Bone Biopsies Of Patients Research Articles

Audit of Outcomes from Bone Biopsies in Patients with Suspected or Progressive Metastatic Breast Cancer

Audit of Outcomes from Bone Biopsies in Patients with Suspected or Progressive Metastatic Breast Cancer

Feasibility and Safety of Percutaneous CT-Guided Bone Biopsies in Patients with Cancer Using a Patient-Mounted Robotic System: A Retrospective Analysis of 40 Consecutive Biopsies

This retrospective study evaluated the feasibility and safety of percutaneous computed tomography (CT)-guided bone biopsies in patients with cancer using a patient-mounted robotic system with steering capabilities. The study included 39 patients (17 women, 22 men; median age, 65.5 years; interquartile range [IQR], 54.8–71.0 years). Forty biopsies were performed in the pelvis, spine, ribs, shoulder, femur, and sternum. The technical success rate was 100%, and the median trajectory length was 55.9 mm (IQR, 47.1–73.6 mm). Intermediate checkpoints were used in 8 biopsies. Median time from the first to final scan was 21 minutes (IQR, 17–37 minutes). The overall procedure time was 30 minutes (IQR, 24–36 minutes). The median dose length product and effective dose were 536.6 mGy⋅cm (IQR, 396.2–837.7 mGy∗cm) and 7.1 mSv (IQR, 4.7–10.8 mSv), respectively. No adverse events occurred. The diagnostic yield for cancer was 72.5%. Percutaneous robotic-assisted bone biopsies demonstrated high technical success, adequate diagnostic yield, and favorable safety profile.

Antimicrobial resistance of Mycobacterium tuberculosis clinical isolates from patients with tuberculous spondylitis

Objective. To conduct a comparative evaluation of the results of phenotypic and molecular genetic methods for testing drug resistance of Mycobacterium tuberculosis isolated from bone biopsies of patients with tuberculous spondylitis. Materials and Methods. A retrospective cohort study was conducted on the case histories of patients diagnosed with tuberculous spondylitis who underwent surgical treatment in the period from 2016 to 2021. The main study subject was surgical material. Antimicrobial resistance patterns of MBT isolates was performed using phenotypic and molecular genetic methods. Results. The vast majority of Mycobacterium tuberculosis isolates possess at least multidrug-resistance (MDR): 92 of 104 isolates (88.5%) according to phenotypic methods, and 192 of 274 DNA samples (70.1%) according to molecular methods. For rifampicin, isoniazid and ofloxacin the results of phenotypic and molecular methods matched in 92.7%, 97.9%, and 92.6% of cases, respectively; for levofloxacin, moxifloxacin and kanamycin – in 78.3%, 77.1%, and 73.1% of cases; , for amikacin and capreomycin – only – in 52.2% and 57.7% of cases, respectively. For rifampicin and isoniazid, the dominant mutations associated with resistance were: serine replacement for leucine in the 531 codon of the rpoB gene for rifampicin and serine replacement for threonine in the 315 codon of the katG gene for isoniazid. Conclusions. Data on the presence of mutations associated with resistance to rifampicin (rpoB gene), isoniazid (katG gene) and aminoglycosides/capreomycin (rrs gene) can be used when prescribing chemotherapy regimens. The presence of mutations associated with MBT resistance to fluoroquinolones and aminoglycosides/capreomycin (eis gene) is not always accompanied by phenotypic manifestation of resistance. For these antimicrobials it is necessary to confirm resistance by phenotypic methods.

2. The association between lumbar bone mineral density and advanced glycation end products derived from confocal fluorescence microscopy: a prospective investigation of bone biopsies in patients undergoing lumbar spinal fusion surgery

2. The association between lumbar bone mineral density and advanced glycation end products derived from confocal fluorescence microscopy: a prospective investigation of bone biopsies in patients undergoing lumbar spinal fusion surgery

Antibiotic resistance among bacteria isolated from war-wounded patients at the Weapon Traumatology Training Center of the International Committee of the Red Cross from 2016 to 2019: a secondary analysis of WHONET surveillance data

