Clinical orthopaedics and related research, Jan 28, 2016
Reconstruction of periacetabular defects after pelvic tumor resection ranks among the most challe... more Reconstruction of periacetabular defects after pelvic tumor resection ranks among the most challenging procedures in orthopaedic oncology, and reconstructive techniques are generally associated with dissatisfying mechanical and nonmechanical complication rates. In an attempt to reduce the risk of dislocation, aseptic loosening, and infection, we introduced the LUMiC(®) prosthesis (implantcast, Buxtehude, Germany) in 2008. The LUMiC(®) prosthesis is a modular device, built of a separate stem (hydroxyapatite-coated uncemented or cemented) and acetabular cup. The stem and cup are available in different sizes (the latter of which is also available with silver coating for infection prevention) and are equipped with sawteeth at the junction to allow for rotational adjustment of cup position after implantation of the stem. Whether this implant indeed is durable at short-term followup has not been evaluated. (1) What proportion of patients experience mechanical complications and what are th...
The Journal of bone and joint surgery. American volume, Jan 17, 2016
A central atypical cartilaginous tumor (ACT)-formerly known as chondrosarcoma grade 1 (CS1)-is a ... more A central atypical cartilaginous tumor (ACT)-formerly known as chondrosarcoma grade 1 (CS1)-is a tumor of intermediate-type malignancy, often treated with surgery. The extent of surgery remains controversial, as some advocate resection and others favor local treatment by curettage. Because of the low prevalence of ACT/CS1, the available data are limited and generally not uniform. The purpose of this study was to present the outcome for a large cohort of patients with ACT/CS1 in the long bones who were treated with curettage and adjuvant phenolization and followed for a minimum of two years according to national guidelines. A retrospective study was designed to analyze data from 108 patients treated for central ACT/CS1 in the long bones between 2006 and 2012. All patients were treated with curettage and adjuvant phenolization, and defects were filled with polymethylmethacrylate, bone graft, or bone substitutes. The primary end point was local recurrence or residual tumor. Secondary e...
BACKGROUND: Aim of our study was to compare functional ability and physical activity in children ... more BACKGROUND: Aim of our study was to compare functional ability and physical activity in children and young adults who underwent surgery for a malignant bone tumor that was located around the knee. METHODS: This cross-sectional study included 82 patients aged 8-25 years with a follow-up of 1-5 years. The functional ability and the amount of physical activity were evaluated by
The International Journal of Tuberculosis and Lung Disease
... It is difficult to pro-duce stable anti-tuberculosis formulations, particularly those contain... more ... It is difficult to pro-duce stable anti-tuberculosis formulations, particularly those containing ethambutol HCl, unless the manu-facturing environment is ... 3 Bhutani H, Singh S, Chakraborti AK, Jindal K C. Mechanistic explanation to the catalysis by pyrazinamide and ethambutol of ...
The International Journal of Tuberculosis and Lung Disease
SETTING: Tuberculosis Centre, University Medical Centre, Groningen, The Netherlands.OBJECTIVES: T... more SETTING: Tuberculosis Centre, University Medical Centre, Groningen, The Netherlands.OBJECTIVES: To study intralesional concentrations of isoniazid (INH), rifampicin (RMP) and pyrazinamide (PZA) in tuberculous pleural effusions and psoas abscesses, and to compare these to reference serum values and minimal inhibitory concentration (MIC).DESIGN: Intralesional concentrations were measured 2 h after drug administration (six pleural effusions, 10 psoas abscesses).RESULTS: A wide range of concentrations was found for pleural effusions and psoas abscesses. Concentrations were below MIC values in none of 15 patients for INH, in two of 13 for RMP, and in eight of nine for PZA. The Cmax:MIC ratio was always >4 for INH, in four of 13 for RMP, and in none of nine for PZA. In 5/8 patients receiving all three drugs, both RMP and PZA had Cmax:MIC ratios <4, indicating sub-therapeutic drug levels.CONCLUSION: Penetration of INH was always sufficient, penetration of RMP mostly below the desired...
The symptoms of a stress fracture are almost identical to those of most bone tumours. Even with t... more The symptoms of a stress fracture are almost identical to those of most bone tumours. Even with the use of various imaging techniques, it can be difficult to establish the correct diagnosis. Although a primary bone tumour requires early treatment to improve its prognosis, the discriminative factor in the diagnosis of a stress fracture is its clinical development over time. A 10-year-old boy was referred to our outpatient clinic on the suspicion of a primary bone tumour in his right tibia. A case was once described in this journal in which a stress fracture had eventually led to an amputation. The suspicion of primary bone tumour often marks the start of a long and intense diagnostic course. A stress fracture is the major diagnostic pitfall when there is a suspicion of such a tumour. If doubts persist after a diagnostic work-up by imaging, consultation with the Bone Tumour Committee is indicated. The patient can also be quickly referred to a centre specialised in treating bone tumours, as was the case in this article.
