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PubMed2006

Ewing's sarcoma in the spinal nerve root: a case report and review of the literature.

Ewing's sarcoma (ES) is a highly malignant tumor composed of uniform small round cells. Recently, a single biologic entity, Ewing's sarcoma family of tumors (ESFT) has been accepted. The entity includes ES, extraskeletal Ewing's sarcoma (EES) and primitive neuroectodermal tumor (PNET). ESFT cells have immunoreactivity for CD99, an antigen determined by the MIC2 gene. Most ESFT has the (11;22) (q24;q12) translocation. The translocation results in the fusion of the EWS gene with the transcription factor gene FLI1 which has been considered a hallmark of ESFT. We present an extremely unusual case with ESFT in a spinal nerve root mimicking a neurogenic dumbbell tumor. A male aged 20 years noticed pain in his right buttock. Magnetic resonance imaging (MRI) revealed a mass in the right L5/S intervertebral foramen and the lesions in the sacrum. Surgery was performed with a presumptive diagnosis of a nerve sheath tumor. At surgery, the tumor was located in the right L5 nerve root sleeve. The sacral lesions were observed closely. At one month after surgery, radiologically multiple lesions were detected in the pelvic bones. Microscopically the lesions from the root and ilium were composed of small round cells immunoreactive for CD99. Reverse transcription-polymerase chain reaction detected transcripts resulting from the fusion of the EWS gene with FLI1 genes in the iliac lesion. Immunoreactivity for CD99 and detection of the EWS-FLI1 hybrid transcripts are important for the correct diagnosis of ESFT arising in an unusual location.

Adult↗
PubMed2006

Improved liver function in patients with liver cirrhosis after autologous bone marrow cell infusion therapy.

We here report nine liver cirrhosis (LC) patients that underwent autologous bone marrow cell infusion (ABMI) from the peripheral vein. Subjects were patients with LC with total bilirubin of less than 3.0 mg/dl, platelet count of more than 5 (10(10)/l), and no viable hepatocellular carcinoma on diagnostic imaging. Autologous bone marrow (BM; 400 ml) was isolated from the ilium under general anesthesia. Mononuclear cells (MNCs) were separated by cell washing and were infused via the peripheral vein. MNC characteristics were confirmed by fluorescence-activated cell sorting analysis (CD34, CD45, and c-kit). After ABMI therapy, liver function was monitored by blood examination for 24 weeks. From 400 ml of BM, we obtained 7.81 +/- 0.98 x 10(9) MNCs. After washing, 5.20 +/- 0.63 x 10(9) MNCs were infused into patients with LC. Significant improvements in serum albumin levels and total protein were observed at 24 weeks after ABMI therapy (p < .05). Significantly improved Child-Pugh scores were seen at 4 and 24 weeks (p < .05). alpha-Fetoprotein and proliferating cell nuclear antigen (PCNA) expression in liver biopsy tissue was significantly elevated after ABMI therapy (p < .05). No major adverse effects were noted. In conclusion, ABMI therapy should be considered as a novel treatment for patients with decompensated LC.

Aged↗
PubMed2001

A new classification of free combined or connected tissue transfers: introduction to the concept of bridge, siamese, chimeric, mosaic, and chain-circle flaps.

Recently, combined tissues or flaps have been used for the repair of extensively massive or wide defects resulting from radical wide resection. To further advance the development of combined tissue transfers, they should be reclassified. Based on our cases with free tissue transfers, we have created a new classification of combined flaps composed of "bridge", "chimeric", "siamese", "mosaic", and "chain-circle" flaps. The bridge flap is fabricated out together of separate flaps with short vascular pedicles. These form a compound flap supplied with a solitary vascular source. The chimeric flap is compounded from multiple different flaps but consists of only a single different tissue form. Each of the flaps is usually supplied by different branches from the same source vessel. It differs from the bridge flap in that the pedicle of each flap or tissue has some length for its movement for transfer. The siamese connected flap has 2 adjacent flaps that are simultaneously elevated, and a disparate vascular pedicle for each flap must be reestablished. This connected flap has double isolated pedicles. Themosaic connected flap consists of 2 adjacent flaps that are simultaneously elevated, and the pedicle of the distal flap is anastomosed to the pedicle branch of the proximal flap in the "bridge" fashion. The vascular pedicle of the proximal flap is anastomosed to a single vascular source. The chain-circle flap has 2 or more flaps like the bridge and chimeric flaps, and the distal end of the vascular source is anastomosed to the branch of the recipient vessel. Based on results with our patients, the lateral circumflex femoral system seems to be the most suitable candidate for the axial pedicle of these combined flaps, because the system has several branches of large and small caliber, and several tissue components, such as the vascularized ilium, rectus femoris muscle, gracilis muscle, lateral femoral cutaneous nerve, and fascia lata, are located nearby.

