S100A4 (p9Ka) protein in colon carcinoma and liver metastases: association with carcinoma cells and T-lymphocytes.

The presence of the EF-hand-calcium-binding protein S100A4 in the carcinoma cells of the primary tumour is associated with a shorter survival time of a group of breast cancer patients. In colon cancer, primary tumours as well as metastases to the liver can be studied. Here we show, using quantitative PCR applied to RNA from 24 normal colon, four liver tissues, 24 colon carcinoma specimens, and 24 livers containing colonic carcinoma metastases, that the level of S100A4 mRNA was significantly higher in the carcinomas compared to normal specimens (Mann-Whitney U-test, P=0.05), and in liver metastases compared to carcinoma specimens (P=0.039). The latter comparison included seven liver metastases and their matched primary carcinomas (P<0.001) from the same patient. In situ hybridization and immunocytochemistry techniques have localized S100A4 to both carcinoma cells and lymphocytes in the malignant specimens. The percentage of specimens stained for S100A4 in the epithelial cells is significantly higher for those isolated from carcinomas and metastases than from the corresponding normal tissue, and from metastases than from corresponding carcinoma (Fisher Exact text, P<0.0016, P=0.04, respectively). In most specimens, S100A4 is present in clusters of T lymphocytes and this distribution is also found in the lymphoid, uninflamed appendix.

Dislocation after total hip arthroplasty using the anterolateral abductor split approach.

The three basic surgical approaches used most commonly in total hip arthroplasty are transtrochanteric, posterior, and anterolateral. Complications related to each of these surgical approaches have been reported including dislocation, trochanteric nonunion, heterotopic ossification, neurovascular damage, postoperative limp, and implant malalignment. The anterolateral abductor split approach previously has been reported to allow ease of access into the hip joint, optimum joint visualization, protection of neurovascular structures of the hip, and predictable results for postoperative hip function restoration. Reviewing a large consecutive series of primary total hip arthroplasty cases (1518), the authors report an overall dislocation rate less than 1% (12:1518; 0.79%). Stratified by preoperative diagnosis, patients undergoing total hip arthroplasty after trauma, or presenting with congenital dysplastic hip are at the highest risk for postoperative dislocation. Primary total hip arthroplasty using the anterolateral, abductor split approach can minimize the rate of postoperative dislocation in the prevailing preoperative diagnostic categories.

Freehand resection of the patella in total knee arthroplasty referencing the attachments of the quadriceps tendon and patellar tendon.

A freehand technique of patellar resurfacing using anatomic references was prospectively evaluated. This technique utilizes an osteotomy beginning at the inferior pole of the patella just posterior to the insertion of the patellar tendon and is carried proximally posterior to the insertion of the quadriceps tendon. Evaluation of 55 total knee arthroplasties in 41 patients showed an average restored patellar thickness within 0.1 mm. The overall patellar thickness was restored to within 1 mm of its preoperative thickness in 50 (91%) of 55 knees. Patellar tilt was equal to or less than 4 degrees in 42 (89%) of 47 arthroplasties evaluated radiographically. The patellar thickness averaged 17.9 mm, well above the critical value of 15 mm reported in the literature.

Particulate debris presenting as radiographic dense masses following total knee arthroplasty.

Two cases of failed total knee arthroplasty associated with significant titanium debris that created massive radiographic densities are reported. The similarities of the failed total knee arthroplasties are that both involve titanium femoral components with failed metal-backed patellar components. At the time of surgical intervention, patellar polyethylene dissociation from metal-backed patellar components was noted with excessive burnishing and wear of the remaining metal-backed patellar component and of the titanium femoral component. Wear of the tibial polyethylene was noted in both cases. The titanium-on-titanium wear couple produced significant debris, resulting in large mass formation about the total knee arthroplasty. Additionally, there were loculated, fluid-filled sacks of titanium debris. Histologic sections performed for both cases revealed significant deposits of titanium in combination with polyethylene. In both cases, radiographs revealed the presence of large, radiodense masses. These cases illustrate that when considering etiologies for radiodense masses about total joint arthroplasty, particulate titanium debris resulting in mass formation must be added to the differential diagnosis.

The fate of anterior vertebral bone grafts in patients irradiated for neoplasm.

Perioperative irradiation is often used with anterior decompression and vertebral interbody fusion for the treatment of spinal neoplasms, yet little is known regarding the healing potential of these grafts. This review of 25 patients with neoplasm who had anterior vertebrectomy, bone strut insertion, and perioperative irradiation was performed to look specifically for evidence of radiographic fusion as determined by plain radiographs, tomograms, or computed tomography reconstruction. Four of 25 patients (16%) were judged to have a pseudarthrosis. All four pseudarthrosis patients but only four of 21 fusion patients had 4000 cg or more of irradiation, a statistically significant difference. There was a trend for lumbar lesions to have a higher risk for nonunion. Concomitant posterior stabilization did not necessarily prevent pseudarthrosis. Two iliac strut grafts with a pseudoarthrosis developed late fracture and one went on to collapse into kyphosis. The pseudarthrosis rate of anterior vertebral strut grafts in the face of irradiation for tumor is relatively high, and late graft fracture can occur if pseudarthrosis develops. Probable risk factors include irradiation greater than 4000 cg and lumbar lesions. Posterior stabilization to protect the graft may be warranted in the highest-risk patients.