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Leblanc J.,Health Science Center | Puloski S.,Health Science Center | Hildebrand K.,Section of Orthopedic Surgery
Journal of Medical Case Reports | Year: 2012

Introduction. Interprosthetic fractures of the humerus are rare. Revisions of total elbow arthroplasty components in these cases are difficult. We report the first case of a patient with hemophilia who underwent a revision with a tibial allograft prosthetic composite without the need for hardware augmentation. Case presentation. A 43-year-old Caucasian man with a history of hemophilia and transfusion-related human immunodeficiency virus and hepatitis B and C presented with an interprosthetic fracture of his humerus after months of pain between his total elbow and total shoulder arthroplasties. Because of the poor remaining bone stock available in his distal humerus, a revision using a barrel-staved tibial allograft prosthetic composite was performed. Our patients factor VIII level was optimized before the operation and he suffered no major long-term complications at 28 months. His only complication was an incomplete radial nerve palsy that ultimately recovered and left him with some numbness on the dorsum of his hand. Conclusion: Careful use of an allograft prosthetic composite is a very reasonable option when a patient experiences an interprosthetic fracture. We have successfully performed revision total elbow arthroplasty for a patient with hemophilia with an interprosthetic fracture using a tibial allograft and no additional fixation, which resulted in his return to full activities of daily living, minimal pain and full incorporation of the allograft to host bone. © 2012LeBlanc et al.; licensee BioMed Central Ltd. Source

Postacchini R.,Italian University of Sport and Movement | Paolino M.,University of Rome La Sapienza | Faraglia S.,Section of Orthopedic Surgery | Cinotti G.,University of Rome La Sapienza | Postacchini F.,University of Rome La Sapienza
Spine Journal | Year: 2013

Background context Although innumerable studies have analyzed the multiple aspects of osteoporotic vertebral fractures, no study has focused on the clinical features related to spine pain in patients with recent osteoporotic vertebral compression fractures (VCFs). Purpose To determine whether the assessment of pain-related behavior (P-RB) of patients with osteoporotic VCFs of recent onset may allow the fracture to be strongly suspected, or even diagnosed, at physical examination. Study design Pain-related behavior of elderly patients attending an outpatient spine clinic was evaluated on the basis of six consecutive movements made on the examining table. Patient sample Fifty-six patients complaining only of lumbar or thoracic pain. The fractured patients (FPs), representing the fracture group (FG), were the 19 who had a recent VCF, whereas the control group (CG) consisted of the remaining 37 patients. Methods Assessment of P-RB was based on six parameters: grimacing, sighing, clenching or blocking eyelids, gaping or strongly tightening the lips, need for help to take positions, and extreme difficulty to turn in the prone position. A score of 1 or a decimal was assigned to each parameter, the final score to each patient being 0 to 6. Three types of injury, acute (I), subacute (II), or chronic (III), were identified on the basis of the time elapsed from the probable occurrence of the fracture. The diagnosis of recent fracture was based on magnetic resonance images. Patients were videotaped during their movements. An examiner, unaware of the clinical history and diagnosis, gave a P-RB score to all patients and indicated whether they had to be placed in FG or CG, and also their presumable type of fracture. Subsequently, a DVD with the videotapes of all patients was given to three independent examiners, not specifically expert of spine conditions, who were asked to make the same evaluations as the first examiner. Results The mean scores for P-RB given by the first examiner were 4.6 to FG and 0.7 to CG (p<.01). He identified as FPs 89% of those who were in FG. The type of fracture was indicated correctly in 88% of patients identified as FPs. The mean scores for the three types of fracture ranged from 5.4 (Type I) to 3.3 (Type III) (p<.001). The mean scores for P-RB given by the independent examiners to FG and CG were similar to those of the first examiner. The rates of correctness in identifying the type of fracture in patients indicated as FPs varied from 87% to 80%. The mean scores assigned to the patients included in the three types of fracture ranged from 5.4 to 2.8. Conclusions Pain-related behavior evaluation of patients with osteoporotic VCF during their movements on the examining table may allow to suspect, or even diagnose, the presence of a fracture, particularly in the initial 4 to 6 weeks after the occurrence. Even orthopedic surgeons not particularly familiar with spine care may be able to suspect the injury during physical examination. © 2013 Elsevier Inc. All rights reserved. Source

Lin Y.-Y.,National Sun Yat - sen University | Jean Y.-H.,Section of Orthopedic Surgery | Lee H.-P.,National Sun Yat - sen University | Chen W.-F.,Chang Gung University | And 10 more authors.
PLoS ONE | Year: 2013

