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Nm23 protein expression was analyzed by immunohistochemical staining using formalin-fixed, paraffin-embedded sections from 39 cases with osteosarcomas and compared with the histologic findings and early metastasis for the purpose of detecting nm23 expression in osteosarcoma and elucidating the clinical significance of its expression. Immunoreactivity of nm23 protein was detected in 48.7% of the total cases. There was no statistical difference between nm23 expression and early metastasis, but there was a trend for cases with nm23 expression to progress to early metastasis within 1 year after operation. The role of nm23 as a tumor metastasis suppressor in osteosarcomas appeared less prominent.

The injection of bone cement by minimally invasive techniques for the treatment of vertebral body fractures or for stabilization of an osteoporotic vertebral body is regarded as promising in spinal surgery. The purpose of this study was to develop a novel injectable bioactive bone cement to address such concerns. The cement was composed mainly of strontium-containing hydroxyapatite (Sr-HA) filler and Bisphenol A Diglycidylether Dimethacrylate (D-GMA) resin. The Sr-HA filler was prepared by precipitation and calcination, then analyzed with Fourier transform infrared (FTIR) spectra and X-ray diffraction (XRD) patterns. Samples of strontium-containing hydroxyapatite cement (SrHAC) were formed by a combination of powder filler and resin matrix, with the setting time and peak temperature recorded. Cell relative growth rate (RGR), Tetrazolium bromide (MTT), and haemolysis tests were used to detect initial in vitro biocompatibility of the new cement. In vitro spinal biomechanical testing and morphological observation after bone cement injection were performed on pig spines. Results indicate that the setting time and peak temperature of the cement was 15 min and 55 degrees C, respectively. Cytotoxicity of the cement was class 1 (no cytotoxicity) and haemolysis was 1% (no haemolysis). Stiffness after cement injection and fatigue loading were 112% and 95% of the intact bone, respectively, which is similar to that of natural bone. Radiopacity of SrHAC allowed easy radiographic imaging. The use of SrHAC cement is, thus, promising in spinal surgery., (Copyright 2000 John Wiley & Sons, Inc.)

Posterior dislocation is an uncommon complication of total knee arthroplasty (TKA) using a posterior stabilized total knee prosthesis, and it usually results from flexion instability. Acute posterior dislocation of a posterior stabilized prosthesis complicated by compartment syndrome of the leg has not previously been reported in the literature. We report a 62-year-old woman with posterior dislocation of her posterior stabilized TKA when her knee was in extension. It was further complicated by compartment syndrome with severe muscle necrosis. The diagnosis of compartment syndrome was delayed, partly because of continuous epidural anesthesia that completely abolished the pain and partly because of the low index of suspicion, as compartment syndrome is not well recognized as a possible complication of TKA. This case report strongly emphasizes that continuous epidural anesthesia is contraindicated in the case of complicated TKA because important clinical cues to neurovascular complications could be masked.

The posterior slope of tibial plateau in 25 pairs of Chinese cadaveric tibia was studied. A digital photograph of the lateral profile of each cadaveric tibia was taken, and the posterior slope angles of medial and lateral plateau relative to the anterior tibial cortex were measured. The posterior slope of the medial plateau was 14.8 degrees, and the posterior slope of the lateral plateau was 11.8 degrees. Lateral radiographs of each cadaveric tibia were taken, and the posterior tibial slope angles relative to simulated extramedullary and intramedullary alignment were determined. With radiographic measurement, the posterior slope was 11.5 degrees using intramedullary method, and it was 14.7 degrees using extramedullary method. The posterior slopes increased with the presence of degenerative changes.

The results of total hip arthroplasty in a group of patients with ankylosing spondylitis are described. Ninety-five arthroplasties were performed in 56 men and 2 women whose average age at operation was 38.9 years (standard deviation [SD], 11.6; range, 19.2-78.8). They were followed for an average of 135.4 months (SD, 81.6; range, 24.4-331.2). We encountered 4 deep infections necessitating the removal of prostheses. Two of 3 dislocations were anterior dislocations. Nineteen arthroplasties were revised at an average of 162.0 months (SD, 49.6; range, 55.1-250.5) after the primary surgery; 9 of them had only the acetabular component revised because of aseptic loosening. Hyperextension of the hips is a common phenomenon that can lead to surgical error and predispose the prosthesis to anterior dislocation.

