Unilateral transfemoral amputees exhibit altered strength and dynamics of muscular co-activation modulated by visual feedback.

Objective.Somatosensory perception is disrupted in patients with a lower limb amputation. This increases the difficulty to maintain balance and leads to the development of neuromuscular adjustments. We investigated how these adjustments are reflected in the co-activation of lower body muscles and are modulated by visual feedback.Approach.We measured electromyography (EMG) signals of muscles from the trunk (erector spinae and obliquus external), and the lower intact/dominant leg (tibialis anterior and medial gastrocnemius) in 11 unilateral transfemoral amputees and 11 age-matched able-bodied controls during 30 s of upright standing with and without visual feedback. Muscle synergies involved in balance control were investigated using wavelet coherence analysis. We focused on seven frequencies grouped in three frequency bands, a low-frequency band (7.56 and 19.86 Hz) representing more sub-cortical and spinal inputs to the muscles, a mid-frequency band (38.26 and 62.63 Hz) representing more cortical inputs, and a high-frequency band (92.90, 129 and 170.90 Hz) associated with synchronizing motor unit action potentials. Further, the dynamics of changes in intermuscular coupling over time were quantified using the Entropic Half-Life.Main results.Amputees exhibited lower coherency values when vision was removed at 7.56 Hz for the muscle pair of the lower leg. At this frequency, the coherency values of the amputee group also differed from controls for the eyes closed condition. Controls and amputees exhibited opposite coherent behaviors with visual feedback at 7.56 Hz. For the eyes open condition at 129 Hz, the coherency values of amputees and controls differed for the muscle pair of the trunk, and at 170.90 Hz for the muscle pair of the lower leg. Amputees exhibited different dynamics of muscle co-activation at the low frequency band when vision was available.Significance.Altogether, these findings point to the development of neuromuscular adaptations reflected in the strength and dynamics of muscular co-activation.

Treatment, recurrence rates and follow-up of Tenosynovial Giant Cell Tumor (TGCT) of the foot and ankle-A systematic review and meta-analysis.

BACKGROUND: The tenosynovial giant cell tumor (TGCT) is a usually benign lesion which arises from the synovium. It affects joints, tendon sheaths and bursae. The clinical course is often unpredictable, and local recurrences frequently occur. The aim of this study was to describe different treatment options, surgical complications, and to develop a follow-up regime based on a systematic literature review and meta-analysis of foot and ankle lesions. METHODS AND RESULTS: 1284 studies published between 01/1966 and 06/2021 were identified. 25 met the inclusion criteria, with a total of 382 patients. Of these, 212 patients had a diffuse (dTGCT) and 170 a localized (lTGCT) TGCT. Patients with a dTGCT had a mean age of 36.6±8.2 years, and 55% were female. The overall complication rate was 24% in dTGCT, irrespective of the therapeutic procedure; the mean follow-up was 37.9±27.4 months with a recurrence rate of 21%, and recurrences occurred between 3 and 144 months, the vast majority (86%) within the first 5 years following intervention. Patients with a lTGCT had a mean age of 31.2±5.7 years, and 53% were female. Complications occurred in 12%. The mean follow-up was 51.1±24.6 months, the recurrence rate was 7%, and recurrence occurred between 1 and 244 months after intervention. CONCLUSION: Diffuse TGCTs of the foot and ankle region have a remarkable recurrence rate irrespective of therapeutic procedures, and most lesions reoccurred within 5, with more than half of these in the first 2 years. The lTGCTs are well treatable lesions, with a low recurrence and a moderate complication rate. Based on these findings, we propose a follow-up regime for the dTGCT including a clinical survey and MR imaging 3 months after surgical intervention (baseline), followed by twice-yearly intervals for the first 2 years, yearly intervals up to the fifth year, and further individual follow-up due to the fact that recurrences can even occur for years later. For the lTGCT a clinical survey and MRT is proposed after 3-6 months after intervention (baseline), followed by annual clinical examination for 3 years, and in case of symptoms MR-imaging. Larger prospective multi-center studies are necessary to confirm these results and recommendations.

Intermuscular coupling and postural control in unilateral transfemoral amputees - a pilot study.

