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PubMedDate not supplied

[Curettage of giant cell tumors with temporary implantation of bone cement].

Curettage with simultaneous bone transplantation is followed by a recurrence rate of 20-60%. In a follow-up of own cases up to 36 years after treatment recurrence was roughly 50%. In the last 10 years we changed to on other treatment procedure, namely optical controlled curettage with temporary cementation. To prevent further damage to the preexisting destabilization of the periarticular cortical bone, tumor excision is done through a small bone window, using a cold lighted mirror to achieve complete curettage. The cavity is then filled with bone cement, which is left in place for 3 months. When at that time there are no signs for tumor persistence, the cement is removed and bone reconstruction performed. An analysis of 17 cases treated this way showed a clearly smaller recurrence rate of 6%; this difference was statistically significant when applying the Kaplan-Meier test.

Adolescent↗
PubMed1989

[Digital image intensifier radiography--application in angiography, urography and bone diagnosis].

In a retrospective study, the clinical usefulness of digital image intensifier radiography was analysed. It could be demonstrated that for angiographic procedures the image quality of a 1024(2) matrix is superior to a 512(2) matrix. For digital excretory urography it could be seen that in 80 to 90% the images were at least sufficient to analyse the renal pelvis. Digital image intensifier radiography of bones was diagnostically sufficient in 76% and analysis of bone architecture was possible in 85%.

Angiography↗
PubMed1988

[Magnetic resonance tomographic results in bone changes associated with sclerosis].

We have compared the value of MRI with conventional radiography and CT in 40 predominantly sclerotic skeletal lesions. We have found that sclerosis and other changes in the bone structure can be demonstrated by MRI in much the same way as with conventional radiography and CT. Using high resolution surface coils, it is possible to demonstrate small areas of new bone formation such as periosteal new bone or the calcification within the nidus of an osteoid osteoma. MRI is particularly appropriate if it is necessary to show soft tissue changes within an area of sclerosis, which may be responsible for the new bone formation and which may be masked on radiographs and CT by the surrounding sclerosis.

Bone Diseases↗
PubMed1975

The use of tomography in the diagnosis of skeletal disorders.

Tomography has definite proven value as a technique in studying objects obscured by overlying shadows. It is an adjunct study to conventional radiographs when the necessary detail for diagnosis is lacking in the routine examination. Particularly in skeletal tumors, tomography can be helpful in disclosing lesions too small to be noticed in the routine radiograph or resolve details in question in the conventional film that are pertinent to the diagnosis. This technique has also been of great benefit in detailing the anatomic structures of the spine, temporomandibular joints and sternoclavicular articulations. It has been of particular value in the evaluation of fracture-healing or the presence of pseudarthrosis and arthritis affecting the larger joints of the body.

Adolescent↗
PubMed1996

Low grade central osteogenic sarcoma. A long-term followup of 20 patients.

Osteogenic sarcoma is a heterogeneous family of tumors that has a variable biologic behavior. Low grade central osteogenic sarcoma is an uncommon form that is characterized by a long premorbid history and is compatible with prolonged survival after treatment. Twenty cases of low grade central osteosarcoma with long-term followup (16 [2.5-48] years) were studied retrospectively. The age distribution was broad (range, 15-83 years). All tumors arose in the lower limb. The primary symptom was pain; mean duration was 44 months (range, 1-180 months). A diagnosis of low grade central osteosarcoma was made primarily for 11 patients. For 9 others, fibrous dysplasia (3), nonossifying fibroma (2), fibroma (1), chondromyxoid fibroma (1), chondrosarcoma (1), and simple bone cyst (1) were diagnosed initially. Intralesional surgery was associated with recurrence in every case. Radical margins were not associated with local recurrence. Four recurrences were higher grade and 1 was dedifferentiated. Three of 4 patients with metastases died of their disease. Five- and 10-year survival was 90% and 85%, respectively. Histology and radiology are complementary for confirming the diagnosis. Low grade central osteosarcoma seems to be controllable by surgery alone if at least wide margins are used.

Adolescent↗
PubMed1996

Osteosarcoma and Ewing's sarcoma in a retinoblastoma patient.

Retinoblastoma, though uncommon, frequently is associated with other second malignant neoplasms, especially bone sarcomas. These second neoplasms can occur in sporadic cases of retinoblastoma, though they more commonly are associated with genetic forms of the disease. This is the first known report of 2 histologically distinct bone sarcomas in a patient with retinoblastoma.

