Therapeutic approach to combined deltoid ligament disruption with lateral malleolus fracture: Current evidence and literature review

Ankle fractures are among the most common injuries treated by orthopaedic traumatologists. These fractures range from stable, simple injuries to complex, multi-planar unstable ones. Osseo-ligamentous structures play a paramount role in maintaining the stability of the ankle joint. The deltoid ligament is among the most important ankle static stabilizers. Rupture of this ligament along with a lateral malleolar fracture is considered by many as an unstable type of injury and usually requires surgical treatment (bi-malleolar equivalent). Left untreated, it may lead to chronic pain, loss of function and secondary arthritis. Due to lack of high-quality evidence, there are no welldefined, well-accepted criteria for the diagnosis and treatment for treating this type of injury.

Hemipelvectomy after severe pelvic injury in Factor VII deficiency toddler

Traumatic hemipelvectomy is a lethal catastrophic injury. The reported average age of individuals surviving this trauma is 21 years old, suggesting the necessity of good physiological reserves to survive this type of injury. Dealing with this injury in children may call for special requirements throughout all the stages of diagnosis, treatment and rehabilitation. Experience in the resuscitation and subsequent treatment of individuals suffering from this traumatic condition in the paediatric population is even scarce. There are only several reported cases involving children and none of the paediatric cases suffered from comorbidities prior to their traumatic injury. The present report describes the successful management of a 16-month-old child with a medical history of a rare bleeding disorder a severe coagulation Factor VII deficiency who underwent right-sided traumatic hemipelvectomy.

Imaging of bone metastases in prostate cancer: an update

Assessing bone metastases is often beyond the scope of plain - film radiography, and nuclear imaging in particular with bone scintigraphy has proved the mainstay for detection of bony disease for over 40 years. Bone scanning with 99mTechnetium - labeled diphosphonates relies on the detection of pathological osteoblastic response elicited from malignant cells. This technique offers the advantage of whole body examination, low cost, availability and high sensitivity. However, it suffers from relative low specificity. The addition of single-photon emission computed tomography (SPECT) to bone scintigraphy has markedly improved the diagnostic benefit. Although the accuracy of SPECT is significantly higher than that of planar scintigraphy, there is still room for improvement of anatomic localization and morphological characterization, a limitation that has currently been mainly overcome with the upcoming of combined SPECT-CT (computed tomography). Positron emission tomography (PET), a modality with higher spatial resolution than that of SPECT can be particularly helpful in detecting small lesions. Moreover, PET imaging using various specific radiotracers has the advantage of detecting malignant disease in both bone and soft tissues. It is highly sensitive mainly in detecting early bone marrow as well as for diagnosing lytic bony metastases and can be also reliably used to monitor therapy response. In this review, we present the current role of SPECT and PET in the imaging of skeletal metastases from prostate cancer.

Serum levels of sex hormones and corticosterone throughout 4- and 5-day estrous cycles in Fischer 344 rats and their simulation in ovariectomized females

Among inbred strains of rats, the Fischer 344 (F344) is commonly used in immunological and behavioral studies. However, little is known about patterns of sex hormones and corticosterone (CORT) secretion throughout the estrous cycle in this strain, which is characterized by a marked CORT response to stress and variable length of cycles. In the current study, using radioimmunoassays, we assessed serum levels of progesterone, estradiol, LH, testosterone, prolactin and CORT, at 1-h intervals throughout the estrous cycle in F344 female rats with 4- and 5-day cycles, as well as in males. Vaginal smears were obtained from 268 females for 15 consecutive days to determine individual length of the estrous cycle and the exact estrous phase upon blood withdrawal, which was conducted once in each rat on the 12th day of smearing. The results indicated that both 4- and 5-day cyclers have two distinct and marked surges of progesterone, one on proestrus day and the other on diestrous-1 day. Testosterone levels in 5-day cyclers peaked on diestrus-3, one day earlier than in 4-day cyclers. Daily peak levels of CORT gradually increased from estrus day to proestrous day, whereas daily nadir levels of CORT remained unchanged. To simulate the natural kinetics of specific sex hormones in ovariectomized females, different doses of estradiol, progesterone, testosterone, prolactin or CORT were injected s.c. or i.p., or 90-day sustained release pellets containing different doses of estradiol or progesterone were implanted. The findings indicated dose- and time-dependent effects, suggesting regimens for modeling the estrous cycle or replacement therapy.

Advantage of yttrium-90-labeled over iodine-131-labeled monoclonal antibodies in the treatment of a human lung carcinoma xenograft

BACKGROUND

The purpose of this investigation was to compare the therapeutic effectiveness of yttrium-90 (90Y)-labeled monoclonal antibodies (MoAbs) with iodine-131 (131I)-labeled MoAbs delivered to human tumor xenografts at their maximum tolerated doses (MTD).

