Giant cell tumor of the capitate: an unusual case with 10 years follow-up.

Giant cell tumor of the small bones, particularly the carpal bones of the hand, is exceedingly rare. We present a case report of giant cell tumor of the capitate in a 24 year-old female with 10 years postoperative follow-up. Although carpal bones are extremely unusual location, orthopedic surgeons should always keep in mind that differential diagnosis must include giant cell tumor of bone whenever an expansile osteolytic lesion with well-defined but nonsclerotic margins is identified in a young adult with closed physes.

May bone cement be used to treat benign aggressive bone tumors of the feet with confidence?

Using bone cement for the reconstruction of defects created after curettage of benign aggressive bone tumors is among acceptable methods. The study aimed to assess the effect of bone cement used in aggressive bone tumors in the feet on the function of the feet. Five patients were reviewed. They were treated between 2004 and 2010. Three cases were female and two male. Their age ranged from 16 to 55 with an average of 34.8. Follow up period ranged from 14 to 86 months with an average of 34. Two cases were giant cell tumor of bone located in calcaneus and 3 were solid variant aneurysmal bone cyst located in talus, navicular and first proximal phalanx. None had any previous treatment. A biopsy was done in all cases. Treatment was curettage, high speed burring (except phalanx case), and filling the cavity with bone cement. The case located in talus recurred and re-operated 1 year later doing the same procedure. Final evaluation included physical examination, X-ray and Maryland Foot Score. No recurrence was present in the final evaluation. No problems were detected related to bone cement. Maryland Foot Scores ranged 84-100, average of 94. Cement integrity was not disturbed. The procedure is found not to effect foot functions adversely.

The influence of aetiology of hip instability on the results of pelvic support osteotomy.

Pelvic support osteotomy and femoral lengthening are sometimes employed in cases of hip instability. We assessed the efficacy of surgery following sepsis and congenital dislocation in relation to functional results. Between March 2005 and May 2007 we performed pelvic support osteotomy and femoral lengthening for 21 hips in 20 patients. Preceding pathology included congenital dislocation in 13 hips (12 patients) and sequelae of sepsis in 8 hips. All surgical procedures were performed as described by Ilizarov. The mean follow-up period was 33.5 months. There was no significant difference between the final Harris Hip Scores of the 2 groups. The number of patients with persisting abductor weakness was similar between the 2 groups. Complications were more frequent following congenital dislocation, and additional physiotherapy to restore knee motion was required in almost half of these. Patient satisfaction was higher in cases with sequelae of sepsis.

Shortening and secondary relengthening for chronically infected tibial pseudarthroses with poor soft tissues.

BACKGROUND: The treatment of chronically infected tibial pseudarthroses with poor soft tissues ends with amputation on many occasions. Aggressive débridement of bone and soft tissue and reconstruction of the extremity, performed as a limb salvage procedure, is an alternative treatment option to amputation. METHODS: Our patients had a mean age of 42 years. According to the Paley classification, one of the patients had A2 pseudoarthrosis, four had B2, and three had B3. One had localized infection, whereas the other seven had diffuse infection, according to the Cierny-Mader system. The mean duration of the infection was 10.75 years, and the mean number of previous operations was 5.13. The mean shortness was 2.4 cm, and the mean bone defect was 1 cm. RESULTS: The mean primary shortening was 8.6 cm, the mean duration of the fixator stay was 9.6 months, and the mean distraction index was 39.1 days/cm. The mean duration of follow-up was 25 months. The bone results were excellent in four cases, good in two, and fair in the other two. The functional results were excellent in one patient, good in six, and fair in one. A total of 11 minor and 3 major complications were seen during the treatment, and one case resulted in amputation. CONCLUSIONS: Despite the high rate of complications, our treatment method enabled limb salvage for patients who had previously been candidates for amputation. With this treatment, there is less need for a second operation, and an additional operation is not necessary for soft tissue coverage.

Correction of a major flexion deformity developed after knee arthrodesis in child age: a case report.