Objective: To examine the applicability and outcome of parent management training in a group of Chinese children referred for aggressive and defiant behaviors., Method: Twenty-five children (aged 4-10 years) were assigned to a standardized 8 to 12 sessions of parent management training. Trained child and adolescent psychiatric nurses conducted the treatment. Measures taken at pretreatment, posttreatment, and 4-month follow-up period included the Child Behavior Checklist, direct observation of parent-child interactions, and a parent perception inventory., Results: Significant therapeutic gains occurred in parent-child interactions, externalizing behaviors, and parents' perception of their parenting behaviors. These were maintained at 4-month follow-up. Fifty-two percent of cases improved to a level below clinical cutoffs. Poor parent-child interactions had stronger correlation with externalizing disturbances than internalizing disturbances. The changes in parent-child interactions had low correlation with the changes in the symptom profiles., Conclusions: The data provide preliminary evidence for the efficacy of parent management training for Chinese children with conduct problems. The rationale for its success and modifications to improve its cultural sensitivity are discussed.

Objectives: To detect the nm23 expression in osteosarcoma, analyze the correlation between nm23 expression and early metastasis and to study the relation between nm23 expression with tumor differentiation and cell proliferation, as defined by Ki-67 labeling., Methods: nm23 oncoprotein expression was measured by immunohistochemical staining using formalin fixed, paraffin embedded sections of 39 surgically resected osteosarcomas and was compared with Ki-67 expression, histological findings and early metastasis. In each sample, the grading of immunoreactivity was recorded as 0, 1+, 2+ according to the percentage of nm23 and Ki-67 labeling cells respectively., Results: The cases with more than 25% positive immunoreactivity of nm23 protein were detected in 48.7% of the total cases. There was no statistical difference between nm23 expression and early metastasis, but the cases with nm23 expression appeared to have a trend to get early metastasis. nm23 expression was significantly correlated with Ki-67 expression, which was associated with differentiation of the tumor cells., Conclusion: The role of nm23 as a tumor metastasis suppressor in osteosarcoma is less prominent. Both nm23 and Ki-67 may help predict the possibility of early metastasis in human osteosarcomas.

A prospective study was made of 1500 elderly patients who suffered from acute hip fractures from 1986 to 1990. There were 36 per cent more fractures in the 6 colder months from November to April than in the rest of the year (P < 0.001). A strong correlation between the monthly adjusted fracture rate and the average lowest ambient temperature was also observed (P < 0.001). The fractures occurred in the older and less active patients during the 6 colder months. More importantly, they needed to wait longer for the operation during this 'high' season. This might be responsible for the higher medical complication rate after the operation. Better health care planning to help with the increased patient load in the 'high' season is essential to reduce the waiting time for the operation and the postoperative medical complication rate.

Study Design: The design for this article is a case report., Objectives: Reported is the case of a patient with Scheuermann's disease who experienced spastic paraparesis caused by multilevel disc herniations and intraspinal meningeal cyst occurring together., Summary of Background Data: Although Scheuermann's disease is associated with disc degeneration and calcification, multilevel disc herniations causing neurologic deficit is exceedingly rare., Methods: A patient diagnosed with Scheuermann's disease was evaluated by laboratory tests and radiographs because of paresthesin in bilateral lower extremities., Results: Evaluation revealed a "cyst" that was separated from the proper subarachnoid space and a disc herniation., Conclusions: Intraspinal cyst and multilevel disc herniations could coexist in Scheuermann's disease. Both could contribute to cord compression. Drainage of the cyst, anterior decompression of the disc herniations, and interbody fusion to stabilize the diseased segments produced good results after 2 years.

