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Ear, Nose, & Throat Journal Aug 2023Inflammatory lesions such as osteomyelitis of the jaw may share some of the radiographic features of malignancy; however, a demonstrable dental cause for it usually...
Inflammatory lesions such as osteomyelitis of the jaw may share some of the radiographic features of malignancy; however, a demonstrable dental cause for it usually exists. In addition, inflammatory lesions generally stimulate a sclerotic bone reaction, which is uncommon in malignancy. The imaging modality of choice for aiding in the differential diagnosis is computed tomography imaging because of its ability to clearly delineate sequestra and periosteal new bone formation.
Topics: Humans; Mandibular Diseases; Osteomyelitis; Tomography, X-Ray Computed; Mandible; Diagnosis, Differential
PubMed: 34002628
DOI: 10.1177/01455613211014289 -
Cureus Sep 2023Voriconazole-induced periostitis (VIP) is an uncommon side effect typically seen in immunosuppressed patients requiring prolonged antifungal therapy. These patients can...
Voriconazole-induced periostitis (VIP) is an uncommon side effect typically seen in immunosuppressed patients requiring prolonged antifungal therapy. These patients can present with bone pain, fragility, and elevated alkaline phosphatase (ALP). We present a case of VIP in a 72-year-old immunocompromised female on antifungal therapy presenting with a comminuted intertrochanteric fracture after a ground-level fall. VIP, although rare, should be included as a differential diagnosis for patients presenting with bone pain and/or fractures with radiographic features of periostitis. This is particularly true when there is a history of or prior imaging suggesting a solid organ transplant. In these cases, a dedicated review of current medications noting long-term voriconazole use in the absence of underlying rheumatologic disease can result in a confident diagnosis.
PubMed: 37885496
DOI: 10.7759/cureus.45947 -
Skeletal Radiology Sep 2023To examine the multimodality imaging characteristics of parosteal lipomas.
OBJECTIVE
To examine the multimodality imaging characteristics of parosteal lipomas.
MATERIALS AND METHODS
With IRB approval, our institutional imaging database and medical record were retrospectively reviewed from 1990-2020 for cases of pathologically-proven and/or imaging diagnosed parosteal lipomas.
RESULTS
There were 22 patients (12 males, 10 females) with a mean age of 57.1 ± 12.7 years (range 31-80 years). 11/22 cases (50%) were pathologically-confirmed on biopsy or surgical resection and 11/22 (50%) had imaging features compatible with parosteal lipoma. Lesions occurred most commonly along the femur (8/22, 36%), followed by the forearm (3/22, 14%). All cases demonstrated a juxtacortical fatty mass containing an osseous excrescence that was firmly attached to the cortical surface. The osseous excrescences were characterized as pedunculated in 16/22 (73%) and sessile in 6/22 (27%). The average largest dimension of the osseus excrescences was 2.4 ± 1.6 cm (range 0.8-6.1 cm) and the lipomatous portions 7.8 ± 3.8 cm (range 2.0-19.5 cm). The excrescences contained mature bone in 12/22 (55%) cases and a mixture of mature bone and radiating bone spicules in 10/22 (45%). There were non-lipomatous elements in the fatty portion of the mass in 13/22 (59%) of cases. Most cases (19/22, 85%) had cortical thickening/periostitis near the base of the osseous stalk. Two patients had a bone scan that demonstrated uptake in the osseous excrescence, and two patients had an FDG PET/CT that demonstrated no uptake.
CONCLUSION
Parosteal lipomas are a rare benign lipomatous tumor with pathognomonic multimodality imaging features that may obviate the need for biopsy.
Topics: Male; Female; Humans; Adult; Middle Aged; Aged; Aged, 80 and over; Retrospective Studies; Positron Emission Tomography Computed Tomography; Lipoma; Bone Neoplasms; Tomography, X-Ray Computed; Magnetic Resonance Imaging
PubMed: 37083978
DOI: 10.1007/s00256-023-04349-w -
Plastic and Reconstructive Surgery.... Oct 2023Alveolar bone graft (ABG) surgery in cleft patients is technically challenging. The procedure requires design, dissection and release of soft tissue flaps to create a...
