Extracorporeal shockwave therapy for the treatment of scaphoid delayed union in a tennis player: A case report.

Operative procedures are considered the gold standard when treating delayed union or non-union of the scaphoid despite their considerable complexity and the risk of intraoperative complications. Although extracorporeal shockwave therapy has been reported as a non-invasive treatment option for non-union cases, only a few papers on delayed union or non-union of the scaphoid have been published. A 57-year-old man with delayed union of a scaphoid fracture was treated with extracorporeal shockwave therapy and showed complete bone healing with promising results two months after the start of treatment without undergoing surgery. This result indicated that extracorporeal shockwave therapy could be an option for treating delayed union of scaphoid fractures.

Hydration Status of Junior Tennis Players and the Difference after a Lecture on Its Practice.

Dehydration reduces exercise performance and causes heat-related illness. However, the fact that dehydration is a serious sports injury is often forgotten, especially among junior tennis players, who engage in tennis matches alone without receiving advice from others. Our objective was to investigate the hydration status of junior tennis players and the difference after attending a lecture on the importance of hydration. In total, 157 junior tennis players attending a training camp participated in this study. The duration of the camp was two days, and a lecture was organized on the first night to educate the players about hydration using a body mass scale. Body mass (BM) was measured immediately before and after practice on the first and second day. The water loss rate (WLR) was calculated by dividing the loss in BM during practice by the BM before practice. In total, 34.4% of players had attended a lecture on hydration in the past. These players had a lower WLR than those who had not, but the difference was not significant. The WLR was significantly lower after attending our lecture than that before. This study suggests that a lecture on hydration could immediately improve the hydration status of the junior tennis players; however, this effect may not be lasting. They may need help from their coaches and parents to implement what they have learned in lecture.

Prospective study and multivariate analysis of the incidence of C5 palsy after cervical laminoplasty.

STUDY DESIGN: A prospective comparative study about the incidence of postoperative C5 palsy and multivariate analysis of the risk factors of C5 palsy. OBJECTIVE: To clarify the risk factors of occurrence of C5 palsy after laminoplasty (LP) by comparing the 2 surgical procedures of open-door and double-door LP prospectively. SUMMARY OF BACKGROUND DATA: The incidence of C5 palsy has been reported to average 4.6%, and there has been no difference of the incidence among surgical procedures. However, there were only indirect retrospective studies. METHODS: A total of 146 patients who underwent the LP procedure between 2006 and 2007 were studied prospectively. In 2006, the patients were assigned to undergo the open-door LP, and in 2007, they were assigned to undergo the double-door LP. The incidence of postoperative C5 palsy was compared prospectively between these 2 LP procedures, and the risk factors of C5 palsy were detected with multivariate logistic regression analysis. RESULTS: Postoperative C5 palsy occurred in 7 of 73 cases after open-door LP (9.6%) and in 1 of 73 cases after double-door LP (1.4%). The incidence of C5 palsy after open-door LP was statistically higher than the one after double-door LP (P = 0.029), and open-door LP was recognized as a significant risk factor for postoperative C5 paralysis (odds ratio: 69.6, P = 0.043). In addition, ossification of posterior longitudinal ligament (OPLL) was recognized as a significant risk factor for postoperative C5 paralysis (odds ratio: 43.8, P = 0.048). CONCLUSION: This study showed significant evidence indicating the higher risk of postoperative C5 palsy in open-door LP than double-door LP. Because OPLL as well as open-door LP were recognized as the risk factors of C5 palsy, asymmetric decompression by open-door LP might introduce imbalanced rotational movement of spinal cord and result in C5 palsy. We recommend double-door LP to minimize the postoperative C5 palsy, in particularly, if the patient has OPLL.

Use of a midline anterior incision for isolated medial tibial plateau fractures.

A technique using an anterior midline incision with a medial parapatellar arthrotomy and a medial full-thickness skin flap for the open reduction and internal fixation of isolated medial tibial plateau fractures is presented. The approach is advocated as an alternative to a posteromedial approach when medial tibial plateau fractures are present alone. The anterior approach is simple and familiar for orthopaedic surgeons. It offers good visualization, simplifies reduction, and provides a functional scar if future procedures are necessary.

Superior pubic ramus fractures fixed with percutaneous screws: what predicts fixation failure?

