Falling can be a serious problem for the elderly.

We present the role of a multidisciplinary approach for the patient with a pathological fracture of the femur. A 56-year-old female complained of pain in the right hip from falling at home. After that she was sent for treatment without knowing her breast mass. For final diagnosis and treatment, the case was brought for discussion and made an appropriate treatment was made for her by the members of tumor board. With a multidisciplinary approach we saved not only her life but also the function of her leg.

Local compressive strength of the superolateral and sueromedial aspects of the anterior half of the talar dome: A biomechanical and histological study.

One cause of osteochondritis dissecans of the talar dome is related to trauma. The lesion occurs at the anterior half of the talar dome. The lateral osteochondritis dissecans is located at the superolateral aspect, while the medial lesion is located at the superomedial aspect. The lateral lesion is more common and its crater is shallower than that of the medial lesion. This study was therefore carried out to determine the local compressive strength of the superolateral and superomedial aspects of the anterior half of the talar dome. Ten pairs of fresh normal cadaveric tali were obtained. Using a universal testing machine, a compressive load was applied through a metal indenter at the superolateral and superomedial aspects of the talar dome until the maximal load was obtained. The maximal load and depth of depression were recorded. Histological studies of the compressive lesion was done using decalcified hematoxylin eosin stain. The results of the study showed that the superolateral aspect of the talar dome could withstand 1.27 times less compression load than could the superomedial aspect without a significant difference in stiffnesses. Moreover, the depth of depression of the superolateral compressive lesion was shallower than that of superomedial. Histological studies showed that the compressive lesion was a depression fracture. The depression fracture was a free osteochondral fragment surrounded by normal osteochondral tissue. The free fragment included articular cartilage, subchondral plate, and subchondral cancellous bone. The result of this study may explain why the prevalence of the lateral traumatic osteochondritis dissecans is higher, and its lesion crater shallower, than that of the medial aspect of the talar dome.

Failure mode of depressive osteochondral fracture under maximum compressive load: Studies of normal, osteoporotic, and osteosclerotic subchondral bones.

Objective: To determine the failure mode of depressive osteochondral fracture under the maximum compressive load. Design: An experimental cadaveric study. A compressive load was applied through an indenter on a femoral condyle to create a depressive osteochondral fracture until the maximum load was reached. Background: Most depressive osteochondral fractures occur without a gross articular cartilage injury because a large amount of load is reabsorbed by the surrounding tissues, especially the subchondral bone under the cartilage. We asked what the mode of depressive osteochondral fracture is. It might function as a load adsorber from the articular cartilage. Methods: Three groups of depressive osteochondral fractures were studied. Croup 1 consisted of 12 pieces of middle third of normal median and lateral femoral condyles. Groups 2 and 3 consisted of 12 pieces of osteoporotic and osteosclerotic middle of both femoral condyles. Using a universal testing machine, a depressive osteochondral fracture was created by applying a uniaxial compressive load through an indenter until the load rose to the maximum level. At that point, the load applied was stopped in order to minimize the extent of subchondral trabeculae fracture. Maximum load was recorded. Pressure and stiffness were calculated. The pattern of depressive fracture was studied histologically. Results: The failure mode of depressive osteochondral fracture wan such that the bone under the articular cartilage had a subchondral plate fracture, an interlacing of bone trabeculae under the plate, and a few fractures of the bone trabeculae. The interlacing of subchondral bone trabeculae was most evident in the normal bone as compared with the osteoporotic and osteosclerotic bones. The osteosclerotic bone failed at the highest load, while the osteoporotic bone failed at the lowest. Conclusion: The subchondral plate fracture and the interlacing of subchondral bone trabeculae under the plate are the characteristics of the failure mode of depressive ostechondral fracture. This failure mode occurs before there is a discernible fracture of the subchondral bone trabeculae. The amount of load causing fracture depends on the quality of the bone. Relevance: The failure mode, especially the interlacing of subchondral bone trabeculae, night function as a load absorber from the articular cartilage. Therefore, the quality of subchondral bone is important for protection of the articular cartilage from compressive load injury.

