Bone Involvement Research Articles

Treatment and Early Outcomes of Capitellar Osteochondritis Dissecans.

Treatment for osteochondritis dissecans (OCD) of the humeral capitellum has been predominantly guided by fragment stability and articular cartilage integrity. Nonoperative management is recommended for stable lesions, whereas surgical intervention is indicated for unstable lesions and those that fail nonoperative care. Several surgical options may be considered, although limited information is available regarding indications for specific surgical techniques and comparative postoperative results. To assess surgical outcomes of patients with capitellar OCD treated according to a decision-making approach focused on subchondral bone involvement. Cohort study; Level of evidence, 3. Patients diagnosed with capitellar OCD at a tertiary academic center were enrolled in a prospective longitudinal cohort study. Patient information was collected at the time of enrollment, and OCD lesions were classified according to the Nelson grade. Clinical and radiologic data were collected both pre- and postoperatively for those undergoing surgical treatment. Surgical procedures were performed based on an evolving treatment framework that included considerations specifically for lesion containment and depth of subchondral bone disease. Timmerman scores were obtained to assess patient functional outcomes. A total of 154 patients were prospectively enrolled, 19 of whom had bilateral disease. The mean age at presentation was 13.7 years; 39% were gymnasts and 28.5% were primary baseball or softball athletes. Surgery was performed on 145 elbows, including 43 drilling/microfracture procedures, 21 internal fixations, and 63 autologous osteochondral grafting (OG) procedures. Clinically, there were significant improvements in pain, elbow motion, and mechanical symptoms. Timmerman scores significantly improved after each type of surgical procedure. A total of 76% of patients returned to their primary sport. When stratified by the Nelson grade, patients with OG had lower revision surgery rates than those treated with drilling/microfracture and fixation. Furthermore, for Nelson grade 2 lesions, patients treated with OG had significantly better postoperative elbow motion and higher Timmerman scores compared with those treated with other procedures. Using a treatment framework incorporating lesion containment and depth of subchondral bone disease, surgery for capitellar OCD provides clinical, radiologic, and functional improvements. Patients treated with OG may have lower revision rates and better functional outcomes compared with those treated with other surgical techniques, with OG warranting consideration even for lower-grade OCD lesions.

Olfactory Neuroblastoma With Divergent Differentiation: Contemporary Management of Unusual Pathology and Literature Review.

Olfactory neuroblastoma (ON; Esthesioneuroblastoma) is a malignant tumor that arises from the olfactory neuroepithelium. Very rarely, ON can histologically display a biphenotypic pattern, with only 7 cases reported in the literature to date. We describe a case of this poorly understood entity and review the patient's histology, pathology, and treatment. An 85-year-old man presented with endoscopy and imaging findings of a sinonasal mass arising from the olfactory cleft. Biopsy and further pathological review established Hyams grade 3 and Kadish stage C tumor. The patient underwent combined endoscopic and open-approach resection due to the involvement of the nasal bone and subsequent adjuvant radiation therapy. Specimen contained Flexner-Wintersteiner rosettes and stained positive for the neuroendocrine marker synaptophysin consistent with ON. A second, epithelial component pattern of goblet cells and mucin was observed suggesting divergent differentiation. We are the first group to report next-generation sequencing of this tumor, which revealed a pathogenic mutation in PIK3CA and a likely pathogenic variant in RUNX1 (AML1). ON with divergent differentiation is very rare, and more robust studies characterizing molecular drivers and pathology may aid in clinical management.

A rare presentation of isolated intraosseous Rosai-Dorfman disease of the tibia – The role of whole-body magnetic resonance imaging in management

Rosai–Dorfman disease (RDD) is a rare non-Langerhans histiocytic disorder, usually presenting with enlarged cervical lymph nodes. Extranodal involvement is quite common and synchronously involves the nasal cavity, paranasal sinuses, skin, orbit, central nervous system, and rarely bones. Isolated bone involvement is rare and can present with local symptoms such as pain, swelling, restriction of activity, and occasionally pathological fracture. The most common sites of osseous RDD are the cranium, facial bones, and tibia, in decreasing order of frequency. Imaging findings of primary osseous RDD can be variable and there are no key features to diagnose this entity with certainty. Hence, the primary role of imaging is to plan the management and post-treatment follow-up. Here, we present a case of primary osseous RDD involving tibial diaphysis and emphasize the importance of whole-body magnetic resonance imaging in ruling out systemic involvement.