The dynamics of the adjustment of center of pressure (CoP) has been utilized to understand motor control in human pathologies characterized by impairments in postural balance. The control mechanisms that maintain balance can be investigated via the analysis of muscle recruitment using electromyography (EMG) signals. In this work, we combined these two techniques to investigate balance control during upright standing in transfemoral unilateral amputees wearing a prosthesis. The dynamics of the CoP adjustments and EMG-EMG coherence between four muscles of the trunk and lower limb of 5 unilateral transfemoral amputees and 5 age-matched able-bodied participants were quantified during 30 s of quiet standing using the entropic half-life (EnHL) method. Two visual conditions, eyes open and eyes closed, were tested. Overall, the group of amputees presented lower EnHL values (higher dynamics) in their CoP adjustments than controls, especially in their intact limb. The EnHL values of the EMG-EMG coherence time series in the amputee group were lower than the control group for almost all muscle pairs under both visual conditions. Different correlations between the EnHL values of the CoP data and the EMG-EMG coherence data were observed in the amputee and control groups. These preliminary results suggest the onset of distinct neuromuscular adaptations following a unilateral amputation.Clinical Relevance - Understanding neuromuscular adaptation mechanisms after an amputation may serve to design better rehabilitation treatments and novel prosthetic devices with sensory feedback.

Levels of activated platelet-derived microvesicles in patients with soft tissue sarcoma correlate with an increased risk of venous thromboembolism.

BACKGROUND: Microvesicles are small vesicles expressing specific antigens from their cells of origin. Elevated levels of microvesicles have been shown to be associated with coagulation disorders as well as with different types of malignancies. This study aims to evaluate a possible correlation of different microvesicle subpopulations with a positive history of venous thromboembolism (VTE) in patients with soft tissue sarcoma. METHODS: Annexin V - positive microvesicles, leukocyte (CD45-positive), platelet (CD61-positive), activated platelet (CD62P-, CD63-positive), endothelium-derived (CD62E-positive) and tissue-factor (CD142-positive) microvesicles were identified in the peripheral blood of patients with soft tissue sarcoma (n = 39) and healthy controls (n = 17) using fluorescence-activated cell sorting (FACS). RESULTS: Both the total amount of Annexin V-positive microvesicles and levels of endothelium-derived (CD62E-positive) microvesicles were shown to decrease significantly after tumor resection (n = 18, p = 0.0395 and p = 0.0109, respectively). Furthermore, the total amount of Annexin V - positive microvesicles as well as leukocyte (CD45-positive) and endothelium-derived (CD62E-positive) microvesicles were significantly higher in patients with grade 3 (G3) soft tissue sarcoma (n = 9) compared to healthy controls (n = 17) (p = 0.0304, p = 0.0254 and p = 0.0357, respectively). Moreover, patients with G3 soft tissue sarcoma (n = 9) presented higher levels of Annexin V-positive and endothelium-derived (CD62E-positive) microvesicles compared to patients with grade 2 (G2) soft tissue sarcoma (n = 8) (p = 0.0483 and p = 0.0045). Patients with grade 1 (G1) soft tissue sarcoma (n = 3) presented with significantly lower levels of platelet (CD61-positive) microvesicles than patients with G3 soft tissue sarcoma (n = 9) (p = 0.0150). In patients with a positive history of VTE (n = 11), significantly higher levels of activated platelet (CD62P- and CD63-positive) microvesicles (p = 0.0078 and p = 0.0450, respectively) were found compared to patients without a history of VTE (n = 28). CONCLUSION: We found significantly higher levels of Annexin V-positive and endothelium-derived (CD62E-positive) microvesicles to be circulating in the peripheral blood of patients with G3 soft tissue sarcoma compared to patients with G2 soft tissue sarcoma. Furthermore, we showed that high counts of activated platelet-derived microvesicles correlate with the occurrence of VTE. Thus, the detection of these microvesicles might be an interesting new tool for early diagnosis of soft tissue sarcoma patients with increased risk for VTE, possibly facilitating VTE prevention by earlier use of thromboprophylaxis.

Spinal Orthoses: The Crucial Role of Comfort on Compliance of Wearing - Monocentric Prospective Pilot Study of Randomized Cross-Over Design.

