The basket plate in the osteosynthesis of comminuted fractures of distal pole of the patella.

The purpose of this study was to evaluate the basket plate in the treatment of comminuted fractures of the distal pole of the patella (patellar apex fracture). The basket plate was designed by Smiljanic Branimir M.D., Clinical Professor of Surgery, at the Department of Surgery, The University Hospital Sestre milosrdnice, Zagreb, Croatia. In the period from 1988 to 2003, more than 100 patients with comminuted patellar apex fractures had been treated with basket plate osteosynthesis in the Department of Surgery. Only 51 patients were subsequently available for knee examination. For evaluation of the knee, we used a modified Cincinnati knee rating system, using a manual dynamometer in the evaluation of the knee extension. The results were excellent in 30 patients, good in 16 and satisfactory in 5 patients; no poor results were observed. The stability of the osteosynthesis by basket plate allows osseous consolidation if the fracture and permits loading the leg with full body weight early in the postoperative period.

The expression and role of insulin-like growth factor II in malignant hemangiopericytomas.

Hemangiopericytoma is a rare soft tissue tumor originating from contractile pericapillary pericytes. To address the issue of molecular genetic events that participate in genesis and progression of hemangiopericytoma we analyzed insulin-like growth factor (IGF) II and IGF I receptor in 29 tumors collected from a human tumor bank network. Seven of these tumors were associated with severe hypoglycemia; six were retroperitoneal and one was located in the leg. Of 22 tumors tested 12 (54.5%) exhibited IGF II mRNA, while almost 90% (17 of 19) of hemangiopericytomas exhibited IGF I receptor mRNA. Sera from some patients whose tumors expressed IGF II mRNA contained elevated levels of IGF II. Removal of the tumor eliminated most of the IGF II immunoreactivity from the sera. The potential role of IGF II as a growth-promoting factor was examined on three malignant primary hemangiopericytoma cell cultures. Extracellular addition of IGF II significantly enhanced cell proliferation in a dose-dependent manner. Antisense oligodeoxynucleotides that specifically inhibit IGF II mRNA, at a concentration of 40 or 80 micrograms/ml, inhibited the growth of hemangiopericytoma cells significantly, by 40%. Simultaneous administration of antisense deoxyoligonucleotides to both IGF II and IGF I receptor inhibited tumor cell proliferation by even 80%. Our data suggest that tumor cells produce IGF II, and that this in turn stimulates their proliferation by autocrine mechanisms.

Some structural characteristics of the inguinal region in the northern Croatia.

In studying anatomical samples of both inguinal hernia patients and healthy controls with no changes observable in the inguinal region, the authors aimed at investigating the constitution of the inguinal region in relation to the formation of inguinal hernia. The morphological investigation of 68 anatomical samples and 44 inguinal regions at autopsy, revealed that the length of the interspinal line, independent of sex, varies from 180 to 310 mm and is 63 to 132 mm removed from the pubic tubercle (the height of the anterior pelvic arch). Thus, in 35% of male and 22% of female subjects the height of the anterior pelvic arch exceeded 75 mm indicating a low position of the groin. The research carried out in 640 inguinal hernia patients and 186 controls indicated a shift towards higher values in the interspinal line in inguinal hernia patients as compared with the controls. In addition, the height of the anterior pelvic arch in patients with inguinal hernia conspicuously exceeded that observed in the controls. The present study undoubtedly shows that the number of muscle and connective structure variations of the inguinal region depends upon the position of the groin in relation to the interspinal plane. The authors therefore agree with the classification of these relationships to high, medial and low groin position. The high position of the pubic tubercles up to 75 mm removed from the interspinal spine is accompanied with the firm constitution of the entire inguinal region. Moreover, the medical position of pubic tubercles 75 to 90 mm removed from the interspinal line does not indicate the risk of developing inguinal hernia. On the other hand, the low position of the pubic tubercles more than 90 mm removed from the interspinal line is often due to the inferior constitution of the inguinal region. This group is regularly at higher risk of developing inguinal hernia, particularly with other risk factors being added as well. The identification of structural characteristics of the inguinal region therefore enables the selection of the most appropriate operation procedure, i.e. between the classic hernia repair and endoscopic approach for prosthetic mesh implantation.