scholarly journals Clinical Features in Metastatic Bone Disease with and without Pathological Fractures: A Comparative Study

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Putu Garry ◽  
Mouli Edward ◽  
Rosy Setiawati ◽  
Sjahjenny Mustokoweni ◽  
Ferdiansyah Mahyudin
Keyword(s):  
Medical Treatment ◽  
Clinical Features ◽  
Bone Disease ◽  
Pathological Fracture ◽  
Metastatic Bone Disease ◽  
Pathological Fractures ◽  
Laboratory Findings ◽  
Primary Tumors ◽  
Significant Difference ◽  
History Of

Background: Pathological fracture complications such as impaired clinical features is suspected to increase the mortality in MBD. In Indonesia, the habit of delayed seeking of medical treatment was common and potentially led to pathological fracture. Aim: This study compared the clinical features between MBD with and without pathological fracture. Methods: This was a retrospective study of MBD at Dr. Soetomo General Hospital in 2011-2015. We compared the clinical features by pain in Visual Analog Scale (VAS); general health presentation represented by laboratory findings; and the history of non-medical treatments. Results: 64 patients had MBD were included in this study. 37 (57.8%) of them presented with pathological fractures, and 27 (42.2%) without. Pain was the most common chief complaint (76.5%). No significant difference found between the MBD with and without pathological fracture in all variables (p=0.122; p=0.64; p=0.823; p=0.417, p=1.000 for VAS, hemoglobin, albumin, calcium, and history of non-medical treatment respectively). This probably associated with the therapy and a variety of primary tumors underlying the MBD. However, 6 out of 10 patients with history non-medical treatment presented with fractures. Conclusion: There's no significant difference in clinical features of MBD from both groups, while those with fractures had worse conditions. Keywords: Metastatic bone disease, Pathological fracture, Clinical features

Metastatic bone disease

2011 ◽  
Author(s):  
Panagiotis D. Gikas ◽  
Timothy W.R. Briggs
Keyword(s):  
Bone Disease ◽  
Multidisciplinary Team ◽  
Pathological Fracture ◽  
Surgical Intervention ◽  
Weight Bearing ◽  
Spinal Metastases ◽  
Metastatic Bone Disease ◽  
Pathological Fractures

♦ Metastatic pathological fractures rarely unite, even if stabilized♦ Never rush to fix a pathological fracture; traction or splintage will suffice while investigations are performed and surgical intervention discussed♦ When surgery is indicated for spinal metastases, both decompression and stabilization are generally required♦ Implants should allow immediate weight-bearing and last the lifetime of the patient♦ Always use a multidisciplinary team.

A Cross-Sectional Study to Compare Differences on Clinical and Laboratory Findings in Children with Seropositive and Seronegative Lupus

2021 ◽  
Author(s):  
Shima Salehi ◽  
Rozita Hosseini Shamsabadi ◽  
Hassan Otukesh ◽  
Reza Shiari ◽  
Monir Sharafi
Keyword(s):  
Autoimmune Disease ◽  
Disease Diagnosis ◽  
Cross Sectional Study ◽  
Rapid Identification ◽  
The Body ◽  
Musculoskeletal Symptoms ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Significant Difference ◽  
History Of