BackgroundA substantial body of evidence has recently emphasized the risks associated with antibiotic resistance (ABR) in conflicts in the Middle East. War-related, and more specifically weapon-related wounds can be an important breeding ground for multidrug resistant (MDR) organisms. However, the majority of available evidence comes from the military literature focused on risks and patterns of ABR in infections from combat-related injuries among military personnel. The overall aim of this study is to contribute to the scarce existing evidence on the burden of ABR among patients, including civilians with war-related wounds in the Middle East, in order to help inform the revision of empirical antibiotic prophylaxis and treatment protocols adopted in these settings. The primary objectives of this study are to: 1) describe the microbiology and the corresponding resistance profiles of the clinically relevant bacteria most commonly isolated from skin, soft tissue and bone biopsies in patients admitted to the WTTC; and 2) describe the association of the identified bacteria and corresponding resistance profiles with sociodemographic and specimen characteristics.MethodsWe retrospectively evaluated the antibiograms of all consecutive, non-duplicate isolates from samples taken from patients admitted to the ICRC WTTC between 2016 and 2019, limited to skin and soft tissue samples and bone biopsies. We collected data on socio-demographic characteristics from patient files and data on specimens from the WHONET database. We ran univariate and multivariable logistic regression models to test the association between bacterial and resistance profiles with sociodemographic and specimen characteristics.ResultsPatients who were admitted with war-related trauma to the ICRC reconstructive surgical project in Tripoli, Lebanon, from 2016 to 2019, presented with high proportion of MDR in the samples taken from skin and soft tissues and bones, particularly Enterobacterales (44.6%), MRSA (44.6%) and P. aeruginosa (7.6%). The multivariable analysis shows that the odds of MDR isolates were higher in Iraqi patients (compared to Syrian patients) and in Enterobacterales isolates (compared to S. aureus isolates).ConclusionsOur findings stress the importance of regularly screening patients who present with complex war-related injuries for colonization with MDR bacteria, and of ensuring an antibiotic-sensitivity testing-guided antimicrobial therapeutic approach.

The association between lumbar bone mineral density and advanced glycation end products derived from confocal fluoresce01. Basic science: Biologynce microscopy: A prospective investigation of bone biopsies in patients undergoing lumbar spinal fusion surgery

The association between lumbar bone mineral density and advanced glycation end products derived from confocal fluoresce01. Basic science: Biologynce microscopy: A prospective investigation of bone biopsies in patients undergoing lumbar spinal fusion surgery

Bone biopsy results in patients with a history of malignancy: a case series of 378 patients.

The value of a bone biopsy in patients who present with a bone lesion and past medical history of malignancy is uncertain. The objective of this study was to evaluate the outcome of bone biopsies in patients with a history of a malignancy undergoing bone biopsy of a lesion in a regional bone tumour unit. Secondary outcomes include the assessment of survival in the different outcome groups. This was a retrospective study of patients, with a previous malignancy and suspicious bone lesions, who underwent bone biopsy for final diagnosis between March 2010 and September 2019. Results of the biopsy were summarized into 3 groups: confirmed original malignancy, confirmed benign diagnosis, and confirmed new malignancy. Survival analysis of each group was also undertaken. A total of 378 patients met the inclusion criteria (mean age 64years, 216 females (57%)). In 250 cases (66%), the original malignancy was confirmed on the bone biopsy; in 128 cases, an alternative diagnosis was confirmed (benign diagnosis in 69 (18%)), and 59 had a new malignancy (16%). Survival was significantly greater for those in whom a benign diagnosis was confirmed (logrank test p = 0.0100). This study shows that for patients presenting with a suspicious bone lesion, together with a history of malignancy, in a third of cases, the bone biopsy will confirm an alternative diagnosis of a benign lesion or a new malignancy. Survival of these patients will vary significantly depending on the biopsy outcome.

Feasibility of Percutaneous Bone Biopsy as Part of the Management of Diabetic Foot Osteomyelitis in a 100% Neuropathic, Grade 3 IDSA/IWGDF Population on an Outpatient Basis.

