Comorbidity clusters in generalized osteoarthritis among female patients: A cross-sectional study

OBJECTIVES

To investigate the prevalence of comorbidities among female patients with generalized osteoarthritis (GOA) in comparison to an age- and sex matched control group. To identify clusters of comorbidities in both groups.

METHODS

An observational, cross-sectional study was conducted. Consecutive female patients with hand and knee osteoarthritis according to the American College of Rheumatology (ACR) classification criteria were invited to participate in the study. A control group of participants without musculoskeletal symptoms, history or evidence of osteoarthritis or inflammatory rheumatic disease were also included. Cardiovascular, obstructive pulmonary, gastrointestinal, endocrine, neurological, malignant diseases and depression were recorded in both groups. In both study groups comorbidity cluster and factor analysis was performed.

RESULTS

The study population included 200 GOA and 200 control participants. The following comorbidities were observed adjusted to Bonferroni correction with a significantly higher prevalence among individuals with GOA: hypertension, uterine leiomyoma, gastroesophageal reflux disease, diverticulosis, upper gastrointestinal tract ulcers, depression, diseases with vertigo (benign paroxysmal positional vertigo and vertebrobasilar insufficiency) and surgery due to otoclerosis. In the GOA group 5 clusters were identified with different comorbidity patterns.

CONCLUSION

We report a high comorbidity rate in GOA. Cluster analysis allowed us to identify different comorbidity subsets for vascular, gastrointestinal and malignant gynaecological disorders. Further research is required to understand the links between GOA and non-musculoskeletal comorbidities.

Ethical standards for orthopaedic surgeons

This paper offers a summary of the ethical guide for the European orthopaedic community; the full report will be published in the EFORT Journal.

Comparison of the degenerative changes in weight-bearing joints following cementing or grafting techniques in giant cell tumour patients: medium-term results

The aim of this retrospective study was to compare and assess the effect of bone grafting and cementing techniques--two common applications used in the treatment of subchondral giant cell tumours of bone (GCTs)--on the development of degenerative changes in the weight-bearing joints of the lower extremity. Eighty patients were included in this follow-up study, 44 of whom underwent curettage followed by bone grafting, and 36 who had curettage followed by cementation. At the 24-month post-operative examination, significantly less degenerative change was found in patients with bone cement than in those with bone grafting. At the 50-month and later (range: 50-148 months) post-operative examination, however, no significant differences were found between the two groups, indicating that there was a significant acceleration of degenerative changes in the cemented group after the 24-month follow-up.

Functional outcome and life quality after endoprosthetic reconstruction following malignant tumours around the knee

Between 1993 and 2002, we treated 43 patients with malignant musculoskeletal tumours of the knee region. All patients had partial resection of the femur or tibia together with endoprosthetic replacement. We were able to follow-up 23 patients with an average follow-up of 30 (12-97) months. Complications occurred in ten cases, of which one was a case of local recurrence. Most of the patients were completely satisfied with their condition, with a decreased walking distance as the only notable restriction. There was no correlation between the functional outcome and life quality assessment and the type of the implanted prosthesis, length of resected bone and type of resection. However, patients with tumours in the distal femur had significantly better functional and life quality outcome than those with a proximal tibial tumour.

Osteosarcoma over the age of forty

The European Musculo Skeletal Oncology Society (EMSOS) has carried out a retrospective review of patients over the age of 40 years with osteosarcoma. 481 patients from 12 centres or multicentric groups were included. 42 patients had osteosarcoma arising in Paget's disease, median survival was 9 months. Patients with axial or metastatic tumours also did badly whilst 41 patients with radiation-induced osteosarcoma had a prognosis paralleling conventional osteosarcoma matched for patient age and site of the tumour. 238 patients had high grade non-metastatic osteosarcoma and had a survival of 46% at 5 years. Older patients had less chemotherapy and fared worse. Osteosarcoma in the elderly is a curable condition and warrants intensive treatment with chemotherapy and surgical resection.

