A single-drain method is effective, reduces hospitalization times and the cost of treatment in patients who undergo lobectomy.

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The aim of this study was to analyse the long-term results of surgical en bloc resection and replacement with non-vascularised, autologous fibular graft for the treatment of large benign humeral lesions without fixation. We retrospectively reviewed data of seven females and 13 males with unilateral benign lesions where steroid injection, curettage and bone grafting or pathological fracture failed to restore integrity. Subperiosteal, en bloc resection of the cystic lesion with a margin of the normal bone was performed. The average age of the patients at the time of operation was 11.8 years (range 4-28 years). All patients were skeletally mature at last follow-up. Aneurysmal bone cysts were histologically identified in seven cases, solitary cysts in 11 and fibrous dysplasia in two cases. No recurrence of the pathology, pain, graft fracture or limitation in range of motion was noted. In three patients in whom the cyst was adjacent to the proximal growth plate of the humerus, there was shortening of the bone at the last follow-up examination measuring 2 cm, 4.5 cm and 6 cm, respectively. Two cases had a valgus deformity of 10° and 15°, respectively, which was evident radiographically at the time of last follow-up. The results of en bloc resection with non-vascularised, autologous fibular graft for the treatment of large benign humeral lesions without fixation are encouraging. The risk of associated complications is low. In our opinion this should be the method of choice in the treatment of large, multi-chamber benign bone lesions of the humerus which fail more "conservative" treatment.

A massive accumulation of inflammatory cells in synovial tissues is a major pathological feature of rheumatoid arthritis (RA). Neutrophiles dominate synovial fluid while rheumatoid synovium is infiltrated with mononuclear cells. Mechanisms regulating influx of particular subpopulations of leukocytes into articular cavity and synovium compartment are not completely defined. An increasing amount of data supports a crucial role of a C-C chemokine RANTES in the RA pathogenesis. Our objective is to evaluate chemotactic activity for neutrophils (NCA), lymphocytes (LCA), and monocytes (MoCA) in SFs obtained from patients with RA and osteoarthritis (OA). We also aimed to characterise the relation between chemotactic activity, RANTES, and percentage distribution of leukocytes in SF. SFs from 11 patients with RA and 6 with OA were included in the study. Modified microchamber Boyden method was employed to assess chemotactic activity. Cytological and biochemical analysis of SF was performed. RANTES was measured with ELISA. Rheumatoid SFs were rich in cells with predominance of neutrophiles while osteoarthritic fluids were lymphocytic. RA SFs were also characterised by increased lactoferrin level. Both NCA and LCA were higher in SF from patients with RA (62 ± 12 and 24 ± 6 cells/HPF, resp) as compared to patients with OA (23 ± 6; P < .05 and 6 ± 2 cells/HPF; P < 0.05). The chemoattractive effect of RA SF was more pronounced on neutrophiles than on lymphocytes. RA SF expressed high RANTES levels (145 ± 36 pg/mL), while OA SF was characterised by only trace amount of this chemokine (2 ± 1 pg/mL). We found positive correlation of RANTES with chemotactic activity for mononuclear cells (LCA+MoCA; R = 0.61; P < .05). Surprisingly, RANTES correlated also positively with neutrophiles number (R = 0.77; P < 0.001). Rheumatoid SF possesses strong chemotactic potency for leukocytes. RANTES is overexpressed in RA SF and is a potential mediator influencing intensity and composition of cellular infiltration in joints affected with inflammatory arthritis.