PURPOSE OF THE STUDY Various spine disorders are regularly treated by orthoses, and success of treatment depends on wearing these devices. In this study we examined the compliance, wear comfort, subjective stabilization and side effects associated with spinal orthoses using an individualized questionnaire and the Compact Short Form-12 Health Survey (SF-12). MATERIAL AND METHODS In this prospective pilot study of randomized cross-over design, twelve healthy volunteers with a mean age of 31.2 years wore three different types of orthoses, each for one week: A hyperextension brace (HB), a custom-made semirigid orthosis (SO) and a custom-made rigid orthosis (RO). The daily duration of wearing the orthosis was defined as primary endpoint; contentment was measured using an individualized questionnaire and the standardized SF-12. RESULTS In the study population calculated probability of wearing the HB and RO was between 0.2 und 38.5% (95% confidence interval). No volunteer wore the SO orthosis for the predefined time. The SO and RO each displayed high subjective stabilization, while the RO was more often associated with side effects like skin pressure marks than the SO. The need for rework due to discomfort was mainly necessary with the RO. We observed no substantial differences in feeling compression and sweating. Noteworthy, eight of 12 subjects complained of uncomfortable sternal pressure due to the upper pad of the HB. The SF-12: scores ranged from 52.1 to 48.6 on the physical (PCS), and from 53.7 to 50.8 on the mental component score (MCS), demonstrating an influence on QoL. DISCUSSION AND CONCLUSIONS The design as well as the orthosis itself influence the compliance of wearing and exert a moderate negative, but acceptable impact on QoL. The SO appeared to correlate with the best overall compromise between comfort and subjective stabilization. Further investigations are necessary in patients with spinal diseases, for whom the effect of orthosis wearing may surpass the potential discomfort. Key words: thoracolumbar spine, orthoses, SF-12 - Quality of Life - QoL, comfort, compliance.

Interobserver Variability in the Differential Diagnosis of Benign Bone Tumors and Tumor-like Lesions.

PURPOSE: The interobserver-variability of radiological diagnosis of benign bone tumors (BBT) and tumor-like lesions (TLL) was examined in order to identify difficult-to-diagnose entities, to examine the frequency of advanced diagnostics and to describe the number of interdisciplinary tumor center diagnoses (IDT) in comparison with diagnoses upon referral (ED) and radiologists´ diagnoses (RD). MATERIALS AND METHODS: We retrospectively reviewed 413 patients with 272 BBT and 141 TLL, classified either histologically or through interdisciplinary consultation. Discrepancies between groups were analyzed and rates of additional imaging and biopsy to establish diagnosis were assessed. RESULTS: In BBT the number of identical radiological diagnoses was 56 (ED) and 81 % (RD) compared to the IDT, while in the latter additional imaging were obtained in 30 % cases. In 21 % (12 % to establish diagnosis) BBT were biopsied, the ED matching the histology 40 %, the RD 60 % and the IDT 76 % of the time. For TLL diagnosed through radiology, ED and RD matched IDT 31 % and 61 % of the time, with additional imaging being obtained in 21 % of cases (IDT). In 36 % (27 % to establish diagnosis) biopsy was performed, with histological diagnosis matching the IDT, RD and ED in 51, 27 and 20 %. Diagnostic challenges were apparent in enchondromas, non-ossifying fibromas (NOF), solitary (SBC) and aneurysmal bone cysts (ABC). Ganglia can be misinterpreted as a tumor. CONCLUSIONS: Establishing a definitive diagnosis for BBT and TLL can be challenging with the latter posing greater difficulties. An interdisciplinary approach involving radiologists, orthopedics and pathologists was found to improve diagnostic accuracy. KEY POINTS: • Benign bone tumors (BBT) and tumor-like lesions (TLL) present a diagnostic challenge, while enchondroma, NOF, SBC and ABC were difficult to diagnose, and ganglia can be misinterpreted as a tumor• Additional imaging studies were required for diagnosis in 29 % and 21 % of cases for BBT and TLL, respectively, biopsies in 12 % of cases for BBT and 27 % for TLL• Sound diagnoses can be made through interdisciplinary case discussion, while reducing the risk of overtreatment Citation Format: • Scheitza P, Uhl M, Hauschild O et al. Interobserver Variability in the Differential Diagnosis of Benign Bone Tumors and Tumor-like Lesions. Fortschr Röntgenstr 2016; 188: 479 - 487.

