[Treatment of Giant Cell Tumor of Bone in the Distal Radius and Ulna]. / Lécba obrovskobunecného kostního nádoru distálního radia a ulny.

PURPOSE OF THE STUDY The preferred treatment of giant cell tumor of bone is curettage with the use of local adjuvant. If the tumor spreads beyond the bone into soft tissues, en bloc excision should be performed. Intralesional curettage allows joint preservation, but it is associated with a high recurrence rate. The purpose of the study was to identify the risk factors for local recurrence and to compare the functional outcomes after both types of surgical procedures. MATERIAL AND METHODS The group included 16 patients (5 women, 11 men) with giant cell tumor of bone in distal forearm treated at the First Department of Orthopedic Surgery, St. Anne s University Hospital Brno in 2005-2019. The mean age of patients was 38 years (22-53). The follow-up period was 6.75 years (2-15) on average. The most common location of the tumor was distal radius (14). In 6 patients denosumab treatment was indicated. Based on the obtained data, we compared the effects of gender, Campanacci grade, type of surgery and administration of denosumab on the risk of local recurrence. The functional outcomes were evaluated retrospectively based on the Musculoskeletal Tumor Society scoring system for upper limb salvage surgeries. RESULTS Resection and reconstruction using an osteocartilaginous allograft was performed in 9 patients. Seven patients were treated with tumor curettage with bone cement used to fill the cavity. The group of patients who underwent curettage showed a significantly higher mean MSTS score 89% compared to the group of patients with resection with the mean MSTS score 66% (P < 0.05). Local tumor recurrence was reported in 3 patients (18.75%). No statistically significant difference was found in gender, tumor grade, radicality of surgery or administration of targeted therapy with respect to the incidence of local recurrence. Altogether 6 complications (37.5%) were observed in the group. DISCUSSION The treatment of a giant cell tumor of bone aims to completely remove the tumor and to preserve the best possible function of the limb. The complications in distal forearm involve particularly an increase incidence of local recurrence and painful or limited range of motion of the wrist. Whereas curettage with the use of local adjuvant is burdened with a higher recurrence rate, resection with allograft reconstruction of bone defect is usually associated with poorer functional outcomes. CONCLUSIONS Tumor curettage using local adjuvant is preferred in a well-circumscribed tumor and offers an excellent functional outcome. En bloc tumor resection and reconstruction using an osteocartilaginous allograft is a suitable treatment option for a locally advanced tumor with a low risk of local recurrence. Key words: giant cell tumor of bone, distal radius, distal ulna, curettage, osteocartilaginous allograft.

Acidified chloroquine treatment for the removal of class I HLA antigens.

With the aim of reducing the damage to platelets while effectively removing class I HLA antigens from their surfaces, we developed a new method using acidified chloroquine diphosphate. Platelets were treated with a 0.2 M solution of chloroquine diphosphate (pH 4.0). More than 90% of the platelets remained viable after treatment. While a marked reduction in reactions of acidified chloroquine-treated platelets with multispecific HLA antisera was noted in comparison with phosphate-buffered-saline-(PBS)-treated platelets, reactions with platelet-specific antibodies were preserved. This was demonstrated by immunofluorescence tests and solid-phase and monoclonal antibody immobilization of platelet antigen assays. Aggregation responses, though reduced in comparison with PBS-treated platelets, were still preserved after acidified chloroquine treatment. Ultrastructural analysis did not show any significant difference from PBS-treated platelets. We conclude that treatment of platelets with acidified chloroquine diphosphate is a simple and effective method for removing class I HLA antigens from their surfaces with minimal damage to their structure and function.

Eosinophilia, mast cell hyperplasia and antibody production in rats following an intraperitoneal injection of Ascaris cuticle including in-vitro studies of immune eosinophil granule lysis.

