Bacterial endotoxic reactions can cause osteonecrosis in humans by disseminated intravascular coagulation. The authors first used a combination of the Shwartzman reaction and corticoid injections in rabbits to develop a new animal model of osteonecrosis. This model showed a significantly higher incidence and wider area of osteonecrosis in the femur and humerus than that found in rabbits with either Shwartzman reaction or steroid injection alone. Osteonecrosis was observed in several foci that were distributed from the diaphysis to the epiphysis in both bones. Histologically, the bone marrow cells underwent necrosis, whereas the bone trabeculae demonstrated either empty lacunae or pycnotic nuclei of osteocytes. Exogenous steroids appeared to potentiate the Shwartzman reaction and the magnitude of osteonecrosis, perhaps by increasing endothelial damage and hypercoagulability of those intraosseous and extraosseous vessels that subsequently thrombosed. This model may not only be useful in clarifying the etiology and early pathogenesis of human osteonecrosis after corticoid therapy, but also in designing Pharmaceuticals for prevention and early treatment.
Femoral heads of spontaneously hypertensive rats (SHR) were investigated histologically and radiologically in comparison with those of Wistar Kyoto (WKY) rats as a control.Incidence of osteonecrosis was much higher in SHR than WKY.In the 10wks old SHR, the necrotic lesion was first seen without reparative reaction.In the SHR older than 20wks, many necrotic lesions were seen with reparative reaction.Radiographs of SHR demonstrated coxa plana and short neck in comparison with WKY.
Abstract12 anemic and 10 non-anemic patients with rheumatoid arthritis were treated with recombinant human erythropoietin (rHuEPO) before arthroplasty. The patients received 400-800 units/kg of rHuEPO subcu-taneously once a week. Autologous blood was collected after the hemoglobin concentration was increased by 5 percent or more. All but one of the patients responded to the treatment. They were given 1-3 units of autologous blood, and underwent the operation without homologous blood transfusion. The mean duration of the treatment was 1 month. In 1 patient with severe anemia, additional transfusion with 2 units of blood was necessary during the operation. In all patients, there was a tendency for the hemoglobin response ratio to rHuEPO to correlate negatively with the initial CRP levels. The treatment did not affect the patients' clinical rheumatologic condition and there were no adverse effects. These results demonstrated that the treatment with subcutaneous rHuEPO is both effective and non-toxic and can therefore eliminate the need for homologous blood transfusion in anemic patients undergoing arthroplasty for rheumatoid arthritis.
201 hips with the Harris-Galante Porous (HGP) system and 41 hips with Hybrid system were compared both clinically and radiographically. According to the radiogram taken at follow-up, radiopaque lines around the stem, which is called “clear zones”, were frequently seen in zone 4, 10, 11 or 12. It was likely that the patients did not have thigh pain when these clear zones appeared exclusively in zone 4, 10, 11, or 12. On the other hand, however, the patients seemed to have thigh pain when the clear zones also appeared in other areas and zone 4, 10, 11, or 12. Thirty-six patients (23%) with osteoarthritis who had HGP system complained of thigh pain. In the group with Hybrid system, only two patients (6%) had thigh pain. However, this thigh pain in the HGP group had a tendancy to disappear gradually and remained in only two patients (6%). Sinking and micromovement of the stem may be one of the causes of the thigh pain.An optimal method for fixation of the femoral component has not been established. The results obtained from our short-term follow-up showed that smaller number of patients had thigh pain in the group of HGP system in comparison with previous reports. However, long-term follow-up study may be still necessary to draw some definite conclusion upon this matter.
Magnetic resonance (MR) images of 8 hips with osteonecrosis were studied to investigate the correlation between the MR signals and the histopathologic changes. The signal of T1-weighted images in the femoral head necrosis reflected the ratio of a fatty streaked structure in the medullary space. The low intensity area of T1-weighted images showed histopathologically where granulation tissue, amorphous necrotic debrice, fibrous tissue, dense trabeculae and chondrometaplastic tissue occupied the medullary space.
We report a case of malignant fibrous histiocytoma occuring in the thigh of an 18 year-old female. At first, the tumor was too large to resect completely, and we therefore used preoperative adjuvant therapy comprising irradiation (Liniac; 60Gy) and multidrug chemotherapy (MAID; combination of Doxorubicin, Ifosphamide, Dacarbazine and uroprotection by MESNA). After treatment, the tumor markedly decreased in size, 60% by volume as measured by CT, and histologically 90% necrosis was confirmed. Hemipelvectomy was performed. However, the patient could not receive further adjuvant chemotherpy because of post-operative deep infection. Six months after surgery, retroperitoneal metastases wete detected, and she died of recurrent disease twelve months later.