Aneurysmal bone cyst (ABC) : treatment options and proposal of a follow-up regime.

The aim of this study was to describe treatment -options and develop a follow-up regime for the -aneurysmal bone cyst, a neoplastic bone lesion with a noticeable recurrence rate. Reports of 28 patients and a mean follow-up of 42.2 months treated multidisciplinary were analysed. Data were complemented by a literature review including 790 patients. Patient age was from seven to 57 years, in line with the literature (1-69 years). Lesions most frequently affect long bones, spine and pelvis ; pain is the most common symptom. Treatment modalities vary, recurrences -occurred in 26.1% in our series, rates ranged from 0-60% in the literature, with the vast majority within 2 years. With regard to the findings we propose, irrespective of treatment, a follow-up regime including clinical survey and imaging, best with MRI, at 3 months, 6 months and at half-yearly intervals within the first two and yearly within the third to fifth year.

Epithelioid osteosarcoma of the scapula.

Epithelioid and epithelial neoplasms of bone are rare. They include different epithelioid variants of vascular lesions, osteoblastoma, chondroblastoma and most importantly metastatic carcinoma. Up to now, only few cases of epithelioid osteosarcoma were described. In this case the authors report a 53-year-old patient presented with a medical history of chronic shoulder pain for 3 years. Magnetic resonance imaging (MRI and computed tomography (CT) showed a destructive, partially calcified osseous lesion of the scapula with expansion into the surrounding soft tissue, suggestive of a primary bone tumor. Histologically, the tumor consisted of epithelioid cells with expression of cytokeratine and the lesion was primarily diagnosed as metastatic carcinoma. With regard to the MRI morphology untypical for metastatic disease the histopathologic slides were re-evaluated and detection of tumor osteoid led to the diagnosis of epithelioid osteosarcoma. Chemotherapy was initiated, however follow-up imaging studies showed rapidly progressive disease of both primary tumor and lung metastases. In conclusion, epithelioid neoplasms of the bone are extremetumourly rare and must be distinguished from metastatic carcinoma. Despite the presence of cytokeratine positive cells a thorough histological evaluation is mandatory and osteoid detection is essential in order to establish the correct diagnosis and further treatment. Key words: osteosarcoma, epithelioid, aneurysmal bone cyst, chondrosarcoma, pathology, immunohistochemistry.

Insights into Enchondroma, Enchondromatosis and the risk of secondary Chondrosarcoma. Review of the literature with an emphasis on the clinical behaviour, radiology, malignant transformation and the follow up.

The Enchondroma is a common, benign, cartilage forming tumour. They usually occur as a single, asymptomatic lesion. Occasionally patients present with multiple enchondromas which is generally defined as enchondromatosis. This entity encompasses several different subtypes including Ollier disease and Maffucci syndrome (enchondromatosis associated with soft tissue haemangiomas) as the most commons. Some of them have a complicated clinical course when malignant transformation occurs. This malignant progression is a well known fact especially in enchondromatosis, but up to now there is still a lack of recommendations concerning the follow up. The aim of this article is to review the clinical and imaging features of patients with solitary enchondroma and enchondromatosis focusing on the development of secondary chondrosarcoma and the follow up.

[Osteochondroma and multiple osteochondromas: recommendations on the diagnostics and follow-up with special consideration to the occurrence of secondary chondrosarcoma]. / Osteochondrom und multiple Osteochondrome : Empfehlungen zur Diagnostik und Vorsorge unter besonderer Berücksichtigung des Auftretens sekundärer Chondrosarkome.

