Antibiotic-impregnated cement spacer as definitive management for osteomyelitis.

BACKGROUND: Osteomyelitis is a challenge for orthopaedic surgeons. There is a lack of scientific evidence to guide treatment. The purpose of this study was to report the clinical outcome of unplanned retention of antibiotic-impregnated cement spacer (ACS) in the management of osteomyelitis. METHODS: Eight patients (7 with tibial infections and 1 with a calcaneal infection) with osteomyelitis received radical debridement and insertion of an ACS into the bone defect as the definitive management. The mean follow-up period was 2 years (6 months to 4 years). All of these patients had a cement spacer in place. RESULTS: No patient exhibited radiographic evidence of excessive bone loss. The patients reported no or occasional mild pain and exhibited complete weight-bearing abilities, with the exception of one patient who required a crutch because of a spinal cord injury. Signs of recurrence of the osteomyelitis were not noted in any of the patients, and no fractures occurred at last follow-up. CONCLUSION: Our study suggests that a proportion of patients with unplanned retention of ACS appear to function well without necessarily requiring further surgical intervention.

Effect of minodronate on the speed of sound of the calcaneus in postmenopausal women with an increased risk of fractures: A clinical practice-based observational study.

BACKGROUND: We previously reported that alendronate and risedronate reduce the urinary levels of cross-linked N-terminal telopeptides of type I collagen (NTX) by 44.9% and 34.7%, respectively, at 3 months after the start of treatment, and increase the speed of sound (SOS) of the calcaneus by 0.6% and 0.65%, respectively, at 12 months after the start of treatment in postmenopausal women with osteoporosis. The aim of the present clinical practice-based observational study was to examine the effect of treatment with minodronate for 12 months on the SOS of the calcaneus and on bone turnover markers in postmenopausal women with an increased risk of fractures. METHODS: Forty-two postmenopausal women with osteoporosis or osteopenia with a clinical risk factor for fractures who had been treated with minodronate for > 12 months were enrolled in the study. The SOS and bone turnover markers were monitored during treatment with minodronate for 12 months. RESULTS: Compared to their baseline values, the urinary levels of NTX at 3 months and the serum levels of alkaline phosphatase at 12 months were significantly decreased at 47.5% and 25.8%, respectively. At 12 months, the SOS increased modestly, but significantly, by 0.47%, compared to the baseline value. CONCLUSION: The present study confirmed that minodronate suppressed bone turnover and modestly increased the SOS of the calcaneus in postmenopausal women with an increased risk of fractures.

Antibiotic Treatment and Surgery for Acute Hematogenous Calcaneal Osteomyelitis of Childhood.

Acute hematogenous calcaneal osteomyelitis characteristically affects children. A recent trend has emerged toward shorter courses of antibiotics. In our randomized, prospective treatment trial of children aged 3 months to 15 years, the intravenous antibiotic (clindamycin or a first-generation cephalosporin) was given only for the first 2 to 4 days and the remainder of the 20- to 30-day course was completed orally. A bone sample for culture was to be taken routinely, but all additional surgery was performed on special demand. We performed a retrospective subanalysis of cases affecting the calcaneus. The follow-up period was 1 year. Of the 14 participants enrolled, 11 completed the 1-year follow-up period, and their data were analyzed. Staphylococcus aureus was the cause of 10 cases; all strains were methicillin sensitive. The median intravenous treatment duration was 3 days. Four patients required open incisional trepanation (trephination). All participants attending the 1-year follow-up examination had fully recovered. The outcome of calcaneal osteomyelitis caused by methicillin-sensitive S. aureus in a child will be good, if the patient seeks treatment early and antibiotic therapy is started promptly. A bone biopsy is needed to obtain a representative sample for bacteriology.

Saturated and monounsaturated fatty acid status is associated with bone strength estimated by calcaneal ultrasonography in Inuit women from Nunavik (Canada): a cross-sectional study.

