Left Ilium Research Articles

Intra-abdominal telangiectatic osteosarcoma: a case report

BackgroundTelangiectatic osteosarcoma is rare and it rarely affects flat bones, especially the bones of the pelvis. It is uncommon for telangiectatic osteosarcoma to be considered as a differential diagnosis when assessing a large intrabdominal mass.Case reportWe present our case of a 33-year-old African female who presented with a sizeable telangiectatic osteosarcoma of the left iliac bone. She reported a 3-year duration of a painless, slow-growing mass arising from the left flank. At examination, a large bony hard mass extending from the left ilium to the umbilicus was noted, almost mimicking an intra-abdominal pregnancy. All laboratory tests were within normal limits and an unconventional surgical approach was used for a one-stage excision of the tumor without complications. The definitive histopathological diagnosis postexcision was that of a telangiectatic osteosarcoma only on the second review of the histological specimen.ConclusionsPelvic telangiectatic osteosarcoma is rare, and the ilium is the commonly affected pelvic bone. These tumors can be sizeable at presentation with intra-abdominal or pelvic extension with a high chance of misdiagnosis. Fortunately surrounding soft tissue involvement seems to be a rare and late finding when present.

Primary alveolar soft part sarcoma of the ilium: A case report and literature review

Introduction: The primary alveolar soft part sarcoma (ASPS) of bone is extremely rare, and the number of published reporting cases is limited. Case Report: We present a 30-year-old woman with primary ASPS of ilium. Computed tomography and magnetic resonance imaging revealed a destructive and moth-eaten appearance in the ilium with a soft tissue mass. 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) revealed high uptakes of FDG in the left ilium. ASPSCR1-TFE3 gene fusion was detected by reverse transcriptase polymerase chain reaction (RT-PCR). Wide resection was performed. One year after the surgery, a local recurrence developed. However, there has been no evidence of disease in the last eight years after the second surgery. Conclusion: 18F-fluorodeoxyglucose positron emission tomography-computed tomography and RT-PCR besides routine radiological and histopathological studies helped achieve the accurate diagnosis and provide appropriate treatment in the present case.

Effect of Local Simvastatin on the Healing of Surgically Created Critical-Sized Bone Defects: An experimental Study on sheep.

Background and objective: the role of simvastatin in lowering serum cholesterol levels is well described. However, recent findings suggest they have a role in bone formation as well. The study aims to determine the effect of local simvastatin application on bone defect healing and compare the amount of new bone produced by a simvastatin-treated defect with that produced by a bone graft (biphasic calcium phosphate) and non-treated defects (left empty) histologically. Methods: Forty-five critical-size defects were created (8mm in diameter and depth) in the iliac bone of 6 sheep. For the first three sheep (5 defects/ilium), the five defects on the right ilium were left empty as a Control group, while the five defects on the left ilium were filled with biphasic calcium phosphate as Test 1 group. For the other three sheep, 5 defects were created on the right ilium, the defects were filled with 10mg crushed simvastatin tablet with gelfoam (as a carrier) as Test 2 group. The animals were sacrificed over periods of 1, 2, and 3 months. Histopathological studies were done for all the samples. SPSS version 28 was used to analyze the results. The numerical variables were checked for normality using Smirnov – Kolmogorov test, then analyzed using ANOVA and unpaired t-test (p–values ≤ 0.05 were considered statistically significant). Results: All 6 adult male sheep passed the scheduled periods uneventfully. During the wound healing period, there was no complication such as infection, excessive hematoma, or wound dehiscence. All 45 standardized iliac bone defects were included in the final analysis (n= 45). The histologic results showed that Test 2 group (defect filled with simvastatin) in the 1st, 2nd, and 3rd months had significantly higher bone formation at the surface and depth of the defects than Test 1 and Control group with P values (<0.0001) at all period intervals. Conclusion: Simvastatin enhances bone formation and accelerates the healing process of the bony defect. Keywords: Bone formation, Bone graft, Bone healing, Simvastatin, Statin.