Local compressive strength at the middle of the weight-bearing surface of the femoral head and talar dome: A biomechanical study.

Objective: To compare the local compressive strength at the middle of the weight bearing surface of the femoral head and talar dome. Design: Cadaveric and comparative experimental study. The compressive strength of the talar dome and the femoral head were measured and compared. Background: The prevalence of late collapse of femoral head from avascular osteonecrosis is higher than that of the talar dome. The femoral head and acetabulum form a hip joint with monoarticulation whereas the talus itself has several articulations with several bones, so the talar dome distributes load more effectively from it the surroundings than does the femoral head. Compressive strength of the weight bearing surface of the femoral head and talar dome, however, may play a role in late collapse. Methods: Ten fresh cadaveric normal adult femoral heads and tali were obtained. A compressive load was applied through an indenter at the middle of the superior quadrant of the femoral head and talar dome by using a universal testing machine until a maximum load was obtained. The maximum load and depth of depression at maximum load were recorded. Results: The middle of the weight bearing surface of the femoral head could withstand an average maximum pressure of 30.42 MPa. Its stillness was 929.04 N/mm and its depth of depression was 1.11 mm. The corresponding figures for the talar dome were 49.64 Mpa, 1631.65 N/mm, and 0.96 mm respectively. Conclusion : This study showed that local compressive strength at the middle of the weight bearing surface of the talar dome was 1.63 times greater than that of the femoral head. Relevance : This finding may explain the higher prevalence of late collapsing avascular necrosis of the femoral head than that of the talar dome.

Deadly soft tissue sarcoma: Curable using a multidisciplinary approach.

We present the role of multidisciplinary approach to treat our patient with a soft tissue sarcoma at her thigh successfully. A 56-year-old female complained of a progressive enlarging soft tissue mass on her thigh before the diagnosis of malignant fibrous histiocytoma was confirmed by appropriate approach. With final diagnosis and staging of the disease, the appropriate treatment was decided from all members of Siriraj Musculoskeletal Tumor Board to save not only patient's life but also preserve her extremity and function.

Eosinophilic meningitis due to Angiostrongylus cantonensis.

We report a 23 year old female who presented with a history of headache. She was admitted to a hospital in Nakornrachasrima province. Eosinophilic meningitis was diagnosed. However, releasing pressure of cerebrospinal fluid (CSF) by lumbar puncture, supportive and symptomatic treatment were performed resulting in appropriate treatment. The patient was referred to Siriraj Hospital due to the persisted headache. Multidisciplinary investigation such as imaging modalities, cytology and serological test for specific antibodies were carried out. Antibody against an A. cantonensis-specific 31-kDa antigen was detected in the serum sample obtained from this patient. In conclusion, A. cantonensis is the possible causative agent of headache in this patient.

Hemorrhagic invasive ductal carcinoma with immunohistological expression of b-subunit HCG: A case report.

A hemorrhagic breast mass was excised from a 27-year-old female. Microscopically, the tumor showed typical areas of invasive ductal carcinoma with intraductal component admixed with some trophoblast-like tumor giant cells in the hemorrhagic area. These cells exhibited β-subunit HCG by immunohistochemistry. The modified radical mastectomy was done after exclusion of the coexisting choriocarcinoma in breast cancer. Postoperatively, the HCG serum level was within normal limit and the gynecological check up showed no positive findings. The modified radical mastectomy specimen revealed that the residual tumor showed the same findings as seen in the previously excised mass.

Desmoplastic cerebral astrocytoma of infancy: A first case report in Thailand.

We report a new and rare entity of childhood brain tumor, desmoplastic cerebral astrocytoma of infancy. This neoplasm arises in the superficial cerebral cortex of infant under two-years of age. The tumor is voluminous size, partially cystic. It composes of astrocytes with massive desmoplasis, mimicking mesenchymal tumor. Despite their large size, the prognosis following successful surgical resection is quite favorable. To the best of our knowledge, this is the first case report in Thailand.