The present study aimed to evaluate the feasibility of percutaneous bone biopsy in an ambulatory setting as part of the management of diabetic foot osteomyelitis (DFO) on an outpatient basis. DFO may complicate some cases of apparently nonsevere foot infections in patients with diabetes and greatly increase the risk of a lower extremity amputation. It has been suggested that bone culture-based antibiotic therapy is a predictive factor of success in patients with diabetes treated nonsurgically for osteomyelitis of the foot. It is recommended to identify the causative microorganism(s) by the means of either a surgical or percutaneous bone biopsy taken appropriately to select the proper antibiotic therapy. Percutaneous bone biopsy in patients not requiring surgery is, however, not performed in everyday practice as it should be according to the current recommendations. In the present retrospective study, we report a series of 23 consecutive patients with a suspicion of DFO in whom 28 bone samples were collected by percutaneous biopsy at the bedside in an outpatient setting. The percentage of positive cultures was in accordance with that reported in the literature. The mean number of isolates per specimen was 1.04. After a mean 12-month follow-up, the remission was almost of 78%. No adverse event related to the bone biopsy was noted. After a 1-year follow-up, no recurrence was recorded among the patients in remission. The results of the present study suggest that bedside percutaneous bone biopsy performed in the ambulatory setting is a valuable and safe tool in the management of DFO on an outpatient basis.

Diagnostic Performance of CT-Guided Bone Biopsies in Patients with Suspected Osteomyelitis of the Appendicular and Axial Skeleton with a Focus on Clinical and Technical Factors Associated with Positive Microbiology Culture Results.

To assess diagnostic performance of CT-guided percutaneous needle bone biopsy (CTNBB) in patients with suspected osteomyelitis and analyze whether certain clinical or technical factors were associated with positive microbiology results. All CTNBBs performed in a single center for suspected osteomyelitis of the appendicular and axial skeleton during 2003-2018 were retrospectively reviewed. Specific inclusion criteria were clinical and radiologic suspicion of osteomyelitis. Standard of reference was defined using outcome of surgical histopathology and microbiology culture and clinical and imaging follow-up. Technical and clinical data (needle size, comorbidities, clinical factors, laboratory values, blood cultures) were collected. Logistic regression was performed to assess associations between technical and clinical data and microbiology biopsy outcome. A total of 142 CTNBBs were included (46.5% female patients; age ± SD 46.10 y ± 22.8), 72 (50.7%) from the appendicular skeleton and 70 (49.3%) from the axial skeleton. CTNBB showed a sensitivity of 42.5% (95% confidence interval [CI], 32.0%-53.6%) in isolating the causative pathogen. A higher rate of positive microbiology results was found in patients with intravenous drug use (oddsratio [OR]= 5.15; 95% CI, 1.2-21.0; P= .022) and elevated white blood cell count ≥ 10× 109/L (OR= 3.9; 95% CI, 1.62-9.53; P= .002). Fever (≥ 38°C) was another clinical factor associated with positive microbiology results (OR= 3.6; 95% CI, 1.3-9.6; P=.011). CTNBB had a low sensitivity of 42.5% for isolating the causative pathogen. Rate of positive microbiology samples was significantly higher in patients with IV drug use, elevated white blood cell count, and fever.

Complications during the treatment of diabetic foot osteomyelitis.

To identify complications of medical treatment in patients with diabetic foot osteomyelitis (DFO). We reviewed 143 records of consecutive patients admitted with DFO, confirmed by bone histopathology or culture. Complications monitored included acute kidney injuries (AKI), development of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), gastrointestinal complications, and venous catheter related complications during a 12months follow-up period. Forty-seven AKI episodes were reported during follow-up; half occurred during the first hospitalization with involvement of antimicrobial therapy in 14 events (29.8%). Patients with AKI were more likely to have recurrent ulcerations (69.2% vs. 45.2%, p=0.02), recurrent infections (38.5% vs. 17.3%, p=0.01), and recurrent hospitalizations (43.6% vs. 28.8%, p=0.02) during follow-up. Only 14 MRSA isolates were found in bone samples at baseline (9.8%). Resistant strains of MRSA and VRE were identified in twenty-one patients (14.7%) during follow-up. Patients re-hospitalized for infection were more likely to have resistant bacterial strains (52.6% vs. 25.8%, p=0.02). In this study, the rates of VRE and MRSA in bone biopsies of patients with DFO were lower than in previous reports. Acute kidney injury occurred frequently in our patient population but might not be associated with antibiotic exposure.

Dickkopf-1 negatively regulates the expression of osteoprotegerin, a key osteoclastogenesis inhibitor, by sequestering Lrp6 in primary and metastatic lytic bone lesions.

