Conjoined Free Fibula Transplantation and First Carpometacarpal Joint Prosthesis for Functional Thumb Reconstruction-A Case Report.

BACKGROUND: Giant cell tumors grow locally invasive with osseous and soft tissue destruction, requiring wide resection to avoid recurrence. Stable reconstruction of the first carpometacarpal (CMC-1) joint remains a challenge due to its high range of mobility. The latter is of paramount for the functionality of the hand. PURPOSE: Therefore, the aim of this study was to report our approach for a combined reconstruction of the first metacarpal and the CMC-1 joint. METHODS: A 58-year-old woman underwent wide resection of a benign giant cell tumor at the base and shaft of the first metacarpal of the left thumb. Because of the loss of the CMC-1 joint and the instability of the thumb, an osseous reconstruction using a vascularized fibular graft combined with a TOUCH Dual Mobility CMC-1 prosthesis was performed to reconstruct the CMC-1 joint. RESULTS: Osseous healing was observed after 3 months. No tumor recurrence and good joint function were documented at the follow-up investigation after 1 year. The patient reported only minor restrictions during activities of daily living. Thumb opposition was possible with a Kapandji score of 8/10. A slight pain while walking remained as a donor-side morbidity at the right lower leg. CONCLUSION: Metacarpal reconstruction with vascularized fibula bone grafts allowed a combined joint reconstruction with a commercially available prosthesis, which is an approach to restore the complex range of motion of the thumb.

Organotypic slice cultures of human gastric and esophagogastric junction cancer.

Gastric and esophagogastric junction cancers are heterogeneous and aggressive tumors with an unpredictable response to cytotoxic treatment. New methods allowing for the analysis of drug resistance are needed. Here, we describe a novel technique by which human tumor specimens can be cultured ex vivo, preserving parts of the natural cancer microenvironment. Using a tissue chopper, fresh surgical tissue samples were cut in 400 µm slices and cultivated in 6-well plates for up to 6 days. The slices were processed for routine histopathology and immunohistochemistry. Cytokeratin stains (CK8, AE1/3) were applied for determining tumor cellularity, Ki-67 for proliferation, and cleaved caspase-3 staining for apoptosis. The slices were analyzed under naive conditions and following 2-4 days in vitro exposure to 5-FU and cisplatin. The slice culture technology allowed for a good preservation of tissue morphology and tumor cell integrity during the culture period. After chemotherapy exposure, a loss of tumor cellularity and an increase in apoptosis were observed. Drug sensitivity of the tumors could be assessed. Organotypic slice cultures of gastric and esophagogastric junction cancers were successfully established. Cytotoxic drug effects could be monitored. They may be used to examine mechanisms of drug resistance in human tissue and may provide a unique and powerful ex vivo platform for the prediction of treatment response.

Empirical criteria for establishing a classification of singing activity in children and adolescents.

This study evaluated a proposed classification system to assess the nature and extent of voice use in young singers to support diagnostic routines, the treatment of voice disorders, and future research in children and adolescents. A classification system was developed and studied in 186 children and adolescents (age range 6-19 years, M=13.5 years). The system was based on three parameters previously shown to contribute to the development of voice disorders in young singers: amount of voice strain, amount of voice training, and the amount of wind instrument use. The subjects were selected on the basis of information from schools and choirs. After this selection, they were interviewed in detail by seven phoniatricians, logopaedists, and voice teachers. The standardized interviews were recorded and used for classification. Afterward, 124 physicians/logopaedists, choirmasters, music teachers, and lay people classified the singing activity by means of six randomized interviews, resulting in a total of 744 second appraisals. The agreement concerning the classification on the part of the interviewers was evaluated for each preselection and each second appraisal result for all three dimensions of the classification for each subject. All of the second appraiser groups showed moderately strong agreement with the interviewers (kappa=0.65-0.83). In the selection in which the test subjects were not interviewed, there was significantly less agreement (kappa=0.29-0.47). However, the additional strain caused by the instrument was already appraised with a very high degree of agreement in the preliminary selection (kappa=0.88-0.93). This classification system is a practical instrument for evaluating singing activity in young singers. It is accessible to lay persons, simplifying and standardizing communication among physicians, logopaedists, and singing teachers. It can be used at the level of a group comparison in scientific investigations.