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BACKGROUND: Osteolysis is one of the most prevalent clinical complications affecting people who undergo total joint replacement (TJR). Wedelolactone (WDL) is a coumestan compound derived from the Wedelia chinensis plant and has been demonstrated to exhibit anti-inflammatory properties. This study aimed to investigate the oral administration of WDL as a potential treatment for particle-induced osteolysis using a well-established mice calvarial disease model. METHODS: Thirty-two C57BL/6 J mice were randomized into four groups: Sham, vehicle, osteolysis group with oral WDL treatment for 4 weeks (WDL 4w), and osteolysis group treated for 8 weeks (WDL 8w). Micro-CT was used to quantitatively analyze the bone mineral density (BMD), bone volume/tissue volume (BV/TV) and trabecular bone thickness (Tb.Th). Osteoclast numbers were also measured from histological slides by two investigators who were blind to the treatment used. RESULTS: The results from micro-CT observation showed that BMD in the WDL 8w group improved significantly over the vehicle group (p < 0.05), but there was no significant difference between WDL 4w and 8w for BV/TV and Tb.Th. Osteoclast numbers in the WDL 4w group were also lower than the vehicle group (p < 0.05), but the difference between WDL 8w and 4w groups was not significant. CONCLUSIONS: Particle-induced osteolysis is an inevitable long-term complication after TJR. The results of this animal study indicate that an oral administration of WDL can help reduce the severity of osteolysis without adverse effects.
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Osteólisis , Animales , Cumarinas , Humanos , Ratones , Ratones Endogámicos C57BL , Osteólisis/inducido químicamente , Osteólisis/diagnóstico por imagen , Osteólisis/tratamiento farmacológico , Extractos Vegetales/uso terapéutico , Proyectos de InvestigaciónRESUMEN
BACKGROUND: Magnetic resonance guided focused ultrasound was suggested for the induction of deep localized hyperthermia adjuvant to radiation- or chemotherapy. In this study we are aiming to validate an experimental model for the induction of uniform temperature elevation in osteolytic bone tumours, using the natural acoustic window provided by the cortical breakthrough. MATERIALS AND METHODS: Experiments were conducted on ex vivo lamb shank by mimicking osteolytic bone tumours. The cortical breakthrough was exploited to induce hyperthermia inside the medullar cavity by delivering acoustic energy from a phased array HIFU transducer. MR thermometry data was acquired intra-operatory using the proton resonance frequency shift (PRFS) method. Active temperature control was achieved via a closed-loop predictive controller set at 6 °C above the baseline. Several beam geometries with respect to the cortical breakthrough were investigated. Numerical simulations were used to further explain the observed phenomena. Thermal safety of bone heating was assessed by cross-correlating MR thermometry data with the measurements from a fluoroptic temperature sensor inserted in the cortical bone. RESULTS: Numerical simulations and MR thermometry confirmed the feasibility of spatio-temporal uniform hyperthermia (± 0.5 °C) inside the medullar cavity using a fixed focal point sonication. This result was obtained by the combination of several factors: an optimal positioning of the focal spot in the plane of the cortical breakthrough, the direct absorption of the HIFU beam at the focal spot, the "acoustic oven effect" yielded by the beam interaction with the bone, and a predictive temperature controller. The fluoroptical sensor data revealed no heating risks for the bone and adjacent tissues and were in good agreement with the PRFS thermometry from measurable voxels adjacent to the periosteum. CONCLUSION: To our knowledge, this is the first study demonstrating the feasibility of MR-guided focused ultrasound hyperthermia inside the medullar cavity of bones affected by osteolytic tumours. Our results are considered a promising step for combining adjuvant mild hyperthermia to external beam radiation therapy for sustained pain relief in patients with symptomatic bone metastases.