Septic arthritis in child age results in sequelae when treated late or inappropriately. Arthrodesis is a salvage option which is rarely performed in children because of its complications and resultant disabilities. We report the case of a 16-year-old boy who had been treated with arthrodesis of his right knee at the age of seven and subsequently developed a progressive osseous deformity, eventually resulting in a 130 degrees flexion deformity of the knee. The deformity and the resulting limb length discrepancy were corrected using the Ilizarov method. In a single stage operation, a wedge resection osteotomy at the distal femur was performed and a ring fixator was applied. The mechanical axis was corrected first by gradual closing of the wedge thus avoiding damage to the posterior neurovascular structures, followed by lengthening.

A modified technique of internal bone transport.

A modification of the technique of internal bone transport is presented. It decreases bone and soft tissue complications during bone transport, increases patient's comfort, the volume of the fixator is smaller and painful scarring is limited. Nine patients with a mean age of 23.9 years were treated with this technique. The aetiology was tumour, trauma or sequelae of infection. The mean bone loss was 7.2 cm in length. Transportation was achieved with a special pulley system. The mean follow-up time was 18.3 months. The external fixation time ranged from 5 to 13.2 months, the mean distraction index was 12.1 days/cm. The mean length of bone transport done was 6.3 cm. An excellent bone result was obtained in 4 cases, a good result in 4 cases and a fair result in one case. An excellent functional result was obtained in 2 lower extremity cases, a good result in 3 cases. Preoperative DASH scores of the upper extremity cases improved from a mean of 80.1 to a mean of 15.85. Complications were seen in 4 cases.

Dose-related effects of recombinant human interleukin-10 on hypoxia-induced skeletal muscle injury in immature rats.

BACKGROUND: The role of cytokines in the pathogenesis of skeletal muscle injury in patients with hypoxia and inflammation remains unclear. The aim of the present study was to determine the dose-related effects of recombinant human interleukin-10 (rhIL-10) on hypoxia-induced skeletal muscle injury in immature rats. METHODS: The study was performed on 1-day-old Sprague-Dawley rat pups that were randomized to one of five groups: nonhypoxic controls (group 1; n=8); rats subjected to hypoxia-reoxygenation (H/O) and returned to their mothers (group 2; n=11); rats subjected to H/O, returned to their mothers, and treated with rhIL-10 (10 microg/kg per day s.c.) for 3 days (group 3; n=10); rats subjected to H/O, returned to their mothers, and treated with rhIL-10 (25 microg/kg per day s.c.) for 3 days (group 4; n=10); or rats subjected to H/O, returned to their mothers, and treated with rhIL-10 (75 microg/kg per day s.c.) for 3 days (group 5; n=10). All animals were killed on day 4, and skeletal muscle specimens were obtained to determine the tissue levels of malondialdehyde (MDA) and superoxide dismutase (SOD) and to check for any histological changes. RESULTS: The polymorphonuclear leukocyte count, amount of interstitial edema, microvessel size, and area of myocyte necrosis was greater in groups 2, 3, 4, and 5 than in group 1, although the findings were significantly less prominent in groups 4 and 5 than in groups 2 and 3. MDA levels significantly increased in groups 2 and 3 compared to those in groups 1, 4, and 5. SOD values decreased significantly in groups 2 and 3 compared to those in groups 1, 4, and 5. CONCLUSIONS: Administration of rhIL-10 reduced skeletal muscle injury produced by hypoxia in immature rats. Intermediate and high doses of rhIL-10 were associated with a significant reduction of skeletal muscle damage, whereas a low dose was not.

Induction of tolerance to hind limb allografts in rats receiving cyclosporine A and antilymphocyte serum: effect of duration of the treatment.

