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PubMed2000

Deferoxamine-induced bone dysplasia in the distal femur and patella of pediatric patients and young adults: MR imaging appearance.

OBJECTIVE: We investigated the MR imaging appearance of deferoxamine-induced bone dysplasia in the distal femur and patella in patients with thalassemia major. MATERIALS AND METHODS: Thirty-five patients with homozygous ss-thalassemia major who were undergoing regular transfusions and chelation therapy underwent coronal T1-weighted MR imaging of the femur, including the femoral head and the distal femoral epiphysis. Additional coronal fat-saturated dual-echo and sagittal T1-weighted images of the distal femur and patella were obtained in 11 patients who were suspected of having distal femoral lesions on the basis of the coronal T1-weighted images of the entire femur. RESULTS: No dysplastic change was detected in the proximal femur on coronal T1-weighted images. In 22 distal femurs of 11 patients, the following abnormalities were detected on MR imaging: blurred physeal-metaphyseal junction (n = 22), distal metaphyseal areas of hyperintensity (n = 21), physeal widening (n = 18), metadiaphyseal lesions (n = 11), epiphyseal lesions (n = 10), and patellar lesions (n = 2). Physeal widening and distal metaphyseal hyperintense areas were all more pronounced peripherally. Of the 21 distal metaphyseal hyperintensities, lateral abnormalities were larger than medial abnormalities in 16. Of the 18 distal femurs in which physeal widening was detected, the lateral widening was more marked than the medial widening in 12. Patients with MR imaging evidence of bone dysplasia have a significantly (p = 0.003) greater height reduction than patients without such evidence of bone dysplasia. CONCLUSION: Deferoxamine-induced bone dysplasia in the distal femur and patella is represented by a spectrum of morphologic changes in the epiphysis, physis, metaphysis, and metadiaphysis on MR imaging.

Adolescent↗
PubMed2001

Deferoxamine-induced dysplasia of the knee: sonographic features and diagnostic performance compared with magnetic resonance imaging.

OBJECTIVE: To evaluate the features and diagnostic performance of sonography in the assessment of deferoxamine-induced dysplasia of the knee. METHODS: The left knees of 32 patients with thalassemia who were receiving regular blood transfusions and chelation therapy were studied with sonography for signs of deferoxamine-induced bone dysplasia. Abnormal physeal and metaphyseal changes detected on sonography included notching at the metaphyseal corner, a blurred or irregular peripheral juxtaphyseal metaphyseal contour, and widening of the peripheral juxtaphyseal metaphyseal echogenic interface. The accuracy of sonography in diagnosing dysplasia was evaluated by using magnetic resonance imaging as the standard of reference. RESULTS: There were 14 true-positive findings, 10 true-negative findings, 7 false-negative findings, and 1 false-positive sonographic diagnosis of dysplasia, giving 67% sensitivity, 91% specificity, a 93% positive predictive value, and a 59% negative predictive value. CONCLUSION: Sonography was specific but only moderately sensitive in the diagnosis of deferoxamine-induced dysplasia at the knee when compared with magnetic resonance imaging.

Adolescent↗
PubMed2002

Stimulatory effect of menaquinone-7 on bone formation in elderly female rat femoral tissues in vitro: prevention of bone deterioration with aging.

Menaquinone-7 (MK-7) is vitamin K2 which is a series of vitamins with multiisoprene units at the 3-position of the naphthoquinone. MK-7 has been shown to prevent bone loss in ovariectomized rats, an animal model for osteoporosis. This study was undertaken to determine whether MK-7 has a stimulatory effect on bone components of elderly female rats in vitro. The femoral-diaphyseal and -metaphyseal tissues obtained from young (4 weeks old) or elderly (50 weeks old) female rats were cultured for 48 h in a Dullbecco's modified Eagle's medium (high glucose, 4.5%) supplemented with antibiotics and bovine serum albumin. Calcium content, alkaline phosphatase activity and deoxyribonucleic acid (DNA) in the diaphyseal and metaphyseal tissues obtained from elderly rats were significantly decreased as compared with those of young rats, indicating that aging causes a deterioration of bone formation. The presence of MK-7 (10(-6) or 10(-5) M) caused a significant increase in biochemical components in the femoral-diaphyseal and -metaphyseal tissues obtained from elderly rat in vitro. The anabolic effect of MK-7 (10(-6) or 10(-5) M) on the femoral calcium content was significantly enhanced in the presence of phytoestrogen genistein (10(-6) or 10(-5) M), suggesting that the mode of action of MK-7 differ from that of genistein. The effect of MK-7 (10(-5) M) in increasing calcium content, alkaline phosphatase activity and DNA content in the diaphyseal and metaphyseal tissues was completely abolished in the presence of cycloheximide (10(-6) M), an inhibitor of protein synthesis in vitro. These findings demonstrate that MK-7 has a stimulatory effect on bone formation in the femoral tissues of elderly female rats in vitro. MK-7 may have a preventive role for bone deterioration with aging.

