Irocy Knackfuss

Effect of tenoxicam on fracture healing in rat tibiae

BACKGROUND Nonsteroidal anti-inflammatory drugs have been implicated in the development of delayed unions and nonunion after fractures in animal models. Previous investigations have identified two important factors as determinants of delayed fracture healing: early drug administration and a dose-dependent effect. OBJECTIVE The purpose of this investigation was to study the effect of tenoxicam, a nonsteroidal anti-inflammatory drug, on the fracture healing process in rat tibiae. METHODS Fifty-eight Wistar rats were randomly divided in four groups (I, II, III, and IV). Group I (control group, n=12) was given 0.1ml saline solution per day intramuscularly. Groups II (n=12), III (n=12), and IV (n=12) were administered 10mg per kg per day of tenoxicam intramuscularly. Administration of substances was begun on a week before to 48h after the fracturing procedure and continued during the entire experiment. Callus formation was studied histologically and histomorphologically, using light microscopy. In addition, a histologic grading based on the morphologic stage of fracture healing was carried out at 4 weeks, according to the criteria proposed by Allen et al. RESULTS There was a significant difference in treatment effect between Group I (saline solution) and Groups II, III, and IV (tenoxicam) (P=0.07). Histologically and histomorphologically, there were qualitative and quantitative delay in callus formation at all tenoxicam groups. This was more pronounced the earlier the nonsteroidal anti-inflammatory drug was started, although no significant difference could be detected between Groups II, III, and IV (P>(alpha=10%)). Four weeks after fracture, Group I (n=3) showed complete osseous union, Groups II (n=3) and III (n=3), complete cartilaginous union, and Group IV (n=3), incomplete osseous union, according to Allen et al. By using this rating scale, the difference between control and drug-treated groups was statistically significant (P<0.1). CONCLUSION Under studied conditions, this investigation shows that administration of tenoxicam intramuscularly delays fracture healing process in rat tibiae. These results suggest the hypothesis that early drug administration may delay bone healing after experimental fractures in animals, although it could not be detected statistically significant.

SYNOVIAL OSTEOCHONDROMATOSIS OF THE RETROCALCANEAL BURSA : A CASE STUDY

A 42-year-old man presented with synovial osteochondromatosis (SO) of the retrocalcaneal bursa with intraosseous lesions in the calcaneum, leading to significant pain and consequent disability. Simple x-rays, computed tomography, and magnetic resonance imaging were performed preoperatively. The patient has remained asymptomatic, clinically and radiographically, without recurrent lesions for 18 months postoperatively.

Coerência espectral do eletrencefalograma em pacientes submetidos a transposição tendinosa: estudo pré e pós-operatório

Tendon transfer of the tibiliais posterior muscle is a surgical intervention widely employed in orthopedics for the correction of drop foot caused by leprosy. However, few models have proposed a thorough investigation of the brain plasticity phenomenon during tendon transfer. Thus, the present study aimed at analyzing EEG spectral coherence (SC) in patients submitted to tendon transfer of the tibiliais posterior muscle by Srinivasans technique and quantitative EEG (EEGq). The sample consisted of four subjects with drop foot caused by leprosy. The SC parameter was evaluated in two experimental moments: pre and post-surgery. Results demonstrated a main moment effect for the C3-CZ electrode pair. Specifically, a significant increase in coherence values was observed. However, the ANOVA did not indicate a significant band/moment interaction. It can be assumed that coherence augmentation indicates that functional rehabilitation promoted by this specific surgery yields cortical alterations.

Changes in cortical relative power in patients submitted to a tendon transfer: a pre and post surgery study

The aim of this study is analyze possible modifications in the cerebral cortex, through quantitative electroencephalography (qEEG) in patients submitted to a tendon transfer procedure (posterior tibialis) by the Srinivasans technique. Four subjects (2 men and 2 women), 49.25 age average (SD +/ 21.4) were studied. All subjects have been through surgical procedure due to leprosy and had, at least, two years of drop foot condition. The qEEG measured the electrocortical activity (relative power) between 8 and 25 Hz frequencies pre and post surgery. A paired t test analyzed all data (p< or =0,05). The results show significant alterations in the alpha relative power, electrodes F7 (p=0.01) and F8 (p=0.021). Altogether, based on findings of the current literature, we can conclude that the tendon transfer procedure suggests electrocortical alterations sensitive to specific qEEG bands.

Aspectos radiográficos e ultra-sonográficos dos pacientes submetidos a alongamento ósseo pelo método de Ilizarov

Ten patients treated with Ilizarov external fixator for limb lengthening were monitored with radiographs and sonography examinations between March, 2001 and March, 2002. Most of the patients were children and adolescents who were submitted to surgery for correction of congenital deformities (six cases). In three patients shortening was secondary to post-traumatic osteomielitis and in one patient due to tumor resection. The femur was affected in 60%, tibia in 30% and fibula in 10% of the cases. The main radiographic findings of bone regeneration during the normal process of limb lengthening were lucent areas, linear ossification, periosteal reaction, soft tissue abnormalities and complete consolidation. Sonographic findings of new bone formation included anechoic areas, sparse echogenic foci within the distraction site, linear longitudinally oriented echogenic foci, amorphous and coarse echogenic foci and complete calcification. There were 15 complications in six patients: fluid collection at the distraction site (five cases), pin site infection (four cases), soft tissue collection (three cases), premature consolidation (two cases) and delayed consolidation (one case).

SQUAMOUS CELL CARCINOMA IN THE FOOT: CASE SERIES AND LITERATURE REVIEW

ABSTRACT Objectives: To report a case series of squamous cell carcinoma (SCC) in the foot, describing previous risk factors, surgical treatment, histopathological findings, and functional and oncological results. Methods: Nine consecutive patients diagnosed with SCC of the foot were treated at a single institution and prospectively analyzed for risk factors related to the disease, surgical outcome, and histopathological, functional and oncological results. All patients had identifiable risk factors for SCC. Results: Definitive treatment consisted of partial (6 patients) or total (3 patients) amputation of the foot. The functional score was good or excellent in the surviving patients. Early identifiable risk factors are present in most patients. Biopsy when this diagnosis is suspected, in association with oncological principles, avoids diagnostic and treatment errors. Conclusion: Despite delayed diagnosis and surgical treatment with partial and total amputations of the foot in our series, we observed good oncological outcomes that avoided systemic spread of the disease and achieved expected functional results. Level of Evidence V; Case series.