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1.
Yakugaku Zasshi ; 140(8): 1081-1085, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32741866

RESUMO

Cancer patients often suffer from severe pain related to bone metastasis. We encountered a patient in whom the addition of topical non-steroidal anti-inflammatory drugs (NSAIDs) for persistent pain related to bone metastasis during therapy with opioids and oral NSAIDs reduced pain, improving activities of daily living (ADL). Fentanyl patches, celecoxib, denosumab, and topical NSAIDs (loxoprofen tape, felbinac) were administered to a 72-year-old patient with gastric cancer and pain related to bone metastasis. Pain control was favorable, with a numerical rating scale (NRS) score of 2 and Japanese version Support Team Assessment Schedule (STAS-J) score of 1. Intervention by pharmacists for the use of topical NSAIDs decreased both the NRS and STAS-J scores to zero, improving ADL. The results suggest that topical NSAIDs relieve bone-metastasis-related pain, improving ADL. When bone-metastasis-related pain is localized, the prescription of topical NSAIDs should be considered, and positive intervention by pharmacists regarding their usage should be promoted.


Assuntos
Administração Tópica , Analgésicos Opioides/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Neoplasias Ósseas/secundário , Dor do Câncer/tratamento farmacológico , Dor do Câncer/etiologia , Neoplasias Gástricas/patologia , Atividades Cotidianas , Administração Oral , Idoso , Neoplasias Ósseas/complicações , Neoplasias Ósseas/fisiopatologia , Quimioterapia Combinada , Humanos , Masculino , Resultado do Tratamento
2.
Oncology (Williston Park) ; 34(8): 317-319, 2020 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-32785928

RESUMO

A 78-year-old man had a medical history of hypertension, atrial fibrillation, chronic kidney disease, and metastatic castration-resistant prostate cancer (CRPC). He had progressed to first-line therapy for CRPC with abiraterone plus androgen-deprivation therapy (ADT) and as second-line therapy he was being treated with docetaxel, with biochemical progression in his last prostate specific antigen measurement. He was admitted to the hospital on April 2020, in the middle of the coronavirus disease 2019 (COVID-19) pandemic, because of painful bone lesions and deterioration of renal function.


Assuntos
Anticoagulantes/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Infecções por Coronavirus/terapia , Cuidados Paliativos , Pneumonia Viral/terapia , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Insuficiência Respiratória/terapia , Idoso , Antagonistas de Androgênios/uso terapêutico , Androstenos/uso terapêutico , Antineoplásicos/uso terapêutico , Betacoronavirus , Conservadores da Densidade Óssea/uso terapêutico , Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Dor do Câncer/complicações , Dor do Câncer/terapia , Infecções por Coronavirus/complicações , Progressão da Doença , Docetaxel/uso terapêutico , Combinação de Medicamentos , Definição da Elegibilidade , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Unidades de Terapia Intensiva/provisão & distribução , Lopinavir/uso terapêutico , Masculino , Oxigenoterapia , Pandemias , Pneumonia Viral/complicações , Neoplasias de Próstata Resistentes à Castração/complicações , Neoplasias de Próstata Resistentes à Castração/patologia , Insuficiência Renal , Insuficiência Respiratória/etiologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Ritonavir/uso terapêutico , Índice de Gravidade de Doença , Ácido Zoledrônico/uso terapêutico
3.
Anticancer Res ; 40(6): 3551-3557, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487657

RESUMO

BACKGROUND/AIM: Previous studies have identified pelvic tumors as a risk factor for surgical site infections (SSI). However, risk factors for extremity tumors are still unclear. This study investigated risk factors for postoperative deep infection in malignant bone tumors of the extremities. PATIENTS AND METHODS: Data from 238 patients with 256 malignant bone tumor surgeries were reviewed. Univariate analysis and multiple logistic regression determined risk factors for deep infection. RESULTS: Deep infection was found in 23 of 256 cases (9.0%). Tibial tumor (OR=6.04; 95%CI=2.14-17.05; p<0.001) and operative time ≥5 hours (OR=3.25; 95%CI=1.15-9.23; p=0.027) were independent risk factors for deep infection. CONCLUSION: Tibial tumor and operative time ≥5 hours are independent risk factors for deep infection after surgery of malignant bone tumor of extremities. Strategies to minimize risk of infection in the tibia and decreasing operative time should be implemented, along with other measures to decrease SSI.