OBJECTIVE: The aim of this study is to examine the relationship between the status in selected saturated (SFAs) and monounsaturated (MUFAs) fatty acids and the Stiffness Index (SI) in Inuit women from Nunavik (Northern Quebec, Canada). DESIGN: Cross-sectional descriptive study. SETTING: Inuit population from 14 communities who participated to Qanuippitaa? How are we? Nunavik Inuit Health Survey in 2004. PARTICIPANTS: 187 Inuit women aged 35-72 years. MEASUREMENTS: SI was determined by ultrasonography (Achilles InSight device) at the right calcaneus of participants. SFAs and MUFAs contents of erythrocyte membrane phospholipids were measured after transmethylation by gas chromatography coupled with a flame ionization detector. Several factors known to be associated with bone strength were concomitantly recorded. Multiple linear regression was used to investigate relations between selected SFAs, MUFAs and SI, taking into consideration several potential confounders and covariates. RESULTS: Total SFAs, in particular behenic acid, and cis-vaccenic acid among MUFAs were negatively associated with SI (ß = -0.028, SE = 0.011, p = 0.0084; ß = -0.060, SE = 0.023, p = 0.0093 and ß = -0.087, SE = 0.019, p <0.0001, respectively), whereas total cis-MUFAs and specifically oleic acid were positively associated with SI (ß = 0.036, SE = 0.011, p = 0.0008; ß = 0.037, SE = 0.011, p = 0.0014, respectively) after adjustment for several covariates. CONCLUSION: Saturated and monounsaturated fatty acid status is associated with bone strength estimated by calcaneal SI values in Inuit women from Nunavik.

Dose-response effect of an intra-tendon application of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) in a rat Achilles tendinopathy model.

The purpose of this study was to assess whether intra-tendon delivery of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) would improve Achilles tendon repair in a rat collagenase-induced tendinopathy model. Seven days following collagenase induction of tendinopathy, one of four intra-tendinous treatments was administered: (i) Vehicle control (sodium acetate buffer), (ii) 1.02 µg rhPDGF-BB, (iii) 10.2 µg rhPDGF-BB, or (iv) 102 µg rhPDGF-BB. Treated tendons were assessed for histopathological (e.g., proliferation, tendon thickness, collagen fiber density/orientation) and biomechanical (e.g., maximum load-to-failure and stiffness) outcomes. By 7 days post-treatment, there was a significant increase in cell proliferation with the 10.2 and 102 µg rhPDGF-BB-treated groups (p=0.049 and 0.015, respectively) and in thickness at the tendon midsubstance in the 10.2 µg of rhPDGF-BB group (p=0.005), compared to controls. All groups had equivalent outcomes by Day 21. There was a dose-dependent effect on the maximum load-to-failure, with no significant difference in the 1.02 and 102 µg rhPDGF-BB doses but the 10.2 µg rhPDGF-BB group had a significant increase in load-to-failure at 7 (p=0.003) and 21 days (p=0.019) compared to controls. The rhPDGF-BB treatment resulted in a dose-dependent, transient increase in cell proliferation and sustained improvement in biomechanical properties in a rat Achilles tendinopathy model, demonstrating the potential of rhPDGF-BB treatment in a tendinopathy application. Consequently, in this model, data suggest that rhPDGF-BB treatment is an effective therapy and thus, may be an option for clinical applications to treat tendinopathy.

The mechanical and histological estimation of calcaneal tendon callus in rats after PRP injection.

BACKGROUND: The study investigated the potential impact of platelet-rich plasma on tendon healing. MATERIAL/METHODS: The study was conducted in 88 young, sexually mature rats, Wistar strain. The animals were randomly divided into two groups. The animals from the examined group (n=44) with an operated calcaneal tendon were given subcutaneously allogeneic PRP. The animals from the control group (n=44) were given 0.9% NaCl solution within the area of calcaneal tendon damage. After 7, 14, 21, and 42 days, the tendons were tested mechanically using the universal testing machines (UTM, Lloyd LRX), and were subjected to histological evaluation. RESULTS: The study evaluated the maximum breaking force (Fmax), the force at the end of the proportional range (Fs) and stiffness of the tendons (H). After 7 days of the experiment, there were significant differences in H (P=0.021), between the examined and control groups. There were no significant differences in Fmax (P=0.53) and Fs (P=0.48) after 7 days. Mean values of Fmax, Fs and H after 14, 21, and 42 days in the study group were significantly higher compared to the control group (P<0.05). In the histological evaluation, the tendons of the examined groups were characterized by higher cellular and vascular density and a more orderly arrangement of collagen fibers compared to the control groups. CONCLUSIONS: Growth factors in allogeneic PRP increased the mechanical strength of regenerating calcaneal tendons after 14, 21, and 42 days from injury. PRP resulted in the increased histological maturity of the tendon callus in examined groups, at each stage of the experiment.

