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Jiang W, Friedlaender G, Lindskog D, Latich I, Lee FY. Comparison of Percutaneous Interventional Ablation-Osteoplasty-Reinforcement-Internal Fixation (AORIF), Long Intramedullary Nailing, and Hemiarthroplasty for the Treatment of Focal Metastatic Osteolytic Lesions in the Femoral Head and Neck. Cardiovasc Intervent Radiol 2023; 46:649-657. [PMID: 37052716 DOI: 10.1007/s00270-023-03425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/17/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Osteolytic metastatic lesions in the femoral head and neck are traditionally treated with intramedullary long nailing (IM) or hemiarthroplasty (HA). Recovery, surgical complications, and medical co-morbidities delay oncologic care. This study sought to elucidate the comparative efficacy of percutaneous ablation-osteoplasty-reinforcement-internal fixation (AORIF), IM, and HA in stabilizing osteolytic lesions in the femoral head and neck. METHODS A retrospective study of 67 patients who underwent IM, AORIF, or HA for osteolytic femoral head and neck lesions was performed. Primary outcome was assessed using a combined pain and ambulatory score (Range 1-10: 1 = bedbound, 10 = normal ambulation) at first follow-up (~ 2 weeks). Surgical complications associated with each treatment were compared. RESULTS Sixty-seven patients (mean age, 65 ± 13, 36 men and 31 women) underwent IM (40), AORIF (19), and HA (8) with a mean follow-up of 9 ± 11 months. Two patients in the IM group (5%), three in the AORIF group (16%), and none in the HA (0%) group required revision procedures. AORIF demonstrated superior early improvement in combined pain and ambulatory function scores by 3.0 points [IQR = 2.0] (IM p = 0.0008, HA p = 0.0190). Odds of post-operative complications was 10.3 times higher in HA than IM (95% confidence interval 1.8 to 60.3). Future revision procedures were not found to be statistically significant between AORIF and IM (p = 0.234). CONCLUSIONS A minimally invasive interventional skeletal procedure for focal femoral head and neck osteolytic lesions may serve as an effective alternative treatment to traditional surgical approaches, conferring a shorter recovery time and fewer medical complications.
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Affiliation(s)
- Will Jiang
- Department of Orthopaedics and Rehabilitation, Pathology and Biomedical Engineering, Yale School of Medicine, 47 College Pl., New Haven, CT, 06510, USA
| | - Gary Friedlaender
- Department of Orthopaedics and Rehabilitation, Pathology and Biomedical Engineering, Yale School of Medicine, 47 College Pl., New Haven, CT, 06510, USA
| | - Dieter Lindskog
- Department of Orthopaedics and Rehabilitation, Pathology and Biomedical Engineering, Yale School of Medicine, 47 College Pl., New Haven, CT, 06510, USA
| | - Igor Latich
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale Interventional Radiology, 47 College Pl., New Haven, CT, 06510, USA
| | - Francis Y Lee
- Department of Orthopaedics and Rehabilitation, Pathology and Biomedical Engineering, Yale School of Medicine, 47 College Pl., New Haven, CT, 06510, USA.
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Moran J, Kahan JB, Schneble CA, Lindskog D, Donohue K. Surgical Excision of a Giant Schwannoma of the Hand: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00115. [PMID: 34534146 DOI: 10.2106/jbjs.cc.21.00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a 78-year-old man who underwent excision of a 13-year-old benign schwannoma originating from the terminal motor branch of the ulnar nerve. The mass measured 13 cm in diameter on presentation and was successfully excised, preserving a functional hand. At 4-year follow-up, the patient was asymptomatic with intact motor and sensory function and no signs of recurrence. To the best of our knowledge, this is the largest schwannoma of the hand to be reported in the literature. CONCLUSIONS Large schwannomas of the hand can successfully be excised with no postoperative complications.
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Affiliation(s)
- Jay Moran
- Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Joseph B Kahan
- Department of Orthopaedics, Yale School of Medicine, New Haven, Connecticut
| | | | - Dieter Lindskog
- Department of Orthopaedics, Yale School of Medicine, New Haven, Connecticut
| | - Kenneth Donohue
- Department of Orthopaedics, Yale School of Medicine, New Haven, Connecticut
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Bellamkonda KS, Tonnessen BH, Molho DA, Lindskog D, Wiznia D. Retroperitoneal Approach for Excision of Wear-Debris Pseudotumor: A Case Report. JBJS Case Connect 2021; 11:01709767-202103000-00030. [PMID: 33730003 DOI: 10.2106/jbjs.cc.20.00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Pelvic pseudotumors may occur as a reaction to wear-debris after hip arthroplasty and are rarely treated with surgery. We describe an instance in which a pelvic pseudotumor along the iliopsoas muscle tendon sheath was debulked using a retroperitoneal approach in a patient presenting for treatment of a prosthetic hip infection. The patient recovered uneventfully and was ambulatory with a new hip prosthesis at 3 months after procedure. CONCLUSIONS Retroperitoneal exposure provided safe, excellent exposure to a wear-debris pelvic pseudotumor in this case.
