Yener Saglik

The use of polymethylmethacrylate in the management of hydatid disease of bone

Hydatid disease of bone is rare. It probably represents between 0.5% and 4% of all human hydatid disease and, in about 60% of patients, affects the spine or pelvis. Between 1986 and 1998, we treated 15 cases of bone hydatidosis. Curettage, swabbing with povidone iodine and filling the defect with polymethylmethacrylate (PMMA) were carried out in ten patients. Three of these had a recurrence after five years, but seven had no signs of relapse during a mean follow-up of 52 months. We believe that the combination of antihelminthic therapy, wide resection and the use of PMMA gives the best outcome in the treatment of bone hydatidosis.

Tumors of the foot and ankle: Analysis 196 cases

A retrospective assessment was performed on 196 tumors of the foot and ankle [out of 1786 bone and soft tissue tumor cases, (10.9%)] between March 1986 and March 1996 in the Ankara University Department of Orthopedics and Traumatology Tumor Section. Mean age was 28 years (range 3 to 75 years). Of the 196 foot and ankle tumor cases, 171 (87.2%) were benign, and 25 (12.8%) were malignant. One hundred ninety-four (98.9%) were primary tumors and 2 (1.1%) were metastatic tumors. One hundred thirty-six (69.4%) originated from bone, whereas 60 (30.6%) originated from soft tissue. The most frequent foot and ankle tumors were osteosarcoma among malignant osseous tumors, squamous cell carcinoma among malignant soft tissue lesions, solitary exostosis among benign osseous tumors, and xanthoma and giant cell tumor among benign soft tissue tumors. Mean follow-up time was 21.3 months (12 to 90 months). One hundred forty (71.4%) of the patients underwent various operations while the remaining 56 (28.6%) were treated conservatively. Of the 140 surgical cases, 13 (9.3%) had a recurrence, 3 (2.1%) died, and 124 (88.6%) had a clinical cure. For most of the patients who required surgery, nonaggressive procedures were sufficient while amputations were required for 14 patients.

Accessory soleus muscle.

Accessory soleus muscle is an uncommon anatomical variant that may present as a soft-tissue mass in the posteromedial region of the ankle. It is congenital in origin but usually presents in the second or third decade of life. Although it is a rare entity, accessory soleus muscle should be included in the differential diagnosis of soft-tissue swelling of the ankle. Awareness of the clinical presentation and specific findings of computed tomography, magnetic resonance imaging, and electromyography help with diagnosis without surgical exploration. We describe a 30-year-old patient with accessory soleus muscle. Magnetic resonance imaging features of the case are described, and the literature is briefly reviewed.

Cemented endoprosthetic replacement for metastatic bone disease in the proximal femur.

In long bones, the most common site for metastases is the proximal femur. For lesions involving this region, osteosynthetic devices frequently fail, and for this reason, endoprosthetic reconstruction may be the optimal choice for treatment. Here, we present a series of 44 patients in whom 45 endoprosthetic reconstructions were performed for metastatic disease. In 28 patients (63.63%), endoprosthetic reconstruction was performed for pathologic fractures, and in 16 patients (36.37%), it was performed for impending fractures indicated by complaints of pain and problems with walking. Full weight bearing was achieved in the early postoperative period in 72.09% of our patients, and sufficient pain control was obtained in all patients. Four patients did not survive past the first 72 hours after surgery, and 11 more patients died within 2 months after surgery. A total of 29 patients (65.9%) survived to the 2-month follow-up visit, and of these, only 12 patients (27.2%) survived past the first postoperative year. We believe that in patients with metastatic disease in the proximal femur, endoprosthetic reconstruction can provide early and stable fixation with pain reduction and good functional results.

Squamous Cell Carcinoma Arising in Chronic Osteomyelitis in Foot and Ankle

Background: Squamous cell carcinoma arising from chronic osteomyelitis is uncommon, and although most occur in the lower extremities, occurrence in the foot and ankle is rare. Methods: Between February, 1991, and May, 2003, we treated 14 patients (13 men and one woman) with squamous cell carcinomas arising in chronic osteomyelitis. The foot and ankle were affected in seven patients, and these comprised our study group. All seven patients were male, with a mean age of 59.5 (range 54 to 63) years. An average of 27 (range 4 to 50) years passed between draining of the osteomyelitis and the diagnosis of the malignancy. Average followup was 68 (22 to 147) months. Results: Six patients had amputations and one had limb salvage. Regional lymph node clearance was done in four patients, but metastasis occurred in only one patient who later died of the disease. Conclusion: In treating recalcitrant ulcers that have not responded to conventional modes of therapy, malignancy should be ruled out and a biopsy done. The treatment of choice for squamous cell carcinoma is amputation. Routine regional lymphadenectomy at the time of amputation seems unnecessary, but regional lymphadenopathy persisting for 3 months after amputation warrants surgical intervention.

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

IntroductionOsteochondromas 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 studyBecause 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.PatientsBetween 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.DiscussionThe 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.ConclusionsPatients 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.

Bilateral Calcaneal Intraosseous Lipoma: A Case Report

Intraosseous lipoma is a rare benign primary lesion of bone. Approximately 180 cases have been reported to date. In the literature, we have been able to find only three patients with bilateral calcaneal involvement. We present a 34-year-old woman who was diagnosed with intra-osseous lipoma in both calcanei.

Primary muscular hydatidosis mimicking soft tissue tumour: a report of five cases.

Primary muscular hydatidosis is rare and usually presents as an asymptomatic, slowly growing mass mimicking a soft tissue tumour. Adequate preoperative planning and wide excision is recommended, as incomplete excision may lead to anaphylactic reactions and local recurrence. It should be considered in the differential diagnosis of soft tissue tumours especially in regions endemic for the parasite.

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.

Primary leiomyosarcoma of bone: a report on three patients

Primary leiomyosarcoma of bone is a rare aggressive tumor that occurs mainly in older people. It resembles other malignancies clinically and radiologically, and differential diagnosis is based on histopathology, including immunohistochemistry. If leiomyosarcoma is found in bone, the possibility that it is a metastasis from a distant tumor should be investigated. The treatment is surgical excision with wide margins. Here we present three patients who had primary leiomyosarcoma of radius, ilium, and femur, respectively, and who were treated surgically.