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PubMed1983

Human osteogenic sarcoma: fine structure of the osteoblastic type.

The fine structure of representative regions of 13 osteoblastic osteogenic sarcomas was studied. These regions contained four morphologically distinguishable subtypes of osteoblastlike cells. In addition, fibroblastlike and chondroblastlike cells were present, along with multinucleated giant cells, leukocytes, macrophagelike cells, and small populations of histogenetically unclassifiable (but probably neoplastic) cells. The morphologic evidence was compatible with the view that the variations in appearance among the subgroups of osteoblastlike cells reflected differences in maturation and differentiation of these cells. In at least one subgroup, the morphologic findings suggested that the cells were capable of manufacturing a secretory product. The multinucleated giant cells occurring in genuine tumor areas appeared to be closely related to neoplastic osteoblasts. The presence of chondroblastlike cells in the tissues illustrates that cells with a diverging differentiation can occur in an osteoblast-dominated cell population. This agrees with the view that the neoplastic cells originate from a mesenchymal stem cell with potential for multifaceted differentiation.

Adolescent↗
PubMed1976

Pain in osteoid osteoma: histological facts.

Six cases of osteoid osteoma were studied histologically using the Gross technique. When the nidus is located centrally, it is reached by amyelinic fibers accompanying the vessel branches or as independent fibers. The pain is generally considered to reflect changes in vessel pressure and it could also be due to direct irritation of the nerve fibers included in or near the calcification focus.

Adolescent↗
PubMed1995

Low risk of recurrence of enchondroma and low-grade chondrosarcoma in extremities. 80 patients followed for 2-25 years.

We analyzed the clinical course in 40 patients with enchondroma and 40 with low-grade chondrosarcoma of the extremities after a median follow-up of 7 years. 13 patients with enchondroma and 2 with chondrosarcoma had only open biopsy and they had no signs of further progression of the lesions. Among 23 patients with enchondroma and 23 with chondrosarcoma who were treated by intralesional curettage, 3 had local recurrences. The 10-year local recurrence rate was 0.04 in the enchondroma group and 0.09 in the chondrosarcoma group. There were no metastases. The results imply that enchondroma and low-grade chondrosarcoma of the extremities should be treated with limited surgery. The morbidity associated with en bloc resection and reconstruction can apparently be obviated without jeopardizing the limb or survival.

Adolescent↗
PubMed1997

[Limb salvage surgery using massive allografts in malignant bone tumors].

The advantages of segmental allografts over arthoplastics are, among others, secured biological healing, easy attachment of tendons and ligaments, and desirable long-tem results. Since 1983, the authors have performed 35 resections of malignant tumors in the extremities followed by reconstructions with implantation of segmental allografts. Five types of grafts were used for the reconstruction of the skeletal defects, intercalary hemicylinder, intercalary cylinder, partial osteoarticular, total osteoarticular, and allograft-prosthetic implant composite. All the patients underwent adjunctive chemotherapy that was considered necessary. The length of follow-up ranged from 6 months to 10 years during which time 6 patients died, 25 were disease-free, and 4 survived as tumors-carriers. Complications in 28.6% of the patients included infection, graft resorption, recurrence and nonunion. Patients undergoing intercalary grafts oblained better functional results than those having osteoarticular grafts. 4 patients had biopsies and bone scans of the grafts 2-4 years postoperation with creeping substituion being observed. Segmental allograft remains a viable approach with predictable results for reconstruction of skeletal defects after resection of malignant bone tumors.

Adolescent↗
PubMed1975

[Comparison of results of 99mTc-polyphosphate-camera-(sequence functional)-scintigraphy, 85Sr-, 87mSr-scanner-scintigraphy, and of radiologic methods in orthopedics].

Comparative studies between radiological (equals R; x-ray, thermography, angiography) and nuclear medical examinations (equals NM; scanner-, scintillation camera-sequential scintigraphy) in 339 patients with different bone diseases led to the following results: Thermography proved to be inferior to scanning in detecting of bone diseases. Angiography was the procedure of choice in detecting malignant bone tumors. Sequential scintigraphy performed by means of the Anger-HP-scintillation camera and Intertechnique-Cine-System allowed to establish the kinetic behaviour of tumors: an early increased TcPoP accumulation was observed in tumors with high perfusion (sarcoma), a late accumulation in those with low perfusion (osteoid osteoma).

Angiography↗
PubMed1997

[Limb salvage and amputation in osteosarcoma: report of 31 cases].

Three different types of operation were performed in 31 osteosarcoma patients, and some cases received chemotherapy. It revealed, wide resection of tumor supplemented with chemotherapy improved the survival and limb salvage rate enormously. Chemotherapy and wide resection were all absolutely essential. The life of prosthesis was long and most patients were satisfied with it. Chemotherapy and limb salvage can enhance the survival and life quality in patients with osteosarcoma.

Adolescent↗
PubMed2000

Coma from fat embolism syndrome after hemiarthroplasty of the hip for metastatic breast cancer to the proximal femur: a case report.

