Potential role of S-adenosylmethionine in osteosarcoma development.

The metastatic form of osteosarcoma is a life threatening one since it metastasizes to the lungs. The major cause of metastatic osteosarcoma is hypomethylation of numerous genes that undergo overexpression to enable the progression of the disease. In the present study, S-adenosylmethionine (SAM), a predominant methyl donor, was administered to find out its effects on osteosarcoma progression. As evidence of tumor suppression, the SAM-treated mouse tissue was analyzed histologically, which exemplifies the control that SAM has over abnormal cell proliferation, especially on primary osteosarcoma, but it lacks positive effects on metastatic osteosarcoma. At the molecular level, the successful inhibition of primary osteosarcoma was found to be associated with a lower expression of Sox2, a protein highly expressed in osteosarcoma stem cells, along with an upregulated expression of TCTP. The data suggest that the administration of SAM has a positive role in treating primary osteosarcoma, but it has no role in suppressing metastatic osteosarcoma. The decreased expression of Sox2 together with upregulation of TCTP following SAM administration indicates that SAM has a control over primary osteosarcoma.

An evaluation of three-dimensional image-guided technologies in percutaneous pelvic and acetabular lag screw placement.

BACKGROUND: Percutaneous stabilization using three-dimensional (3D) navigation system is a promising treatment for pelvic and acetabular fractures. However, there are still some controversies regarding the use of 3D navigation to treat pelvic and acetabular fractures. The purpose of this study was to compare the Iso-C(3D) fluoroscopic navigation, standard fluoroscopy, and two-dimensional (2D) fluoroscopic navigation in placing percutaneous lag screws in pelvic specimens to better understand the merits of 3D navigation techniques. METHODS: Fifty-four instrumentation procedures were performed in this study using six cadaveric pelvic specimens. Three groups were designated for different procedures and tests: group I, standard fluoroscopy; group II, 2D fluoroscopic navigation; and group III, Iso-C(3D) fluoroscopic navigation. Nine screws were placed in each pelvis, including four screws placed bilaterally through the ilium into S1 and S2 vertebrae, four screws placed bilaterally through anterior and posterior columns of acetabulum, and one screw placed through the pubic symphysis. 3D fluoroscopic techniques were evaluated to determine the accuracy of screw position, instrumentation time, and fluoroscopic time. The data were statistically analyzed using SPSS 13.0. RESULTS: The malposition rate was 38.89%, 22.22%, and 0% in standard fluoroscopy, 2D fluoroscopic navigation, and Iso-C(3D) fluoroscopic navigation groups, respectively. There was no significant difference between standard fluoroscopy and 2D fluoroscopic navigation. Compared with Iso-C(3D) fluoroscopic navigation, there were significant differences (analysis of variance [ANOVA], P < 0.05). The mean instrumentation operating time using Iso-C(3D) fluoroscopic navigation technique was 15.4 ± 4.5 min. There were significant differences compared with standard fluoroscopy (31.5 ± 6.2 min) and 2D fluoroscopic navigation (26.3 ± 7.5 min; ANOVA, post hoc Scheffe, P < 0.01). The mean fluoroscopic time of Iso-C(3D) fluoroscopic navigation was 66 ± 4.8 min. Compared with standard fluoroscopy (132.8 ± 7.3 min) and 2D fluoroscopic navigation (47.7 ± 5.6 min), there were significant differences (ANOVA, post hoc least significant difference, P < 0.01). CONCLUSIONS: In the present study, we compared Iso-C(3D) fluoroscopic navigation, 2D fluoroscopic navigation, and standard fluoroscopy. Iso-C(3D) fluoroscopic navigation showed a higher accuracy rate in positioning and a shorter instrumentation operating time. The fluoroscopic time was longer in Iso-C(3D) fluoroscopic navigation than that in standard fluoroscopy, indicating that radiation exposure can be moderately reduced in Iso-C(3D) fluoroscopic navigation operation, although the fluoroscopic time was the shortest in 2D fluoroscopic navigation.

Management of hemodynamically unstable pelvic fracture in pregnancy: a case report and review of literature.

We present an unusual case of an unstable pelvic fracture during pregnancy period, who suffered fetal death and splenic rupture simultaneously which developed massive delayed hemorrhage in abdomen. When considering potential causes of fetal death, direct trauma to the uterus, placenta, or fetus was not associated with a higher fetal mortality rate, compared with maternal hemorrhage. A cesarean section and splenectomy could rescue the maternal life from the hemorrhage situation. Successful treatment of these rare cases is possible with careful pre-, peri-, and post-operative evaluation of the mother and fetus by a multidisciplinary team.

Anterior single screw fixation of odontoid fracture with intraoperative Iso-C 3-dimensional imaging.

