Risk factors of adjacent vertebral collapse after percutaneous vertebroplasty for osteoporotic vertebral fracture in postmenopausal women.

BACKGROUND: Recently percutaneous vertebroplasty (PVP) was frequently performed for treatment of osteoporotic vertebral fractures (VFs). It is widely accepted that new compression fractures tend to occur adjacent to the vertebral bodies, typically within a month after PVP. To determine the risk factors among several potential predictors for de novo VFs following PVP in patients with osteoporosis. METHODS: We retrospectively screened the clinical results of 88 patients who had been treated by PVP. Fifteen cases were excluded due to non-union. Of the remaining 73 patients, 19 (26.0%) later returned with pain due to a new vertebral compression fracture. One patient with a non-adjacent fracture and 2 patients with adjacent factures occurring 3 months later were excluded from the study. The 9 male patients were excluded to avoid gender bias. Ultimately, we divided the 61 remaining postmenopausal female patients (mean age: 78.9 years) into the collapse group (14 patients) who had experienced adjacent vertebral collapse after PVP and the non-collapse group (47 patients) who had not. Logistic regression analysis was performed to identify the risk factors for new VFs after PVP. RESULTS: All 14 cases of adjacent VF occurred within the first month after surgery. The collapse group had significantly advanced age, higher urinary N-terminal cross-linking telopeptide of type I collagen, and lower lumbar and hip bone mineral density (BMD) scores as compared with the non-collapse group. The odds ratios for age, lumbar, total hip, femoral neck, and trochanteric BMD were 4.5, 8.2, 4.5, 7.2, and 9.6, respectively. Positive likelihood ratios suggested that age more than 85 years, lumbar BMD less than 0.700 [-2.6SD], total hip BMD less than 0.700 [-1.8SD], neck BMD less than 0.600 [-2.1], and trochanter BMD less than 0.600 conferred an elevated risk of adjacent VF. CONCLUSIONS: Our study revealed that advanced age and decreased lumbar and hip BMD scores most strongly indicated a risk of adjacent VF following PVP.

Metastatic carcinoma to subcutaneous tissue and skeletal muscle: clinicopathological features in 11 cases.

OBJECTIVE: Metastatic carcinoma to subcutaneous tissue or skeletal muscle is relatively rare. The present study aimed to clarify the clinicopathological features for confirming the diagnosis as soft tissue metastasis and determining the primary site. METHODS: We reviewed records of 11 patients with soft tissue metastasis who were in our institution from 1996 to 2009. RESULTS: In 9 of 10 patients who underwent magnetic resonance imaging, findings consisted of poorly circumscribed high-intensity lesions around the tumor on T2-weighted images, irregular peritumoral enhancement and poorly enhanced lesions at the center of the tumor on T1-weighted images. Systematic immunohistochemical examination was more valuable for diagnosing as soft tissue metastasis and confirming the primary site. The expression patterns of cytokeratins 7 and 20 and tissue-specific antibodies such as thyroid transcription factor-1, MUC5AC and CDX2 were useful diagnostic markers. The primary site could be determined in five patients with cytokeratin 7/20 immunophenotype and positivity for tissue-specific antibodies. In four cases, determination of the primary site finally became possible by comparison with the histological findings of operative specimens in past carcinoma and/or in consideration of radiological findings and the results of cytokeratin 7/20 phenotyping. CONCLUSIONS: Systematic immunohistochemical examination is helpful for confirmation of the primary origin in soft tissue metastasis of carcinoma in addition to clinical information such as the history and condition of past carcinoma, radiological findings and comparison between the histology of biopsy specimens and past carcinoma.

[Neoadjuvant chemotherapy with nedaplatin and UFT for oral squamous cell carcinomas].

The purpose of this study was to evaluate the effect of preoperative combination chemotherapy with nedaplatin and UFT for oral squamous cell carcinomas. Eleven patients were enrolled in this study (four men and seven women, with a mean age of 66.3 years). They received oral UFT (300 or 400 mg/day, total 2,100-24,600 mg with an average of 10,700 mg) from the initial diagnosis to the day before surgery. They also received an administration of nedaplatin (80 or 100 mg/m2) about four weeks before the planned surgery. The locoregional response rate (complete response and partial response) was 36.4%, and histological examination of surgical specimens revealed a response rate of 40%. There was no relationship between total dose of UFT and either clinical or histological response. Three patients showed severe neutropenia under 1,000/m3 and all recovered with (two patients) or without (one) the use of G-CSF. No other severe side effect was recognized. From the results of this study it is suggested that this combination therapy is useful for preoperative patients with oral squamous cell carcinoma, and that it is possible for them to undergo the therapy on an out-patient basis.