BACKGROUND: This study assessed the ability of antilymphocyte serum (ALS) and cyclosporine A (CsA) to induce tolerance for hind limb composite tissue allograft in rats without chronic immunosuppression. METHODS: Hind limb transplantations were performed in Lewis-Brown-Norway (LBN, RT1(1+n)) and Lewis (LEW, RT1(1)) rats. Treatment consisted of ALS only (0.4 mL/kg), CsA only (16 mg/kg), and a combination of CsA and ALS, and it was administered 12 hr before surgery at three different intervals (7, 14, and 21 days). Long-term survivors were tested for tolerance by standard skin grafting from the recipient (LEW), the donor (LBN), and the third party (ACI, RT1 ) 60 days after cessation of the treatment and by mixed lymphocyte reaction at 100 days. T-cell lines were analyzed with flow cytometry. RESULTS: Single use of ALS in all treatment intervals did not prolong allograft survival. Single use of CsA extended survival up to 23 days in the 21-day protocol group. CsA and ALS caused indefinite survival in two of six rats in the 14-day protocol and in all six rats in the 21-day protocol (>420 days). The six long-term survivors in the 21-day protocol accepted the skin grafts from the donor (LBN) and the recipient (LEW) and rejected third-party grafts (ACI). Tolerant animals showed a donor-specific hematopoietic chimerism of 35% to 42% in the peripheral blood. Mixed lymphocyte reaction assay demonstrated tolerance to the host and donor alloantigens and increased response to the third party. CONCLUSIONS: Administration of CsA and ALS for 21 days induced donor-specific tolerance in the recipients of the rat hind limb composite tissue allografts. The mechanism of tolerance should be investigated further.

Induction of tolerance in composite-tissue allografts.

BACKGROUND: Transplantation of composite-tissue allograft (CTA) such as the human hand recently became a clinical reality. The high risks associated with the use of lifelong immunosuppression have been the prohibiting factor in the routine use of the CTA transplants. In this article, we present a new approach of inducing long-term, donor-specific tolerance to CTAs without recipient preconditioning and need for chronic immunosuppression. METHODS: We have developed a clinically applicable 35-day protocol that induces donor-specific tolerance in a rat hindlimb-transplantation model across major histocompatibility complex (MHC) barrier [Lewis-Brown-Norway (LBN, RT1 -->F1) to Lewis (LEW, RT1 ) by using cyclosporine A (CsA) and a mouse monoclonal antibody against rat alphabeta-T-cell receptor (TCR) to systemically eliminate alloresponsive cells. Standard skin grafting, flow cytometry (FC), and mixed lymphocyte reaction (MLR) were used to assess efficacy of immunodepletion and confirm donor-specific tolerance and chimerism. RESULTS: Under this protocol long-term tolerance (>720 days) was induced in all (n=5) CTA recipients across the MHC barrier without further need for immunosuppression. Tolerance was confirmed in all limb-allograft recipients by skin grafting in vivo and by MLR in vitro. The animals rejected third-party grafts, indicating immunocompetence. CONCLUSIONS: In this CTA model, combined protocol of alphabeta-TCR monoclonal antibody and CsA resulted in induction of donor-specific tolerance across the MHC barrier without recipient conditioning. We believe that our findings will foster development of new therapeutic strategies and expand clinical applications for composite-tissue transplantation.

Induction of donor-specific tolerance in rat hind-limb allografts under antilymphocyte serum and cyclosporine A protocol.

Composite tissue allograft (CTA) transplantation became a clinical reality despite major side effects associated with the administration of chronic immunosuppression. Development of new treatment modalities eliminating life-long immunosuppression is essential for the future of CTA transplantation. In this study, combined use of cyclosporine A (CsA) and antilymphocyte serum (ALS) was tested for the potential to induce tolerance in the rat hind-limb allograft recipients across a major histocompatibility (MHC) barrier (Lewis-Brown-Norway [LBN, RT1(l+n)] to Lewis [LEW, RT1(l)] rats). Thirty transplantations were performed in 5 experimental groups. Animals received CsA and ALS 12 hours before surgery for 21 days thereafter. Although the allograft controls rejected their limbs at day 7 combined treatment of CsA and ALS resulted in indefinite survival (over 420 d) in all allograft recipients. Long-term survivors showed 35% to 42% of donor-specific chimerism in the peripheral blood. Clinical tolerance was confirmed by acceptance of the donor-specific skin grafts and immunocompetence was confirmed by rejection of the third-party grafts. Mixed lymphocyte reaction revealed suppressed response against donor-type antigens and increased response to third-party antigens. Donor-specific tolerance across MHC barrier was induced in CTA allografts under 21 days protocol of ALS/CsA.