OBJECTIVE: The purpose of this study is to present the early complications of percutaneous screw fixation of superior pubic ramus fractures and to present a new classification scheme for superior pubic ramus fractures. DESIGN: Retrospective. SETTING: Level 1 trauma center. PATIENTS: One hundred and twelve patients with pelvic fracture between the ages of 14 to 89 years underwent percutaneous screw fixation of 145 pubic ramus fractures. Eighty-one patients with 107 surgically repaired fractures were followed to fracture union. Follow-up averaged 9 months (range 2-52 months). One additional patient who sustained fixation failure 4 days after surgery was included to yield a study group of 82 patients with 108 surgically repaired ramus fractures. INTERVENTION: Patients underwent percutaneous screw fixation of a superior pubic ramus fracture. MAIN OUTCOME MEASUREMENTS: Superior pubic ramus fractures were classified according to a new scheme, the Nakatani system, which categorizes superior ramus fractures according to location with respect to the obturator foramen. Patient radiographs were examined for evidence of loss of reduction, defined as any motion at the ramus fracture site or hardware motion, after fracture surgery. RESULTS: Of the 82 patients followed to union or fixation failure, 12 (15%) had loss of reduction on follow-up radiographs. The average age of patients who lost reduction was 55 years. The most common mechanism of reduction loss was a collapse of the pubic ramus over the screw, with recurrence of an internal rotation deformity of the injured hemipelvis. Ten patients who lost reduction were women, and 11 had undergone ramus screw placement in retrograde fashion. No loss of reduction was seen in Zone III ramus fractures (those that involve the bone lateral to the obturator foramen). No patient sustained recognized neurologic, vascular, or urologic injury as a result of percutaneous screw fixation of a superior pubic ramus fracture. CONCLUSIONS: The prevalence of loss of reduction after percutaneous screw fixation of pubic ramus fractures is 15%. Loss of reduction is more common in elderly and female patients and in patients whose ramus screws are placed in a retrograde fashion. Also, loss of reduction appears to be more common in fractures medial to the lateral border of the obturator foramen.

Establishment and characterization of a KIT-positive and stem cell factor-producing cell line, KTHOS, derived from human osteosarcoma.

Osteosarcoma is a malignant bone tumor that commonly affects adolescents and young adults. In the present study a human osteosarcoma cell line, KTHOS, was established from a primary osteosarcoma lesion in the distal femur of a 16-year-old girl. After 106 passages, the KTHOS cell line retained the biological characteristics of osteosarcoma. The KTHOS cells had spindle to pleomorphic cytoplasm with round to ovoid nuclei containing multiple prominent nucleoli, as expected based on the mesodermic origin of osteoblasts. The KTHOS cells were immunoreactive for osteocalcin, osteonectin, stem cell factor (SCF), and KIT (CD117). Reverse transcriptase-polymerase chain reaction indicated that the KTHOS cell line expressed mRNA for SCF and KIT. The KTHOS cells produced relatively high amounts of soluble SCF as determined by enzyme-linked immunosorbent assay. The results suggest that cell proliferation of the KTHOS cell line might be involved in autocrine and/or paracrine loops of the SCF/KIT signaling system. The KTHOS cell line is a novel human osteosarcoma cell line that releases SCF and expresses KIT. This cell line can be used for studies to explore the mechanisms for oncogenesis of human osteosarcomas.

Inhibitory effect of STI571 on cell proliferation of human malignant fibrous histiocytoma cell lines.

BACKGROUND: Malignant fibrous histiocytoma (MFH) is one of the most common high-grade sarcomas in bone and soft tissue and, due to its chemo-resistance, the prognosis of the disease is poor. ST1571 is a tyrosine kinase inhibitor that was initially developed as a BCR/ABL inhibitor for chronic myeloid leukemia patients. STI571 also selectively inhibits platelet-derived growth factor receptors (PDGFRs) and c-kit. We examined the expression of PDGFRs and c-kit in human MFH cell lines, and the effect of STI571 on cell proliferation. MATERIALS AND METHODS: Four human MFH cell lines (TNMY1, GBS-1, Nara-F and Nara-H) were used. mRNA expression of the receptor tyrosine kinases (PDGFRs and c-kit) was analyzed using reverse transcription-polymerase chain reaction, and the inhibitory effect of STI571 on cell proliferation was analyzed using the MTS assay technique. RESULTS: PDGFRalpha mRNA was expressed in TNMY1 and GBS-1, and PDGFRbeta and c-kit mRNAs were expressed in TNMY1, GBS-1 and Nara-F. All three of these mRNAs were absent in Nara-H. STI571 inhibited cell proliferation of TNMY1, GBS-1 and Nara-F in a dose- and time-dependent manner, but cell proliferation of Nara-H was not inhibited by ST1571 at concentrations of 10 microM or less. CONCLUSION: STI571 significantly inhibited proliferation of the three human MFH cell lines that expressed mRNAs of target receptor tyrosine kinases. The inhibitory effect of ST1571 on cell proliferation in these three cell lines might be due to decreased tyrosine kinase activity. STI571 might be a potent chemotherapeutic agent for human MFHs.

