Norman L. Higinbotham

Primary reticulum-cell sarcoma of bone; summary of 37 cases.

One of the earliest suggestions that reticulum-cell sarcoma could arise from the reticulo-endothelial structures of bone was made by Oberling (17) in 1928. In 1939, Ewing (13) accepted primary reticulum-cell sarcoma of bone as a distinct entity for inclusion in a revised classification of bone tumors for the Bone Sarcoma Registry of the American College of Surgeons. In the same year, Parker and Jackson (18) presented a complete study of 17 cases of this disease; 13 of the cases were from the Bone Sarcoma Registry material and the remainder from their personal experience. Since then only a few reports of small series of cases have appeared in the world literature (15, 19, 22, 23). In the majority of the more recently reported cases the disease was generalized, there were multiple bone foci, or histologic confirmation of the primary focus in bone was not obtained. Definition: Primary reticulum-cell sarcoma of bone is a malignant tumor histologically identical with reticulum-cell sarcoma elsewhere in the bod...

The cure of aneurysmal bone cyst. Irradiation superior to surgery in an analysis of 33 cases.

Although the pathogenesis of aneurysmal bone cyst remains obscure and the condition did not achieve the distinction of a succinct description classifying it as a separate entity until the work of Jaffe and Lichtenstein was published in 1942, it has now been accepted as a distinct bone lesion with rather classical radiographic and pathologic characteristics. Much, however, remains to be said about the appropriate treatment of these lesions since, although benign, they often present serious complications. There are many isolated case reports as well as several more extensive reviews of larger series of cases, but the majority of these papers treat aneurysmal bone cyst as an unusual and interesting entity worthy of discussion and description. Treatment may be relegated to the last paragraph, and in most cases surgery is advocated. Several authors, notably Lichtenstein, suggest radiation therapy for lesions which are surgically inaccessible, and isolated cases so treated were reported as cured. We have not, h...

The Clinical and Radiographic Aspects of Radiation Osteitis

Patients with radiation osteitis were studied in regard to the protean manifestations of this entity as it affects the skeleton, with emphasis on distinguishing radiation osteitis from radiation osteogenic sarcoma, metastatic bony involvement, or simple changes of disuse. Bone fragmentation, resorption, and soft tissue calcification may mimic the appearance of a radiation-induced osteogenic sarcoma. In the absence of infectious or traumatic complications, an area of known radiation osteitis which suddenly changes in appearance, becomes symptomatic, or is associated with a mass lesion should be considered neoplastic.

Parosteal fascitis. A self-limited benign process that simulates a malignant neoplasm.

Abstract 1. 1. Parosteal fasciitis is a self-limited benign process that may simulate a malignant neoplasm clinically, radiographically and pathologically. 2. 2. The salient features of four cases of parosteal fasciitis have been described in an effort to focus attention on its occurrence and, thereby, obviate the serious results of misdiagnosis.

Giant cell tumor of bone

1. The giant-cell tumor is usually benign, but malignant forms are encountered and may result from the transformation of a tumor that is histologically benign at the outset. 2. Surgical extirpation (curettage, resection, and, on rare occasions, amputation) and radiation have been established as successful methods of treatment. Surgery is preferable for accessible tumors, and radiation for inaccessible or extremely advanced tumors. 3. Caution should be exercised when using the roentgen-ray without histological confirmation of the diagnosis, for one may be dealing with an osteolytic sarcoma which bears a close resemblance, roentgenographically, to the giant-cell tumor. 4. Radiation should not be used in conjunction with surgery. Each method should bear the full responsibility of its employment in the individual case. 5. The roentgen-ray in large doses destroys the regenerative powers of the bone; in small doses, it may fail to arrest the disease; therefore, the exact dosage for the individual case is a matter of profound judgment or of fortuitous circumstance. 6. Inexpert radiation is probably less hazardous than surgery in the hands of one unfamiliar with technical operative details. Loss of limb may ultimately result in either instance. 7. Surgical attack should envisage thorough removal of all tumor tissue through adequate exposure, careful wound closure without packing or drainage, and primary wound healing. 8. Protection during the regenerative phase is essential, regardless of the treatment employed, for a pathological fracture usually spells functional impairment and a painful neighboring joint.

Bilateral fracture of the scapula

Abstract 1. 1. A case of bilateral fracture of the scapula is presented which is the first to be reported in the literature, as far as the authors have been able to ascertain. 2. 2. One of the fractures was badly comminuted and displaced. It was partially reduced by means of traction wires and the position greatly improved. 3. 3. The mechanisms of injury and aspects of treatment are discussed.

Use of bank bone in the treatment of central lesions of bone

and WiIson5 separateIy reported in their experiences in two orthohospitaIs with homogenous bone has been derived aImost entireIy from ribs resected on the Thoracic Service by Dr. WiIIiam L. Watson and his associates. Based grafts-They made use of a deep-freeze to store bone obtained at operation or from amputated specimens. They estabIished the fact that refrigerated bone serves as a useful source of bone transplants and that such bone behaves in the host much as does autogenous materia1. Additional experimental and cIinica1 experience by Bush and Garber3 further established the safety and utiIity of the method and Wilson6 reported an impressive foIIow-up study of 214 patients who were subjected to 27X operations in which steriIe homoIogous bone grafts were used. Wilson6 concludes“ I. With careful technique homoIogous bone grafts may be preserved for Iong periods of time for surgical use. 2. Such grafts are we11 toIerated by human tissues and the risk of infection is no greater than with autogenous grafts. 3. The healing of such grafts takes pIace by a process of invasion, absorption and replacement simiIar to that of autogenous bone grafts. 4. The resuIts obtained are identica1 with those from the use of autogenous grafts except that in some instances the heaIing appears to be a IittIe slower. 5. The operation of the bone bank is safe and practical. It offers great advantages to the patient and the surgeon from the standpoint of availability, abundance and the eIimination of the necessity of secondary operations to obtain bone.” It seems unnecessary to repeat here detaiIs which both Bush and Wilson have given concerning the organization and operation of the bone bank. Instead we wish to describe our experiences with this method during a fifteenmonth period in which it has been in use on the Bone Tumor Service at Memorial Hospital. During this period we have had a bone bank and have kept an ampIe supply on hand which IA IB Frc;. 1. A, typical unicamera1 bone cyst in a six year old boy; B, five weeks after curettage, cauterization and implantation of homologous rib chips.