Endometriosis

Background:The treatment of open fractures of the tibial shaft is often complicated by delayed union and nonunion. The objective of this study was to evaluate the safety and efficacy of the use of recombinant human bone morphogenetic protein-2 (rhBMP-2; dibotermin alfa) to accelerate healing of open

Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures a prospective, controlled, randomized study of four hundred and fifty patients

Approximately 95 percent of malignant tumors arising in the testis are germ-cell tumors, a term that indicates their origin in primordial germ cells. Germ-cell tumors also occasionally arise in extragonadal primary sites, and their management follows that of testicular germ-cell tumors. More than 90 percent of patients with newly diagnosed germ-cell tumors are cured, and delay in diagnosis correlates with a higher stage at presentation for treatment.1,2 Management has changed substantially in the past 20 years, largely because of the ability of cisplatin-containing combination chemotherapy to cure advanced disease.3 In this review, we discuss recent developments in our understanding . . .

https://www.nejm.org/doi/pdf/10.1056/NEJM199707243370406

Testicular Germ-Cell Cancer

➤ Tissue engineering is a rapidly evolving discipline that seeks to repair, replace, or regenerate specific tissues or organs by translating fundamental knowledge in physics, chemistry, and biology into practical and effective materials, devices, systems, and clinical strategies.➤ Stem cells and pro

Engineering principles of clinical cell-based tissue engineering.

Currently, adrenal masses are discovered incidentally in 0.35–5% of patients imaged with computed tomography (CT) and are referred to as adrenal incidentalomas [1,2]. As a result, the diagnostic dilemma of separating the small fraction of hypersecretory and/or malignant masses from the majority that are nonhypersecretory adrenal adenomas has become common. Given the fourfold greater autopsy incidence of adrenal adenomas compared with the radiographic incidence, and the oncology data that only 20–41% of adrenal metastases are detected by CT [1,3], it is likely that an increase in prevalence will occur if the spatial resolving capacity of abdominal imaging improves, if abdominal imaging occurs more frequently, and if routine abdominal imaging slice thickness is decreased.

Incidentally discovered adrenal masses

Primary bone lymphoma is an uncommon malignancy that accounts for less than 5% of all primary bone tumors. The radiographic appearances of primary bone lymphoma are variable, and, because the lesion can appear near normal on plain radiographs, a second modality such as bone scintigraphy or magnetic resonance (MR) imaging should be used. Despite this variability, the presence of a solitary, permeative, metadiaphyseal lesion with a layered periosteal reaction on plain radiographs and a soft-tissue mass on MR images, especially in a patient older than 30 years, is highly suggestive of lymphoma. The case for a diagnosis of primary bone lymphoma is further strengthened if the soft-tissue mass and marrow changes are associated with surprisingly little cortical destruction. Primary bone lymphoma has a better prognosis than many other malignant bone tumors; therefore, early identification allows for appropriate treatment. MR imaging not only permits early identification but also depicts the extent of soft-tissue involvement and can be used to assess the outcome of treatment.

Primary bone lymphoma: radiographic-MR imaging correlation.

The detection of adrenal lesions has increased with the expanding use of cross-sectional imaging. Magnetic resonance (MR) imaging is often useful for characterizing adrenal masses. Adrenal masses can be classified into various groups on the basis of the presence of intracellular lipid, macroscopic fat, hemorrhage, and cystic changes and the vascularity and shape of the tumor. These imaging features can be used by the radiologist to suggest or confirm a diagnosis for most adrenal masses, including adenoma, hyperplasia, simple and complicated cysts, lymphangioma, myelolipoma, pheochromocytoma, hemorrhage, cortical carcinoma, neuroblastoma, lymphoma, and metastases. Adenomas and metastases are common, and a decrease in signal intensity on out-of-phase images can be used to differentiate between them. Carcinoma is a possible diagnosis if that decrease in signal intensity is heterogeneous. Benign disease is diagnosed if macroscopic fat or a homogeneous cystlike lesion is seen. Recognition of the typical MR imaging features is important because it often changes the treatment approach and may obviate surgery.

