STIFF ELBOW!! POST TRAUMATIC MYOSITIS OSSIFICANS? A CASE REPORT

Myositis Ossificans is defined as Ossification of Haematoma around a joint resulting in formation of bone mass leading to restriction of joint movements completely in majority of cases. This is also known as Heterotopic Ossification, Ectopic Ossification. It is pathological bone formation in soft tissues especially in between muscle planes. It is extensive, progressive benign lesion occurring most commonly in fiexor muscles of arm, quadriceps muscles, adductor muscles of hip joint in young active adults and athletes [2,3,10] . Massage following trauma is the most aggravating factor of Myositis Ossificans. We report a case of 12 year boy with complaining of stiff elbow since 9 months, restricted elbow joint movements with history of fall while playing 1 year back for which he had taken treatment from local quack with aggressive massaging. There is fixed fiexion deformity of 90°. Clinical examination revealed a palpable bony mass on anterior aspect of elbow and Radiological investigation revealed ossified bony mass bridging elbow joint. Surgical Excision is done and biopsy showed mature stage Myositis Ossificans trabecular bone. Elbow range of movements started and patients has good range of movements with 1 year follow up with good physiotherapy

Stability of the femoral neck and internal fixation with bone cement and steel plate after curettage for benign proximal femoral lesions / 中国组织工程研究

BACKGROUND: For benign bone tumor patients, the life cycle is long. To reduce the incidence of complications and improve the quality of life after surgery through surgery is the common goal of physicians. The quality of life of patients can be increased through discussing the operation mode and prognosis of benign tumor patients, choosing the reasonable operation mode, predicting and reducing the risk of secondary fracture. OBJECTIVE: To analyze the femoral neck force after different surgical methods using finite element technique in the analysis of benign proximal femoral lesions, and to assess the stability of the femoral neck and the risk of fracture after different surgical procedures for cases with a wide range of lesions. METHODS: According to preoperative CT data of lesion sites in 10 subjects with benign tumor of proximal femur, three-dimensional model of internal fixation with bone cement and steel plate after focal curettage (group A) and three-dimensional model of treating with bone cement after focal curettage (group B) were set in this study. Finite element technique was used to simulate the maximum force of the femoral neck when walking. The stress peaks of the femoral neck were compared after surgery between the two groups. The risk of fracture at this location was assessed. Patients signed the informed consent. This study was approved by the Ethics Committee of Chengde Medical College. RESULTS AND CONCLUSION: (1) The stress was significantly lower in the group A than in the group B (P=0.007 < 0.05). (2) The local stress of the model was reasonable in the group A. Ten patients were operated with the protocol of the group A. An additional 17 patients with proximal femur benign lesions who met the requirements but refused to enter the finite element experiment were treated with the surgical program of the group A. (3) The patients were followed up for 14-42 months. During the follow-up, no new fracture was found in the operation area, and the internal fixation device was firm without fracture. At 12 months postoperatively, the mean Musculoskeletal Tumor Society score of all patients was (26.12±2.28). (4) The finite element technology for simulating the stress evaluation and postoperative follow-up verified that the treatment of proximal femur benign tumor with bone cement and steel plate internal fixation after curettage is more reasonable and effective. The scheme can effectively reduce the risk of secondary fracture and enhance the stability in the surgical area.

Finite element analysis to verify the rationality of bone cement combined with plate internal fixation for benign proximal femoral lesions / 中国组织工程研究

BACKGROUND: For the patients with benign osteopathy, the patients usually get a good life cycle after surgical treatment. Through continuous improvement of the operation mode, the stress of the proximal femur after the operation of benign osteopathy is studied by using the finite element analysis. The risk of pathological fracture and secondary fracture is predicted and reduced. To explore the best operation and prognosis is of great significance for prolonging and improving the quality of life of patients. OBJECTIVE: Three-dimensional finite element technique was used to analyze the different surgical models of benign proximal femoral lesions. The differences of different surgical models were compared and the rationality and effectiveness of internal fixation were verified. The reliability of the finite element model was verified in the follow-up of patients after operation. METHODS: Preoperative CT examination was conducted in 10 patients with benign proximal femoral lesions who met the inclusion criteria. Three models of limbs scraping (group A), cavity internal nail re-infusion bone cement (group B) and intracavitary bone cement joint plate screw (group C) were established by MIMICS. The maximum stress values of the left and right side windows of the cortical model of group A, B and C were measured under simulated conditions, and the stress values of the three groups were compared. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUSION: (1) The comparison of the maximum stress values of the anterior and posterior sides of the cortical fenestration in the three groups of models was group A > group B > group C (P < 0.05). The risk of fracture was high in group A, and the risk of fracture in group B was large. The stress in group C was controlled within a reasonable range, and the risk of fracture was low. (2) Therefore, 10 subjects underwent the treatment in group C. The prognosis was good and there were no secondary fractures. The Musculoskeletal Tumor Society score was 27-30 points 1 year after surgery. (3) The model stress is prone to increase the local stress after opening the window. After adding bone cement and steel plate, the stress value of the model window is significantly reduced. After the benign lesions of the proximal femur are scraped, the stress of the fenestration can be effectively reduced by placing the bone cement and the steel plate, and the fracture probability at the surgical site is significantly reduced. Steel plate placement is reasonable.

