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[Periosteal desmoid].

A case of periosteal desmoid is studied. Being of a rather often incidence in children it might be confused with others lesions located on distal femoral metaphysis and which sometimes form part of pathology typical of the developing skeleton as cortical defects and non osteogenic fibromas and the others which might be a question of malignant process. Periosteal desmoid is characterized by appearing as a radiolucent lesion with periosteal speculation of the dorsomedial cortical wall of the medial femoral condyle, on adductor insertion zone. Simple radiology study in these lesions must be emphasized, without necessity to use more cruel techniques.

Adolescent↗

[Periostal hypertrophic osteopathy of bones (long bones) in colitis ulcerosa in adolescents (author's transl)].

The article reports on a 14-year old girl with periostal new formation of bones at the long bones of the lower arms, the femora and the lower legs the individual phalanges and metacarpalia after colitis ulcerosa which had lasted for several years and had progressed stagewise. After a clinically recorded new attack the periostal new formations of bone progressed. Some time after the last attack of colitis the periostal changes in the bones partially receded. The article discusses the hypothetic explanations aiming at interpreting the pathogenesis of hypertrophic osteoarthropathies and periostoses, as given in the literature.

Adolescent↗

Periosteal and metaplastic bone formation in mouse minced muscle regeneration.

Structures resembling exostoses derived from periosteum and metaplastic nodules of cartilage and bone were induced in mouse legs by isotopic implants of minced skeletal muscle or heterotopic implants of nonlimb skeletal and cardiac muscle that does not regenerate. Liver mince implants produced no periosteal response. Control experiments demonstrated that, after excision of the muscle without the placing of any implant, no periosteal response or metaplastic bone occurred unless the periosteum was deliberately injured. Metaplastic nodules of cartilage and bone arose from the fibrous stroma that constituted the greater part of the implant when muscle mince regeneration was unsuccessful. The development of both the periosteal response and the metaplastic bony nodules is inversely related to the efficiency of phagocytosis by macrophages that remove the implanted debris and the concomitant degree of regeneration of new muscle. These phenomena, and, therefore, bone and cartilage formation, are strongly age related. The rapidity and extent of development of both abnormal bone and cartilage--less than 7 days--and its reproducibility may make this phenomenon a useful model for studies on the pathophysiology of bone and cartilage formation, particularly with regard to age.

Animals↗

[Perivascular and osteogenic cells in periosteal ontogenesis].

The structure of the perivascular cells, their interrelations with the vascular wall and differentiating osteoblasts has been studied in the white rat and rabbit fetuses and newborns during periosteal osteogenesis by means of electron microscopic radioautography using 3H-thymidine. The blood bed in the perichondrium in the zones, where osteogenesis is developing, has a capillary-sinusoid type of structure. Among the perivascular cells, poorly differentiated cells, adjoining the endothelium and intensively incorporating 3H-thymidine, are revealed, as well as the cells that are territorially isolating from the endothelium and demonstrating certain signs of their differentiation into the osteogenic ones. This supports the previously obtained data on historadioautography with 3H-thymidine that during the periosteal osteogenesis a successive differentiation of the perivascular cells (via the periosteoblast stage) into osteoblasts takes place. The process is accompanied by a decreased proliferative cell activity, at the expense of a prolonged time of generation and a progressive yield of cells out of the mitotic cycle. The poorly differentiated perivascular cells are considered as induceable ones, and the preosteoblasts--as the determined osteogenic precursor-cells. The cells growing into the perichondrium with capillaries, when the periosteal ontogenesis develops, represent a peculiar population of cells with polypotent properties, which participate in genesis of osteoblasts and periocytes.

Animals↗

Periosteal chondroma. A clinicopathologic study of 23 cases.

The periosteal chondroma (juxtacortical chondroma) is an unusual tumor which usually occurs on the surface of tubular bones in the metaphyseal area. In this study, we reviewed the clinicopathologic features of 22 patients representing 23 instances of periosteal chondroma and discuss the radiologic and histologic features necessary for accurate diagnosis. The characteristic radiologic appearance is of a single cartilaginous mass in the metaphyseal periosteum causing well-defined depression or "saucerization" of the adjacent cortex. The radiologic differential diagnoses include soft-tissue tumors compressing bone, fibrous cortical defect, and periosteal chondrosarcoma or osteosarcoma. Histologic features include lobules of hyaline cartilage with frequent areas of hypercellularity, binucleate chondrocytes, and focal mild cytologic atypia. The histologic features clearly identify the tumor as chondrogenic; however, familiarity with the x-rays may be necessary to recognize the tumor as benign.