Abstract Background: Lupus is an inflammatory and autoimmune disease that involves various tissues and organs of the body. Identification of diagnostic elements to rapid identification of seronegative lupus cases is very important in order to prevent morbidity and progression of disease. This study aimed to compare clinical and laboratory findings of seropositive cases with seronegative lupus patients. Methods: This cross-sectional analytic study was performed on 43 children (17 seronegative and 26 seropositive) with lupus who were admitted to Ali Asghar Hospital during 2007-2017. Seropositive patients had anti-nuclear antibody (ANA) titration >1/80, while seronegative patients had ANA titration <1/80 (at the time of disease diagnosis). Clinical and laboratory findings were compared between two groups.Results: Serositis in patients with ANA- was significantly higher than ANA+ (41.17% vs. 23.07%; p = 0.042). ANA- group had higher autoimmune disease history than ANA+ group (42.85% vs. 15.0%; p = 0.041). The family history of the disease in the ANA- group was greater than ANA+ group (50% vs. 23.52%). The percentage of hypertensive patients in ANA- group was higher than ANA+ group (52.94% vs. 26.92%; p = 0.037). Neurologic symptoms in ANA+ and ANA- groups were 38.46% and 17.64%, respectively (p = 0.043). The frequency of patients with thrombocytopenia in ANA+ group was significantly greater than ANA- group (32% vs. 12.5%; p=0.041). There was no significant difference in other clinical and laboratory findings between two groups. Conclusion: Seronegative lupus patients had higher percentage of musculoskeletal symptoms, autoimmune disease history, familial history of disease, and hypertension, while neurological and thrombocytopenia symptoms were higher in seropositive patients compared to seronegative cases. Therefore, evaluation of these factors can be helpful to diagnosis of seronegative patients.

scholarly journals Active Unicameral Bone Cysts in the Upper Limb are at Greater Risk of Fracture

2009 ◽  
Vol 17 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Inn Kuang Tey ◽  
Arjandas Mahadev ◽  
Kevin Boon Leong Lim ◽  
Eng Hin Lee ◽  
Saminathan Suresh Nathan
Keyword(s):  
Growth Plate ◽  
Lower Limb ◽  
Pathological Fracture ◽  
Bone Cyst ◽  
Lower Limbs ◽  
Unicameral Bone Cyst ◽  
Pathological Fractures ◽  
Risk Of Fracture ◽  
History Of ◽  
Index 2

Purpose. To elucidate the natural history of unicameral bone cyst (UBC) and risk factors for pathological fracture. Methods. 14 males and 8 females (mean age, 9 years) diagnosed with UBC were reviewed. Cyst location, symptoms, and whether there was any fracture or surgery were recorded. Cyst parameters were measured on radiographs, and included (1) the cyst index, (2) the ratio of the widest cyst diameter to the growth plate diameter, and (3) the adjusted distance of the cyst border from the growth plate. Results. There were 11 upper- and 11 lower-limb cysts. 13 patients had pathological fractures and 9 did not. 20 patients were treated conservatively with limb immobilisation; 2 underwent curettage and bone grafting (one resolved and one did not). Seven cysts resolved (5 had fractures and 2 did not). The risk of fracture was higher in the upper than lower limbs (100% vs 18%, p<0.001). Fractured cysts were larger than unfractured cysts (mean cyst index, 4.5 vs. 2.2, p=0.07). Active cysts were more likely to fracture. Conclusion. Conservative management had a 30% resolution rate. Surgery should be considered for large active cysts in the upper limbs in order to minimise the fracture risk.

scholarly journals Prediction of fracture risk and prophylactic intervention in metastatic bone disease: a systematic review

2018 ◽  
Vol 1 (1) ◽  
pp. 44-49
Author(s):  
Bogdan Ştefan Creţu ◽  
Călin Dragosloveanu ◽  
Dragoş Cotor ◽  
Şerban Dragosloveanu ◽  
Cristian Ioan Stoica
Keyword(s):  
Fracture Risk ◽  
Bone Disease ◽  
Meta Analysis ◽  
Metastatic Bone Disease ◽  
Bone Lesions ◽  
Pathological Fractures ◽  
Element Analysis ◽  
Actual Knowledge ◽  
Number Of Patients