Aging↗
PubMed2003

[Segmental tibia fractures: a critical retrospective analysis of 49 cases].

PURPOSE OF THE STUDY: Segmental tibia fracture is defined by the presence of two distinct fracture lines separating the cortical and completely isolating an intermediary segment of the tibia. Little work has been published on this clinical entity. We report a retrospective analysis of 49 patients treated in one center for segmental tibia fracture in order to determine more precisely the indications for three surgical techniques: locked intramedullary nailing with or without reaming, and external fixation. MATERIAL AND METHODS: The series included 34 men and 15 women, mean age 40.8 years. All patients had traffic accident: 25 had multiple fractures, 17 had multiple organ injury, and 9 had floating knees. There were 30 open fractures; 2 patients developed compartment syndrome. The segments were: distal-proximal metaphyso-metaphyseal (n=1), proximal diaphyso-metaphyseal (n=17), diaphyso-diaphyseal (n=27), and distal diaphyso-metaphyseal (n=4). The mean length of the intermediary segment was 14.1 cm. The emergency procedure involved intramedullary nailing with reaming (Grosse-Kempf nail) in 32 patients, intramedullary nailing without reaming in 7 patients (Collin nail in 5 and UTN in 2) and external fixation with non-transfixing pins in 10 patients (Orthofix). External fixation was converted early to intramedullary nailing in three patients (Grosse-Kempf nail in 2 and Collin nail in 1). RESULTS: Three patients were excluded: 2 underwent amputation after failure of vessel repair and 1 developed septic necrosis of a free latissimus dorsi flap; 1 patient died from multiple organ failure. Outcome at at least 18 months was known for 42 patients (4 patients lost to follow-up). There were 4 cases of post-nailing compartment syndrome; one case of deep infection on a Grosse-Kempf nail was treated by external fixation. Among the 27 patients with segment tibia fractures finally stabilized with a Grosse-Kempf nail, nonunion developed in 8; mean time to bone healing was 10 +/- 4.8 months (with dynamization in 13 patients). For the 7 external fixations, nonunion developed in 2; mean time to bone healing was 9.2 +/- 2.9 months. For the 8 nailings without reaming, nonunion developed in 2; mean time to bone healing was 9.5 +/- 2.5 months. Bone healing was not simultaneous in the two foci in more than half of patients. Two patients developed clinical sequelae of their compartment syndrome with deficient knee flexion in two. The 12 cases of aseptic nonunion were successfully treated by nailing with reaming and early weight bearing. DISCUSSION: Comparing our results with the therapeutic modalities used in published reports on segmentary tibia fractures showed that time to bone healing and the rate of nonunion were generally greater than in our series. A critical analysis of these results allows us to propose a more interventionalistic attitude before the development of late healing. We also propose a classification of segmental tibia fractures and a decisional tree for choosing between the three techniques based on the presence of soft tissue damage, the presence of compartment syndrome (nailing without reaming), and the presence of proximal or distal metaphyseal fractures (distal locked nail). Nailing with moderate reaming remains the preferred method.

Adolescent↗
PubMed1992

Morphology of epiphyseal apparatus of a ranid frog (Rana Esculenta)

Morphological, histochemical and ultrastructural investigations on epiphyseal apparatus of Rana Esculenta were made. The most important findings were the following: 1) metaphyseal cartilage is localized inside proximal diaphyseal compact bone as a plug; 2) metaphyseal cartilage do not reduce in thickness during ageing; 3) metaphyseal cartilage do not show vascular invasion and do not mineralize in degenerative zone; 4) trabecular bone was not at all evident in this animal; 5) external periosteum is well vascularized and proliferates in correspondence to marginal epiphyseal end of the diaphyseal. From these results the hypothesis that the ranid frog bone growth is not due to metaphyseal metabolism (as in avian and mammals) but to bone periosteal marginal mineralization is reached.