Adolescent↗

[The periosteum: the "umbilical cord" of bone. Quantification of the blood supply of cortical bone of periosteal origin].

The Periosteum or periosteal membrane is a continuous composite fibroelastic covering membrane of the bone to which it is intimately linked. It consists of multipotent mesodermal cells (11, 15). Although the bone cortex is the main beneficiary of the principal anatomical and physiological functions of the periosteal membrane, the behaviour of the entire bone remains closely influenced by the periosteal activity. These principal functions are related to the cortical blood supply, osteogenesis, muscle and ligament attachments. Through its elastic and contractile nature, it participates in the maintenance of bone shape, and plays an important role in metabolic ionic exchange and physiological distribution of electro-chemical potential difference across its membranous structure. It has also been suggested that the periosteum may have its own specific proprioceptive property. This presentation will study the histo-anatomy and physiology of the periosteum and will discuss in detail its main functions of cortical blood supply and osteogenesis (fig. 1 and 2). It will also present the third intermediary report on a current study of the quantification of cortical vascularisation of femoral bone via the periosteum, using an isotonic salt solution of 85Strontium. The afferent-efferent (arterio-venous) flows of this solution in the thigh vascular system of guinea pigs were measured by gamma spectrometry after a series of selective macro and micro injections of radioactive salt into the femoral arterial system were carried out. Each vascular territory was meticulously selected and the injections were made according to size, starting with the larger vessels, with or without ligatures of neighbouring vessels, going progressively to smaller and smaller vessels not exceeding 100m in diameter.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Periosteal osteosarcoma of the jaw. Apropos of 2 cases].

The authors report two cases of periosteal osteosarcoma of the jaws, a tumour which is one of the two variants of juxtacortical osteosarcoma. Periosteal osteosarcoma involving the jaw bones is extremely rare. Because of its chondroblastic differentiation, sometimes predominant, this tumour may pose some problems of differential diagnosis with chondrosarcoma or pleomorphic adenoma: immunochemistry may be necessary. This localization does not change the clinical, radiologic, histologic and prognostic features of periosteal osteosarcoma.

Aged↗

Enhancement of periosteal chondrogenesis in vitro. Dose-response for transforming growth factor-beta 1 (TGF-beta 1).

Transforming growth factor-beta 1 (TGF-beta 1) has been shown to stimulate chondrogenesis in periosteal explants cultured in agarose suspension. In this study, the dose-response curve for such enhancement was measured. Periosteal explants and fascia lata were harvested from two-month-old rabbits, cultured for six weeks with 0, 0.1, 1, 5, 10, 50, or 100 ng/mL TGF-beta 1 in agarose suspension, then analyzed by histomorphometry and quantitative collagen typing. Cartilage was produced by seven of 11 (64%) of the control periosteal explants cultured in agarose suspension without TGF-beta 1. Transforming growth factor-beta 1 enhanced chondrogenesis in a dose-dependent manner in the range 0.1-100 ng/mL. It was most effective at 50 ng/mL. At very high doses (50 and 100 ng/mL) of TGF-beta 1, even fascia lata control explants exhibited chondrogenesis. These data indicate that TGF-beta 1 can induce differentiation toward cartilage production as well as enhance it once it has been initiated.

Analysis of Variance↗

Femoral periosteal thickening in pustulotic arthroosteitis, including 3-year followup by magnetic resonance imaging.

We describe 2 female patients with femoral periosteal thickening, in association with signs of pustulotic arthroosteitis in the sternocostoclavicular region and spine. In one patient, inflammatory changes were seen in muscular tissue surrounding this area of periosteal thickening, with fibrosis in the corresponding marrow. Over a period of up to 4 years after bone biopsy, cortical hyperostosis was observed spreading over a longer segment of her femoral diaphysis, while its thickness decreased over the longterm. Bone biopsy probably contributed to the striking periosteal thickening surrounded by inflammatory lesions in the surrounding muscles of this patients.

Adult↗

Treatment of extensive cranial bone defects using computer-designed hydroxyapatite ceramics and periosteal flaps.