Assuntos
Neoplasias Ósseas/complicações , Extremidades/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Criança , Pré-Escolar , Extremidades/patologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Adulto Jovem
4.
Clin Nucl Med ; 45(6): 492-494, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32366790

RESUMO

A 39-year-old man with bone pain underwent Tc-MDP bone scan to assess skeletal lesions, which demonstrated multiple fractures and a focus of subtle extraosseous activity in the left thigh. A Tc-hynic-octreotide imaging was performed due to the suspected diagnosis of tumor-induced osteomalacia, which revealed a hypermetabolic subcutaneous nodule in the left thigh, which exactly corresponded to the same site of MDP activity. Biopsy confirmed the subcutaneous nodule as the culprit tumor of tumor-induced osteomalacia. Bone scan, as a conventional imaging, provided useful information for detecting culprit tumor as shown in our case.


Assuntos
Osso e Ossos/diagnóstico por imagem , Neoplasias de Tecido Conjuntivo/diagnóstico por imagem , Neoplasias de Tecido Conjuntivo/etiologia , Medronato de Tecnécio Tc 99m , Adulto , Neoplasias Ósseas/complicações , Humanos , Masculino , Cintilografia , Tomografia Computadorizada por Raios X
5.
Rinsho Shinkeigaku ; 60(4): 272-277, 2020 Apr 24.
Artigo em Japonês | MEDLINE | ID: mdl-32238746

RESUMO

A 67-year-old woman who had undergone laparoscopic proximal gastrectomy for early gastric cancer 10 months previously was admitted to our hospital due to dysarthria. Brain MRI demonstrated acute multiple small infarcts in the right middle cerebral artery (MCA) and the right posterior inferior cerebellar artery (PICA) territory, and she was diagnosed as embolic stroke. Anticoagulant therapy did not prevent further ischemic stroke. No embolic sources were detected by MR angiography, carotid duplex sonography, transthoracic and transesophageal echocardiography, and Holter electrocardiography. We also performed upper gastrointestinal endoscopy and contrast-enhanced CT of the thoracoabdominal area, but there was no evidence of local recurrence or lymph node metastases of gastric cancer. As the ALP and D-dimer levels were gradually increasing, we performed PET/CT, which revealed fluorodeoxyglucose (FDG) uptake in the vertebra bone, and disseminated carcinomatosis of bone marrow with early gastric cancer was diagnosed after bone marrow biopsy on Day 41. After undergoing chemotherapy, she had no further stroke and died on Day 207.


Assuntos
Medula Óssea , Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Embolia Intracraniana/etiologia , Neoplasias Gástricas/complicações , Idoso , Medula Óssea/patologia , Neoplasias Ósseas/patologia , Feminino , Humanos , Recidiva , Neoplasias Gástricas/patologia
6.
Zhongguo Zhen Jiu ; 40(4): 405-10, 2020 Apr 12.
Artigo em Chinês | MEDLINE | ID: mdl-32275370

RESUMO

OBJECTIVE: To observe the effect of early intervention of bone-nearby acupuncture (BNA) combined with electroacupuncture (EA) on the expression of histone deacetylase1(HDAC1), histone deacetylase 2 (HDAC2) andµ-opioid recepter (MOR) in dorsal root ganglia (DRG) of bone cancer pain-morphine tolerance (BCP-MT) rats, and to explore its possible mechanism. METHODS: A total of 35 SD rats were randomized into a sham BCP group (n=6), a BCP group (n=7), a MT group (n=7), a BNA+EA group (n=8) and a shame BNA group (n=7). Except of the sham BCP group, cancer cell inoculation operation at left tibia was given in the other 4 groups to establish the bone cancer pain model. In the MT group, the BNA+EA group and the shame BNA group, intraperitoneal injection of morphine hydrochloride was given to establish the morphine tolerance model. After the operation, bone-nearby acupuncture combined with electroacupuncture was applied at "Zusanli" (ST 36) and "Kunlun" (BL 60) in the BNA+EA group, with dilatational wave, 2 Hz/100 Hz in frequency, 0.5 to 1.5 mA in intensity. Intervention in the shame BNA group was applied at the same time and acupoints as those in the BNA+EA group, the needles were pierced the skin without any electrical stimulation. The needles were retained for 30 min, once a day for continuous 7 days in both BNA+EA and shame BNA groups. Before and 10, 11, 15, 22 days after the operation, the left paw withdrawal threshold (PWT) was measured in the 5 groups. The levels of HDAC1, HDAC2 and MOR in DRG were detected by Western blot. RESULTS: Ten days after the cancer cell inoculation operation, the PWT of the BCP, MT, BNA+EA and sham BNA groups was decreased compared with the sham BCP group (P<0.01). Eleven days after the operation, the PWT of the MT, BNA+EA and sham BNA groups was increased compared with the BCP group (P<0.01). Twenty-two days after the operation, the difference was no significant between the BCP group and MT group (P>0.05); the PWT of the BNA+EA group was increased compared with the MT and sham BNA group (P<0.01). In the BCP group, the DRG levels of HDAC1 and HDCA2 were increased, while the level of MOR was decreased compared with the sham BCP group (P<0.05, P<0.01). In the MT group, the DRG level of HDAC1 was increased compared with the BCP group (P<0.05). In the BNA+EA group, the DRG level of HDAC1 was decreased compared with the MT group and the sham BNA group (P<0.01, P<0.05), while the level of MOR was increased (P<0.01). CONCLUSION: Early intervention of bone-nearby acupuncture combined with electroacupuncture can relieve the morphine tolerance in bone cancer pain rats, it may relate to down-regulating the expression of HDAC1 and up-regulating the expression of MOR in the dorsal root ganglia.