The effect of menopause on bone tissue in former swimmers and in non-athletes.

BACKGROUND: An increased loss of bone density during the first years after menopause induces osteoporosis. OBJECTIVES: The aim of the research presented in this paper was to ascertain the difference in the rate of involutional changes in bone tissue in former athletes and in non-athletes of the same age. MATERIAL AND METHODS: The research involved 18 former swimmers and 18 females of similar age who had never practiced sports. The subjects were subdivided into two subgroups: Subgroup I had been post-menopausal for < or = 5 years, and Subgroup II for > 5 years; this was done to assess bone mineral content relative to the length of the postmenopausal time period. Bone mineral content (BMC) and bone mineral density (BMD) were measured in lumbar vertebrae by dual-emission X-ray absorptiometry (DXA). Bone strength was measured in the heel using the bone stiffness index. Each subject was examined twice, with a one-year period in between. A diagnostic questionnaire was used to compile date on the subjects' physical activity and their gonad functioning. Dietary habits (calcium intake) were established by three interviews and the Dieta 4.0 computer program. Results. Anthropometric features did not differentiate the subjects in the subgroups. Former athletes in both subgroups spent off-work time on physical activities significantly more frequently. In both groups, calcium intake was sufficient and did not exceed 3/4 of the daily norm. A higher calcium intake was found in former athletes compared to non-athletes. The subjects in Subgroup I had significantly greater BMC and BMD than those in Subgroup II. In Subgroup I, the second examination showed somewhat lower reductions in BMC and BMD among the former athletes than among the non-athletes. In Subgroup II, BMC and BMD increased somewhat among the former athletes, while non-significant reductions were observed in the BMC and BMD of the non-athletes. All the subjects undertook pharmacologic treatment after the first examination, which caused improvement of bone parameters in the second examination. CONCLUSIONS: The rate of bone mass loss in former athletes proved to be consistent with the involutional process and similar to that of non-athletes. The reduced BMD in the lumbar vertebrae of 22% of the women in the study demonstrates the need for regular densitometric examinations in postmenopausal females.

Assessment of bone status in inhaled corticosteroid user asthmatic patients with an ultrasound measurement method.

BACKGROUND: The effect of inhaled corticosteroid (ICS) on the bone status of asthmatic patients is still uncertain, because it can differ by race and because there have been few cases in Japan. In this study, the bone status of ICS users with asthma was evaluated in an actual clinical setting in Japan. METHODS: In 7 participating hospitals, ICS users with asthma and control subjects were age- and gender-matched and recruited into this study. To assess bone status, ultrasound measurements of each individual's calcaneus were made using an AOS-100. The ratio of the osteo sono-assessment index (OSI) to the average OSI corrected for age and gender was denoted as %OSI and used for quantitative assessment. The second %OSI measurement was performed 6 months after the first %OSI one. During the study period, individual treatment remained unchanged. RESULTS: There were no significant differences in the 1st and 2nd %OSI between the ICS users and control subjects. However, the 2nd %OSI significantly decreased compared with 1st %OSI in female ICS users, although there were no significant changes in the male and female control subjects and male ICS users. CONCLUSIONS: The 6 month management of asthma in the actual clinical setting, including regular ICS use, might have a harmful influence on the bone status of female asthmatic patients. It may be necessary to manage and treat female patients for potent corticosteroid-induced osteoporosis, although further analyses of bone status in asthma patient ICS users will be required.

BMP-12 treatment of adult mesenchymal stem cells in vitro augments tendon-like tissue formation and defect repair in vivo.

