Heme oxygenase-1 in osteosarcoma.

AIM OF STUDY: The present study was planned to analyze serum heme oxygenase-1 levels in osteosarcoma patients. MATERIALS AND METHODS: Twenty five histopathologically confirmed cases of osteosarcoma localized without metastasis of all the ages attending the Orthopedic Clinics were included in the study group and twenty five patients having musculoskeletal pain (age and sex matched) served as control. Five ml of venous blood was collected aseptically from antecubital vein and serum was be separated by centrifugation and analyzed the same day. Routine biochemistry investigations were performed as per standard enzymatic methods by autoanalyzer. Serum Heme oxygenase-1 was analyzed by enzyme-linked immunosorbent assay. RESULTS: In osteosarcoma patients, serum HO-1 levels were increased as compared to patients having musculoskeletal pain (P < 0.05). Workers have found that HO-1 induction in prostate cancer cell lines (PC3) cells restored the proliferation of osteoblasts, which was inhibited during co-culture with parental prostate cancer cell line PC3 cells. However, no concrete data are available on blood levels of HO in osteosarcoma. Major role of HO-1 is the protection against oxidative injury, additionally, it regulates cell proliferation, modulates inflammatory response and facilitates angiogenesis. CONCLUSION: Findings of the present study suggests that pharmacological agents that regulate HO activity or HO-1 gene silencing may become powerful tools for preventing the onset or progression of various cancers and sensitize them to anticancer therapies.

Homocysteine, a biomarker of osteosarcoma.

AIM OF STUDY: The present study was planned to analyze the status of serum homocysteine (hcy), folate, and Vitamin B 12 in patients with osteosarcoma. MATERIALS AND METHODS: The present study was conducted on 60 orthopedics patients who were divided into two groups, group I with 30 patients of osteosarcoma and group II with 30 patients with musculoskeletal pain. RESULTS: The present study indicated that serum folate and hcy levels were increased in osteosarcoma patients and decreased Vitamin B 12 in osteosarcoma patients when compared to controls. CONCLUSION: Lowered serum Vitamin B 12 levels are possibly due to increased metabolic demand of the tumor. Raised hcy levels could be due to the contribution from rapidly proliferating cells. The present study suggests that these parameters can serve as useful markers for diagnosis and follow-up of disease.

Double Tension Band Osteosynthesis in Inter-Condylar Humeral Fractures.

INTRODUCTION: Intercondylar humerus fractures are uncommon in orthopaedic practice. The treatment for the same has been described in the literature and include paragonal and orthogonal fixation by using plates. Tension band wiring as a treatment for the same is sparsely described in the literature. AIM: To evaluate the effectiveness of "Double Tension Band wiring" method for the treatment of intercondylar fractures of humerus and compare the results with studies involving treatment with locked plates. MATERIALS AND METHODS: Twenty patients, all presenting with fresh fractures of the distal humerus, treated with double tension band wiring were retrospectively evaluated over a period of three years. Fractures were classified according to Jupiter classification of distal humeral fractures. There were 5 high T fractures, 13 low T fractures and 2 Y fractures. According to AO classification, all were C1 fractures. Average age of the patients was 56.20 years (32-70 years). There were 13 males and 07 females. RESULTS: Out of 20 cases treated with this method, rigid fixation and union was achieved in all of them. The average tourniquet time was 69 minutes with minimum of 50 minutes and maximum of 120 minutes. Radiological union was achieved at an average of 10.8 weeks (8-14weeks). Average range of motion was 104.5 degrees with maximum range of motion 120 degrees (10-130) and minimum of 70 degrees (30-100). Excellent or good results were obtained in 80% of the patients in our study. CONCLUSION: Double tension band is a reliable, less demanding and cost effective method of fixation of intercondylar fractures of humerus.

Serum fluoride and sialic acid levels in osteosarcoma.

Osteosarcoma is a rare malignant bone tumor most commonly occurring in children and young adults presenting with painful swelling. Various etiological factors for osteosarcoma are ionizing radiation, family history of bone disorders and cancer, chemicals (fluoride, beryllium, and vinyl chloride), and viruses. Status of fluoride levels in serum of osteosarcoma is still not clear. Recent reports have indicated that there is a link between fluoride exposure and osteosarcoma. Glycoproteins and glycosaminoglycans are an integral part of bone and prolonged exposure to fluoride for long duration has been shown to cause degradation of collagen and ground substance in bones. The present study was planned to analyze serum fluoride, sialic acid, calcium, phosphorus, and alkaline phosphatase levels in 25 patients of osteosarcoma and age- and sex-matched subjects with bone-forming tumours other than osteosarcoma and musculo-skeletal pain (controls, 25 each). Fluoride levels were analyzed by ISE and sialic acid was analyzed by Warren's method. Mean serum fluoride concentration was found to be significantly higher in patients with osteosarcoma as compared to the other two groups. The mean value of flouride in patients with other bone-forming tumors was approximately 50% of the group of osteosarcoma; however, it was significantly higher when compared with patients of group I. Serum sialic acid concentration was found to be significantly raised in patients with osteosarcoma as well as in the group with other bone-forming tumors as compared to the group of controls. There was, however, no significant difference in the group of patients of osteosarcoma when compared with group of patients with other bone-forming tumors. These results showing higher level of fluoride with osteosarcoma compared to others suggesting a role of fluoride in the disease.

