Teruki Kidani

Mesenchymal chondrosarcoma treated with total en bloc spondylectomy for 2 consecutive lumbar vertebrae resulted in continuous disease-free survival for more than 5 years: case report.

Study Design. A case report of an extremely rare malignant spinal tumor successfully treated with total en bloc spondylectomy and chemotherapy. Objective. To describe points for consideration when an osteogenic lesion in the spine is diagnosed and treated. Summary of Background Data. Primary mesenchymal chondrosarcoma in the spine is extremely rare. There were no reports of this tumor being treated with spondylectomy to achieve total surgical resection with a wide margin followed by chemotherapy. Methods. A 44-year-old female presented with low back pain and left flank pain. Magnetic resonance imaging and computerized tomography showed an osteosclerotic tumor of the lumbar vertebrae. Tc-99m HMDP bone scintigraphy was positive, but thallium-201 scintigraphy and gallium scintigraphy were negative. The patient was diagnosed as having chondrosarcoma based on biopsy findings. Results. To resect the tumor completely, total en bloc spondylectomy for 2 consecutive lumbar vertebrae was performed. However, the postoperative pathologic diagnosis was extremely difficult because the patient was initially suspected to have osteosarcoma, but the final diagnosis was mesenchymal chondrosarcoma. Five years after surgery, there have not been any signs of local recurrence or distant metastasis, and the patient has remained continuously disease free. Conclusions. To our knowledge, we reported the first case of mesenchymal chondrosarcoma occurring from the lumbar spine treated with total en bloc spondylectomy and chemotherapy. Successful radical resection of the tumor could be accomplished. Although the effect of chemotherapy on the final results could not be clearly determined, considering that at least continuous disease-free survival was achieved, it is highly likely that chemotherapy contributed to the favorable results.

Reconstruction surgery for patients with musculoskeletal tumor, using a pasteurized autogenous bone graft.

BackgroundThe pasteurized autogenous bone graft (PABG) is a new method to reuse resected and diseased autogenous bones after heat treatment at a comparatively low temperature (60°C–65°C).MethodsThe subjects of this study were ten patients with musculoskeletal tumor who underwent surgery with a PABG in the 6 years between 1995 and 2000.ResultsThe pasteurized bone developed into bone union in all patients, except for the elderly patients who required repeat surgery. There were no infected patients. The PABG was performed by three different types of reconstruction, a segmental method, an intercalary method, and a combination method with an artificial joint as a spacer. No local recurrence of tumor the pasteurized bone was observed from in any patient.ConclusionThe PABG appears to be a comparatively easy, safe, inexpensive, and effective reconstruction method for musculoskeletal tumors.

Genistein inhibits cell invasion and motility by inducing cell differentiation in murine osteosarcoma cell line LM8

BackgroundOne of the problems associated with osteosarcoma is the frequent formation of micrometastases in the lung prior to diagnosis because the development of metastatic lesions often causes a fatal outcome. Therefore, the prevention of pulmonary metastases during the early stage of tumor development is critical for the improvement of the prognosis of osteosarcoma patients. In Japan, soy is consumed in a wide variety of forms, such as miso soup and soy sauce. The purpose of this study is to investigate the effect of genistein, an isoflavone found in soy, on the invasive and motile potential of osteosarcoma cells.MethodsLM8 cells were treated for 3 days with various concentrations of genistein. The effect of genistein on cell proliferation was determined by DNA measurement in the cultures and 5-bromo-2’-deoxyuridine (BrdU) incorporation study. The assays of cell invasion and motility were performed using the cell culture inserts with either matrigel-coated membranes or uncoated membranes in the invasion chambers. The expression and secretion of MMP-2 were determined by immunohistochemistry and gelatin zymography. The subcellular localization and cellular level of β-catenin were determined by immunofluorescence and Western blot. For examining cell morphology, the ethanol-fixed cells were stained with hematoxylin-eosin (H&E). The expression of osteocalcin mRNA was determined by reverse transcription-polymerase chain reaction (RT-PCR).ResultsGenistein dose-dependently inhibits cell proliferation. Genistein-treated cells were less invasive and less motile than untreated cells. The expression and secretion of MMP-2 were lower in the genistein-treated cultures than in the untreated cultures. β-Catenin in untreated cells was located in the cytoplasm and/or nucleus, while in genistein-treated cells it was translocated near to the plasma membrane. The level of β-catenin was higher in genistein-treated cells than in untreated cells. Treatment of LM8 cells with genistein induced morphological changes, markedly decreased the formation of multilayer masses of cells, and markedly increased the expression of osteocalcin mRNA.ConclusionsGenistein decreased invasive and motile potential by inducing cell differentiation in LM8 cells. Genistein may be useful as an anti-metastatic drug for osteosarcoma through its differentiation-inducing effects.