Atypical cartilaginous tumours are usually treated by curettage. The purpose of this study was to... more Atypical cartilaginous tumours are usually treated by curettage. The purpose of this study was to show that radiofrequency ablation was an effective alternative treatment. We enrolled 20 patients (two male, 18 female, mean age 56 years (36 to 72) in a proof-of-principle study. After inclusion, biopsy and radiofrequency ablation were performed, followed three months later by curettage and adjuvant phenolisation. The primary endpoint was the proportional necrosis in the retrieved material. Secondary endpoints were correlation with the findings on gadolinium enhanced MRI, functional outcome and complications. Our results show that 95% to 100% necrosis was obtained in 14 of the 20 patients. MRI had a 91% sensitivity and 67% specificity for detecting residual tumour after curettage. The mean functional outcome (MSTS) score six weeks after radiofrequency ablation was 27.1 (23 to 30) compared with 18.1 (12 to 25) after curettage (p < 0.001). No complications occurred after ablation, whi...
The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of Radiopharmaceutical Chemistry and Biology, 2014
Infections of the bone, spine and prosthetic joints are serious and complex conditions to diagnos... more Infections of the bone, spine and prosthetic joints are serious and complex conditions to diagnose and to treat. Structured diagnostic workup may very well improve the accuracy and speed of diagnosis, thereby improving the outcome since treatment may very well be more successful and less harmful if timely management is started. Literature shows no uniform advise on diagnosis. The EANM organized a consensus meeting with representatives from the involved disciplines in order to develop common flowcharts for the diagnosis of osteomyelitis, spondylodiscitis and prosthetic joint infections. In this report the proceedings of this consensus meeting, including the proposed flowcharts for diagnosis, are published.
Computer aided surgery : official journal of the International Society for Computer Aided Surgery, 2013
Chondrosarcoma of the pelvis is difficult to treat due to the anatomical location and the high in... more Chondrosarcoma of the pelvis is difficult to treat due to the anatomical location and the high incidence of recurrence. Treatment is primarily surgical, and the surgical margins, based on MSTS criteria, have been shown to be predictive of disease recurrence and mortality. However, too-wide margins can decrease post-operative function. In the presented case, computer assisted surgery (CAS) was used to safely enable a joint-salvaging approach in a modified type 2/3 resection of a grade 2 chondrosarcoma of the os ischium and os pubis. The CAS navigation was vital to achieving the desired safe margins. The current follow-up period is 3.5 years, and the patient is disease-free, with no local recurrences or metastases having been detected. Post-operative function is excellent, with good MSTS and SF36 scores. This outcome is a good example of the value of CAS in certain cases.
We describe a 66-year-old woman who presented with firm masses on her left hand, which had recent... more We describe a 66-year-old woman who presented with firm masses on her left hand, which had recently increased in size, and multiple haemangiomas. A diagnosis of Maffucci syndrome was established. Renewed growth of enchondromas during adulthood is suspicious for malignant transformation. Therefore, curettage with adjuvant fenolisation was performed in our patient. Clinical and radiological follow-up was required concerning local recurrence.
The symptoms of a stress fracture are almost identical to those of most bone tumours. Even with t... more The symptoms of a stress fracture are almost identical to those of most bone tumours. Even with the use of various imaging techniques, it can be difficult to establish the correct diagnosis. Although a primary bone tumour requires early treatment to improve its prognosis, the discriminative factor in the diagnosis of a stress fracture is its clinical development over time. A 10-year-old boy was referred to our outpatient clinic on the suspicion of a primary bone tumour in his right tibia. A case was once described in this journal in which a stress fracture had eventually led to an amputation. The suspicion of primary bone tumour often marks the start of a long and intense diagnostic course. A stress fracture is the major diagnostic pitfall when there is a suspicion of such a tumour. If doubts persist after a diagnostic work-up by imaging, consultation with the Bone Tumour Committee is indicated. The patient can also be quickly referred to a centre specialised in treating bone tumour...