We characterized the differentiation of rat bone marrow-derived mesenchymal stem cells (BM-MSCs) into tenocyte-like cells in response to bone morphogenetic protein-12 (BMP-12). BM-MSCs were prepared from Sprague-Dawley rats and cultured as monolayers. Recombinant BMP-12 treatment (10 ng/ml) of BM-MSCs for 12 hours in vitro markedly increased expression of the tenocyte lineage markers scleraxis (Scx) and tenomodulin (Tnmd) over 14 days. Treatment with BMP-12 for a further 12-hour period had no additional effect. Colony formation assays revealed that ~80% of treated cells and their progeny were Scx- and Tnmd-positive. BM-MSCs seeded in collagen scaffolds and similarly treated with a single dose of BMP-12 also expressed high levels of Scx and Tnmd, as well as type I collagen and tenascin-c. Furthermore, when the treated BM-MSC-seeded scaffolds were implanted into surgically created tendon defects in vivo, robust formation of tendon-like tissue was observed after 21 days as evidenced by increased cell number, elongation and alignment along the tensile axis, greater matrix deposition and the elevated expression of tendon markers. These results indicate that brief stimulation with BMP-12 in vitro is sufficient to induce BM-MSC differentiation into tenocytes, and that this phenotype is sustained in vivo. This strategy of pretreating BM-MSCs with BMP-12 prior to in vivo transplantation may be useful in MSC-based tendon reconstruction or tissue engineering.

Ultrasound bone mass in patients undergoing chronic therapy with oral anticoagulants.

The purpose of this study was to assess the effects of chronic oral anticoagulant (OAC) treatment on bone mass using quantitative ultrasound (QUS) techniques. A total of 120 patients (47 women and 73 men) undergoing treatment with OAC and 57 healthy subjects (27 women and 30 men) participated in this study. Bone status was assessed using QUS devices that measure the amplitude-dependent speed of sound (Ad-SoS) in phalanges and the broadband ultrasound attenuation (BUA) in the calcaneus. Men undergoing OAC treatment had lower Ad-SoS, Z-score, T-score, and BUA values (all p < 0.005) and higher levels of undercarboxylated osteocalcin (u-OC) and tartrate-resistant acid phosphatase (TRAP) (both p < 0.0001) than controls. Women receiving OAC treatment had lower BUA values (p < 0.005) and total osteocalcin (OC) levels (p < 0.0001) and higher levels of u-OC and TRAP (both p < 0.0001) than controls. There was a statistically significant negative correlation between u-OC levels and Ad-SoS values in both men (r = -0.432, p = 0.0328) and women (r = -0.332, p = 0.0269) undergoing OAC treatment. In conclusion, patients undergoing OAC treatment had a loss of trabecular and cortical bone mass, possibly due to a decrease in the γ-carboxylation of osteocalcin resulting from the vitamin K antagonism of these drugs.

Association between alcohol consumption and bone strength in Korean adults: the Korean Genomic Rural Cohort Study.

Previous studies have reported an inconsistent relationship between alcohol consumption and bone health. A growing body of research has shown that chronic alcoholism leads to osteopenia and increased incidence of skeletal fractures, but some studies have concluded that alcohol consumption may be associated with higher bone mineral density in elderly populations. However, most studies showing a significant relationship between alcohol consumption and bone status have been in Western countries; and subjects have usually been postmenopausal women. The purpose of the present study was to investigate the association of alcohol consumption with bone strength in Korean adults. Data were from the Korean Genomic Rural Cohort Study, which is an ongoing population-based study of adults aged 40 to 70 years from 5 regions. A total of 7713 participants (3368 men, 4345 women) were surveyed about their annual consumption of alcohol such as soju, beer, makkolli, wine, and whisky. Bone strength was measured by stiffness index using the calcaneal quantitative ultrasound method. Overall, the annual age-specific decrease rate in the stiffness index of women was 2.7 times higher than that of men (0.463% for women, 0.169% for men).After adjustment for eligible covariates, the association between alcohol consumption and risk of reduced bone strength showed a J-shaped curve for both men and women. Compared with nondrinkers, the relative risk of reduced bone strength was 0.52 (95% confidence interval, 0.33-0.83) in men who drank 4 to 5 cups of soju for an amount of 29.626 to 49.375 g of alcohol per day and 0.61 (95% confidence interval, 0.38-0.86) in men who drank 6 to 7 cups of soju for an amount of 49.376 to 69.125 g of alcohol per day. We found no significant relationship between alcohol consumption and bone strength in any other group of men. For women, results suggested that the risk of reduced bone strength was lower in the moderate-consumption group; but no significant relationship was found between alcohol consumption at any level and bone strength. Among Korean adults, alcohol consumption has a J-shaped relationship with risk of reduced bone strength.

