BACKGROUNDRecent studies have suggested that the presence of a pathological fracture does not impact on oncologic outcomes and the feasibility of limb salvage surgery (LSS) in appropriately selected patients when combined with neoadjuvant chemotherapy. These have largely been single institutional studies with limited numbers. The Eastern Asian Musculoskeletal Oncology Group reviewed the data from three large volume Asian orthopedic oncology centers to determine whether the presence of a pathologic fracture affected outcomes in osteosarcoma patients.

METHODSA retrospective review of the data was conducted. Ninety-five cases of nonmetastatic extremity osteosarcoma with a pathological fracture and 887 cases without fracture treated during the same period were compared.

RESULTSIn the fracture group, the LSS rate was 62.1%, and the rate of amputation was 37.9%. In the nonfracture group, the LSS rate was 74.7%, and the amputation was 25.3%. In patients with a pathologic fracture, the rate of local recurrence for LSS and amputation groups was 8.5% and 2.8%, respectively. In this group, the 5-year survival in the LSS group was 66% as against. 46.8% in the amputation group.

CONCLUSIONSOur study suggests that surgically treated patients with pathologic fractures in osteosarcoma have adequate local control and do not have a poorer outcome compared to patients without a fracture. Though osteosarcoma with a pathologic fracture is not a contraindication for limb salvage, appropriate case selection is important when deciding local control options to ensure adequate oncologic clearance.

Adolescent ; Adult ; Aged ; Bone Neoplasms ; complications ; surgery ; Child ; Child, Preschool ; Extremities ; pathology ; surgery ; Female ; Fractures, Spontaneous ; etiology ; surgery ; Humans ; Limb Salvage ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; complications ; surgery ; Osteosarcoma ; complications ; surgery ; Retrospective Studies ; Young Adult

PURPOSE: To evaluate and compare the spontaneous regeneration repair process in femoral bone defects in 6-week-old rabbits and to compare the healing time periods between different rabbit groups. MATERIALS AND METHODS: Bone defects were created at the femur mid-shaft and an external fixator was applied in 50 rabbits. The periosteum was resected in 10 rabbits (defect size: 15%, 25%) and left untouched in the remaining rabbits. Forty rabbits were divided into four groups according to the percentage of bone defects (15%, 20%, 25%, 30%). Radiographs were taken weekly to evaluate the bone regeneration and union. The bone union time was measured between the osteotomy and the cortico-medullary differentiation by examining radiographs. The healing index was defined as the union time (week) per amount (cm) of bone defect. Eight rabbits, 2 from each groups with the bone defects, were investigated by histopathologic examination. RESULTS: The mean union time was approximately 7.0 to 7.3 weeks. The healing index in groups that had a large percentage of bone defects was less than in groups that had a small percentage of bone defects. The periosteum-resected group did not show bone regeneration. Histopathologic examinations showed intramembranous and atypical endochondral ossifications along the periosteum and typical endochondral ossification at the center of the bone defects. CONCLUSION: Spontaneous bone regeneration may be used in children to fill the bone defect instead of performing an internal bone transport. Spontaneous bone regeneration is useful in cases of mid-shaft bone defects or when the remaining bone fragments are large enough for an external fixation application.
Bone Regeneration* ; Child ; External Fixators ; Femur ; Humans ; Osteotomy ; Periosteum ; Rabbits* ; Regeneration

Background/Aims: Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. Methods: Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. Results: Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. Conclusions The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value.

Background/Aims: Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce. Methods: Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively. Results: Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L. Conclusions The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value.