Clinical value of multi-slice spiral CT angiography in the diagnosis of abdominal tumors / 中国基层医药

Objective To study the clinical value of multi－slice spiral CT angiography in the diagnosis of abdominal tumors. Methods From January 2015 to December 2017,90 patients with abdominal neoplasms in the First People＇s Hospital of Yongkang were divided into two groups according to double－blind randomized method,with 45 patients in each group. The patients with conventional CT scan were included in the control group,and the patients with multislice spiral CT angiography were selected as the observation group. The scan results,invasion range and location of abdominal tumor, vascular display and perfusion parameters were compared between the two groups. Results The diagnostic accuracy of abdominal tumor and invasion range in the observation group ( 93. 33% , 80. 00% ) was higher than those of the control group(χ2=5. 414,5. 086,all P＜0. 05). The proportions of abnormal thickening of one supply artery(27 cases) and two blood supply arteries(8 cases) in patients with malignant and borderline venereal lesions with normal diameter were higher than those of patients with benign lesions(χ2=31. 765, 8. 372,all P＜0. 05). The contrast medium through time,blood flow,blood volume and capillary surface permeability in patients with benign lesions and normal average diameter were (10. 55 ± 3. 02) s,(21. 54 ± 5. 58) mL·min－1· 100 g－1,(4.04 ±0.76) mL/100 g,(10.16 ±2.73)mL·min－1·100 g－1,respectively,which were lower than those of patients with malignant and border venereal focal lesions (t =3. 016,5. 005,4. 982,6. 989,all P ＜0. 05). Conclusion Application of multislice spiral CT angiography in the clinical diagnosis of abdominal tumors has high accuracy and can better display the abnormal condition of blood vessels.

Analysis of the significance of thyroid stimulating hormone and thyroid hormone in thyroid carcinoma by ROC curve / 国际检验医学杂志

Objective To investigate the role of thyroid stimulating hormone and thyroid hormone in the diagnosis and differential diagnosis of thyroid carcinoma and thyroid benign lesions.Methods Using ROC curve analysis,70 cases of thyroid cancer patients(sthyoid cancer group)and 70 cases of benign thyroid lesions (benign thyoid disease group)in the hospital were enrolled in the study and analyzed,serum TSH,FT4and FT3levels were measured.The value of ROC curve in the diagnosis and differential diagnosis of thyroid carci-noma and thyroid benign lesions was analyzed.Results The level of TSH in thyroid cancer group was signifi-cantly higher than that in benign thyroid disease group,while the levels of FT3and FT4were significantly low-er than those of benign thyroid lesions(P<0.05).ROC curve analysis showed that the area under the TSH curve was 0.800,and the critical point was TSH 4.55 μIU/mL,with thyroid cancer as a diagonal.With benign thyroid lesions as the diagonal,the area under the FT3curve was 0.791,the critical point was 3.25 ng/mL,the area under the FT4curve was 0.861,and the critical point was 1.54 ng/dL.Conclusion TSH,FT3and FT4 can be used in the differential diagnosis of thyroid cancer and thyroid benign lesions.

Quiste epidermoide gigante en reloj de arena del piso de la cavidad oral / Giant hourglass shaped epidermoid cyst in the floor of mouth

El quiste epidermoide es un quiste de tejido blando de origen ectodérmico que se encuentra con poca frecuencia en la cavidad oral. Clínicamente se caracteriza por ser una lesión asintomática, de larga evolución, recubierta con mucosa normal, y usualmente se diagnostica cuando el aumento de volumen genera molestias en el paciente. El tratamiento varía de acuerdo a su tamaño y localización anatómica. Presentamos el caso de una paciente de 29 años de edad con un quiste epidermoide de gran tamaño, en reloj de arena, del piso de boca. Se describen las características específicas histológicas y clínicas, y se discute la conducta terapéutica seguida.