Assuntos
Neoplasias Ósseas/complicações , Dor do Câncer/terapia , Eletroacupuntura , Gânglios Espinais/metabolismo , Histona Desacetilases/metabolismo , Receptores Opioides mu/metabolismo , Pontos de Acupuntura , Animais , Tolerância a Medicamentos , Morfina , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley
7.
J Orthop Res ; 38(6): 1175-1190, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32162711

RESUMO

Metastatic breast, prostate, lung, and other cancers often affect bone, causing pain, increasing fracture risk, and decreasing function. Management of metastatic bone disease (MBD) is clinically challenging when there is potential but uncertain risk of pathological fracture. Management of MBD has become a major focus within orthopedic oncology with respect to fracture and impending fracture care. If impending skeletal-related events (SREs), particularly pathologic fracture, could be predicted, increasing evidence suggests that prophylactic surgical treatment improves patient outcomes. However, current fracture risk assessment and radiographic metrics do not have high accuracy and have not been combined with relevant patient survival tools. This review first explores the prevalence, incidence, and morbidity of MBD and associated SREs for different cancer types. Strengths and limitations of current fracture risk scoring systems for spinal stability and long bone fracture are highlighted. More recent computed tomography (CT)-based structural rigidity analysis (CTRA) and finite element (FE) analysis methods offer advantages of increased specificity (true negative rate), but are limited in availability. Other fracture prediction approaches including parametric response mapping and positron emission tomography/computed tomography measures show early promise. Substantial new information to inform clinical decision-making includes measures of survival, clinical benefits, and economic analysis of prophylactic treatment compared to after-fracture stabilization. Areas of future research include use of big data and machine learning to predict SREs, greater access and refinement of CTRA/FE approaches, combination of clinical survival prediction tools with radiographically based fracture risk assessment, and net benefit analysis for fracture risk assessment and prophylactic treatment.


Assuntos
Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Tomada de Decisão Clínica , Fraturas Espontâneas/etiologia , Medição de Risco , Neoplasias Ósseas/epidemiologia , Análise de Elementos Finitos , Humanos , Morbidade , Tomografia Computadorizada por Raios X
8.
J Vasc Interv Radiol ; 31(2): 294-300, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31899108

RESUMO

PURPOSE: To assess safety and efficacy of percutaneous cryoablation for pain palliation of metastases to pleura and chest wall. MATERIALS AND METHODS: This retrospective single-center cohort study included 22 patients (27% female, mean age 63 y ± 11.4) who underwent 25 cryoablation procedures for pain palliation of 39 symptomatic metastases measuring 5.1 cm ± 1.9 (range, 2.0-8.0 cm) in pleura and chest wall between June 2012 and December 2017. Pain intensity was assessed using a numerical scale (0-10 points). Statistical tests t test, χ2, and Wilcoxon signed rank were performed. RESULTS: Patients were followed for a median of 4.1 months (interquartile range [IQR], 2.3-10.1; range, 0.1-36.7 mo) before death or loss to follow-up. Following cryoablation, pain intensity decreased significantly by a median of 4.5 points (IQR, 2.8-6; range, 0-10 points; P = .0002 points, Wilcoxon signed rank). Pain relief of at least 3 points was documented following 18 of 20 procedures. Pain relief occurred within a median of 1 day following cryoablation (IQR, 1-2; range, 1-4 d) and lasted for a median of 5 weeks (IQR, 3-17; range, 1-34 wk). Systemic opioid requirements decreased in 11 of 22 patients (50%) by an average of 56% ± 34. Difference in morphine milligram equivalents was not significant (P = .73, Wilcoxon signed rank). No procedure-related complications occurred despite previous radiation of 7 tumors. Of 25 procedures, 22 (88%) were performed on an outpatient basis. CONCLUSIONS: Percutaneous cryoablation for metastases to pleura and chest wall can safely provide significant pain relief within days following a single session.