Experience in treating 80 subcapital femoral neck fractures by AO/ASIF cancellous screws is reported. Immediate full-weight bearing was allowed routinely. The mean follow-up was 28 months. Non-union occurred in 2% and late segmental collapse in 12% of patients with undisplaced fractures. Non-union occurred in 16.7% and late segmental collapse in 30% of patients for displaced fractures. Regression of screws occurred in 30% of patients, all of which were detected within the first month after the operation. It was associated with a significantly higher risk of non-union and late segmental collapse for both undisplaced (P < 0.01) and displaced (P < 0.001) fractures.

Aims: To investigate the effects of fixation on the immunohistochemical demonstration of c-erbB-2 oncoprotein using paraffin wax and cryostat sections; to compare c-erbB-2 expression in non-neoplastic and neoplastic gastric tissues., Methods: Adjacent blocks of tumour and non-neoplastic tissue from four gastrectomy specimens were put into a panel of 10 fixatives including acetone, B5, Bouin's fluid, Carnoy's fluid, buffered formalin, formol dichromate, zinc formalin, 4% paraformaldehyde, periodate-lysine-paraformaldehyde (PLP) and periodate-lysine-paraformaldehyde-dichromate (PLPD) before embedding in paraffin wax for sectioning. Similar tissue blocks were snap frozen and cryostat sections were postfixed in these fixatives, either alone or in combination, before immunostaining., Results: In paraffin wax embedded sections the best fixative was PLP, and in frozen tissues the best results were obtained after fixation of cryostat sections in buffered formalin followed by cold methanol and acetone. Applying these fixatives to samples from a further 16 gastrectomy specimens, strong membrane staining of c-erbB-2 protein was found in the tumour in eight of 16 cases (50%) using paraffin wax sections, and staining was stronger in the better differentiated carcinomas. For frozen tissues, positive membrane staining was found in all gastric adenocarcinomas, but differential staining intensity associated with tumour differentiation could not be detected., Conclusions: These results indicate that fixation and paraffin wax embedding affect the results of immunohistochemical demonstration of c-erbB-2 in gastric cancer. The choice of fixative is critical in the demonstration and evaluation of c-erbB-2 protein expression by immunohistochemistry in gastric carcinomas. Staining results also vary depending on whether frozen or paraffin wax embedded tissues are studied.

One hundred and twenty patients with acute hip fractures treated operatively were randomized into two groups. In the 'drape' group (n = 65) the operation site was covered with plastic adhesive drape after preparation. In the 'no drape' group (n = 55) the operation site was left uncovered. The two groups were otherwise matched. Swabs for culture were taken from skin adjacent to the wound before closure. The drape group had four positive wound swabs. There was only one positive wound swab for the no-drape group. There was no difference in the post-operative wound infection rates.

A prospective study was undertaken to determine the perforation rate of surgical gloves when double-gloving techniques were employed in 120 hip fracture operations. One or more perforations occurred in 30 operations (25%). In 10 operations (8.3%), perforations of both the outer and inner gloves occurred at corresponding sites. The surgeons were able to recognize the perforations during the surgery on five occasions only. Of the 64 perforations identified, 41 (64%) occurred in the left (nondominant) hands, and 42 (65.6%) occurred at the tips of thumbs and index fingers. Nearly half of the perforations (46.9%) occurred at the thumb and index finger of left (nondominant) hands. To reduce the perforation rate, further protection of the thumb and index finger of the nondominant hand of surgeons is therefore required.

Thirty-five patients with sequential fractures of both hips were studied prospectively. The second hip fractures occurred more commonly if the patients were institutionalized, if they suffered from concomitant neurologic diseases such as previous stroke or Parkinsonism, or if there was biochemical evidence of osteomalacia. Twelve patients sustained the contralateral hip fracture within 12 months of the first one. There was a significant correlation between biochemical evidence of osteomalacia and early occurrence of the second hip fracture. Although rehabilitation was difficult for such patients, it was possible with a longer period of intensive physiotherapy; only three patients were not able to walk upon discharge from the hospital after the second hip fracture.