AbstractPathological fractures occur in an area of bone where either the quantity or quality of bone is modified and the main cause of bone metastases that weaken the structure and will lead to fractures are in high proportion given by visceral tumors or primary hematopoietic tumors like myeloma.This paper’s objective was to review the actual knowledge in the treatment of fractures secondary to metastases. Spinal lesions were not discussed in this paper.Literature search was performed using MEDLINE and Web of Science to find literature relevant to fracture risk and prophylactic intervention in metastatic bone disease. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used for this review. As results, we identified 30 papers that were suitable for this review. Most of them concluded that it is difficult to assess the amount of bone involvement on radiographs alone. Using the actual guidelines for prophylactic fixation may result in an under treatment or overtreatment of patients with metastatic bone disease. Their ability to determine which metastatic bone lesions will fracture is altered mainly because of the small number of patients included in the studies. The prediction factors for fracture risk are still to be evaluated. CT, FDG-PET or CT scan-based finite element analysis may be useful tools for the identification of impending pathological fractures requiring prophylactic stabilization.

scholarly journals Pathological fracture of non-ossifying fibroma associated with neurofibromatosis type 1

2019 ◽  
Vol 12 (7) ◽  
pp. e228170 ◽  
Author(s):  
James Ritchie Gill ◽  
Tamer Magid EL Nakhal ◽  
Soo-Mi Park ◽  
Mariusz Chomicki
Keyword(s):  
Clinical Features ◽  
Neurofibromatosis Type 1 ◽  
Pathological Fracture ◽  
Neurofibromatosis Type ◽  
Ossifying Fibroma ◽  
Pathological Fractures ◽  
Cast Immobilisation ◽  
Increased Risk ◽  
Operative Fixation

We report the management of a pathological fracture through a proximal tibial non-ossifying fibroma (NOF) in a 13-year-old girl with neurofibromatosis type 1 (NF1). The fracture was minimally displaced, and the lesion had clinical features of a NOF, and therefore biopsy was not required. Operative fixation has been the preferred method of treatment for pathological fractures through NOF associated with NF1. Multiple NOFs associated with NF1 are rare but can coalesce resulting in large lesions with an increased risk of pathological fracture. In cases which permit, non-operative treatment with cast immobilisation can yield satisfactory results.

scholarly journals Clinical features and prognostic significance of splenic involvement in sarcoidosis

2017 ◽  
Vol 87 (3) ◽  
Author(s):  
Cuneyt Tetikkurt ◽  
Halil Yanardag ◽  
Metin Pehlivan ◽  
Muammer Bilir
Keyword(s):  
Clinical Features ◽  
Systemic Disease ◽  
Prognostic Significance ◽  
Significant Risk ◽  
Organ Involvement ◽  
Laboratory Findings ◽  
Significant Difference ◽  
Splenic Involvement ◽  
Prognostic Outcome ◽  
Splenic Disease

Sarcoidosis is a systemic disease characterized by noncasefied granulomas in various organs. Incidence of splenic disease is variable and is reported to occur in 6.7 to 77 percent of the patients. Firm data establishing the clinical features and the association of splenic involvement with prognosis in sarcoidosis is scant. The aim of our study was to investigate the clinical features and the consequence of splenic involvement on the prognostic outcome of sarcoidosis patients. We evaluated the clinical and laboratory findings in 82 sarcoidosis patients. Forty-two patients with splenic involvement were compared to 48 sarcoidosis patients without splenic disease in regard to laboratory findings, endobronchial disease, extrapulmonary organ involvement, and prognosis. Lung biopsy sample was considered positive if it demonstrated noncaseating granulomas with negative fungal and mycobacterial cultures. Splenic sarcoidosis was identified by ultrasound or computed tomography and was designated as limited, diffuse or without splenic involvement. Extrapulmonary organ sarcoidosis was classified as extensive and limited. Endobronchial disease was categorized as limited or diffuse involvement. The most commonly comprised organ was lung in 95% of the cases followed by lymph nodes, skin, eye, spleen and liver in the order of frequency. Splenic disease was diffuse in 22 patients. Of these patients, 14 had extensive extrapulmonary organ involvement while 16 had diffuse endobronchial disease. There was no significant difference between the three groups for FEV1, FVC, TLC, DLCO/VA, serum and 24h urinary calcium levels. Serum ACE was higher in patients with diffuse splenic involvement (p<0.001). Incidence of persistent chronic disease was significantly higher (p<0.001) in patients with diffuse splenic sarcoidosis. Extensive extrapulmonary organ involvement and diffuse endobronchial disease were more common (p<0.001) in this group. Extensive extrapulmonary organ involvement and diffuse endobronchial disease were more frequent in patients with diffuse splenic sarcoidosis. Patients with diffuse splenic granulomas had a worse prognosis than the patients without splenic involvement or patients with limited splenic disease. Diffuse splenic involvement emerges to be a significant risk factor for persistent chronic sarcoidosis. Extensive granuloma burden in an organ may be the decisive clinical marker for the prognostic outcome of sarcoidosis patients. 