Bone and Joint Involvement in Beta Thalassemic Patients: A Cross-sectional Study

Bone and Joint Involvement in Beta Thalassemic Patients: A Cross-sectional Study

Incidence and gender difference of brain metastases in newly diagnosed follicular thyroid cancer patients.

Population-based estimates of brain metastases in follicular thyroid cancer (FTC) patients with or without distant metastases (DMs) at diagnosis are lacking. To study the prevalence of brain metastases in FTC patients and compare gender disparity. DMs are defined as bone, lung, and brain metastases. Using the SEER database, we identified 5116 patients diagnosed with FTC between 2010 and 2019. The incidences of brain metastases were calculated for the entire cohort and among patients with bone/lung metastases. Cohorts were stratified by gender and age. 4.8% (245) had DMs at diagnosis, primarily in the form of bone metastases (3.6%), followed by lung metastases (2.4%). The incidence of brain metastases at initial diagnosis was only 0.37% (17 females and 2 males), but occurred in 8.2% and 6.1% of patients with bone metastases and lung metastases, respectively. Median survival for patients with brain metastases was only 8.0 months (95% CI, 4.1-11.9). Interestingly, female patients with bone metastases exhibited a significantly higher incidence of brain metastases compared to males (12.0% vs. 1.5%), with a notable odds ratio of 8.971 (95% CI:1.152-69.835) in univariate analysis. Multivariate logistic regression analysis confirmed that being female (odds ratio, 10.08; 95% CI:1.243-81.748) was the sole statistically significant risk factor for brain metastases in FTC patients with bone metastases at diagnosis. An incidence of brain metastases is observed in newly diagnosed FTC patients with DMs, especially in females with bone involvement. Our findings advocate for the early detection of brain metastases in female FTC patients with concurrent bone metastases at diagnosis.

Subchondral curettage cement packing in the distal radius causes wrist joint degeneration: long-term evaluation of distal radius giant-cell bone tumour.

This study investigated wrist joint degeneration after curettage and PMMA treatment for giant cell bone tumours (GCBT) at the distal radius. We performed a retrospective single-centre study, which included 23 patients with GCBT at distal radius treated with curettage and PMMA between 2001 and 2021. The progression of wrist joint degeneration was assessed through radiographic evidence, comparing the postoperative grade with both the preoperative grade and the grade of the contralateral wrist at the latest follow-up. We also analyzed the influence of age, sex, tumour distance of the joint, subchondral bone involvement, tumour size and body mass index. The study included 23 patients with a mean age of 32.1 ± 13.3 years. The average duration of follow-up was 96.4 ± 69 months (range, 24-265 months). The mean tumour-cartilage distance was 1.79 ± 2.4 mm (range, 0-10 mm) and the mean BMI was 23.5 ± 3.8 kg/m2. Degeneration of the wrist joint was evident in 16 patients (69.6%) at the final assessment, however, 10 patients (43.4%) were identified as having a progression of joint degeneration secondary to the surgical procedure among the 16 patients with wrist joint degeneration at the final control view. Age, gender, dominance, tumour-cartilage distance, subchondral bone involvement, tumour size, patient height, weight, and BMI were not associated with secondary joint degeneration. Ten of 23 patients developed wrist joint degeneration over an average follow-up period of 8 years, and no particular factors associated with the degeneration were identified.

