Nora’s disease: a series of six cases

Objectives. Nora’s disease is a mesenchymal bone tumor with controversial diagnosis and treatment due to the benign but locally aggressive course and high recurrence rates. Methods. A retrospective analysis was made of patients diagnosed with Nora’s Disease at Ankara University Orthopedics and Traumatology Clinic. The evaluation was made of the age of the patient, gender, symptoms, lesion location, trauma history, treatment choice and recurrence rates during follow-up. Results. Excision was applied to 6 patients diagnosed with Nora’s disease, and in 1 patient an additional autograft and internal fixation were required. Recurrence was observed in 3 patients, 2 of whom underwent revision surgery and one who did not as there no patient complaints. Conclusions. Nora’s disease is problematic for orthopedic surgeons as there are difficulties in diagnosis, there is no absolute treatment algorithm, recurrence potential is high, and there are limited additional treatment choices. Therefore, treatment and follow-up at clinical center’s dealing with orthopedic tumor surgery can be considered appropriate.Objectives. Nora’s disease is a mesenchymal bone tumor with controversial diagnosis and treatment due to the benign but locally aggressive course and high recurrence rates. Methods. A retrospective analysis was made of patients diagnosed with Nora’s Disease at Ankara University Orthopedics and Traumatology Clinic. The evaluation was made of the age of the patient, gender, symptoms, lesion location, trauma history, treatment choice and recurrence rates during follow-up. Results. Excision was applied to 6 patients diagnosed with Nora’s disease, and in 1 patient an additional autograft and internal fixation were required. Recurrence was observed in 3 patients, 2 of whom underwent revision surgery and one who did not as there no patient complaints. Conclusions. Nora’s disease is problematic for orthopedic surgeons as there are difficulties in diagnosis, there is no absolute treatment algorithm, recurrence potential is high, and there are limited additional treatment choices. Therefore, treatment and follow-up at clinical center’s dealing with orthopedic tumor surgery can be considered appropriate

A Slight Contribution of Retroperitoneal Fat Accumulation to the Metabolic Comorbidities of Patients with Autonomous Cortisol Production

Objective: Autonomous cortisol secretion (ACS) in the adrenal incidentaloma (AI) refers to an excess of low-grade autonomous cortisol without the clinical symptoms of Cushing's syndrome (CS), while ACS is shown to be related to the accumulation of visceral fat. To elucidate whether the accumulation of fat in different compartments, such as total adipose tissue (TAT), peritoneal adipose tissue (PAT), retroperitoneal adipose tissue (RPAT), and subcutaneous adipose tissue (SAT) could predict metabolic problems in patients with ACS. Material and Methods: We conducted a retrospective cohort study, including 74 patients diagnosed with ACS and 8 patients diagnosed with CS. 8 patients with ACS had also undergone adrenalectomy. Baseline (initial admission) and follow-up (most recent visit) data, including the clinical, laboratory, and radiological parameters, were evaluated. Results: Total adipose tissue (TAT), visceral adipose tissue (VAT), PAT, and RPAT increased significantly while the SAT remained stable in patients with ACS. Adrenalectomy in patients with CS resulted in a significant reduction of TAT, VAT, PAT, and RPAT while SAT was relatively preserved. However, no significant change was observed in surgically treated patients with ACS. The independent predictors of cardiovascular events, glucose intolerance, or elevated blood pressure were age, the level of cortisol post dexamethasone suppression test (DexF), and an increase in the RPAT. Conclusion: Visceral fat accumulation, particularly in the retroperitoneal area, slightly contributed to the development of metabolic problems in patients with ACS

Autonomous cortisol secretion in adrenal incidentalomas and increased visceral fat accumulation during follow-up.

Objective: Autonomous cortisol secretion of adrenal incidentalomas (AIs) is associated with poor cardiovascular outcome. Because centripetal obesity is a cardiovascular risk factor, we aimed to investigate whether autonomous cortisol secretion is associated with increased visceral fat accumulation

Is there an association between non-functioning adrenal adenoma and endothelial dysfunction?

