The Malaysian Orthopaedic Association humanitarian mission to Indonesia and Sri Lanka.

The tsunami which occurred off the west coast of North Sumatra on December 26, 2004 devastated the coastal areas of North Sumatra, South-West Thailand, South-East India and Sri Lanka killing more than a quarter of a million people. The destruction was enormous with many coastal villages destroyed. The other countries affected were Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Kenya, Tanzania and the Seychelles. In January 2005, volunteers went in weekly rotation to Banda Aceh in collaboration with Global Peace Mission. These were Dr Hyzan Yusof, Dr Suryasmi Duski, Dr Sharaf Ibrahim, Dr Saw Aik, Dr Kamariah Nor and Dr Nor Azlin. In Banda Aceh, the surgical procedures that we could do were limited to external fixation of open fractures and debriding infected wounds at the Indonesian Red Crescent field hospital. In February, a team comprising Dato Dr K S Sivananthan, Dr T Kumar and Dr S Vasan spent a week in Sri Lanka. In Sri Lanka, Dato Sivananthan and his team were able to perform elective orthopaedic operations in Dr Poonambalam Memorial Hospital. We appealed for national and international aid and received support from local hospitals and the orthopaedic industry. International aid bound for Banda Aceh arrived in Kuala Lumpur from the Philippine Orthopaedic Association, the Chiba Children's Hospital in Japan and the Chinese Orthopaedic Association. The COA donated 1.5 tons of orthopaedic equipments. A special handing over ceremony from the COA to the Indonesian Orthopaedic Association was held in Putrajaya in March. Malaysia Airlines flew in the donated equipment to Kuala Lumpur while the onward flight to Aceh was provided by the Royal Malaysian Air Force. In April, Dr Saw Aik and Dr Yong Su Mei joined the Tsu-Chi International Medical Association for volunteer services on Batam Island, Indonesia. The MOA acknowledges the many individuals and organizations, both governmental and non-governmental, for their contributions in the humanitarian efforts.

A simple method for removal of a broken intramedullary nail.

The removal of broken implanted intramedullary nails secondary to re-fracture or non-union is challenging. In 12 cases a simple and safe method has been used to remove broken implants.

Lymphocyte-synovial cell interactions: a role for beta 1 and beta 3 integrin-mediated adhesion to cellular fibronectin.

The interactions of lymphocytes with cultured synovial cells derived from rheumatoid arthritis patients were examined. A number of lymphoid cell lines bound to these cells. The adherence of several of these lines was inhibited by antibodies to fibronectin. The adherence of the T cell leukemia Jurkat was sensitive to inhibition by antibodies to the fibronectin receptors alpha 4 beta 1 and alpha 5 beta 1. The adherence of the beta 1 integrin negative B cell line RPMI 8866 was inhibited by antibodies to the vitronectin receptor, alpha v beta 3. The interactions of several other cell lines with synovial cells appeared to be independent of this fibronectin-dependent pathway. These results indicate that multiple potential adhesion pathways for cellular interactions in the tissues may exist. The adherence to cell-associated fibronectin may play a contributory role in such processes for certain lymphocyte subsets.

The interactions of gamma delta T cells with extracellular matrix: receptor expression and utilization patterns.

Purified populations and clones of human gamma delta T cells were examined for their ability to interact with extracellular matrix (ECM) components. The stimulation of these cells with phorbol ester induced cellular adhesion for ECM. The adhesion structures for fibronectin and collagen were shown to be members of the CD29 integrin family. The expression patterns of beta 1, beta 2 and beta 3 integrins by these cells were examined. The receptor expression and utilization patterns suggest that alpha beta, gamma delta T cells and B cells have similar repertoires of adhesion structure.

Resorbing bone stimulates tumor cell growth. A role for the host microenvironment in bone metastasis.