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Neoplasias Óseas/terapia , Hipertermia Inducida/métodos , Anciano , Animales , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Terapia Combinada , Simulación por Computador , Estudios de Factibilidad , Femenino , Ultrasonido Enfocado de Alta Intensidad de Ablación/métodos , Humanos , Técnicas In Vitro , Imagen por Resonancia Magnética/métodos , Modelos Animales , Osteólisis/diagnóstico por imagen , Osteólisis/terapia , Ovinos , Análisis Espacio-Temporal , Temperatura , Investigación Biomédica TraslacionalRESUMEN
Multiple myeloma (MM) is a clonal plasma cell proliferative disorder characterized by primary infiltration of bone marrow and excessive production of abnormal immunoglobulin. This disease is the second most common hematologic malignancy (after lymphoma), and its spectrum of characteristic features are widely known by the acronym CRAB (hypercalcemia, renal impairment, anemia, and bone lesions). Traditionally, the diagnosis and treatment of MM have been triggered by clear end-organ damage. However, owing to recently introduced treatment options that can extend patient survival and the increasing recognition of biomarkers that can be used to identify patients at high risk of progression to active disease, the diagnostic criteria have been revised. Bone disease is one of the most prominent features of MM, and imaging has an important role in diagnosis and follow-up, with each whole-body imaging modality having different indications in distinct disease situations. Skeletal survey has been the standard imaging procedure used during the past decade, but it should no longer be used unless it is the only option. Whole-body low-dose CT is a reasonable and cost-effective initial imaging approach. Whole-body MRI is the most sensitive technique for detecting bone involvement and assessing painful complications. PET/CT is the best tool for evaluating treatment response. The importance of radiologists has increased in this scenario. Therefore, to properly assist hematologists and improve the care of patients with MM, it is essential that radiologists know the updated diagnostic criteria for MM, indications for and limitations of each imaging option, and recommendations for follow-up. Online supplemental material is available for this article. ©RSNA, 2019.
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Mieloma Múltiple/diagnóstico por imagen , Imagen de Cuerpo Entero/métodos , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Enfermedades Óseas Metabólicas/etiología , Médula Ósea/diagnóstico por imagen , Médula Ósea/patología , Diagnóstico Diferencial , Humanos , Mieloma Múltiple/complicaciones , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/patología , Neoplasia Residual , Osteólisis/diagnóstico por imagen , Osteólisis/etiología , Plasmacitoma/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Tomografía de Emisión de Positrones/métodos , Valor Predictivo de las Pruebas , Radiofármacos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Particle-induced implant loosening is a major challenge to long-term survival of joint prostheses. Administration of intermittent parathyroid hormone (PTH) has shown potential in the treatment of cases of early-stage periprosthetic osteolysis, while sequential administration of intermittent PTH (iPTH) and bisphosphonates (Bps) has achieved significant effects on treatment of postmenopausal osteoporosis. The objective of this study was to determine whether sequential treatment could preserve bone mass and implant fixation during a pathological course of peri-implant osteolysis in a rat model. Ninety male Sprague Dawley rats were randomly divided into nine groups, four of which were used for confirmation of establishment of the peri-implant osteolysis model at two time points, while the other five were used to determine the efficiency of the sequential treatment on peri-implant osteolysis. Implant fixation and peri-implant bone mass were evaluated using biomechanical testing, micro-CT analysis, and histology at 6 and 12 weeks postoperative. The biomechanical test demonstrated that the maximum loading force during a push-out test was significantly elevated in the sequential treatment group compared to the osteolysis group and iPTH withdrawal group at 12 weeks. Peri-implant bone morphology also indicated a robust increase in bone volume in the sequential treatment group. Sequential administration of iPTH and Bps was effective in preventing experimental peri-implant osteolysis, resulting in improved implant fixation and increased peri-implant bone volume. Clinical significance: The innovative application of sequential treatment in peri-implant osteolysis could be used clinically to improve the prognosis of patients with early-stage periprosthetic osteolysis. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1489-1497, 2019.
