The relationship of fetuin-A and lactoferrin with bone mass in elderly women.

SUMMARY: The relationships of fetuin-A and lactoferrin to bone-related phenotypes were investigated in elderly women. Fetuin-A was associated not only with bone mineral density (BMD) but also with bone resorption marker suggesting an influence of fetuin-A on osteoclasts. INTRODUCTION: The aim of this study is to investigate the relationship of bone-related phenotypes in elderly women with circulating fetuin-A and lactoferrin. METHODS: Eighty-two elderly women were studied. Serum fetuin-A, lactoferrin, C-terminal telopeptide of type I collagen (CTx), total procollagen type 1 amino-terminal propeptide, and plasma intact parathyroid hormone (PTH) were analyzed. BMD of the lumbar spine at L2-4 and at the femoral neck was measured. RESULTS: Serum fetuin-A was significantly associated with L2-4 BMD (r = 0.23, P < 0.05). After controlling for age and body weight, the association remained statistically significant. There was a significant association between serum fetuin-A and serum CTx (r = -0.37, P < 0.001). The association between fetuin-A and L2-4 BMD no longer existed after controlling for serum CTx. There were positive associations of circulating lactoferrin with plasma PTH (r = 0.24, P < 0.05) and serum CTx (r = 0.26, P < 0.05). No association between serum lactoferrin and BMD at the lumbar spine or femoral neck was detected. CONCLUSIONS: Circulating fetuin-A is related to bone mass and bone resorption markers in elderly women. Lactoferrin, in contrast, is associated only with bone resorption markers.

Salvage treatment for sarcomas of the hand.

We report 6 patients (1 male and 5 females; age range, 13-77 years) with hand sarcoma. The lesions were located between the digits and the distal end of the radius. A painless mass was the common manifestation in these patients. An incisional biopsy was performed on every patient, and histology revealed two low-grade malignant sarcomas and four high-grade malignancies. A surgical salvage procedure was performed. The 4 patients with high-grade malignancy underwent adjuvant therapy such as radiotherapy and/or chemotherapy. Four patients are still alive and exhibit acceptable function in the affected hand. Our surgical procedure is presented.

Tuberculous infection of the hand and wrist.

The authors report on 23 patients treated for tuberculosis of the hand and wrist during the past 20 years. Duration of symptoms prior to diagnosis ranged from several months to years. Swelling and pain on motion were common symptoms, as was increased sedimentation rate. Granulomatous inflammation was seen on paraffin section in most of the patients, however tissue cultures were positive for Mycobacterium tuberculosis in only 6 patients in this study. Treatment of these patients were divided into medical and surgical treatments. The incisional biopsy and antituberculous drug were carried out and administered in the medical-treated group for 2 years. The surgical synovectomy as well as debridement and administration of antituberculous drugs were carried out on the surgical group. The results showed no recurrence in this study. Most of the patients showed improved symptoms and an increased range of motion. In conclusion, this treatment resulted in good recovery of function with low morbidity.

A study of simplified porcine skin preservation.

The study of preserved porcine skin was done by using split-thickness skin grafts of pigs weighing approximately 25 to 30 kg. The harvesting of split-thickness skin grafts was performed under aseptic and antiseptic conditions. The povidone-iodine solution and 0.25% acidified sodium hypochlorite solution were used before immersion of the skin in 90% glycerine solution. Prepared skin graft was stored in the freezer compartment of a home refrigerator. Serial studies of the bacteriology and the histology of specimens were performed monthly for 12 months. No bacterial organisms were found during the study. The integrity of the skin lasted up to 5 months, however, the property of the preserved skin was as good as the other biological dressing even after 6 months. This simple, low-cost procedure is useful for restoring allografts or even autografts in a hospital without conveniences or adequate facilities.

The Krukenberg procedure in the bilateral amputee after electrical burn.

Nine Krukenberg procedures were performed in 5 bilateral amputee patients suffering severe electrical injuries of both hands and wrists. The surgical procedure yielded functioning pincers in 7 of 9 operations. The patients could perform their daily activities very well and showed pronounced improvement in their self-confidence, self-reliance, and quality of life. The postoperative rehabilitation of these patients was not difficult. The Krukenberg procedure should be considered a substitute for prosthesis, especially in developing countries.

Experimental microvascular autogenous vein grafts for arterial defects: II. A histopathologic study of the grafts.

Twelve autogenous vein grafts, of average diameter 1.5 mm, which had been used to bridge defects in the contralateral femoral artery of adult rabbits by a minimally traumatic technique, were examined over a 12-week postoperative period. Each graft remained widely patent but showed fibroelastic intimal thickening with time. Further evidence of arterialisation was the development of a prominent subintimal layer of smooth muscle. Also noted was the presence of medial fibrosis, with both calcification and ossification. This latter is suggestive of damage due to disruption of the vasa vasorum. It would appear that arterialisation of microvascular vein grafts occurs independently of surgical trauma and is therefore difficult to avoid. However, these pathologic changes were not as severe, nor was there as much luminal narrowing, as at the previously described anastomotic sites. The most important cause of these changes appears to be arterial pressure.

Experimental microvascular autogenous vein grafts for arterial defects: a study of anastomotic sites.

Autogenous femoral vein grafts with an average external diameter of 1.5 mm and an average length of 2.87 cm have been used to bridge defects in the contralateral femoral artery of 15 adult New Zealand white rabbits. An experimental microvascular technique to minimise trauma to the graft was performed, by which clamps were never applied to the graft itself. Patency was assessed over a 12-week period, and the overall graft success rate, excluding one technical failure, was 86%. Each of the three failures resulted from thrombosis. Histologic examination of the patent anastomoses showed marked medial damage at 1 week, complicated by fibrosis and calcification by 4 weeks; thereafter the intima developed prominent fibroelastic thickening. This led to a degree of luminal narrowing by 12 weeks. However, the underlying medial damage, attributable to operative trauma, did not seem to diminish luminal patency.