Assuntos
Neoplasias Ósseas/cirurgia , Criocirurgia , Manejo da Dor , Dor/prevenção & controle , Cuidados Paliativos , Neoplasias Pleurais/cirurgia , Parede Torácica/cirurgia , Idoso , Analgésicos Opioides/administração & dosagem , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Criocirurgia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/etiologia , Manejo da Dor/efeitos adversos , Medição da Dor , Neoplasias Pleurais/complicações , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/secundário , Estudos Retrospectivos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Fatores de Tempo , Resultado do Tratamento
9.
Anesthesiology ; 132(2): 357-372, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31939851

RESUMO

BACKGROUND: Prolonged endoplasmic reticulum stress has been identified in various diseases. Inflammatory mediators, which have been shown to induce endoplasmic reticulum stress in several studies, have been suggested to serve as the important modulators in pain development. In this study, the authors hypothesized that the endoplasmic reticulum stress triggered by inflammatory mediators contributed to pain development. METHODS: The authors used a male mouse model of bone cancer pain. The control mice were intrathecally injected with tumor necrosis factor-α (TNF-α) and lipopolysaccharide, the bone cancer pain mice were intrathecally injected with the endoplasmic reticulum stress inhibitors 4-PBA and GSK2606414. The nociceptive behaviors, endoplasmic reticulum stress markers, and inflammatory mediators were assessed. RESULTS: Increased expression of the p-RNA-dependent protein kinase-like endoplasmic reticulum kinase and p-eukaryotic initiation factor 2α were found in the spinal neurons during bone cancer pain, along with upregulation of inflammatory mediators (TNF-α, interleukin 1ß, and interleukin 6). Intrathecal administration of TNF-α or lipopolysaccharide increased the expression of endoplasmic reticulum stress markers in control mice. Inhibition of endoplasmic reticulum stress by intrathecal administration of 4-PBA (baseline vs. 3 h: 0.34 ± 0.16 g vs. 1.65 ± 0.40 g in paw withdrawal mechanical threshold, 8.00 ± 1.20 times per 2 min vs. 0.88 ± 0.64 times per 2 min in number of spontaneous flinches, P < 0.001, n = 8) or GSK2606414 (baseline vs. 3 h: 0.37 ± 0.08 g vs. 1.38 ± 0.11 g in paw withdrawal mechanical threshold, 8.00 ± 0.93 times per 2 min vs. 3.25 ± 1.04 times per 2 min in number of spontaneous flinches, P < 0.001, n = 8) showed time- and dose-dependent antinociception. Meanwhile, decreased expression of inflammatory mediators (TNF-α, interleukin 1ß, and interleukin 6), as well as decreased activation of astrocytes in the spinal cord, were found after 4-PBA or GSK2606414 treatment. CONCLUSIONS: Inhibition of inflammatory mediator-triggered endoplasmic reticulum stress in spinal neurons attenuates bone cancer pain via modulation of neuroinflammation, which suggests new approaches to pain relief.


Assuntos
Neoplasias Ósseas/metabolismo , Dor do Câncer/metabolismo , Estresse do Retículo Endoplasmático/fisiologia , Mediadores da Inflamação/metabolismo , Nociceptividade/fisiologia , Animais , Neoplasias Ósseas/complicações , Dor do Câncer/etiologia , Células Cultivadas , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C3H , Gravidez
11.
J Pediatr Orthop ; 40(2): e149-e154, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31181027

RESUMO

BACKGROUND: Nonossifying fibroma (NOF) is the most common benign osseous lesion in children; however, our understanding of which lesions progress to a fracture remains unclear. In this study, we seek to formulate a classification system for NOFs to assess for fracture risk and determine what this classification system tells us regarding fracture risk of the distal tibia and distal femur NOFs. METHODS: Charts were retrospectively reviewed for patients with NOFs. A 4-point criteria was created and used to calculate fracture risk for distal tibia and distal femur NOFs. The analysis included incidence, specificity, and sensitivity. RESULTS: One point was given for each of the following findings on computed tomography (CT) scan: (1) >50% width on coronal view; (2) >50% width on sagittal view; (3) any cortical breach; (4) lack of a neocortex. In total, 34 patients with NOFs of the distal tibia had CT scans, of which 14 fractured. Zero with a 0- or 1-point score fractured, 2 with a 2-point score fractured (20%), 4 with a 3-point score fractured (44%), and 8 with a 4-point score fractured (100%). Sensitivities of 1-, 2-, 3-, and 4-point scores were 100%, 100%, 85.7%, and 57.1%, respectively, and specificities were 71.4%, 71.4%, 80%, and 100%, respectively. A total of 41 patients with NOFs of the distal femur had CT scans, of which 5 fractured. Zero with a 0-point score fractured, 1 with a 1-point score fractured (4%), 0 with a 2-point score fractured, 1 with a 3-point score fractured (20%), and 3 with a 4-point score fractured (100%). Sensitivities of 1-, 2-, 3-, and 4-point scores were 100%, 80%, 80%, and 60%, respectively; and specificities were 60%, 87.8%, 90%, and 100%, respectively. CONCLUSIONS: Our 4-point CT criteria is easy to apply and identifies patients at high risk of fracture, helping surgeons make decisions regarding treatment. LEVEL OF EVIDENCE: Level IV-prognostic study.