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Conservadores de la Densidad Ósea/administración & dosificación , Osteólisis/tratamiento farmacológico , Hormona Paratiroidea/administración & dosificación , Falla de Prótesis/efectos de los fármacos , Ácido Zoledrónico/administración & dosificación , Animales , Huesos/diagnóstico por imagen , Huesos/patología , Evaluación Preclínica de Medicamentos , Masculino , Osteólisis/diagnóstico por imagen , Osteólisis/etiología , Osteólisis/patología , Distribución Aleatoria , Ratas Sprague-Dawley , Microtomografía por Rayos XRESUMEN
Purpose To evaluate the use of susceptibility-weighted MRI for the differentiation of predominantly osteoblastic and osteolytic spine metastases. Materials and Methods For this prospective study, 53 study participants (mean age, 54.5 years ± 14.3 [range, 22-88 years]; 27 men with a mean age of 55.3 years ± 12.7 [range, 22-72 years] and 26 women with a mean age of 53.8 years ± 15.7 [range, 23-88 years]) with clinically suspected spine metastases underwent imaging with standard MRI sequences, susceptibility-weighted MRI, and CT. Sensitivities and specificities of MRI sequences for the detection of predominantly osteoblastic and osteolytic metastases were determined by using CT as the reference standard. The metastases-to-vertebral body signal intensity ratio (MVR) was calculated to compare modalities. Phantom measurements were obtained to correlate bone densities between MRI sequences and CT. Results A total of 64 metastases (38 predominantly osteoblastic, 26 predominantly osteolytic) were detected. Susceptibility-weighted MRI achieved a sensitivity of 100% (38 of 38) and specificity of 96% (25 of 26) for predominantly osteoblastic metastases and a sensitivity of 96% (25 of 26) and specificity of 100% (38 of 38) for predominantly osteolytic metastases. Standard MRI sequences achieved a sensitivity of 89% (34 of 38) and specificity of 73% (19 of 26) for predominantly osteoblastic metastases and a sensitivity of 73% (19 of 26) and specificity of 92% (35 of 38) for predominantly osteolytic metastases. MVR measurements obtained with susceptibility-weighted MRI demonstrated a strong correlation with those obtained with CT (R2 = 0.75), whereas those obtained with T1-weighted MRI, T2-weighted MRI, and turbo inversion-recovery magnitude MRI showed a weak to moderate correlation (R2 = 0.00, R2 = 0.35, and R2 = 0.39, respectively). Susceptibility-weighted MRI showed a strong correlation with CT with regard to metastases size (R2 = 0.91). In phantom measurements, susceptibility-weighted MRI enabled the reliable differentiation of different degrees of mineralization (R2 = 0.92 compared with CT). Conclusion Susceptibility-weighted MRI enables the reliable differentiation between predominantly osteoblastic and osteolytic spine metastases with a higher accuracy than standard MRI sequences. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Schweitzer in this issue.
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Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Magnética/métodos , Neoplasias de la Columna Vertebral , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/patología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteólisis/diagnóstico por imagen , Fantasmas de Imagen , Estudios Prospectivos , Sensibilidad y Especificidad , Neoplasias de la Columna Vertebral/clasificación , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/secundario , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
BACKGROUND: Osteoarthritis (OA) is a slow progressing, degenerative disorder of the synovial joints. Guilu Erxian Glue (GEG) is a multi-component Chinese herbal remedy with long-lasting favorable effects on several conditions, including articular pain and muscle strength in elderly men with knee osteoarthritis. The present study aimed to identify the effects of Guilu Erxian Paste (GE-P) and Liquid (GE-L) extracted from Guilu Erxian Glue in anterior cruciate ligament transection (ACLT)-induced osteoarthritis mice, and to compare the effectiveness of different preparations on knee cartilage degeneration during the progression of osteoarthritis. METHODS: Male C57BL/6J mice underwent anterior cruciate ligament transection to induce mechanically destabilized osteoarthritis in the right knee. 4 weeks later, the mice were orally treated with PBS, celecoxib (10 mg/kg/day), Guilu Erxian Paste (100 or 300 mg/kg/day), and Guilu Erxian Liquid (100 or 300 mg/kg/day) for 28 consecutive days. Von Frey and open-field tests (OFT) were used to evaluate pain behaviors (mechanical hypersensitivity and locomotor performance). Narrowing of the joint space and osteophyte formation were examined radiographically. Inflammatory cytokine (IL-1ß, IL-6, and TNF-α) levels in the articular cartilage were determined by quantitative real-time PCR. Histopathological examinations were conducted to evaluate the severity and extent of the cartilage lesions. RESULTS: Guilu Erxian Paste and Guilu Erxian Liquid (300 mg/kg/day) were significantly more effective (p < 0.01) than celecoxib (10 mg/kg/day) in decreasing secondary allodynia when compared to the saline-treated group (#p < 0.05). Open-field tests revealed no significant motor dysfunction between the Guilu Erxian Paste- and Guilu Erxian Liquid-treated mice compared to the saline-treated mice. Radiographic findings also confirmed that the administration of Guilu Erxian Paste and Guilu Erxian Liquid (100 and 300 mg/kg/day) significantly and dose-dependently reduced osteolytic lesions and bone spur formation in the anterior cruciate ligament transection-induced osteoarthritis mice when compared to the saline-treated group. Notably, Guilu Erxian Liquid (100 mg/kg/day) treatment significantly reduced the mRNA levels of IL-1ß, IL-6, and TNF-α as well as relative the protein expression of IL-1ß and TNF-α to the effect of celecoxib. Guilu Erxian Paste and Guilu Erxian Liquid (300 mg/kg/day) markedly attenuated cartilage destruction, surface unevenness, proteoglycan loss, chondrocyte degeneration, and cartilage erosion in the superficial layers (##p < 0.01 and ###p < 0.001 respectively). CONCLUSIONS: As expected, our findings suggest that the anti-inflammatory effects of Guilu Erxian Liquid (GE-L), following marked decrease on both IL-1ß and TNF-α during the early course of post-traumatic osteoarthrosis (OA), may be of potential value in the treatment of osteoarthritis.
