Oncogenic osteomalacia. A case report.

Oncogenic osteomalacia is a rare condition characterized by the development of pain and fractures in a patient with specific laboratory abnormalities consisting of hypophosphatemia, hyperphosphaturia, and decreased 1,25-OH vitamin D levels. The clinical scenario is completed by the association of this osteomalacic state with the finding of a neoplastic process in the afflicted patient. The authors report a patient in whom the diagnosis of oncogenic osteomalacia was established and treatment begun despite the fact that the associated tumor (benign undifferentiated tumor of meschymal origin) escaped detection for many months. Following discovery of the tumor and identification by magnetic resonance imaging, the patient was cured by surgical resection.

Exposure of the anterior spine. Technique, complications, and results in 85 patients.

The anterior approach to the spine is necessary for correction of some congenital spinal deformities and other conditions, including spinal trauma, infection, and tumor. The morbidity associated with this procedure has not been extensively reviewed in the literature. Between 1981 and 1986, 85 patients (41 male and 44 female) aged 1 to 77 years underwent anterior spinal fusion by an orthopedic or general surgery team (33 pediatric patients and 52 adult patients). Thirty-four patients had scoliosis, 8 had kyphosis, 24 had spinal trauma, 9 had tumor, and 10 had infection. Fifteen patients had restrictive lung disease diagnosed by pulmonary function testing (10 children and 5 adults). The thoracoabdominal approach was used in 50 patients, thoracotomy in 22 patients, and the lumbar approach in 10 patients. Two incisions were used in three patients. Correction was accomplished by interbody fusion in 36 patients (17 with instrumentation) and strut graft in 49 patients (6 with instrumentation). Twelve strut grafts were vascularized ribs and 37 were free ribs. Eighty-two patients survived (96 percent). Seventy-four complications occurring in 50 patients all resolved prior to discharge. These included 28 pulmonary complications, 27 urinary complications, and 5 gastrointestinal complications. Three patients required prolonged mechanical ventilation. Solid fusion was seen in 78 of 85 patients, whereas pseudoarthrosis developed in 7.