Morphological analysis of the distal femur as a surgical reference in biplane distal femoral osteotomy.

Distal femoral osteotomy (DFO) is performed alone or with high tibial osteotomy (HTO) for patients with osteoarthritis and distal femur deformities. DFO is technically demanding, particularly when creating an anterior flange. Herein, we examined the morphological characteristics of the distal femur based on the cortical shape as a surgical reference for biplanar DFO. Computed tomography images of 50 valgus and 50 varus knees of patients who underwent biplanar DFO or total knee arthroplasty were analyzed. Axial slices at the initial level of the transverse osteotomy in the DFO and slices 10 mm proximal and 10 mm distal to that level were selected. The medial and lateral cortical angles and heights (MCLA, LCLA, MCH, and LCH) were measured on axial slices. Statistical comparisons were performed between the medial and lateral cortices and valgus and varus knees. MCLA and MCH were significantly smaller and lower, respectively, than LCLA and LCH (P < 0.01). The MCLA and MCH of varus knees were significantly smaller and lower, respectively, than those of valgus knees (P < 0.01). Surgeons should carefully observe morphological differences in the distal femur cortex, distinguishing between medial and lateral knees and varus and valgus knees during the creation of the anterior flange in the DFO.

Risk Factors for Adverse Events of Nanoliposomal Irinotecan Plus 5-Fluorouracil and L-leucovorin.

Background/Aim: The regimen with nanoliposomal irinotecan plus 5-fluorouracil and L-leucovorin (nal-IRI/FL) is used for metastatic pancreatic cancer. A clinical study has indicated that the uridine diphosphate-glucuronosyltransferase (UGT) 1A1 polymorphism is associated with neutropenia during nal-IRI/FL treatment; however, no studies have reported risk factors for the occurrence of adverse events in the clinical setting. This study aimed to explore the risk factors for adverse events of nal-IRI/FL. Patients and Methods: This study included patients with metastatic pancreatic cancer who started nal-IRI/FL treatment. Patient information, including laboratory data before nal-IRI/FL initiation and adverse events during nal-IRI/FL treatment, was retrospectively obtained from medical records. Results: This study consisted of 36 patients, including 16, 16, and 4 with UGT1A1*6 or *28 wild-type (-/-), heterozygous (+/-), and homozygous (+/+), respectively. Patients with UGT1A1*6 or *28 (+/+) exhibited significantly lower nadir counts of white blood cells (p=0.033) and neutrophils (p=0.043). Multiple regression analyses revealed that the decreased white blood cell count was significantly associated with the genotype of UGT1A1*6 or *28 (+/+) (p=0.009), high aspartate aminotransferase (AST) value before the therapy (p=0.019), and pancreatic head cancer (p=0.030). Also, the decreased neutrophil count was significantly related to the genotype of UGT1A1*6 or *28 (+/+) (p=0.017). Conclusion: Patients with UGT1A1*6 or *28 (+/+) should be especially concerned about neutropenia and leukopenia during nal-IRI/FL treatment. Additionally, high AST value and pancreatic head cancer may be risk factors for leukopenia during nal-IRI/FL treatment.

Humeral Shaft Non-union in a Patient with Osteogenesis Imperfecta Treated with Mandible Locking Plate Fixation: A Case Report.

INTRODUCTION: Osteogenesis imperfecta (OI) is a heritable disorder of connective tissue. Due to poor bone quality, patients with OI develop bone fracture and subsequent non-union at high rates. We report the rare case of humeral shaft non-union successfully treated by a locking plate used formandibular bone in a patient with OI. CASE REPORT: A 26-year-old man with Type III OI and a history of corrective osteotomy with Kirschner wire fixation of his right humerus at the age of 8 years developed gradually increasing pain in his humerus. He sustained humeral shaft non-union due to a broken Kirschner wire used in the previous operation and was referred to our hospital. He underwent internal fixation using an elastic nail with an iliac bone graft. However, 2 years after the operation, bony union was not achieved due to elastic nail breakage, and he complained of pain and activity limitation. He underwent re-operation for the humeral non-union using a locking plate to achieve rigid fixation. Because his humeral shaft was extremely narrow with severe deformity, we used a locking plate for the mandibular bone, which was contoured to fit the medial side of the humeral shaft. Bony union was achieved, the pain was relieved, and the patient returned to his pre-injury activity with no symptoms.4years after the operation, a new fracture line was found in radiographs of the distal part of the non-union. Bony union was achieved by conservative treatment. At present, the function has recovered. CONCLUSION: Humeral non-union in this patient with OI was successfully treated by a mandible locking plate. Although the optimal fixation device for fractures or non-unions in patients with OI has not yet been established, this plate could be a good treatment option for narrow and severely deformed bone.

Enhanced expression of glutathione S-transferase in the hippocampus following acute treatment with trimethyltin in vivo.

We investigated the effects of treatment with trimethyltin (TMT) on the expression of glutathione-related enzymes in mouse hippocampus. TMT promoted the expression of glutathione S-transferase (GST) Ya/Yc mRNA, and GSTA2 protein, but not that of glutamate-cysteine ligase catalytic subunit mRNA, 1 day after injection. TMT produced a slight but significant elevation of GST activity during the period from day 1 to 7 post-treatment. No significant change was seen in the activity of glutathione peroxidase at anytime post-TMT treatment. Our data suggest the prolonged elevation of GST activity in the hippocampus following TMT treatment through enhanced expression of the GST Ya/Yc.