Child↗
PubMed1999

Limb salvage and outcome of osteosarcoma. The University of Muenster experience.

One hundred thirty-six patients with non-metastatic high grade osteosarcoma treated from 1978 to 1994 in one institution with a multidisciplinary approach that included intravenous neoadjuvant chemotherapy were studied to evaluate which factors influence the outcome of modern orthopaedic therapy. Anatomic location, tumor volume, surgical margins, complications, and functional outcome were analyzed. Seventy-nine patients had a limb salvage procedure, 21 had a rotationplasty, and 33 had an amputation. Limb salvage consisted of 32 endoprostheses, 39 allograft replacements, six autograft replacements, and two shortening procedures. Three patients died during preoperative chemotherapy treatment. At a mean followup of 43 months, 81 patients continue to be disease free, three are alive after local recurrence, 17 are alive after having metastatic lesions, five are alive with metastatic lesions present, and 30 patients died of their disease. Forty-seven patients had pulmonary metastatic lesions, 14 had osseous metastatic lesions, three had abdominal metastatic lesions, two had lymphatic metastatic lesions, and eight patients had skip metastatic lesions. Prognosis correlated with chemotherapy response, surgical margins, and tumor volume. The minor complication rate for limb salvage was 4% and the major complication rate was 52%. Amputations had a 6% minor complication rate and 34% major complication rate. Rotationplasties had 10% minor and 48% major complication rates. The Musculoskeletal Tumor Society functional evaluation after limb salvage showed that 23 (38%) patients had more than 75% of the maximum functional score, 34 (56%) were from 50% to 75%, and three (5%) less than 50%. Of the rotationplasties, six (67%) were functionally better than 75% and three (33%) were functionally better than from 50% to 75%. In the group of amputations, 13 (56%) were from 50% to 75%, and 10 (44%) less than 50%. The extent of preoperative necrosis, surgical margins, and tumor volume are the most important prognostic factors. The increase in limb salvage procedures and the better long term survival of patients results in a higher rate of immediate and delayed complications. Functional outcome after rotationplasty is superior to limb salvage reconstruction and amputation.

Bone Neoplasms↗
PubMed1983

Cells at risk for the production of bone tumors in radium exposed individuals: an electron microscope study.

The endosteal cells of bone from a 75-yr-old woman who had acquired radium internally, as a consequence of her previous employment as a radium dial painter, are documented here for the first time by electron microscopy. As a result of amputation for a fibrosarcoma in the region of the right knee joint, fresh samples of bone and tumor tissue from the femur were made available. A sample of bone, also obtained at amputation from an unirradiated control patient, age 65, was examined from the same site in the femur. A comparison of the bone-marrow interface from the two patients showed that, unlike the control bone where cells were seen close to bone mineral a fibrotic layer was interposed between the marrow cells and the bone mineral in the bone from the radium case. This layer varied in thickness up to 50 microns and was often acellular, although cell remnants and cells, which appeared viable, were sometimes seen within this layer. It is suggested that irradiation of those cells proliferating within, and at the edge of, this replacement fibrotic layer may be the most important in the induction of bone tumors rather than the original cells lying within the 0-10 microns range from bone mineral which has previously been supposed. The nuclear dimensions of the endosteal bone lining cells and their distance from bone mineral have been measured in the bones from the radium and control cases. These dimensions are important not only in understanding the mechanisms by which bone tumors arise but in developing models of carcinogenic risks of other alpha-particle emitting isotopes such as plutonium.

Aged↗
PubMedDate not supplied

MR imaging of lymphomas: impact on therapy.

Seventy-six patients with either Hodgkin disease or non-Hodgkin lymphoma underwent magnetic resonance (MR) imaging as part of their evaluation. In this report the unique and common MR findings of these neoplasms are reviewed in each of the major anatomic sites. Further, the impact of these findings on therapy decisions and follow-up is emphasized.

Abdominal Neoplasms↗
PubMedDate not supplied

Abdominal recurrence of osteogenic sarcoma: a case report.