Age Factors↗
PubMed2006

Oral administration of beta-cryptoxanthin prevents bone loss in ovariectomized rats.

The effect of beta-cryptoxanthin, a kind of carotenoid, on ovariectomy-induced bone loss was investigated. beta-cryptoxanthin was isolated from Satsuma mandarin (Citrus unshu. MARC). beta-cryptoxanthin (5 or 10 microg/100 g body weight) was orally administered once daily for 3 months to ovariectomized (OVX) rats. OVX induced a significant increase in body weight and a significant decrease in serum calcium and inorganic phosphorus concentrations as compared with those of sham-operated (control) rats. These alterations induced by OVX were significantly prevented by the administration of beta-cryptoxanthin (5 or 10 microg/100 g). The analysis using a peripheral quantitative computed tomography (pQCT) showed that OVX induced a significant decrease in mineral content and mineral density in the femoral-diaphyseal and -metaphyseal tissues and polar strength strain index in the metaphyseal tissues. These decreases were significantly prevented by the administration of beta-cryptoxanthin (5 or 10 microg/100 g). Moreover, OVX induced a significant decrease in calcium content and alkaline phosphatase activity in the femoral-diaphyseal and -metaphyseal tissues and deoxyribonucleic acid (DNA) content in the metaphyseal tissues. These decreases were significantly prevented by the administration of beta-cryptoxanthin (5 or 10 microg/100 g). This study demonstrates that beta-cryptoxanthin has a preventive effect on OVX-induced bone loss in vivo.

Administration, Oral↗
PubMed1992

Spontaneous recovery from growth disturbances and osteopenia induced by a high carbohydrate diet in hamsters.

Femoral osteopenic changes characterized by a fall in metaphyseal trabecular bone volume (TBV) have been previously reported in hamsters fed a high carbohydrate diet for 45 days. In the present study the effects of the diet were assessed after 90 days. Serum P was significantly reduced (p less than 0.05) in experimental animals; serum Ca was unaltered. Disturbances in body growth had occurred as shown by a reduction in body weight gain (p less than 0.05) in the first 45 days of the experiment and by a decrease in femoral size (p less than 0.02). Osteopenia had also developed: the epiphyseal TBV decreased (p less than 0.05) as well as the thickness of both epiphyseal and metaphyseal trabeculae (p less than 0.001). However signs of partial recovery from this condition were observed as shown by an increased body weight gain in the last 45 days of the experiment (p less than 0.02) and lack of difference in metaphyseal TBV, assumed to be the more labile, between the 2 groups. Moreover bone formation significantly increased along metaphyseal trabeculae and the endosteal aspect of the cortices.

Animals↗
PubMed2006

[The effect of bone marrow ablation on regional biomechanical properties of rat tibia].

OBJECTIVES: Regional (metaphyseal-diaphyseal) biomechanical properties of normal rat tibia, and changes on these biomechanical properties after bone marrow ablation, a model of fracture healing, were examined. METHODS: The study included 24 Sprague-Dawley rats that underwent tibial marrow ablation, and eight control rats with no surgical procedure. Proximal metaphyseal, proximal diaphyseal, distal diaphyseal, and distal metaphyseal samples were prepared from the tibias of all rats. In the control group, stiffness (elastic modulus, E), strength (maximum strength, Smax), and toughness (total energy absorption, U) parameters of the regional tibial segments were evaluated under compression loads. In the experimental group, compression was applied following bone marrow ablation on days 1, 3, 7, 9, and 15, and ablation-induced changes in the regional biomechanical properties were studied. RESULTS: The lowest E, Smax, and U values were obtained from the proximal metaphysis. The highest E and Smax values were from the distal diaphyseal, and the highest U values were from the proximal diaphyseal regions. In ablation-induced rats, decreases were observed in all the mechanical test values during days 1 to 7, followed by slight increases on days 7 to 9, and eventual decreases on days 9 to 15. There were significant differences between the two groups with respect to biomechanical parameters (p<0.05), but no significant differences were found between the tibial regions (p>0.05). CONCLUSION: Biomechanically, the most resistant and the weakest anatomic regions of normal rat tibia are the diaphyseal region and proximal metaphysis, respectively. The metabolic changes occurring after bone marrow ablation lead to changes in the mechanical properties of the tibia. The most affected tibial segments from ablation-induced intramedullary injury are the metaphyseal segments.

