Osteocondromatose em gato: relato de caso / Osteochondromatosis in a cat: case report

A osteocondromatose é caracterizada por nódulos únicos ou múltiplos decorrentes de um crescimento ósseo excessivo benigno. É encontrada em cães, gatos, equinos e humanos. Em felinos, tem maior incidência dos dois aos quatro anos de idade. A etiologia em gatos está relacionada ao vírus da leucemia felina, e também já foi encontrada relação com o fibrossarcoma. A manifestação clínica depende do local acometido e do tamanho da lesão. O diagnóstico definitivo é por meio de histopatologia e o prognóstico é desfavorável, pois ocorrem muitas recidivas. Este relato de caso objetiva descrever a apresentação dessa enfermidade em um felino jovem.(AU)

Osteochondromatosis is characterized by single or multiple nodules resulting from benign excessive bone growth. It is found in cats and dogs, horses and humans. In cats, a higher incidence is found in individuals from 2 to 4 years of age. The etiology in cats is related to the virus of feline leukemia, and is also related to fibrosarcoma. The clinical presentation depends on the area affected and the size of the lesion. The definitive diagnosis is by histopathology and the prognosis is poor because many relapses occur. This case report aims to describe the presentation of the disease in a young cat.(AU)

Osteocondromatosis múltiple familiar: a propósito de un caso / Multiple familial osteochondromatosis: presentation of a case

Los encondromas son tumores benignos de cartílago que crecen de forma lenta en las metáfisis de los huesos. Pueden ser lesiones solitarias o múltiples. Las encondromatosis comprenden un grupo heterogéneo de síndromes, difíciles de diferenciar, caracterizados por la presencia de múltiples encondromas que pueden llegar a producir malformaciones musculoesqueléticas (secundarias al acortamiento de extremidades), escoliosis, fracturas patológicas o seudoartrosis. La complicación más temida, el osteocondrosarcoma, puede acontecer hasta en el 25% de los pacientes. Exponemos el caso de un varón de 67 años, sin diagnósticos previos conocidos, que consulta por la aparición en cadera izquierda de una tumoración dolorosa y rápidamente deformante en el último año. Los antecedentes familiares y los datos clínico-radiológicos confirmaron el diagnóstico de osteocondromatosis múltiple familiar. Aun cuando la evolución clínica y los estudios de imagen hicieron sospechar una degeneración maligna (osteocondrosarcoma), esta no se confirmó en el estudio histopatológico de la pieza quirúrgica (AU)

Enchondromas are benign cartilage tumours that grow slowly in the bone metaphysis. They may involve solitary or multiple lesions. Enchondromatoses include a heterogeneous group of hardly distinguishable syndromes characterised by the presence of multiple enchondromas that may cause musculoskeletal malformations (secondary to limb shortening), scoliosis, pathological fractures, or pseudoarthrosis. The most dreaded complication, osteochondrosarcoma, occurs in up to 25% of patients. We present the case of a 67-year-old male with no previous diagnosis, requiring attention due to the appearance of a painful tumour in his left hip which degenerated rapidly over the past year. Family history and clinical-radiological data confirmed the diagnosis of Multiple Familial Osteochondromatosis. Although clinical evolution and imaging led to suspect a malignant degeneration (osteochondrosarcoma), this was not confirmed by the histopathological study of the surgical sample (AU)

High resolution ultrasonography in the diagnosis of ulnar nerve lesions with particular reference to post-traumatic lesions and sites outside the elbow.