METHODS

Nude mice bearing size-matched human lung adenocarcinoma xenografts (Calu-3) with mean tumor dimensions of approximately 0.8 cm received intravenous injections of the MTD of either 90Y- or 131I-labeled MoAbs. The mice received 125 microCi of 90Y-RS11 or 90Y-RS7, or 300 microCi of 131I-RS11 or 131I-RS7. Tumor size was measured weekly. Body weight and blood counts were monitored to measure toxicity.

RESULTS

The calculated average radiation doses delivered to tumors in mice treated with 90Y-RS11 and 90Y-RS7 were 3578 and 3787 centigray (cGy), respectively, versus 1264 and 1368 cGy for 131I-RS11 and 131I-RS7, respectively. These values were calculated taking into consideration the tumor size-dependent absorbed fractions for the beta particles of both radioisotopes. The calculated radiation doses absorbed in the tumor correlated with the tumor responses observed. Mean tumor volume decreases at nadir were 66% and 87% after 90Y-RS11 and 90Y-RS7 therapy, respectively, with 15 of 30 mice treated with either MoAb having complete regression of their tumors. In contrast, only mean stable disease was observed with the 131I MoAb treatments.

CONCLUSIONS

The results demonstrate the superiority of 90Y-labeled MoAbs over conventionally labeled 131I-labeled MoAbs for therapy in this model. The fact that a substantial percentage of complete remissions was achieved with 90Y-labeled MoAbs suggests a considerable radiosensitivity of the tumor studied, and supports the suitability of choosing this tumor type as an attractive target for future clinical radioimmunotherapy.

Calcitriol-resistant rickets with alopecia

Four children of two kindred had alopecia associated with severe rickets, resistant to treatment, and caused by defective cytoplasmic and nuclear receptors for the active vitamin D metabolite calcitriol (1,25-dihydroxyvitamin D3). Scalp biopsy specimen revealed a normal number and light microscopic features of the hair and hair follicles. Calcitriol-resistant rickets should be added to the list of inherited disorders of hair growth, and the association of rickets with alopecia needs to be considered in the differential diagnosis of hair loss.

Epidermal Langerhans' cells in Behçet's disease

Langerhans' cells were studied in the epidermis of two patients with active Behçet's disease and compared with those in two normal controls. Ultrastructural morphology and the percentage of Langerhans' cells found were similar in patients' (1.88%) and the control epidermis (1.79%). The density of Langerhans' cells in adjacent sites of the same epidermis was not homogeneous, being in the range of 0.8-2.8% in Behçet's disease and 0.6-4% in the controls. In the controls, Langerhans' cells were distributed unevenly. Some were located near the basal layer of the epidermis while the rest were in the mid and upper layers. In Behçet's disease most Langerhans' cells were in the mid-epidermis, but some were immediately beneath the stratum granulosum. In the Behçet's disease epidermis the area occupied by Langerhans' cells was increased by about 25% and the number of granules found increased by about 44%. It is suggested that in Behçet's disease the Langerhans' cells are in a more active state.

Surgical approach to the treatment of refractory lesions of pemphigus vulgaris

A patient with pemphigus vulgaris had lesions on the lip that proved to be refractory to intralesional corticosteroid therapy and to treatment with azathioprine and later to daily administration of 250 mg of prednisone. The patient developed marked cushingoid features and deep vein thrombosis, rendering the continuation of the prednisone therapy unadvisable . Total vermilionectomy of the affected lip was performed and the prednisone was gradually tapered, taking care that oral lesions remained under control. Eighteen months after the operation, the patient is receiving a single alternate-daily dose of 20 mg prednisone, and both the lip and oral lesions are in remission.

Solcoderm treatment of epidermal growths including intradermal nevi

Solcoderm was used in the management of various epidermal growths in 372 patients with 1,002 lesions, including condyloma acuminatum, verruca plana, basal cell epithelioma, intradermal nevus, seborrheic and solar keratosis. No antiseptic precautions or local anesthesia were used during the treatment. The results seem promising and suggest that Solcoderm is a simple, safe, and efficient method for the management of these tumors. Cosmetic results were excellent. It is especially recommended when the lesions are in difficult to manage locations for surgical or other known chemical or physical methods, when the patient is not fit for surgical procedures, and when local anesthesia is contraindicated.

Seborrheic keratosis and papillomatosis: markers of breast adenocarcinoma

Seborrheic keratosis (Leser-Trélat sign) and extensive florid papillomatosis of the skin and the mucous membranes of the nose, mouth, throat, and external genitalia were associated with adenocarcinoma of the breast in a 61-year-old woman.