Abstract Background Geographic differences and background therapy have not been explored in the global VICTORIA trial, which enrolled high-risk patients with recent worsening heart failure with reduced ejection fraction (HFrEF). Methods and results Among 5050 patients enrolled in 5 pre-specified geographic regions, 34% were from Eastern Europe, 18% Western Europe, 23% Asia Pacific, 14% Latin and South America, and 11% North America (Table 1). Patients from Western Europe were older, had more atrial fibrillation, and lower glomerular filtration rates. Patients from Eastern Europe had more coronary artery disease and exhibited more advanced symptoms (∼50% New York Heart Association [NYHA] class III), whereas those from Latin and South America were less symptomatic (∼70% NYHA class II). North American patients had the largest body mass index as well as more diabetes and hypertension. Levels of NT-proBNP at randomization and MAGGIC risk scores were highest in Western European patients. Evidence-based triple medication therapy was used most frequently in Latin and South America and less frequently in North America; conversely, cardiac resynchronization therapy and implantable cardioverter defibrillators were most frequently used in North America and least frequently in Latin and South America. The overall primary composite event rate (cardiovascular death or HF hospitalization) in the placebo arm was 36.6/100 person-years over a median of 10.8 months and after adjusting for the MAGGIC score. When examined by region, these event rates were nominally highest in North America and lowest in Western Europe. Conclusion Substantial regional differences exist in characteristics and treatments among patients in this global trial of patients with HFrEF and a recent worsening event. These findings demonstrate the continuing unmet needs and opportunities for enhancing care in HFrEF. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): VICTORIA was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and Bayer AG, Wuppertal, Germany.
In 1981 a case of spontaneous sternal segment dislocation in a patient with no evidence or history of trauma was reported by Schadmore. We experienced a case similar to the one he described.The patient was a 3-year-old girl who complained of intermittent midsternal pain after her chest was accidentally hit by the head of her one-and-half-year-old friend. No abnormality was detected by roentogenogram at the orthopaedic clinic on the day of injury. Two weeks later., her father noticed that she had a chest deformity and she also exhibited tenderness at the midsernal region, but no redness or local heat were noted.Her lateral chest roentgenogram showed a dislocated first segment of the body of the sternum.At surgery, we found the superior end of the first segment of the body of the sternum. There was no fresh bleeding or reactive granulation tissue. We were able to reposition the segment easily, using a plate to fix it.No finding of osteonecrosis were found on pathological examination. Six months later, after removal of the plate good fixation of her sternal segment was achieved.
Forty-seven orthopaedic donor-patients in eight different institutions were evaluated as an early phase II open study to determine the efficacy and safety of once a week subcutaneous (SC) administration of recombinant human erythropoietin (rHuEPO) for weekly blood collection of 400ml. Of the 47 patients, 10 were excluded from efficacy evaluation for not meeting age (7) or hemoglobin (Hb) (2) criteria, or rHuEPO administration schedule (1). The remaining 37 patients, aged between 38 and 75, were divided into three groups by weekly SC dosage; 200IU/kg (12), 400IU/kg (13) and 600IU/kg (12). Weekly blood collection of 400ml began one week after an initial SC administration.The 37 patients were able to donate autologous blood of 800ml/2 wks or 1200ml/3 wks and required no homologous blood during or after operation. At the time of the first phlebotomy, Hb was significantly increased in all three SC groups. One week after the second phlebotomy, Hb was not significantly decreased in the 600 group (101±6%), while it was decreased significantly in both the 200 group (96±6%) and the 400 group (97±4%) against the preadministration level. The Hb decrease in the 400 group was smaller than that in the 200 group, and it was clinically acceptable. Compared to previous studies at two institutions, equal dosages of rHuEPO at equal frequencies appeared to be more effective with SC administration than with intravenous (IV).None of the 47 patients showed any adverse effects or abnormal laboratory data attributable to rHuEPO administration.Our results indicated that a once a week SC administration of rHuEPO at a dose level of 400IU/kg or more could improve post-phlebotomy anemia as effectively as higher frequency IV administration.
