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Background/aims: This study was undertaken to evaluate changes in the seroepidemiological pattern of Helicobacter pylori in a group of Turkish children over a span of 10 years., Methods: A total of 403 (219+184) serum samples were obtained from a primary school located in the urban part of Ankara in 1990 and 2000. All of the samples were from healthy students aged 7-14 (in 1990, n= 219, 109 females; and in 2000, n= 184, 90 females)., Results: All serum samples were assayed for Helicobacter pylori IgG by means of enzyme-linked immunosorbent assay. The overall prevalence of Helicobacter pylori antibodies was 78.5% in 1990 and 66.3% in 2000. The prevalence of Helicobacter pylori was found to be decreasing over a time span of 10 years (p<0.01). While the most susceptible age group to Helicobacter pylori in 1990 was 10 years (89.5%), in 2000 the susceptible age group was 8 years (85.0%)., Conclusions: Our data suggest that the seroprevalence of Helicobacter pylori infection seems to have decreased during the last 10 years in Turkey. This change may be attributable to the changes in environmental condition and socioeconomic development that have taken place in the country.

We describe the case of a 78-year-old man with a large elastofibroma deep to his scapula that was inconspicuous on MRI examination with his arm at his side in neutral position. The mass was not detected sonographically until the patient abducted his arm, allowing the elastofibroma to emerge from under the scapula. The diagnosis of elastofibroma was suggested by the typical sonographic appearance of a hypoechoic mass with interspersed linear echogenicity, resembling muscle. The mass was excised, and the diagnosis was confirmed on histopathologic examination., (Copyright 2003 Wiley Periodicals, Inc.)

Objective: To report, in 4 patients, the occurrence of 2 different primary tumours in proximity in the same bone. Three patients had osteosarcomas, and 1 had a giant cell tumour; all had coincident metaphyseal fibrous defect., Methods: Four patients (2 women, 1 man and 1 boy; 18, 25, 24 and 10 years of age, respectively) presented with progressive pain in the knee and distal thigh. All were studied by radiography, magnetic resonance imaging was done in 3 patients, and diagnostic open biopsy was performed for all., Results: Radiologic studies demonstrated tumours in the distal end of the femur in all 4 patients. Biopsy tissue showed a metaphyseal fibrous defect in all, with coexistence of an associated giant cell tumour in 1 patient and an osteosarcoma in each of the others. In all cases, the metaphyseal fibrous defect was penetrated by the adjacent tumour., Conclusions: Despite the relative prevalence of metaphyseal fibrous defect, giant cell tumour and osteosarcomas in the distal end of the femur and their occurrence in approximately the same age group, their association has rarely been reported. As both giant cell tumours and osteosarcomas are usually diagnosed late in their clinical course, they may outgrow and destroy any evidence of pre-existing metaphyseal fibrous defect. The rate of destruction is also influenced by the distance between the 2 lesions--the shorter the distance, the earlier the destruction.

We describe two cases of pigmented villonodular synovitis affecting true bursae. This study was also designed to discuss the term "pigmented villonodular bursitis", not confined to true synovial bursae, sometimes creating misunderstanding.

We report a case of a 14-year-old boy with an intracompartmental lytic lesion with poorly defined margins in the right distal tibia that was originally treated with curettage and bone grafting. Histologic examination showed an osteoblastic tumor with unusual features, which was found on consultation to be an osteoblastoma-like osteosarcoma, a rare, low-grade variant of osteosarcoma. Subsequently, the patient underwent en bloc resection of the distal tibia, which was replaced with vascularized bone graft and followed by chemotherapy. Two years later, he is alive with lung metastases.

The clinical behavior of giant cell tumor is related to the radiological appearance. To test the hypothesis that in vitro proliferation of the neoplastic stromal cell population of giant cell tumors is related to the radiological appearance, this study was undertaken. A prospective analysis of the cells migrating from 13 consecutive tumors was conducted. Growth curves and population doubling-times (PDT) for first and fifth passages were calculated and alkaline phosphatase levels were measured and compared to preoperative radiographic staging. A strong negative correlation was found between PDT and the radiographic stage. Tumors in stages I and II (low aggressiveness) were found to have an average cell population doubling-time of 11 (SD 2.2) days, while those in stage III (high aggressiveness) showed a doubling-time of 6 (SD 2.2) days. Low alkaline phosphatase activity was noted in all cultures, a finding consistent with the putative preosteoblastic potential of these stromal cells. This putative origin is also indicated by the differentiation response to retinoic acid. The findings suggest that the in vitro proliferation of the mononuclear stromal cell population of giant cell tumors is related to the radiographic stage and may predict the clinical behavior of these tumors.