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Affiliation(s)
| | - Britt H Tonnessen
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - David A Molho
- Department of Orthopaedics, Yale School of Medicine, New Haven, Connecticut
| | - Dieter Lindskog
- Department of Orthopaedics, Yale School of Medicine, New Haven, Connecticut
| | - Daniel Wiznia
- Department of Orthopaedics, Yale School of Medicine, New Haven, Connecticut
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Biermann JS, Chow W, Reed DR, Lucas D, Adkins DR, Agulnik M, Benjamin RS, Brigman B, Budd GT, Curry WT, Didwania A, Fabbri N, Hornicek FJ, Kuechle JB, Lindskog D, Mayerson J, McGarry SV, Million L, Morris CD, Movva S, O'Donnell RJ, Randall RL, Rose P, Santana VM, Satcher RL, Schwartz H, Siegel HJ, Thornton K, Villalobos V, Bergman MA, Scavone JL. NCCN Guidelines Insights: Bone Cancer, Version 2.2017. J Natl Compr Canc Netw 2017; 15:155-167. [PMID: 28188186 DOI: 10.6004/jnccn.2017.0017] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Bone Cancer provide interdisciplinary recommendations for treating chordoma, chondrosarcoma, giant cell tumor of bone, Ewing sarcoma, and osteosarcoma. These NCCN Guidelines Insights summarize the NCCN Bone Cancer Panel's guideline recommendations for treating Ewing sarcoma. The data underlying these treatment recommendations are also discussed.
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Affiliation(s)
| | | | | | - David Lucas
- _University of Michigan Comprehensive Cancer Center
| | - Douglas R Adkins
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Mark Agulnik
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - G Thomas Budd
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Aarati Didwania
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | | | - Joel Mayerson
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - Carol D Morris
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Victor M Santana
- St. Jude Children’s Research Hospital/The University of Tennessee Health Science Center
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Horowitz MC, Berry R, Holtrup B, Sebo Z, Nelson T, Fretz JA, Lindskog D, Kaplan JL, Ables G, Rodeheffer MS, Rosen CJ. Bone marrow adipocytes. Adipocyte 2017; 6:193-204. [PMID: 28872979 DOI: 10.1080/21623945.2017.1367881] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Adipocytes were identified in human bone marrow more than a century ago, yet until recently little has been known about their origin, development, function or interactions with other cells in the bone marrow. Little functional significance has been attributed to these cells, a paradigm that still persists today. However, we now know that marrow adipose tissue increases with age and in response to a variety of physiologic induction signals. Bone marrow adipocytes have recently been shown to influence other cell populations within the marrow and can affect whole body metabolism by the secretion of a defined set of adipokines. Recent research shows that marrow adipocytes are distinct from white, brown and beige adipocytes, indicating that the bone marrow is a distinct adipose depot. This review will highlight recent data regarding these areas and the interactions of marrow adipose tissue (MAT) with cells within and outside of the bone marrow.
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Affiliation(s)
- Mark C. Horowitz
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Ryan Berry
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Brandon Holtrup
- Department of Molecular, Cell, and Developmental Biology, Yale University, New Haven, CT, USA
| | - Zachary Sebo
- Department of Molecular, Cell, and Developmental Biology, Yale University, New Haven, CT, USA
| | - Tracy Nelson
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Jackie A. Fretz
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Dieter Lindskog
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer L. Kaplan
- Department of Comparative Medicine and Molecular, Cellular, and Developmental Biology, Yale University School of Medicine, New Haven, CT, USA
| | - Gene Ables
- Orentreich Foundation for the Advancement of Science, Cold Spring, NY, USA
| | - Matthew S. Rodeheffer
- Department of Comparative Medicine and Molecular, Cellular, and Developmental Biology, Yale University School of Medicine, New Haven, CT, USA
| | - Clifford J. Rosen
- The Center for Clinical and Translational Research, Maine Medical Center Research Institute, Scarborough, ME, USA
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Abstract
We describe a 23-year-old woman with neuritis ossificans involving the tibial, common peroneal and lateral sural nerves. She presented with chronic debilitating posterior knee pain. An MRI scan showed masses in these nerves, biopsy of which revealed a histological diagnosis of neuritis ossificans. Treatment with OxyContin and Neurotin for two years resulted in resolution of symptoms. Follow-up MRI demonstrated a resolution of two of the three masses. There was a persistent area of ossification without associated oedema in the common peroneal nerve. Neuritis ossificans has the histological appearance of myositis ossificans and follows a similar clinical course. The success of conservative treatment in this case suggests that the potential complications of surgical excision can be avoided.
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Affiliation(s)
| | - D. Lindskog
- Department of Orthopaedic Surgery & Rehabilitation Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06510, USA
| | - R. Eisen
- Greenwich Hospital, 5 Perryridge Road, Greenwich, Connecticut 06830, USA
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