Clinical Features In Metastatic Bone Disease With And Without Pathological Fractures: A Comparative Study

Abstract Background: Pathological fracture complications such as impaired clinical features is suspected to increase the mortality in MBD. In Indonesia, the habit of delayed seeking of medical treatment was common and potentially led to pathological fracture. Aim: This study compared the clinical features between MBD with and without pathological fracture. Methods: This was a retrospective study of MBD at Dr. Soetomo General Hospital in 2011-2015. We compared the clinical features by pain in Visual Analog Scale (VAS); general health presentation represented by laboratory findings; and the history of non-medical treatments. Results: 64 patients had MBD were included in this study. 37 (57.8%) of them presented with pathological fractures, and 27 (42.2%) without. Pain was the most common chief complaint (76.5%). No significant difference found between the MBD with and without pathological fracture in all variables (p=0.122; p=0.64; p=0.823; p=0.417, p=1.000 for VAS, hemoglobin, albumin, calcium, and history of non-medical treatment respectively). This probably associated with the therapy and a variety of primary tumors underlying the MBD. However, 6 out of 10 patients with history non-medical treatment presented with fractures. Conclusion: There's no significant difference in clinical features of MBD from both groups, while those with fractures had worse conditions. Keywords: Metastatic bone disease, Pathological fracture, Clinical feature

Femur Pathological Fracture Caused by Metastatic Bone Disease Derived from Foot Squamous Cell Carcinoma

Background : Bone is an organ and the most common site that prone to metastatic cancer and cause serious morbidity. Besides, metastatic cancer to bone will limit skeletal function so that decrease quality of life and even death that most of them caused by its complication.Objective : Reporting a rare case about Squamous Cell Carcinoma that cause femur pathological fracture caused by Metastatic Bone Disease.Material and Method : Case report in women patients 55 years old with femur close fracture one-third middle caused by Metastatic Bone Disease in RSUD Soetomo Surabaya, period May 2015-March 2016.Data is taken retrospectively from medical record through interview, physical examination, radiological examination, and laboratory.Result and Discussion : Patients are treated in hospital because of femur close fracture one-third middle caused by Metastatic Bone Disease.  Based on physical and radiological examination, it is decided being done by skin traction first. The next plan is surgery. Patients are treated with interlocking nail left femur. Evaluation after surgery is done with medical rehabilitation, that is ROM exercise. Until now, 9 months after surgery, patients still control routinely to be done chemotherapy and there is improvement in patient’s condition.Conclusion : Metastatic process in bone often cause pathological fracture. Bone Metastatic is common from Breast, Lung, Prostate and Kideney Cancer. There was no publication before about Bone Metastatic Disease come from Squamous Cell Cancer. Mirel’s score is used as guiding in fixation prior to the next treatment. Decision of surgery is considered through patient’s objective and subjective appraisal that can be calculated in Abdurrahman score system

Combination of bone marrow aspirate, cancellous bone allograft, and platelet-rich plasma as an alternative solution to critical-sized diaphyseal bone defect: A case series

Introduction: Nonunion due to a critical-sized bone defect is a complicated problem. The healing process must fulfill three mandatory elements of osteogenesis, osteoinduction, and osteoconduction. One ideal source to provide an abundant number of osteogenic cells is from the process of the culture of bone marrow stem cells which demands the availability of processing facility. Unfortunately, this sophisticated option is not always feasible in every hospital in low-income to middle-income countries. We tried to fulfill the requirement of osteogenic cells by using simple and cost-effective bone marrow aspirate. We presented two cases of critical-sized diaphyseal bone defect treated with the combination of bone marrow aspirate, cancellous bone allograft, and platelet-rich plasma (PRP). Presentation of cases: The defect sizes were five and six centimeters in humerus and tibia respectively. We applied a combination of bone marrow aspirate, cancellous bone allograft, and PRP to promote bone healing in the defect sites. Both patients have achieved the good clinical and radiological outcome. Discussion: Critical-sized bone defects require the application of tissue engineering. Aspirated bone marrow can be used as a more affordable option to provide the element of osteogenic cells in bone healing. Combined with cancellous bone allograft and PRP, they fulfill the required ingredients to promote bone regeneration. Conclusion: Bone defects remain one of the most challenging conditions to treat in orthopedic. There are many options to treat the defect but the fundamental prerequisites of cells, scaffolds and growth factors for healing have developed into the concept of tissue engineering: osteogenesis, osteoinduction, and osteoconduction

The enhancement apoptosis of osteosarcoma mesenchymal stem cells co-cultivation with peripheral blood mononuclear cells sensitized by secretome and granulocyte macrophage colony-stimulating factor

The advanced, metastasis, and reccurent of osteosarcoma (OS) patients have a poor prognosis postaggresive surgery and chemotherapy. Peripheral blood mononuclear cells (PBMCs) as cell-based immunotherapy may successful in the OS treatment. To investigate the enhancement apoptosis of OS-mesenchymal stem cells (OS-MSCs) co-cultivated with PBMCs sensitized using the secretome and granulocyte macrophage colony-stimulating factor (GMCSF). This true experimental study with posttest only control group design and in vitro study. The sample was cultured OS-MSCs which confirmed by Cluster of Differentiation-133 using immunocytochemistry (ICC) and histopathology analysis. The sample divided into six groups accordingly: OS-MSC, OS-MSC + PMBC, OS-MSC + PMBC + Secretome, OS-MSC + PMBC + GMCSF, OS-MSC + PBMC + Secretome + GMCSF (n = 5/N = 30). The enhancement of OS-MSCs apoptosis was analyzed through Interleukin-2 (IL-2) level through the Enyzme-Linked Immunosorbent Assay examination, expression of Signal Transducers and Activators of Transcription (STAT)-3 and caspase-3 by ICC. One-way analysis of variance test and Tukey Honestly Significant Difference to analyze the difference between the groups (P 0.05). The co-cultivation of OS-MSCs and PBMSCs activated using secretome and GMCSF has a great ability to enhance OS-MSCs apoptosis

Pendekatan Sistematis Diagnosis, Terapi dan Follow-Up Tumor Muskuloskeletal (Multidisplinary Approach)

Insiden tumor muskuloskeletal rendah, sedangkan terapinya bisa sangat berat bagi pasien dan keluarganya, seperti tindakan amputasi tungkai. Dengan penanganan yang sempurna sekalipun, umur harapan hidup beberapa penderitanya tidak mencapai angka yang tinggi. Oleh sebab itu, di bidang tumor muskuloskeletal, mutlak dibutuhkan standar pelayanan yang tinggi mulai dari skrining, diagnosis, penatalaksanaan dan evaluasi pasca terapi. Salah satu standar pelayanan yang tinggi di bidang diagnosis adalah prinsip multidisiplin dalam penegakan diagnosis. Paling tidak dokter-dokter spesialis orthopedi, patologi dan radiologi bersama-sama membahas informasi dari masing-masing bidang untuk disatukan menjadi diagnosis yang tepat