Chest Wall Hydatid Disease: Surgical management and risk Factors for Recurrence and Mortality

Background Hydatidosis of the thoracic wall differs from other hydatid localizations in its pathophysiology, diagnostic, and therapeutic management. It is a little-studied entity. The objectives of our work were to describe its surgical management and to analyze the factors that may influence recurrence and mortality. Methods A retrospective, descriptive, longitudinal, and multicenter study on four university hospital surgical centers of Tunis, from January 1995 to December 2022 including operated hydatid cysts of the thoracic wall. Overall survival (OS) and cumulative recurrence rates were calculated. Univariate and multivariable Cox regression analyses were performed to identify recurrence and mortality risk factors. Results Forty-nine patients were included. The mean age was 41 ± 17 years [8-76]. The main presenting sign was thoracic parietal swelling (n=22). Chest ultrasound and CT scan showed multivesicular formation in 17 and 33 cases, respectively. Muscle involvement was in the intercostal (n=4), paravertebral (n=13), and pectoralis major (n=3) muscles. Bone involvement was vertebral (n=11), costal (n=12), costo-vertebral (n=21) and sternal (n=2). A posterolateral thoracotomy was performed (n=20). Surgical excision at various levels of the chest wall with spinal stabilization (n=15) was performed. Sixty-three percent of the patients received antiparasitic medical treatment. Recurrence occurred in 37% of cases. Four patients died from hydatidosis-related complications. Factors could be independently associated with recurrence such as male gender, and vertebral involvement. The presence of a visceral hydatid cyst located at a distance from the parietal lesion at the time of diagnosis and the occurrence of postoperative infectious complications could increase mortality. Conclusions Chest wall hydatidosis represents a rare medical condition where surgery remains the preferred treatment modality. However, it carries a substantial burden of morbidity and mortality, influenced by various factors. Further large-scale studies are necessary to gain a deeper understanding of these factors and to optimize management strategies accordingly.

Hydatid disease contributes to spinal cord compression: a case report and literature review

BackgroundHydatid disease is an infectious disease caused by echinococcus that causes liver and lung damage in humans. Bone involvement is rare and accounts for only 0.5%-4% of hydatid diseases; the spine is more prone to be infected with a proportion of 50% in musculoskeletal tissue. Missed hydatid cysts may lead to serious consequence, it is necessary to diagnosis and treatment of hydatid cysts at early stage.Case presentationWe present a case of a 47-year-old Han Chinese male diagnosed with spinal hydatidosis. The patient lived in pasturing areas accompanied by symptoms of low back pain radiating to the legs, progressive weakness, and hypoesthesia in the lower limbs accompanied by difficulty walking. Computed tomography (CT) images showed a spinal hydatid cyst in the lumbar vertebra2 (L2) that caused bone destruction in the vertebral body and lamina. Magnetic resonance imaging (MRI) images showed hyperintense cystic components on L2 with the appearance of a lobulated, multiocular, septate cystic mass and compression of the spinal cord at the segments of L2. The patient underwent subtotal vertebral resection to completely remove the damaged vertebral and paravertebral cysts, and histopathological examination revealed the characteristic features of hydatid cysts. The patient received a postoperative antiparasitic drug treatment and finally achieved a successful treatment.ConclusionsSpinal hydatidosis is a rare infectious disease. It should be considered as an important differential diagnosis for patients accompanying by spinal bone destruction with animal contact history. Surgical removal combined with antiviral drugs is an effective way to treat spinal hydatidosis. In addition, long term follow-up is mandatory for avoiding its recurrence.

Skeletal phenotypes in postmenopausal women affected by primary hyperparathyroidism.

The current primary hyperparathyroidism (PHPT) presents as a mild disease. We explored skeletal phenotypes in postmenopausal women affected by PHPT, focusing on fracture prevalence. PHPT women were retrospectively evaluated at four Italian centers for osteoporosis management (two centers in Milan, n = 244; Cuneo, n = 128; Pisa, n = 131). Data collected from clinical records were analyzed by hierarchical clusterization. Considering the whole PHPT series [n = 503, aged 67.0 (61.0-74.0) years], 90% had low bone mineral density (BMD) and approximately 30% reported at least one fracture. Vertebral fractures were associated with older age and lower hypophosphatemia, while women with appendicular fractures were younger with less severe hypophosphatemia. Fractures were predicted by lumbar T-score. By using a clustering approach, we identified four different skeletal phenotypes (cluster, C): C1 (n = 53) and C2 (n = 172) included women with lumbar and femur neck osteopenia, with low prevalence of fractures (11.3%). Osteoporotic PHPT women were grouped into C3 (n = 142) and C4 (n = 136); all women in C4 experienced fractures, were older, and were more frequently affected with cardiovascular diseases. In contrast, women included in C3 never experienced fractures and had a lower body mass index (BMI), though they were characterized by severe reduction in BMD at both lumbar and femur sites. Ionized and total calcium, phosphate, 25hydroxyvitamin D levels, kidney function, and stone prevalence (range, 26.4%-29.0%) were similar among clusters C1, C2, and C4, while unfractured women in C3 showed slightly higher ionized hypercalcemia, lower hypophosphatemia, and higher hypercalciuria with a trend to more frequently develop kidney stones (38.7%) than women in the remaining clusters. Skeletal involvement in women with PHPT presented heterogeneous phenotypes with different prevalence of fractures. Fractures were not related to PHPT severity, suggesting that other factors besides PHPT, such as age, BMI, and lumbar and femur BMD, should be considered in the evaluation of bone involvement in postmenopausal women with PHPT.

