Osteosclerotic Changes Research Articles

Erdheim-chester disease with bilateral proptosis, coated aorta and hairy kidney

Erdheim-Chester disease (ECD) is a rare histiocytic disorder with a spectrum of clinical manifestations, ranging from asymptomatic single-organ involvement to multisystem disease. We present a classic case of ECD with detailed radiographic and histopathologic findings. A 63-year-old Thai female with a history of triple vessel disease post-PCI presented with bilateral proptosis and blurred vision for one year. On admission, she exhibited marked proptosis epiblepharon, lagophthalmos, conjunctival injection, chemosis, limited extraocular movement and cranial nerve II palsy. Imaging showed increased bilateral retro-orbital infiltrative lesions, osteosclerotic changes, and soft tissue thickening along the great vessels and retroperitoneum. A retro-orbital soft tissue biopsy showed foamy histiocytic proliferation with Touton giant cells. EDC was confirmed by next-generation sequencing revealing a BRAF V600E mutation. This patient received pegylated interferon-alpha. At 1-year follow-up visit, the disease remained stable. In this report, we present a classic case of EDC. The rarity of this disease makes it challenging to diagnose. The typical presentation characteristics raise awareness for the diagnosis of EDC, which is based on features such as osteosclerotic lesions in the long bones, soft tissue infiltration in medium to large vessels (coated aorta) and the bilateral pelvicalyceal systems (hairy kidney). These findings were confirmed through tissue pathology and molecular diagnostics.

Monoclonal gammopathy of clinical signifi cance with osteosclerotic lesions - a case report and a literature review.

Multiple myeloma is a common plasma cell neoplasia usually accompanied by the formation of osteolytic foci, whereas osteosclerotic myeloma is a very rare form of plasma cell dyscrasia. When osteosclerotic myeloma is detected, osteosclerotic foci are usually part of the POEMS syndrome. Osteosclerotic myeloma without other manifestations of the POEMS syndrome is an unusual finding. In a 46-year-old woman, osteosclerotic changes of the temporoparietal region caused soft tissue induration over this lesion, which initiated further investigation. Imaging studies subsequently showed multiple osteosclerotic foci in the skull. Examination of blood proteins revealed 8 g/L of IgG-lambda monoclonal immunoglobulin, subclass IgG1. In search of the cause of the osteosclerotic changes, FDG-PET/CT was performed, which revealed no FDG accumulation, i.e., no other tumor (breast or stomach cancer). Low-dose CT showed irregular bone structure, but not significant osteolytic or osteosclerotic foci. To map the extent of osteosclerotic changes, NaF-PET/CT imagination followed, which revealed multiple spots with high fluoride accumulation. A parietal bone biopsy showed osteosclerosis with minor clonal plasma cell infiltration. Trepanobioptic bone marrow sampling revealed an infiltration of bone marrow with atypical plasma cells in 8%. Flow-cytometric examination of bone marrow showed 0,37% of plasma cells, however predominantly (91%) clonal with lambda expression. MRI of the brain identified asymptomatic meningeal thickening. There was no evidence of POEMS syndrome in the patient; thus, we concluded the diagnosis as monoclonal gammopathy of clinical significance with osteosclerosis which was previously termed osteosclerotic multiple myeloma. Monoclonal gammopathy of clinical significance (MGCS) with osteosclerotic skeletal changes, documented on CT and multiple foci with intensive osteoneogenesis, documented on NaF-PET/CT without evidence of POEMS syndrome, is an extremely rare form of plasma cell dyscrasia. This publication documents the unique clinical manifestations of IgG-lambda type plasma cell proliferation without signs of POEMS syndrome and the role of NaF-PET/CT imaging. Classification of this disease as MGSC with osteosclerotic manifestations is more consistent with the indolent nature of the disease with a significantly better prognosis, compared with multiple myeloma.

Understanding the Injury Mechanism in Hamate Hook Fractures by Investigating Fracture Morphologies: A Case Series Study.