PURPOSE: Osteochondroma represents the most common form of benign bone tumor. Clinical manifestations include deformity of bone, compression of surrounding tissue and vascular or neurological compromise. Osteochondromas may be solitary (solitary osteochondroma, SO) or multiple (multiple osteochondromas MO). Recurrence after surgery is a known problem especially in MO and malignant transformation is rare but more common in MO than in solitary cases. Reliable recommendations regarding diagnostics and clinical follow-up are currently lacking. PATIENTS AND METHODS: A comprehensive literature review and a review of own patient files with SO/MO treated between 2000 and 2011 in this hospital were performed. The age of patients at diagnosis, tumor localization, clinical aspects, recurrence and the risk of malignant transformation in secondary (i.e. epiexostotic) chondrosarcoma were analyzed. The follow-up including patients who received surgery ranged between 2 and 127 months for patients with SO and between 2 and 84 months for MO. RESULTS: A total of 39 patients with SO from this hospital were included in the study. Out of 36 patients who received surgery 3 recurrences were registered after an average time of 62 months. In addition, 11 patients with MO were identified and all received surgery. In 5 out of 11 cases recurrences occurred after an average time of 20.6 months. Secondary chondrosarcomas were not recorded in this series. According to the literature an increased risk of malignant transformation was found for osteochondromas of the axial skeleton, in the proximal aspect of the extremities, as well as for recurrent tumors and for MO. Pain and/or increase in size of lesions after skeletal maturation were the most common clinical signs of transformation. There was a wide time interval between the initial diagnosis and the development of secondary chondrosarcoma. In MO secondary chondrosarcoma has been described before skeletal maturity. CONCLUSIONS: The risk of malignant transformation of SO is generally low. Axial lesions as well as recurrent osteochondromas and MO seem to have an increased risk of malignant transformation. The follow-up, requiring sufficient primary diagnostics, includes regular self-control and can usually be clinically carried out in more peripherally located lesions but in certain cases supplementary X-ray imaging is needed. In cases of anatomical regions which are more difficult to access manually, follow-up examination by magnetic resonance imaging (MRI) is the method of choice. Especially MO patients seem to benefit from long-term follow-up: when the tumor is located in the trunk and in (proximal) long bones MRI or whole-body MRI, respectively, should be performed once a year after skeletal maturity because of the higher risk of malignant transformation in these patients.

Osteoid osteoma of the femoral neck mimicking monarthritis and causing femoroacetabular impingement.

Different aetiologies including the femoroacetabular impingement (FAI) may cause a painful hip, especially in young pa - tients. Two general types of femoroacetabular impingement have been described, the pincer- and the cam type impingement. The latter is characterized by a femoral deformity, usually a bump on the head-and-neck junction that impinges on the acetabular rim. The authors describe the case of a 21-year-old male, bodybuilder, suffering from progressive hip pain with impairment of exercise tolerance, gait and other daily activities. Besides limitation of hip internal rotation physical examination was normal. He had a transitory response to non-steroid anti-inflammatory drugs. Initially performed MRI of the pelvis shows predominant inflammation of the hip joint. In external performed arthroscopy the biopsies of the capsule demonstrated chronic synovitis. In the follow up hip pain remains, however, diagnosis was still unclear. Re-evaluation of the formerly performed and a follow up MRI, and of an additional CT, the findings were compatible with an osteoid osteoma in the femoral cervico-cephalic transition causing itself a cam impingement and monarthritis. The adopted therapeutic strategy consisted on arthroscopic excision of the nidus and trimming of the femoral neck, with clinical recovery after surgical intervention.

The many faces of chondrosarcoma of bone, own cases and review of the literature with an emphasis on radiology, pathology and treatment.

Chondrosarcoma is the third most frequent primary malignant tumor of bone, constituting up to 16% of the malignant osseous neoplasms. Up to date several genetic alterations and markers were described concerning the pathogenesis and the progression of the chondrosarcoma, which represents actually a heterogeneous group of different types including conventional intramedullary, clear cell, myxoid, mesenchymal, and dedifferentiated chondrosarcoma. The pathologic appearance varies, however, in general they grow with a lobulated pattern. Histologically the hyaline cartilage demonstrates high water content and typically enchondral ossification is apparent. Imaging reflect this while radiographic findings suggest the diagnosis when the typical "ring-and-arc" chondroid matrix mineralization, endosteal scalloping and soft-tissue extension were apparent. The CT is used for detecting the mineralization of the matrix, especially when it is subtle or when the lesion is located in complex areas. MRT is the method of choice to detect the high water content of these lesions with a high signal intensity with T2-weighting and its bone marrow extend. Surgical resection is the primary and preferred treatment modality for most individuals with localized disease. In selected cases of the Grad I conventional chondrosarcoma curettage should be discussed. Systemic chemotherapy may be considered in variant forms such as mesenchymal or dedifferentiated chondrosarcomas. In knowledge of the "many faces" of the primary chondrosarcoma individualized patient assessment and optimal clinical management is possible.

