We investigated the lymphocyte-mediated immune response to polymethylmethacrylate bone cement in 26 patients who had revision surgery for aseptic loosening of cemented total hip arthroplasties, at a mean time ofseven years after the first replacement. We studied eight patients with cemented total hip arthroplasties which were not loose as controls. Patch tests to polymethylmethacrylate bone cement were positive in 13 patients with loosening, and these patients had higher lymphoblast transformation values against polymethylmethacrylate bone cement patients with a negative skin reaction (p < 0.01) or those in the control group (p < 0.001). Specific monoclonal antibodies were used to assess the percentage of certain cells of the immune system according to their cluster of differentiation (CD). There was a higher number of total I and B lymphocytes (CD2 and CD22) and interleukin-2 receptor-positive lymphocytes (activated cells, CD25) in patients with loose prostheses. More CD25 lymphocytes were found in patients with positive patch tests. The activation of the lymphocyte-mediated immune response was not related to the presence or absence of aggressive granulomatous lesions at the cement-bone interface.

A series of 44 patients with complete section of the ulnar nerve was reviewed on average 2 years after secondary repair. The procedures applied were fascicular grafting in 33 cases, epineural suture in 7, and suture in 4. Useful ulnar motor function was restored in 22 cases of fascicular grafting, in all 4 of fascicular suture and in 3 of epineural suture. Sensibility recovered in 23 patients operated on by fascicular grafts and in 10 of 11 treated by epineural or fascicular suture. Cases with unsatisfactory results had other associated severe lesions, i.e., median nerve section, vascular damage or tendon injuries. Early repair of clean-cut nerve sections by fascicular or epineural suture gives a good chance for recovery. Grafting should be performed within 3 months and no later than 1 year after the injury.

The outcome of 53 patients operated on either for posttraumatic ulnar neuropathy (PUN) or non-traumatic cubital tunnel syndrome (CTS) was reviewed after 3 years follow-up. Results were analyzed and compared considering the surgical technique used (neurolysis versus anterior transposition or combined) and a variety of clinical features that could influence outcome after nerve release. In the whole series, excellent outcome was obtained in 39 patients (73%). No major differences were found with the different surgical procedures. Slightly better results, but no statistically significant, were found in cases with CTS. As to clinical parameters, patients with CTS had a higher mean age, a shorter duration of symptoms and most were men. The presence of symptoms for more than one year before operation significantly diminished the chance of satisfactory recovery in cases with CTS, but not in those with PUN. For both CTS- and PUN-cases with symptoms for more than one year, neurolysis plus anterior transposition was the more useful technique. Our study shows that CTS and PUN differ to a certain extent in their clinical profile, electrophysiological findings and response to different surgical approaches and hence can be considered as two different clinical entities.

No abstract

The statistical correlation between three different radiological methods (conventional radiography, computed tomography and angiography) and tumor necrosis (TN) of the resected specimen have been studied in a series of 31 patients diagnosed with osteosarcoma (OS). They were treated with a multidisciplinary approach including intraarterial and intravenous chemotherapy followed by limb salvage procedures, plus intraoperative radiotherapy and adjuvant chemotherapy. A clear statistical correlation has been obtained between TN and angiography (p = 0.02) and between TN and two specific radiological signs: "tumoral stain and neovascularity" (p = 0.02) and "peritumoral fat planes" (p = 0.05). Conventional radiography, computed tomography and other radiological signs studied (nutrient vessel, soft tissue mass and central peripheral calcifications) did not show any significant correlation with TN. These results seem to suggest that angiography is a method to evaluate TN preoperatively and also to define the efficacy of neoadjuvant chemotherapy in OS.