Many studies have described hamate hook fractures resulting from direct force from sporting tools. However, several authors have reported fractures that did not occur during swing-related activities. This study aimed to understand the injury mechanism of fractures by investigating their morphologies. We selected patients with hamate hook fractures and collected data on computed tomography scans, injury causes, and how athletes handled sporting tools. We investigated 50 patients, and the study cohort included 32 patients who sustained injuries during sports: 24 during baseball (group A) and 8 during other sports (group B). Sixteen patients sustained injuries from falls (group C), and 2 had their hands crushed while using an industrial press machine (group D). In group A, most patients had a fracture line starting from the middle section of the radial side, accompanied by osteosclerotic changes in their lower hand. In group B, most patients had fracture morphologies similar to those of most patients in group A. The main morphology of fractures in group C was a transverse fracture at the base. Two patients in group D had minimal fragments at the tip of the hooks. Our results question the theory that most hamate hook fractures in athletes are caused by direct force exerted on the palm because the fracture morphology was different from that of patients injured by acute trauma from direct force. Instead, these fractures likely stem from an indirect mechanism involving repetitive force generated by the tendons and muscles acting on the hook.

Relationship between pain and intra-articular pathology in patients with chronic lateral ankle instability.

Repeated ankle sprains can lead to chronic lateral ankle instability (CLAI). It is unclear whether CLAI causes pain unless complicated by intra-articular lesions. This study aimed to analyze the characteristics of pain and the relationship between pain and intra-articular pathology in patients with CLAI. Fifty-three ankles in 46 patients with CLAI who had undergone surgery were retrospectively reviewed. The self-administered foot evaluation questionnaire (SAFE-Q) was given to patients the day before surgery. Intra-articular lesions were assessed using arthroscopy and magnetic resonance imaging (MRI). In addition, the Hounsfield Unit (HU) on computed tomography (CT) of the medial gutter was measured. The relationship between pain and intra-articular findings was also analyzed. The pain and pain-related scores in the SAFE-Q were significantly correlated with synovitis in 96.3% (rs = - 0.532). HU ratios in the tibia and talus were also significantly correlated with pain (rs = - 0.603, - 0.534, respectively). The arthroscopic synovitis score and HU ratios in patients with high pain scores were significantly higher than those in patients with low pain scores. Forty ankles (75.5%) had synovitis and articular cartilage injuries were observed in 22 ankles (41.5%). Patients with fluid collection or bone marrow lesions (BML) scored significantly lower in pain than those without, but there was no significant difference between patients with and without cartilage injury. Multiple regression analysis revealed that a high synovitis score and HU ratio of the talus were significantly associated with high pain. Intra-articular lesions such as synovitis and BML were associated with pain in patients with CLAI. Osteosclerotic changes in the medial gutter also induced ankle pain, indicating that osteoarthritic changes had already begun. Therefore, lateral ankle ligament injuries after ankle sprain should be appropriately treated to avoid secondary degenerative changes.

Disseminated nontuberculous mycobacterial infection in a patient with idiopathic CD4 lymphocytopenia and IFN-γ neutralizing antibodies: a case report

BackgroundDisseminated nontuberculous mycobacterial (NTM) infection usually occurs in immunodeficient patients, such as those with human immunodeficiency virus infection and idiopathic CD4 lymphopenia. However, disseminated NTM diseases have also been reported in immunocompetent patients. Autoantibodies to interferon-gamma (IFN-γ) are known to be involved in disseminated NTM disease, although anti-IFN-γ antibodies are mainly seen in immunocompetent patients rather than those with immunodeficiency. Here, we report a rare case of disseminated NTM patient with idiopathic CD4 lymphopenia and anti-IFN-γ antibodies.Case presentationA 64-year-old Asian male presented with fever, back pain, anorexia and weight loss. Physical examination revealed subcutaneous masses in the forehead, sternoclavicular joint, and right inguinal region. Computed tomography showed multiple osteosclerotic changes with soft structures and osteolytic changes. Both blood and sputum cultures were positive for Mycobacterium intracellulare, confirming the presence of disseminated NTM infection. Histopathological evaluation of the subcutaneous mass in the right inguinal region showed numerous granulomas consisting of epithelioid cells with Langhans-type giant cells. He was diagnosed with idiopathic CD4 lymphocytopenia. Interestingly, he also had anti-IFN-γ autoantibodies with suppression of IFN-γ-dependent signal transducer and activator of transcription 1 (STAT1) phosphorylation. Two-drug combination therapy with clarithromycin and ethambutol was started for the NTM infection, which resulted in a favorable disease course.ConclusionsIn patients with disseminated NTM infection, idiopathic CD4 lymphocytopenia and anti-IFN-γ autoantibody-positive immunodeficiency can be coexisted. It is necessary to clarify the pathogenesis and clinical course of CD4 lymphocytopenic conditions and IFN-γ neutralizing antibody-positive in the disseminated NTM disease.