Synthesis of active high mannose-type lipoprotein lipase in human adipose tissues

Lipoprotein lipase (LPL) activity in the retroperitoneal adipose tissue of a patient with Cushings syndrome and in the subcutaneous adipose tissue of a patient with aseptic necrosis of the femoral head was higher than that in the corresponding tissues of the control subjects. The amount of [35S]methionine incorporated into LPL was also higher in these patients than in control subjects. However, the ratio of activity and amount of radioactivity in the LPL of patients was identical to that of control subjects, indicating that LPL synthesized in the adipose tissues of patients had a normal specific activity. LPL with Mr = 57000 was composed of two types of subunits: one type was partially endo H-sensitive, yielding a product with Mr = 55000, and the other was totally endo H-sensitive, yielding a product with Mr = 52000. Both retroperitoneal and subcutaneous adipose tissues of control subjects contained nearly equal amounts of partially and totally endo H-sensitive subunits. In the retroperitoneal adipose tissue of a patient with Cushings syndrome, 8% of subunits were partially endo H-sensitive and 92% were totally endo H-sensitive. In the subcutaneous adipose tissue of a patient with aseptic necrosis of the femoral head, 21% of subunits were partially endo H-sensitive and 79% were totally endo H-sensitive. The 24-h treatment of subcutaneous adipose tissue of a control subject with 1 mM 1-deoxymannojirimycin (dMM) caused the synthesis of active, but totally endo H-sensitive, LPL. Thus, in human adipose tissue, the processing of one oligosaccharide chain of an LPL subunit to a complex type chain in the trans Golgi was not necessary for the expression of activity.

Mycetoma of foot: a rare case report and review of the literature.

Mycetoma is a chronic infectious disease caused by Actinomycetes, Nocardia, Madurello, Exophiala and Scedosporium, in which a granuloma with draining lesions occur in the foot. It is frequently found in tropical or subtropical regions where people walk barefoot.10,12,25 We report a case of mycetoma in which the patient had never been abroad and whose route of infection was unknown. It was difficult to differentiate from a musculoskeletal tumor.

Definitive intraoperative radiotherapy for musculoskeletal sarcomas and malignant lymphoma in combination with surgical excision

AbstractBackground. The purpose was to estimate retrospectively the outcome of patients with musculoskeletal sarcoma or malignant lymphoma treated with intraoperative radiotherapy (IORT). Methods. Between 1988 and 1999, definitive IORT in combination with surgical excision was performed in 24 patients with musculoskeletal sarcoma (malignant fibrous histiocytoma, 10; osteosarcoma, 6; liposarcoma, 2; chondrosarcoma, 1; synovial sarcoma, 1; Ewings sarcoma, 1; angiosarcoma, 1; epithelioid sarcoma, 1; malignant schwannoma, 1) and 3 patients with malignant lymphoma. The tumor was excised by marginal margin excision, intralesional margin excision, or wide margin excision; 15–45 Gy electrons was then delivered to the affected sites. Results. In the 8 patients without distant metastases at the first visit, 4 patients are alive 6.5–11.5 years after IORT, and 4 patients died <4.5 years after IORT. The incidence of local recurrence was 13%. In the 19 patients with distant metastases at the first visit, 3 patients are alive 2.5–6.7 years after IORT, and 16 patients died 0.2–5.7 years after IORT. The incidence of local recurrence was 45%. Complications after IORT were found in 5 patients: neuropathy, 1 patient; skin necrosis, 1 patient; myelopathy, 1 patient; enteritis ileus, 1 patient; and edema, 1 patient. Conclusion. IORT with a radiation dose of 15–45 Gy in combination with surgical excision appeared to be useful for local control and to be more effective in patients without distant metastases at the first visit than in patients with distant metastases.