We present a case report of fat embolism syndrome (FES) that resulted in prolonged coma after cemented hemiarthroplasty in a patient with metastatic breast cancer. After the cemented hip prosthesis was placed, the patient developed decreased sensorium that progressed to coma in association with hypoxemia and tachypnea. Pulmonary compromise was mild, and the patient required only supplemental oxygen for support. The patient demonstrated no petechiae. Magnetic imaging results were consistent with FES. While the pulmonary symptoms resolved quickly, the patient remained unresponsive for 11 days without purposeful motor function. After waking she recovered rapidly, and at her 2-month follow-up appointment, demonstrated no adverse orthopedic, pulmonary, or neurologic sequelae.

Aged↗
PubMed2000

[The comparative biochemical and morphological characteristics of chondrosarcoma and giant-cell tumor of the bone].

Spectrometry has been employed to assess the levels of collagenase, catepsin D, trypsin-like proteinases and their inhibitors as well as bone acid and alkaline phosphatase both in the center and along the periphery of giant cell tumor of bone (GCTB) and chondrosarcoma. The levels of collagenase, trypsin-like proteinases and their inhibitors in the center of chondrosarcoma were much higher while those of alkaline phosphatase--lower than along tumor periphery. The catepsin D and acid phosphatase concentrations of the center and periphery of chondrosarcoma were similar. It was suggested that an extremely low concentration of trypsin-like inhibitors may contribute to degradation of the matrix in tissues adjacent to chondrosarcoma and, consequently, to tumor invasion development.

Acid Phosphatase↗
PubMed2000

Metastatic renal cell carcinoma of bone: indications and technique of surgical intervention.

PURPOSE: We describe the efficacy of surgical excision of metastatic renal cell carcinoma of bone for achieving local tumor control, pain control and functional outcome with emphasis on the indications and techniques of surgical intervention as well as oncological outcome. MATERIALS AND METHODS: Between 1980 and 1997 we performed surgery on 45 patients (56 lesions) with metastatic renal cell carcinoma of bone. Indications for surgery were solitary bone metastasis, intractable pain, or impending or present pathological fracture. Surgery involved wide excision in 29 cases, marginal excision with adjunctive liquid nitrogen in 25 and amputation in 2. RESULTS: None of the patients had significant bleeding intraoperatively. Mean hospital stay was 9.8 days, during which there was no flap necrosis, deep wound infection, nerve palsy or thromboembolic complication. Postoperatively pain was significantly relieved in 91% of patients, while 89% achieved a good to excellent functional outcome, and 94% with metastatic lesions of the pelvic girdle and lower extremities were ambulatory. Local recurrence developed in only 4 of the 56 lesions (7.1%), including 3 after marginal resection. Survival was more than 2 years in 22 patients (49%) and more than 3 in 17 (38%). CONCLUSIONS: Surgical excision is safe and reliable for restoring mechanical bone stability, relieving pain and providing good function in most patients with metastatic renal cell carcinoma who meet the criteria for surgical intervention. Relatively prolonged survival in these cases justifies considering surgical intervention when feasible.

Adult↗
PubMed1975

[An X-ray approach to differentiate benign and malignant bone tumors (author's transl)].

A critical analysis of X-ray signs induced by the interaction of a bone tumor with bone itself is presented. These enables the physician to recognise a pattern of characteristic findings for each particular tumor. Clinical examples are demonstrated illustrating at the same time a schematic classification of those signs on a roentgenogramm which in many cases facilitate the prediction of the specific diagnosis and in consequence the prognosis of the lesion. The need for an effective cooperation between the involved specialties is stressed.

Adolescent↗
PubMed2001

Allograft replacement in limb salvage surgery for bone tumors.

A retrospective study of a series of eleven patients with active, aggressive benign and malignant bone tumors who were treated by radical resection and massive match-sized allograft replacement was reviewed. There were seven giant cell tumors and four osteosarcoma cases involving mainly either the lower end of the femur or upper end of the tibia. The age of the patients ranged from 11 to 50 years. As the follow-up period was rather short, ranging from 9 to 60 months, the patients are all still alive. Complications included two infections, one local recurrence, and two with resorption of the articular surface of the osteoarticular graft. Though psychosocial benefit was gained in patients with this limb salvage procedure, functional evaluation did not yield a satisfactory result.

Adolescent↗
PubMedDate not supplied

[Percutaneous radio-frequency ablation of osteoid osteoma: technique and preliminary results].

