Intra-Articular Giant Synovial Osteochondroma: Case Reports of the Ankle and Knee Joint

Two cases of giant intra-articular osteochondromas (knee and ankle joint) are reported; pathologically they are rare representations of synovial chondromatosis. A 17-year-old man presented with a tumorous mass which had been localized in his left ankle for many years, increasing in volume during the last months. The lesion was removed by posteromedial ankle arthrotomy. The second case was observed in a 39-year-old woman with a slow-growing mass in her right knee joint. The lesion was removed from the Hoffa fat pad by open anteromedial arthrotomy

A Systematic Review of Music Therapy Practice and Outcomes with Acute Adult Psychiatric In-Patients

PMCID: PMC3732280This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Primary skin fibroblasts as a model of Parkinson's disease

Parkinson's disease is the second most frequent neurodegenerative disorder. While most cases occur sporadic mutations in a growing number of genes including Parkin (PARK2) and PINK1 (PARK6) have been associated with the disease. Different animal models and cell models like patient skin fibroblasts and recombinant cell lines can be used as model systems for Parkinson's disease. Skin fibroblasts present a system with defined mutations and the cumulative cellular damage of the patients. PINK1 and Parkin genes show relevant expression levels in human fibroblasts and since both genes participate in stress response pathways, we believe fibroblasts advantageous in order to assess, e.g. the effect of stressors. Furthermore, since a bioenergetic deficit underlies early stage Parkinson's disease, while atrophy underlies later stages, the use of primary cells seems preferable over the use of tumor cell lines. The new option to use fibroblast-derived induced pluripotent stem cells redifferentiated into dopaminergic neurons is an additional benefit. However, the use of fibroblast has also some drawbacks. We have investigated PARK6 fibroblasts and they mirror closely the respiratory alterations, the expression profiles, the mitochondrial dynamics pathology and the vulnerability to proteasomal stress that has been documented in other model systems. Fibroblasts from patients with PARK2, PARK6, idiopathic Parkinson's disease, Alzheimer's disease, and spinocerebellar ataxia type 2 demonstrated a distinct and unique mRNA expression pattern of key genes in neurodegeneration. Thus, primary skin fibroblasts are a useful Parkinson's disease model, able to serve as a complement to animal mutants, transformed cell lines and patient tissues

Common and distinct neural effects of risperidone and olanzapine during procedural learning in schizophrenia: A randomised longitudinal fMRI study

© 2015 The Author(s). Rationale: Most cognitive domains show only minimal improvement following typical or atypical antipsychotic treatments in schizophrenia, and some may even worsen. One domain that may worsen is procedural learning, an implicit memory function relying mainly on the integrity of the fronto-striatal system. Objectives: We investigated whether switching to atypical antipsychotics would improve procedural learning and task-related neural activation in patients on typical antipsychotics. Furthermore, we explored the differential effects of the atypical antipsychotics risperidone and olanzapine. Methods: Thirty schizophrenia patients underwent functional magnetic resonance imaging during a 5-min procedural (sequence) learning task on two occasions: at baseline and 7-8 weeks later. Of 30 patients, 10 remained on typical antipsychotics, and 20 were switched randomly in equal numbers to receive either olanzapine (10-20 mg) or risperidone (4-8 mg) for 7-8 weeks. Results: At baseline, patients (all on typical antipsychotics) showed no procedural learning. At follow-up, patients who remained on typical antipsychotics continued to show a lack of procedural learning, whereas those switched to atypical antipsychotics displayed significant procedural learning (p = 0.001) and increased activation in the superior-middle frontal gyrus, anterior cingulate and striatum (cluster-corrected p < 0.05). These neural effects were present as a linear increase over five successive 30-s blocks of sequenced trials. A switch to either risperidone or olanzapine resulted in comparable performance but with both overlapping and distinct task-related activations. Conclusions: Atypical antipsychotics restore procedural learning deficits and associated neural activity in schizophrenia. Furthermore, different atypical antipsychotics produce idiosyncratic task-related neural activations, and this specificity may contribute to their differential long-term clinical profiles.Alexander von Humboldt Foundation; Biomedical Research Centre for Mental Health at the Institute of Psychiatry, King’s College London; South London and Maudsley NHS Foundation Trus