In recent years, a significant number of metabolites with potent anti-inflammatory properties have been discovered from marine organisms, and several of these compounds are now under clinical trials. In the present study, we isolated 11-epi-sinulariolide acetate (Ya-s11), a cembrane-type compound with anti-inflammatory effects, from the Formosa soft coral Sinularia querciformis. Preliminary screening revealed that Ya-s11 significantly inhibited the expression of the proinflammatory proteins induced nitric oxide synthase and cyclooxygenase-2 in lipopolysaccharide-stimulated murine macrophages. We also examined the therapeutic effects of Ya-s11 on adjuvant-induced arthritis (AIA) in female Lewis rats, which demonstrate features similar to human rheumatoid arthritis (RA). Animal experiments revealed that Ya-s11 (subcutaneously 9 mg/kg once every 2 days from day 7 to day 28 postimmunization) significantly inhibited AIA characteristics. Moreover, Ya-s11 also attenuated protein expression of cathepsin K, matrix metalloproteinases-9 (MMP-9), tartrate-resistant acid phosphatase (TRAP), and tumor necrosis factor-α (TNF-α) in ankle tissues of AIA-rats. Based on its attenuation of the expression of proinflammatory proteins and disease progression in AIA rats, the marine-derived compound Ya-s11 may serve as a useful therapeutic agent for the treatment of RA. © 2013 Lin et al. Source

Huang S.-Y.,National Sun Yat - sen University | Jean Y.-H.,Section of Orthopedic Surgery | Chen W.-F.,Chang Gung University | Sung C.-S.,Taipei Veterans General Hospital | And 5 more authors.
Behavioural Pharmacology | Year: 2011

The investigators previously found that the administration of lemnalol, a natural marine compound isolated from the Formosan soft coral Lemnalia cervicorni, produced anti-inflammatory and analgesic effects in carrageenan-injected rats. Recently, several studies have demonstrated that the development and maintenance of neuropathic pain are accompanied by releasing of proinflammatory mediators from activated glial cells in the spinal cord. In this study, we investigated the antinociceptive properties of lemnalol, a potential anti-inflammatory compound, on chronic constriction injury (CCI) in a well-established rat model of neuropathic pain. Our results demonstrated that a single intrathecal administration of lemnalol (0.05-10 μg) significantly attenuated CCI-induced thermal hyperalgesia and mechanical allodynia, 14 days postsurgery. Furthermore, immunohistofluorescence analyses showed that lemnalol (10 μg) also significantly inhibits CCI-induced upregulation of microglial and astrocytic immunohistochemical activation markers in the dorsal horn of the lumbar spinal cord. Double immunofluorescent staining demonstrated that intrathecal injection of lemnalol (10 μg) markedly inhibited spinal proinflammatory mediator tumor necrosis factor-α expression in microglial cells and astrocytes in neuropathic rats. Collectively, our results indicate that lemnalol is a potential therapeutic agent for neuropathic pain, and that further exploration of the effects of lemnalol on glial proinflammatory responses is warranted. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

De Filippo M.,University of Parma | Saba L.,University of Parma | Negrini G.,University of Parma | Silva M.,University of Parma | And 3 more authors.
Skeletal Radiology | Year: 2015

Objective: The aim of this study was to test reproducibility of the CT Pico method in a cadaveric model and to compare CT Pico measurements with a high-precision laser probe for optical scanning. Materials and methods: The glenoid surface of ten dried cadaveric scapulae (with intact surface) was measured by and high-precision laser probe for optical scanning, the latter being assumed as a reference standard. Measurements were done according to the Pico technique, using a circle-shaped region of interest (ROI) that was placed on the inferior glenoid rim. Measurements obtained using the CT Pico method (three readers) and with laser were compared to assess differences between radiological assessment and the reference standard. Each observer performed two repeated measurements from each scapulae (20 for each observer). Results: Mean differences between laser measurements and each CT reader were 18.4 % (range, −4 to 61 %) for reader 1, 12.4 % (range, −15 to 64 %) for reader 2, and 11 % (range, −14 to 58 %) for reader 3. Considering all the 60 measurements made by the three readers, 39 measurements out of 60 (65 %) were outside the range [−5 %; +5 %] while 26 measurements (43 %) are outside the range [−10 %; +10 %]. The largest differences (positive and negative) were +64 and −14 %, respectively. Intra-operator reproducibility was high in most cases (intraclass correlation coefficient (ICC) =0.93, ICC = 0.91, ICC = 0.93 and Lin’s Concordance correlation coefficient (CCC) = 0.92, CCC = 0.90, CCC = 0.92 for reader 1 to 3, respectively. However, in five cases the CT Pico measurements showed absolute differences between the first and second measurements that exceeded 10 %. Conclusions: The inter-observer variability for CT measurement of the glenoid surface using the CT Pico method was high when compared with laser, in the assessment of glenoid surface in cadaveric specimens, thus the CT Pico method is not reliable and could cause errors in the clinical management of the patient. Level of evidence Level II, Development of diagnostic criteria on consecutive patients (with universally applied reference “gold” standard) © 2015, ISS. Source

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