Aseptic nonunion of the humeral shaft.

A total of 78 cases of aseptic nonunion of the humeral shaft treated at the third division of the Rizzoli Orthopaedic Institute between 1980 and 1997 were evaluated. There was a mean time of 19 months between trauma and definitive treatment. Surgical treatment consisted in osteosynthesis with a plate and bone grafting in 75 cases, and synthesis with screwed bone grafting alone in 3 cases. Consolidation was obtained in 96% of cases. The bone graft used (homo- or autoplastic) encountered complete osteointegration in a maximum time of 8 months. Postoperative motility of the shoulder and elbow were comparable to the preoperative findings.

Inveterate fractures of the acetabulum.

The authors reviewed 44 inveterate fractures of the acetabulum treated surgically by internal osteosynthesis. The definition of inveterate fracture concerns lesions that are treated from 21 to 90 days after trauma. Based on an analysis of this series several features of a prognostic and therapeutic nature may be determined. In particular, it may be observed just how difficult it is to standardize therapeutic strategies in relation to polymorphism and anatomopathologic progression of the lesions.

Arthrodesis of the knee after tumor resection: a comparison between autografts and allografts.

Cases of arthrodesis of the knee performed after bone tumor resection using autografts (Group I) and allografts (Group II) were compared (follow-up was comparable). The two groups show differences in type of pathology, treatment and length of resection. Nonetheless, the percentage of complications and the final results were similar. Despite the fact that arthrodesis of the knee is used less and less for reconstruction, it is our belief that the use of autografts should be substituted by allografts whenever possible.

Osteosynthesis with percutaneous wiring in fractures of the proximal humerus.

The authors report the preliminary results of osteosynthesis with percutaneous wiring in the treatment of fractures of the proximal humerus. This method which is still described in very few cases, is characterized by several advantages such as its minor invasiveness, and respect for vascularization of the fragments that guarantee good functional results. The application of threaded pins or pins of large diameter guarantees excellent hold with a low incidence of loosening secondary to loss of reduction. The use of a traction device applied to the surgical table simplifies reduction maneuvers and osteosynthesis.

The use of massive bone allografts for intercalary reconstruction and arthrodeses after tumor resection. A multicentric European study.

A multicentric study was conducted by the European Musculoskeletal Oncology Society on 113 cases of resection for tumors of the major long bones and reconstruction with massive allografts, as intercalary diaphyseal or for arthrodesis. The follow-up was at least 12 months. There was a 14% incidence of infection, with a higher frequency (18.5%) in intercalary grafts as compared to arthrodeses (7%). Fracture of the graft occurred in 15.5% of the cases with a prevalence in the humerus (28.5%) as compared to the tibia (21.4%) and femur (14.7%). Fracture constantly occurred after osteosynthesis with screws, in 16% of the cases after osteosynthesis with a plate, and in 12.5% of the cases after osteosynthesis with an intramedullary nail. It was observed in 32% of the grafts preserved at -30 degrees, in 17% of those irradiated, and in 7% and 7.6% of those preserved at -180 degrees and -80 degrees, respectively. Delayed union and non-union was observed in 57% of the cases: 63% in intercalary grafts, 48% in arthrodeses. Final results after treatment of complications were excellent and good in 63% of the entire series. The results should, however, be evaluated after 3 years, as during this period of time important transformation phenomena of the graft occur. Complications are observed in 75% of the cases, but they may be reduced if planning is correct and surgery is accurate. Each complication may be dealt with and resolved without high risks for preservation of the limb.

miR-204 targets Bcl-2 expression and enhances responsiveness of gastric cancer.

Micro RNAs (miRs) are small non-coding RNAs aberrantly expressed in human tumors. Here, we aim to identify miRs whose deregulated expression leads to the activation of oncogenic pathways in human gastric cancers (GCs). Thirty nine out of 123 tumoral and matched uninvolved peritumoral gastric specimens from three independent European subsets of patients were analyzed for the expression of 851 human miRs using Agilent Platform. The remaining 84 samples were used to validate miRs differentially expressed between tumoral and matched peritumoral specimens by qPCR. miR-204 falls into a group of eight miRs differentially expressed between tumoral and peritumoral samples. Downregulation of miR-204 has prognostic value and correlates with increased staining of Bcl-2 protein in tumoral specimens. Ectopic expression of miR-204 inhibited colony forming ability, migration and tumor engraftment of GC cells. miR-204 targeted Bcl-2 messenger RNA and increased responsiveness of GC cells to 5-fluorouracil and oxaliplatin treatment. Ectopic expression of Bcl-2 protein counteracted miR-204 pro-apoptotic activity in response to 5-fluorouracil. Altogether, these findings suggest that modulation of aberrant expression of miR-204, which in turn releases oncogenic Bcl-2 protein activity might hold promise for preventive and therapeutic strategies of GC.

Infection in limb salvage surgery for bone tumors.

The authors present a retrospective study of 66 infected cases in their series of limb salvage surgery performed from January 84 to August 92. Special emphasis was given to the alternative techniques of treatment in infection. In 85% of the cases healing was achieved, however removal of the implant and amputation are still frequent occurrences. Time to recovery is very demanding.

[Digital pacinian hyperplasia. Report of a case associated with foreign body reaction]. / Iperplasia paciniana digitale. Descrizione di un caso con associata reazione da corpo estraneo.

Digital Pacinian Hyperplasia is a non tumoral, very rare lesion. To date, only 31 cases have been reported, occasionally named Digital Pacinian Neuroma. Digital pain is usually associated to. Local trauma is reported in about half of the cases. We report a new case occurred in a 62 year-old male, associated with inflammatory and foreign body reaction. No recurrence was observed 6 months after surgical excision. Differential diagnosis and controversies about this lesion are discussed.

Metal- and ligand-centered monoelectronic oxidation of mu-nitrido[((tetraphenylporphyrinato)manganese)phthalocyaninatoiron)], [(TPP)Mn-N-FePc]. X-ray crystal structure of the Fe(IV)-containing species [(THF)(TPP)Mn-N-FePc(H(2)O)](I(5))02THF.

The reaction of mu-nitrido[((tetraphenylporphyrinato)manganese)(phthalocyaninatoiron)], [(TPP)Mn-N-FePc], with I(2) in THF develops with the formation of two different species, i.e., [(THF)(TPP)Mn-N-FePc(H(2)O)](I(5)).2THF (I) and [(TPP)Mn(IV)-N-Fe(III)Pc](I(3)) (II). On the basis of single-crystal X-ray work and Mössbauer, EPR, Raman, and magnetic susceptibility data, I, found to be isostructural with the corresponding Fe-Fe complex, is shown to contain a low-spin triatomic Mn(IV)=N=Fe(IV) system (metal-centered oxidation). Data at hand for II (Mössbauer, EPR, Raman) show, instead, that oxidation takes place at one of the two macrocycles, very likely TPP (ligand-centered oxidation). The same cationic fragment present in I, and containing the Mn(IV)=N=Fe(IV) bond system, is also obtained when (TPP)Mn-N-FePc is allowed to react in THF with (phen)SbCl(6) (molar ratio 1:1). There are indications that the use of (phen)SbCl(6) in excess (2:1 molar ratio), in benzene, probably determines further oxidation with the formation of a species showing the combined presence of the Mn(IV)-Fe(IV) couple and of a pi-cation radical.