Iatrogenic Lumbar Vertebral Fracture during Osteosynthesis for a Trochanteric Fracture of the Femur in Diffuse Idiopathic Skeletal Hyperostosis

Vertebral fractures occur with only slight trauma in patients with diffuse idiopathic skeletal hyperostosis (DISH). However, a lumbar vertebra fracture, due to an intraoperative body position has not been previously reported. An 87-year-old woman with kyphosis sustained a left trochanteric fracture of her femur. The patient was placed in a supine position during the operation. Postoperatively, the patient experienced severe right thigh pain. Magnetic resonance imaging revealed an L4 vertebral fracture. Computed tomography revealed ankylosis from the upper thoracic spine to the sacrum. While in a supine position under general anesthesia, the contact of the patient's lower back with operating table likely created a fulcrum at her lumbosacral spine acting as a long lever arm, bearing the mass of her upper body. We performed L1-S2 posterior stabilization. DISH patients with kyphosis placed in a supine position have an increased risk for lumbar vertebral fracture.

Scintigraphic Evaluation of Patients with Malignant Tumor of the Head and Neck by Thallium-201-chloride (Tl-201) Scintigraphy / Oral Science International

The purpose of this study was to evaluate the usefulness of thallium-201-chloride (Tl-201) scintigraphy for the examination of patients with tumors of the head and neck, and to estimate the correlation of the expression of Na⁺/K⁺-ATPase with Tl-201 scintigraphy. Tl-201 scintigraphy was performed in 61 patients with squamous cell carcinoma and 10 patients with benign tumors of the salivary gland. The tumor retention index was obtained from the early and delayed dynamic Tl-201 scintigraphies. The expression of Na⁺/K⁺-ATPase on the cell membrane was evaluated immunohistochemically. Evaluation of correlations between the histopathological tissue differentiation of tumors, the tumor retention index of Tl-201 scintigraphy and the expression of Na⁺/K⁺-ATPase was performed. The tumor retention index of Tl-201 scintigraphy correlated well with the histopathological tissue differentiation of tumors and also showed a good correlation with the expression of Na⁺/K⁺-ATPase. In addition, the expression of Na⁺/K⁺-ATPase demonstrated a close correlation with the histopathological tissue differentiation of malignant tumors. The tumor retention index could be used for the differentiation of malignant tumors from benign tumors and the expression of Na⁺/K⁺-ATPase was estimated as one of the most important factors for Tl-201 accumulation in malignant tumors.