Brain metastases as the first clinical manifestation of prostate cancer: a case report

Background. Intracranial metastases, as the first clinical symptom of prostate cancer (PC), are extremely rare, with only anecdotal case reports in the literature.
 Aim. To present a case of multiple brain metastases (MCI) as the first clinical manifestation of PC with isolated facial nerve injury (FNI).
 Materials and methods. A 66-year-old patient with PC and multiple brain and bone metastases was observed.
 Results. The patient considered himself sick for 4 months when weakness in the left arm, headache, dizziness, facial asymmetry, staggering when walking, and memory loss appeared. He received non-surgical treatment prescribed by a neurologist. A clinical examination revealed a neurological deficit in the form of FN central palsy of grade 3 according to the House-Brackmann score. Magnetic resonance imaging of the brain showed masses in the right insular, left temporal lobes, and left cerebellar hemisphere of 3.7×3.3×2.9, 1.1×0.8 and 0.5×0.6 cm, respectively, with marked perifocal edema. According to the magnetic resonance imaging of the pelvis in the right half of the prostate gland, a tumor of 2.2×1.0×2.7 cm and PI-RADS 5 score was detected, and a metastatic lesion of the left ilium was found. Bone scintigraphy showed metastases in the thoracic and lumbar spine. A core biopsy of the prostate was performed. Histological and immunohistochemical studies revealed acinar adenocarcinoma with a Gleason score of 6 (3+3) points. The level of total prostate-specific antigen was 8.6 ng/mL. A final diagnosis was made: stage IV prostate cancer, T2aN0M1c, with brain and bone metastases. Given the neurological symptoms, radiation therapy was performed on the brain with a total radiation dose of 30 Gy, followed by androgen deprivation and monochemotherapy with docetaxel and bisphosphonates.
 Conclusion. Multiple brain lesions as the first clinical manifestation of PC are extremely rare. An isolated lesion of FN with neurological deficit in the form of central palsy indicates an advanced metastatic process. The primary method of treatment is palliative radiation therapy with a total radiation dose of 30 Gy, followed by androgen deprivation and chemotherapy.

Therapy-Related Acute Myeloid Leukemia After Chemotherapy For Osteosarcoma: Report of 2 Cases and Review of The Literature

Abstract Introduction/Objective Therapy-related acute myeloid leukemia (t-AML) and myelodysplastic syndrome (t-MDS) are rare but well-established late complications of chemotherapeutic agents or radiation therapy used to treat various malignancies. Many cases of t-AML/t-MDS have been described secondary to Hodgkin, non-Hodgkin lymphoma, and other solid tumors. However, only a few cases of t-AML and t-MDS have been reported following osteosarcoma treatment. We describe two patients diagnosed with osteosarcoma who developed t-AML after receiving multiple chemotherapeutic agents. Methods/Case Report A 12-year-old male with Li-Fraumeni syndrome was diagnosed with osteosarcoma of the left ilium and sacrum with pulmonary metastases. Despite multiple lines of chemoradiation therapy including doxorubicin and ifosfamide, tumor progressed at the primary tumor site. The patient subsequently presented with altered mental status and pancytopenia. Bone marrow biopsy demonstrated AML. He died despite supportive care. A 14-year-old female was diagnosed with left tibial osteosarcoma with bony and pulmonary metastases. She was treated on standard osteosarcoma chemotherapy including doxorubicin, cisplatin, methotrexate, ifosfamide and etoposide, surgery, and radiation. 1 year following therapy, she had local recurrence of osteosarcoma without progression despite not starting chemotherapy. However, 3 years later, she developed pancytopenia, and immature white blood cells were identified on peripheral smear. Bone marrow biopsy revealed AML-M7. Despite supportive care and zoledronic acid, she ultimately died from sepsis and disseminated intravascular coagulation. Results (if a Case Study enter NA) NA Conclusion With improved therapy and survival for osteosarcoma patients, these patients should be monitored for secondary malignancies. T-AML is rare following osteosarcoma treatment, but outcome remains poor, despite treatment. Underlying Li-Fraumeni syndrome may influence the risk of development of secondary malignant neoplasms. Literature review of types and prognosis of t-AML following osteosarcoma will be reviewed and compared to our cases, including related genetic predisposing factors and chemotherapeutic agents. Our second patient is the first reported case of AML-M7 secondary to osteosarcoma treatment.

A saurischian (Archosauria, Dinosauria) ilium from the Upper Triassic of southern Brazil and the rise of Herrerasauria.