Radiofrequency ablation (RFA) is a treatment technique in which an electrode is introduced throug... more Radiofrequency ablation (RFA) is a treatment technique in which an electrode is introduced through a cannula into the centre of a tumour. This electrode is activated for a period of time, resulting in the tumour surrounding the electrode being thermally ablated. This technique is already being used in the treatment of liver and lung tumours. RFA is performed relatively infrequently for osteoid osteoma. A hospitalised patient is usually treated for osteoid osteoma by surgical removal of the tumour and its surrounding tissue. Several reports have shown that RFA is not only more effective than the surgical method, but is also safer for the patient. The rehabilitation period after RFA treatment is also significantly shorter. It is expected that RFA will replace surgical excision in the treatment of patients with osteoid osteoma.
Nederlands tijdschrift voor geneeskunde, Jan 19, 2008
To determine, on the basis of the available literature, whether kyphoplasty is a safe technique f... more To determine, on the basis of the available literature, whether kyphoplasty is a safe technique for the treatment of osteoporotic vertebral compression fractures that leads to functional improvement in the patient's activities of daily living. Review of the literature. METHOD. Publications on the results of kyphoplasty were retrieved from Medline, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies were included on the treatment of osteoporotic vertebral compression fractures with kyphoplasty involving more than 15 patients and with a follow-up of at least 6 months. The quality of the studies was assessed using the Newcastle Ottawa quality assessment scale. 12 studies met the inclusion criteria. No randomised controlled trials were retrieved. Severe complications such as pulmonary embolism, spinal stenosis, radiculopathy, and epidural haematoma occurred in 13 of the 737 patients. Leakage of cement occurred in 133 out of 1205 treated vertebrae. In 2 s...
Diagnosis and treatments of bone metastasis were reviewed with clinical experiments in National M... more Diagnosis and treatments of bone metastasis were reviewed with clinical experiments in National Medical center Hospital. As for diagnosis of bone metastasis, early detection of bone metastasis was significantly improved by using bone scintigrams recently progressed. But the results of reviews suggest the possible improvements in diagnosis of bone metastasis. X-CT (X-ray Computed Tomography) for diagnosis of bone metastasis is advantages in three dimensional delineation of the extend and spread of bone lesions in bone marrow over bone scintigram. MRI (magnetic resonance imaging) has clinically been developed since 1981, does not directly represent bone structures but soft tissues in bone marrow, giving useful information concerning changes and spread of metastatic bone tumor not only inside the bone but also around it. MRI is now in technical progress and expected some improvements, could be expected in early diagnosis of bone metastasis. Regarding as treatment, we have individually ...
Clinical orthopaedics and related research, Jan 28, 2016
Reconstruction of periacetabular defects after pelvic tumor resection ranks among the most challe... more Reconstruction of periacetabular defects after pelvic tumor resection ranks among the most challenging procedures in orthopaedic oncology, and reconstructive techniques are generally associated with dissatisfying mechanical and nonmechanical complication rates. In an attempt to reduce the risk of dislocation, aseptic loosening, and infection, we introduced the LUMiC(®) prosthesis (implantcast, Buxtehude, Germany) in 2008. The LUMiC(®) prosthesis is a modular device, built of a separate stem (hydroxyapatite-coated uncemented or cemented) and acetabular cup. The stem and cup are available in different sizes (the latter of which is also available with silver coating for infection prevention) and are equipped with sawteeth at the junction to allow for rotational adjustment of cup position after implantation of the stem. Whether this implant indeed is durable at short-term followup has not been evaluated. (1) What proportion of patients experience mechanical complications and what are th...
The Journal of bone and joint surgery. American volume, Jan 17, 2016
A central atypical cartilaginous tumor (ACT)-formerly known as chondrosarcoma grade 1 (CS1)-is a ... more A central atypical cartilaginous tumor (ACT)-formerly known as chondrosarcoma grade 1 (CS1)-is a tumor of intermediate-type malignancy, often treated with surgery. The extent of surgery remains controversial, as some advocate resection and others favor local treatment by curettage. Because of the low prevalence of ACT/CS1, the available data are limited and generally not uniform. The purpose of this study was to present the outcome for a large cohort of patients with ACT/CS1 in the long bones who were treated with curettage and adjuvant phenolization and followed for a minimum of two years according to national guidelines. A retrospective study was designed to analyze data from 108 patients treated for central ACT/CS1 in the long bones between 2006 and 2012. All patients were treated with curettage and adjuvant phenolization, and defects were filled with polymethylmethacrylate, bone graft, or bone substitutes. The primary end point was local recurrence or residual tumor. Secondary e...