We performed cranioplasty using hydroxyapatite ceramics and periosteal flaps in three patients with extensive cranial bone defects. These defects were left after post-brain surgery infection forced the removal of cranial bone. Hydroxyapatite ceramics made by using computer-aided design from three-dimensional computed tomographic image data were implanted in these patients. The defects were relatively large (the largest was 16.5 x 7.5 cm) and had a high degree of curvature. Three pieces were required in one patient, although one piece was sufficient in the other two patients. The surgical technique consisted of removal of the epidural granulation tissue, exposure of the cranial bone defect site, and shaping of the hydroxyapatite ceramics to fit the defect entirely, followed by the implantation of the hydroxyapatite ceramics. In anticipation of induction of the bone to hydroxyapatite, we covered the hydroxyapatite ceramics with periosteal flaps of cranial bones; however, based on only these three patients, our knowledge of the ossification-promoting effect is incomplete. More clinical cases should be investigated to evaluate further the clinical efficacy of this method for treatment. As we have reported here, the treatment of cranial bone defects by using computer-designed hydroxyapatite ceramics and a periosteal flap is safe and highly effective.

Adult↗

Periosteal chondroma masquerading as osteochondroma.

The authors describe two cases of a lesion that closely resembled osteochondroma occurring at the posterior aspect of the distal femur in the popliteal region. Histopathologic examination after open biopsy revealed that the lesions were periosteal chondromas, and they were resected. Osteochondroma, particularly that undergoing malignant transformation, should perhaps be considered in the differential diagnosis of periosteal chondroma; the key to distinguishing between these two lesions is the separation of periosteal chondroma from the medullary portion of the bone by intervening cortex.

Adult↗

Psoriatic onycho-pachydermo-periostitis. A variant of psoriatic distal interphalangeal arthritis?

BACKGROUND: Joint and nail involvement in psoriasis is relatively common. In contrast, bony involvement of the terminal phalanx under a psoriatic nail is rare. We report on this psoriatic onycho-pachydermo-periostitis and suggest pathophysiologic mechanisms. OBSERVATIONS: Two new cases are reported and the data are compared with the data from eight similar cases reported in the literature. All subjects presented with similar changes--onychopathy, soft-tissue thickening, and radiologic features consisting of bone erosions and a periosteal reaction of the terminal phalanx. Of the 10 patients, two had no history of psoriasis before a diagnosis of psoriatic onycho-pachydermoperiostitis was made. The inflammation is likely transmitted from the psoriatic nail to the adjacent underlying bone by the same mechanism as in enthesopathies. CONCLUSION: Psoriatic onycho-pachydermo-periostitis should be recognized as a specific entity in the spectrum of psoriatic disease.

Adult↗

Juxtacortical dedifferentiated chondrosarcoma from a primary periosteal chondrosarcoma.

In this report, we describe dedifferentiation in a primary periosteal chondrosarcoma in the proximal tibia of a 73-year-old man. The diagnosis of primary periosteal chondrosarcoma was made by the characteristic radiographic, gross, and microscopic features of the tumor. The presence of dedifferentiation, however, in the form of malignant fibrous histiocytoma, was an unexpected histologic finding. Although rare, dedifferentiation is a well-recognized occurrence in secondary chondrosarcomas arising from precursor osteochondromas. This event has not been previously documented in the setting of primary periosteal chondrosarcoma.

Aged↗

The osteogenic potential of free periosteal autografts in tibial fractures with severe soft tissue damage: an experimental study.

The present study was undertaken on 80 adult male New Zealand rabbits to assess the effect of free nonvascularized, autologous, periosteum transplants on bone healing in a rabbit fracture model comparable to a tibial fracture with severe soft tissue damage. Comparison was made between transplantation of free autologous periosteal grafts on the anteromedial side of the tibia and nontransplantation on the contralateral tibia (control). We produced a standardized transverse osteotomy of both tibial diaphyses. The medullary cavity was reamed and nailed ; a 1-cm segment of periosteum was excised from either side of the osteotomy. Periosteal and extraosseous ingrowth was prevented at the osteotomy site by a silastic sheet wrapped around two-thirds of the circumference of the tibia. On the silastic-free bone window, in one group we spanned the osteotomy with a free nonvascularized longitudinally-oriented autologous periosteum sewn to the adjacent periosteum proximally and distally. In the second group, the periosteum was placed transversely with a gap between it and the adjacent periosteum proximally and distally. Revascularization of the graft was determined with the colored microsphere technique. Our data suggest that orthotopically-placed autologous nonvascularized periosteum retains its osteogenic potential in a poorly vascularized environment comparable to a tibial fracture with severe soft tissue damage ; the effect is enhanced if the graft is in contact with intact periosteum. Histologically, callus formation after periosteal grafting resembles endochondral and intramembranous ossification.

