[Attending to the individual case--cooperative care. Mortality due to primary malignant bone tumors has decreased considerably].
Explore the source record for details and available documents.
Bone Neoplasms↗
Biomedical subjects
L Bernd
Publications and source records attributed to L Bernd.
[Telecommunication and telepathology. New diagnostic routes for orthopaedics and orthopaedic pathology].
In a pilot project of the Department of Bone Pathology of the University of Hamburg and the Orthopaedic Department of the University of Heidelberg, the cases of 121 patients with suspicion of a primary bone tumour have been discussed at weekly interdisciplinary conferences during the period from July 2001 to May 2002., The consequent differential diagnoses were made prior to the biopsy, the optimal location of the biopsy and the further strategy was determined according to the guidelines of the international bone tumour centres. The latter includes the decision if a conventional biopsy or a intraoperative pathology examination on frozen sections should be performed. In 27 cases an intraoperative pathology examination was performed and then assessed in Hamburg. In 24 cases this diagnosis was identical with the final diagnosis. In three cases no definitive diagnosis could be made from the frozen sections. Additionally the pathohistological diagnoses of the cases of the previous week have been discussed in the video-conferences. Through this a unusually close interdisciplinary cooperation over a large distance has evolved, that is highly appreciated especially by the young and less experienced colleagues at the department of bone pathology and the orthopaedic department in Heidelberg. The awareness of the potential and limitations of a medical subject leads to an improved safety in the diagnostic process for bone tumours. The interdisciplinary discussion of all aspects of the diseases may also optimise the therapy of bone tumours.
Bone Neoplasms↗
[Improving local control in patients with aggressive fibromatosis by combined surgery and radiotherapy].
INTRODUCTION: The purpose of this retrospective analysis is to evaluate whether the combination of surgery and radiation therapy in patients with aggressive fibromatosis influences the therapeutic outcome. METHOD: Clinical, radiological and pathological results of 23 consecutive cases with histologically proven aggressive fibromatosis were retrospectively analyzed. The median follow-up was 59 months. RESULTS: Twelve patients received surgery alone for their first treatment, 10 patients had a combination of surgery and radiotherapy and 1 patient had radiochemotherapy. Of 23 patients 14 (63%) had one or more local recurrences and 9 (39%) were recurrence-free. The patients received a total of 50 treatments: 29/50 (58%) treatments were followed by a local recurrence and 21/50 (42%) were without relapse. Twenty-nine treatments with local recurrence consisted of 25/29 (86%) surgical treatments, 3/29 (10%) combinations of surgery and radiation therapy, and 1/29 (3%) radiochemotherapy. Of the patients who had only surgery for their first treatment, after one year 8 of 12 (66%) and after 5 years all patients had a local recurrence. In the group with surgery and radiotherapy, there was no recurrence after 1 year and 1 recurrence after 5 years (p = 0.0001). CONCLUSION: We recommend a complete tumor resection, without mutilating the patient. Radiation therapy in combination with surgery in contrast to surgery alone is an efficient treatment option for reducing local recurrence.
Adolescent↗
[Mantel transplant for defect reconstruction after resection of malignant bone tumors of the lower extremity].
We treated 11 patients with primary sarcoma and 1 patient with enchondroma of the femur or tibia. Bridging the osseus defect we used an intercalary allograft shell and contralateral fibula as described by Capanna et al. [7]. The median bone defect after resection of the tumor was 15.7 (9.0-28.5) cm, average follow up was 29.2 (13-56) month. Anastomosis of the autologous fibula was successful in 8 cases. There were 3 cases necessitating later amputation. The other cases showed good clinical (Enneking-score) and radiological (ISOLS-score) results. These results indicate the described technique as a suitable method for defect reconstruction with good functional outcome.
Adolescent↗
[Parosteal osteosarcoma (POS). Clinical and therapeutic aspects].