Autolymphocyte therapy (ALT) is tumor-specific, adoptive cellular therapy of neoplastic disease using nonspecific ex vivo activation of autologous peripheral blood lymphocytes (PBL), which are composed primarily of memory T-cells (ALT-cells) and are active in patients with metastatic renal cell carcinoma and melanoma. Ex vivo pretreatment of tumor target cells with certain chemotherapeutic agents can enhance susceptibility to lysis by antitumor lymphocytes. To determine if cis-diamminedichloroplatinum(II) (CDDP) enhances ex vivo antitumor cytotoxicity of ALT-cells and if this lysis is mediated by T- and/or NK-cells and is human leukocyte antigen (HLA)-restricted, human soft tissue sarcoma (STS) target cells were derived from primary and metastatic surgical specimens and were incubated with and without CDDP. ALT-cells were prepared from autologous PBL obtained prior to surgery. Primary (PSTS) and metastatic (MSTS) target cells from each group were labelled with chromium 51 (51Cr) and used as targets for ALT-cells, CD45-depleted ALT-cells, CD56 (NK)-depleted ALT-cells, and PBL in a standard (4-hour) and delayed (18-hour) 51Cr release assay. Interferon-gamma (IFN-gamma) release was measured as an indication of antitumor effect and recognition by the noncytolytic lymphocytes in ALT-cells. Primary tumor target cells incubated in CDDP showed enhanced lysis as measured by the 51Cr release assay compared to non-CDDP-treated controls. Metastatic tumor target cells showed less lysis than the primary targets, although this was enhanced by pretreating metastatic tumor targets with CDDP. Lysis of all tumor targets was significantly greater when ALT-cells were used as the effector cells rather than PBL. Depletion of memory T-cells abrogated ex vivo lysis. Depletion of NK cells (CD56+) affected ex vivo lysis of autologous targets during the 4-hour but not the 18-hour assay. Ex vivo ALT-cell lysis and IFN-gamma release against only the autologous tumor targets confirmed tumor-specificity in one patient. Restriction of ALT-cell lysis and IFN-gamma release against HLA-A2+ autologous and one allogeneic HLA-A2+ STS tumor target, but not other non-STS targets, was demonstrated in another patient. These data suggest that CDDP may help render STS susceptible to tumor-specific, immune-mediated attack and that the combination of ALT and CDDP may lead to effective tumor-specific chemoimmunotherapy in patients with metastatic STS.

A case of eosinophilic granuloma in an unusual location (ischium) is presented. Eosinophilic granuloma, a benign lesion of bone, has many radiographic appearances that vary with location. The flat bone of the skull and pelvis are common sites of involvement. Although the iliac wings and pubic rami are not uncommon sites for such a lesion, the ischium is a rare site. This occurrence prompted us to report this case.

Limb-sparing surgery has proven to be a feasible alternative to amputation for treatment of malignant tumors about the knee. Microvascular surgery and the possibility of providing healthy, stable soft-tissue coverage to the affected limb have expanded the possible role of limb-sparing techniques. Microvascular free flaps were utilized in 26 patients undergoing resection for large malignant tumors of the knee or adjacent to the knee. Patients were then followed for a minimum of 3 years to a maximum of 7 years and evaluated for tumor recurrence and limb function. Survival and disease-free interval were 68 and 77 percent, respectively, in stage II patients and only 50 and 0 percent, respectively, in stage III patients. Function, as determined by the MSTS functional evaluation system, was found to be fair to good in all patients. Microvascular free-tissue transfer has proven to be a valuable adjunct in limb-sparing surgery.

Intramuscular myxoma is a distinct benign tumor confined to muscles. This tumor usually favors the thigh and shoulder. We are reporting a case of intramuscular myxoma of the forearm in an elderly female, a very rare site for this tumor. The magnetic resonance features of intramuscular myxoma are described. The differential diagnosis that included acute hematoma, acute abscess, intramuscular synovial cyst, schwannoma and malignant soft tissue tumors with myxomatous degeneration is discussed. The association between intramuscular myxomas and fibrous dysplasia has been emphasized.

