[Maxillary fissure cysts in Senegal. Analysis of a series of 14 cases]

The fissurary cyst is an non-odontogene and epithelial cyst. Their frequency in Senegal compared to the epidemiological records in European countries had led the authors to carry out a study. Around 14 fissurary cysts have been recorded in a seven year period. The teeth affected by the tumour could be saved in case of an early diagnosis.

Learning from the Japanese Registry: how will we prevent long-term complications? Niigata Research Programme for beta 2-M Removal Membrane

As compared to Europe and USA, the survival rate of chronic haemodialysis (HD) patients in Japan is demonstrated by the Japanese Registry to be high. However, another Japanese Registry nationwide survey on their quality of life revealed serious osteoarticular disorders increasing with the duration of HD. Selecting plasma beta2-microglobulin (beta2-M) as a marker, a prospective study on the long-term clinical effect of a beta2-M-removable membrane (PMMA BK membrane) has been performed and the changes in joint pains and plasma beta2-M have been followed for 5 years. In addition, the incidence of carpal tunnel syndrome (CTS) and bone cysts among 225 patients maintained on HD with BK membrane was analyzed retrospectively. By continued use of BK membrane, plasma beta2-M was maintained at a significantly lower level than that in HD with conventional cellulosic membranes. The total score of joint pain in HD patients treated with BK membrane was significantly decreased and maintained at this low value throughout 5 years. In HD patients treated with BK membrane for a long period, the occurrence of CTS and bone cyst was less and postponed, as compared to patients on HD with conventional cellulosic membranes. HD-related amyloidosis had not been observed for 5 years in patients treated with BK membrane from the introduction of haemodialysis.

Cystic radio-lucency of carpal bones in haemodialysis patients. An early indicator of the onset of carpal tunnel syndrome

Patients receiving haemodialysis for more than 10 years were selected for this study in order to clarify an apparent sequential association of cystic lesions of carpal bones and carpal tunnel syndrome. X-rays and computed tomographs of 138 hands of 69 patients revealed cystic radiolucency of carpal bones in 35% of the hands. Radiographs were classified into three groups: Group A--cyst growing, Group B--cyst not growing, and Group C--cyst absent. The prevalence of carpal tunnel syndrome was 100% (27/27) in Group A, 5.6% (1/18) in Group B, and 6.5% (6/93) in Group C. Growth of the cyst precedes the development of carpal tunnel syndrome by about 2 or 3 years. Growth of the bone cyst indicates that inflammation had already extended to the tenosynovium and median nerve. Cystic radio-lucency of the carpal bones appears to be a useful indicator of the onset of carpal tunnel syndrome.

Association of glenoid labral cysts with labral tears and glenohumeral instability: radiologic findings and clinical significance

PURPOSE

To determine the relationship between labral cysts and labral tears and glenohumeral instability.

MATERIALS AND METHODS

Magnetic resonance (MR), clinical, and arthroscopic examinations of the shoulder and the surgical findings of 20 patients were correlated and retrospectively analyzed. A cystic-appearing mass adjacent to the labrum was the selection criterion for inclusion.

RESULTS

MR imaging showed labral tear intimately associated with cystic-appearing mass in these 20 patients. The tear and cyst complex was located anteriorly in two patients, posteriorly in nine, and superiorly in nine. The mass extended into the spinoglenoid notch in six patients, the suprascapular notch in three, and both notches in four. Physical examination showed glenohumeral instability in the direction of the labral tear and cystic-appearing mass in 11 patients (55%). Findings at intraarticular surgery, performed in eight patients, confirmed a labral tear with communication between the joint space and the cyst.

CONCLUSION

Glenoid labral cysts are associated with glenoid labral tears and shoulder instability.

Pathological fractures secondary to unicameral bone cysts

We carried out a retrospective review of 75 children with unicameral bone cysts, who had sustained 52 pathological fractures, to determine which cysts were likely to be at risk and whether healing was accelerated after a fracture. Most lesions were in the metaphysis of a tubular bone, the commonest sites being the the upper part of the humerus and femur. The percentage of bone occupied by the cyst in the transverse plane was more than 85% in both anteroposterior and lateral radiographs in every case of pathological fracture. In most cases, the cyst recurred and sometimes became large without any acceleration of healing.

Primary bone tumours of the shoulder: an audit of the Leeds Regional Bone Tumour Registry

An audit of the prospectively gathered data of the Leeds Regional Bone Tumour Registry found that primary bone tumours of the shoulder constituted 145 of 2039 cases (7%). Seventy-five per cent of these occurred in the proximal humerus, 20% in the scapula and 5% in the outer half of the clavicle. Malignant and benign tumours were of equal overall frequency (73 vs 72) but the malignant lesions tended to occur in an older population (mean ages 43 years and 17 years respectively). Simple bone cyst was the commonest diagnosis in children, chondrosarcoma in the middle age group and osteosarcoma in the over-60s. Presenting symptoms were a poor guide to whether the lesion was malignant or not and the correct preoperative diagnosis was made only in a minority of cases. In 134 cases the diagnosis made by the referring pathologist was confirmed by the Bone Tumour Registry but in 11 cases, the diagnosis was changed by the Tumour Registry and differed with important clinical implications. Bone tumour registries provide a valuable source of cumulative information about uncommon tumours and facilitate accurate diagnosis, teaching and research.