Connective Tissue↗
PubMed1996

Failure of a non-porous-coated acetabular component inserted without cement in primary total hip arthroplasty.

Thirty-four patients (thirty-eight hips) had a primary total hip arthroplasty with insertion of a non-porous-coated titanium-alloy acetabular component without cement. This component is initially stabilized with use of a central acetabular polyethylene peg, which is inserted into the pelvis, as well as supplementary cortical-bone screws inserted into the ilium. The original diagnosis was degenerative joint disease in thirty-four hips and avascular necrosis in four hips. Twenty-five femoral components were inserted with cement, and thirteen non-porous-coated femoral implants were inserted without cement. The acetabulum was prepared with so-called line-to-line reaming. Thirty-five hips in thirty-one patients were available for clinical and radiographic follow-up at a mean of 4.5 years (range, two to seven years). Serial measurements of the position of the acetabular component revealed that eighteen cups (51 per cent) had migrated. Of these, eleven had been revised. Radiolucent lines of at least one millimeter in thickness at the bone-prosthesis interface were noted adjacent to all but six of the acetabular components. Although this series was small, it demonstrates an unacceptably high rate of failure of non-porous-coated acetabular components after a relatively short duration. We question the efficacy of this acetabular component, inserted without cement, as part of a primary total hip arthroplasty.

Acetabulum↗
PubMed1999

Revision of the acetabular component without cement after a previous acetabular reconstruction with use of a bulk femoral head graft in patients who had congenital dislocation or dysplasia. A follow-up note.

BACKGROUND: Revision of an acetabular component that has failed after a total hip arthroplasty in which a bulk femoral head autogenous graft or allograft was used as a structural graft for acetabular reconstruction is an uncommon but complex and challenging procedure. We previously reported the results for seventy hips at an average of 16.5 years after a total hip arthroplasty in which an acetabular reconstruction had been performed with a femoral head graft. In the present study, we evaluated a subset of nine hips from that series that had a subsequent revision of the acetabular component without cement. The purpose of the current study was to assess the usefulness of the bone graft in this revision. METHODS: The nine patients (nine hips) were followed clinically and radiographically for an average of seventy-six months (range, sixty-one to 114 months) after the index revision. In six hips the autogenous femoral head graft previously had been bolted to the lateral side of the ilium, and in one hip the femoral head allograft had been affixed in this manner. In the two remaining hips, the allograft had been placed within the acetabulum. The hips were classified according to the extent of acetabular bone loss, with use of criteria described previously. Three hips had stage-I bone loss; four, stage-II; and two, stage-IIB. A porous-coated hemispherical acetabular component was inserted without cement and fixed with screws in each hip. At least 70 percent of the porous coating was in contact with viable bone. RESULTS: At the time of the latest follow-up after the index revision, all nine acetabular components were functioning well without loosening or osteolysis and none had been revised. The average Harris hip score was 77 points (range, 61 to 98 points) compared with 49 points (range, 27 to 96 points) preoperatively. One hip had had revision of the femoral stem, and another had had exchange of the acetabular liner because of recurrent dislocations. There was no additional resorption of the residual bulk graft that was in contact with the metal shell in any hip. CONCLUSIONS: In this small series of complex acetabular revisions, the healed bulk graft provided valuable additional bone stock for the support of an acetabular component that was inserted without cement. Insertion of the acetabular component into the available bone, which consisted in major part of host bone and in minor part of united revascularized bulk graft, resulted in a well functioning hip after an intermediate duration of follow-up. In all except two hips, the enlarged bone stock allowed insertion of a larger acetabular component than had been used previously.

Acetabulum↗
PubMed2000

Reattachment of the migrated ununited greater trochanter after revision hip arthroplasty: the abductor slide technique. A review of four cases.