A report of recurrent simple bone cysts in two cases--a seven-year-old and a six-year-old male--is presented. In each case curettage and cortical banked bone graft were performed. On follow-up, there was no clinical or radiographic evidence of further recurrence.

Cancer rehabilitation is becoming more of a focus for the field of physiatry due to increased longevity and the side effects of treatment. In order to investigate the rehabilitation needs of patients undergoing limb-sparing procedures, chart analysis was conducted on 17 children treated for primary bone tumors by resection and an expandable endoprosthetic replacement. Each patient underwent a course of postoperative inpatient and outpatient physical therapy and was followed over an average of 2.5 years. Gait training was relatively straightforward and in seven patients required neither orthosis nor ambulatory aid. The other ten patients walked with a knee orthosis, axillary crutches, or both. Until the time came for reoperation to lengthen the implant, a shoe lift of 1in maximum was added to compensate for the limb length discrepancy. These findings compare favorably with the more complex requirements of high proximal amputees with external prostheses, including more difficult gait training and the need for frequent adjustments, as well as prosthetic replacement as the children grow. It is clear that children undergoing limb-sparing surgery have special needs that should be addressed, including early mobilization, gait training, adjustment to repeated brief hospitalizations for lengthening, and continued follow-up to monitor their activity restriction.

The overall spectrum of hemangiomas involving long tubular bones is exemplified by three cases, the first being medullary, the second periosteal, and the third intracortical. The clinical presentation was progressive pain at the site of the lesion in all cases. The medullary hemangioma involved the distal shaft of the humerus and was entirely radiolucent. The periosteal tumor was exceptional in that it affected the proximal shaft of the tibia in contrast to the seven previously reported cases that involved the midshaft of the bone. The intracortical hemangioma was in the tibia, the site of all three previously reported cases. Hemangioma of bone may show variable roentgenographic patterns related to the anatomic location and the type of involved bone. The final diagnosis is dependent on histologic evaluation.

Magnetic resonance imaging (MRI) was performed in six cases of intramuscular myxoma of the extremities and revealed the following characteristics. All tumours were confined to muscle and had a sharply defined border. All had a signal intensity lower than skeletal muscles on T1-weighted images and brighter than fat on T2-weighted images. The signals were homogeneous on both T1- and T2-weighted images. This study did not include contrast enhancement. The diagnosis was confirmed by an open biopsy. All tumours were resected with no recurrence. Diagnosis based on these MRI characteristics was incorrect in two cases of intramuscular ganglia and in a case of intramuscular cysticercus cellulose. MRI features of intramuscular myxoma are typical in the majority of cases. Benign intramuscular lesions that contain mainly fluid can mimic intramuscular myxomas.

Limb-sparing surgery has a definite role in the treatment of osteosarcoma in children. Increased survival, however, raises problems of limb-length discrepancy and prosthetic longevity. The concept of an expandable adjustable prosthesis addresses the problem of leg-length discrepancy. The problem of prosthesis longevity will require further long-term evaluation of current designs and methods of fixation, as well as the development of a permanent prosthesis or biologic replacement. At skeletal maturity, the expandable prosthesis may either be maintained or substituted with another implant or biological alternative if warranted by the clinical situation.

The Swarm rat chondrosarcoma has been the subject of extensive biochemical studies. However, to our knowledge, there are no previous reports in the literature on transplantation of this tumor into bone. This article describes the natural history of the tumor when implanted into the bone of the rat, and correlates its histological growth pattern with its radiological appearance. Our results showed that the tumor grows slowly in the bone. The rate of intramedullary growth, however, was variable and was not the same in all the animals. Its growth pattern resembles human chondrosarcoma, with extensive invasion of the marrow and cortex. In the first few weeks after implantation, the only radiological changes noted were mild medullary radiopacities. At a later stage, 12-14 weeks postimplantation, as the tumor infiltrated the bone, significant radiological abnormalities were observed in the medullary cavity and cortex. Periosteal reaction was seen after the tumor invaded the cortex with the production of a soft-tissue mass. Distant dissemination was rare; only 1 of 24 rats developed pulmonary metastases. The Swarm rat chondrosarcoma is a well-differentiated malignant tumor that histologically resembles well-differentiated human chondrosarcoma. Transplanted into bone, it may be useful as an experimental model for comparative studies with human chondrosarcoma.