Osteoporosis in Systemic Mastocytosis: A Scoping Review

Background: Mastocytosis (MS) is a rare disease that can involve various organs, including the bone. Given the incidence of the disease in the global population, MS poses a challenge for physicians, and early therapeutic intervention in the initial stages could significantly impact the quality of life of affected patients. Objective: The aim of this scoping review was to provide an overview of secondary osteoporosis in systemic mastocytosis (SM), focusing on the heterogeneity of its manifestations, the benefits of early diagnosis, and appropriate pharmacological treatment. Design: A technical expert panel (TEP) consisting of 8 physicians with expertise in metabolic bone diseases conducted the review following the PRISMA-ScR model. A strength of this study is that it provides various therapeutic approaches for patients with bone involvement in SM, although the limited available literature on the topic constituted a limitation. The TEP sought evidence regarding the following diagnostic and therapeutic modalities in the management of SM: “bisphosphonate therapy”, “zoledronic acid therapy”, “denosumab therapy”, “IFN-alpha therapy”, and “IFN-alpha therapy in combination with pamidronate”. Results: Clinical data showed a correlation between densitometric outcomes, serum tryptase levels, and mast cell infiltration in the bone marrow, between increased bone mineral density and the presence of osteosclerosis in cases of advanced SM, between the severity of osteoporosis and hypertryptasemia, and also provided results on the long-term effects of bisphosphonate therapy, the therapeutic efficacy of zoledronic acid administration, the positive effect of denosumab on the reduction of serum tryptase levels (even if is proved in a limited numbers of cases) and the prevention of new fractures, and the effect of IFN-alpha in more severe cases of SM, either alone or in combination with pamidronate. Conclusions: Studies have demonstrated the effectiveness of various treatments depending on the form of mastocytosis, whether indolent systemic or advanced systemic, in the prognosis of the disease. However, this role should be further investigated in additional clinical studies, considering the limited data on the use of these interventions.

Frequency and characteristics of ectopic parathyroid adenomas in a cohort of patients referred for 18F-fluorocholine PET/CT.

This article aimed to study the frequency and characteristics of ectopic/intrathyroidal parathyroid adenomas in patients referred for 18F-fluorocholine PET/computed tomography (CT). From 11 June 2015 to 15 January 2024, 729 patients were studied. Recorded patient variables included hyperparathyroidism type, sex, age, presence of symptoms, renal involvement, bone involvement, parathyroid hormone (PTH), and serum calcium, phosphate, and vitamin D as well as 24-h urine calcium excretion. PET/CT results were also collected. In case of parathyroidectomy, the weight of the adenomas was recorded. Continuous variables were expressed as mean ± SD. Differences were evaluated with Mann-Whitney U-tests or two-sample t-tests, when appropriate. P-values ≤0.05 were considered statistically significant. PET/CT showed no adenoma in 163 (22%), adenoma in 451 (62%), hyperplasia/multiglandular disease in 32 (4%), and equivocal results in 83 (11%) patients. A total of 6/729 (1%) adenomas were located intrathyroidally and 16/729 (2%) had an ectopic location. Patients with ectopic/intrathyroidal adenoma showed significantly higher serum PTH levels than patients with no visualization of adenoma on PET. The mean mass of the adenoma was 1 ± 2.3 g in patients with orthotopic adenomas versus 2.7 ± 3.3 g in patients with ectopic/intrathyroidal adenomas; however, this was not significantly different (P = 0.09). In the presented cohort, the frequency of ectopic/intrathyroidal parathyroid adenomas was 3%. No significant difference in weight was found between orthotopic and ectopic/intrathyroidal parathyroid adenomas.

