Vascular endothelial growth factor expression in osteosarcoma.

UNLABELLED: Vascular endothelial growth factor expression by osteosarcomas at biopsy has been shown to have a negative influence on survival. Whether it continues to be expressed and influence outcome in tumors after neoadjuvant chemotherapy has not been determined. To determine if a high-degree of vascular endothelial growth factor expression by the surviving osteosarcoma cells in the resected tumor has a negative influence on prognosis, we retrospectively reviewed 52 patients with Stage IIB osteosarcoma around the knee, 48 of whom received neoadjuvant chemotherapy. Vascular endothelial growth factor expression by the surviving tumor cells in the surgically resected specimens was determined by immunohistochemical staining. Followup was for a minimum of 92 months. The presence of vascular endothelial growth factor expression in greater than 25% of tumor cells was independently associated with a reduced overall and disease-free survival rate. LEVEL OF EVIDENCE: Prognostic study, Level II (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Osteomyelitis and secondary septic arthritis caused by Sphingomonas paucimobilis.

We describe a case of osteomyelitis and secondary septic arthritis caused by Sphingomonas paucimobilis in an immunosupressed adolescent which did not present typically, leading to a delay in diagnosis. This case highlights the need to thoroughly investigate musculoskeletal pain in the immunocompromised patient in order to exclude an infection as a cause.

Stage-IIB osteosarcomas around the knee. A study of MMP-9 in surviving tumour cells.

We studied 55 patients with stage-IIB osteosarcoma around the knee with respect to the expression of matrix metalloproteinase (MMP)-9 in the surviving tumour cells in surgical resection specimens. They were followed up for a minimum of 2.5 years. Factors significantly associated with poor overall survival were a high serum level of alkaline phosphatase at diagnosis and tumour cells expressing MMP-9 in the resection specimens. The only factor strongly associated with disease-free survival was the immunohistochemical status of tumour cells for MMP-9 in the resection specimens. The percentage of necrosis after chemotherapy failed marginally to reach statistical significance. On Cox regression analysis only MMP-9 remained significant for overall and disease-free survival.

A new technique for posterior cruciate ligament reconstruction.

We describe a new technique for arthroscopically assisted posterior cruciate ligament reconstruction. We use the TransFix (Arthrex, Naples, FL) pin to provide a single and strong tibial attachment point for the 4-stranded semitendinosus and gracilis tendons. The TransFix technique for anterior cruciate ligament reconstruction has been found to give better initial fixation strength than other techniques using semitendinosus and gracilis grafts, and it provides adequate graft length for secure fixation. Strong and secure graft fixation in knee ligament reconstruction is very important for early and fast rehabilitation.

Bilateral endoprosthetic replacements of the proximal femur.

Patient. We report the case of a 20-year-old caucasian male with an Ewing's sarcoma in the left upper femur. After induction chemotherapy, he underwent resection of the left upper femur and insertion of a cemented proximal femoral replacement. Four years later, he presented with a solitary bone metastasis in the right upper femur. He underwent further chemotherapy followed by resection and endoprosthetic replacement of the other proximal femur. He remains disease free with excellent function almost a year after the second operation.Discussion. We believe this is the first reported case of bilateral proximal femoral endoprostheses.