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Antiinflamatorios no Esteroideos/uso terapéutico , Artritis Experimental/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Osteoartritis/tratamiento farmacológico , Animales , Artritis Experimental/diagnóstico por imagen , Artritis Experimental/patología , Cartílago Articular/efectos de los fármacos , Cartílago Articular/patología , Citocinas/biosíntesis , Citocinas/genética , Progresión de la Enfermedad , Evaluación Preclínica de Medicamentos/métodos , Regulación de la Expresión Génica/efectos de los fármacos , Mediadores de Inflamación/metabolismo , Masculino , Ratones Endogámicos C57BL , Actividad Motora/efectos de los fármacos , Osteoartritis/diagnóstico por imagen , Osteoartritis/patología , Osteólisis/diagnóstico por imagen , Osteólisis/tratamiento farmacológico , RadiografíaRESUMEN
Purpose To evaluate a CT structural analysis protocol (SAP) for estimating the strength of human female cadaveric spines with lytic lesions. Materials and Methods Osteolytic foci was created in the middle vertebra of 44 thoracic and lumbar three-level segments from 11 female cadavers (age range, 50-70 years). The segments underwent CT by using standard clinical protocol and their failure strength was assessed at CT SAP. The spines were mechanically tested to failure in pure axial compression or in compression with torsion. The relationships of defect size, bone mineral density, and predicted failure load (at CT SAP) with measured vertebral strength were assessed with linear regression. Analysis of variance and Tukey test were used to evaluate the effect of region and mechanical test on spine strength. Results With axial compression, CT SAP predictions of vertebral strength correlated with the thoracic (r = 0.84; P < .001) and lumbar (r = 0.85; P < .001) segment-measured strength. Bone mineral density correlated with the lumbar (r = 0.64; P = .003) and thoracic (r, 0.51; P = .050) strength. At compression with torsion, CT SAP predictions of strength were moderately correlated with vertebral strength (r = 0.66; P = .018). At compression with torsion, bone mineral density was not correlated with spinal strength (thoracic and lumbar: r = 0.31 and r = 0.26, respectively; P = .539 and .610, respectively). The lytic focus size (range, 28%-41%) was not associated with vertebral strength. Conclusion CT SAP assessment of strength in vertebrae with lytic lesions correlated with the measured strength of female vertebral bodies. © RSNA, 2018 Online supplemental material is available for this article.
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Fuerza Compresiva/fisiología , Osteólisis/diagnóstico por imagen , Osteólisis/fisiopatología , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/fisiopatología , Tomografía Computarizada por Rayos X/métodos , Anciano , Densidad Ósea/fisiología , Cadáver , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/fisiopatología , Persona de Mediana Edad , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/fisiopatologíaRESUMEN
A novel multifunctional Ag2 S quantum dot (QD)-based nanomedicine of alendronate (Ald)/doxorubicin (DOX)@Ag2 S is developed for highly effective bone tumor therapy in an orthotopic model. The bone-targeting and osteolysis inhibition of Ald and the chemotherapeutic effect of DOX on the bone tumor are in situ visualized by Ag2 S QDs with emission in the second near-infrared window.
