A 'waterfall' transfer-based workflow for improved quality of tissue microarray construction and processing in breast cancer research.

A major focus in cancer research is the identification of biomarkers for early diagnosis, therapy prediction and prognosis. Hereby, validation of target proteins on clinical samples is of high importance. Tissue microarrays (TMAs) represent an essential advancement for high-throughput analysis by assembling large numbers of tissue cores with high efficacy and comparability. However, limitations along TMA construction and processing exist. In our presented study, we had to overcome several obstacles in the construction and processing of high-density breast cancer TMAs to ensure good quality sections for further research. Exemplarily, 406 breast tissue cores from formalin-fixed and paraffin embedded samples of 245 patients were placed onto three recipient paraffin blocks. Sectioning was performed using a rotary microtome with a "waterfall" automated transfer system. Sections were stained by immunohistochemistry and immunofluorescence for nine proteins. The number and quality of cores after sectioning and staining was counted manually for each marker. In total, 97.1 % of all cores were available after sectioning, while further 96 % of the remaining cores were evaluable after staining. Thereby, normal tissue cores were more often lost compared to tumor tissue cores. Our workflow provides a robust method for manufacturing high-density breast cancer TMAs for subsequent IHC or IF staining without significant sample loss.

An examination of injuries in major league soccer. The inaugural season.

We analyzed the injury data collected from the 10 teams (237 players) that constituted Major League Soccer during its inaugural season. The overall injury rate was 6.2 per 1000 hours of participation. An injury rate of 2.9 per 1000 hours was noted for practice and 35.3 per 1000 hours was found for games. The difference was statistically significant. With regard to severity, 36% of injuries (143 of 399) were categorized as an incident (no time lost from competition). Of the 256 injuries that caused the player to lose playing time, 59% were classified as minor (<7 days lost), 28% as moderate (7 to 29 days lost), and 13% as major (>30 days lost). Seventy-seven percent of the injuries (197 of 256) were to the lower extremity; most frequently affected were the knee (N = 54) and ankle (N = 46). Neither the player's age nor playing position was found to be associated with prevalence or severity of injury. We believe that this information serves to underscore the notion that soccer, as it is played at the professional level, is a sport with a relatively low incidence of injury.

Patellofemoral arthrosis: the treatment options.

Patellofemoral arthritis is a relatively common and frequently complex problem encountered by those who treat patients with anterior knee pain. Because the pathologic conditions that precipitate this pain are so varied, the treatment options must also be varied. Using the Insall classification system for chondral injuries, we explored the treatment options available. Special emphasis was placed on grade IV changes and the surgical treatment of this condition. We reviewed the following options: spongialization, tibial tubercle elevation, patellectomy, patellar resurfacing, patellofemoral arthroplasty, and autologous chondrocyte transplantation. Regardless of the procedure favored, proper patellar tracking must be restored. Without such attention to patellar alignment, patients cannot achieve pain-free function.

The BHAGL lesion: a new variant of anterior shoulder instability.

This article describes a new lesion associated with anterior instability of the shoulder. The bony humeral avulsion of the glenohumeral ligaments (BHAGL) is a rare lesion that may occur after anterior dislocation of the shoulder. There is a bone fragment noted on radiographs of the shoulder that may appear similar to a bony glenoid avulsion. Computed tomography typically will show that the bone is attached to the glenohumeral ligaments and does not originate from the glenoid. Arthroscopy may or may not show the lesion. This variant of anterior shoulder instability may present with impingement or instability symptoms. If symptoms fail to respond to conservative management, treatment through open excision of the bony fragment and reattachment of the glenohumeral ligaments to their origin on the anterior aspect of the humerus is indicated.

Ultrastrucure of the superior oblique tendon.

Individual collagen fibers in the superior oblique tendon of patients with superior oblique palsy studied at 60,000x with transmission electron microscopy are fewer in number and larger in diameter when compared to normal fibers. The relationship of these changes to function and to gross morphologic changes are not clear.

Patellofemoral complications following total knee arthroplasty. Correlation with implant design and patient risk factors.