BACKGROUND: Proximal migration of the ununited greater trochanter following total hip arthroplasty may produce pain and substantial functional disability. Successful reattachment of the migrated fragment is difficult following multiple hip procedures. The purpose of this report is to describe four patients in whom a severely migrated trochanteric fragment was reattached successfully with a modified Charnley-Harris wiring technique after subperiosteal advancement of the abductor muscles from their origin on the iliac wing. METHODS: This series consisted of one man and three women with an average age of sixty years (range, fifty-one to sixty-eight years) at the time of the index procedure. The patients were followed for an average of eighty-one months (range, fifty-five to ninety-six months). All patients had undergone mobilization of the abductor muscles based on the superior gluteal neurovascular pedicle to aid with trochanteric reattachment, and all had undergone prior hip operations (average, two). Advancement of the abductor muscles was achieved through a separate transverse curvilinear incision over the iliac crest, and subperiosteal releases of the entire origins of the gluteus minimus, medius, and maximus muscles from the ilium were performed. RESULTS: Roentgenographic union of the trochanteric fragment occurred in all four patients. There were three excellent functional outcomes (Harris hip scores of 90, 94, and 96 points) and one fair functional outcome (76 points). The average improvement in the Harris hip score was 47.5 points (range, 35 to 58 points). Two patients continued to have a mild or moderate Trendelenburg gait postoperatively. Two patients had heterotopic bone formation of no clinical importance. CONCLUSIONS: Use of this technique resulted in union of the greater trochanter, pain relief, and decreased functional disability without major complications in these four patients. More widespread use of this technique may be indicated for the treatment of symptomatic non-union of the greater trochanter when the fragment cannot be reattached to its anatomical location with the hip in less than approximately 20 degrees of abduction.

Aged↗
PubMed2002

Periacetabular osteotomy through a modified ollier transtrochanteric approach for treatment of painful dysplastic hips.

BACKGROUND: Elimination of abnormally high joint-loading resulting in excessive contact stresses may prevent or reduce the onset of osteoarthrosis in a dysplastic hip. A number of periacetabular osteotomies have been shown to be effective in restoring normal hip-joint mechanics. We treat acetabular dysplasia with a periacetabular osteotomy performed through a modified Ollier transtrochanteric approach. In this report, we describe the operative technique and the clinical and radiographic results. METHODS: Thirty-six patients (thirty-eight hips) in whom a painful dysplastic hip had been treated with a periacetabular osteotomy between March 1991 and June 1999 were included in the study. There were thirty-five female patients and one male patient with a mean age (and standard deviation) at the operation of 29.42 +/- 9.1 years. The technique utilizes a u-shaped skin incision, and a routine osteotomy of the greater trochanter with distal transfer if needed, and allows excellent visualization enabling the surgeon to perform the periacetabular osteotomy without penetrating the joint. RESULTS: At a mean of five years and six months postoperatively, the mean modified Harris hip score had improved from 59.1 +/- 15.8 points preoperatively to 87.97 +/- 14.3 points. Radiographically, the degree of osteoarthrosis had decreased in eleven hips, remained unchanged in twenty-four, and worsened in three. The mean anterior center-edge angle had increased from 22.0 degrees +/- 12.9 degrees to 36.1 degrees +/- 12.3 degrees, the mean lateral center-edge angle had increased from -2.7 degrees +/- 14.4 degrees to 26.6 degrees +/- 14.1 degrees, the mean acetabular index angle had improved from 23.4 degrees +/- 6.6 degrees to 12.7 degrees +/- 4.6 degrees, and the mean acetabular head index had increased from 48.2% +/- 12.7% to 73.1% +/- 16.0%. The Shenton line was restored in eleven hips. Thirty patients (thirty-two hips; 84%) had a satisfactory result. A poor preoperative functional score was associated with an unsatisfactory outcome (p = 0.00191). Complications included prolonged limping (eleven hips); numbness in the distribution of the lateral femoral cutaneous nerve (four); osteonecrosis of the rotated acetabular fragment (two); and acetabulofemoral impingement, heterotopic ossification, and a defect on the rotated ilium (one hip each). CONCLUSIONS: Painful dysplastic hips should be treated before function becomes seriously impaired. We believe that periacetabular osteotomy through a modified Ollier approach, which allows osseous cuts to be made under direct vision, can be learned readily. It provides improved femoral head coverage and relief of symptoms in most painful dysplastic hips in adolescents and young adults.

Acetabulum↗
PubMed2003

Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip.