Investigating the subchondral trabecular bone microstructure in patients with osteonecrosis of the femoral head using multi-detector row computed tomography.

To analyse the microstructural changes of subchondral trabecular bone in patients with osteonecrosis of the femoral head (ONFH) using multi-detector row computed tomography (MDCT). We retrospectively investigated 76 hips in 50 patients diagnosed with ONFH between 2017 and 2021. Groups 1, 2, 3, and 4 comprised hips without ONFH, ONFH without femoral head collapse (FHC), ONFH with mild collapse (<2 mm), and ONFH with severe collapse (>2 mm), respectively. All patients underwent MDCT, and the subchondral trabecular bone microstructure was assessed. Regions of interests were set at the lateral boundary of the femoral head necrotic lesion and centre of the acetabular weight-bearing portion. In both the femoral head and the acetabular regions, there were significant differences in Groups 2 and 3 compared to Group 1, with increased volumetric bone mineral density and apparent bone volume fraction, and more plate-like with increased connectivity, indicating that osteosclerotic changes were occurring. In both the femoral head and the acetabular regions, osteosclerotic changes of subchondral trabecular bone microstructure were present before FHC.

Potential relationship between the dosage of prednisolone and delayed healing at tooth extraction: A retrospective study

Background/purposeDelayed healing of the extraction socket is not uncommon when tooth extraction is performed on patients taking prednisolone. This study aimed to identify specific dosage of prednisolone and factors associated with delayed healing of the extraction socket in patients taking prednisolone. Materials and methodsThis single-center retrospective study included 80 patients who underwent tooth extraction under local anesthesia and were taking prednisolone orally. Patients were divided into the nondelayed healing group (n = 50) and delayed healing group (n = 30), and their background and dosage of prednisolone were compared. ResultsThe dosage of prednisolone was significantly higher in the delayed healing group than in the nondelayed healing group. A receiver operating characteristics curve analysis resulted in moderate accuracy when the cutoff value was set at 8.0, with 67% sensitivity, 76% specificity, and 0.765 area under the curve. The multivariate logistic regression analysis revealed that prednisolone dosage >8.0 mg/day (odds ratio [OR], 10.8; 95% confidence interval [CI], 2.79–41.6) and osteosclerotic changes beyond the alveolar bone around the tooth to be extracted (OR, 10.3; 95% CI, 2.81–37.8) in X-ray imaging had significant effects on delayed healing. ConclusionThe results of this study suggested that delayed healing following tooth extractions in patients taking prednisolone was related to a dosage of 8.0 mg/day or higher and osteosclerotic changes.

Patellar Tracking in Total Knee Arthroplasty-Influence on Clinical and Functional Outcome.

Anterior knee pain is a common problem after primary total knee arthroplasty (TKA). The aim of this study was to find parameters in patellar positioning which influence the clinical and functional outcome after TKA. Included were 59 patients who underwent TKA, of which three patients were treated bilaterally (n = 62 included knees). In a periodical follow-up of up to 5 years, each patient had to answer three questionnaires (HSS, WOMAC, SF-36) and underwent three radiographies of the knee (including merchant view) and a clinical examination, including Range Of Motion (ROM). All radiographs were evaluated by a single observer blinded to clinical data, who collected multiple parameters of sagittal and axial patellar alignment including newly developed methods for measuring patellar shift and tilt. Depending on the measurement results, three groups were built for each parameter and the influence on the outcome was determined. A lateral patellar tilt of more than 4° resulted in lower scores for both the HSS and WOMAC. The rarely investigated patellar facet angle showed a significantly inferior clinical and functional outcome in late follow-up of >24 months if lower than 142°, possibly due to progressive osteosclerotic changes of the patella caused by increased contact stress with corresponding patellar morphology. No significant difference was found for all other parameters. The newly developed method for measuring patellar shift has proven to be a valuable and easy instrument in the postoperative setting.

Bone metastases with post-treatment intralesional fatty content of the spine: imaging features from T1-weighted imaging with CT finding correlations.