Recently, an inverse role for Wnt signaling in the development of osteoclasts in the bone was demonstrated. In the present study, we examined whether there is a commonality in the mechanism of bone resorption and lysis that occur in a diverse set of bone metastatic lesions, as well as in primary bone lesions. Compared with control bone tissue and bone biopsies from patients with nonmetastatic primary tumors (i.e., breast carcinoma, lung adenocarcinoma, and prostate carcinoma), patients with bone metastatic lesions from the three aforementioned primary tumors, as well as osteolytic lesions obtained from the bone biopsies of patients with multiple myeloma, demonstrated an upregulated expression of the glycoprotein Dickkopf-1 at both the mRNA and protein levels. Additionally, by coimmunoprecipitation, Dickkopf-1 pulled-down low-density lipoprotein receptor-related protein 6 (Lrp6), which is a key downstream effector of the Wnt signaling pathway. The expression of Lrp6 was unaltered in the osteometastatic lesions. This negative regulation was associated with a lowered expression of osteoprotegerin in the osteometastatic lesions, an observation that was previously reported to promote osteoclastogenesis. These findings provide a common mechanism for the inverse relationship between the Wnt signaling pathway and the development of primary or metastatic bone lesions. Pharmacological modulation of the Wnt signaling pathway might benefit the clinical management of primary and metastatic bone lesions.

Abstract 2425: An in vitro platform to dissect drug responsiveness in refractory anemia with ringed sideroblasts (RARS)

Abstract Background: The pathophysiology of low-risk myelodysplastic syndrome (LR-MDS) remains unknown and therapeutic options are limited. In a phase-II trial, with oral rigosertib, a small molecule inhibitor of PI3K and PLK pathways, was shown to have a 39% response rate, in patients with LR-MDS. Rigosertib caused an increase in hemoglobin, a decrease in transfusion requirements, and, in some patients who were previously refractory, “re-sensitization” to erythropoietin (EPO) therapy. Thus far, the mechanism of this responsiveness remains unknown. Whole exome sequencing revealed broad spectrum mutations in these patients, including mutations in SF3B1, SRSF2 and TET2. However, there was no correlation between mutational spectrum and responsiveness. Methods: CD34+ cells were isolated from bone marrow (BM) mono nuclear cells derived from BM aspirates. Bone marrow stromal cells (BMSC) were isolated from bone biopsies of patients with MDS. Normal CD34+ cells and BMSC were obtained commercially. CD34+ cells were co-cultured with stromal cells plated a day before and stimulated with concentrations of EPO and rigosertib. Differentiation was assessed by staining cells with various markers of erythroid differentiation and analyzed by FACS. We show that co-culture of CD34+ stem cells from the bone marrow of patients with their own BMSC recapitulates key features of the MDS phenotype and rigosertib responsiveness. Results: Normal (non-MDS) CD34+ cells co-cultured with normal BMSC showed striking responsiveness to EPO stimulation, as evidenced by the increased production of CD45- low/GPA+/ band 3+/Integrin-Alpha4+ erythroid cells (2.47 fold increase compared to no EPO). In contrast, RARS CD34+ cells co-cultured with MDS stromal cells showed no erythroid differentiation with EPO stimulation (1.09 fold change compared to EPO). Notably, LR-MDS co-cultures showed increased erythroid differentiation with the addition of 20 nm and 100 nm rigosertib in the presence of EPO (1.28 and 1.4 fold increase, respectively, compared to EPO alone). Moreover, co-cultures obtained from 3/3 patients that showed responsiveness in vivo were responsive to combined EPO/rigosertib stimulation in vitro, while 2/2 non-responsive patients were not responsive in vitro. Conclusions: We have created an in vitro platform to dissect the mechanism of rigosertib responsiveness in RARS patients. This is a novel co-culture-based system that recapitulates key features of the RARS phenotype. Without reliable animal models for this disease, this platform may offer a viable method to characterize drug responsiveness, dissect mechanisms, and offer patient-specific drug responsiveness information, since individual CD34+ cells are co-cultured with a patient's own BMSC. We wish to use this in vitro co- culture test to prospectively predict responsiveness to experimental drugs in patients, thereby focusing the drug on only selected patients. Citation Format: Daniela Georgieva, Sheherzad Preisler, Michael Churchill, Abdullah Mahmood Ali, Azra Raza, Siddhartha Mukherjee. An in vitro platform to dissect drug responsiveness in refractory anemia with ringed sideroblasts (RARS). [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2425. doi:10.1158/1538-7445.AM2015-2425

