Unicompartmental knee arthroplasty for medial gonarthrosis: 5 to 9 years follow-up evaluation of 77 knees

A total of 77 knees in 60 consecutive patients were operated on for medial gonarthrosis using a cemented porous coated anatomical (PCA) unicompartmental knee arthroplasty. Their average age was 71.3 years; 11 were men and 49 women. Clinically, the results in 67 knees were rated as being good to excellent, with mean preoperative and postoperative flexion of 123 and 122 deg, respectively. No deep infections or deep venous thrombosis occurred, but there was one dislocation of the femoral component. Overall clinical and radiographic results were satisfactory in 88% at 7.0 years' follow-up. Kaplan-Meier survivorship analysis indicated that the failure rate of unicompartmental knee arthroplasty was 12% at average follow-up. In patients aged 70 years or more, unicompartmental knee arthroplasty for medial gonarthrosis should be considered an excellent alternative to high tibial osteotomy.

Matching of acoustic features during the vocal exchange of coo calls by Japanese macaques

A central issue in studies of vocalizations of non-human primates is the extent of their plasticity. Japanese macaques, Macaca fuscata, frequently utter coo calls and exchange these calls with other group members to maintain contact vocally. I conducted a playback experiment to examine whether monkeys that respond vocally match the acoustic features of their reply to those of the calls they have heard. Six to eight stimulus calls with different acoustic properties in terms of fundamental frequency components were played back to each of seven females, in an attempt to elicit replies from the subjects. There were significant positive regressions of the frequency range of stimuli with that of the replies. Japanese macaques thus matched some of the acoustic features of their replies to those of the preceding calls, suggesting that they might be able to modify the acoustic features of their calls according to the features of the prior calls of another group member.Copyright 1998 The Association for the Study of Animal Behaviour Copyright 1998 The Association for the Study of Animal Behaviour.

Gorham massive osteolysis

Gorham syndrome (massive osteolysis) is a very rare tumour-like lesion characterized by progressive osteolysis. The diagnosis must be confirmed by the microscopic finding of intramedullary angioma-like vascular structures. We report a case of a 15-year-old boy with a pathological fracture in his left humerus. Imaging modalities such as magnetic resonance imaging, computed tomography, angiography and bone scintigraphy failed to disclose to tumorous lesion that filled a cavity in the left humerus. After observing the boy's progress for 6 months, a temporary diagnosis of Gorham syndrome was made, and surgical treatment was chosen. After resection of the left humeral head and the proximal one-quarter of the humerus, thorough curettage was performed in the distal humerus and an intramedullary artificial humeral head fixed with adequate success. Pathological examination of the specimen revealed intramedullary haemangioma of the humerus.

Granular-lattice (Avellino) corneal dystrophy in Japanese patients

PURPOSE

To determine amyloid deposition in the corneas of granular corneal dystrophy in Japanese patients.

METHODS

Eight Japanese patients (10 eyes) with a clinical diagnosis of granular corneal dystrophy were investigated clinically and histologically. Each specimen obtained at surgery was stained with hematoxylin-eosin, Masson trichrome or Mallory, and Congo red stain. Amyloid deposit was identified by birefringence and dichroism under cross-polarized light after staining with Congo red.

RESULTS

Seven (70%) of the 10 corneal buttons (six of eight patients) had amyloid deposits, as shown by Congo red staining with birefringence and dichroism. Of the six amyloid-positive patients, two patients (who were siblings) showed discrete gray-white corneal deposits with additional linear deposits. This finding is typical of Avellino corneal dystrophy. The corneas of the remaining four patients showed the discrete deposits typical of granular dystrophy. Some of them showed a few whitish fusiform and stellate opacities in the mid stroma, suggestive of Avellino corneal dystrophy.