BACKGROUND: The long-term results of total hip arthroplasty performed with cement and use of a bulk autograft for acetabular reconstruction in patients with developmental dysplasia of the hip have varied considerably. We evaluated the results of total hip arthroplasties performed with acetabular bulk autograft to identify the factors that influence the results of this procedure. METHODS: Acetabular roof defects secondary to developmental dysplasia of the hip were reconstructed with a bulk femoral head autograft at the time of total hip arthroplasties performed with use of the Charnley technique and prosthesis. Thirty-seven hips in thirty patients (mean age at the time of the operation, fifty-seven years) were followed for ten to twenty-six years (mean, nineteen years). The Crowe classification of hip subluxation or dislocation was Group II for sixteen hips, Group III for seventeen, and Group IV for four. RESULTS: Coverage of the socket by the graft ranged from 5% to 49% (mean, 33%). Twenty-nine sockets were located within the true acetabulum, and eight were placed more proximally. At the time of the latest follow-up, all of the patients had an excellent clinical result, all of the grafts had united, and no hip had radiographic evidence of failure of the fixation. CONCLUSIONS: We found that total hip arthroplasty performed with cement and use of a bulk autograft to reconstruct an acetabulum with severe bone deficiency secondary to developmental dysplasia of the hip can provide long-term success in patients forty-eight years of age and older when coverage of the socket by the graft does not exceed 50%. When it is not possible to achieve >50% coverage of the socket by the ilium at the level of the true acetabulum, more proximal placement of the socket to obtain adequate coverage is recommended.

Acetabulum↗
PubMed2003

Radiographic definition of pelvic osteolysis following total hip arthroplasty.

BACKGROUND: Radiographs are the standard clinical tool used to monitor patients with pelvic osteolysis after total hip arthroplasty; however, previous reports have questioned the value and accuracy of this method. With use of a cadaveric model, we investigated the accuracy of radiographs in determining the location and size of periacetabular osteolysis. METHODS: We implanted total hip arthroplasty components in eight cadaveric hips and made four radiographs of each hip from different views. We then removed the components and created two pelvic defects in each hip. We measured the volume of each defect, reimplanted the components, and made another set of radiographs. The defects were then enlarged two more times, with the volume measured and another set of radiographs made each time. In total, 128 radiographs were made of forty-eight lesions. An orthopaedist who was blinded to the location of the lesions assessed the radiographs with regard to the presence and size of osteolytic lesions. RESULTS: The overall sensitivity for the detection of osteolysis on a single radiograph was 41.5%, and the overall specificity was 93.0%. Sensitivity was dependent on the location and size of the lesions but not on the radiographic view. Sensitivity ranged from 72% for lesions in the ilium to </=15% for lesions in the ischium and acetabular rim. The detection rate for lesions with a volume of >10 cm (3) was significantly higher than that for smaller lesions (p < 0.001). When all four radiographic views of one lesion were analyzed together, sensitivity increased to 73.6%. Despite the low sensitivity, specificity remained high, indicating that once osteolysis is evident radiographically, the likelihood that a lesion truly exists is high. Additionally, we found that the extent of osteolysis was substantially underestimated on radiographs. CONCLUSIONS: The use of radiographs to assess and monitor osteolysis has both limitations and merits. Using multiple views, an experienced orthopaedist identified only 73.6% of pelvic lesions. However, once a pelvic osteolytic lesion is evident radiographically, the likelihood that it truly exists is high.

Aged↗
PubMed2004

Total hip arthroplasty with bulk femoral head autograft for acetabular reconstruction in DDH. Surgical technique.

BACKGROUND: The long-term results of total hip arthroplasty performed with cement and use of a bulk autograft for acetabular reconstruction in patients with developmental dysplasia of the hip have varied considerably. We evaluated the results of total hip arthroplasties performed with acetabular bulk autograft to identify the factors that influence the results of this procedure. METHODS: Acetabular roof defects secondary to developmental dysplasia of the hip were reconstructed with a bulk femoral head autograft at the time of total hip arthroplasties performed with use of the Charnley technique and prosthesis. Thirty-seven hips in thirty patients (mean age at the time of the operation, fifty-seven years) were followed for ten to twenty-six years (mean, nineteen years). The Crowe classification of hip subluxation or dislocation was Group II for sixteen hips, Group III for seventeen, and Group IV for four. RESULTS: Coverage of the socket by the graft ranged from 5% to 49% (mean, 33%). Twenty-nine sockets were located within the true acetabulum, and eight were placed more proximally. At the time of the latest follow-up, all of the patients had an excellent clinical result, all of the grafts had united, and no hip had radiographic evidence of failure of the fixation. CONCLUSIONS: We found that total hip arthroplasty performed with cement and use of a bulk autograft to reconstruct an acetabulum with severe bone deficiency secondary to developmental dysplasia of the hip can provide long-term success in patients forty-eight years of age and older when coverage of the socket by the graft does not exceed 50%. When it is not possible to achieve >50% coverage of the socket by the ilium at the level of the true acetabulum, more proximal placement of the socket to obtain adequate coverage is recommended.