Expression of transforming growth factor beta isoforms and their receptors in malignant fibrous histiocytoma of soft tissues.

PURPOSE: Transforming growth factor beta (TGF-beta) is a multifunctional growth factor that variably affects proliferation, differentiation, and extracellular matrix formation. Little information is currently available on the TGF-beta expression in malignant fibrous histiocytoma (MFH). The aims of the present study were to investigate the expression of TGF-beta isoforms and their receptors in human MFH specimens. EXPERIMENTAL DESIGN: The expression of TGF isoforms, and TGF-beta receptors (TGF-beta R1 and -beta R2) were immunohistochemically evaluated in 43 paraffin-embedded MFH specimens. Furthermore, the correlation of the TGF-beta and receptor expression with tumor proliferative activity assessed by MIB-1 indices was analyzed. RESULTS: Positive immunoreactivity for TGF-beta1, -beta2, and -beta 3 was identified in tumor cells of 42, 40, and 38 of the 43 MFHs, respectively. In each TGF-beta isoform immunostaining, the specimens were divided into two groups based on the number of positive tumor cells: those with low (<25%) and those with high (>==25%) immunoreactivity. There were no statistically significant differences in the MIB-1 indices between the two groups. Positive immunoreactivity for TGF-beta R1 and -beta R2 was identified in tumor cells of 36 and 24 of the MFHs, respectively. The specimens were divided into two groups based on their receptor expression patterns: those with both TGF-beta R1- and -beta R2-positive immunoreactivity (n = 23), and those with both or either TGF-beta R1- and -beta R2-negative immunoreactivity (n = 20). The MIB-1 indices in the both-TGF-beta R1- and -beta R2-positive group were significantly higher than those in the other group (P = 0.0102). There was no significant difference in pulmonary metastasis ratios between the two groups. CONCLUSIONS: These findings strongly suggest an association of the TGF-beta ligand/receptor system with a significantly higher MIB-1 index in human MFHs. Investigation of the TGF-beta R1 and -beta R2 coexpression might be useful in predicting tumor behavior of MFHs.

Expression of betacellulin, heparin-binding epidermal growth factor and epiregulin in human malignant fibrous histiocytoma.

BACKGROUND: Heparin-binding epidermal growth factor (HB-EGF), betacellulin (BTC) and epiregulin (EPR) are members of the EGF system and involved in the cell growth of various epithelial malignancies. There have been no reports on the HB-EGF, BTC and EPR expression in mesenchymal malignancies of fibrohistiocytic origin including malignant fibrous histiocytoma (MFH). MATERIALS AND METHODS: We investigated the expression of HB-EGF, BTC, EPR and EGF-receptor (EGF-R) in 43 human MFH tissue samples using immunohistochemical techniques. RESULTS: Positive immuno-reactivity for HB-EGF, BTC, EPR and EGF-R was identified in 28 (65%), 7 (16%), 43 (100%) and 36 (84%) out of the 43 MFH cases analyzed, respectively. Coexpression of HB-EGF/BTC, BTC/EPR and HB-EGF/EPR was observed in 6 (14%), 7 (16%) and 28 (65%) of the MFHs, respectively. Coexpression of HB-EGF/EGF-R, BTC/EGF-R and EPR/EGF-R was observed in 25 (58%), 6 (14%) and 36 (84%) of the MFHs, respectively. CONCLUSION: These results revealed that HB-EGF, BTC and EPR are expressed not only by epithelial tumor cells, but also by MFH cells. It is suggested that HB-EGF and EPR might be more important tumor growth regulators of MFH through autocrine or paracrine pathways, when compared with BTC.

Phalangeal microgeodic syndrome resulting in rapid digital shortening.