Denosumab and zoledronic acid treatment in patients with genitourinary cancers and bone metastases.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5079-5079 ◽  
Author(s):  
Luis Costa ◽  
Karim Fizazi ◽  
Fred Saad ◽  
Janet Elizabeth Brown ◽  
Roger Von Moos ◽  
...  
Keyword(s):  
Zoledronic Acid ◽  
Bone Disease ◽  
Proportional Hazards Model ◽  
Transitional Cell ◽  
Cox Proportional Hazards ◽  
Metastatic Bone Disease ◽  
Cox Proportional Hazards Model ◽  
Phase Iii ◽  
Pivotal Phase ◽  
Significant Difference

5079 Background: Phase III trial results showed that denosumab is superior to zoledronic acid (ZA) in preventing skeletal-related events (SREs) in patients with cancer and metastatic bone disease (Lipton et al; 2012, Eur J Cancer). Genitourinary (GU) cancers are some of the most commonly diagnosed cancers worldwide. We now compare the efficacy and safety of denosumab (DMAb) or ZA in a subgroup analysis of patients with GU cancers enrolled in the pivotal phase III trials. Methods: Patients were randomized 1:1 to receive DMAb (120 mg, SC) or ZA (4 mg, IV, adjusted for renal function) every 4 weeks. Daily calcium and vitamin D supplements were strongly recommended. Time to 1st on-study SRE, using a Cox proportional hazards model, time to 1st and subsequent on-study SRE, using the Anderson-Gill model, and safety were evaluated for the GU subgroup in an ad hoc analysis. Results: 2,128 patients (1,052 DMAb; 1,076 ZA) had GU cancers (prostate = 1,901, renal = 155, bladder = 63, and transitional cell = 9). DMAb significantly delayed the time to 1st on-study SRE by 4.0 months compared with ZA (20.7 months vs 16.7 months) in patients with GU cancers (Table). DMAb also significantly delayed the time to 1st and subsequent on-study SRE. Time to disease progression and overall survival were similar between treatment groups. Adverse events (AEs) and serious AEs were reported by similar percentages of patients in both groups (AEs: 96.9% denosumab, 96.8% ZA; serious AEs: 62.8% denosumab, 60.2% ZA). 14.6% of DMAb pts and 15.9% of ZA pts had a renal AE. Hypocalcemia was reported for 12.9% of DMAb patients and 6.2% of ZA patients. There was no significant difference in the incidence of positively adjudicated osteonecrosis of the jaw between the DMAb (2.2%) and ZA (1.6%) groups (p=0.34). Conclusions: Among patients with GU cancers and metastatic bone disease, DMAb was superior to ZA in preventing SREs. Clinical trial information: NCT00330759 and NCT00321620. [Table: see text]

scholarly journals Diagnostic use of intramedullary reaming biopsy in metastatic long bone disease