Acetabulum↗
PubMed1995

Intravenous single and repeated dose toxicity studies of cimadronate (YM175), a novel bisphosphonate, in beagle dogs.

Cimadronate (YM175) is a novel bisphosphonate with potent inhibitory activity on bone resorption under development for the treatment of tumor-induced hypercalcemia, metastatic bone disease and osteoporosis. We conducted intravenous single and repeated dose toxicity studies of cimadronate in beagle dogs. In the single dose study, animals received a single dose of 0.3, 1, 3 or 10 mg/kg of cimadronate and the animals were observed for at least 14 days. At 10 mg/kg, both the male and female dog showed toxic signs such as vomiting, decreased locomotor activities and hypothermia and were killed in extremis within a week after dosing. In the 30-day study, animals received cimadronate at a dosage of 0 (vehicle), 0.03, 0.1, 0.3 or 1 mg/kg/day. At 0.03 mg/kg/day or more, histological findings indicated an increased amount of primary spongiosa in the rib and ilium. At 1 mg/kg/day, degenerative nephropathy, aggregation of spermatozoa and glandular hypoplasia of the prostate gland were observed. On day 16 of dosing one male animal died of acute renal failure. In the 26-week study, animals received cimadronate once weekly at a dosage of 0 (vehicle), 0.31, 0.62, or 1.25 mg/kg. Histopathological examination showed an increased amount of primary spongiosa in the rib at all dosage levels. In addition, similar findings were observed in the lumbar vertebrae at 1.25 mg/kg/week. Histopathological changes in the kidney and male reproductive organs were not observed.

Animals↗
PubMed1993

Two cases of lung carcinoma with osteoplastic bone metastasis.

Two cases of lung carcinoma with osteoplastic bone metastasis are reported. The bone roentgenogram of a 66-year-old woman with pleuritis carcinomatosa revealed multiple sclerotic changes in the right forearm, lumbar spine, and pelvis. Biopsy at internal fixation of the left humerus revealed metastatic adenocarcinoma with osteoplastic change. In a 77-year-old man with small cell carcinoma of the lung, after chemotherapy, osteoplastic bone changes were detected in roentgenograms. An ivory vertebra formation was seen in L1, L2 and L4, and bone scintigram showed, additionally, uptake in the ilium.

Adenocarcinoma↗
PubMed2005

[Tissue engineering for jawbone].

One goal of jawbone reconstruction is to regenerate bone that is strong enough to support dentures or dental implants. Here we describe mandibular reconstructions using bioabsorbable poly (L-lactic acid) (PLLA) mesh and particulate cancellous bone and marrow (PCBM). PLLA mesh is made of monofilaments spun from molecular weight 20.5 x 10(4) that is elongated and woven into mesh. Mandibles of 62 patients with tumors, cysts, or alveolar atrophy were reconstructed with PLLA mesh trays/sheets and PCBM. The operative procedures were as follows: 1) a heat-softened PLLA mesh sheet or tray was cut and bent to conform to the shape and size of the bone defect; 2) PLLA mesh was fixed to the residual bone with stainless steel wire; and 3) the tray was filled with PCBM harvested from the ilium. Clinical evaluations six months after surgery showed that in 35 cases (56.5%) the results were judged to be excellent (bone formation range: beyond 2/3), in 17 cases (27.4%) they were good (bone formation range under 2/3, but re-operation unnecessary), and in 10 cases (16.1%) they were poor (cases not falling into either category above). Long-term observations showed that in 32 cases (80.0%) bone resorption was less than 10% of the regenerated bone. Among the patients wearing early dentures or dental implants, bone resorption was less. There is a good success rate for jawbone reconstruction surgery using PLLA mesh and PCBM, and patients can expect to have mandibles strong enough to support dentures and dental implants. In addition, there is an advantage of regenerating in the donor site as well. However, we need to develop therapies that combine bioactive factors to promote angiogenesis and osteogenesis or hybrid artificial bone for patients with poor regional blood circulation and for elderly patients who have too few osteoprogenitor cells.

