Effect of platelet-rich plasma on the biologic activity of the human rotator-cuff fibroblasts: A controlled in vitro study.

To assess the in vitro effect of platelet-rich plasma (PRP) on biological activity of the human rotator cuff fibroblasts and to describe the optimal dose-response to maximize cellular stimulation while reducing potential risk. Rotator cuff (RC) fibroblasts of n = 6 patients (mean age of 65.2 years) undergoing arthroscopic cuff tear reconstruction were cultured in vitro for 21 days and stimulated with PRP in three different concentrations (1-, 5-, and 10-fold). Samples were obtained for DNA and GAG measurement at 1, 7, 14, and 21 days. The biological outcomes were regressed on the PRP concentration. The application of PRP significantly influenced the fibroblast proliferation and activity of the human rotator cuff with elevated glycosaminoglycan (GAG) and DNA levels. The dosage of PRP had the significantly highest impact on this proliferation using a onefold or fivefold application. PRP has a significant effect on fibroblast proliferation of the human rotator cuff in vitro with an optimal benefit using a onefold or fivefold PRP concentration. This study justifies further in vivo investigations using PRP at the human rotator cuff.

High-dose-rate intraoperative brachytherapy (IOHDR) using flab technique in the treatment of soft tissue sarcomas.

BACKGROUND: Adjuvant radiotherapy has been shown to improve local control in patients with soft tissue sarcoma. Additional brachytherapy represents a means of enhancing the therapeutic ratio, as biological and dosimetric advantage over single external-beam irradiation (EBRT) can be expected. High-dose-rate intraoperative brachytherapy (IOHDR) as a boost therapy should therefore be able to further diminish the rate of local recurrence even when performing marginal resection. There are sparse data on IOHDR using flab applicators as adjuvant boost to EBRT in combination with marginal resection of soft tissue sarcomas. PATIENTS AND METHODS: Within a period of 8 years, we prospectively studied 39 adult patients treated by marginal resection, IOHDR using the flab technique and EBRT for soft tissue sarcomas. There were 32 high-grade and seven low-grade tumors, 35 were > 5 cm. Mean follow-up was 26 months (range 3-59 months). RESULTS: We could not detect any local recurrences. No treatment-related loss of limb or life occurred. There were no neurologic or vascular complications, all patients maintained functioning extremities as evidenced by a mean Musculoskeletal Tumor Society (MSTS) functional score of 88.5 (70-100). Treatment-related wound morbidity occurred in eleven patients necessitating revision surgery in eight. Metastatic disease developed in seven patients, six of them had died. The 2-year actuarial disease-free survival was 84%. CONCLUSIONS: IOHDR using the flab technique in combination with EBRT and marginal resection is an efficient treatment technique leading to optimal local control rates and limited functional impairment.

Categorization diminishes the reliability of hip scores.

Scoring systems frequently are used to assess the outcome of total hip arthroplasty. The result may be presented as a numeric value, or in descriptive terms such as excellent, good, fair, and poor (category system). The current study was done to investigate the influence of descriptive and numeric outcomes for interobserver reliability and interscore correlation of five different hip scores. Sixty-four patients (83 hips) were included in the study. The average age of the patients at followup was 70 years (range, 48-88 years). The average followup was 6.2 years (range, 2-17 years). For the numeric outcome a higher interobserver reliability (correlation coefficient, 0.71-0.81) and interscore correlation (correlation coefficient, 0.81-0.92) were found compared with the category system (interobserver reliability[correlation coefficient, 0.57-0.72]; interscore correlation [correlation coefficient, 0.46-0.62]). Findings from the study suggest that categorization of the results of total hip arthroplasty reduces interobserver reliability and interscore correlation.

Differentiation of malignant and benign musculoskeletal tumors: combined color and power Doppler US and spectral wave analysis.

PURPOSE: To assess the use of combined color Doppler ultrasonography (US), power Doppler US, and spectral wave analysis (SWA) in differentiating malignant and benign musculoskeletal tumors. MATERIALS AND METHODS: Seventy-nine musculoskeletal tumors (34 malignant, 45 benign) were examined with color and power Doppler US and SWA. Two radiologists independently assessed US images and SWA findings. Echotexture and vessel characteristics such as stenoses, occlusions, loops, shunts, trifurcations, vascular pattern, and resistive index were evaluated. All tumors were subject to US-guided or open biopsy for histologic correlation. RESULTS: Combined color and power Doppler US and SWA revealed four major (stenosis, occlusion, trifurcation, vascular pattern) and three minor (shunt, self loop, resistive index) vessel characteristics, which proved helpful in differentiating benign from malignant lesions. Echotexture showed moderate sensitivity (82% [28 of 34 tumors]) and low specificity (38% [17 of 45 tumors]). When comparing several combinations of vessel characteristics, a combination of any two major characteristics demonstrated the best results (sensitivity, 94% [33 of 39 tumors]; specificity, 93% [three of 45 tumors]). Combining more than two characteristics resulted in lower sensitivity. CONCLUSION: Combined color and power Doppler US and SWA may enable assessment of vascular architecture and altered flow of musculoskeletal tumors. Vascular architecture analysis enables differentiation of benign and malignant lesions and evaluation of musculoskeletal tumors.