The Carnian (Upper Triassic) rocks of the Candelária Sequence present a rich record of dinosaurs, including some of the oldest known dinosaurs worldwide. In this contribution we describe the first unequivocal dinosaur from the Pivetta site, located in the Restinga Sêca municipality, Southern Brazil. The specimen CAPPA/UFSM 0373 is an isolated but well-preserved left ilium. A thorough examination of the specimen's anatomy and a phylogenetic analysis provides evidence that CAPPA/UFSM 0373 belongs to the Herrerasauria. We were able to identify several similarities with potential non-herrerasaurid herrerasaurians (e.g., Tawa hallae, "Caseosaurus crosbyensis"), which were previously only known from North American deposits. In contrast, herrerasaurids (e.g., Herrerasaurus ischigualastensis) are almost exclusively known from South America. Our results support the nesting of CAPPA/UFSM 0373 as an early-diverging herrerasaurian. Furthermore, this is potentially the first record of a non-herrerasaurid herrerasaurian in unambiguous Carnian beds, suggesting a hidden diversity of dinosaurs in the Carnian rocks of the Candelária Sequence, which can be revealed even by fragmentary specimens.

Composite hemangioendothelioma- report of two cases located in bone and review of the literature

BackgroundComposite hemangioendothelioma (CHE) is a rare intermediate-grade vascular tumor characterized by a complex histologic component. It occasionally metastasizes, but local recurrence is not uncommon. CHE is mainly located in the extremities’ distal dermis and subcutaneous soft tissues. It is rarely located in the bone. We report here two cases originally occurred in bone.Case presentationThe first case of CHE occurred solely on the left pubis. The second case is a patient post-resection of CHE in the manubrium sterni 10 years ago [1], who presented with multiple lesions in the left ilium and T6, T12 vertebra. All these lesions in the two cases showed osteolytic bone destruction on computed tomography (CT) scans and showed relatively high signal intensity on the fat-suppressed sequences of T2-weighted magnetic resonance (MR) images and isointense signal intensity on T1-weighted MR images. After injection of contrast agent (Gd-DTPA), the lesions showed inhomogeneous enhancement. 2-deoxy-2 [F-18] fluoro-D-glucose positron emission tomography-computed tomography (18FDG PET-CT) showed increased FDG uptake in these osteolytic bone destruction areas with SUVmax around 5.0. Both patients underwent surgery. Lesions in the left pubis and left ilium were confirmed by postoperative pathology while lesions on the vertebrae were only biopsied, not surgically resected. The first patient had no recurrence or metastasis in 5 years after surgery. The second patient had surgery recently and is still being followed up.ConclusionsCHE occurring in bone is rarely reported. Our report provides more detailed information on the diagnosis of CHE. Given that CHE is locally aggressive and occasionally metastatic, PET-CT may be helpful in staging and follow-up.

Incidental Detection of Ilium Langerhans Cell Histiocytosis on 99mTc-DTPA Renal Dynamic Scintigraphy.

We report the case of a 24-year-old man who underwent 99mTc-DTPA scintigraphy for the evaluation the renal function. This scan incidentally showed an abnormal uptake of 99mTc-DTPA in the left lower abdominal region. SPECT/CT fusion images showed osteolytic bone destruction in the left ilium associated with soft tissue mass and elevated DTPA uptake. Biopsy pathology of the ilium lesion demonstrated Langerhans cell histiocytosis.

Ischemic Stroke due to Intracerebral Steal from Calvarial Metastasis: a Case Report (P2-5.001)

<h3>Objective:</h3> NA <h3>Background:</h3> Malignancy is an important risk factor for ischemic stroke. Various mechanisms may explain the association between cancer and ischemic stroke, including hypercoagulation, accelerated atherosclerosis, and toxic effects of chemotherapy and radiation. Here, we report a rare case in which a patient with known occlusive radiation vasculopathy (ORV) presented with ischemic strokes caused by an “intracerebral steal” phenomenon from new metastatic calvarial lesions. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 64-year-old woman with remote history of left neck squamous cell carcinoma and prior left frontal stroke from left common carotid artery (CCA) occlusion secondary to ORV presented to the emergency department with acute-onset right hemiparesis. Brain magnetic resonance imaging revealed scattered infarcts in the convexity of the left hemisphere as well as adjacent calvarial destruction. On functional and structural MRI, the calvarial lesion demonstrated increased vascularity and diffusion restriction. CT angiography redemonstrated complete occlusion of the left CCA and strong right-to-left collateral circulation across the anterior communicating artery. The remainder of the stroke workup, including echocardiogram, laboratory analyses, venous dopplers, and carotid ultrasound was unrevealing. CT scans of the chest, abdomen and pelvis revealed only lytic lesions in the T11 vertebra, left ilium and right sacrum, and biopsy of the latter revealed adenocarcinoma. <h3>Conclusions:</h3> In this patient, neck radiation therapy had resulted in a chronic occlusion of the left CCA. Years later, a hypervascular skull metastasis drew from this limited blood supply, causing ischemic strokes in the parenchyma adjacent to the hypermetabolic calvarial metastasis. This case of an “intracerebral steal” phenomenon demonstrates how hypervascular extradural lesions may also lead to ischemia, particularly in cases of ipsilateral poor hemodynamic reserve. <b>Disclosure:</b> Miss Murthy has nothing to disclose. Dr. Kumar has nothing to disclose. Dr. Testai has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Swanson Martin &amp; Bell, LLP. Dr. Testai has received publishing royalties from a publication relating to health care. Edward Michals has stock in Off Color Brewing. Edward Michals has received personal compensation in the range of $100,000-$499,999 for serving as a Staff Physician with University of Illinois.