Packing with high-porosity hydroxyapatite cubes alone for the treatment of simple bone cyst

In 23 patients, simple bone cysts were treated by curettage followed by packing the cavity with cubes of high-porosity hydroxyapatite (HA). In 22 patients, HA was packed exclusively without autogeneic bone graft. Except in one patient who sustained pathologic fracture at the femoral diaphysis, HA was packed with a fibula strut graft. Each case had an uneventful postoperative course and was followed, on average, two years. Complete healing without cyst recurrence occurred in 18 cases (78%). In three cases--all rapidly growing children--a new cyst appeared between the epiphyseal plate and the HA packing, but the original cysts did not recur. In two multiloculated cysts, the cavities were not filled fully and healing was incomplete, yet there was no cyst recurrence. In the entire group, new bone surrounding HA was roentgenographically evident within an average of 2.3 months. Thus, the result of packing high-porosity HA for simple bone cysts compares favorably with the cure rates reported either with autogeneic bone graft, or topical steroid injection.

[Aneurysmal bone cyst or giant cell tumor. The value of x-ray diagnosis for differential diagnosis]

Depending on analysis of radiographic morphology, location and patient's age of 72 aneurysmal bone cysts (ABC) and 47 giant cell tumours (GCT), the following criteria suggest an ABC with a high positive predictive value: location in the diaphysis (100%), in the shaft (92%), in the metaphysis or metadiaphysis (86%), patient younger than 17 years (97%) and growth rate grade Lodwick-IA (88%). GCT were selected via the following criteria: epimetaphyseal location (82%) and growth rate grade Lodwick-II (100%). In 14% of the cases, differential diagnosis between both entities is radiologically impossible.

Aneurysmal bone cyst of the maxilla: case report and review of the literature

Aneurysmal bone cyst (ABC) is a rare benign lesion of the head and neck. A case of an ABC in a 12-year-old female is presented, the twentieth reported such case in the maxilla. Literature review shows ABC are common in the long bones; only 2% are in the head and neck. Of the 77 lesions in the head and neck found in the literature, 31 (40%) are in the mandible, 20 (26%) are in the maxilla (including this case) and the remainder mainly in the skull. Current recommended treatment is curettage with enucleation first if technically possible.

Benign tumors of the cervical spine

Benign tumors of the cervical spine are relatively infrequent but have a number of common characteristics that aid in the evaluation and treatment of these lesions. The tumors are most common in the first and second decades of life, presenting as pain, neck stiffness and torticollis. In approximately 70%, the lesions are visible on plain roentgenograms and the remainder are well visualized on bone scan and computed tomographic scan. The majority are present in the posterior elements and may be treated adequately with excisional biopsy by curettage. Stage 3 lesions are best treated by marginal excisional techniques and may require adjunctive techniques such as embolization or radiation therapy. The location of the lesion and extent of excision determine the necessity for fusion.

Dialysis-associated arthropathy: a multicentre survey of 171 patients receiving haemodialysis for over 10 years. The Co-operative Group on Dialysis-associated Arthropathy

In order to determine the prevalence of dialysis-associated arthropathy (DAA) and what factors favour its development, we conducted a survey in 19 centres in northeastern France, of all patients receiving haemodialysis for over 10 years (171). A diagnosis of DAA was made in 84 patients (49%) by two investigators, using as criteria single or combined presence of carpal tunnel syndrome (32%), erosions and bone cysts of the large limb joints (33%) and destructive spondylarthropathy (14%). The 84 patients with DAA were compared with the 87 dialysis patients free of these clinical or radiological abnormalities. The affected patients were significantly older at the start of dialysis than unaffected patients. The risk of developing carpal tunnel syndrome increased with the duration of dialysis. Amyloid deposits were found in carpal tunnel tissue obtained from 24 of the 39 operated patients (62%) during surgery. Destructive spondylarthropathy was significantly associated with the presence of disc calcifications and more frequent in AN 69-treated patients in whom secondary hyperparathyroidism appeared to be more severe. The use of an AN 69 membrane for at least 90% of the dialysis period (in 15 patients) was not associated with a lower prevalence of DAA. We found that after 10 years of haemodialysis DAA occurred whatever type of membrane was used and the prevalence increased with the patient's age and the duration of dialysis.

[Incidence of primary benign and malignant neoplasms and bone pseudotumoral lesions. An epidemiologic analysis of 585 cases diagnosed at the Faculdade de Medicina of the Universidade Federal de Minas Gerais]

The authors present an epidemiological study of 585 primary bone neoplasms and tumor-like lesions in order to investigate their incidence and distribution according to age, sex and skeletal location. A statistical agreement between the pertinent literature and the collected data was found. In this series, the most common benign neoplasms were the osteochondroma (45.3%) followed by chondroma (19.6%). Among the intermediate and malignant neoplasms, osteosarcoma was the most frequent (30.0%) followed by myeloma (16.0%). Fibrous dysplasia accounted for 46.6% of all tumor-like lesions, followed by solitary bone cyst (18.6%).

