Charcoal bamboo as a bone substitute: an animal study.

Charcoal bamboo (Bambusae glaucescens) was placed in the resected tibial diaphysis of sixteen New Zealand White rabbits. At two, four and six weeks and again at six months after the operations, four rabbits in each period were killed and all specimens were examined under a light microscope and a scanning electron microscope. The six-week specimens showed that there was neobone invasion into the pores of the charcoal bamboo. There was no evidence of fibroencapsulation or inflammatory response. Due to its structure as a uniform porous material with interconnecting pores and carbon composition, the charcoal bamboo has been proved to be an osteotropic material. Clinical relevance: Charcoal bamboo should be an alternative bone substitute which may be used in humans in the near future. This material is available and easy to produce and prepare in developing countries.

Iliotibial band for anterior cruciate ligament reconstruction: a new technique for graft augmentation, placement and fixation.

A simple surgical technique to reconstruct the ACL deficient knee was described. A strip of ITB and fascia lata augmented by degradable suture materials was used as the substitute. The strip was introduced into the isometric area of the original ACL attachment through a drill hole made in the lateral femoral condyle. Drilling was guided by the anatomical landmarks without using special device. The graft was then rigidly fixed to the tibia by intraosseous compression, the method previously described by the author. Clinical results were assessed by both subjective symptoms and physical examinations. In 33 patients followed-up for an average of 34.1 months, thirty of them who were chronic cases had few or no symptoms concerning pain, swelling, laxity and stiffness at the last visit. Lachman test, anterior drawer and Slocum test were negative in 87.92, 81.87 and 100 per cent respectively. This technique requires only basic instruments and skill, and is thus generalizable to institutions having limited surgical facilities.

Rotational deformity of the distal humerus in cubitus varus.

The medial rotation deformity of the distal humerus usually exists in the cubitus varus deformity but has received little attention. Study of this deformity in 29 cases of cubitus varus was carried out using the osteotomized bony specimens that were removed during closed wedge osteotomy in order to determine the actual bone deformity. The average duration of the varus deformity was 5.6 yrs (range 1 to 11). The medial rotation deformity of the distal humerus averaged 27 degrees (range 15 to 45). There was no correlation between the degree of rotation and that of the varus deformity (correlation coefficient r = 0.15). The affected-side shoulder compensated well in both internal and external rotation, and had a greater arc of rotation than that of the normal side. The affected-side shoulder exhibited an internal rotation deformity with an average of 16 degrees (range 5 to 25), with restriction of external rotation of only 13 degrees (range 0 to 20) in comparison to normal side shoulder.

Osseous adenocarcinoma of unknown primary site: study of survival and prognostic factors.

A prospective study of 149 patients suffering from adenocarcinoma of unknown primary site (ACUPS) of bone was carried out. The tumors are classified as 63 extraspinal, 67 spinal and 19 mixed involvement. Upon meticulous physical examination, Virchow's node was detected in 15 cases, rectal shelf in 11 cases and hepatomegaly in 44 cases. Blood chemistry showed elevation of alkaline phosphatase (> 3 sigma units) in 98 cases and chest roentgenogram showed pulmonary lesions in 23 cases. Treatment was surgery and radiotherapy in 64 and two cases respectively. In all of these patients histological findings of the biopsy or resection specimen had confirmed the diagnosis of adenocarcinoma. Among 124 evaluable patients, overall survival was analysed using Kaplan-Meier life table analysis. Survival rates at one, two and four months after diagnosis were 80.7, 60.5 and 25 per cent with a mean and median survival times of 90 and 77 days respectively. Statistical analysis was also performed to ascertain the prognostic importance of the following variables: age, gender, Virchow's node, rectal shelf, hepatomegaly, serum alkaline phosphatase, pulmonary lesion, and multiplicity and site of the osseous lesions. The presence of pulmonary lesion or hepatomegaly significantly produced unfavorable impact on the duration of survival (p = 0.0004 and 0.0150, respectively) while other remaining factors had not.