Disseminated bone lesions in AIDS‐associated Kaposi sarcoma, a bad prognosis? About four cases

Kaposi sarcoma (KS) can present with a wide range of clinical features ranging from minimal cutaneous disease to a rapidly progressing neoplasm. Bone lesions are most often discovered accidently in the context of radiological investigations done for the screening of KS‐visceral involvement [1]. Little is known on clinical outcome and response to antiretroviral therapy (ART) and/or chemotherapy of these lytic osseous lesions. We report four cases with bone involvement in the context of systemic KS and aim at describing the long‐term clinical outcome in two of these patients. Cases of AIDS‐associated KS with disseminated bone lesions were collected in the HIV Unit, University Hospital Geneva, Switzerland. Patients were compared on clinical, biological and radiological features and therapeutic responses. Between 2002 and 2012, four HIV1‐infected patients with T1 stage of KS presented disseminated osseous lesions (Table 1). Mean age was 43 years (range 39 ‐ 47 years), mean time of follow up until our analysis was 48.5 months (SD 53.8), and mean CD4 count at KS diagnosis was 190.5 c/mL (SD 202.8). All patients showed hypodense bone lesions predominating the axial skeleton (figure 1), but no radiological imaging was performed to search for peripheral bone lesions.No patient reported pain or experienced pathological fractures. In one patient a dual‐energy X‐ray absorptiometry (DXA) showed a bone mineral density within normal range after 10 years of KS diagnosis with disseminated bone lesions. No radiological change was observed in that patient despite stable KS disease after 13 cycles of liposomal doxorubicin and ART (figure 1). We describe a well‐documented long‐term follow up of disseminated osseous AIDS‐associated KS disease. In our four cases, lytic bone lesions were asymptomatic and were not associated with bone fragility. We even could confirm the KS nature of the lesions by bone biopsy in patient B (3 months after KS diagnosis), as the differential diagnosis is wide, and include bacillary angiomatosis, cancers or metastasis. Chemotherapy and antiretroviral treatment did not affect bone lesions using CT scan despite a good response on other KS‐affected sites. Prognostic factors are well established in AIDS‐associated KS [2]; however disseminated bone disease does not seem to have an impact on disease evolution. A larger sample size is needed to confirm this hypothesis.Patient with 10yr follow up, lumbar vertebre after 6 (2002) and 13 (2012) sycles of chemotherapy with Liposomal Doxorubicin.image Baseline characteristics for all four patients with AIDS‐related KS and osseous lesions. Staging classification is based on Known SE et al. J Clin Oncol 1989; 7: 1201–7 and includes the following parameters: T for Tumor (T0 = KS confined to skin and minimal oral disease, T1 = all other manifestations), I for Immune system (I0 = CD4 cells >200/ µL and I1 = CD4 cells <200 µL) and S for systemic illness (S0 = no history of opportunistic infections, S1 = history of opportunistic infections and thrush) Patient Sex Age Ethnicity Kaposi stage (TIS) Follow‐up time since KS diagnosis Visceral involvement Bone lesion (imaging) HHV8 viremia at KS diagnosis (full blood c/mL) Chemotherapy (first line, number of cycles, time period) Last HIV‐RNA (c/µL) ART including PI (y/n) Special comment A M 47 (1965) CAU 1/1/1 10 years yes Axial skeleton, disseminated, hypodense (CT scan) n.a. Liposomal Doxorubicin (13, 1999–2004) < 20 yes DXA‐scan BMD within normal range B M 45 (1969) SSA 1/1/1 8 months Yes Axial skeleton, disseminated, hypodense (CT scan) 2200 Paclitaxel (4, 2012–ongoing) 45 yes KS confirmation by bone biopsy C M 41 (1971) SSA 1/0/1 5 years Yes Axial skeleton, disseminated, hypodense (CT scan) Not done none 94 no D M 39 (1973) SSA 1/1/1 6 months Yes Axial skeleton, single lesions, hypodense (CT scan) 62200 Paclitaxel (3, 2012–ongoing) < 20 yes (but stop May 2012) (Abbreviations: SSA = Sub Saharan Africa; CAU = Caucasian; n.a.=not available DXA = Dual‐energy X‐ray absorptiometry; BMD = bone mineral density)