Parosteal osteosarcoma is a malignant bone-forming tumor, which is characterized by its superficial origin and its high structural differentiation. Because of the radiological and histological variability, finding the right diagnosis is a great challenge for physicians, radiologists, and pathologists, especially at the time of primary manifestation. Usually there is a low-grade malignancy. Often a benign tumor is imitated so that finding the correct diagnosis is indispensable. Wide resection with sufficient margin is the adequate therapy. High-grade parosteal osteosarcoma needs adjuvant chemotherapy. Our own experience with secondary dedifferentiation and the possibility of primary undergrading shows that regarding diagnostics, operative therapy, and follow-up parosteal osteosarcoma should be treated like conventional osteosarcoma.
Adolescent↗
[Low-grade central osteosarcoma . 3 case reports].
Low-grade central osteosarcoma is a well-differentiated subtype of osteosarcoma, which is often confused with benign lesions. Males and females were affected about equally in our study. The tibia and femur were most commonly involved. Three case reports demonstrate the distinct features of the tumor. Excision of the tumor almost invariably led to recurrences. Wide resection was almost never followed by recurrence and seems to be the treatment of choice for this very rare variant of osteosarcoma.
Adolescent↗
Destructive osteoblastoma of the cervical spine with complete neurologic recovery.
STUDY DESIGN: Case report. OBJECTIVE: To describe a patient with a large tumor lesion of the 6th vertebrae affecting surrounding soft tissue, and symptoms of cord compression. Histologic diagnosis indicated a destructive osteoblastoma following dorsal and anterior resection and internal fixation. SETTING: University Hospital, Germany. METHODS: A 23-year old male patient was admitted with a 2-month history of increasing upper extremity weakness and pain. X-ray and MRI indicated massive involvement of the anterior and posterior elements of the 6th vertebrae with a large soft tissue mass. Following emergency decompression and dorsal stabilization, the pathologic investigation revealed a destructive osteoblastoma. Subsequent dorsal and anterior resection with internal fixation were performed. RESULTS: The patient initially presented with symptoms of beginning paraplegia of C6/7. According to the neurologic classification of spinal cord injury, motor function score was 56 and sensory function score 83. After emergency dorsal decompression and internal fixation with Luque-Instrumentation he showed increasing neurological recovery. Complete neurological recovery was achieved at 2 and 12-months postoperatively, following secondary dorsal and anterior resection of the tumor and internal fixation with bone cement (PalacosR) and Harms-cage. Radiologic signs of local recurrence were identified 1 year postoperatively. CONCLUSION: Osteoblastoma of the cervical spine is rare. Patients often present with severe neurological symptoms due to significant tumor mass. Complete resection is necessary to regain full recovery, to prevent recurrence and, in some cases, malignant transformation.
Adult↗
Correlation of intraoperatively irradiated volume and fibrosis in patients with soft-tissue sarcoma of the extremities.
PURPOSE: To investigate the influence of intraoperatively irradiated volume on soft-tissue fibrosis. METHODS AND MATERIALS: Fifty-three patients with soft-tissue sarcoma of the extremities were treated with intraoperative radiotherapy (IORT) (median dose 15 Gy) and postoperative fractionated therapy (median dose 46 Gy). The median follow-up was 41.5 months (range 18-94). Late toxicity was classified according to the LENT-SOMA criteria. A Cox regression model was calculated to identify the parameters that could influence soft-tissue fibrosis Grade 3 or 4. Five parameters were observed: extent of surgical procedure, IORT in case of recurrence, extent of IORT volume, extent of IORT dose, and extent of postoperative volume. In addition, a logistic regression model was calculated to demonstrate the relationship between the IORT volume and fibrosis development. RESULTS: The overall survival rate after 5 years was 84%. The actuarial tumor control rate was 90% after 5 years. Eleven patients developed soft-tissue fibrosis. Five patients developed Grade 3 fibrosis and 1 patient developed Grade 4 fibrosis. Only the IORT volume had a significant influence on Grade 3 or 4 fibrosis development. An IORT volume of 210 cm(3) conveyed a 5% risk (confidence interval 1-20%) of the development of severe fibrosis. The risk of severe Grade 3 or 4 fibrosis increased to 50% (confidence interval 15-80%) if a volume of 420 cm(3) was irradiated. CONCLUSION: The effect of volume in patients treated with IORT was remarkable. The ratio of side effects was relatively low. The risk of soft-tissue Grade 3 or 4 fibrosis increased with the extent of the IORT volume. Compared with the literature, IORT provides excellent local control in these patients.
