A unicameral bone cyst (UBC) is a benign lesion involving the metaphyseal-diaphyseal region of long bones.Intervention has been advocated to prevent fractures, especially in the weight-bearing long bones.Minimally aggressive surgical methods in the treatment of these cysts with the intention to reduce long-term morbidity were proposed recently.The purpose of this investigation was to evaluate the different factors that influence the healing rate of a UBC treated only with cannulated screws.Between 2000 and 2015 a total of 66 children with UBC localized in humerus or femur were treated with the continuous decompression method using cannulated screws.We analyzed the impact of the age of the patient, gender, localization of the cyst, time between surgeries and the number of treatments in an attempt to predict the treatment outcome.The mean radiological follow-up in the HUMERUS group was 50.6 months, and in the FEMUR group 31.3 months.The success rate after the first and the second intervention in the HUMERUS group was 39 % and 71 %, respectively, and in the FEMUR group 71 % and 100 %, respectively.In the estimated logit model four characteristics have a statistically significant positive effect on the healing rate: greater age of the patient, male sex, localization in femur and no third surgery intervention incidence.However, when the third intervention is indicated, we suggest using a more aggressive surgical approach.

Treatment of unicameral bone cysts (UBC) in the humerus with drainage screws is scarcely reported in the literature. The aim of this retrospective study was to compare drainage screws and alternative treatment methods with respect to the number of required surgical procedures to achieve sufficient UBC healing, postoperative fractures/recurrences/complications, and radiological outcome. Medical archives of two tertiary orthopedic referral centers were screened for all patients who were treated surgically for humeral UBC in the period 1991–2015 with a histologically/cytologically confirmed diagnosis. Sex, age, all surgical procedures, fractures, complications, recurrences, and the final radiological outcome were compared between patients treated with drainage screws, elastic intramedullary nails, or curettage with optional grafting. The study included 106 operated patients with a mean age of 10.3 years, with a mean follow-up of 5.7 years. The average number of UBC-related surgical procedures in sex-matched and age-matched treatment groups was 2.7 with drainage screws, 2.8 with intramedullary nails, and 3.5 with curettage/grafting ( P =0.54). Intramedullary nails (odds ratio 0.20) and older age (odds ratio for each year 0.83) predicted a lower risk of postoperative UBC recurrence. Patients with drainage screws had the highest UBC recurrence rates and the lowest rates of changed initial treatment method. There was no difference between the treatment groups in the postoperative fracture rate, complications, or the final radiological outcome. UBC treatment in the humerus therefore requires approximately three surgical procedures, irrespective of the treatment modality chosen. Adding an elastic intramedullary nail to a humeral UBC cyst may reduce recurrence risk and prevent further fractures. Level of Evidence: Level III – therapeutic retrospective comparative study.

We describe a case of a 19-year-old young man with oligoarthritis type of juvenile idiopathic arthritis, who presented with several month duration of lower neck pain and progressive muscular weakness of all four limbs. X-rays of the cervical spine demonstrated spontaneous apophyseal joint fusion from the occipital condyle to C6 and from C7 to Th2 with marked instability between C6 and C7. Surgical intervention began with anterolateral approach to the cervical spine performing decompression, insertion of cage and anterior vertebral plate and screws, followed by posterior approach and fixation. Care was taken to restore sagittal balance. The condition was successfully operatively managed with multisegmental, both column fixation and fusion, resulting in pain cessation and resolution of myelopathy. Postoperatively, minor swallowing difficulties were noted, which ceased after three days. Patient was able to move around in a wheelchair on the sixth postoperative day. Stiff neck collar was advised for three months postoperatively with neck pain slowly decreasing in the course of first postoperative month. On the follow-up visit six months after the surgery patient exhibited no signs of spastic tetraparesis, X-rays of the cervical spine revealed solid bony fusion at single mobile segment C6-C7. He was able to gaze horizontally while sitting in a wheelchair. Signs of myelopathy with stiff neck and single movable segment raised concerns about intubation, but were successfully managed using awake fiber-optic intubation. Avoidance of tracheostomy enabled us to perform an anterolateral approach without increasing the risk of wound infection. Regarding surgical procedure, the same principles are obeyed as in management of fracture in ankylosing spondylitis or Mb. Forestrier.