Bone Turnover in Bone Biopsies of Patients with Low-Energy Cortical Fractures Receiving Bisphosphonates: A Case Series

Recent reports of long-term bisphosphonate-treated patients developing cortical fractures have raised concerns that such fractures may relate to excessive suppression of bone turnover after prolonged use of these drugs. To evaluate the bone histology of patients presenting with cortical fractures after bisphosphonate therapy, we conducted a retrospective analysis of patients treated at Washington University Bone Health Program presenting with a history of low-energy cortical fractures (femoral shaft, pelvis, rib, metatarsal, and ankle), who had received bisphosphonates for at least two consecutive years and had undergone bone biopsy. Fifteen of 54 patients who underwent bone biopsy between November 2004 and March 2007 met the criteria. Of these, 10 patients had findings of suppressed trabecular bone remodeling, as demonstrated by lack of double tetracycline labels. There were no significant differences in bone density, clinical features, and biochemical features between those with suppressed turnover and the other five subjects with normal remodeling. However, the low-turnover group had received bisphosphonates (primarily alendronate) for a significantly longer duration (6.5 +/- 0.6 vs. 3.9 +/- 0.8 years, P = 0.02). Thus, about two-thirds of patients presenting with cortical fractures while on long-term treatment with bisphosphonates had suppressed turnover. Since the prevalence of such histological findings in nonfracture patients remains unknown, the impact of suppressed bone turnover on the development of cortical fractures cannot be determined. Considering the widespread use of bisphosphonates, it appears that the overall risk of cortical fractures is low. However, there may be a subset of as yet unidentified patients who could be predisposed to this complication.

Histomorphometric Measurements of Bone Turnover, Mineralization, and Volume

A recent Kidney Disease: Improving Global Outcomes report suggested that bone biopsies in patients with chronic kidney disease should be characterized by determining bone turnover, mineralization, and volume. This article focuses on the calculations and interpretation of these measurements. In most cases of renal osteodystrophy, the bone formation rate is roughly similar to the bone resorption rate; therefore, the bone formation indices can be used to describe turnover. It is important to remember that these conventions will not apply in some situations. Activation frequency should not be confused with bone formation rate or bone metabolic unit birth rate. Abnormal mineralization can be described using the osteoid volume, increased osteoid maturation time, or increased mineralization lag time. The concept of bone volume is the easiest to understand, but there is a large error from one biopsy to the next in the same person. There are some difficulties with each of the measurements, and further research in patients with chronic kidney must be done to enable a consensus to be reached about cut points to define categories within the spectrum of renal osteodystrophy and how to evaluate treatment responses.

Bone biopsy in patients with osteoporosis

Although rarely used to diagnose and manage patients with osteoporosis, bone biopsies are performed to establish bone quality, including degree of mineralization and microarchitecture; to assess bone turnover and bone loss mechanisms; and to analyze treatment effects on bone structure and bone turnover. Bone biopsies are also the only method to diagnose mineralization defect or frank osteomalacia. Due to the availability of antiresorptive agents and anabolic drugs, determining bone turnover and bone-loss mechanisms is critical to appropriate treatment regimen selection. Bone biopsies establish the safety and efficacy of new therapeutic modalities. Further, new techniques such as molecular morphometry (in situ hybridization and immunohistochemistry) and analysis of bone content and crystal perfection have been applied to undecalcified bone and elucidated pathogenetic mechanisms or abnormalities in bone microstructure.

PHOSPHORUS METABOLISM AND MANAGEMENT IN CHRONIC KIDNEY DISEASE: The Role of Magnesium Binders in Chronic Kidney Disease

AbstractMagnesium is predominately an intracellular cation that plays a critical role in cellular physiology. Serum levels are often slightly elevated in patients on chronic hemodialysis and older reports suggests that total body stores may also be increased, based on bone biopsies in patients treated with higher dialysate magnesium levels than are currently in use today. Several studies have shown that magnesium, particularly in the form of magnesium carbonate, is an effective phosphate binder and can decrease patients’ exposure to calcium. Retrospective studies suggest that magnesium may prevent vascular calcification in dialysis patients, although this remains controversial and has not been evaluated prospectively. Magnesium may reduce arrhythmias postoperatively and, while it may theoretically reduce arrhythmic death in dialysis patients, this hypothesis has never been tested. While short‐term or adjuvant use of magnesium carbonate appears safe and effective as a phosphate binder, more studies are needed to evaluate the long‐term effects on vascular calcification, bone histology, and mortality.