Animals↗
PubMed1975

The lead line in bone---a lesion apparently due to chondroclastic indigestion.

The metaphyseal line of increased radiodensity which occurs in lead poisoning was studied in children and young monkeys with lead encephalopathy and in guinea pigs. The histologic lesion consists of impaired resorption of calcified metaphyseal cartilage, depressed bone deposition on cartilaginous surfaces, and the accumulation of numerous multinucleate giant cells, some containing lead inclusions. By electron microscopy, the giant cells appear to be osteoclasts and chondroclasts containing large amounts of mineralized cartilage matrix. We interpret the lead line to be the result of a lead-induced inability of cartilage-resorbing cells to degrade mineralized matrix, with a resultant impairment of metaphyseal cartilage resorption. The radiodensity of the lead line would thus be due to persistent mineralized metaphyseal cartilage and not to a primary osseous change. Some observations on lead inclusions in these cells suggest that the fibrillar component forms before the amorphous part.

Animals↗
PubMed1991

Radiographic findings in young llamas with forelimb valgus deformities: 28 cases (1980-1988).

Twenty-eight llamas with a mean age of 6.2 months had bilateral forelimb valgus deformities. The range of valgus deformity, as measured on a craniocaudal radiographic view, was 6 to 25 degrees, with a similar degree of deviation in each limb. Morphologic abnormalities in the distal portion of the radius and ulna were more prominent in the ulna and included metaphyseal and epiphyseal flaring, physeal ectasia, and metaphyseal sclerosis. Distal radial epiphyseal ectasia, and metaphyseal sclerosis. Distal radial epiphyseal wedging was believed to be secondary to the ulnar deformity. Radial bowing with lateral and caudal concavity and unequal cortical thickness was evident. Epiphyseal and metaphyseal flaring with physeal ectasia was noticed in the distal portion of the third and fourth metacarpal bones. Carpal bones were unaffected.

Animals↗
PubMed1984

The effect of iatrogenic trauma on the bone scintigram: an animal study: concise communication.

An animal study was performed to assess the effect on the Tc-99m phosphate bone scintigram of injury by needle aspiration or drill hole to metaphyseal and diaphyseal areas in immature and mature bones. Results showed that in 12 immature rabbits such trauma to metaphyseal regions had no effect on the bone image. Similar metaphyseal trauma in two mature dogs showed definite abnormalities on the bone image, but in one mature rabbit, no abnormality could be identified by scintigram. Diaphyseal trauma always gave a definitely abnormal bone image. Extrapolation of these results to humans should be cautious, but it suggests that needling or drilling in metaphyseal regions in neonates or young children probably does not affect later bone images.

Age Factors↗
PubMed1982

Scanning electron microscopy of the femoral epiphyseal plate and metaphysis of the rat after short-term fluoride ingestion.

Anorganic preparations of the distal metaphyseal and epiphyseal regions of the femoral bones from young male rats given 150 ppm fluoride in the drinking water for 10 weeks were examined by scanning electron microscopy. Longitudinal sections of the bones revealed an increase in the zone of mature hypertrophied cells of the epiphyseal plates as compared with controls. The lacunae in this zone varied considerably in size and shape, and were arranged in irregular nests rather than in parallel rows. Within the cavity of the shaft, the amount of cancellous bone was reduced, particularly in the central areas of the metaphyses where the network of trabeculae was sparsely distributed. The trabeculae located in the more peripheral areas of the metaphyses were broad and heavy in appearance. Areas of fully or partially mineralized bone were markedly reduced. The bone surfaces were rough, irregular and covered with numerous Howship's lacunae. The results of this investigation indicate that the initial effects of fluoride on bone include an inhibition of resorption in the epiphyseal plate coupled with an increase in resorption of metaphyseal trabecular bone.

Animals↗
PubMed1995

[Bone reaction to contact with a granulated titanium surface. Apropos of 101 total hip prostheses with six years follow-up].