PURPOSE: To report our personal experience with the percutaneous technique for in situ destruction of osteoid osteoma using radio-frequency ablation. MATERIAL AND METHODS: From January 2000 to January 2001 we performed 16 radio-frequency ablations in 15 patients. All candidates for treatment had previously undergone clinical and radiologic examinations to confirm features typical of osteoid osteoma. After administration of spinal anesthetic, procedures were performed with CT-guidance, using a Kirschner wire introduced into the localized lesion, and a guiding cannula. A hole was first cut into the bone with a cutter, then a few biopsy specimens were obtained with a Jamshidi needle. Finally, we introduced a small radio-frequency electrode into the bone, through the biopsy track. Sufficient current was used to heat the electrode tip to 85-90 degrees C with consequent thermal necrosis of the tissue. The healing was continued for 6 minutes. RESULTS: All patients well tolerated the percutaneous procedure and only 1 underwent a second, successful radio-frequency ablation. In all cases, pain relief was noted to occur very rapidly and all patients could bear full weight on the treated extremity within 24 hours after the procedure. No late complications attributable to the ablation were noted, except for a small eschar next to the puncture site. DISCUSSION AND CONCLUSIONS: The results of the present study suggest that percutaneous ablation is preferred to operative excision because it generally requires shorter hospital stay and is not associated with complications. Furthermore, in our experience, pain relief was noted to occur very rapidly in 100% of cases. In agreement with the literature data, our results show that CT-guided percutaneous radio-frequency ablation can actually replace operative excision in the treatment of osteoid osteoma as it achieves the same clinical outcomes with significantly lower costs.

Adolescent↗
PubMed2000

[Treatment of tibia and femur massive defect with pedicled fibula transposition].

OBJECTIVE: To investigate the repairing result for the massive bony defects of upper and middle tibia and lower femur. METHODS: Since 1974, four types of pedicled-fibula transposition were performed to repair the massive bone defect of tibia and femur in 25 cases, which included; 9 cases with benign tumor of upper part of tibia were performed muscle-pedicled fibula transposition and knee fusion after tumor resection; 9 cases with extensive benign tumor or tumoroid lesion of tibia shaft were performed muscle-pedicled fibula transposition and tibia-fibula fusion after tumor resection; 2 cases with extensive benign tumor or tumoroid lesion of middle and lower parts of tibia were performed vascular pedicled fibula transposition and tibia-fibula fusion; 5 cases with benign tumor of distal femur were performed vascular pedicled fibula reversal transposition and knee fusion. RESULTS: After 3 months to 11 years follow-up, 23 cases showed bone healing at 6 months postoperatively. The other 2 cases showed bone healing at 12 months postoperatively. All cases had satisfactory functional rehabilitation. CONCLUSION: Pedicled-fibula transposition is a choice method for repairing massive defects of tibia and femur.

Adolescent↗
PubMed2002

Extremity osteosarcoma--a Southeast Asian experience.

INTRODUCTION: We present our experience with limb salvage emphasising the use of vascularised bone grafts in combination with autoclaved tumour bone for limb salvage in osteosarcoma. MATERIALS AND METHODS: Thirty-six cases with extremity osteosarcoma, all of which were managed at a single institution between 1980 and 1999, were reviewed at a mean follow-up of 9 years (range, 10 months to 200 months). There were 26 patients who underwent limb salvage surgery and 10 patients who had amputation. RESULTS: In the limb salvage group, 12 bone defects were bridged using vascularised bone grafts alone while autoclaved tumour bone was used for reconstruction in the remaining 14 patients. In these 14, there were 10 with autoclaved tumour bone and vascularised bone, 2 with autoclaved bone and non-vascularised bone and 2 with autoclaved bone alone. The joint was preserved in 13 of the 26 reconstructions. Of these, 11 involved preservation of the knee joint contributing to a quantum gain in function with 84% good and excellent results. The actuarial survival was 64% at 2 years and 48% at 5 years, with no significant difference between ablation and limb salvage. CONCLUSION: The use of the autoclaved bone provided yet another effective alternative for bridging large defects following resection of high grade tumours.

Adolescent↗
PubMedDate not supplied

Chondromyxoid fibroma: a study based on 18 cases.

The authors report on 18 cases of chondromyxoid fibroma seen at the Institute of Orthopedics and Traumatology, University of São Paulo, from 1953 to 1990. A survey of the literature on chondromyxoid fibromas was conducted and radiographic analysis of all cases is presented, with a mean follow-up of 64 months. The surgical treatment employed in each case is discussed, with emphasis on the use of cement as an adjuvant. This procedure was used in 10 patients, who have been free of recurrence up to the present time.

Adolescent↗
PubMed1992

[Post-traumatic osteoid osteoma. Apropos of 2 cases and review of the literature].

Two cases of osteoid osteoma which became clinically apparent after a prolonged silent period are reported. One was located in the tibia in a 30-year-old female and the other in the femur in a 26-year-old male. Both developed after a surgical procedure, at the site of the operation; one was located on the track of an internal fixation screw. Diagnosis was delayed despite the suggestive timing of the pain; isotopic scanning, CT scan and angiography provided suggestive data and diagnosis was confirmed by histologic studies. A review of the literature found 13 other cases meeting the following criteria: initial trauma, silent period, suggestive pain, discovery of an osteoid osteoma at the site of the trauma, and recovery following surgical treatment. The role of the trauma is discussed.

Adult↗