The efficacy of a combination of etoposide, ifosfamide, and cisplatin in the treatment of patients with soft tissue sarcoma

BACKGROUND

Successful chemotherapy for patients with soft tissue sarcoma (STS) has been limited by a lack of active drugs. The most effective single agents are doxorubicin, dacarbazine, and, more recently, ifosfamide. Previously the most widely used combination has been CYVADIC (cyclophosphamide, vincristine, doxorubicin, and dacarbazine). In one randomized trial, ifosfamide was superior to cyclophosphamide; two nonrandomized studies also reported favorable results. Etoposide monotherapy was successful in 8%; the effectiveness of cisplatin was 5-23%. In view of these findings, the authors treated STS patients with an etoposide, cisplatin, and ifosfamide (VIP) combination.

METHODS

The eligibility criteria included histologically confirmed, inoperable, metastatic or locally recurrent STS; a World Health Organization (WHO) performance status of 0-2; a maximum age of 75 years; and progressive, measurable disease. A total of 104 patients were treated from January 1990 to June 1997. The median age of the patients was 42.4 years. The patients were treated with a combination of etoposide (100mg/m(2) for 5 days), ifosfamide (2000 mg/m(2) for 2 days), and cisplatin (20mg/m(2) for 5 days) once a month via a peripheral vein. The treatment response and the toxicity were assessed according to WHO criteria.

RESULTS

Of 104 evaluable patients, 47 responded. The overall response rate was 46% (complete response: 10%; partial response: 36%). In 43 patients the disease remained stable (41%). Remission duration was 4.6 months. Toxicity was moderate. The main adverse events were alopecia (100%), nausea and vomiting (73%), and leukopenia (29%).

CONCLUSIONS

This new combination is promising for the treatment of patients with advanced STS.

Limb-saving surgery, survival, and prognostic factors for osteosarcoma: the Hungarian experience

BACKGROUND AND OBJECTIVES

There are many factors thought to have an influence on the prognosis of osteosarcoma that have been reported in the literature. Their significance, however, still remains controversial in most cases. Experience with osteogenic sarcoma (OS) was reviewed in order to evaluate surgical results and survival and to determine the prognostic factors.

METHODS

Ninety-six patients with high-grade osteosarcoma of the extremities were treated between 1986 and 1997 in the authors' institution. They were divided into 3 groups: In group I, all 75 patients with nonmetastatic OS received intensive chemotherapy (high-dose methotrexate, doxorubicin, ifosfamide, and cisplatin) and underwent surgery. In group II, 9 patients already had metastases at the time of referral. In group III, 12 patients received chemotherapy in delayed or suboptimal form. Results and Conclusions In group I, there were local recurrences in 3 patients (7%) and metastases in 8 patients (20%) with limb-saving, whereas these numbers were 1 (3%) and 14 (38%) in those who had amputation. The 5-year disease-free survival (DFS) was 72% and 69% in the limb-saving and amputation groups, respectively. In groups II and III, 5-year DFS was extremely poor, 10% and 20% only, underlining the importance of stage and intensity of chemotherapy, respectively. With univariate analysis, sex, duration of symptoms, and radiographic appearance of OS had no prognostic value, whereas tumor volume <60 cm(3), wide or radical surgical margin, distal location of OS, cartilagineous ground substance <20%, and response to chemotherapy were positive prognostic factors. The last 4 variables maintained their significance in the multivariate Cox model as well. Age >30 years showed indirect negative influence on the final outcome through enhanced intolerability to the drugs and less cooperability of the patients. The results on survival with limb-saving surgery were well comparable with those of amputation.

Aneurysmal bone cyst: its pathogenesis based on angiographic, immunohistochemical and electron microscopic studies

Based on angiographic, immunohistochemical as well as electron microscopic findings, authors outline a hypothesis for the etiopathogenesis of aneurysmal bone cysts. No changes were found at the arterial site in 16 studied aneurysmal bone cysts, with no signs of an arteriovenous shunt. In certain cases, however, dilated and tortous efferent veins became visible in the late venous phase. Due to the impedance of venous flow, the intracystic pressure increases and the small veins become dilated causing formation of aneurysmal slits. This is supported by the immunohistochemical finding that S-actin shows concentric arrangement around the aneurysmal cavities. Endothelial lining and basal membrane remnants were detectable in places, though the aneurysmal slits were devoid of continuous endothelial lining and basal membrane. We suggested that the aneurysmal bone cyst corresponds to a hemodynamic disturbance and is due to primary or secondary venous malformation of the bones.