Limb sparing in growing children has proved to be very effective from an oncologic perspective, with good, long-term acceptance by the patients. As in the adult, when performed by experienced surgeons, limb sparing neither compromises the survival rate nor significantly increases the local recurrence rate, compared with cross-bone amputation. Discussions include patient evaluation, surgical options, materials and methods, and results.

Periosteal chondroma is a slow-growing benign cartilaginous tumor of limited size arising within or under the periosteum, which, through constant pressure, induces cortical erosion and periosteal reaction. Ten new cases of periosteal chondroma are reported. All were treated by marginal or intralesional excision. No local recurrence was seen following this treatment. These patients demonstrated the clinical, roentgenographic, and pathologic features of this benign entity, which aid diagnosis, thereby avoiding overtreatment.

The first reported case of a periosteal ganglion to be documented by computerized tomography is presented. The lesion was located on the shaft of the tibia and was unrelated to ligamentous and joint structures. A review of the literature reveals that the most common site for this lesion is the upper leg, as noted in our case; for that reason, periosteal ganglion should be included in the differential diagnosis of any soft tissue lesion in this location. CT may be more useful than plain films to demonstrate periosteal ganglion when cortical erosion is absent.

A recurrent osteoblastoma involving the acetabulum in a 27-year-old woman was found to be locally aggressive and histologically appeared to become more anaplastic with each recurrence. However, there was no evidence of distant metastases. Similar cases have been reported under such names as pseudomalignant or malignant osteoblastoma. In view of the prolonged clinical course without evidence of distal metastases, the term "aggressive osteoblastoma" seems to be more appropriate. The treatment of choice for such tumors should be further en bloc resection, avoiding the morbidity and possible mortality of the chemotherapy demanded by true malignant tumor of bone, as well as unnecessary ablative surgery.

Eighty-seven pertrochanteric fractures consecutively treated between the years 1978 and 1981 are reviewed. External and internal rotation types are described relative to their aetiology. The final typing of the fracture can be made only on reduction. What we have called 'internal rotation fractures' show an excellent correlation with the unstable fracture gradings described by Boyd, as well as very osteoporotic Singh gradings (1-3). It is contended that the latter is the main factor in its production as opposed to the more common external rotation variety. An appeal is made for recognition of the fracture, its reduction by means of external rotation and adequate fixation. Early weight bearing is not advised, in order to prevent subsequent varus deformity with extrusion of the implant.

Eleven cases of osteoblastoma (spongious osteoblastoma) and four cases of osteoid osteoma (cortical osteoblastoma) involving the spine, diagnosed at Hadassah Hospital between 1970 and 1983 were analyzed. The age range was 7 to 34 years and the average clinical follow up was 63 months. The cervical spine was involved in four patients, thoracic in four, lumbar in six and the sacrum in one patient. Back or neck pain associated with stiffness was present in all cases and was often accompanied by scoliosis or torticollis. All the patients with osteoid osteoma were symptom relieved by surgery without recurrence. Seven of the patients with benign osteoblastoma presented with neurological signs or symptoms and three of these had recurrence following primary surgery. Although cortical and spongious osteoblastoma are considered as members of the same family of benign tumors of osteoblastic derivation, spongious osteoblastoma does not seem to be limited in growth potential as is cortical osteoblastoma.

A 34-year-old man developed a spindle-cell sarcoma originating in a preexisting lesion of monostotic fibrous dysplasia. A review of the literature reveals 83 cases of a malignant degeneration in fibrous dysplasia; osteosarcoma was the most common type of tumor. The next most common were fibrosarcoma and chondrosarcoma. The malignant tumor usually developed in the third or fourth decade of life. The most frequent anatomic sites were the craniofacial bones, the femur, and the tibia. Twenty-three of the 83 cases were treated with local radiation. In fibrous dysplasia, any abrupt alteration in the clinical course, manifested by pain and swelling, raises the possibility of malignant degeneration.

A case report of clear cell sarcoma of the tendinous portion of the quadriceps in the knee joint of a 33-year-old female is presented. This insidious, usually painless malignant tumor is often misdiagnosed and may be referred to the sports medicine specialist as a sport-related injury. The duration of symptoms and the size of the lesion are important prognostic factors. Wide excision or radical surgery is necessary to cure such tumors. With improved reconstructive techniques, including free vascularized myocutaneous flaps, limb-sparing surgery is now possible.