Results of 211 total knee arthroplasty operations were retrospectively evaluated to identify patients with knees at greatest risk for the development of patellofemoral complications and to determine the incidence and type of patellofemoral complications associated with different patellar implants. Patellofemoral complications occurred in 27 knees (12.8%). Osteoarthritis and obesity were associated with an increased incidence of patellofemoral problems. Significantly higher rates of patellofemoral complications were noted with metal-backed patellar implants and with patellar components implanted without cement. The loosening rate with cementless fixation was 13.5%. The lowest rate of patellofemoral complications following total knee arthroplasty was obtained with all-polyethylene domed patellar components implanted with cement.

The accuracy of the clinical knee examination documented by arthroscopy. A prospective study.

The diagnostic accuracy of the clinical examination for intraarticular injuries of the knee was documented by arthroscopy over a 6-month period. Two-hundred ninety patients (296 knees) were evaluated by history, physical examination, and standard radiographs. Supplemental diagnostic studies included 41 magnetic resonance images, 2 arthrograms, and 1 previous arthroscopy that had been recently performed. Overall, the correct diagnosis was made in 165 knees (56%), an incomplete diagnosis in 92 (31%), and an incorrect diagnosis in 39 (13%). There were only 2 knees (0.07%) with no discernable lesions. When a single lesion was present in the knee, the diagnosis was made correctly in 72% of cases. When more than 2 were discovered, the diagnosis was correct in only 30%. However, all individual lesions were diagnosed with an accuracy of greater than 90%. The lesions most difficult to diagnose were chondral fractures, fibrotic fat pads, tears in the anterior cruciate ligament, and loose bodies. Knees with acute lesions and those with a single diagnosis proved to be significantly easier to diagnose (P < 0.01). The variables that proved to be insignificant were age, sex, magnetic resonance imaging, surgeon, workers' compensation, or pending litigation.

Achilles tenodesis for calcaneus deformity in the myelodysplastic child.

Calcaneus deformity in patients with neurologic disorders leads to gait disturbances, a high incidence of osteomyelitis, cellulitis, and skin breakdown, and a major problem in the fitting of shoes of orthoses. Correction of this deformity remains a difficult challenge for the orthopedic surgeon. Twelve tenodeses of the tendo Achillis to the fibula or tibia were performed in eight patients with myelodysplasia in an attempt to control calcaneus deformity. The average age of the patients at the time of surgery was 7.4 years (range, 3.1-13.5 years) with an average follow-up period of 6.3 years (range, two to 10.9 years). The clinical examination demonstrated definite improvement in the ability to brace, prevent skin breakdown, and improve gait in all but one patient who had progressive hindfoot valgus. Roentgenographically, there was improvement in the tibiocalcaneal angle in 67%, fibular station in 58%, talar tilt in 25%, and growth of the posterior aspect of the calcaneus in 58%.

Treatment of isolated ulnar shaft fractures with functional bracing.

A prospective study was initiated using functional bracing to treat isolated ulnar shaft fractures. Forty-seven consecutive patients with 48 fractures were treated from July 1987 to January 1989. Twenty-eight patients with 29 fractures were available for follow up. Three of these fractures were subsequently excluded, as they had open reduction and internal fixation, leaving a group of 26 fractures. The mean time to union was 45 days (6.4 weeks). Fractures of the middle third of the ulnar diaphysis had the highest mean time to union, as did those with an oblique fracture pattern of 26% to 50% initial displacement. For union time, there was no significant difference for fracture location (P > .05 via t-test) or for fracture pattern (P > .05 via analysis of variance).

Acute rupture of the tibialis anterior tendon: a case report.

Acute rupture of tendons on the dorsum of the foot is rare and the diagnosis can be difficult. We present the case of a 51-year-old man who sustained an acute rupture of the tibialis anterior tendon. Pain about the medial aspect of the midfoot and ambulation with a steppage gait were the keys to formulating a correct diagnosis. The tendon was repaired primarily 10 days after injury. At his final follow-up examination 6 months after surgery, the patient was asymptomatic and ambulated with a normal gait.