Despite post-treatment intralesional fatty content (PIFAT) in bone metastases indicating a healing processes after treatment, the imaging features of PIFAT have not been studied in detail. To analyze imaging features from T1-weighted (T1W) imaging with computed tomography (CT) finding correlations in bone metastases with PIFAT of the spine. A total of 29 bone metastases with PIFAT were analyzed with T1W and CT images before and after treatment. On T1W imaging after treatment, the lesions were categorized into three types according to fat distribution patterns. CT attenuation changes after treatment were also evaluated. According to the MD Anderson (MDA) criteria, response types for all lesions were obtained on magnetic resonance (MR) and CT images. The types from T1W imaging in bone metastases with PIFAT were as follows: 14 with a return to totally normal marrow signal intensity within the lesion; 13 with an inhomogeneous patchy pattern in the lesion; and two with a peripheral halo of fatty marrow or peripheral fat signal intensity foci in the lesion. Among bone metastases with PIFAT, 93.1% showed osteosclerotic changes in this study. According to the MDA criteria, the concordance between the response types of the MR and CT images was 57.2%. Knowledge of imaging features from T1W imaging with CT correlation in bone metastases with PIFAT is important for the accurate interpretation of post-treatment MR and CT studies. Both MR and CT images have a complementary value regarding the post-treatment evaluation of bone metastases with PIFAT.

Quantitative Segmentation Analysis of the Radiological Changes by Using ITK-SNAP: Risk Assessment of the Severity and Recurrence of Medication-related Osteonecrosis of the Jaw.

Background and purpose: Medication-related osteonecrosis of the jaw (MRONJ) severely impairs patients' quality of life and is remarkably refractory to treatment. There are lots of studies about identification of the radiographic features of MRONJ, yet reports about quantitative radiographic analysis for the risk assessment of the severity and recurrence of MRONJ are rarely heard. The aim of this study was to investigate the volumes of osteolytic lesions and radiodensity values of osteosclerotic lesions in MRONJ patients by using ITK-SNAP for severity prediction and prognosis evaluation.Materials and methods: Of 78 MRONJ patients (78 lesions) involved in this retrospective study, 53 were presented as osteolytic lesions and 25 were presented as osteosclerotic changes alone. Comprehensive CBCT images, demographics and clinical data of patients were investigated. The volumetric analysis and radiodensity measurement were performed by ITK-SNAP. SPSS 25.0 were used for statistical analysis.Results: The osteolytic lesion volumes in MRONJ patients receiving intravenous bisphosphonates (P=0.004) and patients without osteoporosis (P=0.027) were significantly large. No significant correlation between the volumes and bisphosphonates duration was found (P=0.094). The radiodensity values of osteosclerotic lesions was significantly correlated with bisphosphonates duration (P=0.040). The surrounding area of post-surgical lesions in MRONJ patients with recurrence showed significantly great radiodensity values (P=0.025). No significant correlation between the radiodensity values and the transformation from osteosclerotic lesions to osteolytic lesions was observed (P=0.507).Conclusion: MRONJ patients receiving intravenous bisphosphonates develop into large volumes of osteolytic lesions more easily. Long-term bisphosphonates duration is possibly related with higher bone density of osteosclerotic lesions, while higher density is not associated with the transformation from osteosclerotic lesions to osteolytic lesions. A rise of bone mineral density nearby post-surgical lesions is probably a predictor for MRONJ recurrence.

Mandible Aseptic Osteonecrosis Caused by admission of the Narcotic Substances Containing Aminophosphonic Impurities: Levelling with Trilon B

The aim of our study was to correct osteosclerotic changes (aseptic osteonecrotic lesion) of mandibular bones in laboratory white rats. Changes were caused by 1 and 3 monthly intragastric administration of amino phosphonic impurity. It was formed during artisanal manufacture of meta-amphetamine. A dose was 63 mg/kg 1 time per day, and followed by exposure to 5% water solution of Trilon B at a dose of 250 mg/kg. Mandible structure was researched by light microscopy. Three additional functional indices and elements of node-strut analysis were enrolled. Indices and their abbreviations were used in accordance to Committee on Histomorphometry Nomenclature (ASBMR).&#x0D; It was found that intragastric administration of Trilon B at a dose of 250 mg/kg after one-month- and three-month influence of amino phosphonic impurity (by-product of methamphetamine artisanal synthesis) at a dose of 63 mg/kg led to improvements of mandible bone remodeling. Also, enhancement of processes that removed osteosclerotic changes as well as an involution of myelofibrosis took place.