Abstract:Congenital idiopathic clubfoot is a deformity typically occurring in an otherwise healthy child which occurs in 11,4 in 10.000 live births. Approximately one-half of cases present with bilateral deformity and affects boys and girls equally. Clubfoot is characterized by adduction, supination and cavus deformity of the forefoot and midfoot, varus of the heel, and a fixed plantar flexion (equinus) of the ankle. Treatment od idiopathic type of clubfoot consists of corrective manipulation and casting by the Ponseti method, where usually four to six casts are needed. Equinus is corrected with tendo Achillis tenotomy followed by foot abduction brace application.Complex type of clubfoot, which has more severe rigid deformation, is present in 6,5% of all clubfeet and is refractory to the usual corrective manipulation and casting by the Ponsetti method. Clinically, complex clubfoot is characterized as short, stubby foot, having rigid equinus, severe adduction and plantar flexion of all metatarsals, a deep crease above the heel and a transverse crease in the sole of the foot. Modified Ponsetti method for treatment of complex clubfoot consists of simultaneus correction of adduction and heel varus and subsequent cavus and rigid equinus correction. After the Achillis tendon tenotomy, modified foot abduction brace is applied, where foot is in 40° outer rotation in contrast to 70° abduction used in less rigid congenital idiopathic clubfoot. Relapse occurs in 14% and is ussually related to problems with shoe fit and patient coplience.

Abstract: Congenital idiopathic clubfoot is a deformity typically occurring in an otherwise healthy child which occurs in 11,4 in 10.000 live births. Approximately one-half of cases present with bilateral deformity and affects boys and girls equally. Clubfoot is characterized by adduction, supination and cavus deformity of the forefoot and midfoot, varus of the heel, and a fixed plantar flexion (equinus) of the ankle. Treatment od idiopathic type of clubfoot consists of corrective manipulation and casting by the Ponseti method, where usually four to six casts are needed. Equinus is corrected with tendo Achillis tenotomy followed by foot abduction brace application. Complex type of clubfoot, which has more severe rigid deformation, is present in 6,5% of all clubfeet and is refractory to the usual corrective manipulation and casting by the Ponsetti method. Clinically, complex clubfoot is characterized  as short, stubby foot,  having rigid equinus, severe adduction and plantar flexion of all metatarsals, a deep crease above the heel and a transverse crease in the sole of the foot. Modified Ponsetti method for treatment of complex clubfoot consists of simultaneus correction of adduction and heel varus and subsequent cavus and rigid equinus correction. After the Achillis tendon tenotomy, modified foot abduction brace is applied, where foot is in 40° outer rotation in contrast to 70° abduction used in less rigid congenital idiopathic clubfoot. Relapse occurs in 14% and is ussually related to problems with shoe fit and patient coplience.

To evaluate the in vitro biomechanical characteristics of patellar tendon ligaments (BTB) when stored as fresh frozen or as glycerol cryopreserved allografts.

The best established role of acetylcholinesterase (EC 3.1.1.7, AChE) is termination of neurotransmission at cholinergic synapses. However, AChE is also located at sites, where no other cholinergic components are present and there is accumulating evidence for non-cholinergic functions of this protein. In the process of skeletal muscle formation, AChE is expressed already at the stage of mononuclear myoblast, which is long before other cholinergic components can be demonstrated in this tissue. Myoblast proliferation is an essential step in muscle regeneration and is always accompanied by apoptosis. Since there are several reports demonstrating AChE participation in apoptosis one can hypothesize that early AChE expression in myoblasts reflects the development of the apoptotic apparatus in these cells. Here we tested this hypothesis by following the effect of siRNA AChE silencing on apoptotic markers and by determination of AChE level after staurosporine-induced apoptosis in cultured human myoblasts. Decreased apoptosis in siRNA AChE silenced myoblasts and increased AChE expression in staurosporine-treated myoblasts confirmed AChE involvement in apoptosis. The three AChE splice variants were differently affected by staurosporine-induced apoptosis. The hydrophobic (H) variant appeared unaffected, a tendency towards increase of tailed (T) variant was detected, however the highest, 8-fold increase was observed for readthrough (R) variant. In the light of these findings AChE appears to be a potential therapeutic target at muscle injuries including organophosphate myopathy.