Gorham-Stout disease and multiple cervical lymphangiomas: case report.

Gorham-Stout disease is a rare condition characterized by extensive bone loss due to the proliferation of new vascular and lymphatic structures. It can occur in any bone and cause pathologic fractures with poor bone healing. Complications such as effusions and lymphangiomas can also develop. Gorham-Stout disease pathogenesis is still being studied, and treatment options are limited, but sirolimus has shown promise in stabilizing or reducing symptoms. We present a case of a 19-year-old male with Gorham-Stout disease, multiple cervical lymphangiomas, and several thoracic complications successfully treated with sirolimus. Rare lymphatic diseases should be considered as a potential cause in adult patients with bone involvement and multiple cystic lesions in the neck, axillary, or abdominal regions after excluding more common causes. The complexity of diagnosing Gorham-Stout disease should be emphasized.

Multisystem ALK-Positive Histiocytosis With DCTN1::ALKFusion in an Adult, Responsive to Alectinib: Case Report and Literature Review.

Anaplastic lymphoma kinase (ALK)-positive histiocytosis has emerged as a clinically relevant diagnosis featuring a wide span of clinical presentations, which are unified by the presence of ALK-positive histiocytes on histopathology and molecular drivers involving the ALK kinase gene. This report presents an adult case of multisystem ALK-positive histiocytosis with xanthogranuloma-like features on histopathology that was responsive to ALK inhibition, and includes a review of ALK-positive histiocytoses with cutaneous involvement reported in the literature. A 56-year-old male developed a widespread eruption of red-brown papules on the face, trunk, and upper extremities. Histopathological evaluation revealed a well-circumscribed, nodular dermal infiltrate of epithelioid histiocytes with Touton giant cells, rare bizarre multinucleated cells, and focal emperipolesis. The lesional cells were positive for CD68 and ALK1 immunohistochemical stains, and negative for CD1a. Next-generation sequencing identified a DCTN1::ALK fusion. On imaging, he was found to have bone, lung, soft tissue, and salivary gland involvement. ALK inhibition was initiated with alectinib, resulting in rapid improvement of cutaneous lesions and eventual complete resolution of abnormal imaging findings, which was sustained at 24 months of follow-up. This case adds to the spectrum of ALK-positive histiocytoses and further demonstrates the positive response with targeted therapy.

When Giant Lymphangioma Meets Hydrops Fetalis: An Uncommon Case Report of Lower Extremity Involvement

Abstract Approximately 75% of lymphangiomas manifest in the head and neck region, with limb and bone involvement observed in only 2% of cases. This case report presents a rare instance of fetal lymphangioma associated with hydrops fetalis, affecting the left lower extremity and abdomen. A 22-year-old secundigravida woman was referred to the gynecology department at 31.2 weeks of gestation. Initial fetal ultrasound revealed a live fetus with a large lymphangioma involving the left lower extremity, gluteal region, and abdomen. Additional ultrasound findings included subcutaneous edema, pericardial effusion, ascites, placentomegaly, and tricuspid regurgitation. Postnatal clinical examination confirmed the diagnosis of lymphatic malformation. Notably, only one other similar case has been reported in the English-language PubMed database. This report adds to the medical literature as a rare instance of prenatally diagnosed lymphangioma-associated hydrops fetalis.

Proteomic Profiling of Lymph Nodes Differentiates Classic Hodgkin Lymphoma With and Without Skeletal Involvement.

