M. Chigira

The aetiology and treatment of simple bone cysts

The internal pressure of simple bone cysts was found to be slightly higher than the normal pressure of the bone marrow in the contralateral limb. The pressure within the cyst was measured during drilling with a Kirschner wire; it gradually decreased as the number of drill-holes increased. The PO2 of the cyst fluid was markedly lower than that of either venous or arterial blood measured synchronously. It is suggested that venous obstruction in the bone is the likely cause of these cysts. Seven patients with simple bone cysts were treated by the multiple drill-hole method, and the clinical outcome was excellent. Multiple drilling may prove to be the treatment of choice for simple bone cysts in the younger patient, as it presents fewer hazards than other procedures.

Simple bone cysts treated by multiple drill-holes 23 cysts followed 2–10 years

We treated 23 simple bone cysts by the multiple drill-hole method and reviewed them a mean of 5 (2-10) years later. 11 cysts were located in the humerus, 9 in the femur, 2 in the tibia, and 1 in the pubis. The cysts recurred in 15 cases after the initial operation. 12 recurrent cysts were treated with reoperations. At the follow-up, good bone formation with no sign of recurrence was seen in 15 cases. A residual cyst was found in 8 cases, but further treatment was not considered necessary.

Possible cardiac side effects of granisetron, an antiemetic agent, in patients with bone and soft-tissue sarcomas receiving cytotoxic chemotherapy

The cardiac effect of granisetron, a selective 5-hydroxytryptamine3 receptor antagonist, on 12 patients with bone and soft-tissue sarcomas treated by cytotoxic chemotherapy consisting of multiple courses was examined. Of the 12 patients, 4 showed significant electrocardiographical changes, including sinus bradycardia, integral change of P-waves, junctional escape beat, and atrioventricular (AV) block with Wenckebach phenomenon, indicating stimulatory regulation of the vagus nerve. These changes were observed in each patient after several courses of chemotherapy but not in the first course. There was no correlation between the electrocardiographical changes and the chemotherapeutic agents used or the type of tumor present. A patient with osteosarcoma showed persistent bradycardia in three courses, all protocols of which contained high-dose methotrexate. From these findings we conclude that the cardiac responses may be due to stimulated activity of the vagal efferent nerve, which is regulated reflexly by afferent nerve activity suppressed by granisetron. On the other hand, the antiemetic efficacy of granisetron was satisfactory. These results suggest that careful observation of the heart is necessary when granisetron is used, especially for chemotherapy consisting of repeated multiple courses.

Toxicity of silica-containing calcium phosphate glasses demonstrated in mice

Suspensions of calcium phosphate glass containing various concentrations of silica (glass composition (moles): 100 Ca(PO3)2 to x SiO2,x = 0, 5, 10, 15 or 40) dispersed in normal saline were injected intraperitoneally into C57BL/6 mice to determine the mortality within 30 days. The mortality was 0/10, 3/10, 9/10, 10/10 and 10/10 at x = 0, 5, 10, 15 and 40 mol of silica, respectively. By means of inductively coupled plasma analysis, the amount of dissolved silica (Si4+) in water at 37 degrees C from the calcium phosphate glass depended on the amount of silica in the glasses. The mortality of mice was directly proportional to the silica content of the glass injected intraperitoneally. These results clearly show that the dissolved silica (Si4+) from the glass, monomeric or low molecular silicic anion, is highly toxic. The SiO2 component in biomaterials has toxic potential when dissolved in the body.

Sternocostoclavicular hyperostosis. A report of nineteen cases, with special reference to etiology and treatment.