CONCLUSION

The high frequency of amyloid deposits in Japanese patients with granular corneal dystrophy may be caused by an allelic heterogeneity of the gene.

beta-Sitosterolemia with generalized eruptive xanthomatosis

The clinical features of the first case of a patient with sitosterolemia and generalized eruptive xanthomatosis are described. A six-year-old girl with generalized eruption was referred to the lipid clinic because of the high plasma cholesterol levels determined by the enzymatic method. Neither clinical signs nor results of laboratory examinations appeared to be abnormal, except for the eruption and the increase in the plasma cholesterol concentration. A family survey revealed high plasma cholesterol concentrations in the mother and one of two other siblings. Histological examination showed the eruption to be a xanthoma. Plasma sterol analysis by high-performance liquid chromatography revealed a noticeable increase in plasma plant sterol as well as cholestanol concentrations in the proband and the hypercholesterolemic sibling. The other family members had slightly high plasma sterol concentrations. This is the first case of a sitosterolemic patient with eruptive xanthomatosis. The case indicates that the clinical features of the xanthoma in sitosterolemia are not only tuberous or tendon but also eruptive, and also suggests that sitosterolemia should be considered in the differential diagnosis of hypercholesterolemia in almost every case with tuberous or eruptive xanthoma. The diagnosis is clinically important, since the disease can be treated successfully by diet therapy and bile acid binding resins.

Density and fine structure of peripheral nerves in various skin lesions of atopic dermatitis

The density and fine structure of the peripheral nerve system in various skin lesions of 64 patients with atopic dermatitis (AD) was quantitatively analyzed by immunohistochemical staining with antibodies directed against protein gene product (PGP) and substance P (SP). The density of PGP-positive peripheral nerves was 2.5 x 10(3) microns2/delta s (delta s = 0.24 mm2 selected area) in early acute lesions, 3.8 x 10(3) microns2/delta s in subacute lesions, 4.9 x 10(3) microns2/delta s in lichenified lesions and 7.1 x 10(3) microns2/delta s in prurigo lesions of AD. The density of nerve fibers in subacute, lichenified and prurigo lesions was significantly higher than in uninvolved skin of AD patients (2.0 x 10(3) microns2/delta s). Electron microscopically, bulging of axons with many mitochondria and a loss of their surrounding sheath of Schwann cells suggests that the free nerve endings in skin lesions of AD are in an active state of excitation. Many pinocytotic vesicles in the periphery of basal keratinocytes facing nerve endings which contained many neurovesicles suggests reciprocal effects between keratinocytes and nerve endings. The number of SP-positive nerve fibers in AD lesions was far less than one-tenth of the number of PGP-positive nerve fibers.

Prostaglandin levels of primary bone tumor tissues correlate with peritumoral edema demonstrated by magnetic resonance imaging

BACKGROUND

Several reports have shown peritumoral edema accompanying primary bone tumors demonstrated by magnetic resonance imaging (MRI). However, the mechanism of this inflammatory reaction is still unclear. The authors postulated that the reaction was caused by some chemical mediators including prostanoids, because several investigators have observed that some types of bone tumors synthesize prostanoids. Therefore, the authors compared MRI findings and tumor prostaglandin (PG) levels.

METHODS

The subjects were 29 patients with primary bone tumor or tumor-like conditions: chondroblastoma (n = 5); chondrosarcoma, including rare variants (n = 8); giant cell tumor (n = 6); osteochondroma (n = 5); osteoblastoma (n = 2); Ewing's sarcoma (n = 2); and eosinophilic granuloma (n = 1). T1- and T2-weighted spin echo images were obtained in all but one patient before surgery. The tumor concentration of prostaglandin E2, 6-keto-PGF1 alpha, and thromboxane B2 were measured by radioimmunoassay.

RESULTS

MRI distinctly showed bone marrow edema in 9 and soft tissue edema in 12 of the 28 patients examined. These findings were significantly correlated with the PG levels. Moreover, the PG levels were correlated with the histologic classifications (P < 0.001). In particular, the chondroblastomas showed prominent concentrations of PGs compared with other cartilaginous tumors or giant cell tumors.

CONCLUSIONS

Although peritumoral edema accompanying benign and malignant bone tumors is not necessarily related to one single pathophysiologic mechanism, these results suggest that PG production was an important cause of the inflammatory reaction that was revealed by MRI. Recognition of this phenomenon is advantageous not only for strict diagnostic purposes but also for understanding the characteristic features of individual primary bone tumors.