2017 ◽  
Vol 99 (6) ◽  
pp. 452-455
Author(s):  
RA Afinowi ◽  
A Chaturvedi ◽  
HR Cattermole
Keyword(s):  
Diagnostic Accuracy ◽  
Metastatic Disease ◽  
Bone Disease ◽  
Pathological Fracture ◽  
Metastatic Bone Disease ◽  
Long Bone ◽  
Histopathological Analysis ◽  
Diagnostic Use ◽  
Intramedullary Reaming ◽  
Adequate Tissue

INTRODUCTION Bone is the third most common site of metastasis. A histological diagnosis is important in guiding therapy and prognosis. In up to 15% of cases of metastatic disease, the primary tumour remains unknown. This emphasises the importance of adequate, reliable and accurate sampling when performing any type of biopsy. Reaming biopsy is commonly performed during intramedullary nailing of metastatic long-bone disease but there is little published evidence on the diagnostic use and reliability of this technique. AIMS AND METHODS We reviewed 49 cases of confirmed metastatic bone disease to determine adequacy for analysis, diagnostic accuracy and factors affecting reliability. RESULTS Adequate tissue for histopathological analysis was obtained in 96% of cases but metastasis was confirmed in only 51% of cases. The presence of a pathological fracture had no effect on accuracy of the results but metastasis was more likely to be missed in the presence of tissue crushing and or necrosis (P = 0.015). DISCUSSION This study determines the use and accuracy of bone reaming biopsy in metastatic disease and, to the best of our knowledge, is the only study determining the effect of additional factors such as the presence of a pathological fracture and tissue necrosis or crushing on the diagnostic accuracy of this technique. CONCLUSIONS In spite of adequate tissue sampling, the diagnostic accuracy and, hence, reliability of intramedullary reaming biopsy in metastatic bone disease is less than optimal. A reaming histopathology report suggesting no evident metastasis should always be taken in clinical context.

When and where do patients with bone metastases actually break their femurs?

2020 ◽  
Vol 102-B (5) ◽  
pp. 638-645 ◽  
Author(s):  
A. Sternheim ◽  
F. Traub ◽  
N. Trabelsi ◽  
S. Dadia ◽  
Y. Gortzak ◽  
...  
Keyword(s):  
Bone Disease ◽  
Pathological Fracture ◽  
Roc Curves ◽  
Metastatic Bone Disease ◽  
Risk Of Fracture ◽  
Receiver Operating Characteristic Curves ◽  
Predicted Values ◽  
Sensitivity Specificity ◽  
Imminent Risk

Aims Accurate estimations of the risk of fracture due to metastatic bone disease in the femur is essential in order to avoid both under-treatment and over-treatment of patients with an impending pathological fracture. The purpose of the current retrospective in vivo study was to use CT-based finite element analyses (CTFEA) to identify a clear quantitative differentiating factor between patients who are at imminent risk of fracturing their femur and those who are not, and to identify the exact location of maximal weakness where the fracture is most likely to occur. Methods Data were collected on 82 patients with femoral metastatic bone disease, 41 of whom did not undergo prophylactic fixation. A total of 15 had a pathological fracture within six months following the CT scan, and 26 were fracture-free during the five months following the scan. The Mirels score and strain fold ratio (SFR) based on CTFEA was computed for all patients. A SFR value of 1.48 was used as the threshold for a pathological fracture. The sensitivity, specificity, positive, and negative predicted values for Mirels score and SFR predictions were computed for nine patients who fractured and 24 who did not, as well as a comparison of areas under the receiver operating characteristic curves (AUC of the ROC curves). Results The sensitivity of SFR was 100% compared with 88% for the Mirels score, and the specificity of SFR was 67% compared with 38% for the Mirels score. The AUC was 0.905 for SFR compared with 0.578 for the Mirels score (p = 0.008). Conclusion All the patients who sustained a pathological fracture of the femur had an SFR of > 1.48. CTFEA was far better at predicting the risk of fracture and its location accurately compared with the Mirels score. CTFEA is quick and automated and can be incorporated into the protocol of CT scanners. Cite this article: Bone Joint J 2020;102-B(5):638–645.

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