Adolescent↗
PubMed1982

CT of acetabular fractures: comparison with conventional radiography.

Computed tomography (CT) and plain radiography of the pelvis were compared in 26 adult patients in whom acetabular fractures or posterior femoral head dislocations were demonstrated or suspected on initial radiographs. The detection of abnormalities of the sacrum, sacroiliac joint, iliac wing, acetabular roof, joint space, anterior pelvic column, posterior pelvic column, posterior acetabular lip, pubic rami, and quadrilateral surface of the ilium by the two methods was compared. The ability of the two techniques to establish the stable fragment was also examined. Three independent readings of each examination for each pelvic region were tabulated, and sensitivity and specificity values were calculated. There was no significant difference between plain radiography and computed tomography in detection of fractures of the iliac wing, anterior pelvic column, posterior pelvic column, and the pubic rami, with high sensitivity and specificity for both examinations. CT was more sensitive than plain radiography in detecting fractures involving the sacrum, quadrilateral surface, acetabular roof, and posterior acetabular lip. In addition, abnormalities of the hip joint space, principally loose bone fragments, were detected more often by CT. Sensitivity of both examinations for abnormalities of the sacroiliac joint was relatively poor, but examinations were highly specific. Determination of the stable fracture fragment(s) was readily accomplished by CT scanning in all 26 patients; in five patients incorrect determinations were made with conventional radiographs alone.

Acetabulum↗
PubMed1999

Primary leiomyosarcoma of bone.

OBJECTIVE: This study describes radiographic and MR imaging features of primary leiomyosarcoma of bone. SUBJECTS AND METHODS: Twelve patients (five men and seven women, 39-79 years old) who were treated at two oncology centers for primary leiomyosarcoma of bone involving the femurs, tibia, ilium, and inferior pubic ramus were studied. None of the patients had preexisting disease or disease elsewhere at the time of diagnosis. Pathologic diagnosis was obtained in all patients. RESULTS: Radiographs of all patients showed a matrix that was exclusively osteolytic. In long bones (seven patients), the tumor had an average length of 11 cm (range, 7-17 cm) and revealed an elongated configuration. In the pelvis (five patients), the average length of the tumor was 10 cm (range, 4-15 cm). MR imaging confirmed an intramedullary lesion in all patients, with extension into the soft tissues in eight patients and no identifiable soft-tissue mass in the remaining four patients. Four of the five pelvic tumors had a prominent soft-tissue mass, whereas only four of the seven long bone lesions revealed a soft-tissue mass that was, in all instances, small. The tumor was hypointense on T1-weighted images and showed heterogeneous signal intensity on T2-weighted conventional and fast spin-echo sequences. We saw low signal intensity (short T2) in eight patients and homogeneous hyperintense signal intensity in one patient. In the remaining three patients, T2-weighted spin-echo sequences obtained with fat saturation showed high signal intensity (long T2) in the tumors. CONCLUSION: Primary leiomyosarcoma of bone is a rare tumor that on radiography reveals no matrix and on MR imaging reveals areas of T2 shortening in relation to fat on conventional and fast spin-echo sequences.

Adult↗
PubMed2005

Evaluation of an osteoconductive resorbable calcium phosphate cement and polymethylmethacrylate for augmentation of orthopedic screws in the pelvis of canine cadavers.