Assuntos
Neoplasias Ósseas/classificação , Fraturas do Fêmur/etiologia , Fibroma/classificação , Fraturas Espontâneas/etiologia , Fraturas da Tíbia/etiologia , Adolescente , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Criança , Feminino , Fibroma/complicações , Fibroma/diagnóstico por imagem , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco/métodos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
12.
Bull Hosp Jt Dis (2013) ; 77(4): 279-284, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31785143

RESUMO

Appendicular metastasis from multiple myeloma (MM) frequently presents with a pathologic fracture. In this case report, a patient with a long history of MM and an associated pathologic fracture was treated using a specialized brace. This orthosis uses a deforming element to asymmetrically increase the soft tissue pressure around the pathologic fracture. The patient experienced rapid pain relief and bony healing without surgical intervention.


Assuntos
Neoplasias Ósseas/terapia , Fixação de Fratura/instrumentação , Fraturas Espontâneas/terapia , Mieloma Múltiplo/terapia , Aparelhos Ortopédicos , Fraturas do Rádio/terapia , Idoso , Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Desenho de Equipamento , Consolidação da Fratura , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/fisiopatologia , Humanos , Masculino , Mieloma Múltiplo/complicações , Mieloma Múltiplo/secundário , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/etiologia , Fraturas do Rádio/fisiopatologia , Resultado do Tratamento
13.
Medicina (Kaunas) ; 55(12)2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31766671

RESUMO

Background and objectives: Patients suffering from bone metastasis are at high risk for pathological fractures and especially hip fractures. Osteolytic metastases can induce a high morbidity rate (i.e., pain, facture risk, mobility impairment), and operation on them can be difficult in this frail population having a reduced life expectancy. Several medical devices have been investigated for the prevention of these pathological hip fractures. Materials and Methods: To investigate these solutions, a literature review and a meta-analysis of primary studies was performed. Data sources included electronic databases (PubMed, CENTRAL and ClinicalTrials.gov) from 1990 until 1 January 2019. Titles, abstracts and full-text articles were reviewed in order to select only studies evaluating the performance of the studied solution to prevent osteoporotic and/or pathological hip fracture. The main outcomes were the occurrence of hip fracture, pain evaluation (VAS score) and adverse events occurrence (including severe adverse events and deaths). All randomised controlled trials (RCTs) and cohort studies were considered. A Bayesian cumulative meta-analysis was undertaken on the primary studies conducted in patients with bone metastasis. Results: A total of 12 primary studies were identified, all were cohort studies without a control group, and one compared two devices, and were thereafter considered separately. In those 12 samples, 255 patients were included, mean age 61.7 years. After implantation, the cumulative risk of fracture was 5.5% (95% confidence interval, 3.0% to 8.6%), and adverse event occurrence was 17.4% (95%CI, 12.6 to 22.8%), with a median follow-up of 10 months. The posterior probability of a fracture rate below 5% was 40.3%. Conclusions: The literature about medical devices evaluation for preventing hip fractures in metastatic patients is poor and mostly based on studies with a limited level of evidence. However, this systematic review shows promising results in terms of efficacy and tolerance of these devices in patients with bone metastases. This treatment strategy requires further investigations.