Unicameral bone cyst of the talus

The authors present a rare case of a talar unicameral bone cyst in a 9-year-old boy. This is the first such case presented in podiatric literature; the lesion has been cited infrequently in world literature. A brief review of the literature is discussed, along with the diagnostic tests, possible complications, and proper therapy for this lesion.

Aneurysmal bone cyst of the mandible

Aneurysmal bone cyst is an uncommon benign lesion that rarely presents in the craniofacial region. No prior reports of this entity involving the mandible could be found in the otolaryngologic literature, and it has been reported only infrequently in the maxilla. Two previously unreported cases originating in the mandible are presented with a review of the literature, pathology, and diagnosis of this lesion. Treatment of this lesion consists of complete surgical removal and immediate bone grafting for reconstruction.

Lunate implant arthroplasty. Evaluation of 19 patients

The results of lunate implant arthroplasty are unpredictable and many untoward postoperative problems are encountered. A retrospective review of 19 patients operated on for lunatomalacia (Kienböck's disease) by Silastic (HP) implant arthroplasty suggests that prevention of postoperative scapholunate dissociation seems to be the key to successful results. Knowledge of the predominant role played by the palmar ulnolunate and radiolunate ligaments is important to the understanding of this mechanism. The intrinsic stability accomplished by the geometry of the carpal bones requires adequate ligamentous support. This restraint, however, may be weakened by pre-existing absence of certain palmar fibres, by the disease process or by the surgery. In the present study three operative methods have been assessed: dorsal approach and implant stem fixation; dorsal approach, removal of implant stem and Kirschner-wire fixation; volar approach, removal of implant stem, no internal fixation but palmar capsuloligamentous reinforcement. Consistently good results have been obtained using the latter technique. It seems as if most of the usual postoperative problems of lunate implant arthroplasty can be avoided by this method which warrants continued trial.

Comparison of diving experience factors between divers classified as positive and negative for bone cysts

Official U.S. Navy diving records for enlisted divers who were 35 years of age and older were examined for differences in diving experience between those who were classified as positive or negative for bone cysts. One-third of the divers (n = 31) were classified as positive, and two-thirds (n = 62) as negative, for bone cysts. Diving experience factors included total years of diving experience, frequency of dives between 15 and 31 m, frequency of dives deeper than 31 m, number of saturation dives, number of dives involving decompression, and number of cases of decompression sickness. None of these factors differed significantly between the two groups. While previous findings showed that bone cysts are twice as prevalent among divers as among a comparison group of Navy enlisted men matched to divers for age, rank, and occupational specialty, these results indicate that this high prevalence rate does not appear to be related to specific types of diving exposure. Other environmental factors such as long-bone injury, disease, or exposure to hazardous or toxic substances may account for differences in the prevalence of bone cysts between the two groups.

Aneurysmal bone cyst of the jaws. Report of a case associated with fibrous dysplasia and review of the literature

A case of aneurysmal bone cyst (ABC) of the mandible, recurring for the third time and arising in conjunction with fibrous dysplasia, is reported. A comprehensive review of the literature and analysis of over 50 cases of ABC of the jaws yielded the following results: ABCs of the jaws constitute 1.5 % of all non-odontogenic and non-epithelial cysts of the jaws, and 1.9 % of all ABCs of the skeleton. The mandible was affected in 55 % of the cases, the maxilla in 45 % of the patients. Females represented 53 % of the patients and males the remaining 47 %. Seventy-four percent of the ABCs occurred in patients 20 years old and younger. This lesion is regarded as non-neoplastic and as most likely secondary to a pre-existing bone lesion. Our review established that 21 % of the reported cases in the jaws had developed in association with various primary lesions of bone, including fibro-osseous lesions. The primary bone lesion initiates an osseous, arteriovenous fistula which, through its hemodynamic forces, creates a secondary reactive lesion, that is an aneurysmal bone cyst. We also established a recurrence rate of 26 %, based upon previously reported cases as well as our own. The treatment of choice is surgical curettage with cryosurgery and immediate packing with bone chips.

Clinical significance of hyperparathyroidism in familial multiple endocrine adenomatosis type I (MEA I)

In order to investigate the suggestion that hyperparathyroidism in patients with familial MEA I has a mild and nonprogressive clinical course, we have compared clinical, biochemical, roentgenologic and histologic features of 29 patients with hyperparathyrodism originating from six families with the MEA I syndrome with those of 28 unselected patients with isolated nonfamilial hyperparathyroidism. The patients from the families with MEA I were significantly younger, had lower serum calcium and inorganic phosphate concentrations and a lower incidence of elevated alkaline phosphatase levels. Furthermore, they had multiple enlarged parathyroid glands and recurrence of the disease significantly more often. There was, however, no significant difference in the incidence of renal impairment, urolithiasis, subperiosteal resorption or large bone cysts on roentgenograms, histologic changes in bone biopsy specimens or mortality due to hyperparathyroidism. Therefore, the suggestion that this type of hyperparathyroidism has a milder clinical course is not confirmed in the present study.