OBJECTIVE: Recent studies suggest that high resolution ultrasonography (HRU) is useful in evaluating ulnar neuropathy (UN) at the elbow. These studies do not include UN outside the elbow and lesions related to previous trauma. We investigate diagnostic utility of HRU in UN at any location of traumatic and non-traumatic etiology. METHODS: Patients with clinically suspected and electrophysiologically defined UN at the elbow and outside the elbow were included. Nerve conduction studies (NCS) were compared with HRU. HRU defined UN in terms of change in cross-sectional area. RESULTS: Our retrospective analysis included 46 UN. In 25 cases both NCS and HRU localised neuropathy to the elbow. In 15 where NCS was abnormal but non-localising, HRU localised the lesion in 14, 7 outside the elbow. In three of these, HRU characterised further pathology (synovial osteochondromatosis (n=2), myositis ossificans (n=1). Cross-sectional area of the ulnar nerve at the sulcus significantly correlated with distal NCS parameters. CONCLUSIONS: HRU is of greater use than NCS in the localisation of UN both at the elbow and outside the elbow and in UN related to previous trauma. SIGNIFICANCE: HRU is useful for the localisation of ulnar neuropathy.

Traqueobroncopatía osteocondroplásica. A propósito de un caso / No disponible

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Condromatosis sinovial. Estudio de 39 pacientes / Synovial chondromatosis. A study of 39 patients

Objetivo: Estudiar las manifestaciones clínicas, el empleo de las técnicas de diagnóstico por la imagen y la evolución de las condromatosis sinoviales en nuestra área sanitaria. Pacientes y métodos: El hospital POVISA tiene vinculada una población de 127.000 habitantes. Se revisaron retrospectivamente las historias clínicas de todos los pacientes de nuestra área sanitaria en los que se estableció histológicamente el diagnóstico de condromatosis sinovial entre enero de 1992 y diciembre de 2003. Resultados: Se recogieron 38 condromatosis de localización articular, todas monoarticulares, y 1 extraarticular, que correspondieron a 20 varones y a 19 mujeres, cuya edad (media ± DE) en el momento del diagnóstico fue de 56,5 ± 12,7 años (rango: 16-79 años). La principal localización articular fue la rodilla (15; 39,5%), seguida de la cadera (8; 21%) y de la temporomandibular y codo, ambas en 3 (7,9%) pacientes. Se documentó una artropatía previa en 18 (18/38; 47,4%) pacientes. El período sintomático previo al diagnóstico fue de 25,4 ± 34 meses. Las manifestaciones clínicas más frecuentes fueron el dolor articular (100%), la restricción de la movilidad (77%) y la tumefacción (57%). Se realizaron radiografías simples en todos los pacientes y sugirieron el diagnóstico en 20 (51,3%) de ellos. Los hallazgos de la resonancia magnética orientaron al diagnóstico en 12 (80%) de los 15 pacientes en los que se solicitó. En todos los casos se procedió a la extracción de los cuerpos libres y a una sinovectomía que se realizó por vía artroscópica en 6. Fue necesario colocar una prótesis articular (cadera o rodilla) en 16 (42%) pacientes. Durante el seguimiento posquirúrgico (23,7 ± 5,3 meses) no se identificó ningún caso de condrosarcoma y la tasa de recidivas fue baja (7,9%). Conclusiones: En nuestro medio, casi la mitad (47,4%) de las condromatosis sinoviales asentaron sobre una articulación previamente dañada, la demora del diagnóstico superó los 2 años y fue necesaria una prótesis de cadera o rodilla en el 42% de los pacientes(AU)

Objective: To study the clinical manifestations, use of diagnostic imaging techniques and outcome of patients with synovial chondromatosis in our health area. Patients and methods: POVISA Hospital provides health services to a population of 127,000 inhabitants. The clinical histories of all the patients in this area who were histologically diagnosed with synovial chondromatosis between January 1992 and December 2003 were reviewed. Results: There were 38 cases of joint chondromatosis, all monoarticular, and one case of extra-articular chondromatosis in 20 men and 19 women aged 56.5 ± 12.7 years (mean ± SD) at diagnosis (range: 16-79 years). The main joint affected was the knee (15; 39.5%), followed by the hip (8; 21%) and the temporomandibular joint and elbow, both of these in three patients (7.9%). Previous arthropathy was recorded in 18 patients (18/38, 47.4%). Symptom duration prior to diagnosis was 25.4 ± 34 months. The most frequent clinical manifestations were joint pain (100%), restricted movement (77%) and swelling (57%). Plain radiographs were carried out in all patients and suggested the diagnosis in 20 (51.3%). Magnetic resonance imaging findings led to a diagnosis in 12 out of 15 patients in whom this procedure was required (80%). In all patients loose bodies were removed and synovectomy was performed by arthroscopic procedures in six. In 16 patients (42%) total joint replacement was required. The mean postoperative follow-up was 23.7 ± 5.3 months. No cases of chondrosarcoma were identified and the recurrence rate was low (7.9%). Conclusions: In our setting, almost half (47.4%) of the cases of synovial chondromatosis occurred in a previously damaged joint: the correct diagnosis was delayed by more than 2 years and total arthroplasty was required in 42% of the patients(AU)

