Does image guidance improve accuracy of core needle biopsy in diagnosis of soft tissue tumours?

The aim of this study was to compare accuracy of an image guided percutaneous core needle biopsy (PCNB), using ultrasound or computed tomography, to PCNB without image guidance in the diagnosis of palpable soft tissue tumours. One hundred forty patients with a suspected soft tissue sarcoma underwent a percutaneous core needle biopsy with or without image guidance. One hundred eleven patients had subsequent surgical excision. The accuracy of guided PCNB and blind PCNB was calculated by comparing the histological results of the needle biopsy to the surgical specimen. The diagnostic accuracy of blind percutaneous core needle biopsy was 78% (36 of 46 biopsies) and was significantly lower (p < or = 0.025) in comparison to image guided percutaneous core needle biopsy, which was 95% (62 of 65 biopsies). We suggest that image guidance improves the diagnostic accuracy of PCNB especially for small-size deep sited suspected soft tissue tumours.

Through-the-nail technique.

Ipsilateral fractures of the neck of the femur and the femoral shaft are uncommon injuries and they present considerable challenge as the concurrent survival of the femoral head and union of the femoral shaft fracture is of paramount importance. We present a young male patient who sustained a Garden IV fracture of the neck of his right femur following a road traffic accident, with the fracture being adjacent to an ipsilateral intramedullary nail inserted 10 years previously for a midshaft femoral fracture; the nail was broken, with its proximal fragment lying behind the greater trochanter. The patient was operated on within 6 hours from the injury. An attempt was made to remove the nail but this was abandoned as warring iatrogenic bone loss was encountered, due to the proximity of the fracture to the nail entry point. Instead, three cancellous lag-screws were inserted to fix the fracture in a triangular fashion. Two screws placed posteriorly behind the nail, and one anterior screw through the nail.

Prostaglandin EP2 and EP4 receptor agonists in bone formation and bone healing: In vivo and in vitro evidence.

BACKGROUND: Using agonists that selectively stimulate PGE2 receptors, the adverse effects that have limited the clinical utility of PGE2 can be avoided and there may be potential for their use as therapeutic agents in the treatment of bone loss in humans. OBJECTIVE: A comprehensive review of the recent literature on the effect of prostaglandins and their agonists on bone mineral density and fracture healing. METHODS: In vitro and in vivo evidence was collected using medical search engines MEDLINE (1950 to March 2008) and EMBASE (1980 to March 2008) databases. RESULTS/CONCLUSION: EP4 receptors have been identified in human osteoblast cell lines and have also been shown to activate osteoblast directly and osteoclast indirectly via osteoblastic activation. Although there are strong in vitro and in vivo collective data indicating that EP2 receptors may have a role in mediating the anabolic effects of PGE2 on bone, to date no functional EP2 receptors have been identified on human osteoblasts or osteoclasts. This suggests that PGE2 effect on bone formation and resorption in humans may be governed by activation of the EP4 receptor on osteoblasts. Selective EP4 receptor agonists may therefore provide therapeutic potential for systemic use in the treatment of osteoporosis and fracture healing. Further studies need to be carried out in order fully elicit the role of EP2 receptor agonists in fracture healing and bone formation in humans.

Growth hormone: does it have a therapeutic role in fracture healing?

BACKGROUND: The role of growth hormone (GH) in augmenting fracture healing has been postulated for over half a century. GH has been shown to play a role in bone metabolism and this can be mediated directly or indirectly through IGF-I. OBJECTIVES: The use of GH was evaluated as a possible therapeutic agent in augmenting fracture healing. METHOD: A literature search was undertaken on GH and its effect on bone fracture healing primarily using MEDLINE/OVID (1950 to January 2009). Key words and phrases including 'growth hormone', 'insulin like growth factor', 'insulin like growth factor binding protein', 'insulin like growth factor receptor', 'fracture repair', 'bone healing', 'bone fracture', 'bone metabolism', 'osteoblast' and 'osteoclast' were used in different combinations. Manual searches of the bibliography of key papers were also undertaken. RESULTS: Current evidence suggests a positive role of GH on fracture healing as demonstrated by in vitro studies on osteoblasts, osteoclasts and the crosstalk between the two. Animal studies have demonstrated a number of factors influencing the effect of GH in vivo such as dose, timing and method of administration. Application of this knowledge in humans is limited but clearly demonstrates a positive effect on fracture healing. Concern has been raised in the past regarding the safety profile of the pharmacological use of GH when used in critically ill patients. CONCLUSION: The optimal dose and method of administration is still to be determined, and the safety profile of this novel use of GH needs to be investigated prior to establishing its widespread use as a fracture-healing agent.