Teng-Le Huang

Comparison between F-18-FDG positron emission tomography and histology for the assessment of tumor necrosis rates in primary osteosarcoma

Background: The purpose of this prospective study was to identify if F‐18‐fluorodeoxy‐D‐glucose positron emission tomography (F‐18‐FDG PET) was a reliable noninvasive surrogate of histologic response in determining the efficacy of neoadjuvant chemotherapy before surgical resection in primary osteosarcoma. Methods: Between January 2003 and December 2003, 10 patients with primary osteosarcomas were examined using F‐18‐FDG PET before neoadjuvant chemotherapy and surgery. The mean age at the time of first intervention was 19 years (range, 4‐47 years). Positive prognostic significance was defined as more than 90% tumor necrosis response following neoadjuvant chemotherapy. The parameters of FDG uptake were correlated with histologic findings. The intraclass correlation coefficient was used to validate the tumor necrosis rates determined by PET and histology. Results: The tumor necrosis rate determined by PET was comparable with that determined histologically. The mean standardized uptake value before and following neoadjuvant chemotherapy were 8.2 and 4.4, respectively. The average tumor necrosis rate determined by PET was 22%. However, the mean tumor necrosis rate determined histologically was 54.5%. According to the intraclass correlation coefficient models, the intraclass correlation coefficient equaled 0. The relationship of tumor necrosis rates determined by F‐18‐FDG PET and histology seems to be statistically insignificant. Conclusion: In this preliminary study, FDG PET did not seem to be a promising tool for evaluating the response of primary osteosarcoma to neoadjuvant chemotherapy.

A Minimally Invasive Endoscopic Surgery for Infectious Spondylodiscitis of the Thoracic and Upper Lumbar Spine in Immunocompromised Patients

This study evaluates the safety and effectiveness of computed tomography- (CT-) assisted endoscopic surgery in the treatment of infectious spondylodiscitis of the thoracic and upper lumbar spine in immunocompromised patients. From October 2006 to March 2014, a total of 41 patients with infectious spondylodiscitis underwent percutaneous endoscopic surgery under local anesthesia, and 13 lesions from 13 patients on the thoracic or upper lumbar spine were selected for evaluation. A CT-guided catheter was placed before percutaneous endoscopic surgery as a guide to avoid injury to visceral organs, major vessels, and the spinal cord. All 13 patients had quick pain relief after endoscopic surgery without complications. The bacterial culture rate was 77%. Inflammatory parameters returned to normal after adequate antibiotic treatment. Postoperative radiographs showed no significant kyphotic deformity when compared with preoperative films. As of the last follow-up visit, no recurrent infections were noted. Traditional transthoracic or diaphragmatic surgery with or without posterior instrumentation is associated with high rates of morbidity and mortality, especially in elderly patients, patients with multiple comorbidities, or immunocompromised patients. Percutaneous endoscopic surgery assisted by a CT-guided catheter provides a safe and effective alternative treatment for infectious spondylodiscitis of the thoracic and upper lumbar spine.

Primary Anterior Cruciate Ligament Reconstruction by Dacron Prosthesis Augmented with Iliotibial Band or Fascia Lata: A 14-year Subjective Outcome Study

Purpose. A retrospective cohort study was conducted to evaluate the subjective long-term results of Dacron prosthetic ligaments in the management of primary anterior cruciate ligament reconstruction. Methods. Sixty-four patients who underwent primary anterior cruciate ligament reconstruction with a Dacron prosthesis were followed for a mean of 10.9 years. Ligaments were reconstructed with a Dacron prosthesis augmented with either the iliotibial band or the fascia lata, using a modified Macintosh over-the-top technique. The subjective outcomes were evaluated by the Lysholm knee scoring scale, the Tegner activity scale and patients satisfaction based on visual analog scale assessment. Results. Dacron prostheses were removed within a mean interval of 4.5 years in 12 patients (19%). The mean overall Lysholm knee score was 81.4 and the mean Tegner activity rating scale was 5.3. More than 40% of patients had fair to poor outcomes and more than 45% reported being dissatisfied with the prosthesis at the most recent follow-up. Conclusion. Prosthetic ligaments are still far from being perfect. Reconstruction with autologons graft remains the standard procedure for anterior cruciate ligament reconstruction.

Effect of different molecular weight Hyaluronans on osteoarthritis-related factors in fibroblast-like synoviocytes from patients with tibia plateau fracture

Preventing fractured joint from arthritic change remains a challenge, especially in weight-bearing joints. Hyaluronan (HA) has been proved to effectively relieve pain and improve function in chronic osteoarthritis (OA) joint. However, controversies still exist in its potential use in fractured joints and whether this effect is molecular weight dependent. We analyzed and compared the effects of two different molecular weight HAs on six OA-related factors expression in fibroblast-like synoviocytes (FLS) from twelve patients with tibia plateau fracture