Adolescent↗
[Characteristic perfusion pattern of osseous giant cell tumor in dynamic contrast-enhanced MRI].
PURPOSE: To describe the perfusion pattern of giant cell tumor (GCT) of bone with Gd-enhanced dynamic MR imaging. To compare time-intensity-curves in patients with local recurrence and postoperative alterations without recurrence. METHODS: Nine patients (5 women, 4 men) with GCT of bone underwent 19 dynamic MRI examinations. Mean age was 34 years (range 24-64 years). All diagnoses were proven by pathology. Dynamic contrast-enhanced MRI was performed at 1.0 T using T1-weighted gradient echo sequences. GCT was located in the distal radius (4x), tibia (3x), fibula (1x) and humeral head (1x). RESULTS: All giant cell tumors showed a uniform perfusion pattern with a steep slope and maximum intensity value followed by an early and rapid washout phase. The same pattern appeared in five local recurrences of GCT in four patients. In nine follow-up examinations without local recurrence dynamic MRI yielded in uncharacteristic perfusion patterns. CONCLUSION: These results demonstrate a uniform perfusion pattern of GCT of bone obtained by dynamic MRI. It is characterized by a steep slope followed by an early and rapid washout phase. This characteristic pattern can also be obtained in local recurrences. Dynamic contrast-enhanced MRI appears a helpful method for primary diagnosis of GCT of bone and detection of local recurrences after surgery.
Adult↗
[Vascularized fibula transplantation in orthopedic oncology. Personal experience and review of the literature].
Primary malignant bone tumors can be treated predominantly with limb salvage. After resection of large articular segments adjacent to the dia- or metaphysis of long bones modular endoprosthetic devices are most commonly used for reconstruction. In case non-vascularized corticocancellous bone is transplanted in order to bridge extensive bone defects, the risk of pseudarthrosis and fracture of the donor bone is significantly higher in comparison to a free vascularized transplant. From 1988 until 1999 we treated 20 patients with extensive bone defects after resection of tumors affecting the upper and lower extremity using a vascularized fibular graft. In this retrospective analysis we collected the data focusing on bone integration and functional outcome. The graft union was classified according to the standards of the "International Symposium of Limb Salvage". Evaluation of the functional outcome was quantified using the Enneking-score. The stabilisation of the transplant was obtained exclusively by plate fixation in the upper extremity. In 10 in a total of 12 patients the reconstruction using a vascularized fibula transfer was reinforced with an allograft in the lower extremity. The functional evaluation score reached 73% of normal function at the last follow-up. After 18 months the radiographic evaluation of graft union was "excellent" in 75%, "good" in 11%, "fair" in 6% and "poor" in 9% according to the criteria of the ISOLS. Main complications were graft fracture in of 15% and pseudarthrosis in 14.3%. Reconstruction of extensive bone defects using free vascularized fibula grafts are a demanding operative procedure. The procedure combines a biologic form of reconstruction with a legitimate expectation of good long term outcome and a relatively low rate of complications.
Adolescent↗
Quantitative evaluation of skeletal tumours with dynamic FDG PET: SUV in comparison to Patlak analysis.
