selected musculoskeletal late effects in survivors of childhood cancer.

Survivors of childhood cancer are at risk for treatment-related musculoskeletal late effects. Early detection and orthopedic intervention can help ameliorate musculoskeletal late effects and prevent subsequent complications. This systematic review summarizes the literature describing associations between cancer, its treatment, and musculoskeletal late effects. We searched PubMed and Web of Science for English language articles published between January 1970 and December 2012. The search was limited to investigations with at least 15 participants and conducted at least 2 years after completion of therapy for childhood, adolescent, or young adult cancer. Some late skeletal effects, including low bone mineral density, osteonecrosis, slipped capital femoral epiphyses, oncogenic rickets, and hormonerelated growth disturbances have been previously reviewed and were excluded, as were outcomes following amputation and limb-salvage procedures. Of 2347 references identified, 30 met inclusion criteria and were retained. An additional 54 studies that met inclusion criteria were found in reference lists of retained studies. Of 84 studies, 60 focused on associations between radiotherapy, six between chemotherapy, and 18 between surgery and musculoskeletal late effects. We found that younger age, higher radiation dosage, and asymmetric or partial bone radiation volume influences the effects of radiation on the musculoskeletal system. Methotrexate and vincristine are associated with long-term muscular strength and flexibility deficits. Laminectomy and chest wall resection are associated with spinal malalignment, and enucleation is associated with orbital deformities among survivors. Radiotherapy, chemotherapy, and surgery are associated with musculoskeletal late effects independently and additively. Associations are additionally influenced by host and treatment characteristics.

Advantages and limitations of imaging the musculoskeletal system by conventional radiological, radionuclide, and hybrid modalities.

The endpoint of an efficient and accurate diagnosis of musculoskeletal pathology can take many different routes. Currently, conventional radiological techniques, such as plain radiography, ultrasonography, computed tomography, and magnetic resonance imaging are used in the assessment of patients with benign and malignant bone disease. An understanding of the advantages and limitations of the modalities available will help expedite diagnosis, and hence treatment. In this review, we discuss the advantages and limitations of the modalities available in investigating benign and malignant musculoskeletal pathology.

Radiation exposure from musculoskeletal computerized tomographic scans.

BACKGROUND: Computerized tomographic scans are routinely obtained to evaluate a number of musculoskeletal conditions. However, since computerized tomographic scans expose patients to the greatest amounts of radiation of all imaging modalities, the physician must be cognizant of the effective doses of radiation that are administered. This investigation was performed to quantify the effective doses of computerized tomographic scans that are performed for various musculoskeletal applications. METHODS: The digital imaging archive of a single institution was retrospectively reviewed to identify helical computerized tomographic scans that were completed to visualize the extremities or spine. Imaging parameters were recorded for each examination, and dosimetry calculator software was used to calculate the effective dose values according to a modified protocol derived from publication SR250 of the National Radiological Protection Board of the United Kingdom. Computerized tomographic scans of the chest, abdomen, and pelvis were also collected, and the effective doses were compared with those reported by prior groups in order to validate the results of the current study. RESULTS: The mean effective doses for computerized tomographic scans of the chest, abdomen, and pelvis (5.27, 4.95, and 4.85 mSv, respectively) were consistent with those of previous investigations. The highest mean effective doses were recorded for studies evaluating the spine (4.36, 17.99, and 19.15 mSv for the cervical, thoracic, and lumbar spines, respectively). In the upper extremity, the effective dose of a computerized tomographic scan of the shoulder (2.06 mSv) was higher than those of the elbow (0.14 mSv) and wrist (0.03 mSv). Similarly, the effective dose of a hip scan (3.09 mSv) was significantly higher than those observed with knee (0.16 mSv) and ankle (0.07 mSv) scans. CONCLUSIONS: Computerized tomographic scans of the axial and appendicular skeleton are associated with substantially elevated radiation exposures, but the effective dose declines substantially for anatomic structures that are further away from the torso.

Selective loss of unmyelinated nerve fibers after extracorporeal shockwave application to the musculoskeletal system.

