Monostotic Paget's disease of the femur: a diagnostic challenge and an overlooked risk.

BACKGROUND: Although radiological diagnosis of Paget's disease of bone (PD) is usually straightforward, monostotic cases may potentially raise specific problems which lead to performing invasive procedures. Therefore, the purpose of this study is to ascertain whether or not monostotic femoral Paget's disease (MFPD) presentation poses particular diagnostic difficulties which prompt excessive use of excisional biopsies. METHODS: We retrospectively reviewed the medical records of 24 MFPD patients identified from a series of 412 patients; their clinical features were compared with those of the remaining 164 monostotic cases and the radiological images were systematically assessed. RESULTS: When compared with the remaining monostotic cases, MFPD patients were more prone to having normal alkaline phosphatase levels (31.8% vs. 16.4%; 0.08) and a significantly higher percentage of patients have PD symptoms (75% vs. 51%; 0.02) and complain of bone pain (73.9% vs. 40.8%; 0.003). Six (25%) MFPD patients evidenced a fracture over the pagetic lesion. This incidence is higher than that of the monostotic cases of other locations (8.4%; p=0.02). The existence of PD lesion was not recognised initially in 10 cases and an excisional bone biopsy was performed in 7 (29%). One patient subsequently experienced a fracture through the biopsy site and another two experienced worsening of their previous bone pain. CONCLUSION: The femur is a relatively common monostotic PD location which often causes diagnostic confusion, prompting a bone biopsy in many cases. Careful assessment of this lesion by X-ray examination may help attain an early appropriate diagnosis and avoidance of unnecessary surgical morbidity.

Long-term experience of bosentan for treating ulcers and healed ulcers in systemic sclerosis patients.

OBJECTIVES: Our objective was to evaluate the efficacy and tolerability of bosentan in patients with systemic sclerosis (SSc) who develop ulcers and healed ulcers. We also wanted to analyse the effect of bosentan on other skin and general outcome measurements. METHODS: In the present prospective, observational, non-controlled study, we followed all patients with SSc who started treatment with bosentan for ischaemic ulcers and healed ulcers from January 2003 to June 2006 in our centre. We recorded skin and general outcome measurements at baseline and at 6 months. RESULTS: Fifteen patients were included. After a median follow-up of 24.7 months (range: 4-36), there was a significant decrease in the number of ulcers. A trend towards efficacy was seen in the number of healed ulcers and in the severity of ulcers. No significant effect was seen in other skin and general outcome measurements. Toxicity related to bosentan included mild transitory events and one toxic hepatitis. CONCLUSION: Bosentan may be a safe long-term alternative for treating the recurrence of skin ulcers and healed ulcers in SSc patients.

Study of biological stabilization processes of cattle and poultry manure by thermogravimetric analysis and (13)C NMR.

The biological stabilization process of cattle and poultry manure was studied using thermogravimetric analysis and (13)C nuclear magnetic resonance. The stabilization processes carried out were composting, anaerobic digestion and a mixed process (partly aerobic, partly anaerobic). It was observed from the analyzed samples that the biological stabilization processes reduce the volatile content of the bio-wastes and increase the degree of aromaticity. The stabilization of cattle manure by means of aerobic processes was able to further oxidize and enriched in aromatic compounds the bio-waste when compared with the digestion process. On the other hand, the stabilization of poultry manure resulted in a greater aromatization under the digestion process. Stabilized samples with a high degree of aromaticity presented a lower volatile content accompanied by a reduction in the intensity of the differential thermogravimetry peak registered under an inert atmosphere, indicative of the thermal decomposition of the organic matter. The thermal decomposition of all the analyzed materials (fresh and stabilized samples) commenced at around 200 degrees C but for the digested poultry manure, which decomposition initiated close to 250 degrees C. All stabilized samples yielded a lower degree of volatilization to that one observed in fresh samples.