Animals↗

Insulin-like growth factor binding proteins localize to discrete cell culture compartments in periosteal and osteoblast cultures from fetal rat bone.

Insulin-like growth factor (IGF)-I and IGF-II are expressed at biologically effective levels by bone cells. Their stability and activity are modulated by coexpression of IGF binding proteins (IGFBPs). Secreted IGFBPs may partition to soluble, cell-associated, and matrix-bound compartments. Extracellular localization may sequester, store, or present IGFs to appropriate receptors. Of the six IGFBPs known, rat osteoblasts synthesize all but IGFBP-1. Of these, IGFBP-3, -4, and -5 mRNAs are induced by an increase in cAMP. Little is known about extracellular IGFBP localization in bone and nothing about IGFBP expression by nonosteoblastic periosteal bone cells. We compared basal IGFBP expression in periosteal and osteoblast bone cell cultures and assessed the effects of changes in cAMP-dependent protein kinase A or protein kinase C. Basal IGFBP gene expression differed principally in that more IGFBP-2 and -5 occurred in osteoblast cultures, and more IGFBP-3 and -6 occurred in periosteal cultures. An increase in cAMP enhanced IGFBP-3, -4, and -5 mRNAand accordingly increased soluble IGFBP-3, -4, and -5 and matrix-bound IGFBP-3 and -5 in both bone cell populations. In contrast, protein kinase C activators suppressed IGFBP-5 mRNA, and its basal protein levels remained very low. We also detected low Mr bands reactive with antisera to IGFBP-2, -3, and -5, suggesting proteolytic processing or degradation. Our studies reveal that various bone cell populations secrete and bind IGFBPs in selective ways. Importantly, inhibitory IGFBP-4 does not significantly accumulate in cell-associated compartments, even though its secretion is enhanced by cAMP. Because IGFBPs bind IGFs less tightly in cell-bound compartments, they may prolong anabolic effects by agents that increase bone cell cAMP.

Animals↗

Idiopathic periosteal hyperostosis with dysproteinemia (Goldbloom's syndrome): case report and review of the literature.

Idiopathic subperiosteal new bone formation is uncommon in childhood. We report a case of diffuse periostitis in association with hypergammaglobulinemia and hypoalbuminemia in a 12-year-old boy. In 1966, 2 cases of idiopathic periosteal hyperostosis with accompanying dysproteinemia were documented. This report serves as a review of this unique and perplexing problem in clinical diagnosis.

Child↗

Successful treatment of psoriatic onycho-pachydermo periostitis (POPP) with adalimumab.

Psoriatic onycho-pachydermo periostitis (POPP) is recognized as a rare subset of psoriatic arthritis, characterized by psoriatic onychodystrophy, connective tissue thickening above the distal phalanx, and a periosteal reaction. Therapy for this rare disease is based on treatments used for psoriatic arthritis, but traditional disease-modifying antirheumatic drugs, such as sulfasalazine and methotrexate, have shown inconsistent and unsatisfactory results. We report herein a successful therapeutic approach for POPP using the fully human anti-tumor necrosis factor (TNF) antibody adalimumab in a 42-year-old male patient. After 4 months of anti-TNF treatment, a remarkable normalization of the clinical appearance was achieved and magnetic resonance imaging showed complete resolution of the initial inflammatory lesions. Therefore, we consider a TNF-blocking strategy as promising for treatment of POPP.

Adalimumab↗

Proliferative periosteal processes of phalanges: a unitary hypothesis.

A unitary hypothesis is offered to explain the various proliferative processes occurring around the phalanges. In the past, these have been separately designated as proliferative periostitis, bizarre parosteal osteochondromatous proliferation, and turret exostosis. Because the appearances of these entities depend on temporal factors, breaching of the periosteum, and local anatomic features, we suggest a single term, proliferative periosteal processes of phalanges.

Bone Diseases↗