Diagnosing Osteomyelitis with Percutaneous Bone Biopsy in Patients with Diabetes and Foot Ulcerations

PURPOSE: Microbiological and histological analysis of a bone specimen is the criterion standard for diagnosing osteomyelitis. The role of percutaneous bone biopsy (PBBx) in diabetic patients with possible osteomyelitis remains controversial: does PBBx improve diagnostic accuracy, provide important microbiological information, and can it be performed safely? METHODS: We reviewed a series of 34 diabetic patients at one institution with suspected osteomyelitis who underwent (a) clinical evaluation, (b) wound culture, (c) imaging with standard X-rays, 99Tc-bone scans, and 111In-labelled white blood cell scans, and (d) fluoroscopically-guided PBBx. RESULTS: Osteomyelitis was diagnosed in 15 of 34 patients (44%), defined as PBBx or surgical bone specimens positive by culture or histology, or imaging and prolonged clinical follow-up. The overall sensitivity of PBBx for the diagnosis of osteomyelitis was 73% (11/15 patients diagnosed). Sensitivity increased to 89% among the 9 patients with osteomyelitis who had received ≤20 days of antibiotic therapy prior to biopsy. Four of eleven patients (36%) with intermediate probability imaging studies were subsequently diagnosed with osteomyelitis. PBBx identified 3 of these 4 patients with osteomyelitis. The only false-negative occurred in a patient who had received 30 days of antibiotics prior to biopsy. Among patients with osteomyelitis and positive bone cultures, the causative organism identified by PBBx was not cultured from the overlying wound in 4 of 11 instances (36%). S. aureus was cultured from 55% of bone biopsies. There were no immediate or long-term complications of PBBx. CONCLUSION: Percutaneous bone biopsy is safe, highly specific and moderately sensitive for diagnosing osteomyelitis in patients with diabetic foot ulcers, particularly in the absence of prolonged antibiotic therapy prior to biopsy. PBBx may be most rationally utilized when the results of imaging studies are inconclusive (intermediate pre-test probability) or when an uncommon etiologic organism for osteomyelitis is cultured from the overlying wound (in order to direct antibiotic therapy).

Morphological analysis of iliac crest bone biopsies in patients with osteoporosis and treatment according to the ADFR concept with (1-38)hPTH and diphosphonate (EHDP)—Osteoporosis study I, Hannover

Morphological analysis of iliac crest bone biopsies in patients with osteoporosis and treatment according to the ADFR concept with (1-38)hPTH and diphosphonate (EHDP)—Osteoporosis study I, Hannover

Correlation of the findings of magnetic resonance imaging with those of bone biopsy in patients who have stage-I or II ischemic necrosis of the femoral head.

A prospective study was undertaken to determine the diagnostic accuracy of magnetic resonance imaging in the evaluation of a symptomatic hip for which a diagnosis of early ischemic necrosis of the femoral head was suspected. Fifteen patients (sixteen symptomatic hips), for whom the findings of magnetic resonance imaging were consistent with a diagnosis of osteonecrosis of the femoral head, had a core decompression and a biopsy of the contents of the core. Preoperative magnetic-resonance imaging was useful for planning which segment of the femoral head should be biopsied. Plain radiographs and tomograms of the hips were also made. On the basis of the plain radiographs, ten hips were determined to have Stage-I findings and six hips, Stage-II ischemic necrosis, according to the system of Ficat and of Arlet and Ficat. Histological study revealed evidence of necrosis in all of the biopsy specimens of bone. We concluded that findings of magnetic resonance imaging that are characteristic of osteonecrosis correlate well with the results of biopsies of bone in patients who have an early stage of ischemic necrosis. Magnetic resonance imaging is a highly sensitive and specific method for both the diagnosis and the location of Stage-I and Stage-II osteonecrosis.