The relationship between serum osteopontin and FGF 23 levels with valvular calcification in hemodialysis patients
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BACKGROUNDS AND AIMS: Cardiovascular calcification is an important cause of morbidity and mortality in hemodialysis (HD) patients. Vascular and valvular calcification are indicators of increased tissue calcification. The relationship of osteopontin (OPN) - which is known as a vascular calcification inhibitor - and fibroblast growth factor-23 (FGF-23) - which its related to vascular calcification, as recently shown - to valvular calcification is unknown. In this cross-sectional study, we examined the relationship between heart valve calcification, serum OPN, and FGF-23 levels. MATERIALS AND METHODS: 85 adults who were on HD treatment for at least 6 months were included in the study. Echocardiographic evaluation was made with the General Electric echocardiography device and the same cardiologist. FGF-23 and osteopontin levels were measured by ELISA. RESULTS: 54% of our patients were male, mean age was 49.8 ± 15.1 years, and mean HD duration was 52.5 ± 39.6 months. 34% of the patients were diabetic, and 17.6% had a history of coronary artery disease. 1.25 mmol/L calcium were used as dialysate calcium in 84.7% of the patients. 60% of the patients were on vitamin D replacement therapy, and 7.1% were receiving cinacalcet treatment. Valvular calcification ratio of the patients was 44%. Mean FGF-23 level was 682 ± 771.7 pg/mL, and mean OPN level was 22.2 ± 8.2 ng/mL. When the patients with and without heart valve calcification were compared, the group with heart valve calcification was older and had lower serum OPN levels. There were differences between the groups on left atrial diameters, left ventricular end-diastolic diameters, and posterior-wall thicknesses. In the logistic regression analysis, it was seen that age and serum OPN levels were predictors of valvular calcification. CONCLUSION: Serum osteopontin level is associated with heart valve calcification in HD patients, but there was no relationship found with FGF-23. Further research is needed on the subject.
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Surgical management of grade I chondrosarcoma of the long bones.

The aim of this study was to compare the rates of local recurrence according to surgical treatment options in low-grade chondrosarcomas of the long bones. A retrospective review was made of 30 consecutive patients (12 male, 18 female) with a mean age of 40.7 years (range: 16-69 years) with intramedullary low-grade chondrosarcoma of the long bones treated either by intralesional curettage or wide resection at our institution between 1995 and 2011. The mean overall follow-up was 74 months (range : 24-186 months). There was no difference in local recurrence rates between patients treated with intralesional resection or wide resection (p = 0.98). Intralesional curettage seems to be feasible in selected cases to reduce the patient's postoperative morbidity in Grade I chondrosarcoma cases.

Spinal osteochondroma: a report on six patients and a review of the literature.

INTRODUCTION: Osteochondromas are the most common benign tumour of the bone. They occur in two forms as solitary and hereditary multiple form. Osteochondromas are generally located on the metaphysis of the long bones. From 1 to 4% of osteochondromas occur in the spine. Spinal osteochondromas can cause cord and root compression and also be asymptomatic. In the diagnosis of osteochondromas, radiological methods are very important. PURPOSE OF STUDY: Because spinal osteochondroma is very rare, other benign and malign tumours should be kept in mind during differential diagnosis. In this paper, six patients with spinal osteochondral lesions were evaluated at our orthopaedic oncology department. PATIENTS: Between 1986 and 2009, six patients, four males, two females with an average age of 31.2 (9-65) were diagnosed with spinal osteochondroma at our clinic. Although one patient was diagnosed following another complaint, five patients were suffering from pain. In addition, four patients had swelling and one patient had neurological symptoms. Five patients were treated surgically, and the sixth one was followed conservatively. DISCUSSION: The patients with spinal osteochondral lesions applied with mostly pain and swelling at the dorsal of the vertebrae. Because neurological symptoms are rarely seen, radiological examination is of great importance in diagnosis. CONCLUSIONS: Patients suffering from spinal osteochondroma, due to the risk of secondary chondrosarcoma, must be closely evaluated both clinically and radiologically. If necessary, the patient must be treated surgically following histopathological diagnosis.

Patellar bone stock after extra-articular knee resection preserving extensor mechanism: A cadaveric study.