PURPOSE: Nonpulmonary metastases from osteogenic sarcoma are rare. A patient had a localized osteogenic sarcoma of the left femur which recurred in the abdomen, a previously unreported metastatic site. PATIENT AND METHODS: An 18-year-old boy was treated for osteosarcoma. He had abdominal pain, vomiting, weight loss, and symptoms of intestinal obstruction at the time of relapse. RESULTS: The patient had diffuse widespread intraabdominal osteogenic sarcoma as the only site of initial recurrence. Abdominal computerized tomography revealed ascites and calcified masses on the hepatic and peritoneal surfaces. Laparoscopic visualization of the abdomen showed hemorrhagic ascites and multiple calcified tumor on the peritoneum, diaphragm, and liver. A biopsy of a representative lesion confirmed the diagnosis of osteogenic sarcoma. The patient died from progressive disease. CONCLUSION: As the initial treatment for patients with osteogenic sarcoma is intensified, the pattern of metastases may change. Unusual sites of recurrence such as in this patient may become more prevalent. A clinical presentation of an acute abdomen in a patient previously treated for osteogenic sarcoma should prompt suspicion of intraabdominal recurrence.

Abdominal Neoplasms↗
PubMedDate not supplied

Spinal canal involvement in infantile myofibromatosis: case report and review of the literature.

PURPOSE: An unusual case of infantile myofibromatosis with spinal canal involvement is reported and the literature is reviewed. PATIENT AND METHODS: A female neonate had bladder and bowel dysfunction and paresis of the lower extremities. RESULTS: Intrapelvic and paravertebral masses with extension into the spinal canal were detected by imaging studies. In addition, radiologic examination showed multiple metaphyseal radiolucent lesions of the long bones and pathologic fracture of the left femur. The histopathologic diagnosis of the paravertebral tumor and bone lesions was infantile myofibromatosis. Surgical resection of the paravertebral and intrapelvic masses was performed to improve her neurologic impairments. Paresis of the lower limbs gradually improved, whereas bladder and bowel dysfunction remained unchanged. CONCLUSIONS: Only six cases of infantile myofibromatosis associated with spinal canal involvement have been reported. Three patients with flaccid paresis of extremities and respiratory distress died in the newborn period. The other three patients showed improvement of the paresis. The prognosis of infantile myofibromatosis without visceral complication is generally good, but neurologic impairment may occur at birth if the spinal cord is compressed.

Bone Neoplasms↗
PubMed2003

Cardiopulmonary complications of intramedullary fixation of long bone metastases.

Intramedullary fixation of long bone metastases is an effective method of treating or preventing pathologic fractures. An important complication of this technique is the development of pulmonary embolism, which may occur at any number of steps during bone manipulation. Passage of normal marrow contents or tumor into the pulmonary circulation is thought to cause various biochemical, hemodynamic, or physical responses that lead to hypotension, arrythmia, and O2 desaturation. Death is a known risk of this procedure. Numerous surgical and anesthetic strategies have been developed to prevent or treat pulmonary embolic phenomena; however, the most important prophylaxis may be a heightened awareness of this possibility during any procedure that involves intramedullary manipulation of tumor containing bone.

Blood Coagulation Disorders↗
PubMed2006

Endoprosthetic reconstruction in 250 patients with sarcoma.

UNLABELLED: We assessed the clinical results and complications associated with a new endoprosthetic replacement system (Mutars) used in 250 patients with a malignant bone or soft tissue tumor. The key features of the system are its cementless, hexagonal-shaped stem (titanium alloy), the possibility of torsion adjustments in 5 degrees -increments, and the Trevira tube for soft tissue attachment. The mean age of the patients was 30.7 years, and the mean followup was 45 months. Prosthetic survival at 5 years was 89.7% for the upper extremity and 68.5% for the lower extremity. Prosthetic survival without any reoperation was 73.4% at 3 years postoperatively and 60.4% at 5 years postoperatively. Prosthetic failure was caused by deep infection in 12% (30 patients) of patients and aseptic loosening in 8% (20 patients) of patients. Stem fracture occurred in only 1.6% (four patients) of patients. Dislocation rates were reduced by using the Trevira tube. Limb survival was achieved in 82.6% to 93.1% of patients depending on the endoprosthetic replacement site, and functional results ranged between 63% to 83% according to the Tumor Society score. Our results suggest limb salvage with the Mutars endoprosthesis is successful with good functional results. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series).

Adolescent↗