The epidermoid cyst is a soft tissue cyst of ectodermal origin found infrequently in the oral cavity. Clinically, it is characterized by an asymptomatic lesion, of long evolution, covered with normal mucosa, and is usually diagnosed when the volume increases and generates patient discomfort. Treatment varies according to its size and anatomical location. We report the case of a 29 year old patient with a large, hourglass shaped, epidermoid cyst in the floor of the mouth. Specific histological and clinical characteristics are described and the therapeutic behavior followed is discussed.

Fibro-osseous pseudotumor of the digit.

Fibro-osseous pseudotumor of the digit is a very rare benign lesion however it may be a cause of concern as it forms differential diagnosis to aggressive bone forming tumors like extraskeletal osteosarcoma. Till date only a few cases have been reported in the literature. We came across a case of 7yr old female presented with complains of post traumatic progressively growing hard swelling present on the palmar surface of the hand at the hypothenar region for last 6 months. Investigations i.e. X-rays, MRI and CT scan were done along with other blood investigations to rule out other common diseases such as exostosis or myositis ossificance or extraskeletal osteosarcoma. Excisional biopsy of the lesion confirmed the diagnosis of fibro-osseous pseudotumor of the digit.

Imaging Findings of Solitary Spinal Bony Lesions and the Differential Diagnosis of Benign and Malignant Lesions

OBJECTIVE: The purpose of this study was to present the MRI and CT findings of solitary spinal bone lesions (SSBLs) with the aims of aiding the differential diagnoses of malignant tumors and benign lesions, and proposing a diagnostic strategy for obscure SSBLs. METHODS: The authors retrospectively reviewed the imaging findings of 19 patients with an obscure SSBL on MRI at our hospital from January 1994 to April 2011. The 19 patients were divided to benign groups and malignant groups according to final diagnosis. MRI and CT findings were evaluated and the results of additional work-up studies were conducted to achieve a differential diagnosis. RESULTS: At final diagnoses, 10 (52.6%) of the 19 SSBLs were malignant tumors and 9 (47.4%) were benign lesions. The malignant tumors included 6 metastatic cancers, 3 multiple myelomas, and 1 chordoma, and the benign lesions included 4 osteomyelitis, 2 hemangiomas, 2 nonspecific chronic inflammations, and 1 giant cell tumor. No MRI characteristics examined was found to be significantly different in the benign and malignant groups. Reactive sclerotic change was observed by CT in 1 (10.0%) of the 10 malignant lesions and in 7 (77.8%) of the 9 benign lesions (p=0.005). CONCLUSION: Approximately half of the obscure SSBLs were malignant tumors. CT and MRI findings in combination may aid the differential diagnosis of obscure SSBLs. In particular, sclerotic change on CT images was an important finding implying benign lesion. Finally, we suggest a possible diagnostic strategy for obscure SSBLs on MRI.

Diagnostic Difficulties in Fine Needle Aspiration of Benign Salivary Glandular Lesions

BACKGROUND: The diagnostic accuracy of fine needle aspiration cytology (FNAC) of salivary lesions is relatively high, but cytologic interpretation might be confusing if the sample is lacking typical cytologic features. METHODS: There were 77 cases of benign salivary lesions, consisting of pleomorphic adenoma (PA) in 61 cases, Warthin's tumor (WT) in 12 cases, and other benign lesions in 4 cases. The causes of the discrepancies between the FNAC and the histologic diagnoses were evaluated. RESULTS: Major discrepancies were noted in 4 of the 61 PA cases, and in 1 of 12 WT cases. The causes of the major discrepancies were a mislabeled site in 1 PA and 1 WT case, and an interpretation error in 3 PA cases. Minor discrepancies were more common in the WT cases (7 of 12 cases) than in the PA cases (11 of 61 cases). The causes of the minor discrepancies were a mislabeled site in 1 PA and 1 WT case, an inadequate sample in 7 PA and 2 WT cases, a lack of typical cytomorphology in 2 PA and 2 WT cases, and an interpretation error in 1 PA and 2 WT cases. CONCLUSIONS: To increase the diagnostic accuracy in the benign salivary lesions, recognition of both characteristic and less typical cytomorphology is needed.