ОСОБЕННОСТИ КЛИНИЧЕСКОГО ТЕЧЕНИЯ ОСТРОЙ ЛУЧЕВОЙ БОЛЕЗНИ СРЕДНЕЙ СТЕПЕНИ ТЯЖЕСТИ ОТ КРАТКОВРЕМЕННОГО ВНЕШНЕГО КРАЙНЕНЕРАВНОМЕРНОГО ГАММА-НЕЙТРОННОГО ОБЛУЧЕНИЯ И МЕСТНЫХ ЛУЧЕВЫХ ПОРАЖЕНИЙ НИЖНИХ КОНЕЧНОСТЕЙ И ПРАВОЙ РУКИ III И IV СТЕПЕНИ ТЯЖЕСТИ

Purpose: The purpose of the work is to assess acute radiation sickness of moderate severity from short-term external extremely uneven gamma-neutron irradiation and local radiation injuries of the lower extremities and right hand of III and IV severity. Material and methods: Patient T., born in 1940, at the age of 25, began working from 1965 to 1968 as an apparatchik in plant No. 1 of department 20 at Production Association «Mayak» in contact with plutonium. On December 10, 1968, at 11:30 p.m., the accident occurred. The victim was at a distance of about 50 cm from the source, which was below and mostly to the right of him. The patient was exposed to short-term exposure to neutrons and gamma radiation. A few minutes later, numbness appeared in the right half of the trunk and extremities. Twenty-five minutes later, vomiting appeared, vomiting was repeated: 8 times before admission to the hospital, at the health center, after washing in the shower, in the hospital. Made gastric lavage, intravenous administration of pentacin, diphenhydramine, glucose, bloodletting (500 ml), twice transfused blood (250 ml each), polyglucin (500 ml), promedol, atropine. On examination, slight hyperemia of the right half of the face, injection of the sclera was noted. In the blood test, made for the first time after 2 and a half hours from the start of the events, there were 9000 leukocytes, lymphocytes – 15 %. On the morning of December 11, 1968, the patient complained of a burning sensation in the right half of his face; repeated vomiting. There were 7600 leukocytes at that time. The victim was offered to go to the 6th Clinical Hospital in Moscow (Sector No. 9 of the Institute of Biophysics), the patient agreed. Examination results: A clinical description of acute radiation sickness of moderate severity from short-term external extremely uneven gamma-neutron irradiation and local radiation injuries of the lower extremities and right arm of III and IV severity is given. The features of the clinical picture of radiation sickness were entirely determined by the nature of the acting radiation factor and the position of the radiation source in relation to the victim and the associated topography of the lesion. Irradiation was directed from bottom to top and from right to left, hence the difference in exposure doses: on the right, the dose changed from bottom to top from more than 2500 rad (foot, lower leg, right hand) to less than 250–300 rad (in the head region), while in the middle – in the area from the iliac crest to the costal arch – the dose exceeded 500 rad on the left; from bottom to top, the drop occurred from a dose close to 2000 rad (foot and lower third of the lower leg) to 460 rad (in the anterior spine of the left ilium). The neutron nature of the acting radiation factor caused damage to surface tissues and visceral organs and bone marrow, the latter to a lesser extent due to the smaller contribution of the gamma factor to this accident. Conclusion: The primary reaction and laboratory data of the first days of the disease indicated a severe lesion. However, the hematological syndrome was not severe. If it were not for the pain syndrome associated with an extremely severe local injury, the general condition of the patient would not have been so severe. Local trauma, which endangered the life of the patient, led him to a deep disability. Therefore, despite the average severity of the hematological syndrome, this form of acute radiation sickness was regarded as severe. The weakening of the hematological syndrome, apparently, was caused by the extreme severity of the local injury, which played the role of a hematopoiesis stimulator.