Acute carpal tunnel syndrome caused by pseudogout occurred in a Chinese patient. The radiological findings mimicked those of synovial chondromatosis. Such radiological findings were very unusual. Diagnosis of such conditions may be difficult, since the clinical features may be confused with those of gout and infection. Surgical release is the treatment of choice.

Of 1430 patients with proximal femoral fractures admitted into Queen Mary Hospital, Hong Kong from 1985 to 1990, 146 patients (10.2 per cent) had a history of previous cerebrovascular accidents. The fracture was on the hemiplegic side in 82 percent of patients. Most patients were treated by operation. Intensive physiotherapy was given to these patients for an average of 6 weeks. The prefracture walking ability was regained or even improved upon discharge in 60.9 per cent of patients. After an average follow-up of 21 months, 31 per cent had satisfactory walking and active daily activities. There was significant correlation of the performance upon discharge from the hospital with the walking ability at the final follow-up.

We report a prospective study of 245 open digital fractures of the hand in 201 patients. Management followed clear guidelines set out in protocol. The incidence of infection (2.04%) and non-union (2.45%) was low. Proximal phalangeal fractures and comminuted fractures did worst and associated significant soft tissue injuries had a particularly deleterious effect on the outcome. A classification based on the different soft-tissue components involved is proposed. In fractures associated with simple lacerations or isolated digital nerve injury only, one can expect about 40% good results and about 25% poor results. Where extensor tendon injury or extensive skin loss are also present, there will be approximately 18% good results and 50% poor results. If there is also injury to the flexor tendon or more than one component of significant soft-tissue damage, about 80% will be poor and good results are rare.

Common acute lymphoblastic leukaemia antigen (CALLA) was first characterised in lymphoid leukaemic cells. The antigen is present in different stages of lymphoid cell differentiation as well as in subsets of myeloid cells, and further studies have also shown its presence in non-lymphoid tissues. The recent cloning and sequencing of the gene permitted deduction of its amino acid sequence which is identical with the human membrane-associated enzyme, neutral endopeptidase. Strong immunostaining for CALLA was detected in the human liver with a canalicular pattern. Immunoelectron microscopy also confirmed that the antigen was localised only in the area of the bile canaliculi. Although the function of neutral endopeptidase in the canaliculi is unknown, this antigen may prove useful in the study of biliary function and diseases.

With the aid of microwave irradiation, a modified method for rapid detection of Campylobacter has been devised. Compared with the conventional Warthin-Starry method, both staining period and concentration of the silver solution are considerably reduced but there is excellent staining and good tissue morphology.

A recombinant virus Ac373-HB was detected and purified from the transfection mixture of wild type and recombinant virus in the baculovirus expression system using a combination of limiting dilution and DNA dot-blot hybridization. This method allows for a quick and convenient way of detection and purification of recombinant virus without the need to use a plaque purification step. It is generally applicable to other expression systems besides the baculovirus system described here.

To evaluate observer variability during microcomputer-assisted planimetry, nuclear features (area, perimeter, and form factor) were studied in a case of malignant lymphoma. Tissue fixed in glutaraldehyde, embedded in plastic and sectioned at 1 micron was studied using a Zeiss Kontron IBAS 2000 image analysis system. Manual tracing of nuclear outline was performed to obtain the parameters. Both interindividual and intraindividual reproducibilities were evaluated, the former among 8 observers and the latter by the observers repeating the measurements. With the present technique, intraindividual reproducibility was high and correlation was excellent for area, perimeter and form factor measurements. A high degree of interindividual inconsistency was demonstrated for all parameters. Interindividual correlation was poor for form factor. It is concluded that poor interindividual reproducibility even when the objective method of morphometry is used may be a significant problem in tissue investigations, especially when results from different laboratories are being compared.

An improved technique for the demonstration of nucleolar organiser regions (NORs) was devised. It has the advantage that any non-specific background deposits which mimic the NOR dots formed during staining are trapped by the celloidin film. The specificity of the silver staining is also increased by the postfixation treatment of sections in an acetic acid-ethanol mixture. Moreover, it is economical because of the low silver content and small volume of the incubation solution used.