Alveolar bone graft (ABG) surgery in cleft patients is technically challenging. The procedure requires design, dissection and release of soft tissue flaps to create a seal around the bone graft. In addition, visualization during the procedure is challenging within the confines of the cleft. These features make ABG surgery difficult to learn and teach, and it is, therefore, a suitable procedure for the use of a simulator. A high-fidelity cleft ABG simulator was developed using three-dimensional printing, polymer, and adhesive techniques. Simulated ABG surgery was performed by two expert cleft surgeons for a total of five simulation sessions to test the simulator's features and the ability to perform the critical steps of an ABG. ABG surgery was successfully performed on the simulator. The simulations involved interacting with realistic dissection planes as well as multi-layered synthetic soft (periosteum, mucosa, gingiva, adipose tissue) and hard (teeth, bone) tissue. The simulator allowed performance of cleft marginal incisions, dissection, and elevation of a muco-gingival-periosteal flap, creation of nasal upturned and palatal downturned flaps, nasal and palatal side closure, insertion of simulated bone graft material, and advancement of the muco-gingival-periosteal flap for closure of the anterior wall of the cleft. The ABG simulator allowed performance of the critical steps of ABG surgery. This is the first ABG simulator developed, which incorporates the features necessary to practice the procedure from start to finish.
PubMed: 37908329
DOI: 10.1097/GOX.0000000000005363 -
The Journal of Bone and Joint Surgery.... Aug 2023Fracture repair involves the reactivation of developmental signaling cascades, including Wnt signaling that stimulates bone formation and bone regeneration. Rodent data...
Dual Inhibition of the Wnt Inhibitors DKK1 and Sclerostin Promotes Fracture Healing and Increases the Density and Strength of Uninjured Bone: An Experimental Study in Nonhuman Primates.
BACKGROUND
Fracture repair involves the reactivation of developmental signaling cascades, including Wnt signaling that stimulates bone formation and bone regeneration. Rodent data indicate that dual inhibition of the Wnt signaling antagonists sclerostin and Dickkopf-1 (DKK1) increases callus bone volume and strength while increasing bone mass systemically.
METHODS
We evaluated the effects of 16 weeks of subcutaneously administered carrier solution (vehicle, VEH), anti-sclerostin antibody (Scl-Ab), anti-DKK1 antibody (DKK1-Ab), or Scl-Ab plus DKK1-Ab combination therapy (COMBO) on ulnar osteotomy healing in nonhuman primates (cynomolgus monkeys; 20 to 22 per group).
RESULTS
Scl-Ab and COMBO therapy increased systemic markers of bone formation versus VEH, with COMBO leading to synergistic increases versus Scl-Ab or DKK1-Ab monotherapies. The COMBO and Scl-Ab groups showed reduced serum markers of bone resorption versus VEH. The COMBO and DKK1-Ab groups exhibited greater callus bone mineral density (BMD), torsional stiffness, and torsional rigidity versus VEH. Lumbar vertebrae from the Scl-Ab and COMBO groups showed greater BMD and bone formation rate versus VEH, and the femoral mid-diaphysis of the Scl-Ab and COMBO groups showed greater periosteal and endocortical bone formation rates versus VEH.
CONCLUSIONS
DKK1-Ab increased BMD and strength at the ulnar osteotomy site, Scl-Ab increased bone formation and BMD at uninjured skeletal sites, and Scl-Ab plus DKK1-Ab combination therapy induced all of these effects, in some cases to a greater degree versus 1 or both monotherapies. These results in nonhuman primates suggest that DKK1 preferentially regulates bone healing while sclerostin preferentially regulates systemic bone mass.
CLINICAL RELEVANCE
Combination therapy with antibodies against sclerostin and DKK1 may offer a promising therapeutic strategy for both fracture treatment and fracture prevention.