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Antineoplásicos/farmacología , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/secundario , Sistemas de Liberación de Medicamentos , Osteólisis/tratamiento farmacológico , Puntos Cuánticos , Alendronato/farmacocinética , Alendronato/farmacología , Animales , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/fisiopatología , Huesos/diagnóstico por imagen , Huesos/patología , Huesos/fisiopatología , Bovinos , Línea Celular Tumoral , Relación Dosis-Respuesta a Droga , Doxorrubicina/farmacocinética , Doxorrubicina/farmacología , Evaluación Preclínica de Medicamentos , Humanos , Macrófagos/efectos de los fármacos , Macrófagos/patología , Macrófagos/fisiología , Ratones , Nanomedicina , Trasplante de Neoplasias , Osteoclastos/efectos de los fármacos , Osteoclastos/patología , Osteoclastos/fisiología , Osteólisis/diagnóstico por imagen , Osteólisis/patología , Osteólisis/fisiopatología , Puntos Cuánticos/uso terapéutico , Compuestos de Plata/farmacocinética , Compuestos de Plata/farmacologíaRESUMEN
Aseptic loosening mediated by wear particle-induced osteolysis (PIO) remains the major cause of implant loosening in endoprosthetic surgery. The development of new vitamin E (α-tocopherol)-blended ultra-high molecular weight polyethylene (VE-UHMWPE) with increased oxidation resistance and improved mechanical properties has raised hopes. Furthermore, regenerative approaches may be opened, as vitamin E supplementation has shown neuroprotective characteristics mediated via calcitonin gene-related peptide (CGRP), which is known to affect bone remodeling in PIO. Therefore, the present study aimed to further clarify the impact of VE-UHMWPE wear particles on the osseous microenvironment and to identify the potential modulatory pathways involved. Using an established murine calvaria model, mice were subjected to sham operation (SHAM group), or treated with UHMWPE or VE-UHMWPE particles for different experimental durations (7, 14 and 28 days; n=6/group). Morphometric analysis by micro-computed tomography detected significant (p<0.01) and comparable signs of PIO in all particle-treated groups, whereas markers of inflammation [tumor necrosis factor (TNF)-α/tartrate resistant acid phosphatase (TRAP) staining] and bone remodeling [Dickkopf-related protein 1 (DKK-1)/osteoprotegerin (OPG)] were most affected in the early stages following surgery. Taking the present data into account, VE-UHMWPE appears to have a promising biocompatibility and increased ageing resistance. According to the α-CGRP serum levels and immunohistochemistry, the impact of vitamin E on neuropeptidergic signaling and its chance for regenerative approaches requires further investigation.
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Osteólisis/etiología , Osteólisis/patología , Polietilenos , Vitamina E , Animales , Biomarcadores , Resorción Ósea/metabolismo , Resorción Ósea/patología , Huesos/metabolismo , Huesos/patología , Péptido Relacionado con Gen de Calcitonina/metabolismo , Granuloma/metabolismo , Granuloma/patología , Inflamación/etiología , Inflamación/metabolismo , Inflamación/patología , Masculino , Ratones , Osteoclastos/metabolismo , Osteogénesis , Osteólisis/diagnóstico por imagen , Osteólisis/metabolismo , Polietilenos/administración & dosificación , Cráneo/diagnóstico por imagen , Cráneo/metabolismo , Cráneo/patología , Vitamina E/administración & dosificación , Microtomografía por Rayos XRESUMEN
BACKGROUND: The purpose of this retrospective study was to determine the clinical and radiographic results, prevalence of polyethylene wear and osteolysis, and fracture of alumina delta ceramic femoral head or highly crosslinked, remelted polyethylene (HXLPE) liner associated with the use of alumina delta ceramic femoral head-on-HXLPE bearing in cementless total hip arthroplasty in patients younger than 50 years. METHODS: We reviewed the cases of 119 patients (130 hips) who underwent a cementless total hip arthroplasty using alumina delta ceramic-on-HXLPE bearing when they were 50 years or younger at the time of surgery. The most common diagnoses were osteonecrosis (51%) and osteoarthritis secondary to developmental dysplastic hip (39%). Osteolysis and polyethylene wear rates were evaluated with use of radiography and computed tomography. In addition, prevalence of fracture of alumina delta ceramic head and polyethylene line was documented. The mean follow-up was 8.3 years (range, 7-9 years). RESULTS: The mean Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index score, University of California, Los Angeles activity score were 94 points, 14 points, and 8.1 points, respectively, at the final follow-up. No patient had thigh pain. All acetabular components and all but one femoral components were well fixed. The mean annual penetration rate of femoral head was 0.022 ± 0.003 mm/year. No hip had osteolysis or ceramic head or HXLPE liner fracture. CONCLUSION: Our average 8.3-year results with the use of alumina delta ceramic-on-HXLPE bearing in the patients younger than 50 years suggest that cementless acetabular and femoral components provide a high survival rate without evidence of osteolysis or ceramic head or AXLPE liner fracture.