Intraosseous lipomatosis. A case report

We report a case of systemic intraosseous lipomatosis involving the proximal femur, both ends of the tibia, and the tarsal and metatarsal bones. The lesions progressed during a five-year follow-up with a pathological fracture of the tibial plateau. CT scans were characteristic and helpful in diagnosis but MR imaging added little information. Intraosseous lipomatosis is a hamartomatous malformation due to hyperplasia of adipose tissue, and is fundamentally different from solitary benign intraosseous lipoma. Management involves reconstruction of any pathological fracture. Large progressive lesions should be treated by curettage and grafting in an attempt to prevent such fractures.

Comparative distribution patterns of type I and III collagens and fibronectin in human arteriosclerotic aorta

The distribution patterns of type I and III collagens and fibronectin were studied in arteriosclerotic lesions of human aortas as well as in the regions devoid of any macroscopic lesions of the same aortas. Frozen sections were analyzed for fibronectin and collagens by indirect immunofluorescence or immunoperoxidase analysis with specific antisera prepared in rabbits against human plasma fibronectin and against human type I and III collagens. Tissue samples were also stained for type I and III collagen distribution using Picro Sirius red according to the method described by Junqueira et al. (1979). In the regions devoid of any visible macroscopic lesions, there is a co-distribution in the media of the aortic wall of type I and III collagens, with a predominance of type I collagen. Type I collagen is also visible in the intima, as a continuous layer. This is attributed to an age-dependent change of the aorta (arteriosclerosis). Fibronectin can be demonstrated as a thin layer in the subendothelium and as a weak immunofluorescence over the media. In recent or evolutive arteriosclerotic plaques, fibronectin and type III collagen appear to be strongly increased and superimposed. There is also an increase of type I collagen in the intimal region of the plaque. The co-distribution of type III collagen and fibronectin in the arteriosclerotic plaques may suggest a tissue-repair-type of process, analogous to that which can be observed during wound healing. Our results suggest that in arteriosclerotic lesions, type III collagen and fibronectin are predominantly synthesized.(ABSTRACT TRUNCATED AT 250 WORDS)

On the presence of a metalloprotease in human skin fibroblasts that degrades the human skin elastic fiber system

Succinyl-trialanine paranitroanilide, a specific synthetic substrate of elastases, was shown to be hydrolyzed by Triton X-100 extracts of human skin fibroblasts at near neutral pH. The neutral endopeptidase has been partially purified by ion exchange chromatography (DEAE Sephadex) and affinity chromatography using an AH-Sepharose (Ala)3 column. The enzyme has been purified 85-fold and appears to be a metalloprotease as shown by its inhibitory profile. In its partially purified form, the neutral endopeptidase was found inactive toward benzoyl arginine paranitroanilide, benzoyl tyrosine paranitroanilide, azocasein, type I collagen, and [3H]ligamentum nuchae-insoluble elastin. Structural glycoprotein microfibrils isolated from porcine aorta are extensively degraded by this neutral protease. It could also hydrolyze, but to a lesser extent, insoluble elastin purified from human aortas; it was, however, found inactive toward bovine ligamentum nuchae elastin. Its potentiality to degrade the human skin elastic fiber system (namely elastic fibers, oxytalan, and elaunin fibers) has been assessed by a morphometric analysis of the length of these fibers (on tissue sections appropriately stained to identify the components of the elastic fiber system) prior to and after enzyme action. Analysis of the data obtained by morphometry indicated that this neutral protease attacked rapidly both elaunin and oxytalan fibers of human dermis, but only slowly the mature elastic fibers.

Distribution of fibronectin in diabetic skin

Distribution of the fibronectin (FN) present in the forearm skin was studied in 23 controls and 34 insulin dependent diabetics. All the subjects were lean males under 50 years. After biopsy FN was studied by an indirect immunofluorescence technic. A semi-quantitative evaluation was attempted by giving a score to the fluorescent intensity read at the three following sites: vascular basement membranes, papillary dermis, and the dermo-epidermal basement membranes. We found an increased amount of FN-immunofluorescence in diabetic skins. This increase was seen not only in vascular basement membranes but also at the two other sites. No correlation was found between apparent FN levels and the duration or equilibration of diabetes. These results are consistent with other findings of the literature concerning the involvement of the intercellular matrix in diabetes.