OBJECTIVE: This study aimed to evaluate the thickness of the remaining patellar bone stock following extra-articular knee resection (EKR) preserving the extensor mechanism in human cadaveric knee joints. METHODS: A total of 14 human cadaveric knee joints (8 men and 2 women) were dissected, and the patellar thickness from the joint capsule insertion to the anterior cortex of the patella was measured using an electronic caliper. The mean age of the cadavers was 37 years (range=28-50). Measurements were performed by an anatomist and an orthopedic surgeon. As the total number of the cadavers was not enough to show the patellar thickness with sampling (sex and age), we endeavored to supplement the content with magnetic resonance images (MRI). Accordingly, the patellar bone thickness was also measured on axial MRI scans of 100 adult and 25 pediatric knees of patients (71 women and 54 men; mean age=36 years; age range=7-67 years) admitted to our hospital in whom meniscal tears were suspected. The rate of specimens with remaining patellar thickness of less than 10 mm after presumed resection was evaluated. The macroscopic measurements in cadavers and MRI measurements in adult knees were compared statistically. RESULTS: The mean thickness of the residual patellar bone of the cadaver dissections following a presumed EKR preserving the extensor mechanism was 8.2 mm (range=3.4-15.8). Additionally, in 71.4% (10/14) of the cadaveric knees, the thickness of residual patellar bone was less than 10 mm. In MRI scans, the average thickness of residual patella after presumed resection was 8.6 mm (range: 3.6-16) in adult knees and 6.9 mm (range: 3.4-10) in pediatric knees, and the residual patellar thickness less than 10 mm after presumed resection was determined in 72% of all MRI scans. Macroscopic measurements in cadaveric knees were statistically similar to MRI scan measurements in adult knees (p=0.765, Mann-Whitney U test). CONCLUSION: Evidence from this study revealed that the thickness of the remaining patellar bone stock after EKR preserving the extensor mechanism may be low. A preoperative assessment with MRI can guide the surgeon to select the appropriate method for knee resection in order to prevent from the complications of resected patella.

The use of fibular autograft and ankle arthrodesis for aggressive giant cell tumor in the distal tibia: a case report.

The case describes successful distal tibial resection, fibular autograft, and ankle arthrodesis in two patients who had giant cell tumor in the distal tibia. At long-term followup, the patients had no pain and no limitation in daily or low-impact recreational activities. In conclusion, due to the large resection that is often necessary for aggressive tumors, fibular autograft and ankle arthrodesis may be a useful method in the distal tibia.

Tumours and tumour-like lesions of the patella: a report of eight cases.

We report eight cases of tumours and tumour-like lesions of the patella. Six lesions were primary and two were metastatic, both originating from adenocarcinoma of the rectum. Patients with anterior knee pain related with a tumourous condition usually have significant delay in diagnosis. The importance of considering a neoplastic condition for the common complaint of anterior knee pain, and recognising the patellar tumour with plain radiographs is stressed. In our series, all patients had positive findings on plain lateral radiographs of the patella and we recommend a simple lateral roentgenogram for the initial diagnostic work up for a suspected patellar tumour. Further imaging modalities should be used for accurate staging and histological diagnosis of the lesion.

Benign fibrous histiocytoma of the hand: a case report and literature review.

Benign fibrous histiocytoma (BFH) of the bone is a rare benign lesion characterised by the presence of fibroblasts and histiocytes. Fibrohistocytic lesions involving bone with identical histological appearances are common during childhood such as fibrous cortical defect. However, BFH is very rare and can only be differentially diagnosed with its presentation, localisation and radiologic features. Here we describe a 33-year-old man with BFH in a rare location, a phalanx. To our knowledge this is the second reported case of a BFH involving the proximal phalanx of the thumb in an adult. We report clinical, radiologic and histological findings of the case and briefly review the literature on the subject.

[Chondroblastoma of the metatarsal bone and its 17-year follow-up]. / Metatarsal yerlesimli kondroblastom ve 17 yillik takibi.

Chondroblastoma is a rare bone tumor of cartilaginous origin. Metatarsal involvement is very rare, with a few cases. We presented a case of chondroblastoma localized in the fourth metatarsal bone. The patient presented with persistent pain of eight-month duration on the lateral side of his foot, which developed after an inversion ankle sprain. Radiological examination showed a large osteolytic lesion with sclerotic margins in the fourth metatarsal bone. The lesion was treated with extra-articular curettage and autogenous bone grafting. During a 17-year follow-up, the patient had no complaints, and there were no clinical or radiological findings of local recurrence or metastasis.