Assuntos
Neoplasias Ósseas/complicações , Fraturas do Fêmur/prevenção & controle , Cabeça do Fêmur/cirurgia , Fraturas Espontâneas/prevenção & controle , Fixadores Internos , Cirurgia Assistida por Computador/métodos , Teorema de Bayes , Neoplasias Ósseas/secundário , Humanos
14.
Medicine (Baltimore) ; 98(48): e18175, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770268

RESUMO

RATIONALE: Hereditary multiple exostoses (HME) is an autosomal dominant disease that causes multiple exostoses throughout the body. It usually occurs around the metaphysis of the long bones, and when it involves the hip, symptoms arise due to deformity and the mass effect. If the lesion does not involve the joint or is not associated with arthritis, symptoms can be relieved by surgical excision of the osteochondroma. However, if secondary osteoarthritis (OA) or subluxation of the joint has progressed, joint replacement arthroplasty should be considered. PATIENT CONCERNS: A 57-year-old woman with HME visited our outpatient department with severe right hip pain. She complained of difficulty walking and severe discomfort during activities of daily living. She was short in stature and had a family history of HME. DIAGNOSIS: A physical examination revealed limited motion in the hip joint and a limb length discrepancy. Plain radiography and a computed tomography scan revealed huge osteochondromas on bilateral proximal femurs and advanced OA with subluxation of the right hip joint. INTERVENTIONS: Cementless total hip arthroplasty of the right hip joint via the modified posterolateral approach was done. OUTCOMES: The patient showed good clinical scores and functional improvement at the 2-year follow-up. LESSONS: Total hip arthroplasty for an anatomically deformed joint is technically difficult, and there are many factors to consider that can make surgeons reluctant to use this modality. However, with careful preparation, arthroplasty is a good surgical option for symptomatic and functional recovery in HME patients with hip joint involvement.


Assuntos
Artroplastia de Quadril/métodos , Neoplasias Ósseas , Exostose Múltipla Hereditária , Fêmur , Articulação do Quadril , Luxações Articulares , Neoplasias Ósseas/complicações , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Exostose Múltipla Hereditária/complicações , Exostose Múltipla Hereditária/patologia , Exostose Múltipla Hereditária/cirurgia , Feminino , Fêmur/diagnóstico por imagem , Fêmur/patologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/etiologia , Luxações Articulares/cirurgia , Pessoa de Meia-Idade , Radiografia/métodos , Recuperação de Função Fisiológica , Resultado do Tratamento
15.
Biomed Res Int ; 2019: 8206913, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31781646

RESUMO

Objective: To explore the incidence and significance of intra- and extra-osseous edema associated with benign tumors and tumor-like diseases. Methods: Magnetic resonance imaging (MRI) data from 300 benign osseous tumors and tumor-like diseases diagnosed by pathology were retrospectively reviewed. Borderline tumors, cases associated with pathological fractures, and skull lesions were excluded from the study. Bone marrow and soft tissue edema were defined on T2WI with fat suppression on MRI in all cases. The incidence rate of edema in benign tumors and tumor-like diseases was determined using the χ 2 test. The preoperative diagnoses were reviewed, and the effect of edema on the differential diagnosis of benign and malignant tumors was analyzed. Results: The incidence rate of bone marrow and soft tissue edema associated with benign tumors and tumor-like diseases was 35.7% (107/300), including 84.4% (27/32) Langerhans cell histiocytosis, 86.4% (19/22) osteoblastoma, 93.9% (31/33) osteoid osteoma, and 85.2% (23/27) chondroblastoma cases. There was no statistically significant difference in the incidence of edema among the four diseases (χ 2 = 1.7, P > 0.05). Of 107 cases associated with edema, 49 (45.8%) were misdiagnosed as malignant tumors by MRI preoperatively. Conclusion: Bone marrow and soft tissue edema are a common finding associated with benign bone tumors and tumor-like diseases, and they are frequently detected in Langerhans cell histiocytosis, osteoblastoma, osteoid osteoma, and chondroblastoma.


Assuntos
Neoplasias Ósseas/complicações , Edema/etiologia , Edema/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Medula Óssea/patologia , Neoplasias Ósseas/diagnóstico , Criança , Pré-Escolar , Condroblastoma/diagnóstico , Condroblastoma/patologia , Diagnóstico Diferencial , Edema/diagnóstico , Feminino , Fraturas Ósseas/complicações , Histiocitose de Células de Langerhans/diagnóstico , Histiocitose de Células de Langerhans/patologia , Humanos , Incidência , Lactente , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoblastoma/diagnóstico , Osteoblastoma/patologia , Osteoma Osteoide/diagnóstico , Osteoma Osteoide/patologia , Estudos Retrospectivos , Adulto Jovem
16.
Acta Med Acad ; 48(2): 217-224, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31718222

RESUMO

OBJECTIVE: Gardner's syndrome is a variant of familial adenomatous polyposis, characterized by gastrointestinal polyps, multiple osteomas, and skin and soft tissue lesions. Diagnosis by means of an understanding of its various symptoms is of great importance. CASE REPOSRT: This report presents the case of a 32-year-old man with obvious asymmetry and disfigurement on his face, due to multiple osteomas and soft tissue lesions. These clinical signs prompted us to further investigation, leading to the diagnosis of a case of Gardner's syndrome, with asymptomatic polyposis of the colon. Polyps have virtually an almost 100% risk of undergoing malignant transformation. CONCLUSION: Early diagnosis and treatment of this pathological entity are crucial, while the presence of osteomas should alert us to this diagnosis.