Correlation Between Bone Density and Lumbar Compression Fractures

Objectives: Bone densitometry is widely used to evaluate osteoporosis; however, it is pointed out that bone density may be high in the case of fractures, deformities, and osteosclerotic changes. The present study evaluated bone density measured at our hospital and evaluated its correlation with the presence or absence of lumbar spine fractures. Methods: Bone density of the lumbar spine and femur was measured in 185 patients from July 2017 to June 2019 at our hospital, and the presence or absence of a lumbar spine compression fracture was evaluated on the basis of the image. Information regarding age, sex, lumbar bone density, presence or absence of lumbar fracture, number of lumbar fractures, and grade of lumbar fracture was also statistically evaluated. Results: Analysis was performed for 185 patients (20 males and 165 females, average age 76.9 ± 7.5 years). The bone density was 0.830 ± 0.229 of compression fractured bodies (number of vertebral bodies were 132) and 0.765 ± 0.178 g/cm3 of noncompression fractured bodies (number of vertebral bodies was 608). Discussion: The presence of lumbar fractures significantly increases bone density. For diagnosing osteoporosis, both bone density and the possibility of lumbar spine fractures must be considered.

Computed tomography imaging characteristics help to differentiate pyogenic spondylitis from brucellar spondylitis.

Both pyogenic spondylitis (PS) and brucellar spondylitis (BS) can cause deformities and permanent neurologic deficits without prompt diagnosis and treatment. However, differential diagnosis is challenging. The aim of this study was to compare the computed tomography (CT) imaging features of PS with those of BS. Thirty-two patients with PS and 44 with BS were enrolled in the study. CT images were obtained in all cases. Data on bone destruction and formation, vertebral wall destruction, and osteosclerotic changes were collected and compared using the Chi-square test or t test. A P value < 0.01 was considered statistically significant. Positive predictive values (PPV) for detecting PS or BS were reported. Involvement of the lumbar vertebrae and multiple spinal levels was more common in the BS group than in the PS group. Bone destruction was significantly greater in the PS group than in the BS group (30.8 vs 18.0%; t = 3.920, P = 0.000), with more extensive destruction of the vertebral body (35.8 vs 12.5%, χ2 = 12.672, P = 0.002, PPV = 63.16%). In the BS group, there was more osteosclerosis around erosions (70.5 vs 43.3%, χ2 = 11.59, P = 0.001, PPV = 67.74%) and fan-shaped osteosclerosis (27.3 vs 19.4%, χ2 = 18.556, P = 0.006, PPV = 64.86%), more bone formation around the vertebra (77.2 vs 34.3%, χ2 = 33.608, P = 0.000, PPV = 76.83%), more bone formation under the anterior longitudinal ligament (63.6 vs 19.4%, χ2 = 30.133, P = 0.000, PPV = 76.09%), more longer anterior bone formation (3.55 vs 0.78mm, t = 3.997, P = 0.000), and more anterior and closed-bone formation with local erosion (42.0 vs 9.0%, χ2 = 74.243, P = 0.000, PPV = 74.36%). CT images have unique advantages of revealing the morphology of erosions, osteosclerosis, and bone formation around the vertebra and help to differentiate PS from BS. These slides can be retrieved under Electronic Supplementary Material.

Evidence of Skeletal Fluorosis at the Ray Site, Illinois, USA: a pathological assessment and discussion of environmental factors

ObjectiveTo carefully assess skeletal lesions in close environment context in order to evaluate whether skeletal fluorosis was present in individuals living in the prehistoric Midwest, USA. MaterialsSkeletal remains from minimally 117 individuals recovered from the Ray Site, located in western Illinois (USA) and dated to the Middle/early Late Woodland periods (50 BC-AD 400). MethodsMacroscopic evaluation of all recovered skeletal elements. ResultsEight individuals display a constellation of abnormal bony changes, including osteosclerosis, a high frequency of fractures, and dental abnormalities. ConclusionsThe osteosclerotic changes along with the naturally high fluoride content of west central Illinois soil and water suggests the presence of skeletal fluorosis. SignificanceThis is the first report of skeletal fluorosis from archaeologically recovered human remains from North America. LimitationsThe ambiguous nature of the skeletal changes associated with fluorosis, especially in the less severe stages of the disease, renders determination of the etiology difficult. Suggestions for Further ResearchThe continuation of paleopathological investigations of fluoride toxicity within archaeological communities recovered from this region with emphasis on the incorporation of biomedical and environmental data. Furthermore, complementary analyses of the chemical composition and the histological presentation of the skeletons could provide support for this diagnosis.