Early imaging to detect bone metastatic disease of a 54-year-old woman with history of breast cancer: a case report

The World Health Organization (WHO) has predicted a global amount of 19 million cancer case in 2025. After the lungs and liver, bone is the third most common site of tumour spread. The bone is a dynamic tissue that plays a critical role not only in structural support and movement, a reservoir for minerals and energy, but also houses of the bone marrow, which is the main site of postnatal hematopoiesis. A 54-year-old Indonesian woman presented to orthopaedist with complaints of sudden left hip pain and progressive difficulty in walking for three weeks. She reported severe pain that is exacerbated by any physical activity and movement. She has a medical history of breast cancer (pathologically confirmed in Sanglah General Hospital) which had undergone radiotherapy and chemotherapy a year ago. Outpatient left hip X-rays revealed lytic lesions at left acetabulum to left ilium, suggestive of metastatic disease. The established imaging techniques projectional radiography, skeletal scintigraphy, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) have undergone further development, with a resulting improvement in their diagnostic yield.

A new chelid turtle, Prochelidella palomoi sp. nov., from campanian Anacleto Formation, Neuquén Basin, North-Western Patagonia, Argentina.

The new turtle remains were found in the Anacleto Formation (Campanian) exposed in the Aguada Grande site. This area is located 10 km from the south of the city of Rincón de Los Sauces, in the north of the province of Neuquén, Patagonia, Argentina. The specimen (MAU-Pv-AG-452) consists of a partially preserved skull, carapace remains, an almost complete plastron, and a left ilium. The skull shows some features (a developed retropterygoid foramen, and a big muscle attachment area over the basisphenoid) that allow us to refer this specimen to the genus Prochelidella. The visceral view of the first costal bone exhibits deeper axillary buttresses that extend 2/3 of the costal width. This condition is also observed in the costal bone of Prochelidella buitreraensis from the Candeleros Formation (Cenomanian). The scute pattern observed in the anterior lobe of the plastron shows a large gular that extends along the entoplastra length, and small extragulars over the epiplastra. In contrast with the scute scheme observed in Prochelidella cerrobarcinae and Prochelidella portezuelae where the gular does not extend beyond the first 1/3 of the entoplastron. The phylogenetic analyses performed recovered this new species as a member of Prochelidella. The material recovered from the Anacleto Formation represents the first undoubtedly finding of Prochelidella in the late Cretaceous (Campanian) and the second skull recognized for the genus.

Multiple Grade IV Pressure Injuries in a Young Boy: ALook Into the Pathognomic and Management of Iliac Crest Pressure Injury

Pressure Injury (PI), not only exerts physical burden on a patient’s body but also adds to his mental and economic stress [1]. Chronically ill, bed ridden and aged patients are always predisposed to development of pressure injury unless nursed with frequent position changes over an air mattress [2]. Every now and then, we come across, young patients who develop PI, either because of insensate and powerless lower limbs or prolonged bed ridden medical conditions. The temptation to close any pressure ulcer primarily should always be resisted [3]. We hereby, present a case report of a 17 years boy, who sustained cervical spine injury after road traffic accident, 10 months back and later developed multiple pressure injuries over bilateral trochanter and left ilium. We discuss the pathognomics of occurrence of pressure injury at unusual sites like ilium and our management for coverage of such defects.

Acetabular Reconstruction Using Multiple Porous Tantalum Augments: Three-Quarter Football Augment

Reconstruction of a large acetabular bone defect is a complex problem in revision hip arthroplasty. The authors report a novel method of reconstructing an uncontained acetabular defect (Paprosky type IIIb) using multiple tantalum augments. A 73-year-old female patient presented to our institution with a chronically dislocated primary left total hip arthroplasty with radiographs demonstrating migration of acetabular component and formation of pseudoarthrosis within the left ilium. Extensive arthrolysis and anatomic reconstruction of the acetabular bone defect were performed using the novel method of multiple tantalum augments. Postoperatively, recovery was initially complicated by multiple dislocations requiring an exchange to an elevated liner, however subsequently achieved good function.