Malignant triton tumor of the gluteal region in a patient unaffected by neurofibromatosis: A case report.

Malignant triton tumor (MTT) is a rare variant of malignant peripheral nerve sheath tumor (MPNST) made up of both malignant schwannoma cells and malignant rhabdomyoblasts. A 26-years-old male patient was admitted with an asymptomatic gluteal mass. Magnetic resonance imaging showed heterogeneous soft tissue mass and he underwent open biopsy. Malignant peripheral nerve sheath tumor was diagnosed. He was given adjuvant chemotherapy following the removal of the tumor with hip disarticulation. The tumor was diagnosed as "malignant triton tumor" based on pathological examination including immunohistochemical studies. There were no signs of metastasis but recurrence was observed at 9 months follow up. MTT is usually associated with Neurofibromatosis 1 and located in head, neck region. In this case sporadic involvement of gluteal region and aggressive behavior of the lesion despite radical surgery was demonstrated.

Embolization of benign and malignant bone and soft tissue tumors of the extremities.

PURPOSE: To reveal the effectiveness and reliability of preoperative, curative, and palliative embolization of benign and malignant bone and soft tissue tumors of the extremities. MATERIALS AND METHODS: Diagnostic angiography was performed on 35 patients (14 females, 40%; 21 males, 60%) between 6 and 70 years of age (mean, 32 years) who were referred to our digital subtraction angiography (DSA) unit between March 2000 and March 2004, and had extremity bone or soft tissue tumors. Among 17 patients who were initially assessed to be appropriate for angiographic embolization, DSA-assisted intra-arterial embolization was performed on 11 pre-operatively, and 6 curatively or palliatively. Effectiveness of the procedure was evaluated using imaging modalities, including angiography, X-ray, computed tomography, and magnetic resonance imaging as well as with post-operative findings. RESULTS: Among the 11 patients that underwent pre-operative embolization, 10 showed a significant reduction in intra-operative and early post-operative bleeding. Additionally, manipulation and excision of the tumors during surgery were easier as a result. Partial or full remission occurred in 3 of 6 patients that underwent lesion embolization. Two other patients had surgical procedures after finding their lesions had increased in size. In one patient with stable lesion size, cranial metastasis was discovered later. CONCLUSION: Pre-operative, palliative, and curative selective/superselective intra-arterial embolization is an effective and potentially developing method for benign and malignant, hypervascularized bone and soft tissue tumors of the extremities, when it is performed by an experienced team with proper embolizing agents.

Primary angiosarcoma of the fibula : a case report.

Primary vascular neoplasms of bone are rare and have a poor prognosis. Angiosarcoma of bone originates in vascular endothelial cells within bone tissue. Patients may present with unifocal or multifocal osseous disease. The most commonly involved bones are femur and tibia, followed by pelvis, vertebral column and bones of the upper limb. Here we present a 72-year-old male patient who had primary angiosarcoma of the fibula. He was treated with amputation, and the metastases that later emerged were successfully managed with chemotherapy.

Management of fibrous dysplasia. A report on 36 cases.

A consensus on the clinical course of fibrous dysplasia has not yet emerged in the literature. We retrospectively evaluated 36 patients who were diagnosed with fibrous dysplasia in our institution and were followed for a mean duration of 56.5 months (range 7-210 months). Their mean age was 25.8 years (range 5-67 years); 46.7% were male. The most frequent presenting complaints were pain (66% of patients) and pathological fracture (20%). Osteosarcoma developed in one patient 20 years after he had undergone radiation therapy for fibrous dysplasia in the tibia. Mazabraud syndrome was encountered in two patients, and aneurysmal bone cyst associated with fibrous dysplasia was seen in one patient. Fibrous dysplasia is generally considered a static disease, but with long-term follow-up it is found to have a more dynamic nature. For this reason, patients with fibrous dysplasia should be followed carefully over the long-term.

Surgical treatment of osteoblastoma : a report of 20 cases.