OBJECTIVE: To evaluate the effect of an osteoconductive resorbable calcium phosphate cement (CPC) on the holding power of bone screws in canine pelvises and to compare the effect with that for polymethylmethacrylate (PMMA). SAMPLE POPULATION: 35 pelvises obtained from canine cadavers. PROCEDURE: Each pelvis was sectioned longitudinally. Within each pair of hemipelvises, one 4.0-mm cancellous screw was placed in the sacroiliac (SI) region and another in the iliac body. Similar regions on the contralateral-matched hemipelvis were assigned 1 of 3 augmentation techniques (CPC-augmented 4.0-mm cancellous screws, PMMA-augmented 4.0-mm cancellous screws, and CPC-augmented 3.5-mm cortical screws). Pullout force was compared between matched screws and between treatment groups prior to examination of cross sections for evaluation of cement filling and noncortical bone-to-cortical bone ratio. RESULTS: CPC and PMMA augmentation significantly increased pullout force of 4.0-mm screws inserted in the SI region by 19.5% and 33.2%, respectively, and CPC augmentation significantly increased pullout force of 4.0-mm cancellous screws inserted in the iliac body by 21.2%. There was no difference in the mean percentage augmentation between treatment groups at either location. Cement filling was superior in noncortical bone, compared with filling for cortical bone. Noncortical bone-to-cortical bone ratio was significantly greater in the sacrum (6.1:1) than the ilium (1.3:1). CONCLUSIONS AND CLINICAL RELEVANCE: CPC and PMMA improve the ex vivo holding strength of 4.0-mm cancellous screws in the SI and iliac body regions and SI region, respectively. Cement augmentation may be more effective in areas with greater noncortical bone-to-cortical bone ratios.

Absorptiometry, Photon↗
PubMed2004

Scintigraphic abnormalities of the pelvic region in horses examined because of lameness or poor performance: 128 cases (1993-2000).

OBJECTIVE: To identify scintigraphic abnormalities in the pelvic region of horses examined because of hind limb lameness or poor performance and determine the clinical relevance of areas of abnormal radiopharmaceutical uptake (ARU) in these horses. DESIGN: Retrospective study. ANIMALS: 128 horses. PROCEDURE: Medical records were reviewed, and information on signalment, history, admitting complaints, physical examination findings, and results of lameness examinations was recorded. Clinical relevance of areas of ARU was determined by comparison with results of other diagnostic tests. For horses with clinically relevant areas of ARU, follow-up information was obtained through telephone interviews with owners and trainers and analysis of race records. RESULTS: Areas of ARU were identified in the tuber coxae (25 horses), ischiatic tuber (9), hip joint (10), third trochanter (10), ilium (5), sacral tuber region (22), greater trochanter (1), cranial femoral cortex (1), skeletal muscle surrounding the pelvis (34), or multiple areas (11). In 44 horses, areas of ARU were associated with the primary cause of lameness; in 51, areas of ARU were not associated with the primary cause of lameness; and in 33, the primary cause of lameness was not determined. Thirty-six of the 44 horses with clinically relevant areas of ARU were available for follow-up; 15 (42%) had a good outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that pelvic scintigraphy may be useful in identifying abnormalities in horses with hind limb lameness or poor performance.

Animals↗
PubMed2006

Use of multigeneration-family molecular dog leukocyte antigen typing to select a hematopoietic cell transplant donor for a dog with T-cell lymphoma.

CASE DESCRIPTION: A 7-year-old Golden Retriever was examined because of anorexia, lethargy, vomiting, and gradual weight loss. CLINICAL FINDINGS: Splenomegaly, pancytopenia, high serum calcium concentration, and high alkaline phosphatase activity were detected. Magnetic resonance imaging revealed an enlarged mesenteric lymph node and increased signals from the bone marrow of the ilium and vertebral bodies. Histologic examination and immunophenotyping of biopsy specimens confirmed a stage V (b) T-cell malignant lymphoma. TREATMENT AND OUTCOME: Clinical remission was attained by use of 2 chemotherapy cycles, followed by an allogeneic hematopoietic cell transplant performed at 18 weeks after diagnosis. A donor was identified by molecular dog leukocyte antigen typing methods. The patient was conditioned with 2 fractions of 4 Gy total body irradiation delivered 3 hours apart at 7 cGy/min, followed by an IV infusion of recombinant canine granulocyte colony-stimulating factor mobilized leukapheresis product and postgrafting immunosuppression with cyclosporine. Chimerism analyses revealed full donor engraftment that has been maintained for at least 58 weeks after transplant. Remission has been confirmed by normal results of serum thymidine kinase assays and the absence of peripheral blood clonal T-cell receptor gene rearrangements. CLINICAL RELEVANCE: Systemic chemotherapy induces remissions; however, most dogs succumb to disease recurrence because of multidrug resistance. Outcome of allogeneic hematopoietic cell transplantation in dogs can be excellent because of improved donor-recipient selection by use of molecular dog leukocyte antigen typing, compared with early attempts, and better prevention of graft versus host disease, better supportive care, and substitution of peripheral blood mononuclear cells for bone marrow.

Animals↗