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Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera/estadística & datos numéricos , Diseño de Prótesis , Acetábulo/cirugía , Adulto , Óxido de Aluminio , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Cerámica , Femenino , Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/cirugía , Estudios de Seguimiento , Luxación Congénita de la Cadera/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/etiología , Osteoartritis de la Cadera/cirugía , Osteólisis/diagnóstico por imagen , Osteólisis/epidemiología , Osteólisis/etiología , Polietileno , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , República de Corea/epidemiología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: To determine the prognostic value of tumor-induced cortical bone destruction at computed tomography (CT) in newly diagnosed diffuse large B-cell lymphoma (DLBCL). MATERIALS AND METHODS: This retrospective study included 105 patients with newly diagnosed DLBCL who had undergone CT and bone marrow biopsy (BMB) before R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisolone) chemo-immunotherapy. Cox regression analyses were used to determine the associations of cortical bone status at CT (absence vs. presence of tumor-induced cortical bone destruction), BMB findings (negative vs. positive for lymphomatous involvement), and dichotomized National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) strata (low risk vs. high risk) with progression-free survival (PFS) and overall survival (OS). RESULTS: Univariate Cox regression analysis indicated that cortical bone status at CT was no significant predictor of either PFS or OS (p = 0.358 and p = 0.560, respectively), whereas BMB findings (p = 0.002 and p = 0.013, respectively) and dichotomized NCCN-IPI risk strata (p = 0.002 and p = 0.003, respectively) were significant predictors of both PFS and OS. In the multivariate Cox proportional hazards model, only the dichotomized NCCN-IPI score was an independent predictive factor of PFS and OS (p = 0.004 and p = 0.003, respectively). CONCLUSIONS: The presence of tumor-induced cortical bone destruction at CT was not found to have any prognostic implications in newly diagnosed DLBCL.
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Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/mortalidad , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/mortalidad , Osteólisis/diagnóstico por imagen , Osteólisis/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Causalidad , Comorbilidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Pronóstico , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Tasa de Supervivencia , Tomografía Computarizada por Rayos X/estadística & datos numéricosRESUMEN
This study reports the case of a 47-year old female with low back pain radiating to groin and anterior regions of the left thigh and leg. At symptoms onset, electromyography showed left L3-L4 radiculopathy, and nuclear magnetic resonance revealed disc protrusion at the same level with impingement of the spinal nerve root. The clinical symptoms were ascribed to lumbar disco-radicular conflict. The patient underwent steroidal anti-inflammatory treatment with epidural steroid injections, chiropractic spinal manipulations and rehabilitation program, with no relief. Thirteen months after the onset of pain, a computed tomography of sacroiliac joints showed osteolytic lesion in the iliac bone of left joint, and a bone scintigraphy highlighted foci of intense uptake at left iliac bone and left proximal extremity of the femur. The bone biopsy and pathological examinations showed findings consistent with large B-cell non-Hodgkin lymphoma. This case report highlights the fact that in making differential diagnosis of low back pain radiating to the leg we have to consider the rare possibility that pain can be due to non-Hodgkin lymphoma that involves simultaneously the iliac bone and proximal extremity of the femur.
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Desplazamiento del Disco Intervertebral/complicaciones , Dolor de la Región Lumbar/etiología , Vértebras Lumbares/patología , Linfoma de Células B/complicaciones , Osteólisis/etiología , Ciática/etiología , Aminas/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica , Terapia Combinada , Ácidos Ciclohexanocarboxílicos/uso terapéutico , Ciclofosfamida , Diagnóstico Tardío , Diagnóstico Diferencial , Doxorrubicina , Femenino , Gabapentina , Humanos , Dolor de la Región Lumbar/terapia , Linfoma de Células B/diagnóstico , Linfoma de Células B/terapia , Manipulación Quiropráctica , Persona de Mediana Edad , Osteólisis/diagnóstico por imagen , Prednisona , Radiografía , Inducción de Remisión , Ciática/diagnóstico , Ciática/terapia , Vincristina , Ácido gamma-Aminobutírico/uso terapéuticoRESUMEN
BACKGROUND: We asked whether cementless total hip arthroplasties that made use of alumina-on-highly cross-linked polyethylene bearings would improve hip score and functional activity and reduce the prevalence of polyethylene wear, osteolysis, and aseptic loosening. METHODS: Consecutive primary total hip arthroplasties were performed in fifty patients (a total of sixty hips among thirty-four men and sixteen women) who were younger than thirty years of age. The average age at the time of the index arthroplasty was 28.3 years (range, twenty-one to twenty-nine years). The average follow-up was 10.8 years (range, ten to twelve years). Osteolysis and polyethylene wear rates were evaluated with use of radiography and computed tomography. RESULTS: The mean Harris hip score, which was 38 points (range, 6 to 45 points) preoperatively, had improved to 95 points (range, 85 to 100 points) at a mean follow-up time of 10.8 years. The mean penetration (and standard error of the mean) of the polyethylene liner was 0.031 ± 0.004 mm per year. No hip had osteolysis or aseptic loosening. CONCLUSIONS: At a minimum of ten years and an average of 10.8 years postoperatively, the current generation of cementless acetabular and femoral components with alumina-on-highly cross-linked polyethylene bearings was functioning well and was not associated with the development of osteolysis in our group of patients younger than thirty years of age. While the long-term prevalence of polyethylene wear and osteolysis remains unknown, the midterm data are promising.
