Roman Radl

Immunohistochemical analysis of desmoid tumours.

Background/Aims: Although the standard treatment for desmoid tumours is complete surgical resection with wide margins, the optimal adjuvant treatment for recurrent or inoperable disease is unclear, often being based on sporadic immunohistochemical reports with a low number of cases. Therefore, a large immunohistochemical study was performed, to provide a theoretical basis for adjuvant treatment regimens. Methods: One hundred and sixteen tissue samples from 80 patients (49 female, 31 male; mean age, 34 years; range, 0–83) with desmoid tumours (46 extra-abdominal, 21 abdominal, 13 intra-abdominal) were tested for oestrogen receptors α and β, progesterone and androgen receptors, and somatostatin, in addition to HER2, cathepsin D, Ki-67, and c-KIT by immunohistochemistry. Results: All samples were negative for oestrogen receptor α, HER2, and the progesterone receptor. Positive staining for the androgen receptor was found in six extra-abdominal cases. Staining for oestrogen receptor β was positive in four extra-abdominal, two abdominal, and one intra-abdominal case. Staining for somatostatin was positive in six extra-abdominal, two abdominal, and one intra-abdominal case, and staining for cathepsin D was positive in all cases. Positive staining for Ki-67 was found in 14 extra-abdominal, three abdominal, and three intra-abdominal cases. C-KIT was detectable in one abdominal case only. Conclusions: The data from this immunohistochemical study show that the published effects of antioestrogens and imatinib mesylate in the treatment of aggressive fibromatoses may not be attributable to oestrogen receptor α or c-KIT expression.

The Effect of a Single Infusion of Zoledronic Acid on Early Implant Migration in Total Hip Arthroplasty A Randomized, Double-Blind, Controlled Trial

BACKGROUND Aseptic loosening is the most frequent cause of implant failure in total hip arthroplasty. While a direct link between aseptic loosening and periprosthetic bone loss remains elusive, there is plentiful evidence for a close association with early implant migration. The present trial was primarily designed to evaluate whether a single infusion of 4 mg of zoledronic acid prevented early implant migration in patients with osteonecrosis of the femoral head. METHODS Fifty patients were consecutively enrolled to receive either zoledronic acid or saline solution after cementless total hip arthroplasty. Radiographs, biochemical parameters of bone turnover, and the Harris hip-rating score were determined preoperatively and at each follow-up examination at seven weeks, six months, one year, and yearly thereafter. The median follow-up period was 2.8 years. RESULTS We found a significant subsidence of the stem of up to a mean (and standard deviation) of -1.2 +/- 0.6 mm at two years within the control group, and the cups had a mean medialization of 0.6 +/- 1.0 mm and a mean cranialization of 0.6 +/- 0.8 mm (p < 0.001). Treatment with zoledronic acid effectively minimized the migration of the cups in both the transverse and the vertical direction (mean, 0.15 +/- 0.6 mm and 0.06 +/- 0.6 mm, respectively; p < 0.05), while only a trend to decreased subsidence of the stem was detected. Finally, the Harris hip score rapidly increased over time in both treatment groups, although this increase was significantly more pronounced in the zoledronate-treated group than in the control group (analysis of variance, p = 0.008). CONCLUSIONS A single infusion of zoledronic acid shows promise in improving initial fixation of a cementless implant, which may improve the clinical outcome of total hip arthroplasty in patients with osteonecrosis of the femoral head.

Venous Thrombosis After Hallux Valgus Surgery

Background: Although surgery for the treatment of hallux valgus is frequently performed, the exact rate of deep vein thrombosis following this procedure is unknown. We performed a single-center, prospective, phlebographically controlled study to quantify the rate of venous thrombosis following operative correction of hallux valgus. Methods: Consecutive patients undergoing chevron bunionectomy for correction of hallux valgus deformity were enrolled in the study. Patients with clinical or hematological risk factors for venous thrombosis were excluded. One hundred patients with a mean age of 48.9 years were operated on and did not receive medical prophylaxis against thrombosis. All patients were assessed with phlebography at a mean of twenty-nine days postoperatively. Results: Venous thrombosis was found in four patients (4%). The mean age of these patients (and standard deviation) was 61.7 ± 6.1 years compared with a mean age of 48.4 ± 13.9 years for the patients in whom thrombosis did not develop (p = 0.034). Conclusions: Patients are at a low risk for venous thrombosis following surgical treatment of hallux valgus. The need for prophylaxis against thrombosis should be calculated individually for each patient according to his or her known level of risk. Routine medical prophylaxis against thrombosis might be justified for patients over the age of sixty years. Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.