Slight brightness and osteosclerotic changes of bones on plain X-ray could be clues to the diagnosis of disseminated carcinomatosis of bone marrow.

Clinicians should be alert to the presence of slight brightness and osteosclerotic changes of bones on plain X‐rays, especially in patients without a history of gastric, colon, breast, lung, or prostate cancers, which could lead to the diagnosis of disseminated carcinomatosis of bone marrow.

PB2068 THE CASTLEMAN DISEASE: HISTOLOGICAL VARIANTS, POEMS‐SYNDROME AND PRODUCTIVE PLASMA CELL VASCULITIS

Background:The Castleman disease (CD) is a rare, little‐studied disease characterized by lymphadenopathy with follicles hyperplasia and active neoangiogenesis. Occurs in the form of two histological variants: plasma cell and hyaline‐vascular. The total vasculitis in the vessels of internal organs, previously not noted by researchers, was revealed in the analysis of 2 sectional cases of CD.Aims:To study the state of microcirculatory vessels in patients with plasma cell and hyaline‐vascular type of CD in sections of biopsied lymph nodes.MethodsSections of biopsied lymph nodes were used. It was used hematoxylin‐eosin and reaction to antibodies to CD138 to identify plasma cells. In all patients with plasma cell variant cells were painted with antibodies to HSV‐8. Vessels estimated in perinodular tissue of capsule and fat. We examined 15 patients with CD. According to histology and CD138 content, the plasma cell variant was diagnosed in 8 patients, 7 men and 1 woman aged from 40 to 70 years. In 5 patients approved POEMS syndrome by the presence of M‐protein, disorders of neuro‐muscular conduction according to the electro‐neuromyography, and other symptoms. In 7 patients was diagnosed hyaline vascular type of CD, including 5 women and 2 men aged from 30 to 60 years.Results:In 1 patient with plasma cell variant of CD revealed HSV8 reaction with intranuclear staining antibodies. Vasculitis in the form of vascular walls thickening of the microcirculatory bloodstream with a decrease or obliteration of their lumen, wall fibrosis and plasma cell infiltration was found in all 15 patients. The most pronounced changes in the form of fibrosis, complete vascular obliteration and massive perivascular infiltration CD138+ cells by type of massive colonies of hundreds of cells were found in patients with the POEMS‐ syndrome. They also noted the location of single CD138 + cells inside the intima of the sclerosal vessels. Fibroplastic vascular changes in patients with POEMS‐syndrome were weirdly shaped in the form of “mood masks”. It coincided with massive osteosclerotic changes of the vertebrae on radiographs. Massive development of fibrosis corresponds to the POEMS pathogenesis. All patients with its presence later died.Summary/Conclusion:The Castleman disease, regardless of the histological variant, includes in its morphological pattern productive plasma cell vasculitis, most pronounced in the plasma‐cell variant with POEMS‐ syndrome.

An Ancient Skeleton with Multiple Osteoblastic Bone Lesions Containing a Scapular Sunburst Appearance from a 5th-6th Century Grave Excavated in Oita, Japan.

A human skeleton of a middle-aged adult male was found in a 5th–6th century Kinoue-Kodo stone coffin excavated from the southwest marginal region of the Oita plains, northeast Kyushu, Japan. The skeleton was buried respectfully in the ancient tomb, and red pigment was applied to his face after death. We report herein findings from computed tomography imaging of the skeleton and discuss the multiple osteoblastic lesions identified in the humerus, scapula, clavicle, vertebra, pelvic bones, and skull of this individual. These lesions comprised cortical bone thickening with periosteal reaction localized to the surface and osteosclerotic changes mainly observed in the trabecular structure of cancellous bone. In particular, a typical sunburst pattern was also noted on the left scapula as another characteristic lesion found in this case. By differential diagnosis, the disease suffered by this individual was most likely to be metastatic bone tumors, especially of prostate cancer. This person may have survived until many bone metastases had developed throughout his whole body.

Early osteosclerotic changes predict chemotherapy response in non-small-cell lung cancer patients with bone metastases.