Primary carcinoid of the larynx is an unusual neoplasm. Only one case could be traced in the literature so far. Another case, a 55-year-old male patient, is presented and discussed. The tumor proved to be malignant, showing histological, histochemical and electron microscopical characteristics of a carcinoid. Initially there was a striking discrepancy between the scanty findings in the larynx and the wide metastatic spread of the tumor into the cervical lymph nodes along the internal jugular vein, and the progression of the process was markedly slower than that of laryngeal carcinoma. Despite the massive dose of radiotherapy that had been administered after radical neck dissection in an attempt to preserve the larynx, the tumor continued to expand, infiltrating the laryngeal tissues and causing stenosis that necessitated total laryngectomy, thus again proving that the treatment of choice in laryngeal carcinoid should be wide surgical excision.

In recent years the orthopaedist has become the initial physician to see soft tissue neoplasms. A review of the current concepts of treatment of these lesions, therefore, seems to be in order.

Giant cell tumor is considered to be a lesion which behaves locally in an aggressive fashion and has a high local recurrence rate. Several physical adjuvant methods have been employed to reduce the local recurrence rate including cryosurgery with liquid nitrogen, phenol instillation, and the use of methylmethacrylate. In laboratory conditions, the authors applied a CO2 laser beam to eliminate traces of residual tumor tissue. As a mode of physical adjuvant treatment, use of the laser seems to be a promising technique for local tumor control.

One hundred fifty-three orthopedic operations in 129 children were analyzed for the significance of postoperative fever (POF) as a predictive factor for possible complications. In 72% of the operations, a temperature of greater than 37 degrees C was recorded. In 63 operations (41%), the temperature was greater than 38 degrees C. Sixteen children had positive clinical signs that might explain the fever, and all of them had a temperature of greater than 38 degrees C. Duration of operation of greater than 1 h, clubfoot releases, open reduction of fractures, and spine fusion operations gave higher incidences of POF. POF indicates a complication only when associated with positive physical findings. A postoperative temperature of greater than 38 degrees C, therefore, mandates repeated physical examination, which is the most reliable method of discovering the presence of complications.

The rapid development of an intraosseous ganglion following an intraarticular fracture of the distal radius in a patient suffering from familial Mediterranean fever is presented. The case supports the view that trauma may be an etiological factor in the genesis of intraosseous ganglia.

Six patients with spinal cord compression as the presenting symptom of malignant lymphoma are described. These patients suffered from back pain for several months and were diagnosed after sudden paraparesis appeared. Five patients were treated by operative decompression followed by local irradiation, and all regained their motor function. A sixth patient presented with a more insidious paraparesis. A bone marrow aspiration established the diagnosis of malignant lymphoma, and this patient recovered with radiation and steroids alone. Thus, we recommend considering malignant lymphoma as a possible cause of acute cord compression, attempting to establish the diagnosis on an emergency basis within several hours, and attempting to achieve decompression with local radiotherapy and intravenous dexamethasone.

The current local recurrence rate following limb sparing surgery for osteosarcoma is on the order of 5 per cent. Major advances in both reconstructive surgery and adjuvant chemotherapy have dramatically improved the disease-free survival rate and the quality of life in patients with osteosarcoma.

Subperiosteal hemangioma (SPH), an exceptionally rare lesion, was diagnosed in a 68-year-old man. SPH is usually small and is most commonly located in the midshaft of a long tubular bone such as the tibia or fibula. A wide range of age groups is affected. SPH may present with mild pain or local swelling unassociated with trauma. Radiologically, it usually appears as a shallow cup-shaped depression surrounded by cortical thickening. Several other periosteal and intracortical lesions must be considered in the differential diagnosis, but the final diagnosis rests on microscopic evaluation. The treatment of SPH is marginal excision; local recurrences have not been reported after such treatment.

Juxtacortical liposarcoma is an uncommon entity. The purpose of this paper is to report the case of a 63-year-old man with juxtacortical liposarcoma. Liposarcomas arising as surface lesions of bone are extremely rare. Histologically, juxtacortical liposarcoma is composed of myxoid and round-cell areas. Because of the extent of compartmental involvement and the high-grade malignancy, limb-sparing surgery was not considered for the patient. A review of the English literature on diagnosis and treatment indicates a grave prognosis.