Tibiotalare Arthrodese bei angeborener Fibulaaplasie

Das Problem: 10-jähriger Patient mit angeborenen Fibulaaplasien beidseits. Auf der linken Seite extreme Valgusfehlstellung des dreistrahligen Fußes im oberen Sprunggelenk mit schmerzhaften Funktionsstörungen beim Stehen und Gehen, die mit orthopädietechnischen Maßnahmen nicht mehr befriedigend beseitigt werden konnten und zu verschiedenen therapeutischen Überlegungen, wie Amputation des Fußes, supramalleoläre Umstellungsosteotomie und tibiotalare Arthrodese, Anlass gaben. Die Lösung: Tibiotalare korrigierende Arthrodese mit einem sog. Minifixateur unter Erhaltung der distalen Epiphysenscheibe der Tibia. Operationstechnik: Erste Inzision auf der Medialseite zur Darstellung der Beugesehnen und des Gefäß-Nerven-Bündels unter Schonung des Nervus suralis und der Vena saphena parva. Freilegung des Innenknöchels nach Durchtrennung seiner Band- und Kapselverbindungen sowie Lokalisation des oberen Sprunggelenkspalts. Längsschnitt auf der Lateralseite des oberen Sprunggelenks. Z-förmige Verlängerung der einzig angelegten Peronealsehne. Eröffnung des oberen Sprunggelenks auf der Lateral- und Ventralseite. Resektion der Gelenkflächen des Talus und der distalen Tibia entsprechend einer Operationsskizze, nach der eine achsengerechte Unterstellung des Rückfußes unter die Tibialängsachse in Rechtwinkelstellung erreicht wird. Einbringen eines Kirschner-Drahts von der Fußsohle in die Tibia zur temporären Fixation der erreichten Korrektur. Anlegen des sog. Minifixateurs: Ein gewindetragender Kirschner- Draht wird durch die Synostose, ein zweiter durch die Epiphyse und ein dritter durch das proximale Tibiadrittel gebohrt. Nach Montage des Fixateurrahmens Kompression der Resektionsflächen und Distraktion zwischen dem proximalen und mittleren Kirschner-Draht. Ergebnis: Im Alter von 16 Jahren trägt der Patient einen Innenschuh in normalen Konfektionsschuhen; er ist schmerzfrei und nimmt an allen Aktivitäten des Alltags teil. Das Längenwachstum der Tibia ist nicht beeinträchtigt worde

Cement Spacer Formed in a 3D-Printed Mold for Endoprosthetic Reconstruction of an Infected Sarcomatous Radius: A Case Report

CASE The ulcerated recurrent clear cell sarcoma of the forearm with bony invasion of the radius needed an uncontaminated resection and control of infection. A mold was printed based on CT-reconstructed 3D models of the patient's anatomy to create an antibiotic-loaded cement spacer as endoprosthetic replacement used in combination with soft-tissue reconstruction and systemic antibiotics. CONCLUSION This then undescribed novel technique allowed for fast local recovery of the patient's hand function and return to work. In selected cases, such an anatomically formed spacer may be preferred for faster functional recovery and longer intervals before definitive reconstruction is possible

Osteofibrous Dysplasia with Rhabdoid Elements in a 38-Year-Old Man with Spontaneous Regression Over Five Years: A Case Report

CASE: A 38-year-old man presented with multifocal, partially confluent osteolytic lesions in the proximal dia-meta-epiphyseal region of the proximal aspect of the left tibia, which had been found incidentally when a radiograph was made after a rotational knee injury. When the results of a percutaneous core needle biopsy proved inconclusive, an open biopsy was performed. Osteofibrous dysplasia (OFD) with scattered groups of plump cells with a rhabdoid phenotype, shown to express both vimentin and pan-cytokeratin, was found. Because the lesion was an incidental finding, we decided to proceed with observation. Three months after the open biopsy, imaging showed marked regression of the lesion; there was nearly complete normalization 5 years later. CONCLUSION: To our knowledge, there has been only 1 prior reported case with these pathologic features, and there have been no reports of complete spontaneous regression in an adult patient with OFD. Treatment recommendations for OFD and for OFD-like adamantinoma range from observation to aggressive resection