Beta 2-microglobulin amyloid deposit in HLA-B27 transgenic rats.

Beta 2-microglobulin (beta 2-m) amyloid deposition develops serious orthopedic complications in patients with long-term hemodialysis. However, the exact pathogenesis of amyloid deposition in patients with dialysis is unknown. We used transgenic rats with HLA-B27 and beta 2-m to develop an in vivo animal model with beta 2-m amyloid-associated disorders to investigate the mechanism of formation and to report histological findings of beta 2-m amyloid deposition. Transgenic rats were divided into two groups: group 1, no treatment; group 2, arthritis induced by type II collagen. A large number of cells labeled with beta 2-m were observed in the bone marrow and synovium of the knee joint in transgenic rats. In addition, amyloid deposition, identified by Congo red staining, was found only in the knee joints of the transgenic rats with collagen-induced arthritis. Immunostaining with beta 2-m demonstrated the same pattern of tissue distribution as Congo red in serial sections. We hypothesized that elevated serum beta 2-m level-associated local chronic inflammation leads to the development of amyloid deposits and resultant arthropathy.

Health-related quality of life (HRQOL) in Japanese osteoporotic patients and its improvement by elcatonin treatment.

Health-related quality of life (HRQOL; "QOL" hereafter) was evaluated in Japanese osteoporotic patients using three questionnaires; the SF-36 (MOS 36-Item Short-Form Health Survey; generic, profile-type), the EQ-5D (Euro Qol-5 Dimensions; generic, preference-based), and the JOQOL (Japanese Osteoporosis Quality of Life 1999; disease-targeted). The eight subscales and two summary scores of the SF-36 were impaired in these patients even after correction for age and sex. The scores on the EQ-5D and JOQOL correlated well with the subscales of the SF-36 that represent the physical aspects of physical function and bodily pain, which suggests that physical aspects are important determinants of overall QOL status in osteoporotic patients. Although the QOL scores did not correlate with bone mineral density, they were markedly influenced by the presence of vertebral fractures. In particular, the presence of two or more vertebral fractures greatly decreased the QOL scores. We then evaluated the QOL scores before and after treatment. The patients were either given calcium supplementation alone or calcium plus once-weekly elcatonin (Elcitonin, Asahi Kasei Pharma, Tokyo, Japan) injection. Elcatonin treatment markedly improved diverse aspects of the QOL, whereas calcium alone did not. The current data suggest that osteoporosis, especially in the presence of vertebral fracture, is associated with compromised QOL, and therapeutic intervention for osteoporosis should be evaluated in terms of QOL, as well as in terms of increases in bone mineral density and fracture prevention.

Successful limb salvage of pathological fracture of the distal tibia caused by cancer metastasis.

Pathological fractures of the distal tibia as a result of cancer metastases are rare. In particular, the management of intraarticular fractures of the distal tibia has not been established. In this article, we present a case of pathological intraarticular fracture with an extensive bone defect of the distal tibia that was successfully treated by limb salvage with a locked intramedullary nail and pirarubicin-impregnated methylmethacrylate. A 52-year-old patient with duodenal cancer presented with a painful swelling in the left crus. The condition was diagnosed as an impending pathological fracture of the tibia because of cancer metastasis. During radiation therapy, an actual pathological fracture of the distal tibia occurred due to an accident. Limb-salvage surgery was performed by removing the metastatic lesion, followed by using a locked intramedullary nail. Three distal and seven proximal locking screws were inserted into the tarsal bones and the remaining tibia. About 10 cm of bone defect was reconstructed by pirarubicin-impregnated methylmethacrylate. Consequently, good stability was achieved. One month later the patient could walk without any aid. Postoperative functional score was 77% according to the Musculoskeletal Tumor Society criteria. There was no recurrence; however, the patient died of lung metastases 4 months after the limb-salvage surgery.