PURPOSE OF THE STUDY: The failures of cemented hip prosthesis have prompted research into a new process of fixation and a new design of the system. Stability is achieved by adherence the bone onto a blasted titanium surface. The shell is implanted without screws. The stem has an anatomical shape to improve metaphyseal fixation of the femur. MATERIAL AND METHODS: The rugosity of the blasted titanium surface which has an average depth of 50 millimicrons allows new bone-growth without any fibrous interposition. Bone ingrowth starts from the third week onward and within two years a homogenous bone sheath is produced. Several experiments on animals have shown the quality of the bone-growth onto this blasted surface. The bone reaction has the same qualities as a hydroxy-apatite coating. It is of better quality than other titanium surfaces. The press-fit obtained by the shape allows this bone-growth. The reliability of this biological fixation is enabled for the shell by the perfect distribution of loads due to the hemispherical shape and the greatest possible thickness of the polyethylene. For the stem, the purely metaphyseal fixation appears to be a very important factor to enable painless long term stability. Another advantage of this method of fixation is that the prosthesis can be removed without any damage to the bone and can be reimplanted without any artificial fixtures with excellent results. RESULTS: Histological results. Within a few weeks a new strip of bone will settle onto the porous metal without any fibrous interposition. This strip is connected to the cortical bone by small brackets of bone which gradually thicken over the months and guarantee anchorage. Radiological results. In 1 per cent of all cases a border or a gap has formed around the shell; there is no migration. Around the proximal part of the stem thin ribs in tension appeared at the beginning and over the months the width of these increased. Within two years they had filled the space between the metal and the cortical bone. Around the distal part of the stem, which is smooth, there is no bone-growth. Clinical results. In nearly 94 per cent of cases a perfect result was obtained which could only be achieved if the prosthesis was perfectly stable. There was mild pain in only 4 per cent of cases. Revision and observation. Two revisions for ceramic head fracture confirmed that it was possible to remove the prosthesis without damage to the bone. DISCUSSION: A correct pressure distribution on bone would appear desirable for the two components. For the acetabulum a thick layer of polyethylene and for the stem a metaphyseal anchorage are desirable. CONCLUSION: It is perhaps too early at this stage to speculate on the long term results. Nevertheless as of now we observe that the principle of a metaphyseal fixation significantly decreases the incidence of mild pain. On the other hand, the follow-up of nearly seven years of bone fixation on a blasted titanium surface would seem sufficient to show us that this method has proven to be a significant improvement.

Animals↗
PubMed1997

[Value of external fixation in proximal tibial fractures].

PURPOSE OF THE STUDY: This study was a retrospective analysis of 39 proximal metaphyseal tibial fractures treated by Orthofix fixator in two trauma departments. MATERIAL AND METHOD: There were 28 men and 10 women with a mean age of 49.5 years. 13 pedestrians were stroked by a car and 18 had a traffic accident on a motorcycle. In 27 cases, the fracture was open with following Cauchoix grading: 15 types 2, 6 types 1 and 6 types 3. All fractures were partially or totally included in the proximal epiphyseal square of the AO system. 14 fractures were metaphyseal, 13 diaphyso-metaphyseal and 12 had an articular irradiation. All external fixations were performed using the Orthofix device, with image intensification. A partial weight bearing was allowed for 2.4 months as an average and full weight bearing at mean 3.7 months. 7 skin grafts, 2 micro surgical (latissimus dorsi) and 2 local flaps were necessary. RESULTS: In 3 patients this technique failed. 3 patients had an autologous bone graft at the metaphyseal and 2 at the diaphyseal fracture site. 30 patients healed without other procedure after an average delay of 5.5 months. During the healing and weight bearing time, 6 frontal deformities appeared and 5 flexion contractures were not reoperated. With a minimum follow up of one year (mean 3 years) 22 fractures had no deformity, 8 had a valgus deformity (5 degrees to 10 degrees) and 3 a varus deformity (6 to 17 degrees). For the 25 patients with an isolated proximal tibial fracture, 11 (44%) had an excellent functional result (no pain, full range knee motion, normal daily activity); 12 (48%) had a good result (episodic pain, minimally knee discomfort, flexion limitation). DISCUSSION: Orthofix fixator appear to be a good solution for comminuted fractures. These fractures have anatomical and epidemiological particularities. AO classification system is not useful; a new one is proposed. External fixator must be placed meticulously after closed fracture reduction.