This study was carried out to evaluate bone lesions using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) and to explore whether dynamic and quantitative PET data may help to differentiate benign lesions from malignant masses. Forty patients with primary bone lesions were studied. The final diagnosis was confirmed by histopathology. A 60-min dynamic FDG PET acquisition was undertaken in all subjects. From the dynamic PET images, indices such as the average and maximal standardised uptake values (SUVs), the tumour SUV-to-muscle SUV ratio (T/M) and the SUV at 60 min-to-SUV at 30 min ratio (averSUV60/30 min and maxSUV60/30 min) were produced. Patlak graphical analysis was used to obtain the influx constant (Ki), and the metabolic rate of FDG (MRFDG) was calculated. Based on the receiver operator characteristic curve, the sensitivity and specificity for each parameter in differentiating between malignant and benign lesions were evaluated. The histological results revealed 21 malignant tumours and 19 benign lesions in this group. The MRFDG and SUV indices in malignant lesions were significantly higher than those in benign lesions. However, each index showed a considerable overlap between benign and malignant lesions. Average SUV correlated positively with MRFDG (r=0.67). When a cut-off of 1.8 average SUV was used, the sensitivity and specificity for discrimination of malignancy from benign disease were 85% and 82.4%, respectively. MRFDG showed a similar sensitivity (82.4%) and a better specificity (92.9%). A combination consisting of a cut-off of average SUV (1.8) and averSUV60/30 min (1.1) resulted in an improvement of specificity to 93.3%, with a small reduction in sensitivity (81.3%) as compared with exclusive use of SUV. The results of this study indicate that a detectable difference in glucose metabolism exists between malignant and benign skeletal lesions. The static FDG uptake indices alone may not enable adequate differentiation between benign and malignant lesions. Quantitative dynamic imaging may provide more helpful information, but will not permit a definite diagnosis. The use of uptake indices may represent an alternative and interesting approach to the evaluation of bone lesions.
Adolescent↗
A man with hereditary exostoses and high-grade non-Hodgkin's lymphoma of the bone.
Multiple cartilaginous exostoses (MCE) is an autosomal dominant disorder that can lead to malignant transformation from exostoses to a secondary chondrosarcoma. We present a case report of a 52-year-old man with MCE who had a palpable mass at the left shoulder. At the site of the left proximal humerus, a cartilaginous exostosis was localized, suggesting that the tumor developed by a malignant transformation of an exostosis into a secondary chondrosarcoma. Interestingly, a biopsy showed a diffuse large B-cell lymphoma with Burkitt-like features. To our knowledge, the association of high-grade lymphoma and hereditary exostoses has not been described previously. This case demonstrates that a malignant tumor at the location of a cartilaginous exostosis is not necessarily a chondrosarcoma and that a biopsy is an essential part of the diagnostic work-up.
Bone Neoplasms↗
[Intraoperative extracorporeal irradiation and replantation (EIR) in the treatment of primary malignant bone tumors].
In 6 patients with primary malignant bone tumors (4 Ewing, 1 recurrent Adamantinoma, 1 maligne Haemangioperizytoma) the local therapy was performed as intraoperative extracorporeal irradiation and replantation. During the follow-up 10 (6-24) months no local recurrence in the replanted segment occurred. One recurrence occurred in the host bed; in two cases the replanted segment had to be removed because of severe infection. The other cases showed good functional and radiological results. These clinical findings and the reports in the literature seem to allow the application of the intraoperative extracorporeal irradiation and replantation procedure for defect reconstruction in cases of chemo- and radiotherapy-sensitive bone tumors.
Adolescent↗
[Surgical management of skeletal metastases of the extremities].
Operations on skeletal metastases of the extremities represent the most frequent surgical treatment in orthopedic oncology. From 1970 to 1997, 340 patients were operated on in 383 surgical procedures in the Orthopedic Department of the University of Heidelberg. Carcinoma of the breast and renal cell carcinoma were the most common primary tumors. Operations concerned mainly the femur with acetabulum (55%) and the humerus with glenoid (25%). A pathologic fracture occurred in 51%. While in these cases surgical treatment is absolutely necessary, it is contraindicated in preterminal patients. In imminent fractures or peripheral compression syndromes, the indication is relative and has to be justified on a multidisciplinary basis. Marginal resection of the tumor is allowed because of the limited life expectancy of most patients. Only in patients with solitary metastases and a better prognosis the resection of metastasis margin can be more extensive. Intensification of local therapy by adjuvant irradiation is indicated in an R2 situation, depending on the patient's prognosis. An analysis of our cases from 1994 to 1996 exemplifies the increasing use of modular tumor endoprostheses (52%). In meta-diaphyseal and diaphyseal cases, cement-augmented osteosynthesis is mainly used (34%). The application of these established reconstruction techniques after metastasis resection in cases with adjuvant radiotherapy assures a pain-free extremity capable of weight bearing.