Summary. Prophylactic substitution treatment and radiosynoviorthosis have a leading role in preventing irreversible haemophilic arthropathy. The aim of the study was to evaluate the effects of prophylaxis treatment and radiosynovectomy on the length of intervals between subsequent haemorrhages in haemophilic patients. Thirty‐three joints were treated with radiosynovectomy in 28 patients with bleeding disorders. 90Y colloid was used in knees and 186Re colloid for elbows, shoulders and ankles. Twenty patients were on prophylaxis. Joint X‐rays were evaluated on the Pettersson scale between 0 (normal) and 13 (severe joint destruction). During an observation period (range 6–44 months) bleeding episodes were recorded and data statistically analysed. Before radiosynovectomy, increasing intensity of the prophylaxis 10% lengthens intervals between two haemorrhages by 1% (P < 0.05). In patients with a Pettersson score higher than nine, intervals between bleedings are shorter by 73% (P < 0.05), in comparison with patients with lower Pettersson scores of 0–5. After radiosynovectomy, the length of the first non‐bleeding interval increased by 120% (to 60 days) in comparison with the intervals before the procedure (P < 0.001). But, in the following year and half, every subsequent non‐bleeding interval was 8% shorter (P < 0.1). In that period, prophylaxis shortened the non‐bleeding interval by 1.7% (P < 0.05) per 10% increase of its intensity. Radiosynovectomy is more efficient in patients with less affected joints and is less efficient in younger patients. Prophylaxis reduced time between the bleedings episodes after isotope application. Before radiosynovectomy, prophylaxis reduces the number of haemorrhages. Our findings support data previously published by Rodriguez‐Merchan et al. [J Thromb Haemost, 5 (2007) P‐W‐126].

Acetylcholinesterase (EC 3.1.1.7, AChE) is one of the components of the neuromuscular junction (NMJ). Its expression and targeting in the skeletal muscle fiber is therefore under the control of the mechanisms responsible for the formation of the highly complex structure of this synapse. Recently, it has been demonstrated that myotubes of the C2C12 mouse muscle cell line form highly differentiated pretzel-like postsynaptic accumulations of acetylcholine receptors (AChRs) in the complete absence of the nerve if they are cultured on the laminin coating. This finding questions previously stressed importance of the nerve-derived factors in NMJ synaptogenesis and therefore deserves additional testing. The aim of this paper was to test whether the reported nerve-independency can be demonstrated also in the cultured human muscle meaning that the findings on C2C12 cultures can be extrapolated also to the human muscle. In our experiments aneurally cultured human myotubes failed to form AChR clusters on its surface, no matter if they were grown on normal gelatine or laminin coating. However, when innervated by neurons extending from the rat embryonic spinal cord, human myotubes formed AChR clusters with elaborate topography but strictly on the areas contacted by the nerve. One can hypothesize that higher nerve dependency of the NMJ synaptogenesis in humans in comparison to other species reflects species-specific differences in the organization of movement. Humans have the highest "fractionation of movement" capacity which probably requests different, more nerve-controlled development of the motor system including nerve-restricted development of the neuromuscular contacts.

We determined the role of mechanical decompression in the resolution of unicameral bone cyst. A total of 69 children with unicameral bone cysts were treated either by (i) open curettage and bone grafting, (ii) steroid injection or (iii) cannulated screw insertion. During a mean follow-up of 69 months (range, 12-58), the cysts were evaluated by radiological criteria. The healing rates in the three groups were 25, 12 and 29% after the first treatment, and a further 50, 19 and 65% after the second. The study has demonstrated the advantages of the decompression technique for unicameral bone cysts over other treatment modalities studied.

Objective To analyse the early effect of colloidal Y-90 beta irradiation, as used for radiation synovectomy (RSV), on the viability of human chondrocytes in an ex-vivo model.Methods Twenty osteochondral plugs (6 mm in diameter) were procured from femoral condyles of an adult male donor and stored in normal saline at 4 C. The cartilage surfaces of 10 plugs were contaminated with colloidal Y-90 citrate corresponding to the standard knee RSV dose (185 MBq) matched for the sample size (430 kBq). The remaining 10 plugs served as controls. At days 1, 2, 3, 6 and 13, two osteochondral plugs from each group were stained for viability with live/dead probes and scanned under a confocal laser microscope. The ratios of viable (green channel) and non-viable (red channel)pixels were acquired in four cartilage depth regions and statistically analysed with a regression model.Results The irradiation did not significantly alter the viable/non-viable pixel ratio during the first 2 days, but longer exposures led to a significant and time progressive reduction from 8.7% (day 3) to 12.5% (day 13). The ratio was less affected deeper in the cartilage, where it increased about 1 % for every 100 pm from the surface.Conclusions Surface exposure of human cadaveric cartilage to a therapeutic dose of colloidal Y-90 decreased chondrocyte viability, expressed as the viable/non-viable pixel ratio, in the early post-irradiation period. The findings established in the ex-vivo simulation may reflect the changes in knee cartilage occurring after RSV therapy.