Single point of care embolization, ablation, and stabilization of unstable pelvic metastatic disease

A 56-year-old man presented with intractable pain and inability to ambulate. Computed tomography showed an osteolytic renal cell carcinoma metastasis in the left ilium causing instability (Fig 1). Following a multidisciplinary discussion, percutaneous embolization, ablation, and pelvic stabilization were planned subsequent to radiation of the tumor. Triple therapy was necessary as nonembolized vascular renal cell carcinoma metastases may cause heat sink, incomplete ablation, and tumor progression, resulting in the failure of hardware.

Distribution of Acute and Chronic Lesions in the Sacroiliac Joints of Patients with Axial Spondyloarthritis.

ObjectiveIn this study, we aimed to investigate whether there was a pattern of distribution of acute and chronic lesions in the sacroiliac joints (SIJ) of patients with axial spondyloarthritis (axSpA).MethodsA total of 96 patients diagnosed as axSpA were retrospectively included in this study. The Spondyloarthritis Research Consortium of Canada sacroiliac joint inflammation score (SIS) and structural score (SSS) were used to evaluate the acute and chronic lesions in the SIJs. Scores representing the distribution of bone marrow edema, fatty lesions and erosions were extracted respectively. By dividing the SIJs into sacral or iliac sections, upper or lower sections, anterior and posterior levels, differences of scores representing acute and chronic lesions were analyzed by Kruskal Wallis’ tests.ResultsSIS scores were not significantly different in sacral or iliac sections, in upper or lower sections, on anterior or posterior levels. SSS scores were also not significantly different in different sections, except for higher occurrence rates of erosions in the iliac sections. Post-hoc analysis showed that there was a higher erosion score in the left ilium than left sacrum, as well as in right ilium than left sacrum.ConclusionThere was no specific distribution pattern of acute or chronic lesions in the SIJs in patients with axSpA. A bigger study sample was needed to confirm the distribution of erosions in sacral or iliac sections.

Quantifying Bone Marrow Fat Fraction and Iron by MRI for Distinguishing Aplastic Anemia from Myelodysplastic Syndromes

ROIs were manually drawn at the level containing the largest section of the left posterior superior ilium (A, B, D, E). The zoomed version of the ROIs showed in the upper left corner. (A, D) FF value of AA and MDS is 86.98% and 25.84%, respectively. (B, E) Iron content from R2*image is 117.91 and 147.98/second. (C, F) Histologic sections images of AA and MDS. Compared with MDS group (F), the number of fat cells (black arrow) in the AA group (C) was increased by Zeng et al. (1754–1760) image

P085 Chronic recurrent multifocal osteomyelitis: about 2 cases

Abstract Background Chronic recurrent multifocal osteomyelitis (CRMO) also known as aseptic osteomyelitis is a rare auto-inflammatory disease with an incidence estimated at 4/100 000 population [1]. The aim of our work was to report two cases of CRMO that illustrate challenges in the diagnosis of this rare disease. Method We report the case of two patients diagnosed with CRMO. Clinical, biological and radiological data as well as disease outcomes were described. We also collected data about treatment modalities. Results Two patients aged of 7 and 10 years respectively, without any notable pathological history, presented recurrent episodes multifocal painful swelling of limbs. In the first case, the symptoms concerned the left ankle and knee as well as the left hip, all associated with lameness and an altered general condition, with neither fever nor skin manifestations. In the second case, the swelling involved the right shoulder, right hip and the left ankle. There was no elevated CRP or ESR in any of patients. Immunological status (RF, anti-CCP, AAN) as well as the HLA-B27 antigen test were negative. In the first patient, standard radiographs showed lytic lesions of the proximal metaphysis of the tibia, the greater trochanter and the left lateral malleolus. MRI of the pelvis, knee, and sternum of the first patient revealed edematous involvement of the left greater trochanter, the right ilium, the proximal metaphyseal region of the tibia and the right edge of the sternum, whereas in the second patient, a whole-body MRI showed inflammatory signs over the left greater trochanter, the insertion of the gluteus medius and obturator externus, right trochanteric bursitis and oedema of the entire right ilium. In the first patient, bone scintigraphy showed intense uptake of radioisotopes in the left ilium, the 7 th right costo-vertebral junction, the trochanteric mass, the upper end of the tibia and the lower end of the left fibula. Bone biopsy showed bone remodeling in both cases without evidence of infection or tumor. The diagnosis of CRMO was retained, supported by the prompt response to NSAIDs and short-term corticosteroid therapy. However, the second patient presented, 8 years later, pain in the sterno-clavicular joint as well as the right hip. A relapse of the disease was confirmed by MRI. Therapeutic escalation with zoledronic acid 0.025 mg/kg intravenous infusion every six months allowed the resolution of the symptoms. Conclusion These observations illustrated a rare disorder in children, characterized by lytic lesions predominantly in the metaphysis of long bones. Bone scintigraphy allowed an early assessment of disease extension and histological examination ruled out a malignant tumor and an infection. The first-line treatment is anti-inflammatory drugs. In case of failure, bisphosphonates seem to be effective.