A single intraperitoneal injection of Ascaris cuticle caused a local eosinophilia with peak levels at 2 wk after injection. Mast cells reduced in number and size at 1 wk were found in increased numbers at 3 wk. Injection of a collagen-poor fraction of cuticle known as "cuticlin" resulted in a diminished eosinophil and mast cell response compared with injection of whole cuticle. Precipitating antibodies to soluble Ascaris cuticle collagen were detected in the serum and peritoneal fluid from day 5 onward. It is proposed that the eosinophilia and mast cell hyperplasia are the result of immunization of the animal to an antigen present in Ascaris collagen and rendered soluble by the action of mononuclear phagocytes. The eosinophil and mast cell response to Ascaris cuticle mimicked the response in connective tissue to living nematode parasites. It is concluded that the cuticle of nematode parasites may be responsible for eosinophilia and mast cell hyperplasia in the host.

Thirty-five-day modified red cells and 7-day stored platelet concentrates from triple bags of identical PVC formulation.

There is continuous need for blood components with long shelf life. To this end the 'circle' triple pack has been modified to provide 35-day red cell and 7-day platelet concentrates, in PVC bags of identical formulation and 0.4 mm thick. The plasticizer is a mixture of DEHP and TOTM (CLX Mark II). The primary pack contains 63 ml of CP 277.5 mM glucose. The third pack contains 100 ml of citric acid 2 mM, trisodium citrate 20 mM, NaH2PO4 20 mM, NaCl 123 mM, glucose 40 mM, and adenine 1.26 mM. Plasma is adenine-free. With these modifications both hard- and soft-spun red cells gave satisfactory biochemical and autologous survival indices up to 35 days of storage, the haematocrit not exceeding 60%. Platelet concentrates were acceptable at 7 days of shelf-life.

Survival of transfused platelets collected into new formulation plastic packs.

Platelet concentrates were prepared in plastic packs of polyvinyl chloride with tri(2-ethylhexyl) trimellitate as plasticizer. They were stored, with gentle shaking, at room temperature for periods up to 7 days before labelling with isotope and reinfusing. In vivo survival studies, platelet counts, pH and electron microscopy indicated that platelet concentrates prepared in the new plastic were superior to those prepared in the standard pack currently in use. Oxygen was found to diffuse through the new pack more rapidly than through the standard pack. A shelflife of up to 1 week at room temperature seems possible for platelet concentrates prepared in the new plastic.

The nosocomial and occupational hepatitis type B infection in a chest disease hospital. A prospective study.

The results of a prospective study of hepatitis B infections among the patients of a Chest Disease Hospital are reported. A thousand and sixteen patients admitted during the twelve months study period were screened for the Hepatitis B(Surface)-Antigen(HBsAg) on admission and during the stay and were kept under epidemiological surveillance for six months following the discharge. The HBsAg prevalence was 3.54% on admission and the cumulative infection rate during the follow up period was 12.64 per 100 patients. The HBsAg prevalence on admission was significantly higher in males than in females, the susceptibility to infection found in the course of the study was in both sexes similar. The majority of infections was inapparent with the ratio of 8.6:1 of inapparent to clinically manifested forms. The incidence of viral hepatitis among the personnel was comparable to the incidence among the personnel of other hospital departments.

Hepatitis B (surface) antigen and viral hepatitis in family contacts of acute hepatitis B patients.

The results of a follow up study among family contacts of acute hepatitis B patients are reported. The family members were tested for HBsAg in the time of hospitalization of the index case and after three months again, the families were kept under epidemiological surveillance for six months. 19 (4,54%) out of the 418 persons screened for the first time were HBsAg-positive. The highest prevalence of HBsAg-positive persons was found in the families of patients without history of parenteral exposure. 5 (1%) of family contacts were hospitalized from 2 to 4 months following admission of the index case. All were the spouses of index case patients and none of them had other history of parenteral exposures than blood sampling for purpose of this study. 2 (0,58%) cases of silent antigenaemia were found among the 344 persons examined at the second screening.