Demineralized extracts of bone matrix and conditioned media from cultured fetal rat calvaria have been reported to contain growth stimulatory activity for bone cells. To investigate the potential role of these local bone growth factors in the development of bone metastases, we chose the Walker 256 carcinosarcoma, a rat mammary tumor which causes osteolytic bone metastases and hypercalcemia. 45Ca-labeled, 19-day fetal Sprague-Dawley rat calvaria were cultured for 96 hours in BGJb medium. Walker cells from ascites tumors or cultures were grown in unconditioned media or in conditioned media harvested from the bone cultures, in the presence of 10% fetal calf serum. Media were changed every 2 days, cells were counted daily for 5 days, and 3H-thymidine uptake into acid insoluble residues was measured. The growth of tumor cells was 5-6-fold greater in conditioned media than in unconditioned media and the effect was dose dependent. Cells cultured in conditioned media demonstrated a approximately 3-fold enhancement of 3H-thymidine incorporation. Generation of growth stimulatory activity correlated with the extent of bone resorption, measured by release of 45Ca from the fetal parietal bones (r = 0.85; P less than 0.001). Conditioned media from bones cultured with 10(-7) M prostaglandin E2 (PGE2) contained greater amounts of growth stimulatory activity than untreated conditioned media, but PGE2 itself did not stimulate tumor cell growth. Addition of 3.5 mM PO4 to bone cultures blocked bone resorption and the generation of growth factors. Growth stimulatory activity was stable to heat (56 C for 30 minutes) and trypsin digestion, with an apparent molecular weight of less than 17,000 daltons by high-performance liquid chromatography. Conditioned medium also stimulated the growth of 13762 rat mammary adenocarcinoma cells, MB-MDA-231 human breast carcinoma cells, TE-85 osteosarcoma cells, a murine fibrosarcoma and rat embryonic fibroblasts, with the most potent effects noted for Walker tumor cells, the TE-85 osteosarcoma, and human breast carcinoma lines. These results suggest a mechanism by which bone resorption could promote the development of skeletal metastasis.

Adhesion, chemotaxis, and aggregation of Walker carcinosarcoma cells in response to products of resorbing bone.

Cells from the Walker 256 carcinosarcoma, a rat breast tumor with a propensity to metastasize to bone, were labeled with [131I]5-iodo-2'-deoxyuridine and then added to 96-hour organ cultures of fetal Sprague-Dawley rat calvaria that had been prelabeled with 45Ca and incubated with various stimulators or inhibitors of resorption. In conditioned media from resorbing bone cultures, the number of cells that attached to the bone surfaces correlated with the degree of bone resorption (r = 0.65; P less than .005). The attachment response was maximal after 180 minutes of cocultivation and was inhibited by preincubation of the tumor cells with 10(-5) M cytochalasin B. Cellular attachment appeared to be promoted by a trypsin-sensitive factor released into the organ culture medium from resorbing bones. Enhanced tumor cell attachment did not appear to be related to a change in the surface properties of the resorbing bone, since it was not observed when the conditioned media were replaced with fresh medium. Furthermore, tumor cells placed in conditioned medium demonstrated increased attachment to plastic surfaces and formed aggregates. While there was a direct correlation between the ability of conditioned medium to promote cellular adhesion and chemotactic migration (r = 0.85; P less than .05), the factors responsible for chemotaxis and adhesion could be separated by gel filtration. The release of such factors from resorbing bones may promote the formation of secondary bone tumors, since in this system attachment of unlabeled cells was followed by proliferation of tumor cells and evidence of bone invasion.

The treatment of pseudoarthrosis of the neck of the femur by repositioning osteotomy.

Repositioning osteotomy in the treatment of pseudoarthrosis of the neck of the femur improves the biomechanical preconditions to promote bony union of the pseudoarthrosis. This operative procedure is the method of choice for pseudoarthrosis of the neck of the femur without evidence of avascular necrosis of the femoral head. It is also the method of choice in children and in adolescents even if there is avascular necrosis of the femoral head. The operative technique as advocated by the A.O. group permits exact planning, stable osteosynthesis both of the pseudoarthrosis of the neck of the femur as well as the osteotomy, and allows early mobilisation. In a small series of five cases, union was achieved in all within eight months after the operation.