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Tena-Sanabria ME, Jesús-Mejenes LY, Fuentes-Herrera G, Álvarez-Martínez FA, Victorio-García NP, Núñez-Enríquez JC. A report of two children with Gorham-Stout disease. BMC Pediatr 2019; 19:206. [PMID: 31234820 PMCID: PMC6591827 DOI: 10.1186/s12887-019-1561-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/28/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Gorham-Stout disease is a rare condition characterized by unifocal and massive type IV osteolysis (variant of idiopathic nonhereditary osteolytic disease) with a slow progression, which is self-limiting for some years. It is characterized by recurrent vascular tumors with disruption of the anatomical architecture and intraosseous proliferation of vascular channels that leads to the destruction and resorption of the bone matrix. The aim of this study is to present the clinical features of this disease, as well as the importance of prompt diagnosis and treatment, with a review of the reported cases. CASE REPORTS We describe two cases of Gorham-Stout disease between 2013 and 2017 with surgical interventions, follow-up and results. Case one involves an 11-year-old male with involvement of the left iliac bone, with adequate evolution after a surgical procedure with a lyophilized cadaveric tricortical bone allograft. Case two involves a 6-year-old male with cervical spine C1-C3 repercussion; in the protocol for surgical treatment, he presented with signs of spinal cord compression and died. CONCLUSION Diagnosis of Gorham-Stout disease is made by exclusion, and its clinical presentation varies widely, from spontaneous remission to a fatal outcome.
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Affiliation(s)
- Mario Edgar Tena-Sanabria
- Unidad Médica de Alta Especialidad, Servicio de Ortopedia Pediátrica, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Larisa Yarindy Jesús-Mejenes
- Unidad Médica de Alta Especialidad, Servicio de Ortopedia Pediátrica, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Gabriela Fuentes-Herrera
- Unidad Médica de Alta Especialidad, Servicio de Ortopedia Pediátrica, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Félix Alejandro Álvarez-Martínez
- Unidad Médica de Alta Especialidad, Servicio de Ortopedia Pediátrica, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Nora Patricia Victorio-García
- Unidad de Investigación en Epidemiología Clínica, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Avenida Cuauhtémoc 330. Colonia Doctores Delegación Cuauhtémoc C.P, 06720, Mexico City, Mexico
| | - Juan Carlos Núñez-Enríquez
- Unidad de Investigación en Epidemiología Clínica, Hospital de Pediatría "Dr. Silvestre Frenk Freund", Centro Médico Nacional "Siglo XXI", Instituto Mexicano del Seguro Social, Avenida Cuauhtémoc 330. Colonia Doctores Delegación Cuauhtémoc C.P, 06720, Mexico City, Mexico.
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Zhang S, Wu D, Shi L, Zhang Y, Long K, Fan Y, Zhu B, Jin X, Ren Y, Zhang C, Wang P. Gorham disease of the mandible: a report of two cases and a literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:e71-e76. [PMID: 30266374 DOI: 10.1016/j.oooo.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 07/03/2018] [Accepted: 08/23/2018] [Indexed: 11/15/2022]
Abstract
Gorham disease, a rare disorder of unknown etiology, is characterized by the clinical and radiologic disappearance of bone. Because the etiology is unknown, diagnosis is difficult. Therefore, radiographic manifestations play a vital role in the diagnosis of this disease. Thus far, there has been no completely effective treatment. Most remedies are limited to symptom management. Despite the fact that any bone can be affected, one of the most prevalent sites is the maxillofacial region. In this paper, 2 cases of Gorham disease involving the maxillofacial region are reported, including preoperative and postoperative radiographic features.