Classic Hodgkin lymphoma (CHL) is a highly curable disease, even in advanced stages. Controversy remains over whether bone involvement negatively affects overall and progression-free survival in patients treated with intensive chemotherapy regimens. Whether cases that present with bone lesions harbor specific tumor microenvironmental features is unknown. We investigated protein expression in diagnostic lymph node biopsies from CHL patients with and without skeletal involvement at diagnosis to identify potential markers of skeletal disease. Protein expression patterns in diagnostic formalin-fixed paraffin-embedded lymphoma lymph node samples from CHL patients were analyzed by nano-liquid chromatography-tandem mass spectrometry. Patients were grouped according to skeletal involvement, which was defined as the presence of one or more FDG-avid lesions on a diagnostic FDG-PET/CT scan. Protein profiles identified patients with skeletal disease at diagnosis and showed disrupted cellular pathways, including immune system processes, cell adhesion, and cell growth/survival. Immunohistochemical evaluation also demonstrated differential expressions of angiotensin-converting enzyme (ACE), intercellular adhesion molecule 3 (ICAM3), integrin alpha-X (ITGAX), and calreticulin (CALR). In conclusion, proteomics identified altered protein expression profiles in lymph nodes among CHL cases presenting with disease disseminated to the skeletal system, which implies altered disease pathogenesis for these patients.

A Rare Case of Osteoid Osteoma of the Medial Cuneiform Bone at Tibialis Anterior Insertion Confirmed by Bone Scan SPECT/CT.

A 34-year-old man presented with progressive foot pain that was initially on the medial soft tissue but eventually localized to the medial side of midfoot. Despite undergoing various imaging tests and conservative treatments over 2 years, the patient remained undiagnosed. After 6 months, soft tissue and bone involvement were observed on the medial cuneiform. A needle biopsy was inconclusive. Since bone tumor is rare in the medial cuneiform, the patient was referred to our department for 99mTc-MDP bone scan. The imaging and clinical findings suggested osteoid osteoma as the likely diagnosis, which was confirmed as intraarticular nidus under tibialis anterior attachment, after surgical resection and pathological examination.

Role of 18F-FDG-PET/CT in the initial staging of very high-risk Ewing Sarcoma in a prospective multicentric Phase II Study: Is there still a place for bone marrow sampling?

The Ewing Sarcoma Family of Tumors (ESFT) constitutes a group of rare malignancies, wherein approximately one-third of cases exhibit metastatic spread, particularly impacting prognosis when bone and/or bone marrow (BM) are involved. Primary extra-pulmonary metastatic ESFT often necessitates intensified therapeutic approaches. Accurate staging plays a pivotal role in clinical decision-making, with fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) currently serving as a non-invasive modality for assessing ESFT's BM extent. In the French phase II COMBINAIR3 (NCT03011528) study, a comprehensive approach for patients with extra-pulmonary ESFT metastasis was evaluated. We prospectively compared the efficacy of PET/CT to BM aspiration and biopsy (BMAB) analysis in patients undergoing initial staging. Among the 42 patients analyzed (median age 14 y, 2:1 male/female ratio), 45% presented with pelvic primary tumors and 83% had bone/BM involvement at diagnosis. Our findings showed PET/CT had 100% specificity and 83.3% sensitivity in detecting initial BM involvement. Overall, PET/CT correctly classified 92.8% of patients, reaching 100% accuracy in patients identified with bone involvement, thus surpassing the standard BMAB. These results suggest that the conventional use of BMAB in the initial staging of high-risk ESFT patients can be omitted, promoting PET/CT as a non-invasive alternative, thus improving staging accuracy and treatment decisions in ESFT management.

Assessment of hearing and balance functions in patients with acromegaly by the use of an audiovestibular test battery: a cross-sectional study.