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Artroplastia de Reemplazo de Cadera/instrumentación , Prótesis de Cadera , Osteólisis/etiología , Polietileno/uso terapéutico , Falla de Prótesis/etiología , Actividades Cotidianas , Adulto , Óxido de Aluminio/uso terapéutico , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/rehabilitación , Femenino , Estudios de Seguimiento , Humanos , Artropatías/diagnóstico por imagen , Artropatías/rehabilitación , Artropatías/cirugía , Masculino , Osteólisis/diagnóstico por imagen , Osteólisis/rehabilitación , Diseño de Prótesis , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND AND PURPOSE: Excessive wear of acetabular liners in hip replacements may lead to osteolysis and cup loosening. Different head materials are currently used. We measured differences in wear between alumina and cobalt-chrome heads with the same polyethylene liner. PATIENTS AND METHODS: 39 patients (43 hips) with osteoarthritis were included in a study with 10-year follow-up. Wear was measured as proximal and 3D penetration of the head in the liner with radiostereometry (RSA). All the patients were followed clinically with Harris hip score (HHS) for up to 10 years. Radiolucent lines and osteolytic lesions were assessed on plain radiographs. RESULTS: With alumina heads, proximal wear (95% CI) after 10 years was 0.62 (0.44-0.80) mm as compared to 1.40 (1.00-1.80) mm in the cobalt-chrome group. For 3D wear, the results were 0.87 (0.69-1.04) mm for alumina heads and 1.78 (1.35-2.21) mm for cobalt-chrome heads. Median (range) HHS was 98 (77-100) in the alumina group and it was 93 (50-100) in the cobalt-chrome group (p = 0.01). We found no difference in osteolysis between the groups. INTERPRETATION: We found better wear properties with alumina heads than with cobalt-chrome heads. We recommend the use of alumina heads in patients in whom a high wear rate might be anticipated.
Asunto(s)
Óxido de Aluminio , Artroplastia de Reemplazo de Cadera/métodos , Aleaciones de Cromo , Prótesis de Cadera , Osteoartritis de la Cadera/cirugía , Diseño de Prótesis/métodos , Falla de Prótesis , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Osteólisis/diagnóstico por imagen , Polietileno , Análisis RadioestereométricoAsunto(s)
Anestesia Local , Dolor de Espalda/cirugía , Neoplasias Óseas/cirugía , Neoplasias de la Mama/patología , Vértebras Cervicales/cirugía , Osteólisis/cirugía , Vertebroplastia , Anciano , Dolor de Espalda/diagnóstico por imagen , Dolor de Espalda/etiología , Neoplasias Óseas/complicaciones , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Vértebras Cervicales/diagnóstico por imagen , Femenino , Fluoroscopía , Humanos , Osteólisis/diagnóstico por imagen , Osteólisis/etiología , Dimensión del Dolor , Radiografía Intervencional , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: The aim of the work was to use the magneto-stimulation in JPS system as a therapy aiding the treatment of chronic inflammation of periapical tissues of a tooth and to evaluate its effectiveness in RTG in Digora 2.1 digital system and in conventional RTG. MATERIAL AND METHODS: The research was based on 62 teeth of 56 people (some treated for the first time). There was also a comparative group. In the work the magnetic field was used since the first day ofendodental treatment. Every patient had RTG done before and after the magnetostimula-tion. The qualitative and quantitative evaluations were done. The optical density both in the area of the osteolisis and in the laudable bone was presented in tables and graphs. The statistical analysis was also done. Conventional RTG was also used to evaluate the research. CONCLUSION: It was ascertained that magnetic field of low induction has a positive effect on the regeneration processes in chronic inflammations of periapical tissues of the tooth, visible in RTG.