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Affiliation(s)
- Sheng Zhang
- Medical college, Xijing University, Xi'an City, Shaanxi Province, China
| | - Dandan Wu
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Radiology, School of Stomatology, Xian, China
| | - Liqiang Shi
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Radiology, School of Stomatology, Xian, China
| | - Yuxing Zhang
- Medical college, Xijing University, Xi'an City, Shaanxi Province, China
| | - Kaiping Long
- Medical college, Xijing University, Xi'an City, Shaanxi Province, China
| | - Yun Fan
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Radiology, School of Stomatology, Xian, China
| | - Bing Zhu
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Radiology, School of Stomatology, Xian, China
| | - Xiaohang Jin
- Medical college, Xijing University, Xi'an City, Shaanxi Province, China
| | - Yan Ren
- Medical college, Xijing University, Xi'an City, Shaanxi Province, China
| | - Chunli Zhang
- Medical college, Xijing University, Xi'an City, Shaanxi Province, China
| | - Pei Wang
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Radiology, School of Stomatology, Xian, China.
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Dsouza SL, Kulkarni A, Sageer H, Pajai N, Kotak N. A Case of Gorhams Syndrome: An anesthetic challenge. J Anaesthesiol Clin Pharmacol 2018; 34:132-133. [PMID: 29643644 PMCID: PMC5885435 DOI: 10.4103/0970-9185.227395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Supriya Lynette Dsouza
- Department of Anaesthesiology, Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Adarsh Kulkarni
- Department of Anaesthesiology, Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Hashim Sageer
- Department of Anaesthesiology, Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Naveen Pajai
- Department of Anaesthesiology, Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Nirav Kotak
- Department of Anaesthesiology, Seth G.S Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Srivastava SK, Aggarwal RA, Nemade PS, Bhoale SK. Vanishing bone disease of chest wall and spine with kyphoscoliosis and neurological deficit: A case report and review of literature. Indian J Orthop 2017; 51:107-114. [PMID: 28216760 PMCID: PMC5296840 DOI: 10.4103/0019-5413.197559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Vanishing bone disease is an extremely rare disorder of unknown etiology characterized by idiopathic osteolysis of bone. We describe a case of vanishing bone disease of chest wall and spine with kyphoscoliosis and neurological deficit. A 17-year-old male presented with gradually progressive deformity of back and dorsal compressive myelopathy with nonambulatory power in lower limbs. Radiographs revealed absent 4th-7th ribs on the right side with dorsal kyphoscoliosis and severe canal narrowing at the apex. The patient was given localized radiotherapy and started on a monthly infusion of 4 mg zoledronic acid. Posterior instrumented fusion with anterior reconstruction via posterolateral approach was performed. The patient had a complete neurological recovery at 5 weeks following surgery. At 1 year, anterior nonunion was noted for which transthoracic tricortical bone grafting was done. Bone graft from the patient's mother was used both times. At 7 months following anterior grafting, the alignment was maintained and the patient was asymptomatic; however, fusion at graft-host interface was not achieved. Bisphosphonates and radiotherapy were successful in halting the progress of osteolysis.