Accidents, Traffic↗
PubMed1989

The (even) bolder model. The clinical psychologist as metaphysician-scientist-practitioner.

Is the clinical psychologist best characterized as a scientist-practitioner? Or does the practice of science and psychotherapy involve metaphysics to such an extent that the clinical psychologist ought to be considered a metaphysician-scientist-practitioner? To answer these questions, the roles, if any, of metaphysics in science and psychotherapy are examined. This article investigates this question by examining the views of the logical positivists, Karl Popper and Imre Lakatos, and concludes that the practice of science and psychotherapy involves metaphysics in (a) problem choice, (b) research and therapy design, (c) observation statements, (d) resolving the Duhemian problem, and (e) modifying hypotheses to encompass anomalous results.

Humans↗
PubMed1994

Lessons from the Tao for birthing practice.

The metaphysics of the Tao Te Ching, as the basic structure of the universe, is used to examine birthing as creation. Lessons from the Tao regarding cultivating naturalness are drawn upon to provide suggestions for women in preparation for birthing, as well as for the nurses and midwives who attend them. Compatibility of this metaphysical view of birthing with Rogers's and Newman's nursing theories is identified, and the importance of honoring the metaphysical and spiritual aspects of birthing in nursing practice is stressed.

Female↗
PubMed2000

SPONASTRIME dysplasia: report of an 11-year-old boy and review of the literature.

SPONASTRIME (SPOndylar and NAsal changes, with STRIations of the MEtaphyses) dysplasia is a rare, autosomal recessive bone disorder first described by Fanconi et al. [1983: Helv Paediatr Acta 38:267-280]. Radiographic findings include abnormal vertebral bodies with age-dependent changes, and striations of the metaphyses, scoliosis, and retarded ossification of the carpal bones. Physical features include severe short stature, lumbar lordosis, midface hypoplasia, frontal bossing, and a depressed nasal root. To date, 12 patients from 6 families have been reported. Four additional patients have been reported with a variant of this condition, which includes mental retardation. We report on an 11-year-old boy with features consistent with SPONASTRIME dysplasia. Height was 106.1 cm (-6 SD). He had a coarse appearing face with a depressed nasal bridge, short, upturned nose, and midface hypoplasia. Intelligence was normal. A clinical evaluation at 6 years of age suggested the diagnosis of spondyloepiphyseal dysplasia (SED). However, genetics evaluation at 11 years of age with repeat radiologic studies revealed delayed carpal ossification (-4 to -5 SD), metaphyseal irregularities and striations most notably in the distal femurs and the proximal tibias, lumbar lordosis, narrow interpedicular distances of the lumbar spine, and pear-shaped vertebral bodies. These findings were most consistent with the diagnosis of SPONASTRIME dysplasia, and not SED. Although radiographic findings of SPONASTRIME dysplasia are distinguishable from SED, the physical appearance may be similar. Many bone dysplasias have overlapping radiographic findings and clinical presentation but with different recurrence risks, making genetic counseling a challenge.

Adolescent↗
PubMed1993

Nonepiphyseal giant cell tumor of the long bones. Clinical, radiologic, and pathologic study.

BACKGROUND: Giant cell tumors (GCT) usually involve the epiphyses of long bones and only rarely involve the metaphysis or diaphysis without epiphyseal extension. METHODS: This report presents the clinical and pathologic features of 14 patients with metaphyseal and diaphyseal GCT. Of these tumors, 10 were metaphyseal; 2, metadiaphyseal; and 2, diaphyseal. RESULTS: The sites of involvement included the proximal tibia in six patients, distal radius in three, proximal fibula in one, distal fibula in one, distal ulna in one, proximal humerus in one, and distal femur in one. Radiographically, the tumors were lucent, and the majority were sharply marginated without sclerosis. By contrast with conventional epiphyseal GCT, which generally appear in the mature skeleton, a large proportion (50%) of the GCT in this series were in patients who had open epiphyseal growth plates. Despite the unusual clinical presentation, the behavior of metaphyseal and diaphyseal GCT was similar to that of the typical epiphyseal GCT. There was a 43% recurrence rate after curettage in this series. CONCLUSIONS: It is important to distinguish this subset of GCT from other giant cell-rich lesions more common in these sites, including aneurysmal bone cyst, osteosarcoma, and nonossifying fibroma.

Adolescent↗