Adrenal masses: mr imaging features with pathologic correlation.

STUDY DESIGN A study on the efficacy of recombinant human bone morphogenetic protein 2 (rhBMP-2) in a nonhuman primate anterior interbody fusion model. OBJECTIVES To investigate the efficacy of rhBMP-2 with an absorbable collagen sponge carrier to promote spinal fusion in a nonhuman primate anterior interbody fusion model. SUMMARY OF BACKGROUND DATA RhBMP-2 is an osteoinductive growth factor capable of inducing new bone formation in vivo. Although dosage studies using rhBMP-2 have been performed on species of lower phylogenetic level, they cannot be extrapolated to the primate. Dosage studies on nonhuman primates are essential before proceeding with human primate application. METHODS Six female adult Macaca mulatta (rhesus macaque) monkeys underwent an anterior L7-S1 interbody lumbar fusion. All six sites were assigned randomly to one of two fusion methods: 1) autogenous bone graft within a single freeze-dried smooth cortical dowel allograft cylinder (control) or 2) rhBMP-2-soaked absorbable collagen sponges within a single freeze-dried smooth cortical dowel allograft cylinder also soaked in rhBMP-2. The animals underwent a baseline computed tomography scan followed by 3- and 6-month postoperation scans. Anteroposterior and lateral radiographs of the lumbosacral spine were performed monthly. After the monkeys were killed, the lumbar spine fusion sites were evaluated. Histologic evaluation of all fusion sites was performed. RESULTS The three monkeys receiving rhBMP-2-soaked collagen sponges with a freeze-dried allograft demonstrated radiographic signs of fusion as early as 8 weeks. The control animals were slower to reveal new bone formation. The computed tomography scans revealed extensive fusion of the L7-S1 lumbar vertebrae in the group with rhBMP-2. A pseudarthrosis was present in two of the control animals. CONCLUSIONS This study was able to document the efficacy of rhBMP-2 with an absorbable collagen sponge carrier and a cortical dowel allograft to promote anterior interbody fusion in a nonhuman primate model at a dose of 0.4 mg per implant site (1.5 mg/mL concentration). The late of new bone formation and fusion with the use of rhBMP-2 and cortical dowel allograft appears to be far superior to that of autogenous cancellous iliac crest graft with cortical dowel allograft.

/pdf/the-use-of-recombinant-human-bone-morphogenetic-protein-2-3echtqir20.pdf

The use of recombinant human bone morphogenetic protein 2 (rhBMP-2) to promote spinal fusion in a nonhuman primate anterior interbody fusion model.

We reviewed 349 proved cases of eosinophilic granuloma detected in 82 patients. Most bony lesions can be detected on plain radiographs. Bone scintigraphy may reveal additional lesions, especially in complex bones, although a radiographic bone survey tends to be superior in the detection of early lesions. CT or MR can be helpful in providing better delineation of a bone lesion

https://www.ajronline.org/doi/pdfplus/10.2214/ajr.153.5.1021

Radiologic features of eosinophilic granuloma of bone

The computed tomographic (CT) findings in 118 patients with the diagnosis of leiomyosarcoma were reviewed. The tumor masses visualized in these patients were often quite large; extensive necrotic or cystic change was a frequent finding. Calcification was not observed in these tumors. The liver was the most common site of metastasis in these patients, with marked necrosis of the liver lesions a common finding. Other manifestations of tumor spread included pulmonary metastases, mesenteric or omental metastases, retroperitoneal lymphadenopathy, soft-tissue metastases, bone metastases, splenic metastases, and ascites. The metastatic lesions were often centrally necrotic. Although the CT appearance of leiomyosarcoma is not specific, these findings, when present, suggest consideration of this diagnosis.

Ali Shirkhoda

Papers

Primary bone lymphoma: radiographic-MR imaging correlation.

Adrenal masses: mr imaging features with pathologic correlation.

The use of recombinant human bone morphogenetic protein 2 (rhBMP-2) to promote spinal fusion in a nonhuman primate anterior interbody fusion model.

Radiologic features of eosinophilic granuloma of bone

Leiomyosarcoma: computed tomographic findings.