Post-traumatic Fibro-Osseous Lesion of the Fourth Rib Simulating a Chest Wall Tumor: A Case Report / 가정의학회지

Post-traumatic fibro-osseous lesions (PTFOL) are a rare and benign tumor that typically affects the ribs and is probably caused by an excessive post-traumatic reactive process. PTFOL primarily affects the sixth, seventh, and eighth ribs. Here, we report a case of a PTFOL with an unusual location and expansion that simulated a malignant chest tumor. A 28-year-old male patient with a history of minor chest trauma presented with pain. Chest radiography revealed a large, well-defined lesion on the left fourth rib, and computed tomography (CT) of the chest revealed a lytic lesion-type IC on the posterior and middle arches of the left fourth rib with a cartilaginous matrix and discontinued periosteal reaction without soft tissue mass extension. Additionally, magnetic resonance imaging of the chest revealed an ovoid, expansive mass with cystic lobules and lobulated contours extending almost over the entire left fourth rib, measuring 134×47 mm in size. This mass has a low signal on T1-weighted images and a heterogeneous intermediate signal on T2-weighted images, with intense enhancement after gadolinium injection suggestive of a malignant chest tumor. A CT-guided bone biopsy confirmed the presence of an intramedullary lesion consisting of fibrous connective tissue with fusiform fibroblastic cells without atypical signs. The lesion was delimited by bone trabeculae with nibbled edges, indicating exaggerated osteoclastic activity compatible with a diagnosis of PTFOL. The patient was treated with simple analgesics, and chest pain was relieved, with an unchanged volume of the lesion at 1 year of follow-up.

[Utility of biochemical markers of bone turnover in diagnosis of osteoporosis and fracture risk prediction]

Currently, for the diagnosis of osteoporosis, we search risk factors and measure bone mineral density [BMD] by DXA. However, bone turnover markers, unused still in practice, have shown an interest especially in the prediction of fracture risk. To determine the relationship between bone markers, BMD and osteoporotic fracture. Prospective study of 65 women referred for measure of BMD during the period between May and August 2010. Each patient had a dosage of serum bone formation markers: osteocalcin [OC] and N-terminal propeptide of type I collagen [P1NP] and bone resorption markers: serum and urinary C-terminal telopeptide of type I collagen [beta-CTX or CrossLaps] as well as parathyroid hormone and calcium. Risk factors of osteoporosis were identified in each case. Our 65 women had a mean age of 58.6 +/- 12.1 years. The majority [83%] were menopausal women. Osteoporosis was found in 52%, osteopenia 26% and normal BMD 22% of cases. An increase in bone turnover markers was correlated with menopause [p = 0. 001 for the OC, p = 0.016 for urinary CTX], a low body mass index [p = 0.015 for OC, p = 0.042 for serum CTX] and osteoporosis [p <0.001 for P1NP, p <0.001 for serum and urinary CTX]. Corticosteroid therapy was correlated with a decrease in bone formation markers [p = 0.002 for P1NP]. The presence of fracture was only associated with increased urinary CTX [p = 0.05]. Bone turnover markers increase in menopausal women and in case of low BMD. However, their contribution in the diagnosis of osteoporosis is low. They are rather an interest in the prediction of fracture risk

[Survival prognosis factors in multiple myeloma]

Outcome in multiple myeloma [MM] is very heterogeneous in survival and therapeutic response, constantly fatale despite her therapy progress. To determine the prognostic factors and survival in MM. We carried out a transversal study of 100 patients in the rheumatology department of hospital Monastir between 1991 and 2010. In each case we determinate the survival delay and also the clinical, laboratory, radiological data at diagnosis and therapeutic response. The mean age was 64.4 years and sex ratio H/F=1.27. MM is IgG type in 57%, IgA in 28% and light chain in 11% of cases. The survival mean is 34 months and the survival median is 26 months. Univariate analysis showed five prognostic factors: age [p = 0.016], anaemia [p=0.033], beta 2 microglobulin [p < 0.0001], CRP [p = 0.0001], albumin [p = 0.002], LDH [p=0.001], plasmocyte proliferation rate [p=0.003] and rapidly therapeutic response [p <0.001]. beta 2 microgrobulin-CRP classification and the international staging system [ISS] presented a high prognosis signification [p < 0.0001]. Multivariate analysis demonstrated two prognostic factors: beta 2 microglobulin and CRP. Our study showed that MM presented many prognostic factors, which easily realized in daily practice. These prognostic factors are essentially to evaluate prognosis and select patients for appropriate therapeutic indication. beta 2 microgrobulin- CRP classification and the international staging system [ISS] are more predictive than Durie Salmon classification in MM survival

[Contribution of dynamic radiographs in atlantoaxial subluxation in rheumatoid arthritis]

Cervical spine [CS] involvement is common during rheumatoid arthritis [RA] and it is distinguished by its potential gravity. To determinate the occurrence of atlantoaxial subluxation [AAS] by dynamic incidences X-Ray and to assess its predictive factors. Our study included a cohort of 40 patients carrying RA, who fulfilled the American College of Rheumatology criteria, for more than 2 years. All patients had a complete physical and laboratory evaluation. Radiological evaluation included CS radiographs in anteroposterior, lateral, and lateral in full flexion and extension views. The occurrence of CS involvement was about 47.5% by XRay dominated by AAS which found in 42,5% of the cases. Among AAS, anterior AAS was the most frequent with a prevalence of 22,5% followed by lateral AAS in 12,5% then vertical and rotatory AAS in 10% of cases each one and posterior AAS in 2,5% of the cases. Comparison between patients with and without CS involvement indicated the presence of two predictive factors: the sharp modified score and the C - reactive protein [p=0.002 and p=0.004 respectively]. Our study demonstrated that AAS is frequent in RA particularly in active forms with structural lesions. AAS can be asymptomatic, for this reason systematic diagnosis by X-Ray with dynamic views is important