SAPHO syndrome in the differential diagnosis of metastasis

SAPHO syndrome was proposed in the late 80s in order to group different osteoarticular manifestations with specific radiological findings such as the hyperostosis of the front part of the chest wall. Prevalence, etiology and pathogenesis of the disease are unknown, while diagnosis is made both clinically and by the specific gammagraphic image of «bull horn» in the sternoclavicular joint. The following case of a 64-year-old woman diagnosed with infiltrating ductal carcinoma of the right breast pT1N0Mx is reported. When studying the extent of the disease, a gammagraphic image of diffuse blast injury in the sterna manubrium was evidenced, which allowed the suspicion of Paget's disease or metastatic injury. Study was completed with a chest CT in which manubrium sclerosis was evidenced, suggesting metástasis. Res ults of the studies pointed out SAPHO syndrome as the most likely diagnostic option. The low tumor stage of the patient prompted the idea of possible alternative diagnoses. A deeper knowledge of this clinical condition may be crucial to avoid mistakes when classifying a subject in more advanced tumor stages, and consequently, to prevent the use of more aggressive chemotherapy and radiotherapy treatments.

The role of radiotherapy for prevention of heterotopic ossification after major hip surgery

Heterotopic ossification or ectopic bone formation represents a widely known complication after surgery involving joint spaces. Posttraumatic heterotopic ossification can be found at any site. The most common postsurgical site is the hip following total hip arthroplasty. This review explores the treatment options to prevent ectopic bone formation after major surgery of hip, especially, the role of radiotherapy.

Evaluation of the toxicity of the combined treatment of chemoradiotherapy, according to the scheme of Macdonald, after radical surgery in patients diagnosed of gastric cancer

PURPOSE

In this study we evaluated the acute toxicity of the combined treatment with chemoradiotherapy, according to the scheme of McDonald et al, in patients diagnosed with gastric cancer, after radical curative surgery.

METHODS

From July 2001 to December 2005, a total of 24 patients, with diagnosis of adenocarcinoma of the stomach or adenocarcinoma of the gastroesophageal junction, who were operated with total or subtotal gastrectomy with free resection margins, were treated at our service with a combined scheme of adjuvant chemoradiotherapy.

RESULTS

Grade 3 toxicity or higher appeared in three patients (12%) and grade 2 in five of the twenty-four patients (21%). Two patients (8%) needed to suspend treatment before the scheduled end date of treatment due to acute toxicity. No acute toxicity of cardiological, hepatic or renal nature was registered, and the most frequent toxicity was the gastrointestinal toxicity (detected in the 79% of the patients).

CONCLUSIONS

Combined treatment with chemoradiotherapy, according to the scheme of Macdonald, in diagnosed patients with gastric cancer, after radical curative surgery is a well tolerated treatment, with a low degree of acute toxicity, thus the treatment compliance is not difficult.