The cases of nineteen patients with sternocostoclavicular hyperostosis were reviewed retrospectively. Of particular interest were the responses to antibiotics and prostaglandin inhibitors. The prostaglandin inhibitors relieved the pain within three to four weeks in sixteen of eighteen patients so treated. However, the inhibitors gradually became less effective in most patients. Oral antibiotics were more effective than the inhibitors in relieving the pain of eight of the eleven patients who were given antibiotics. Pustulosis palmaris and plantaris, commonly associated with sternocostoclavicular hyperostosis, diminished after antibiotic therapy, as did the chest pain in most patients. The similarities between the age and sex distributions and the responses to antibiotics of the patients with sternocostoclavicular hyperostosis and those with pustulosis suggest that these disorders have a common etiology, and that the pustulosis may be a so-called bacterid reaction and the hyperostosis, a manifestation of a systemic reaction to a focal infection.

Symmetry of bone lesions in osteopoikilosis. Report of 4 cases.

A sclerotomic symmetry in the bony lesions was clearly demonstrated in 4 patients with osteopoikilosis. Occurrence of the lesions was highest at the C6-7 and L3-4 levels.

Radiological evidence of healing of a simple bone cyst after hole drilling

SummaryWe report the long-term results with ten patients with simple bone cysts with special retrospective reference to the radiographic evidence of healing after hole drilling. Cortical thickening was initially observed within 3 months, and minimal new bone formation around Kirschner wires left in situ was observed within 4 months. New bone formation gradually progressed from the cyst wall and around the wire. Consolidation of a cyst cavity was uniformly observed 6–7 months after drilling. In several patients residual cysts were seen between the wire and cortical shell. In younger patients, a cystic cavity reappeared after extraction of the wire, although complete radiographic healing had been observed. These findings suggest that a Kirschner wire plays an important role in preventing relapse of simple bone cysts after hole drilling.

Transient osteoporosis of the hip in the first trimester of pregnancy

SummaryA patient with transient osteoporosis of the hip in her first trimester of pregnancy is reported in this study. Rapid symptomatic improvement after artificial abortion was observed. These findings exclude pressure on the obturator nerve, Sudecks osteodystrophy, venous obstruction, and excessive demand of proteins and calcium in the etiology of this condition. Rather it is here suggested that chemical or hormonal factors related to pregnancy play an important role in the etiology.ZusammenfassungEs wird über eine Patientin mit transitorischer Osteoporose der Hüfte während der ersten 3 Monate der Schwangerschaft berichtet. Nach Interruptio wurde eine schnelle symptomatische Besserung beobachtet. Dies schließt Druck auf den Nervus obturatorius, Sudecksche Dystrophie, venöse Stauung, übermäßiger Bedarf an Proteinen und Kalzium als ätiologische Momente der Veränderung aus. Stattdessen nehmen die Autoren eher an, daß chemische oder hormonelle Faktoren, die im Zusammenhang mit der Schwangerschaft stehen, eine entscheidende Rolle in der Ätiologie spielen.

Effects of protein kinase inhibitors on the cell motility stimulated by autocrine motility factor

Preincubation of Dunn osteosarcoma cells for 1 h with both 100 nM of staurosporine and 10 micrograms/ml of genistein resulted in a significant decrease in the motility stimulated by autocrine motility factor (AMF), whereas these reagents did not affect the basal motility and proliferation at these concentrations. The effect of the agents on the stimulated motility was both dose- and time-dependent. The motility stimulated by the anti-AMF receptor mAb was also inhibited. In contrast, H-8 had a negligible effect upon the stimulated motility. These data suggest that both kinase C and tyrosine kinase play a role in AMF-stimulated cell motility, while protein kinase A, which is selectively associated with the adenylate cyclase pathway, may not be required for the stimulation.

HLA phenotypes in patients who have osteosarcoma.

Human leukocyte antigen (HLA) phenotypes were studied in twenty Japanese patients who had typical osteosarcoma. The HLA-A11 phenotype was found in ten (50 per cent) of the twenty patients, compared with 16.6 per cent of 235 control subjects (chi square = 13.248; p less than 0.0005)--an odds ratio of 5.026. These data suggest that major histocompatibility complex-linked genes may determine susceptibility to osteosarcoma.