Muscle relaxing agent in cutaneous leiomyoma

The management of pain in cutaneous leiomyoma involving large areas of the body surface is problematic. The surgical approach is not practical and the pain in these cases is refractory almost to all analgesic agents. This is a description of a case in which a muscle relaxing agent proved to be the only effective therapeutic approach.

Radiological aspects of Behçet disease

The systemic manifestations of Behçet disease were evaluated retrospectively in 45 patients. Twenty-seven patients underwent radiographic examination. Twenty-two examinations (64.7%) showed positive but nonspecific findings, most of them involving the vascular tree. The roentgen diagnosis of Behçet disease will be influenced by the dermatologic and ophthalmologic findings.

Pellagra as the presenting manifestation of Crohn's disease

An 18-yr-old woman hospitalized with classical signs of pellagra was found to have Crohn's disease of the small and large bowel as well as malabsorption of nicotinic acid and iron. The symptoms of pellagra disappeared after intramuscular treatment with nicotinic acid, while the malabsorption was corrected following steroid therapy for the Crohn's disease. Pellagra should thus be added to the list of complications of Crohn's disease that are secondary to malabsorption. Although this complication seems to be very rare, it may be worthwhile to check for nicotinic acid malabsorption in untreated cases of Crohn's disease in order to determine its real prevalence.

Sensitivity to endogenous progesterone. Report of a case

A patient with a cyclic premenstrual eruption, clearing spontaneously with the menstrual flow, is reported. Hypersensitivity to endogenous progesterone in this case was confirmed by positive intradermal and leukocyte migration inhibition tests. Treatment with conjugated estrogens was followed by remission of symptoms. The importance of awareness to the possibility of progesterone autoimmune mechanisms is emphasized.

Familial koilonychia

Familial koilonychia involving 7 members in 3 generations is reported, one of them was complicated with an episode of bacterial infection of all fingernails. The familial distribution of the process in this report suggests an autosomal dominant transmission with high degree of penetrance.

Mast cells in Behçet's disease: ultrastructural and histamine content studies

In order to assess the role of mast cells in the pathogenesis of mucocutaneous lesions of Behçet's disease, the following investigations were performed: (1) a comparative study of ultrastructural features of mast cells in spontaneous and reactive (pathergic) lesions of the process and in apparently uninvolved skin of patients in the active stage of the disease; (2) comparative estimation of the histamine content at the site of cutaneous hyperreactivity lesions and in apparently uninvolved skin of the same patients. Various forms and degrees of degranulation were revealed among the mast cells. These forms were obviously more frequent in spontaneous and reactive lesions than in the uninvolved skin, 66 and 56% as compared with 7.7%. Also the histamine content was twofold more in the reactive lesions than in the unaffected skin of the same patient, 43 ng/mg tissue as compared with 21 ng/mg tissue. The results of our study seem suggestive of an active role of mast cells in this process. The role is probably similar to that of basophils in cutaneous basophilic hypersensitivity.

HLA-DRw4 in pemphigus vulgaris patients in Israel

Pemphigus vulgaris (PV) is relatively common in Jews. Three HLA antigens were significantly more frequent in 39 Israeli Jewish PV patients than in controls A26 - 59% vs 20%; Bw38 - 61% vs 20%; and DRw4 - 90% vs 38%. The joint occurrence of A26-Bw38-DRw4 was observed in 46% of PV patients and in 10% of controls. Similar results were recently reported for Jews in the Los Angeles area. Yet, when our patient sample was grouped into Ashkenazi and non-Ashkenazi Jews, it was evident that each of the three antigens had a higher frequency both in Ashkenazi patients and controls as compared to non-Ashkenzai. The relative risk for DRw-4 in Ashkenzim was 33.8 as compared to 14.4 in the total sample of Israeli PV patients. The phenotype A26-Bw38-DRw4 was present in 57% of Ashkenazi patients and in 13% of controls. Ashkenazi Jews have the highest prevalence of PV, and HLA associations were strongest with Ashkenazi PV patients. These associations were with three antigens, all of high frequency in that group.

The quantification and significance of mast cells in lesions of Behçet's disease

Mast cells in the upper dermis and mucosal subepithelial layer were counted in thirty consecutive light microscopy oil-immersion fields of the following: thirty-four skin and oral specimens from lesions in patients with active Behçet's disease, eight specimens of apparently uninvolved skin of the same patients, and 102 lesions of a variety of other skin diseases. The results revealed a significant increase in the number of mast cells in Behçet's lesions. Furthermore, the histamine content of five reactive lesions showed a two-fold increase compared with that in apparently uninvolved skin of patients with active Behçet's disease. It is suggested that mechanisms similar to cutaneous basophil hypersensitivity may be involved in the production of Behçet's lesions.