Use of adriamycin-impregnated methylmethacrylate in the treatment of tumor metastases in the long bones

Internal fixation or endoprosthetic replacement of a long bone metastatic lesion was performed using adriamycin-containing bone cement (methylmethacrylate) after resection or curettage of the lesion in 25 patients (27 limbs). Survival rate, limb function, and local recurrence rate were retrospectively evaluated in this patient cohort. Survival rate was 53% at 12 months and 30% at 24 months, which was better than in previous reports. One patient showed local recurrence radiographically. Postoperatively, none of the patients developed infection, delayed wound healing, myelo-suppression attributed to adriamycin, and 74% of the patients were able to walk outdoors.

[Effects of voluntary exercise on nonspecific immunological mechanisms in mice]

We studied the effects of voluntary exercise on nonspecific immunological mechanisms in mice. In this study, 7 week old male ICR mice were divided into two groups: a non-exercise group (control) and a group given voluntary exercise (Vex group). Each mouse of the Vex group was kept in an individual cage equipped with a voluntarily revolving wheel that the mouse had free access to. The duration of voluntary exercise was 3 days per week for 8 weeks. The following results were obtained: 1) After 8 weeks of voluntary exercise, food consumption, the weight of the anterior tibialis muscle and succinate dehydrogenase activity in the anterior tibialis muscle increased significantly in the Vex group compared to the control group. 2) By means of the carbon clearance method, phagocytosis of the reticuloendothelial system was increased in the Vex group. 3) Glucose consumption capacity and O-2 production capacity of peritoneal macrophages (M phi) were significantly increased in the Vex group compared to the control group. 4) The acid phosphatase (APH), beta-glucuronidase (GLU) and lactate dehydrogenase (LDH) activities of peritoneal M phi increased significantly in the Vex group. 5) Concanavalin A (Con A)-induced cell proliferation in the spleen was high in the Vex group. Based on the above findings, it may be surmised that voluntary exercise enhances nonspecific immunological mechanisms and thereby improves the host defense mechanisms in mice.

Prevalence of infantile and early childhood eczema in a Japanese population: comparison with the disease frequency examined 20 years ago

To investigate the prevalence of infantile and early childhood eczema in a Japanese population, we clinically inspected the entire bodies of 4-month-old infants (341 cases), 10-month-old infants (339 cases) and 3-year-old children (341 cases). The examination was performed in spring, when exacerbations of infantile and childhood eczema most frequently occur in Japan. Eczema was observed in 30-31% of the infants, and in 20% of the 3-year-old children. The prevalence was almost the same as in similar age groups that we examined 20 years ago.

Malignant hemangioendothelioma of the left calcaneus associated with fever and hematological abnormalities

A case of malignant hemangioendothelioma of the left calcaneus associated with unique system manifestations is reported here. The severe toxic manifestations included: high fever, anemia, leukocytosis, coagulation abnormalities, and other signs. Because of poor response to many antibiotic regimens, the confusion of diagnosis, and severe coagulation abnormalities with clinical signs that the life of the patient was endangered, below the knee amputation was performed. Pathological studies revealed a malignant hemangioendothelioma. A review of the case suggests that the signs and symptoms were possibly due to an immune response to the tumor rather than to secondary infection, although the latter possibility cannot be completely excluded.

Giant cell-rich osteosarcoma: a case report

This report discusses a rare case of giant cell-rich osteosarcoma. The patient, a 19-year-old male, was diagnosed with a metadiaphyseal osteolytic lesion when he consulted a local doctor complaining of motion pain without swelling. Radiography revealed a geographic osteolytic lesion, cortical thinning and ballooning without obvious cortical destruction. However, a fine onion skin-like periosteal reaction was observed on the lateral side of the femur. The transitional none was narrow and endosteal scalloping was also noted. Needle biopsied material clearly showed nuclear atypism of the stromal tumor cells with numerous osteoclast-like giant cells. Using a combination of pathological examination, radiography, computed tomography (CT) and magnetic resonance imaging (MRI), a diagnosis of giant cell-rich osteosarcoma was reached. After chemotherapy, resection and limb salvage surgery with an autogeneous autoclaved bone graft, a vascularized fibular graft were performed, and the patient has shown excellent limb function without local recurrence or distant metastasis during the past 72 months.