Application of extracorporeal shockwaves (ESW) to the musculoskeletal system may induce long-term analgesia in the treatment of chronic tendinopathies of the shoulder, heel and elbow. However, the molecular and cellular mechanisms behind this phenomenon are largely unknown. Here we tested the hypothesis that long-term analgesia caused by ESW is due to selective loss of nerve fibers in peripheral nerves. To test this hypothesis in vivo, high-energy ESW were applied to the ventral side of the right distal femur of rabbits. After 6 weeks, the femoral and sciatic nerves were investigated at the light and electron microscopic level. Application of ESW resulted in a selective, substantial loss of unmyelinated nerve fibers within the femoral nerve of the treated hind limb, whereas the sciatic nerve of the treated hind limb remained unaffected. These data might indicate that alleviation of chronic pain by selective partial denervation may play an important role in the effects of clinical ESW application to the musculoskeletal system.

Neuromuscular electrical stimulation of completely paralyzed abdominal muscles in spinal cord-injured patients: a pilot study.

STUDY DESIGN: Prospective placebo-controlled. OBJECTIVE: The effect of abdominal neuromuscular electrical stimulation (NMES) in patients with spinal cord injury. The principal parameters observed in this study are lung capacity, colonic transit, patient satisfaction of used method and of aesthetics effect on abdominal wall. SETTINGS: Centre de Traumatologie et de Réadaptation, Brussels, Belgium. METHODS: A total of 10 volunteers participated in this study and were assigned to two groups-the effective electrical stimulation group (ESG) and the placebo-controlled group (PG). NMES of abdominal muscles was performed 25 min per day for 8 weeks. RESULTS: NMES significantly decreased forced vital capacity (FVC) in ESG but not in PG. In ESG, colonic transit was accelerated in ascending, transverse and descending colon but transit in rectosigmoideum was not affected. In PG, no variations in colonic transit were observed. Satisfaction scale shows a better influence on aesthetics effect in ESG than in PG. CONCLUSION: This pilot study shows that NMES of paralyzed abdominal muscles positively affects colonic transit except in rectosigmoideum segment and negatively affects FVC. It could be a simple self-used method to regulate colonic transfer with considerably good cosmetic effect on abdominal wall. However, regular verification of FVC will probably be necessary.

Neuromuscular electrical stimulation induced forelimb movement in a rodent model.

Upper extremity neuromuscular electrical stimulation (FNS) has long been utilized as a neuroprosthesis to restore hand-grasp function in individuals with neurological disorders and injuries. More recently, electrical stimulation is being used as a rehabilitative therapy to tap into central nervous system plasticity. Here, we present initial development of a rodent model for neuromuscular stimulation induced forelimb movement that can be used as a platform to investigate stimulation-induced plasticity. The motor points for flexors and extensors of the shoulder, elbow, and digits were identified and implanted with custom-built stimulation electrodes. The strength-duration curves were determined and from these curves the appropriate stimulation parameters required to produce consistent isolated contraction of each muscle with adequate joint movement were determined. Using these parameters and previous locomotor EMG data, stimulation was performed on each joint muscle pair to produce reciprocal flexion/extension movements in the shoulder, elbow, and digits, while 3D joint kinematics were assessed. Additionally, co-stimulation of multiple muscles across multiple forelimb joints was performed to produce stable multi-joint movements similar to those observed during reach-grasp-release movements. Future work will utilize this model to investigate the efficacy and underlying mechanisms of forelimb neuromuscular stimulation therapy to promote recovery and plasticity after neural injury in rodents.

A comparison of skeletal chord-length distributions in the adult male.