Differential diagnosis of primary malignant bone tumors in the spine and sacrum. The radiological and clinical spectrum: minireview.

Although primary malignant tumors of the spine and sacrum are described in all orthopedic textbooks, it is still remarkable how little attention is paid to differential diagnosis of persisting lower back pain and how to detect in special the underlying tumor disease. Chordoma, osteosarcoma, chondrosarcoma, plasmacytoma, lymphoma and Ewing's sarcoma, their radiological manifestation, age distribution and preferred location in the spine and sacrum are reviewed and discussed.

Spontaneous healing of pathologic humerus fracture caused by a cartilaginous tumor.

Conservative treatment of pathologic fractures of the long bones have been reported very infrequently, especially when fracture is caused by an tumour. This report highlights the possibility of an nonoperative treatment of a pathologic humerus fracture caused by an cartilaginous tumour with radiographic criterions of an chondrosarcoma.

[Tumor-like lesions]. / Tumorähnliche Knochenläsionen.

Tumor-like bone lesions include various conditions of a non-neoplastic nature originating from or affecting the bone as solitary or sometimes multiple bone lesions. This review discusses the most important cystic tumor-like lesions, such as simple bone cyst, aneurysmal bone cyst, intraosseous ganglion, epidermoid cyst and subchondral cyst. MR is the most sensitive method of detection, and is the most accurate in depicting the extent of involvement of these lesions. MR signal characteristics may aid in differential diagnosis. Conventional radiographs are often more specific with respect to the underlying histopathology.

Differential diagnosis of benign tumors and tumor-like lesions in the spine. Own cases and review of the literature.

Although benign tumors and tumor-like lesions of the spine are shown in every orthopedic teaching book, it is often surprising how little attention is paid to the differential diagnosis and diagnostic investigations, respectively, since surgical treatment and postoperative control depends on exact diagnosis. Clinically the importance of this fact can not be over-emphasized. The most common complaint is pain, either local or radicular in nature. Bone deviations are diagnosed radiologically. Different types of benign bone tumors and tumor-like lesions of the spine including osteochondroma, osteoblastoma, osteoid osteoma, aneurysmal bone cyst, eosinophilic granuloma, hemangioma, and giant cell tumor, their appearance relation to the age and location in the spine were reviewed and the common histologic subtypes described. Clinical, laboratory and histopathologic findings, radiologic inclusive MRT and scintigraphic features are evaluated. Diagnostic investigations including the invasive techniques of CT guided needle biopsy, Yamshidi needle biopsy and costotransversectomy for biopsy are shown. Treatment including radiation, chemotherapy and the surgical procedure as well as the postoperative treatment of patients with benign tumors and tumor-like lesions of the spine are discussed.

Experimental use of an albumin-glutaraldehyde tissue adhesive for sealing tracheal anastomoses.