Microgeodic phalangeal syndrome is a rare condition affecting the fingers in children. Radiographically, the affected phalanges show sclerosis with multiple small areas of osteolysis. The pathogenesis of microgeodic phalangeal syndrome is considered to be a transient disturbance of the peripheral circulation caused by cold temperatures. In most cases, the symptoms and the radiographic changes return to normal within several months without any treatment. We present a rare case of microgeodic phalangeal syndrome in the middle phalanx of the right index finger in an 8-year-old girl, in whom the affected phalanx shortened within 6 weeks of the initial presentation. It was speculated that minor trauma to the finger might have contributed to the collapse and shortening of the phalanx. The current case indicates that the use of a splint for the affected finger in the early period after onset of symptoms might be recommended to avoid digital shortening.

Coexpression of hepatocyte growth factor and its receptor c-Met correlates with high MIB-1 proliferative index in malignant fibrous histiocytoma.

Hepatocyte growth factor (HGF) is a multifunctional cytokine that variably affects cell motility, proliferation, and morphogenesis. Little information is currently available on the HGF and its receptor c-Met expression in malignant fibrous histiocytoma (MFH). We immunohistochemically investigated the HGF and c-Met expression in 43 MFH tissue specimens. Furthermore, the correlation of the HGF and c-Met expression with tumor proliferative activity assessed by MIB-1 indices was analyzed. Our results showed that positive cytoplasmic immunoreactivity for HGF and c-Met was identified in tumor cells in 36 (84%) and 20 (47%) of the 43 MFH cases analyzed, respectively. Coexpression of HGF and c-Met was observed in 20 (47%) of the 43 MFHs, and was correlated with high MIB-1 proliferative indices (p = 0.0446). These findings strongly indicate that the HGF/c-Met signaling system plays an important role in promoting cell proliferation of human MFHs via an autocrine loop.

Apophysitis of the ischial tuberosity mimicking a neoplasm on magnetic resonance imaging.

We present multimodality imaging features of an ischial tuberosity apophysitis in a 13-year-old boy who was an active baseball pitcher. Roentgenography of the pelvis and computed tomography showed mild irregularity in the inferior margin of the left ischial tuberosity. T1-weighted MRI showed a wide area with low signal intensity in the left ischial body; T2-weighted fat-suppression images showed areas with markedly high signal intensity in the ischial apophysis and body and the surrounding periosteum; contrast-enhanced T1-weighted fat-suppression MRI showed that the ischial body, surrounding periosteum, and origin of the hamstring muscles strongly enhanced; technetium-99m scintigraphic scans showed increased isotope uptake in the entire ischial body. Histological specimens obtained from the bone showed increased osteoblastic activity, edema, and proliferation of benign spindle cells and small vessels in the bone marrow spaces. In the present case, because MR imaging demonstrated extensive signal abnormalities involving the apophysis, periosteum, and intramedullary portion of bone, a neoplasm could not be excluded, and a biopsy was undertaken.

Amphiregulin and epidermal growth factor receptor expression in human malignant fibrous histiocytoma of soft tissues.

BACKGROUND: Amphiregulin is a member of the epidermal growth factor (EGF) system and a potent mitogen for various epithelial tissues. Little information, however, is currently available on the amphiregulin and EGF receptor (EGF-R) expression in mesenchymal malignancies of a fibrohistiocytic origin including malignant fibrous histiocytoma (MFH). MATERIALS AND METHODS: We investigated the amphiregulin and EGF-R expression in 43 human MFH tissues using immunohistochemical techniques. Furthermore, the correlation of the ligand and the receptor expression with tumor proliferative activity assessed by MIB-1 indices was analyzed. RESULTS: Positive immunoreactivity for amphiregulin and EGF-R was identified in 34 (79%) and 36 (84%) of the 43 MFH cases analyzed, respectively. Coexpression of amphiregulin and EGF-R was observed in 30 (70%) of the 43 MFHs analyzed. There were no significant differences in MIB-1 indices between both the amphiregulin and EGF-R-positive MFHs and the remaining MFHs. CONCLUSION: These results show that amphiregulin is expressed not only by epithelial tumor cells but also by MFH cells. Our data provide evidence indicating the presence of an autocrine mechanism of proliferation control involving the amphiregulin/EGF-R signaling system in human MFHs.

Periosteal osteoblastoma of the distal femur.