The influence of personality traits on the subjective outcome of operative hallux valgus correction

We studied prospectively the influence of personality traits on the subjective outcome of a chevron osteotomy in 42 patients with hallux valgus. The mean age of patients was 48.3 (20–70) years. Personality traits were evaluated by the means of the Freiburg Personality Inventory (FPI-R). Three months postoperatively 37 patients were satisfied, and five patients not satisfied with the operative procedure. The preoperative AOFAS Score improved from an average of 48.7 (30–65) points to 87.9 (50–100) points. A comparison of satisfied and dissatisfied patients revealed statistically significant differences in the personality traits aggressiveness (p=0.003), extraversion (p=0.001) and health worries (p=0.04). The postoperative hallux valgus angle was 12.2±7.8° and 13.4±8.3° (p=0.74) among satisfied and not satisfied patients, respectively, and the intermetatarsal angle (I–II) was 7.4±2.5° and 7.6±4° (p=0.89), respectively. The results suggest that the patient’s subjective result after the operative correction may be influenced by some individual, personality profiles.RésuméNous avons étudié l’influence des traits de la personnalité sur le résultat subjectif d’une ostéotomie en chevron chez 42 malades avec hallux valgus. L’âge moyen des malades était de 48,3 ans (20–70). Les traits de la personnalité ont été évalués au moyen de l’Inventaire de Personnalité de Fribourg (FPI-R). A trois mois postopératoires 37 malades étaient satisfaits de la procédure opératoire, et 5 ne l’étaient pas. Le Score préopératoire AOFAS a été amélioré d’une moyenne de 48,7 (30–65) points à 87,9 (50–100) points. Une comparaison de malades satisfaits et non satisfaits a révélé des différences statistiquement significatives dans le caractère agressif des traits de la personnalité (p=0,003), extraversion (p=0,001) et inquiétude sur sa santé (p=0,04). L’angle de l’hallux valgus postopératoire était respectivement de 12,2±7,8° et 13,4±8,3° (p=0,74) pour les malades satisfaites et les malades non satisfaits, et l’angle intermétatarsien (I–II) était de 7,4±2,5° et 7,6±4° (p=0,89) respectivement. Les résultats suggèrent que le résultat subjectif après la correction opératoire peut être influencé par le profil de personnalité du malade.

Intraosseous lipoma: retrospective analysis of 29 patients

We reviewed 29 patients with intraosseous lipoma treated between 1985 and 2002. Mean patient age was 48 (20–75) years. According to Milgram’s classification, ten cases were classified as stage I, 14 as stage II, and three as stage III. All patients were initially treated by curettage. In 11 cases an additional phenolization was performed. The average follow-up was 32 (6–208) months. At the last follow-up, none had any clinical or radiological signs of recurrence. The adequate treatment of a symptomatic intraosseous lipoma is curettage and bone grafting. In the current study, phenolization showed no added benefit. An asymptomatic intraosseous lipoma without impending pathological fracture can be treated conservatively.RésuméNous avons examiné 29 malades avec un lipome intraosseux traité entre 1985 et 2002. L’âge moyen des malades était de 48 ans (20–75). D’après la classification de Milgram, dix cas ont été classés comme stade I, 14 comme stade II, et trois comme stade III. Tous les malades ont été traités initialement par curetage. Dans 11 cas une phénolisation supplémentaire a été faite. Le suivi moyen était de 32 mois (6–208). Àu dernier examen aucun n’avait de signe clinique ou radiologique de récidive. Le traitement adéquat d’un lipome intraosseux symptomatique est un curetage avec greffe osseuse. Dans cette étude, la phénolisation n’a montré aucun avantage supplémentaire. Un lipome intraosseux asymptomatique sans menaçe de fracture pathologique peut être traité d’une manière conservatrice.

Aneurysmal bone cyst: a hereditary disease?

Recent genetic and immunohistochemical studies propose that the primary aneurysmal bone cyst is a tumour and not a reactive tumour-simulating lesion. Based on a familial case of aneurysmal bone cyst the authors contacted 135 patients with this disease. Sixty-eight females and 67 males (median age 14 years; range 2–73 years) were asked if other family members had bone lesions. One hundred and seven patients (79%) denied having other family members with lesions, 23 patients (17%) did not answer, and five patients (4%) gave evidence of other bone lesions in the family. These data indicate that a predisposing genetic defect could be part of a multifactorial pathogenesis in the development of some aneurysmal bone cysts.