Randomized trial of adjuvant zoledronic acid in postmenopausal women with high-risk breast cancer.

PURPOSE: We present the results of a randomized multicenter clinical trial of adjuvant zoledronic acid (ZA) in postmenopausal women with high-risk breast cancer. The primary objective was change in bone mineral density (BMD) at the lumbar spine and femoral neck at 1 year. Secondary objectives included change in calcaneal BMD, disease-free survival (DFS), overall survival (OS), and toxicity. PATIENTS AND METHODS: Postmenopausal women with stage II/III breast cancer diagnosed up to 5 years previous were eligible and randomized to either observation or ZA 4 mg intravenous every 3 months. Bone mineral density testing was performed at 0, 6, and 12 months. RESULTS: Sixty-eight women were enrolled (36 ZA and 32 observation). The population was a median of 2 years from diagnosis and the majority received tamoxifen during the study. There was a significant difference in the mean change from baseline to 1 year follow-up for lumbar spine (increased by 4.28% ± 0.62%; P = .01), total femur (increased by 1.9% ± 0.4%; P = .03), trochanter (increased by 2.97% ± 0.69%; P = .03), and calcaneal BMD (increased by 2% ± 0.57%; P = .01) in favor of the ZA arm. No significant difference in the mean change for the femoral neck was seen. No significant differences in DFS or OS were observed. CONCLUSION: Zoledronic acid significantly improved the BMD at multiple skeletal sites in postmenopausal women largely on tamoxifen. No new safety signals were noted. There were insufficient events to comment on DFS or OS.

[Observation on therapeutic effect of acupuncture at Xuanzhong (GB 39) combined with Chinese herbs pyrogenic dressing therapy for treatment of calcaneus spur].

OBJECTIVE: To compare therapeutic effects of acupuncture at Xuanzhong (GB 39) combined with Chinese herbs pyrogenic dressing therapy and common acupuncture on calcaneus spur. METHODS: A single-blind, randomized and controlled trial was adopted. Sixty-six cases were randomly divided into an observation group (n=34) and a common acupuncture group (n=32). The observation group was treated with acupuncture at Xuanzhong (GB 39) combined with Chinese herbs pyrogenic dressing therapy and the common acupuncture group with common acupuncture, Yanglingquan (GB 34), Kunlun (BL 60) etc. selected. The markedly effective rate and the changes of heel pain scores, heel swelling scores, heel burning sensation scores, and walking function scores were compared between the two groups before and after treatment. RESULTS: The markedly effective rate of 64.7% (22/34) in the observation group was higher than 37.5% (12/32) in the common acupuncture group (P<0.05). After treatment, all the scores in the two groups were significantly improved as compared with before treatment (all P<0.05), and the observation group was better than the common acupuncture group (all P<0.05). CONCLUSION: The therapeutic effect of acupuncture at Xuanzhong (GB 39) combined with Chinese herbs pyrogenic dressing therapy on calcaneus spur is superior to that of common acupuncture.

Intratendinous septic abscess of the Achilles tendon after local steroid injection.

UNLABELLED: In the treatment of pathological processes of the skeletal system, local injection of corticosteroid has become a common form of treatment. Although rare, pyogenic abscess can develop secondary to local corticosteroid injection. In this article, we describe the case of a patient who presented with pain, swelling, and hyperemia following local infiltration of corticosteroid about the Achilles tendon. Magnetic resonance image scanning of the Achilles tendon revealed a smoothly shaped intratendinous mass 3 x 1 cm in diameter, extending to the posterosuperior aspect of the calcaneus. A needle aspiration of the suspected abscess revealed S aureus, and subsequent surgical drainage and debridement revealed chronic inflammation secondary to infection at the site of previous local corticosteroid injection. Antibiotic therapy was used following incision and drainage, and recurrence of infection was not detected throughout the duration of follow-up. LEVEL OF CLINICAL EVIDENCE: 4.