AIM: The purpose of this study was to test the performance of an albumin-glutaraldehyde tissue adhesive (BioGlue, manufactured by CryoLife Inc., Kennesaw, GA, USA) when used on tracheal resections in rabbits, which is a sensitive model to investigate the biocompatibility of the glue. METHODS: The 24 animals were anesthetized and underwent cervicotomy with resection of a 10 mm long tracheal segment. The experimental group (18 animals with 2, 4 and 12 week endpoints) had a tracheal anastomosis performed with a maximum of 4 sutures for the approximation of the tissue margins. The anastomotic line was then circumferentially covered with the adhesive. Control animals (6 animals, 4 week endpoint) had a tracheal anastomosis performed with the use of twice interrupted, airtight running suture. The experiments were conducted after approval by the Institutional Ethics Committee and in accordance with the European Convention on Animal Care. RESULTS: Macroscopic evaluation revealed a tight closure of the anastomosis in 23 animals. One rabbit developed tracheo-cutaneous fistula, 2 rabbits experienced intraluminal granulations due to infection, and 1 rabbit developed tracheal stenosis due to insufficient sutures with axis-displacement of the anastomosed tracheal lumina. On microscopic examination, after 2 weeks an inflammatory tissue response consisting of neutrophils, macrophages and foreign body giant cells was found surrounding the glued area. After 4 weeks the tissue was granulomatous in character with an increasing number of multinucleated giant cells. In general, persistent granulomatous inflammation and fibrous scar tissue was seen after 12 weeks. Both, macroscopically and microscopically, fibroangioblastic tissue responses were found in the control group after 4 weeks. CONCLUSIONS: Despite secondary healing disruptions such as granuloma formation, our investigations suggest that the results of albumin-glutaraldehyde tissue adhesive sealed tracheal anastomoses with a few approximating sutures are comparable with those using suture technique. Short term results demonstrated good biocompatibility of the glue.

[Psammous desmo-osteoblastoma of the right maxilla. Case report and differential diagnosis of a rare tumor]. / Psammöses Desmoosteoblastom des rechten Oberkiefers. Fallbericht und Differenzialdiagnose einer seltenen Tumorentität.

CASE REPORT: We report the case of a 9-year-old female patient with a moderate swelling of the right maxilla. A tumor was diagnosed by conventional X-ray within the region of tooth 17 in the right tuber maxillae. The histological diagnosis after biopsy of the lesion was "fibrous dysplasia Jaffe-Lichtenstein". One year later, the tumor was still growing, and computed tomography was carried out. The first histological diagnosis was confirmed by another biopsy; the differential diagnosis was "ossifying fibroma". In the following years, the tumor grew and expanded into the right orbit and maxilla. Four years after the first diagnosis the tumor was removed operatively. DIFFERENTIAL DIAGNOSIS OF THE OPERATIVE SPECIMEN: The histology showed round, partially trabecular or calcified bodies, known as psammoma-like ossicles. Therefore, in light of the clinical course and the radiographic appearance, the correct diagnosis was "psammous desmo-osteoblastoma". DISCUSSION: The psammous desmo-osteoblastoma and its differential diagnosis are discussed in this article.

Experimental use of an albumin-glutaraldehyde tissue adhesive for sealing pulmonary parenchyma and bronchial anastomoses.

OBJECTIVE: Despite advanced surgical techniques, major complications of bronchial anastomoses and parenchymal repair, including early leak, fistula formation and granulations still occur. The purpose of this study was to test the performance of an albumin-glutaraldehyde tissue adhesive (BioGlue), CryoLife Inc., Kennesaw, GA) as a sealant for bronchial anastomoses and parenchyma lesions. METHODS: Twenty-four sheep were split into two surgical groups. The first group consisted of six control sheep receiving standard sutured bronchial anastomosis with a 4-week end-point. The second group included 18 sheep receiving both a bronchial anastomosis and parenchymal defect repair using the adhesive with 2, 4, and 12 week end-point. Histopathologic evaluation was conducted at the study end-points. RESULTS: Bronchial anastomosis and parenchymal tissue repair can be sealed successfully against air leakage with adhesive. Macroscopic evaluation revealed a tight closure of the anastomosis and parenchyma defect in all postoperative stages, initially by the adhesive layer, and later by connective tissue. On microscopic examination, an inflammatory tissue response consisting of polymorphonuclear neutrophils, macrophages, granulation tissue and foreign body giant cells were found surrounding the glued area after 2 weeks. After 4 weeks the tissue response presented a granulomatous character. No granulomatous or foreign body reaction was present in the hand sutured group. After 12 weeks few remnants of adhesive surrounded by fibrous scar tissue were detectable in bronchial anastomosis and parenchymal repair. Healing was not considerably complicated by foreign body reaction or tissue granulation. CONCLUSION: This study supports BioGlue to be effective as an adjunct in sealing bronchial anastomosis and lung parenchyma defects in sheep, with minimal secondary healing disruptions such as granuloma formation. The results of this study indicate that the use of BioGlue in human pulmonary surgery should be effective.