Unusual K-wire migration.

The authors report a case of intra-abdominal migration of a Kirschner wire from the left hip to the right lobe of the liver in a 5-year-old child. The wire was used for stabilization of the left hip after open reduction for neglected unreduced congenital dislocation of the left hip. The migrated wire was removed by laparotomy. Surprisingly, no injury was noted to any intervening abdominal structure intra-operatively. This unusual migration of a Kirschner wire into a child's liver has not been reported previously.

Prolapsed intervertebral disc with sciatica: the role of common peroneal nerve block.

A total of 210 patients of Lumbar disc prolapse with sciatica were given common peroneal block by infiltrating 2% xylocaine around the common peroneal nerve 3 cm below the head of fibula on the affected side. After receiving the block the pain decreased on from grade 2.99 +/- 0.46 to 0.91 +/- 0.99, and straight leg raising increased from 32.1 +/- 12.55 to 59.66 +/- 12.11 degrees. The method, as an outpatient procedure, has been found to be simple and useful in the patients of sciatica with prolapsed lumbar intervertebral disc potentially appropriate for a low-resource setting.

Compressive peroneal neuropathy during harvesting season in Indian farmers.

Thirty patients (34 limbs) with compressive peroneal neuropathy induced by prolonged squatting of more than 5 h during harvesting season were treated conservatively and followed-up to an average of 28.2 months. A marked preponderance of involvement of the left side was noticed. We attribute this to the intermittent extension of the right lower limb habitually used by Indian farmers to propel themselves forwards while squatting during harvesting. All but two lesions recovered fully within 3 to 9 weeks: one patient took 16 and another 20 weeks. We recommend non-operative treatment for this benign lesion.

Medial opening wedge high tibial osteotomy for osteoarthritis of knee: long-term results in 50 knees.

To retrospectively study the long term results of high tibial valgus osteotomy in management of primary medial compartment osteoarthritis, with special reference to patient satisfaction and functional assessment, we conducted this study in radiologically established 50 knees of patients with primary osteoarthrosis of knee. In these patients with medial compartment disease (varus knee), medial open wedge osteotomy was performed using full thickness iliac crest grafts. These were called for follow-up after average 7.5 years and clinico-radiological assessment was done. Although many surgeons of the west do not favour this osteotomy, we found the procedure to be quite acceptable to our patients in whom the primary concerns of cost and squatting habits are well taken care of. The authors feel that this osteotomy is still relevant in the third world. Results do deteriorate with time but most patients consider the surgery satisfactory.

Painful bilateral bipartite patellae--case report.

Bipartite patella is usually asymptomatic. Painful bipartite patella is either non-surgically managed by immobilization, anti-inflammatory drugs and physical therapy or treated by excision. We report a case in whom locally injected bupivacaine and steroid (methylprednisolone acetate) injection relieved the symptoms completely in a case of bilateral painful bipartite patellae.

An innovative compression-clamp for open contaminated fractures of patella: a short report of five cases.

Five patients with open contaminated fractures of the patella were managed using an indigenously designed external clamp cum compressor. All had an infected lacerated wound at the fracture site, and one had open exposed knee joint (Gustilo grade IIIB open fracture). These patients reported after 3-7 days of injury. The wounds were thoroughly washed and débrided and the clamp cum compressor was applied. They were encouraged to do active knee movements immediately post-operatively. The wounds healed within 3-4 weeks, and the fractures united within 10-16 weeks. Good functional results were achieved in four of the five.

Critical evaluation of compartment pressure measurement by saline manometer in peripheral hospital setup.

A hundred limbs of patients suffering limb trauma were assessed by at least two different reviewers for symptoms of compartment syndrome, both clinically, and by a simple, locally devised apparatus for pressure measurement. We have found the apparatus to be very effective, safe, reproducible and simple. Orthopaedic surgeons working in peripheral hospitals in the developing world can make use of this apparatus which costs less than 5 dollars to assemble. This technique may assist an early decision regarding surgical decompression at a peripheral hospital or referral to specialist unit, thus saving valuable time and expense.