Consequences of lifetime isolated growth hormone (GH) deficiency and effects of short-term GH treatment on bone in adults with a mutation in the GHRH-receptor gene.

OBJECTIVE: Growth hormone (GH) influences bone mass maintenance. However, the consequences of lifetime isolated GH deficiency (IGHD) on bone are not well established. We assessed the bone status and the effect of 6 months of GH replacement in GH-naive adults with IGHD due to a homozygous mutation of the GH-releasing hormone (GHRH)-receptor gene (GHRHR). PATIENTS AND METHODS: We studied 20 individuals (10 men) with IGHD at baseline, after 6 months of depot GH treatment, and 6 and 12 months after discontinuation of GH. Quantitative ultrasound (QUS) of the heel was performed and serum osteocalcin (OC) and C-terminal cross-linking telopeptide of type I collagen (ICTP) were measured. QUS was also performed at baseline and 12 months later in a group of 20 normal control individuals (CO), who did not receive GH treatment. RESULTS: At baseline, the IGHD group had a lower T-score on QUS than CO (-1.15 +/- 0.9 vs.-0.07 +/- 0.9, P < 0.001). GH treatment improved this parameter, with improvement persisting for 12 months post-treatment (T-score for IGHD = -0.59 +/- 0.9, P < 0.05). GH also caused an increase in serum OC (baseline vs. pGH, P < 0.001) and ICTP (baseline vs. pGH, P < 0.01). The increase in OC was more marked during treatment and its reduction was slower after GH discontinuation than in ICTP. CONCLUSIONS: These data suggest that lifetime severe IGHD is associated with significant reduction in QUS parameters, which are partially reversed by short-term depot GH treatment. The treatment induces a biochemical pattern of bone anabolism that persists for at least 6 months after treatment discontinuation.

Cross-sectional study on bone density-related sonographic parameters in children with asthma: correlation to therapy with inhaled corticosteroids and disease severity.

The aim of this study was to screen asthmatic children for bone density-related sonographic parameters on the calcaneal bone. Findings were correlated to therapy with inhaled corticosteroids (ICS) as well as with asthma severity (AS), concomitance and severity of atopic dermatitis (AD), and rhinitis (AR). We enrolled 173 children with AS1-3 consecutively; 44% (AS1) had not received any ICS medication; 56% (AS2 and -3) received ICS therapy for > or =6 months (medium daily dose, 286 microg fluticasone-proprionate-equivalent/maximum 500 microg); and in addition 38% (n = 65) presented with AD and 66% (n = 115) with AR. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) results were compared to regional normative values of 3299 children obtained with the identical system. ICS-treated children showed a tendency toward reduced age-, weight-, and height-adjusted standard deviation scores (SDS) for SOS compared to children without ICS treatment, which tendency did not reach statistical significance and was not as consistent for BUA (mean of ICS-treated children compared to our controls: SOS-SDS, -0.29/-0.31/-0.30; BUA-SDS, -0.23/-0.17/-0.05). For ICS-treated children, the proportion of patients with BUA and SOS values below -1 SDS was statistically significant higher for age-adjusted BUA and SOS than for children without ICS medication (BUA 15.00% vs. 5.41%; SOS 32.98% vs. 17.56%). However, we cannot differentiate possible negative effects of ICS from influences of the underlying inflammatory disease because higher asthma severity was associated with greater use of ICS medication. Additionally, the higher physical activity of children with less severe asthma can have influenced quantitative ultrasound (QUS) parameters positively, compared to patients with a higher degree of exercise-induced symptoms. For differentiation of possible negative effect of ICS on ultrasonic bone quality and for evaluation of the potentials of the method, further longitudinal QUS assessment of asthmatics receiving a new ICS treatment is needed.