Assuntos
Neoplasias Ósseas/complicações , Ossos Faciais , Síndrome de Gardner/patologia , Osteoma/complicações , Neoplasias de Tecidos Moles/complicações , Adulto , Neoplasias Ósseas/patologia , Transformação Celular Neoplásica/patologia , Diagnóstico Precoce , Síndrome de Gardner/complicações , Humanos , Masculino , Osteoma/patologia , Neoplasias de Tecidos Moles/patologia
17.
Niger J Clin Pract ; 22(11): 1539-1545, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31719275

RESUMO

Background: Metastatic disease of bone is a common complication of most of the advanced malignancies. The majority of patients with bone metastases (BM) experience pain during their disease course and pain control can significantly improve their quality of life. Radiotherapy (RT) is an important modality in the management of BM and different schedules are followed worldwide. Aim: The aim of this study was to compare two multi-fractionated RT regimens (30Gy in 10 fractions and 20Gy in 5 fractions) with respect to the patient's performance, response and pain score in palliative management of painful BM. Methods: This prospective observational study was undertaken between October 2015 and September 2017 at a government medical college in central India. Two fractionation regimens (30 Gy/10 fractions and 20 Gy/5 fractions) were used to treat 50 patients with painful BM (n = 25 in each arm). Patients were treated on telecobalt machine and response assessment done in terms of complete/partial/intermediate response and pain progression. Assessment was performed at one, two and three months post treatment. Statistical analysis was done using Fisher's exact test, student t-test and Chi-square test. A value of P < 0.05 was considered significant. Results: There were 9 males (36%) and 16 females (64%) in arm A, and 15 males (60%) and 10 females (40%) in arm B. The median age was 47.50 years (range 28-81 years) in arm A and 54 years (range 34-85 years) in arm B. There was no statistically significant difference between the two groups in terms of pain palliation at a 1 month (p = 0.73), 2 month (p = 0.75) or 3 month (p = 0.71) follow up. In addition, the mean performance scores at the end of 3rd month in the 2 arms did not show any statistically significant difference (p = 0.51). Conclusion: A shorter treatment schedule (5 fractions) was equally efficacious as the standard schedule (10 fractions) in our setting. With the advantage of shorter overall treatment time and avoidance of re-irradiation, this schedule may be favourable for high volume centres.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Relação Dose-Resposta à Radiação , Manejo da Dor/métodos , Dor/etiologia , Cuidados Paliativos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/complicações , Progressão da Doença , Fracionamento da Dose de Radiação , Feminino , Instalações de Saúde , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Dor/radioterapia , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Dosagem Radioterapêutica , Resultado do Tratamento
18.
J Am Podiatr Med Assoc ; 109(6): 463-466, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755776

RESUMO

Nora's lesion, or bizarre parosteal osteochondromatous proliferation (BPOP), is a rare benign lesion that is made up of varying degrees of cartilage, bone, and spindle cells. Most notably, calcification of the cartilage or "blue bone," is a feature of the disorder. The condition principally affects long tubular bones of the hands and feet, and is generally seen in patients in their second and third decades of life. We present a case of BPOP occurring in the second interspace with symptoms that would be consistent with a more common diagnosis of predislocation syndrome, or a second interspace neuroma. This case study may help the clinician in considering a more subtle cause of a splay deformity in the second interspace, and walk through the diagnostic and treatment course for BPOP.


Assuntos
Neoplasias Ósseas/complicações , Pé Chato/etiologia , Osteocondromatose/complicações , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Neuralgia/etiologia , Osteocondromatose/diagnóstico , Osteocondromatose/terapia , Fotomicrografia , Radiografia , Cintilografia , Tecnécio , Dedos do Pé/diagnóstico por imagem
19.
Mol Med Rep ; 20(6): 5100-5110, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31661120