BACKGROUND: Aim of our study was to compare functional ability and physical activity in children ... more BACKGROUND: Aim of our study was to compare functional ability and physical activity in children and young adults who underwent surgery for a malignant bone tumor that was located around the knee. METHODS: This cross-sectional study included 82 patients aged 8-25 years with a follow-up of 1-5 years. The functional ability and the amount of physical activity were evaluated by
The International Journal of Tuberculosis and Lung Disease
... It is difficult to pro-duce stable anti-tuberculosis formulations, particularly those contain... more ... It is difficult to pro-duce stable anti-tuberculosis formulations, particularly those containing ethambutol HCl, unless the manu-facturing environment is ... 3 Bhutani H, Singh S, Chakraborti AK, Jindal K C. Mechanistic explanation to the catalysis by pyrazinamide and ethambutol of ...
The International Journal of Tuberculosis and Lung Disease
SETTING: Tuberculosis Centre, University Medical Centre, Groningen, The Netherlands.OBJECTIVES: T... more SETTING: Tuberculosis Centre, University Medical Centre, Groningen, The Netherlands.OBJECTIVES: To study intralesional concentrations of isoniazid (INH), rifampicin (RMP) and pyrazinamide (PZA) in tuberculous pleural effusions and psoas abscesses, and to compare these to reference serum values and minimal inhibitory concentration (MIC).DESIGN: Intralesional concentrations were measured 2 h after drug administration (six pleural effusions, 10 psoas abscesses).RESULTS: A wide range of concentrations was found for pleural effusions and psoas abscesses. Concentrations were below MIC values in none of 15 patients for INH, in two of 13 for RMP, and in eight of nine for PZA. The Cmax:MIC ratio was always >4 for INH, in four of 13 for RMP, and in none of nine for PZA. In 5/8 patients receiving all three drugs, both RMP and PZA had Cmax:MIC ratios <4, indicating sub-therapeutic drug levels.CONCLUSION: Penetration of INH was always sufficient, penetration of RMP mostly below the desired...
The symptoms of a stress fracture are almost identical to those of most bone tumours. Even with t... more The symptoms of a stress fracture are almost identical to those of most bone tumours. Even with the use of various imaging techniques, it can be difficult to establish the correct diagnosis. Although a primary bone tumour requires early treatment to improve its prognosis, the discriminative factor in the diagnosis of a stress fracture is its clinical development over time. A 10-year-old boy was referred to our outpatient clinic on the suspicion of a primary bone tumour in his right tibia. A case was once described in this journal in which a stress fracture had eventually led to an amputation. The suspicion of primary bone tumour often marks the start of a long and intense diagnostic course. A stress fracture is the major diagnostic pitfall when there is a suspicion of such a tumour. If doubts persist after a diagnostic work-up by imaging, consultation with the Bone Tumour Committee is indicated. The patient can also be quickly referred to a centre specialised in treating bone tumours, as was the case in this article.
Atypical cartilaginous tumours are usually treated by curettage. The purpose of this study was to... more Atypical cartilaginous tumours are usually treated by curettage. The purpose of this study was to show that radiofrequency ablation was an effective alternative treatment. We enrolled 20 patients (two male, 18 female, mean age 56 years (36 to 72) in a proof-of-principle study. After inclusion, biopsy and radiofrequency ablation were performed, followed three months later by curettage and adjuvant phenolisation. The primary endpoint was the proportional necrosis in the retrieved material. Secondary endpoints were correlation with the findings on gadolinium enhanced MRI, functional outcome and complications. Our results show that 95% to 100% necrosis was obtained in 14 of the 20 patients. MRI had a 91% sensitivity and 67% specificity for detecting residual tumour after curettage. The mean functional outcome (MSTS) score six weeks after radiofrequency ablation was 27.1 (23 to 30) compared with 18.1 (12 to 25) after curettage (p < 0.001). No complications occurred after ablation, whi...
The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of Radiopharmaceutical Chemistry and Biology, 2014
Infections of the bone, spine and prosthetic joints are serious and complex conditions to diagnos... more Infections of the bone, spine and prosthetic joints are serious and complex conditions to diagnose and to treat. Structured diagnostic workup may very well improve the accuracy and speed of diagnosis, thereby improving the outcome since treatment may very well be more successful and less harmful if timely management is started. Literature shows no uniform advise on diagnosis. The EANM organized a consensus meeting with representatives from the involved disciplines in order to develop common flowcharts for the diagnosis of osteomyelitis, spondylodiscitis and prosthetic joint infections. In this report the proceedings of this consensus meeting, including the proposed flowcharts for diagnosis, are published.