Osteoblastoma is a locally aggressive osteoblastic lesion of bone with rare malignant transformation. We retrospectively evaluated 20 patients who were diagnosed and surgically treated for osteoblastoma in our institution. Their mean age was 22.5 years (range: 10 to 34). The most frequent location was in the posterior elements of the spine, followed by the long bones of the extremities and the talus. Intralesional curettage was the most common modality of treatment; it was used in 11 patients, with a 13% recurrence rate. This series demonstrates that osteoblastoma may be locally aggressive and may recur after removal. Although it is usually treated successfully with curettage, wide excision should be considered along with careful follow-up over the long term owing to the possibility of recurrence or malignant transformation.

[Prognostic factors in patients with malignant fibrous histiocytoma of the extremities]. / Ekstremite yerlesimli malign fibröz histiyositomlu hastalarda prognostik faktörler.

OBJECTIVES: We evaluated prognostic factors in patients with malignant fibrous histiocytoma of the extremity. METHODS: The study included 26 patients (22 males, 4 females; 15 patients < age 60) with a diagnosis of malignant fibrous histiocytoma of the extremity. Clinical and pathological data were analyzed including age, gender, affected extremity, presentation status (primary or recurrent), localization (proximal or distal), size, depth, and grade of the tumor, resection quality, adjuvant therapy, and the presence of distant metastasis at the time of diagnosis. RESULTS: The mean follow-up of 16 patients who were alive was 44.8 months (range 24 to 120 months). The mean symptom duration before diagnosis was seven months (range 1 to 26 months). All the patients underwent surgical resection. A margin-negative R0 resection was obtained in 17 patients. Amputation was performed in seven patients. Adjuvant chemotherapy and radiotherapy were administered to 17 patients and 10 patients, respectively. Local recurrence was detected in eight patients. Two patients had distant metastasis at the time of diagnosis while eight patients developed distant metastasis within a mean of 13 months (range 7 to 20 months) postoperatively. Kaplan-Meier analysis showed an overall five-year survival rate of 61.5%, being 100% in low-grade tumors, and 28.2% in high-grade tumors. Tumor grade was the only significant parameter affecting survival in both univariate (p=0.004) and multivariate (p=0.023) analyses. CONCLUSION: Patients with high-grade malignant fibrous histiocytoma have a poorer prognosis.

[Chondromyxoid fibroma: an evaluation of 11 patients]. / Kondromiksoid fibroma: 11 olgunun degerlendirilmesi.

OBJECTIVES: We evaluated surgical treatment of patients with chondromyxoid fibroma. METHODS: The study included 11 patients (6 females, 5 males; mean age 31 years; range 8 to 53 years) who underwent surgical treatment for chondromyxoid fibroma. The most common site of involvement was the tibia in three patients. Diagnosis was made preoperatively by tru-cut biopsies in seven patients and all the diagnoses were confirmed postoperatively by histopathologic examination. In addition to plain radiographs, computed tomography was used in 10 patients, and magnetic resonance was used in six patients. Surgery included wide resection, marginal excision or intralesional curettage followed by autologous bone graft or bone cement. The mean follow-up was 62.8 months (range 2 to 162 months). RESULTS: The main presenting symptom was pain in all the patients. Two patients with thoracic wall and tibia involvement, respectively, complained of a mass. Radiologic imaging showed soft tissue involvement in two patients. Recurrence occurred in three patients (27.3%), in whom initial surgical procedures were curettage alone (n=2) or with iliac graft (n=1). One patient with involvement in the phalanx of the thumb presented with pain 46 months after the second operation. A tru-cut biopsy yielded a diagnosis of secondary chondrosarcoma for which ray amputation was performed. No wound site infections or functional loss developed after surgical treatment. CONCLUSION: Chondromyxoid fibroma may develop in various bones of the body and occur at a wide age range. Curettage with autologous bone graft is an effective surgical method.

[Alveolar soft part sarcoma of the extremities: an evaluation of four cases]. / Ekstremite yerlesimli alveoler yumusak doku sarkomu: Dört olgunun degerlendirilmesi.