Topics: Animals; Fracture Healing; Antibodies, Monoclonal; Bone and Bones; Bone Density; Osteogenesis; Fractures, Bone; Primates
PubMed: 37159527
DOI: 10.2106/JBJS.22.01092 -
Infectious Diseases Now Nov 2023Most osteoarticular infections (OAI) occur via the hematogenous route, affect children under 5 years of age old, and include osteomyelitis, septic arthritis,... (Review)
Review
Most osteoarticular infections (OAI) occur via the hematogenous route, affect children under 5 years of age old, and include osteomyelitis, septic arthritis, osteoarthritis and spondylodiscitis. Early diagnosis and prompt treatment are needed to avoid complications. Children with suspected OAI should be hospitalized at the start of therapy. Surgical drainage is indicated in patients with septic arthritis or periosteal abscess. Staphylococcus aureus is implicated in OAI in children at all ages; Kingella kingae is a very common causative pathogen in children from 6 months to 4 years old. The French Pediatric Infectious Disease Group recommends empirical antibiotic therapy with appropriate coverage against methicillin-sensitive S. aureus (MSSA) with high doses (150 mg/kg/d) of intravenous cefazolin. In most children presenting uncomplicated OAI with favorable outcome (disappearance of fever and pain), short intravenous antibiotic therapy during 3 days can be followed by oral therapy. In the absence of bacteriological identification, oral relay is carried out with the amoxicillin/clavulanate combination (80 mg/kg/d of amoxicillin) or cefalexin (150 mg/kg/d). If the bacterial species is identified, antibiotic therapy will be adapted to antibiotic susceptibility. The minimum total duration of antibiotic therapy should be 14 days for septic arthritis, 3 weeks for osteomyelitis and 4-6 weeks for OAI of the pelvis, spondylodiscitis and more severe OAI, and those evolving slowly under treatment or with an underlying medical condition (neonate, infant under 3 months of old, immunocompromised patients). Treatment of spondylodiscitis and severe OAI requires systematic orthopedic advice.
Topics: Infant; Infant, Newborn; Child; Humans; Child, Preschool; Staphylococcus aureus; Discitis; Anti-Bacterial Agents; Communicable Diseases; Osteomyelitis; Arthritis, Infectious; Amoxicillin
PubMed: 37741341
DOI: 10.1016/j.idnow.2023.104789 -
Clinical Rheumatology Jul 2023
Topics: Humans; Voriconazole; Periostitis; Positron Emission Tomography Computed Tomography; Antifungal Agents; Positron-Emission Tomography
PubMed: 36811806
DOI: 10.1007/s10067-023-06547-2 -
Seminars in Musculoskeletal Radiology Aug 2023The periosteum is a membrane that covers almost all bones in the body. It is a living structure but attracts little attention unless it reacts excessively. We highlight...
The periosteum is a membrane that covers almost all bones in the body. It is a living structure but attracts little attention unless it reacts excessively. We highlight the important points in the anatomy, histology, and physiology of the periosteum, the stimuli and various aspects of periosteal reaction, and the main conditions underlying periosteal reaction.
Topics: Humans; Diagnostic Imaging; Periosteum
PubMed: 37748465
DOI: 10.1055/s-0043-1770354 -
Frontiers in Endocrinology 2023Osteoporosis in childhood distinguishes itself from adulthood in four important ways: 1) challenges in distinguishing otherwise healthy children who have experienced... (Review)
Review
Osteoporosis in childhood distinguishes itself from adulthood in four important ways: 1) challenges in distinguishing otherwise healthy children who have experienced fractures due to non-accidental injury or misfortunate during sports and play from those with an underlying bone fragility condition; 2) a preponderance of monogenic "early onset" osteoporotic conditions that unveil themselves during the pediatric years; 3) the unique potential, in those with residual growth and transient bone health threats, to reclaim bone density, structure, and strength without bone-targeted therapy; and 4) the need to benchmark bone health metrics to constantly evolving "normal targets", given the changes in bone size, shape, and metabolism that take place from birth through late adolescence. On this background, the pediatric osteoporosis field has evolved considerably over the last few decades, giving rise to a deeper understanding of the discrete genes implicated in childhood-onset osteoporosis, the natural history of bone fragility in the chronic illness setting and associated risk factors, effective diagnostic and monitoring pathways in different disease contexts, the importance of timely identification of candidates for osteoporosis treatment, and the benefits of early (during growth) rather than late (post-epiphyseal fusion) treatment. While there has been considerable progress, a number of unmet needs remain, the most urgent of which is to move beyond the monotherapeutic anti-resorptive landscape to the study and application of anabolic agents that are anticipated to not only improve bone mineral density but also increase long bone cross-sectional diameter (periosteal circumference). The purpose of this review is to provide a practical guide to the diagnosis and management of osteoporosis in children presenting to the clinic with fragility fractures, one that serves as a step-by-step "how to" reference for clinicians in their routine clinical journey. The article also provides a sightline to the future, emphasizing the clinical scenarios with the most urgent need for an expanded toolbox of effective osteoporosis agents in childhood.
Topics: Humans; Adolescent; Child; Adult; Osteoporosis; Bone Density; Fractures, Bone; Bone Density Conservation Agents; Risk Factors
PubMed: 38374961
DOI: 10.3389/fendo.2023.1266986