Very limited data ore available in the literature on the doses of unwanted radiation that patients receive following treatment with radiosynoviorthesis (RSO). Objective: The aim of this stud), was to assess the radiation exposure after RSO with Re-186 colloid in hemophiliacs. Methods: This study involved 12 hemophiliacs who were treated for hemophilic joint disease with 14 RSOs by using Re-186 colloid. Whole-body scintigrams were performed 1, 6, and 24 hours and 3 and 7 days after RSO. Measurements, using a whole-body counter, were done immiediately after scintigraphy, with the treated joint protected with a lead shield. The cumulative activity of Re-186 in the body and in the lymph nodes was calculated. The distribution of Re-186 in the body was determined by using the values for small colloids as proposed by the International Commission on Radiological Protection (ICRP) Publication 53. The computer code, OLINDA/EXM (Vanderbilt University, Nashville, TN), was used for the calculation of the internal dose. A constant distance of I in between the ankle joint and body organs, and of 0.33 m between the elbow or shoulder joint and body organs, was used to calculate the contribution of gamma radiation to the effective radiation dose. Results: The mean effective dose received by hemophiliacs after RSO with Re-186 colloid was 28 +/- 9 mu Sv/MBq of the activity injected into the Joint. The patients received 0.8-3.7 mSv (1.9 +/- 0.8 mSv) owing to the leakage of Re-186 from the treated joint and its retention in the body. The highest doses were established in the spleen (26.0 +/- 10.7 rnGy), the liver (17.6 +/- 7.2 mGy), and red marrow (3.0 +/- 0.8 mGy). The contribution of gamma radiation to the effective (lose was less than 0.1 mSv in RSO of the ankle, 0.4 mSv in the elbow, and 0.6 mSv in the shoulder-joint treatment. The activity of Re-186 in the regional lymph nodes was noted in 4 of the 14 treatments. In these cases, the estimated average dose received by individual lymph nodes was 14.7 +/- 1.9 Gy. Conclusions: RSO with Re-186 colloid is a safe treatment method. The effective dose received by patients after RSO by using Re-186 colloid is low, as are the radiation doses to the most exposed organs. If Re-186 is retained in the regional lymph nodes, the lymph node radiation dose would be high.

UNLABELLED:Radiosynoviorthesis is a well-accepted method for the treatment of recurrent hemarthrosis in hemophilic patients.OBJECTIVES:The aims of our study were to evaluate the effectiveness of radiosynoviorthesis in patients suffering from hemophilic hemarthrosis, to determine the effect of treatment on antihemophilic factor consumption, and to assess the patient's satisfaction with radiosynoviorthesis.METHODS:Between 2001 and 2003, 26 radiosynoviortheses were done in 21 hemophilic patients; in 4 patients the treatment was repeated, and in 1 patient two joints were treated. 90Y colloid was used for the knee joint, and 186Re colloid was used for ankle, shoulder, and elbow radiosynoviorthesis.RESULTS:The bleeding frequency decreased by at least 50% in 53% of patients in the year after radiosynoviorthesis, as compared to the year prior to the therapy. Considering only those patients who had at least 12 bleedings into the treated joints in the year preceding the therapy, the bleeding frequency decreased by at least 50% in 62% of these patients. In this group, the consumption of the antihemophilic factor was notably reduced (on average, by 25,800 I.U./year). All patients reported that the treated joint was much better or better than before the radiosynoviorthesis.CONCLUSION:Radiosynoviorthesis is an effective method for the treatment of hemophilic hemarthrosis, particularly in patients with frequent intra-articular bleedings. The antihemophilic factor consumption was markedly reduced only in patients with frequent joint bleeding. Radiosynoviorthesis is well accepted by patients suffering from hemophilic hemarthrosis.

The subject of this article is the state of a benign bone disease. The principle aim of this study is the construction of a statistical model for estimating the otherwise unobservable variable for the state of the disease. The distribution of intensity of X-ray images of the affected part and the healthy part of the bone are evaluated. Quantiles of both distributions are used in the estimation of a multinomial logit model by which the variable for the state of the disease is quantified.