We presented four patients (3 women, 1 man; mean age 40 years; range 20 to 56 years) who had alveolar soft part sarcoma in the left arm, right elbow, right tibia, and left thigh, respectively. All the patients presented with a mass. Two patients had lung metastasis at the time of diagnosis. T1- and T2-weighted magnetic resonance images of all the patients showed a soft tissue lesion with hyperintense signal changes and heterogeneous contrast enhancement. Diagnoses were made by histopathologic examination of biopsy samples. All the patients received chemotherapy. Surgical resection was performed in three patients. Two patients with involvement of the left arm and right elbow died within three years after diagnosis. One patient with involvement of the left thigh developed lung and brain metastases at the end of postoperative eight years. One patient with tibial involvement remained disease-free during 10 months of follow-up.

Chemotherapy in primary osteogenic sarcoma in patients over the age of forty.

OBJECTIVE: In this study, we sought to review the clinical and histopathological features and the chemotherapy regimens in osteogenic sarcoma in patients over 40 years of age, and we aimed at identifying the possible prognostic factors in this particular group of patients. METHODS: We reviewed 287 patients with osteosarcoma treated between the year 1986 and 2010. Patients from this group who met the following criteria were considered eligible for our study; presence of primary OS, had typical histological and radiographic features of OS, no prior history of cancer or any treatment elsewhere and no prior history of preexisting bone abnormalities. RESULTS: The Kaplan-Meier survival curve for the entire group, with a 95% confidence interval, at two and five years showed the survival rates as 76.2% and 72.8% respectively. The surgical margin was a significant factor affecting the survival. Presence of a pathological fracture also had a significant effect on the survival rate. CONCLUSION: Osteogenic sarcoma remains a challenging disease to treat. Despite the expectation that elderly patients may not tolerate aggressive modern chemotherapy as the younger patients, we believe that patients with primary OS over the age of 40 should be treated aggressively with effective chemotherapy and complete surgical excision whenever possible. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Parosteal lipoma as a rare cause of peripheral neuropathy and local irritation: A report of 12 cases.

OBJECTIVE: The aim of this study was to evaluate the clinical features and functional results of patients with parosteal lipomas. METHODS: A total of 12 patients (8 females and 4 males; mean age: 45 (10-62) years) with parosteal lipomas who were treated between April 1986 and April 2014, were included into the study. The medical records of the patients were reviewed to analyze the clinical features and functional results of the patients. RESULTS: Of the 12 lipomas, 5 were localized in the proximal arm, 4 in the forearm, 1 in the distal arm, 1 in the distal thigh and 1 in the distal tibia. All patients presented with a progressive, slow-growing mass that was associated with thumb extension weakness in 1 case, and brachialgia-like symptoms in 1 case. Plain radiographs showed a juxtacortical mass in all cases and irregular ossification in 3 cases. In all cases, marginal excision was performed and no clinical recurrence was observed after a mean follow-up of 16 months. CONCLUSION: Parosteal lipomas are uncommon tumors that can be diagnosed with their characteristic radiological features. Parosteal lipomas occurring in the proximal radius may easily cause paralysis of the posterior interosseous nerve or muscle weakness. LEVEL OF EVIDENCE: Level IV, Therapeutic study.

Manifestations and management of osteochondromas: a retrospective analysis of 382 patients.

Osteochondromas represent the most common primary bone tumours; they reportedly represent 20-50% of all benign bone tumours and 10-15% of all bone tumours. Malignant transformation is their most severe complication. However, deformities and interference with major joint function are the most frequent complaints in patients with hereditary multiple osteochondroma. Treatment should therefore aim not only at surgical resection of the masses but also at prevention of deformities. This article reports observations made on 69 patients with hereditary multiple osteochondroma and 313 patients with solitary osteochondroma, with a mean follow-up of 13.4 years.

Aneurysmal bone cyst of the hand: a report of four cases.

Aneurysmal bone cysts are benign lesions that rarely occur in the bones of the hand. Curettage and bone grafting are the most common treatment modalities performed considering the possible functional loss after total excision. Four cases of aneurysmal bone cyst of the hand were identified. Three out of four cases were treated initially with curettage and bone grafting alone without any other local therapy. One had total excision of the lesion. There were two recurrences in the curettage group. Both were treated with excision and followed up for a minimum of 12 months. Curettage alone was associated with high recurrence rates. Total excision of the lesion was the most successful procedure employed. In view of the high recurrence rates following curettage alone and non-neoplastic nature of the lesion, adjuvant treatment modalities such as cryosurgery, electric cauterisation should be considered for initial treatment of ABC. Resection should be preserved for recurrent cases.