In radiation protection, skeletal dose estimates are required for the tissues of the hematopoietically active bone marrow and the osteogenic cells of the trabecular and cortical endosteum. Similarly, skeletal radiation dose estimates are required in therapy nuclear medicine in order to develop dose-response functions for myelotoxicity where active bone marrow is generally the dose-limiting organ in cancer radioimmunotherapy. At the present time, skeletal dose models in both radiation protection and medical dosimetry are fundamentally reliant on a single set of chord-length distribution measurements performed at the University of Leeds in the late 1970's for a 44-y-old male subject. These distributions describe the relative frequency at which linear pathlengths are seen across both the marrow cavities and bone trabeculae in seven individual bone sites: vertebrae (cervical and lumbar), proximal femur (head and neck), ribs, cranium (parietal bone), and pelvis (iliac crest). In the present study, we present an alternative set of chord-length distribution data acquired within a total of 14 skeletal sites of a 66-y-old male subject. The University of Florida (UF) distributions are assembled via 3D image processing of microCT scans of physical sections of trabecular spongiosa at each skeletal site. In addition, a tri-linear interpolation Marching Cube algorithm is employed to smooth the digital surfaces of the bone trabeculae while chord-length measurements are performed. A review of mean chord lengths indicate that larger marrow cavities are noted on average in the UF individual for the cervical vertebrae (1,038 vs. 910 microm), lumbar vertebrae (1,479 vs. 1,233 microm), ilium (1,508 vs. 904 microm), and parietal bone (812 vs. 389 microm), while smaller marrow cavities are noted in the UF individual for the femoral head (1,043 microm vs. 1,157 microm), the femoral neck (1,454 microm vs. 1,655 microm), and the ribs (1,630 microm vs. 1,703 microm). The mean chord-lengths for the bone trabeculae show close agreement for both individuals in the ilium (approximately 240 microm) and cervical vertebrae (approximately 280 microm). Thicker trabeculae were seen on average in the UF individual for the femoral head (ratio of 1.50), femoral neck (ratio of 1.10), lumbar vertebrae (ratio of 1.29), and ribs (ratio of 1.14), while thinner trabeculae were seen on average in the UF individual for the parietal bone of the cranium (ratio of 0.92). In two bone sites, prominent discrepancies in chord distribution shape were noted between the Leeds 44-y-old male and the UF 66-y-old male: (1) the bone trabeculae in the ribs, and (2) the marrow cavities and bone trabeculae within the cranium.

Monte Carlo investigations of distance-dependent effects on energy deposition in K-shell x-ray fluorescence bone lead measurement.

Radiation energy deposition results are presented from a Monte Carlo code simulating the lower part of a leg during an in vivo 109Cd K-shell x-ray fluorescence (KXRF) bone lead measurement. The simulations were run for a leg phantom model representing an adult subject, assuming concentrations of 10 microg Pb per gram bone mineral and tracing 500 million photons in each simulation. Trials were performed over a range (0.5-6.0 cm) of source-to-sample (S-S) distances. Energies deposited due to Compton and photoelectric processes occurring in the bone and the soft tissue were obtained. The data show an increase in the amount of energy deposited in the bone as the sample is moved closer to the source (from 2.0 cm to 0.5 cm). However, there is a decrease in the amount of energy deposited in the soft tissue as the sample is moved closer to the source over the same distance interval. In decreasing the S-S distance from 2.0 cm to 0.5 cm, the amount of energy deposited in the sample as a whole was found to increase by 11%. By calculating the energy deposition in the bone and in the soft tissue as a fraction of the total energy deposited in the sample, the corresponding changes are quantified as a function of S-S distance. Similarly, the proportions of energy deposited via the photoelectric effect and Compton scattering are presented as a function of S-S distance.

Feasibility of combining multi-channel functional neuromuscular stimulation with weight-supported treadmill training.

More than 3 million stroke survivors live with residual disabilities and mobility deficits even after rehabilitation. Therefore, it is important to develop new, more effective, gait training methods. The purpose of this study was twofold: (1) testing the feasibility of combining multi-channel functional neuromuscular stimulation (FNS) using intramuscular (IM) electrodes and body weight supported treadmill training (BWSTT) for gait training; and (2) documenting the potential gait practice advantages afforded by combining FNS-IM and BWSTT. Eight subjects with gait deficits in the chronic phase (>12 months) were enrolled. Intramuscular electrodes were placed in the paretic hip abductors, knee flexors and extensors, and ankle dorsiflexors, plantarflexors, and evertors. Subjects were treated with exercise and gait training using the combined technologies 1 1/2 h/week, four times/week, for 12 weeks. Feasibility was tested according to performance of the technologies, clinician skill factors, and subject satisfaction. Impairment, function, and quality of life were measured. Provision of practice for eight gait characteristics was catalogued. We found the following results for the combined technologies: (1) the combined technologies were safe and feasible; (2) clinicians required five training sessions to reach proficiency; (3) subjects were satisfied; (4) there were significant gains in impairment and functional measures; (5) a greater number of gait practice characteristics were provided with the combined technologies than with either alone.

Normal tissue tolerance to intraoperative radiotherapy.