Normal Magnetic Resonance Imaging Appearance of Marrow Adjacent to the Sacroiliac Joints in Children During Development.

On magnetic resonance imaging (MRI) for sacroiliitis, increased T2 marrow signal can be misinterpreted as marrow edema. We hypothesize that a changing but predictable pattern for marrow signal intensity adjacent to the sacroiliac joints is present from infancy through skeletal maturity. The purpose of our study is to characterize the distribution of increased T2 signal intensity within the marrow adjacent to the sacroiliac joints in healthy children. A retrospective review of the electronic health record identified 345 children who underwent MRI examination of the sacrum, sacroiliac joints, or pelvis. Those with underlying disease that may potentially alter sacroiliac marrow signal were excluded. Sixty children, 30 girls and 30 boys, were assessed for T2 marrow signal intensity greater than the interforaminal sacrum and less than or equivalent to the primary spongiosa of the posterior iliac crests at the S1, S2, and S3 levels. The width of increased T2 signal intensity at each sacral level, right and left sides, ilium, and sacrum was measured (mm). The Mann-Whitney U test was used to determine if there were differences between skeletally immature and skeletally mature subjects; defined as aged 15 years for girls and 17 years for boys. When 30 girls and 30 boys are assessed, the width of increased T2 marrow signal adjacent to the sacroiliac joints is significantly greater in skeletally immature than in skeletal mature female subjects for right S1 sacral side (P = 0.0100), left S1 sacral side (P = 0.0119), right S2 sacral side (P = 0.037), left S2 sacral side (P = 0.0020), and in male subjects for the right S2 sacral side (P = 0.0178), right S2 iliac side (P = 0.0415), right S3 sacral side (P = 0.0024), and left S3 sacral side (P = 0.0037). There were insufficient subjects for whom the ilii extended beyond the S2 sacral segments to assess for the S3 iliac sides. Healthy children and adolescents have increased T2 signal intensity within the sacral marrow adjacent to the sacroiliac joints, likely the vascular primary spongiosum, which is greater in adolescence compared with skeletal maturity. Knowledge of this normal pattern is beneficial in interpreting MRI examinations for the presence of sacroiliitis.

Osseodensification Versus Subtractive Drilling Techniques in Bone Healing and Implant Osseointegration: Ex Vivo Histomorphologic/Histomorphometric Analysis in a Low-Density Bone Ovine Model.

The aim of this study was to qualitatively and quantitatively assess the effect of osteotomy preparation by conventional, subtractive, or osseodensification instrumentation on osteotomies, treated with or without endosteal implants, and healing capacity. Seven sheep were used, and 56 osteotomies were made in the left and right ilium of the sheep (n = 8/sheep [4 per side/time point (3 and 6 weeks)]). Two different instrumentation techniques were used: (1) conventional/regular drilling in a three-step series of a 2-mm pilot and 3.2-mm and 3.8-mm twist drills and (2) osseodensification drilling with a Densah Bur 2.0-mm pilot and 2.8-mm and 3.8-mm multi-fluted tapered burs. Drilling was performed at 1,100 rpm with saline irrigation. Qualitative histomorphometric evaluation of the osteotomies after 3 and 6 weeks did not indicate any healing impairment due to the instrumentation. In all samples, histologic examination suggested bone remodeling and growth (empty and treated with an implant), irrespective of preparation technique. Osteotomies prepared using the osseodensification instrumentation showed the existence of bone chips autografted into the trabecular spaces along the length of the osteotomy wall. The osseodensification group yielded higher osseointegration rates, as distinguished through qualitative assessment, bone-to-implant contact, and bone-area-fraction occupancy, indicating an increased osteogenic potential in osteotomies prepared using the osseodensification technique.