Patients with acromegaly may have abnormalities in their hearing and balance as a result of modifications in body composition and involvement of the temporal bone. The objective of this study is to examine if there are any changes in the auditory and vestibular systems in individuals with acromegaly by using audiogram and vestibular function tests. This prospective study included 33 healthy controls and 33 acromegaly patients who were matched for age and gender distribution. A pure-tone audiometry test was conducted, including frequencies ranging from 250Hz to 8000Hz. Videonystagmography (VNG) was employed to assess nystagmus, an essential parameter used for assessing vestibular functions. The Video Head Impulse Test (v-HIT) was used to assess the vestibulo-ocular reflex (VOR). The Dizziness Handicap Inventory (DHI) was applied to evaluate the subjective complaints of the participants. The acromegaly patients had significantly elevated hearing thresholds at all frequencies (250, 500, 1000, 2000, 4000, and 6000Hz) compared to the control group (p < 0.005). The VNG tests, including gaze horizontal, gaze vertical, saccade, spontaneous nystagmus, optokinetic, smooth pursuit, and positioning tests, did not show any statistically significant difference between the two groups (p values > 0.05). The patient group demonstrated reduced VOR gains compared to the control group in the anterior and posterior channels (p < 0.005). There was no statistically significant difference between the two groups for the occurrence of aberrant eye movements (p values > 0.05). The patient group had a total DHI score of 6.6 ± 3.2, while the control group had a score of 3.2 ± 2.6 (independent samples t-test; p < 0.001). Therefore, The patient group exhibited significantly greater subjective vestibular symptoms. Patients with acromegaly experience impaired auditory function. The central vestibular system remains unaffected, while the gains of the vestibulo-ocular reflex (VOR) in the posterior and anterior semicircular canals are decreased. Additionally, these patients report experiencing subjective dizziness. Screening for hearing and balance in patients with acromegaly may improve the quality of life of patients and prevent problems related to balance disorders at an early stage.

Retrospective analysis of fractures in crab-eating foxes (Cerdocyon thous)

This study assessed axial and appendicular fractures in crab-eating foxes (Cerdocyon thous; Linnaeus, 1766) admitted to the Reference Center for Wildlife. Medical records and plain radiographs of C. thous were retrospectively evaluated. Seventy-four free-ranging C. thous were admitted over 10 years, of which 21 had fractures in the appendicular and/or axial skeleton. Appendicular skeleton fracture was verified in 42.86 % of the animals, five of whom had long bone involvement and four the hip bones. More than one fracture in the appendicular skeleton occurred in 14.28 % of the animals, with the most common being a long bone fracture with a hip fracture. Axial skeleton fractures were observed in 9.52 % of the cases, with one fracture located in the vertebral column and the other in the head. Five animals died and nine were euthanized due to injury severity, prognosis and/or poor outcome after treatment. Seven animals showed good evolution after treatment, and four animals were released. In conclusion, hip bone fractures, isolated or combined with injuries to other bones of the axial and/or appendicular skeleton, were the most common injuries in C. thous. The characteristics of multiple trauma were associated with high mortality and complications.

Oral and radiological features of mucormycosis in post-Covid patients – a clinical study

Introduction. Mucormycosis, commonly referred to as “black fungus,” has emerged as a life-threatening opportunistic infection, particularly in post-COVID patients. This study aims to evaluate the clinical, radiological, and treatment-related features of mucormycosis in post-COVID patients and assess their outcomes. Materials and methods. This observational clinical study was conducted from April 2021 to October 2021, involving 50 consecutive post-COVID patients who presented with clinical and radiological features of mucormycosis. Demographic data, clinical symptoms, comorbidities, laboratory investigations, radiological findings, and treatment details were collected. Patients underwent computed tomography (CT) to assess bone involvement, sinus, and orbital involvement. Treatment regimens, including antifungal therapy and surgical interventions, were recorded. Patients were followed up for recurrence and long-term outcomes. Results. The majority of the patients were males (58%) and in the 31-45 age group (34%). Diabetes mellitus (60%) and steroid use (80%) were the most common comorbidities. Clinically, 70% of patients presented with soft tissue swelling or necrosis, and 44% had black eschar on the palate. CT findings revealed maxillary bone involvement in 56% of cases and sinus involvement in 50%. Orbital involvement was noted in 20%. Amphotericin B was the most commonly used antifungal therapy (70%), and 60% of patients underwent debridement. The overall recovery rate was 70%, with a recurrence rate of 16%. Facial deformities or ongoing oral issues were noted in 24% of patients during follow-up. Conclusion. Mucormycosis in post-COVID patients is associated with high morbidity, particularly in those with diabetes and those treated with corticosteroids. Antifungal therapy combined with surgical intervention yielded a 70% recovery rate, although recurrence and long-term complications were observed. Early diagnosis, appropriate antifungal therapy, and aggressive surgical management are critical to improving outcomes. Preventive strategies, including better management of comorbidities and judicious use of steroids, are essential in reducing the burden of mucormycosis in post-COVID patients.