Much experimental evidence has been accumulated assessing the tolerance of various tissues to IORT, and much of the tolerance data have resulted from the use of canine models. Guidelines of IORT tissue tolerance established in experimental models have been used in the clinical application of IORT at numerous institutions. Although the radiotolerance of differing tissues can vary among species, sufficient clinical experience has accumulated to validate the canine tissue tolerance model as representative of human tissue responses to IORT. Cellular effects from radiation principally stem from direct damage to DNA, and thus proliferating tissues are among the most radiosensitive, with arrested or abnormal cell division. These tissues can manifest striking early toxicity, reflecting the rate of cell division that is affected by the radiation. Irradiation of nonproliferating or slowly proliferating tissues may show little or no early toxicity, but late effects can be manifested to considerable and varying degrees. In much of this late toxicity, pathologic changes develop from progressive ischemia, brought about by the gradual obliteration of small blood vessels. Irradiated endothelium often becomes replaced by a thickened fibrous layer, which, in small vessels, leads to occlusion and ischemic necrotic changes in the supplied tissue. In larger vessels, fibrosis can lead to wall weakening and aneurysmal dilatation, rupture, or thrombosis. The common denominator, then, of radiation damage to many tissues is related to vascular effects. Although the tolerance to IORT-induced toxicity can vary considerably among tissues, doses ranging to 25 Gy can generally be tolerated without significant toxicity. Vital areas where IORT dose must be carefully monitored include critical vasculature, gastrointestinal viscera, ureter, significant motor or sensory nerve trunks, and central nervous system structures. Higher doses can generally be delivered safely to anatomic areas at risk for tumor that are at a distance from sensitive organs or tissues. The general principle providing the rationale of IORT should always be practiced: maximize the radiation dose to the tumor and tumor-harboring tissues while minimizing dose exposure to surrounding normal tissues.

[A century of progress in the knowledge and treatment of nephroblastoma]. / Un siècle de progrès dans la connaissance et le traitement du néphroblastome.

Since its initial description by Max Wilms over a century ago, nephroblastoma has benefited from considerable improvements both in terms of basic knowledge about it and management of it. Today, the majority of these very young patients can expect a long-term survival in excess of 90% at the price of a light therapy that combines surgical resection, chemotherapy based on ill-toxic agents, and in selected cases, radiotherapy of remarkably low toxicity. The contribution of large international studies will be emphasized here.

Effects of pediatric cancer therapy on the musculoskeletal system.

This review discusses the effects of treatment of pediatric malignancies on the musculoskeletal system with an emphasis on plain radiographic and MR imaging findings following radiation therapy, chemotherapy, bone marrow transplantation and hematopoietic growth factor administration.

[The immediate and late results of radiation effects on the occurrence of congenital defects in the locomotor apparatus based on screening data on newborns in the maternity hospitals of the city of Kiev]. / Blyz'ki i viddaleni rezul'taty radiatsiinoho vplyvu na vynyknennia vrodzhenykh vad oporno-rukhovoho aparatu za materialamy skryninhu novonarodzhenykh u polohovykh budynkakh m. Kyieva.

On the basis of screening of 15939 newborns at the maternity homes of Kiev after the accident at the Chernobyl atomic station it was found that the number of children with congenital malformation of the locomotor apparatus in 1991-1992 increased by 28.7% as compared with the data of the first postaccident years (1986-1987). Congenital pathology of the hip joint (dysplasia in average 23.5 per 1000 births, hip dislocation 3.6:1000) and foot deformity (7.9:1000) had the highest incidence with a tendency to increase at the latest years.

Discussion of the combined effect of weightlessness and ionizing radiation on the mammalian body: morphological data.

The combined effect of weightlessness and ionizing radiation, from the Cs137 source at 800 rads for 24 h, on the animal body was studied. The morphological examination of organs and tissues of rats flown aboard the biosatellite Cosmos-690, kept in the ground-based simulation experiment, and kept in the vivarium, indicated prevalence of radiation-induced changes in both experimental groups of rats. An exposure of animals to space flight factors did not produce a substantial aggravation of radiation-induced effects. This is indicated by the lack of significant differences in the weight of testes, thymus, and spleen of flight and simulation rats. However, this exposure affected adversely the development of reparative processes in the hemopoietic tissue of bone marrow. Inflight irradiation aggravated weightlessness-induced changes. A combined effect of weightlessness and irradiation did not result in the summation of the effects exerted on skeletal muscles by either factor alone.