Soft tissue necrosis following using calcium phosphate cement in calcaneal bone cyst: case report.

Calcium phosphate cements have received widespread attention for their possible role as bone-grafting material and bone fillers in skeletal defects. They were evaluated as a biomaterial in many aspects. No serious harmful effects such as foreign body reaction and tissue necrosis against to calcium phosphate cements have been reported yet. They were accepted as highly biocompatible materials. In this paper, we represent a patient who had soft tissue necrosis around lateral malleolar region, following using percutaneous calcium phosphate cement as a filler bone substitute in calcaneus bone cyst. The possible mechanisms were discussed.

Tranilast suppresses the disease development of the adjuvant- and streptococcal cell wall-induced arthritis in rats.

This study explores the effects of the anti-allergic and anti-fibrotic agent tranilast on adjuvant- and streptococcal cell wall-induced arthritis in rats, animal models of rheumatoid arthritis in humans. Tranilast (150 or 300 mg/kg, twice daily) or vehicle only was administered orally to the two arthritis models, from 17 days before sensitization. As a comparative control, methotrexate (0.1 mg/kg, once daily) was given to another group. Tranilast suppressed the increase in foot volumes, paw thicknesses, clinical scores, and histopathological scores of the ankle joints in both models dose-dependently. In addition, the fibrosis indices of the ankles were dramatically decreased by tranilast in both of the models. Compared to the effects of methotrexate, tranilast seemed to work more effectively in the streptococcal cell wall-induced arthritis model than in the adjuvant-induced arthritis model. From these observations, it can be concluded that tranilast suppresses the development of arthritis in multiple models and is potentially a novel therapeutic agent for human rheumatoid arthritis.

Treatment of a solitary calcaneal cyst with endoscopic curettage and percutaneous injection of calcium phosphate cement.

We report the case of a 35-year-old man who presented with pain in the right heel. Plain radiographs and computerized tomography revealed a solitary cyst of the calcaneus. Endoscopic curettage of the lesion and endoscopically assisted filling of the lesion with calcium phosphate bone cement injected percutaneously were performed. After 12 months, no recurrence was noted and the patient was symptom free.

Skeletal status assessed by quantitative ultrasound at the calcaneus in females with bronchial asthma on prolonged corticosteroid therapy.

OBJECTIVE: The aim of the study was to assess skeletal status in bronchial asthma female patients after long-term oral corticosteroid (CS) therapy. METHODS: Eighty-two female patients (25 with and 57 without fractures; mean age 58.0+/-7.8 years) were compared with 999 females (821 controls without fractures, mean age 58.6+/-7.2 years and 178 females with previous osteoporotic fractures, mean age 57.8+/-7.1 years). Mean age and years since menopause did not differ between patients and controls. The duration of CS therapy was 8.4+/-7.3 years, and daily mean dose equivalent to prednison was 8.8+/-3.5 mg. Skeletal status was evaluated by quantitative ultrasound (QUS) measurements at the heel using the Achilles system (Lunar, USA) which measures speed of sound (SOS (m/s)) and Broadband Ultrasound Attenuation (BUA (dB/MHz)). The Achilles software also calculates a stiffness index (SI (%)). The precision expressed using the root mean square coefficient of variation (RMS_CV%) was: 0.26% for SOS, 4.37% for BUA, and 2.13% for SI. RESULTS: Patients (all, with and without fractures) had significantly lower QUS values than controls without fractures and their values did not differ significantly from controls with fractures. Controls with fractures had significantly lower QUS values than controls without fractures. There was no difference between patients with and without fractures. The duration of the therapy did not influence skeletal variables in any group. Receiver operating characteristic curve (ROC) analysis was performed to assess the discriminatory capability of calcaneal QUS for CS-treated patients by calculating the area under the ROC curve (AUC). AUCs were: 0.70 for SOS, 0.68 for BUA and 0.70 for SI. CONCLUSIONS: In females with bronchial asthma on prolonged CS therapy, skeletal status is affected but does not differ from controls with fractures therefore CS therapy seems to be a risk factor for osteoporotic fracture. Calcaneal QUS measurements can be a useful tool in the assessment of CS bone-side effects.