Lesiones benignas de mama que pueden simular un carcinoma en estudios imagenológicos / Benign breast lesions that mimic carcinoma in diagnostic imaging

La mayoría de las lesiones que se encuentran al realizar estudios mamarios son benignas. Muchas de ellas tienen un aspecto típico y definido, ya sea en mamografía o ecografía y no requieren de evaluaciones adicionales. Existe un grupo de entidades benignas que, sin embargo, puede simular un carcinoma en las imágenes. Los radiólogos debemos conocer las características de las mismas y tenerlas en cuenta como posibles diagnósticos diferenciales de una imagen de alta sospecha.

Most of the lesions found during breast imaging exams are benign. Many of them have a typical and definite appearance on mammography and ultrasound, and require no further evaluation. However, some benign lesions cannot be differentiated from carcinomas, given their suspicious and less specific radiological features. Radiologists should be aware of the imaging characteristics of these lesions and include them in the differential diagnosis of a malignant-appearing finding.

Hiperplasia estromal pseudoangiomatosa de la mama (PASH): presentación de dos casos / Pseudoangiomatous stromal hyperplasia

La hiperplasia estromal pseudoangiomatosa (PASH) es una lesión mamaria benigna infrecuente, que afecta comúnmente a mujeres premenopáusicas y que se presenta como un nódulo único, móvil, de consistencia firme y por lo general unilateral. Hay un sobrecrecimiento benigno de tejido conectivo fibroso de la mama que produce numerosos espacios que semejan estructuras vasculares. En la actualidad, la alternativa diagnóstica la provee la punción biopsia percutánea eco-dirigida o por estereotaxia, la que permite determinar la naturaleza de la lesión y descartar patología maligna, como el angiosarcoma, a fin de evitar la realización de biopsias quirúrgicas innecesarias. Presentamos dos casos que fueron categorizados en el control inicial por mamografía como BI-RADS 4c, lo que determinó la realización de una punción biopsia.

Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast lesion, which commonly affects premenopausal women. It occurs as a single node, which is mobile, firm and usually unilateral. PASH is characterized by a benign overgrowth of fibrous connective tissue of the breast, which produces numerous spaces resembling vascular structures. The diagnostic alternative is currently provided by the ultrasound guided percutaneous biopsy or stereotactic biopsy, which determines the nature of the lesion and rules out malignancy, such as angiosarcoma, in order to avoid unnecessary surgical biopsies. We present two lesions that were classified as BI-RADS 4c in the initial control by mammography, which led to a needle biopsy.

The Usefulness of US-guided Vacuum-Assisted Breast Biopsy for Probably Benign Lesions

PURPOSE: We wished to determine the usefulness of ultrasound-guided vacuum-assisted biopsy (mammotome) for the removal of the breast lesions that had displayed benign evidence on sonography. METHODS: During an 11 month period, vacuum-assisted breast biopsy was performed for 186 probably benign lesions on sonography using 11-gauge (127 cases) and 8-gauge (59 cases) devices. The age of the patients ranged from 19 to 65 years, and the size of the lesions ranged from 0.4 to 3 cm. We retrospectively analyzed the clinical findings and medical history of the patients who underwent vacuum- assisted breast biopsy, and we then evaluated the complications, the histopathologic results, and the follow-up US findings. RESULTS: Of the 186 cases, the lesions were palpated in 95 cases (51%), and lesions were detected in women during a screening examination in 40 cases (36%), and lesions were detected in women having a history of benign breast biopsy or having a cancer operation in the remaining 18 cases (10%). Severe bleeding during or after the procedures was noted in 4 cases (2.2%). The lesions were pathologically proved as benign in 185 cases and malignant in 1 case. With vacuum-assisted breast biopsy, high-risk benign disease was found in 7 cases, but none of the lesions was pathologically upgraded on the subsequent open surgical biopsy. On the 3-month follow-up US, variable sized hematomas were observed in 6 of 24 cases (25%). We performed incidental treatment on four of the vacuum- assisted breast biopsy patients for nipple discharge that was caused by intraductal papilloma. CONCLUSION: US-guided vacuum-assisted breast biopsy is a minimally invasive, fast and convenient biopsy technique. In addition, it is safe and accurate to use for the histological diagnosis because it would remove all the sonographically demonstrated evidence of a probable benign lesion. This technique can potentially be a useful alternative to some forms of surgical biopsy for the properly selected patients.