PURPOSE: The purpose of this study was to assess the value of isocentric C-arm three-dimensional (Iso-C 3D) fluoroscopy for the insertion of an anterior odontoid screw. The results of the Iso-C 3D group were compared with that of an historic control group using conventional fluoroscopy. METHODS: Twenty-nine patients diagnosed with type II or rostral-type III odontoid fractures were treated with a single anterior screw fixation in this study. The Iso-C 3D group included 13 patients and the other 16 patients were in the historic control group. All operations were performed by a single surgeon using standard procedure and manner. The clinical and radiographic results were recorded and compared between the two groups. RESULTS: The fluoroscopy time in the Iso-C 3D group was 42.9 s as compared to 68.1 s in the control group (P < 0.01). The mean operative time was 91.5 min in the Iso-C 3D group when compared with 81.6 min in the control group (P = 0.20). The rate of bony fusion was 96.6% (28/29), the failure rate of reduction or fixation was 13.8% (7.7% in Iso-C 3D group; 18.8% in control group). The Smiley-Webster scale showed that 90% of patients achieved good or better outcomes CONCLUSIONS: In conclusion, this technique can be safely extended to the treatment of technically difficult to treat spinal injuries and at the same time reduce total radiation exposure time both for the patient and the surgeon.

Quantitative anatomic basis of antegrade lag screw placement in posterior column of acetabulum.

BACKGROUND: Lag screw fixation has been recommended for treatment of acetabular and pelvic fracture for several years. The aim of the present study was to determine the projection of the axis of the posterior column on the inner table of the iliac wing in the supra-acetabular region. METHODS: Thirty adult dried bony hemipelves specimens and other five intact adult dried pelvic specimens were included in this study. The projection point of the axis of the posterior column of the acetabulum was determined on the inner table of the iliac wing of the hemipelves specimens. The perpendicular distance from the optimal entry point to the linea terminalis of pelvis was measured and recorded as the lateral distance. The same measurement along the linea terminalis from the optimal entry point to the junction between the anterior border of iliosacral articulation and the linea terminalis of pelvis was made and recorded as the posterior distance. The depth of the anchor path and the corresponding average retroversion angulation and extraversion angulation were also measured. According to the results acquired from this study, a series of 6.5 mm lag screws were inserted into the posterior column of each side of the other five intact specimens, respectively, to evaluate the position of the screws. The data were expressed as mean +/- SD and analyzed by using the descriptive methods with SPSS 10.0. RESULTS: The average length of lag screw was 104.8 +/- 4.2 mm. The average lateral distance was 16.8 +/- 2.1 mm. The average posterior distance was 23.5 +/- 3.4 mm. The corresponding average retroversion angulation and extraversion angulation were 57 degrees 36' +/- 4 degrees 28' and 119 degrees 18' +/- 2 degrees 32', respectively. The insertion of the single 6.5 mm lag screw of adequate length was possible in the posterior column along its anchor path and no accidental extraosseous or intraarticular screw placement had occurred. CONCLUSIONS: The present study describes a safe anchor path of antegrade lag screw fixation in the posterior column. Insertion of the lag screws of adequate length is possible in the posterior column along its functional axis.

[Operative treatment of the scapular fractures through modified Judet approach].

OBJECTIVE: To investigate the effect of operative treatment of scapular fractures through modified Judet approach. METHODS: From January 1997 to October 2005, 21 patients (15 females, 6 males; mean age 34 years) of scapular fractures were treated by open reduction and internal fixation through the modified Judet approach. According to Hardegger classification system, there were 11 patients of scapular body fractures, 10 patients of scapular neck fractures, 8 patients of glenoid rim fractures, 7 patients of glenoid fossa fractures, 9 patients of scapular spine fractures, and 6 patients of scapular acromion fractures. RESULTS: Eighteen patients were followed up with an average of 21 months (range 6 months-4 years). According to Rowe scores system, 12 patients showed excellent, 3 showed good, 2 showed fair, and 1 showed poor. CONCLUSIONS: The modified Judet approaches have the advantages of wide exploration, safety, and easy fixation. It is a good choice to the operation for most types of scapular fractures through the modified Judet approach.

The diagnosis and treatment of severe cerebral fat embolism.

OBJECTIVE: To improve the diagnosis and treatment of severe cerebral fat embolism (SCFE). METHODS: The data of nine patients with SCFE were retrospectively analyzed. The manifestations of the central nerve system, respiratory system and hemorrhage were recorded, at the same time, accessory examination including arterial oxygen, fat macroglobules in venous blood and image examination was adapted. The patients were treated with exopexy, pharmocotherapy and oxygentherapy. RESULTS: Two of the nine patients died of severe complications, the other seven recovered without severe sequela. CONCLUSIONS: Gurd standard should be improved for early diagnosis of SCFE. If svere complications can be prevented, patients who receive early treatment will have favourable prognosis.