Bone Neoplasms↗
No indications for percutaneous lumbar discectomy?
A questionnaire was used to assess the outcome of automated percutaneous lumbar discectomy (APLD), to correlate patients' data and to identify criteria for pain relief and patient satisfaction. Two hundred and thirty eight patients were operated on by APLD between 1988 and 1990. The questionnaire returned by 182 patients (76.4%) was suitable for evaluation. The mean follow-up was 2.5 years. Overall, 60% reported pain relief and 52% were satisfied with APLD. Conventional operations were carried out subsequently on 45 patients (25%). Bivariate and multivariate analyses were done for preoperative (age, gender, neurological deficit, Lasegue's sign, sports activity), perioperative (weight of disc material removed, level of APLD) and post-operative (conventional nucleotomy, change in condition, pain relief, satisfaction, sports activity, return to work, compensation claims) parameters. The only significant parameters for improvement in condition and pain relief was age, where patients younger than 41 do better. Risk factors for reoperation were a positive Lasegue's sign and over 41 years of age. Patient satisfaction was significantly higher for patients without sensory deficit preoperatively.
Adolescent↗
Bone quality in the lumbar spine in high-performance athletes.
Little is known about the influence of high-performance training on the bone quality of the lumbar spine, in particular, the effects on bone mineral density (BMD) in athletes with high weight-bearing demands on the spine. Measurements were therefore performed in internationally top-ranked high-performance athletes of different disciplines (weight lifters, boxers, and endurance-cyclists). The measurements were carried out by dual-energy X-ray absorptiometry, and the results compared with the measurements of 21 age-matched male controls. The BMD of the high-performance weight lifters was greater than that of the controls by 24% (0.252 g/cm2) on the AP view by 23% (0.200 g/cm2) on the lateral view (P < 0.01), while difference in BMD between the boxers and the controls was +17% (0.174 g/cm2) on the AP view and +19% (0.174 g/cm2) on the lateral view. The BMD of the lumbar spine in all endurance cyclists was lower than that in the controls (AP view -10%, 0.105 g/cm2; lateral view -8%, 0.067 g/cm2; P > 0.05). The results show that training program stressing axial loads of the skeleton may lead to a significant increase of BMD in the lumbar spine of young individuals. Other authors' findings that the BMD of endurance athletes may decrease are confirmed. Nevertheless the 10% BMD loss of cyclists was surprisingly high.
Absorptiometry, Photon↗
A computertomographic study on the congruence of the hip joint.
This study describes investigations into the appearance of intra-articular spaces of hip joints. In CT scans of cadaver hip joints in the supine position an increased intra-articular space was found dorsally, while in the prone position the same hip joint showed an increased intra-articular space ventrally. It is assumed generally that the gap between the bone ends seen on plane X-rays represents the cartilage, but this study indicates that there may in fact be a space between the cartilage surfaces in the unloaded joint.
Journal Article↗
Late results after subtrochanteric angulation osteotomy in young patients.
Young patients with painful congenital dislocation of the hips need surgery if conservative treatment is unsuccessful. A total of 24 patients after 28 subtrochanteric angulation osteotomies without resection of the femoral head were followed up (mean, 17 years) to evaluate long-term results. Most patients maintain improved function: 20 hips showed persistent gain of abduction, 14 patients showed improvement of gait, and 18 patients described less pain. The degree of angulation must equal the inclination of the pelvic wall to influence hip stability as well as hip range of motion. Osseous reactions of support-seen in 10 hips-are not proof of operative success. Angulation osteotomy does not exclude later surgical procedures such as total hip replacement.
Adolescent↗