Development of tumor-specific caffeine-potentiated chemotherapy using a novel drug delivery system with Span 80 nano-vesicles

In recent years, chemotherapy with caffeine has manifested potently high efficacy against osteosarcoma, although adverse effects have been observed. Recently, we developed a novel drug delivery system (DDS) with nonionic vesicles prepared from Span 80 which have promising physicochemical properties as an attractive possible alternative to commonly used liposomes. Herein, we demonstrated that tumor-specific caffeine-potentiated chemotherapy for murine osteosarcoma administered by a novel DDS with Span 80 nano-vesicles showed significant antitumor effects as well as limited adverse effects. The osteosarcoma cell line, LM8, was transplanted into C3H/HeJ mice which then were administered therapeutic agents. Ifosfamide (IFO) was employed as well as caffeine as an enhancer. Span 80 vesicles containing IFO and/or caffeine were freshly prepared. On days 0, 2 and 4, different combinations of the agents were administered to mice: IFO alone (direct i.v.), IFO vesicles (IV), IV + caffeine, IV + caffeine vesicles (CV), PBS alone vesicles (PV), and PBS alone as negative control (PBS i.v.). Then, the mice were sacrificed on day 7. Antitumor effects of the reagents were also analyzed in vitro. Moreover, fertility examination was performed. In vitro, a combination of IV+CV showed significant induction of apoptosis in the early phase. Tumor volumes in the IV+CV group were significantly reduced compared with the other groups. Histological analyses showed that the IV and IV+CV groups had significantly lower viable tumor areas. The IFO direct i.v. group showed a certain grade of renal injury as well as marked suppression of spermatogenesis, while the IV or IV+CV group showed no marked changes. The fertility test revealed that the male mice with IV+CV administration had normal fertility, and no malformations were detected in their progeny. This DDS model is of potential importance for clinical application in the therapy of metastatic osteosarcoma.

Active-dimeric form of lipoprotein lipase increases in the adipose tissue of patients with rheumatoid arthritis treated with prednisolone.

The synthesis, activity and mass of LPL in adipose tissue were studied in patients with rheumatoid arthritis (RA) treated with prednisolone (PSL) (PSL-treated group) and untreated patients with osteoarthritis (untreated group). LPL activity and mass in the extracts of acetone/ether powder of adipose tissue were 2.4 and 1.6 times, respectively, higher in the PSL-treated group than in the untreated group. There were no differences in the amount of 35S incorporated into LPL during the 2-h incubation of adipose tissue with [35S]methionine between PSL-treated and untreated groups. These results indicate that degradation of LPL was inhibited in the adipose tissue of the PSL-treated group. In the adipose tissue of the untreated group, 72% of the LPL was the inactive-monomeric form, which was eluted with 0.4-0.75 M NaCl from the heparin-Sepharose column, and 28% was the active-dimeric form, which was eluted with 0.8-1.2 M NaCl. In the adipose tissue of the PSL-treated group, 40% was inactive-monomeric, and 60% was active-dimeric. Thus, the relative amount of the active-dimeric form of LPL was increased in the adipose tissue of the PSL-treated group. Taken together, our present results indicate that the higher level of LPL activity in the PSL-treated group was a result of the inhibition of the degradation of the active-dimeric form.

Polyostotic fibrous dysplasia with gigantism and huge pelvic tumor: a rare case of McCune–Albright syndrome

We report a rare case of polyostotic fibrous dysplasia on endocrine hyperfunction with elevated human growth hormone and normal serum level of prolactin. There were some differential points of gender, gigantism, endocrine function, and GNAS gene from McCune–Albright syndrome. Malignant transformation was suspected in the pelvic tumor from imaging because rapid growth of the tumor by imaging was observed; however, no malignant change occurred in this case.

A child who recovered completely after spinal cord injury complicated by C2-3 fracture dislocation: case report.

Study Design. This was a case of a child who recovered completely after spinal cord surgery complicated by C2–C3 fracture dislocation. Objectives. To clarify the important issue with regard to the diagnosis and treatment of possible spinal cord injury complicated by C2–C3 fracture dislocation in children. Summary of Background Data. Reports on spinal cord injury complicated by C2–C3 fracture dislocation in children who recovered completely after surgery are very rare. Moreover, there are no reports of cases in which described MRI and magnetic resonance angiography obtained 5 years after surgery. Methods. A 4-year-old girl with complete fracture dislocation of C2–C3 and spinal cord injury of Frankel B because of a traffic injury. A middle incision was made in a prone position under general anesthesia, and C2–C3 was fixed with interlaminal wiring according to the McGraw modified method. Results. The postoperative course was excellent, and the patient recovered completely. An MRI performed 5 years after surgery revealed no definitive abnormality in spinal cord and patency of vertebral arteries. Conclusion. This was a very rare case of spinal cord injury complicated C2–C3 fracture dislocation in children. The present case is of interest in that it demonstrated the possibility of recovery in a child from spinal cord injuries of Frankel B immediately after injury, if complex injuries in multiple organs are controlled by systemic management.