Psychostimulants prescribed to children for ADHD following distal radius fractures significantly reduce bone density as a function of duration

Methylphenidate and mixed amphetamine salts (MAS) are psychostimulant medications widely prescribed for various psychiatric disorders. Although these medications are known to adversely impact bone mineral content and density, as well as biomechanical integrity during skeletal development in rats, their effect on bone density in children remains largely unknown. The primary aim of this work was to investigate the effects of methylphenidate and MAS on bone density following distal radius fractures in pediatric populations, and secondarily assess any impact on healing. The retrospective case-control study was designed to assess fracture healing in patients treated with stimulant drugs and matched controls. For the primary outcome, X-rays (n = 188) were evaluated using an optical density image analysis technique to compare bone density throughout the bone healing process. Results showed that methylphenidate and MAS significantly reduced bone healing by approximately 20% following distal radius fractures in these children. The data also suggested that duration of psychostimulant use played a role in bone healing; the longer the treatment (1-5 years), the lower the bone density was observed (by approximately 52%) as compared to controls (no medication). However, subjects taking these drugs for longer than 5 years did not show a significant difference. Our results suggested that children taking psychostimulants for up to 5 years had slower bone healing following distal radius fractures. Orthopedic surgeons planning elective surgeries should be cognizant of this as a potential issue in recovery after any elective bone procedures and preoperatively optimize bone health as well as counsel patients and their families.

Malignant melanoma: from subcutaneous nodule to brain metastasis

A thirteen-year-old patient, diagnosed with melanoma was followed cytogenetically using short-term cultures of specimens from a subcutaneous nodule, lymph node, and brain metastases. Simple hypodiploid karyotypes with loss of heterozygosity for chromosomes 5, 9, 10, 16 and 17 and two structural changes in 3 and between 13 and 21 increased in complexity to near triploid in the lymph node. Two cell types of the lymph node showed a progression of structural rearrangements prior to metastasis to the brain. Translocation of 6p to chromosome 2, deletions of 8, and a translocation (2;19) preceded p and q arm deletions of both chromosomes 9 and 11 in the lymph node. Cells metastasizing to the brain showed the accumulation of all previous aberrations and had acquired a direct duplication of distal 17 long arm. Whether or not elevated levels of protein kinase C, located on chromosome 17q contribute to tumor adhesion and growth on the brain remains to be elucidated. Identification of most chromosomes undergoing rearrangement was carried out using whole chromosome painting probes in in situ hybridizations. Some of these rearrangements would have been impossible to identify by standard karyotyping.