Determination of bone age in children with cartilaginous dysplasia (multiple hereditary osteochondromatosis and Ollier's enchondromatosis).

Cartilaginous dysplasias (multiple hereditary osteochondromatosis [MHO] and Ollier's enchondromatosis [OE]) are common pediatric orthopaedic conditions. Long bone growth deformities commonly develop in children with MHO and OE. The timing of procedures frequently used to treat these deformities is often dependent upon the bone age. It was the purpose of this study to investigate bone ages in a series of 40 children with MHO and OE. There were 6 girls and 9 boys with OE, and 9 girls and 16 boys with MHO. Each child's age, gender, race, and diagnosis were recorded. Hand-wrist radiographs obtained during routine evaluation of hand-wrist deformities or scanograms were identified, randomly numbered, and blinded regarding the identity and age of the child. Each radiograph was reviewed by five different observers at two different times separated by a minimum of 3 weeks. Statistical analyses were performed, looking at differences between bone and chronological age; inter- and intraobserver variability in bone age assessment; and differences by observer. The average chronological age (n = 40) was 7.8 +/- 3.6 years, average bone age (n = 400) was 7.2 +/- 3.7 years, and average difference between chronological and bone age (n = 400) was 0.6 +/- 1.3 years (P < 10-6). Intra- and interobserver variability was +/-1.5 and +/-1.6 years. There were no differences between observers in the average chronological/bone age difference (P = 0.63). Clinicians should be aware of this average 0.6-year delay in bone age when planning an epiphysiodesis for limb length equalization in children with cartilaginous dysplasias.

Evaluation of the forearm in untreated adult subjects with multiple hereditary osteochondromatosis.

BACKGROUND: Limb-length discrepancy or angular deformities as a result of altered bone growth may lead to a decreased range of motion and impaired function as well as premature osteoarthritis in patients with multiple hereditary osteochondromatosis. The purpose of this study was to describe the function of the forearm in untreated patients in order to facilitate comparison with studies of the results of treatment of this condition. METHODS: The medical records of fifty-one pediatric patients were identified and served as the basis for identifying a cohort of adult relatives with the disorder. Participants were asked about pain and limitations in vocational or recreational activities and about concerns with regard to cosmetic appearance. Radiographs of the forearm and wrist were made to quantify the deformity. Functional outcome was assessed on the basis of a comparison with the norms for grip and pinch strength and for scores on the hand function test of Jebsen et al. Limitations in the range of motion of the upper extremities were converted to standard impairment ratings. RESULTS: Participants included twenty-two men and seventeen women with an average age of forty-two years (range, twenty to eighty years). Most of the patients were employed in careers of their choice, with only five (13%) indicating that they were limited in any way in the performance of their jobs. Twenty-six subjects (67%) participated in recreational activities, and sixty-eight arms (88%) were reported to be free of pain. Objective measurement of function demonstrated greater disability than that found from subjective reporting. Fourteen arms had an impairment rating of >10%, while twenty had decreased pinch strength and sixteen had decreased grip strength. Ten arms (13%) had decreased hand function according to the hand test of Jebsen et al. Radiographic evaluation demonstrated osteoarthritic changes in three limbs. CONCLUSIONS: Affected individuals had definite decreases in hand and wrist function, yet these did not result in major increases in pain or in limitations in daily work and recreation. This cohort provides a basis for comparison with the results of operative treatment in affected individuals with multiple hereditary osteochondromatosis.