Solid variant of an aneurysmal bone cyst (giant cell reparative granuloma) of the 3rd lumbar vertebra

A 9-year-old girl with a solid variant of an aneurysmal bone cyst in the 3rd lumbar vertebra showed a good response to low-dose radiation as the only treatment. The solid variant of aneurysmal bone cyst is thought to be a reactive response to intraosseous hemorrhage and is also called giant cell reparative granuloma or giant cell reaction. These lesions in the jaw and the short tubular bones of the hands and feet frequently recur after surgery. Aneurysmal bone cysts of the spine also show a fairly high recurrence rate after incomplete resection or radiation therapy. However, 7 previous cases of the solid variant of aneurysmal bone cyst in the spine and this case did not show recurrence after a mean follow-up period of 45 months. This difference in behaviour suggests that the solid variant should be recognized before surgery as being distinct from conventional aneurysmal bone cysts, especially in the spine.

[Rhabdomyolysis related-acute renal failure in a patient with hyperosmolar nonketotic diabetic coma (HNKC): demonstration of myoglobin casts after normalization of renal function]

We report a patient with rhabdomyolysis secondary to hyperosmolar nonketotic diabetic coma (HNKC), who progressed to acute renal failure. A 43-year-old male with diabetes mellitus for three years was admitted to our hospital because of loss of consciousness. The laboratory findings at admission were as follows: serum glucose 1792 mg/dl, serum Na 129 mEq/1, BUN 71 mg/d1, serum creatinine 3.3 mg/d1, CPK 715 IU/1, plasma osmolality 370 mOsm/1, and negative urine ketone bodies. A diagnosis of HNKC was made. On the 2nd day, he had oliguria and the serum creatinine increased despite adequate treatment of HNKC by the administration of intravenous fluid and insulin. On the 4th day, CPK reached 47,300 IU/1, and serum myoglobin was also increased, indicating rhabdomyolysis. His renal function improved gradually and was almost normalized on the 20th day. Renal biopsy on the 23rd day showed myoglobin at the distal renal tubules, which appeared to be involved in the pathogenesis of renal failure by rhabdomyolysis. However, we found little abnormality association with diabetic nephropathy in the renal tissue. Since HNKC is known to induce acute renal failure rarely without diabetic nephropathy, these findings suggested that the acute renal failure was caused mainly by the rhabdomyolysis. Acute renal failure induced by rhabdomyolysis in patients with HNKC is rare, but fatal. The present study showed that the measurement of serum CPK and urine myoglobin was helpful for early diagnosis. Only 12 cases have been reported to have developed renal failure due to rhabdomyolysis among patients with HNKC. To our knowledge, we demonstrated for the first time that myoglobin at the distal renal tubules after renal function was normalized.

Inflammatory reaction in chondroblastoma

OBJECTIVE

The objective of this study was to evaluate the inflammatory reaction accompanying chondroblastoma and to define the value of the finding in clinical practice.

DESIGN

We reviewed the clinical, radiographic, and magnetic resonance (MR) findings in six patients with histologically proven chondroblastoma.

RESULTS

In all cases, MR imaging showed marrow and soft tissue edema. In four of six cases, periosteal reaction related to intra-osseous edema was more clearly demonstrated on MR imaging than on radiographs. Follow-up MR studies after surgery were available in three patients and all showed disappearance of inflammatory responses such as marrow and soft tissue edema, and reactive synovitis.

CONCLUSION

We propose that these inflammatory reactions of chondroblastomas are important signs for detecting residual tumor in recurrences after surgery, as well as for making a precise diagnosis. The MR changes may also be valuable in demonstrating eradication of the tumor.