RESUMO

Bone cancer pain (BCP) is a severe complication of advanced bone cancer. Although cannabinoid receptor 2 (CB2) agonists may have an analgesic effect, the underlying mechanism remains unclear. CB2 serves a protective role in various pathological states through the activation of autophagy. Therefore, the present study aimed to determine whether the analgesic effects of the selective CB2 agonist JWH015 was mediated by the activation of autophagy in BCP. BCP was induced by the intra­femur implantation of NCTC2472 fibrosarcoma cells in C3H/HeN mice. The pain behaviors were assessed on the following postoperative days. The selective CB2 agonist JWH015 (1 and 2 µg) was intrathecally administered on day 14 following implantation. AM630 (1 µg), a CB2 antagonist, was injected 30 min before JWH015 administration. Lipopolysaccharide (LPS; 100 nM)­stimulated primary neurons were treated with JWH015 (1 µM) and AM630 (1 µM) to further verify the mechanism by which CB2 affects autophagy. The results demonstrated that autophagy flux was impaired in spinal neurons during BCP, as indicated by the increased ratio of microtubule­associated protein 1 light chain 3ß (LC3B)­II/LC3B­I and increased expression of p62. Intrathecal administration of JWH015 attenuated BCP, which was accompanied by the amelioration of impaired autophagy flux (decreased LC3B­II/LC3B­I ratio and decreased p62expression). In addition, the activation of glia cells and upregulation of the glia­derived inflammatory mediators, interleukin (IL)­1ß and IL­6 were suppressed by JWH015. In LPS­stimulated primary neurons, IL­1ß and IL­6 were increased, and autophagy flux was impaired; whereas treatment with JWH015 decreased the expression of IL­1ß and IL­6, LC3B­II/LC3B­I ratio and expression of p62. These effects were by pretreatment with the CB2­selective antagonist AM630. The results of the present study suggested that the impairment of autophagy flux was induced by glia­derived inflammatory mediators in spinal neurons. Intrathecal administration of the selective CB2 agonist JWH015 ameliorated autophagy flux through the downregulation of IL­1ß and IL­6 and attenuated BCP.


Assuntos
Autofagia/efeitos dos fármacos , Dor do Câncer/metabolismo , Agonistas de Receptores de Canabinoides/farmacologia , Indóis/farmacologia , Mediadores da Inflamação/metabolismo , Manejo da Dor , Receptor CB2 de Canabinoide/metabolismo , Medula Espinal/metabolismo , Animais , Neoplasias Ósseas/complicações , Dor do Câncer/tratamento farmacológico , Dor do Câncer/etiologia , Agonistas de Receptores de Canabinoides/administração & dosagem , Citocinas/metabolismo , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Indóis/administração & dosagem , Injeções Espinhais , Masculino , Camundongos , Neuroglia/efeitos dos fármacos , Neuroglia/metabolismo , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Ratos , Medula Espinal/efeitos dos fármacos , Medula Espinal/fisiopatologia
20.
Eur J Radiol ; 120: 108694, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31593844

RESUMO

PURPOSE: To evaluate the clinical, radiological and periprocedural features associated with the occurrence or worsening of acetabular fracture (OWAF) following percutaneous cementoplasty of the acetabulum (PCA) in cancer patients. METHOD: All patients who underwent PCA in our comprehensive cancer center for an acetabular metastasis between January 2008 and December 2015 were included. Clinical features, characteristics of the metastasis on computed tomography (CT-scan) (location [roof, quadrilateral surface, anterior and posterior columns], number of locations, matrix, extra/intra-articular fractures, extra-osseous or subchondral extensions) and of the procedure (extra- or intra-articular cement leakage (IACL), percentage of filling of each location, complications) were reported as well as prior, concomitant or post-PCA treatments. The endpoint was OWAF on CT-scan during post-PCA follow-up. Log-rank tests and Cox models were used to identify prognostic factors. RESULTS: 140 PCA were identified in 129 patients (11 bilateral procedures, median age: 66.6). Eighteen (18/140, 12.9%) had an initial articular fracture. IACL was seen in 12/140 (8.6%) PCA. The only feature associated with IACL was a pre-existing articular fracture (p = 0.009). Of the 111 patients with imaging follow-ups, 18 (16.2%) showed OWAF. In multivariate analysis, the presence of cement filling (even partial) of all acetabular metastatic locations was the only feature predictive of OWAF-free survival (hazard ratio = 3.8, p = 0.031). CONCLUSIONS: Injecting cement in all areas affected by acetabular metastases could prevent OWAF. Because survival following PCA is not negligible, completing an insufficient first PCA could help preserve patients' quality of life.


Assuntos
Acetábulo/lesões , Neoplasias Ósseas/complicações , Neoplasias Ósseas/terapia , Cementoplastia/efeitos adversos , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Acetábulo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico por imagem , Cementoplastia/métodos , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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