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Affiliation(s)
- Sudhir Kumar Srivastava
- Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Rishi Anil Aggarwal
- Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India,Address for correspondence: Dr. Rishi Anil Aggarwal, Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Parel, Mumbai - 400 012, Maharashtra, India. E-mail:
| | - Pradip Sharad Nemade
- Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sunil Krishna Bhoale
- Department of Orthopaedics, Seth G.S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Herd RS, Sprung J, Weingarten TN. Primary osteolysis syndromes: beware of difficult airway. Paediatr Anaesth 2015; 25:727-37. [PMID: 25736220 DOI: 10.1111/pan.12643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary osteolysis syndromes represent a number of rare conditions characterized by destruction and resorption of bone that is unrelated to neoplasia, infection, or trauma. AIM To characterize the periprocedural course of patients with primary osteolysis syndrome undergoing procedures that require anesthesia care. METHODS The medical records database from our institution was searched from 1976 to 2013 to identify patients with primary osteolysis syndromes who received anesthesia care. We reviewed demographic characteristics, comorbidities, and perioperative course of patients with different forms of primary osteolysis. A systematic review of the literature was performed to identify reports describing the anesthetic management of patients with these conditions. RESULTS We identified 11 patients with a primary osteolysis syndrome who received 111 anesthetics. The patients' ages at the time of surgery ranged from 3 to 62 years. Difficult airway management was a common finding. On preoperative examination, difficulty with endotracheal intubation was predicted in 8 of 11 patients. Three patients had preexisting tracheostomies. One patient required multiple awake fiberoptic intubations. Another two patients where successfully intubated early in life via direct laryngoscopy, but eventually required awake fiberoptic intubations as the disease process caused progressive distortion of airway structures. Intraoperative complications were absent. In the postoperative period, three patients required prolonged mechanical ventilation due to airway swelling, respiratory failure, and infection. CONCLUSIONS Airway management may be challenging in patients with primary osteolysis syndromes. Because the osteolytic process advances with aging and craniofacial dysmorphism may progressively worsen, the airway should always be reassessed before surgery with an appropriate strategy for potentially difficult intubation. In all patients with primary osteolysis, a potential for pathologic fracture must be considered and careful intraoperative positioning is warranted.
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Affiliation(s)
- R Scott Herd
- Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juraj Sprung
- Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Toby N Weingarten
- Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN, USA
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Ohla V, Bayoumi AB, Hefty M, Anderson M, Kasper EM. Complex single step skull reconstruction in Gorham's disease - a technical report and review of the literature. BMC Surg 2015; 15:24. [PMID: 25880917 PMCID: PMC4365769 DOI: 10.1186/s12893-015-0014-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/24/2015] [Indexed: 11/13/2022] Open
Abstract
Background Gorham’s disease is a rare osteolytic disorder characterized by progressive resorption of bone and replacement of osseous matrix by a proliferative non-neoplastic vascular or lymphatic tissue. A standardized treatment protocol has not yet been defined due to the unpredictable natural history of the disease and variable clinical presentations. No single treatment has proven to be superior in arresting the course of the disease. Trials have included surgery, radiation and medical therapies using drugs such as calcium salts, vitamin D supplements and hormones. We report on our advantageous experience in the management of this osteolyic disorder in a case when it affected only the skull vault. A brief review of pertinent literature about Gorham’s disease with skull involvement is provided. Case presentation A 25-year-old Caucasian male presented with a skull depression over the left fronto-temporal region. He noticed progressive enlargement of the skull defect associated with local pain and mild headache. Physical examination revealed a tender palpable depression of the fronto-temporal convexity. Conventional X-ray of the skull showed widespread loss of bone substance. Subsequent CT scans showed features of patchy erosions indicative of an underlying osteolysis. MRI also revealed marginal enhancement at the site of the defect. The patient was in need of a pathological diagnosis as well as complex reconstruction of the afflicted area. A density graded CT scan was done to determine the variable degrees of osteolysis and a custom made allograft was designed for cranioplasty preoperatively to allow for a single step excisional craniectomy with synchronous skull repair. Gorham’s disease was diagnosed based on histopathological examination. No neurological deficit or wound complications were reported postoperatively. Over a two-year follow up period, the patient had no evidence of local recurrence or other systemic involvement. Conclusions A single step excisional craniectomy and cranioplasty can be an effective treatment for patients with Gorham’s disease affecting the skull vault only. Preoperative planning by a density graded CT aids to design a synthetic bone flap and is beneficial in skull reconstruction. Systemic involvement is variable in this patient’s population.
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Affiliation(s)
- Victoria Ohla
- Department of Neurochirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Germany.,Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, LMOB Suite 3B, Boston, MA, 02215, USA
| | - Ahmed B Bayoumi
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, LMOB Suite 3B, Boston, MA, 02215, USA
| | - Markus Hefty
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Matthew Anderson
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ekkehard M Kasper
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, LMOB Suite 3B, Boston, MA, 02215, USA.
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