Osteoblastomas located on the surface of the cortical bone, so-called periosteal osteoblastomas, are extremely rare. We report on a case of periosteal osteoblastoma arising from the posterior surface of the right distal femur in a 17-year-old man. Roentgenographic, computed tomographic, magnetic resonance imaging, and histologic features of the case are presented. Periosteal osteoblastoma should be radiologically and histologically differentiated from myositis ossificans, avulsive cortical irregularity syndrome, osteoid osteoma, parosteal osteosarcoma, periosteal osteosarcoma, and high-grade surface osteosarcoma. Although periosteal osteoblastoma is rare, this tumor should be included in the differential diagnosis of surface-type bone tumors.

Expression of stem cell factor and lack of c-kit expression in malignant fibrous histiocytoma of soft tissues.

BACKGROUND: Little information is available on the expression of stem cell factor (SCF) and its receptor c-kit in soft tissue tumors of a fibrohistiocytic origin, including malignant fibrous histiocytoma (MFH). MATERIALS AND METHODS: We investigated the endogenous expression of SCF and c-kit in 43 MFH tissue samples using immunohistochemical techniques. Furthermore, we examined the correlation of SCF expression in MFHs with proliferative activity assessed by mitotic indices and MIB-1 immunohistochemical staining. RESULTS: Positive immunoreactivity for c-kit was identified in tumor cells of only one MFH case, while the remaining 42 cases were negative. In the one positive case, immunohistochemical staining was focal. Positive immunoreactivity for SCF was identified in 31 out of 43 cases studied (72%, focal; 11, moderate; 6, diffuse; 14). There were no significant differences in the MIB-1 and mitotic indices between the SCF-positive and negative groups. CONCLUSION: Our data indicate that any direct autocrine effects of the SCF/c-kit system on cell growth regulation are precluded in most MFH cases studied, but it is speculated that SCF might indirectly influence tumor growth by promoting local neovascularization.

Immunohistochemical analysis of platelet-derived growth factor and its receptors in soft tissue malignant fibrous histiocytoma.

BACKGROUND: Little information is available regarding the expression of platelet-derived growth factor (PDGF) isoforms and their receptors in soft tissue malignant fibrous histiocytoma (MFH). MATERIALS AND METHODS: We investigated expression of PDGF isoforms and their receptors (PDGF-R alpha and -R beta) in 43 MFH tissue specimens using immunohistochemical techniques. Furthermore, we examined the correlation of PDGF expression in MFHs with proliferative activity assessed by MIB-1 immunohistochemical staining. RESULTS: Positive cytoplasmic immunoreactivity for PDGF-AA, -BB and -AB was identified in tumor cells of 28 (66%), 4 (10%) and 26 (61%), respectively, of the 43 MFHs analyzed. Positive cytoplasmic immunoreactivity for PDGF-R alpha and -R beta was identified in tumor cells of 41 (95%) and 32 (74%), respectively, of the MFHs. Thirty-four (79%) MFHs coexpressed one or more PDGF isoforms and their corresponding receptors. In PDGF-AA immunostaining, MIB-indices in the high immunoreactivity group (> 10% of tumor cells) were significantly higher than those in the low immunoreactivity group (< 10% of tumor cells) (p = 0.031). CONCLUSION: Our data provide evidence to support the presence of an autocrine/paracrine mechanism of proliferation control involving the PDGF ligand/receptor system in human MFHs.

Expression of stem cell factor and c-kit in human malignant fibrous histiocytoma cell line (TNMY1).

BACKGROUND: The expression of c-kit and/or its ligand, stem cell factor (SCF), has been related to tumor proliferation, in several tumor systems. MATERIALS AND METHODS: We analyzed the expression of the SCF/its receptor (c-kit) mRNA and the production of soluble SCF in a human malignant fibrous histiocytoma (MFH) cell line (TNMY1). RESULTS: Immunocytochemical analysis revealed that the TNMY1 cells were positive for both SCF and c-kit. Reverse transcriptase-polymerase chain reaction (RT-PCR) showed that the TNMY1 cell line expressed mRNA for SCF and c-kit. By using an enzyme-linked immunosorbent assay (ELISA), the TNMY1 cells were found to produce relatively high amounts of soluble SCF. However, the addition of soluble SCF to the TNMY1 cells did not alter the in vitro growth ability of the cells. CONCLUSION: Our data showed that the MFH cells produced consistent amounts of SCF but did not demonstrate autocrine growth modulation. Thus, SCF secretion may have a paracrine activity in the growth of MFH cells.