To explore the relationship between osteosclerotic changes and chemotherapy response in non-small-cell lung cancer (NSCLC) patients with bone metastases (BM). Fifty-two NSCLC patients with BM were enrolled from 1 January 2010-31 June 2015 and divided into two groups based on their CT features: an osteosclerotic change (OC) group and a no-osteosclerotic change (NOC) group. The disease control rate (DCR) was evaluated, and progression-free survival (PFS) was analysed using Kaplan-Meier curves. Univariate and multivariate Cox regression analyses were performed to analyse the factors that could affect PFS. Osteosclerotic changes were observed in 35/52 patients. The median interval when osteosclerotic changes occurred was 2 months (range 1-3 months) after chemotherapy. The OC group had a significantly higher 3-month DCR than the NOC group (p < 0.001). The OC group had a higher 1-year PFS rate than the NOC group (1-year PFS: 74.9% vs. 30.2%, p < 0.001). Univariate Cox regression analysis indicated that pathological subtype (HR = 4.419; 95% CI = 1.635-11.941, p = 0.003) and osteosclerotic changes (HR = 0.199; 95% CI = 0.083-0.477, p < 0.001) were significant predictors of PFS. Early osteosclerotic changes predict chemotherapy response in NSCLC patients with BM. • Osteosclerotic changes were prevalent CT features after chemotherapy in NSCLC patients. • Osteosclerotic changes were positively related to increased 3-month DCR. • Osteosclerotic changes were positively related to increased 1-year PFS rate.

Brown Tumour in the Mandible and Skull Osteosclerosis Associated with Primary Hyperparathyroidism – A Case Report

BACKGROUND:The hyperparathyroidism (HPT) is a condition in which the parathyroid hormone (PTH) levels in the blood are increased. HPT is categorised into primary, secondary and tertiary. A rare entity that occurs in the lower jaw in association with HPT is the so-called brown tumour, which an osteolytic lesion is predominantly occurring in the lower jaw. It is usually a manifestation of the late stage of the disease. Osteosclerotic changes in other bones are almost always associated with renal osteodystrophy in secondary HPT and are extremely rare in primary HPT. This article reports a rare case of a brown tumour in the mandible as the first sign of a severe primary HPT, associated with osteosclerotic changes on the skull.CASE REPORT:A brown tumour in the mandible was diagnosed in 60 - year old female patient with no previous history of systemic disease. The x - rays showed radiolucent osteolytic lesion in the frontal area of the mandible affecting the lamina dura of the frontal teeth, and skull osteosclerosis in the form of salt and pepper sign. The blood analyses revealed increased values of PTH, calcitonin and β – cross-laps, indicating a primary HPT. The scintigraphy of the parathyroid glands showed a presence of adenoma in the left lower lobe. The tumour lesion was surgically removed together with the lower frontal teeth, and this was followed by total parathyroidectomy. The follow - up of one year did not reveal any signs of recurrence.CONCLUSION:It is critical to ensure that every osteolytic lesion in the maxillofacial region is examined thoroughly. Moreover, a proper and detailed systemic investigation should be performed. Patients should undergo regular check-ups to prevent late complications of HPT.

A Novel Digital Templating Methodology for Arthroplasty: Experience from Patients with Osteonecrosis of the Femoral Head

To assess the accuracy of a novel digital templating methodology for total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH). A retrospective study was carried out on 77 hips in 58 patients who had undergone uncemented THA for ONFH. Preoperative radiographs were templated using a 2-step procedure: (i) calculation of basic cup and stem sizes based on the anatomical morphology; (ii) adjustment of the basic sizes to account for variables such as femoral external rotation, osteoporotic changes in the femur, osteosclerotic changes in the acetabulum, and the type of stem. Basic and adjusted sizes were compared with the actual sizes of the implants used. Before adjustment, the overall accuracy was 69% and 70% for stem size and the cup respectively. Among all the cases, 31 femoral components (40%) and 17 acetabular components (22%) required adjustment. After adjustment, the accuracy of templating for stem and cup sizes in these adjusted cases improved from 52% to 87% (p = 0.002), and 41% to 82%, respectively (p = 0.032). And the overall templating accuracy improved to 83% on the stem side (p = 0.038) and 79% on the cup side (p = 0.195). Preoperative digital templating was useful in predicting cup and stem sizes in patients with ONFH. Radiographic signs of femoral rotation or osteoporotic changes call for appropriate adjustment to improve the accuracy of templating for THA.