Computer aided surgery : official journal of the International Society for Computer Aided Surgery, 2013
Chondrosarcoma of the pelvis is difficult to treat due to the anatomical location and the high in... more Chondrosarcoma of the pelvis is difficult to treat due to the anatomical location and the high incidence of recurrence. Treatment is primarily surgical, and the surgical margins, based on MSTS criteria, have been shown to be predictive of disease recurrence and mortality. However, too-wide margins can decrease post-operative function. In the presented case, computer assisted surgery (CAS) was used to safely enable a joint-salvaging approach in a modified type 2/3 resection of a grade 2 chondrosarcoma of the os ischium and os pubis. The CAS navigation was vital to achieving the desired safe margins. The current follow-up period is 3.5 years, and the patient is disease-free, with no local recurrences or metastases having been detected. Post-operative function is excellent, with good MSTS and SF36 scores. This outcome is a good example of the value of CAS in certain cases.
We describe a 66-year-old woman who presented with firm masses on her left hand, which had recent... more We describe a 66-year-old woman who presented with firm masses on her left hand, which had recently increased in size, and multiple haemangiomas. A diagnosis of Maffucci syndrome was established. Renewed growth of enchondromas during adulthood is suspicious for malignant transformation. Therefore, curettage with adjuvant fenolisation was performed in our patient. Clinical and radiological follow-up was required concerning local recurrence.
The symptoms of a stress fracture are almost identical to those of most bone tumours. Even with t... more The symptoms of a stress fracture are almost identical to those of most bone tumours. Even with the use of various imaging techniques, it can be difficult to establish the correct diagnosis. Although a primary bone tumour requires early treatment to improve its prognosis, the discriminative factor in the diagnosis of a stress fracture is its clinical development over time. A 10-year-old boy was referred to our outpatient clinic on the suspicion of a primary bone tumour in his right tibia. A case was once described in this journal in which a stress fracture had eventually led to an amputation. The suspicion of primary bone tumour often marks the start of a long and intense diagnostic course. A stress fracture is the major diagnostic pitfall when there is a suspicion of such a tumour. If doubts persist after a diagnostic work-up by imaging, consultation with the Bone Tumour Committee is indicated. The patient can also be quickly referred to a centre specialised in treating bone tumour...
Radiofrequency ablation (RFA) is a treatment technique in which an electrode is introduced throug... more Radiofrequency ablation (RFA) is a treatment technique in which an electrode is introduced through a cannula into the centre of a tumour. This electrode is activated for a period of time, resulting in the tumour surrounding the electrode being thermally ablated. This technique is already being used in the treatment of liver and lung tumours. RFA is performed relatively infrequently for osteoid osteoma. A hospitalised patient is usually treated for osteoid osteoma by surgical removal of the tumour and its surrounding tissue. Several reports have shown that RFA is not only more effective than the surgical method, but is also safer for the patient. The rehabilitation period after RFA treatment is also significantly shorter. It is expected that RFA will replace surgical excision in the treatment of patients with osteoid osteoma.
Nederlands tijdschrift voor geneeskunde, Jan 19, 2008
To determine, on the basis of the available literature, whether kyphoplasty is a safe technique f... more To determine, on the basis of the available literature, whether kyphoplasty is a safe technique for the treatment of osteoporotic vertebral compression fractures that leads to functional improvement in the patient's activities of daily living. Review of the literature. METHOD. Publications on the results of kyphoplasty were retrieved from Medline, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Studies were included on the treatment of osteoporotic vertebral compression fractures with kyphoplasty involving more than 15 patients and with a follow-up of at least 6 months. The quality of the studies was assessed using the Newcastle Ottawa quality assessment scale. 12 studies met the inclusion criteria. No randomised controlled trials were retrieved. Severe complications such as pulmonary embolism, spinal stenosis, radiculopathy, and epidural haematoma occurred in 13 of the 737 patients. Leakage of cement occurred in 133 out of 1205 treated vertebrae. In 2 s...
Diagnosis and treatments of bone metastasis were reviewed with clinical experiments in National M... more Diagnosis and treatments of bone metastasis were reviewed with clinical experiments in National Medical center Hospital. As for diagnosis of bone metastasis, early detection of bone metastasis was significantly improved by using bone scintigrams recently progressed. But the results of reviews suggest the possible improvements in diagnosis of bone metastasis. X-CT (X-ray Computed Tomography) for diagnosis of bone metastasis is advantages in three dimensional delineation of the extend and spread of bone lesions in bone marrow over bone scintigram. MRI (magnetic resonance imaging) has clinically been developed since 1981, does not directly represent bone structures but soft tissues in bone marrow, giving useful information concerning changes and spread of metastatic bone tumor not only inside the bone but also around it. MRI is now in technical progress and expected some improvements, could be expected in early diagnosis of bone metastasis. Regarding as treatment, we have individually ...
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