Asunto(s)
Pérdida de Hueso Alveolar/prevención & control , Campos Electromagnéticos , Magnetismo/uso terapéutico , Osteólisis/prevención & control , Absceso Periapical/complicaciones , Absceso Periapical/terapia , Radiografía Dental/métodos , Absorciometría de Fotón , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/etiología , Enfermedad Crónica , Humanos , Osteólisis/diagnóstico por imagen , Osteólisis/etiología , Absceso Periapical/diagnóstico , Modalidades de Fisioterapia/instrumentación , Raíz del Diente/diagnóstico por imagen , Resultado del TratamientoRESUMEN
A 68-year-old patient underwent revision surgery for recurrent dislocation of a ceramic-on-polyethylene uncemented hip arthroplasty implanted 6 months previously. The aluminum oxide femoral head was found to have titanium deposition measuring 5 by 10 mm in an area articulating with the highly cross-linked polyethylene liner. The liner was observed to possess severe scratching produced by articulation with the titanium deposited on the ceramic head. Despite improved scratch resistance of ceramic-bearing surfaces, irregularities introduced by metallic deposition after recurrent dislocation can damage a highly cross-linked polyethylene liner.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Luxación de la Cadera/cirugía , Osteólisis/etiología , Falla de Prótesis , Anciano , Óxido de Aluminio , Humanos , Masculino , Microscopía Electrónica de Rastreo , Osteólisis/diagnóstico por imagen , Polietileno , Radiografía , Reoperación , Propiedades de Superficie , TitanioRESUMEN
OBJECTIVE: To evaluate the clinical benefit and mainly to monitor quantitatively the recalcification of osteolytic lesions after radiotherapy with or without intravenous infusion of disodium pamidronate (DP) in different doses. PATIENTS AND METHODS: 42 patients with solitary lytic metastasis in weight-bearing bones were studied. Primary endpoints were the mean value and energy of gray-level histogram in plain radiographs (MVGLH and EGLH) and relative electron density (RED) of CT scans in bone lesions. In eleven patients (group A) the DP dose was increased stepwise from 90 up to 180 mg (flat dose), while in other 15 patients (group B) a flat dose of 180 mg was administered intravenously in 2 h. In both groups, the first session of DP was given concurrently with local radiotherapy (30 Gy in ten fractions, 5 days a week). Another 16 patients (group C) underwent radiotherapy only. RESULTS: Morbidity related to pamidronate was mild. Significant differences from the baseline (p < 0.05, Wilcoxon test) were recorded for MVGLH, EGLH and RED values, regarding all groups. Improvement was significantly higher in patients of group B versus A, while the results of pamidronate groups (A and B) were superior to group C, concerning the above indices (p < 0.05, Mann-Whitney test). Additionally, pamidronate groups had significantly lower skeletal morbidity than group C. CONCLUSION: The 2-h infusional flat dose of 180 mg every 4 weeks seems to be tolerable and superior to 90 mg regarding palliation and mainly recalcification of osteolytic lesions. Radiotherapy alone is effective but inferior to the combined treatment. Last but not least, the findings of MVGLH, EGLH and RED indicate an important increase in bone mass and bone formation, which was difficult to be identified visually by the experts.
Asunto(s)
Antineoplásicos/administración & dosificación , Densidad Ósea/efectos de los fármacos , Neoplasias Óseas/secundario , Regeneración Ósea/efectos de los fármacos , Difosfonatos/administración & dosificación , Procesamiento de Imagen Asistido por Computador , Osteólisis/radioterapia , Tomografía Computarizada por Rayos X , Adulto , Antineoplásicos/efectos adversos , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/radioterapia , Quimioterapia Adyuvante , Terapia Combinada , Difosfonatos/efectos adversos , Fraccionamiento de la Dosis de Radiación , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Osteólisis/diagnóstico por imagen , Osteólisis/tratamiento farmacológico , Pamidronato , Aceleradores de PartículasRESUMEN
OBJECTIVE: To discuss the clinical manifestation, radiographic features, and treatment of 7 cases of posttraumatic osteolysis of the distal clavicle. Also, to furnish evidence indicating that the current terminology for this disorder is ambiguous and to propose a new classification system. CLINICAL FEATURES: Three cases resulted from acute trauma, and 4 cases were caused by sports-related repetitive microtrauma. All the cases involved young male patients who had similar clinical presentations that included shoulder pain with decreased shoulder range of motion. Radiographic findings ranged from small erosive changes to aggressive osteolysis of the distal clavicle. INTERVENTION AND OUTCOME: All the patients were treated with conservative care consisting of sling immobilization, ice, various physiotherapeutic modalities, and mobilization exercises. The patients that followed through with care showed clinical improvement within 3 months. Follow-up radiographic examinations, when performed, demonstrated reconstitution of the distal clavicle of various degrees, although lagging behind clinical evidence of improvement. CONCLUSION: Traumatic osteolysis of the distal clavicle may result from acute trauma or repetitive microtrauma. Radiographic changes are varied, including irregularity of the distal clavicle, cystic erosions, and blatant osteolysis. Positive outcomes may be achieved with conservative care; however, patient compliance plays a fundamental role in the overall prognosis.