Mesothelioma mortality in Europe: impact of asbestos consumption and simian virus 40

BackgroundIt is well established that asbestos is the most important cause of mesothelioma. The role of simian virus 40 (SV40) in mesothelioma development, on the other hand, remains controversial. This potential human oncogene has been introduced into various populations through contaminated polio vaccines. The aim of this study was to investigate whether the possible presence of SV40 in various European countries, as indicated either by molecular genetic evidence or previous exposure to SV40-contaminated vaccines, had any effect on pleural cancer rates in the respective countries.MethodsWe conducted a Medline search that covered the period from January 1969 to August 2005 for reports on the detection of SV40 DNA in human tissue samples. In addition, we collected all available information about the types of polio vaccines that had been used in these European countries and their SV40 contamination status.ResultsOur ecological analysis confirms that pleural cancer mortality in males, but not in females, correlates with the extent of asbestos exposure 25 – 30 years earlier. In contrast, neither the presence of SV40 DNA in tumor samples nor a previous vaccination exposure had any detectable influence on the cancer mortality rate in neither in males (asbestos-corrected rates) nor in females.ConclusionUsing the currently existing data on SV40 prevalence, no association between SV40 prevalence and asbestos-corrected male pleural cancer can be demonstrated.

Two cases of calcaneal osteosarcomas presenting as aneurysmal bone cysts.

Aneurysmal bone cysts (ABC) (benign lesions of bone that can arise as a primary or secondary lesions to other bone pathology) and osteosarcomas (malignant bone-forming tumors) are different pathological entities; however, sometimes they share strikingly similar clinical, radiological, and histological features. Osteosarcomas, as a whole, affect the same age group as ABC. Symptoms often are the same, and the long bones are predominantly affected.9 Especially the radiographic features of telangiectatic osteosarcoma in its early stages may mimic a benign process, such as primary ABC,9,15 hence, the synonym ‘‘ABC-like osteosarcoma.13,14 The occurrence of these two entities in the calcaneus is rare with less than 1% for osteosarcomas14 and three in a series of 135 patients (136 locations) with ABC.11 While the treatment for osteosarcomas is well established, with biopsy followed by chemotherapy and a wide or radical resection, the optimal treatment for primary ABC is controversial. Treatment with percutaneous sclerotherapy (Ethibloc injection) has been reported in patients with suspected ABC without histological diagnosis.5 These authors stated that histological examination was not mandatory if the clinical presentation and radiographic features are characteristic for an ABC. Between January, 1998, and January, 2003, 135 patients with benign and 83 patients with malignant primary bone tumors, including 21 patients diagnosed

NO MIDTERM BENEFIT FROM LOW INTENSITY PULSED ULTRASOUND AFTER CHEVRON OSTEOTOMY FOR HALLUX VALGUS

Chevron osteotomy is a widely accepted method for correction of symptomatic hallux valgus deformity. Full weight bearing in regular shoes is not recommended before 6 weeks after surgery. Low intensity pulsed ultrasound is known to stimulate bone formation leading to more stable callus and faster bony fusion. We performed a randomized, placebo-controlled, double-blinded study on 44 participants (52 feet) who underwent chevron osteotomy to evaluate the influence of daily transcutaneous low intensity pulsed ultrasound (LIPUS) treatment at the site of osteotomy. Follow-up at 6 weeks and 1 year included plain dorsoplantar radiographs, hallux-metatarsophalangeal-interphalangeal scale and a questionnaire on patient satisfaction. There was no statistical difference in any pre- or postoperative clinical features, patient satisfaction or radiographic measurements (hallux valgus angle, intermetatarsal angle, sesamoid index and metatarsal index) except for the first distal metatarsal articular angle (DMAA). The DMAA showed statistically significant (p = 0.046) relapse in the placebo group upon comparison of intraoperative radiographs after correction and fixation (5.2 degrees) and at the 6-week follow-up (10.6 degrees). Despite potential impact of LIPUS on bone formation, we found no evidence of an influence on outcome 6 weeks and 1 year after chevron osteotomy for correction of hallux valgus deformity.

Management of congenital fourth brachymetatarsia by additive autologous lengthening osteotomy (AALO): a case series.

Congenital brachymetatarsia is a rare deformity with an incidence ranging from 0.02% to 0.05% and a clear female preponderance of 25:1, affecting mainly the fourth metatarsal bone. In some cases, brachymetatarsia may occur due to iatrogenic or traumatic damage of the growth plate. This deformation of the foot may cause considerable distress for the patients, not only because of esthetic deficiency but also because of impaired function. Thus, surgery is an option to achieve a satisfactory outcome, esthetically as well as functionally. According to previous case reports, 1-stage intercalary bone grafting and gradual lengthening of the metatarsal bone via distraction osteogenesis have been applied as operative techniques. The usual technique of 1-stage intercalary bone grafting requires an additional incision at the iliac crest. Thus, harvesting of the bone material may lead to donor-site morbidity. Kim et al have performed an alternative technique, similar to ours, where the autograft for the lengthening of brachymetatarsia was taken from the adjacent metatarsal bones. The extent of lengthening in 1-stage procedures is quite limited due to soft tissue tension. With distraction osteogenesis, greater length gain can be achieved, and ischemia due to tissue tension should not occur. However, there is the disadvantage of a longer treatment duration, the possibility of pin-track infections, and a risk of delayed or nonunion of the bone.