Background and aim: Subtle changes in hypothalamic-pituitary-adrenal (HPA) axis of subjects with non-functioning adrenal adenoma may be associated with endothelial alterations. We sought to investigate endothelial function, visceral adiposity and osteoprotegerin (OPG) and interleukin-18 (IL-18) levels in subjects with non-functioning adrenal adenomas. Subjects and methods: The adenoma group included 40 subjects without clinical and subclinical findings of hypercortisolism or other adrenal gland disorders. Twenty-two body mass index-matched controls were also enroled. The patients and control subjects underwent hormonal evaluation and assessment of anthropometric and metabolic parameters. Endothelial function was assessed with flow-mediated dilatation (FMD) of the brachial artery and intima media thickness (IMT) of common carotid arteries. Visceral adipose tissue area was measured by computed tomography. Plasma OPG and serum IL-18 levels were also measured. Results: When compared with healthy controls, the adenoma group had elevated systolic blood pressure, post-dexamethasone suppression test cortisol and reduced DHEAS. Visceral adipose tissue area and IMT of common carotid arteries were comparable. In the adenoma group, FMD of the brachial artery was significantly impaired and IL-18 level was significantly elevated. Visceral adipose tissue area was independently related with FMD. Homeostasis model assessment (HOMA) was the independent factor associated with visceral adipose tissue area. Cortisol, DHEAS and visceral adipose tissue area were independently associated with HOMA. Conclusions: We achieved evidence that could be attributable to endothelial alterations in subjects with non-functioning adrenal adenomas. Impaired FMD appeared to be a consequence of subtle changes in HPA axis in terms of elevated cortisol and reduced DHEAS as these conditions were known to disturb endothelial-dependent vasodilatation. (J. Endocrinol. Invest. 34: 265-270, 2011) (C) 2011, Editrice Kurti

The Effect of Falsely Highlighted Intestinal Intraluminal Areas and the Fat in Paraspinal Muscles on Abdominal Adipose Tissue Measurements Using Computed Tomography

Objective: The measurement of abdominal fat using computed tomography (CT) is a reliable method for evaluating metabolic disorders. However, some limitations exist with the current CT measurement methods. One of them is falsely highlighted intestinal intraluminal areas and the other one is fat in paraspinal muscles. We aimed to investigate the effects of highlighted intestinal intraluminal areas and fat in paraspinal muscles on the measured values of abdominal fat. Material and Methods: Measurements were performed on 246 abdominal CT scans of 129 patients using dedicated quantitative CT software. Visceral and subcutaneous fats were measured at the level of L1-L2 disc space using two different methods. Method 1 included the highlighted intestinal intraluminal areas and fat in paraspinal muscles for measurements, whereas method 2 excluded them. The values measured using two methods were compared for a statistically significant difference. In addition, the correlation between anthropometric data and subcutaneous adipose tissue measurement methods was analyzed. Results: The mean age of patients was 53 years, and the mean body mass index was 29.73 kg/m(2). The waist circumference data were available of 91 patients, and the mean waist circumference was 94 cm. The Wilcoxon signed-rank sum test showed a statistically significant difference between methods 1 and 2 (p0.9), the Passing-Bablok regression analysis indicated a systematic and proportional error between measurements. Conclusion: Falsely highlighted intestinal intraluminal areas should be excluded for accurate visceral adipose tissue measurements, and the fat in paraspinal muscles affects subcutaneous fat measurement results

Detection of laryngeal tumors and tumoral extension by multislice computed tomography-virtual laryngoscopy (MSCT-VL)

Virtual endoscopy is becoming a widely used non-invasive clinical diagnostic tool. The present study was designed to compare the sensitivity and specificity of the conventional endoscopy and virtual laryngoscopy with respect to laryngeal masses. A total of 38 patients (20 males, 18 females, mean age 61 years) with the complaint of hoarseness were included in the study. Laryngeal mucosa, lumen and mass pathology were evaluated initially by direct endoscopy and then by virtual laryngoscopy during multislice CT of the larynx. Histopathologic evaluation of the masses was also made. The main pathology of the patients was found to be laryngeal masses (60% of patients, one mass for each patient), which were polyps (n = 8), papilloma (n = 4) and carcinoma (n = 11) according to histopathologic evaluation. Retrospective evaluation of 6 lesions detected in virtual but not in conventional laryngoscopy resulted with the finding of viscous-dense mucous secretion. On the contrary, three lesions detected by conventional laryngoscopy could not be detected by virtual evaluation. A total of six patients were evaluated and considered as normal both by conventional and virtual laryngoscopic examinations. Sensitivity of the virtual laryngoscopy was 88% (23/26) while its specificity was only 50% (6/12). Positive and negative predictive values were 79% (23/29) and 66% (6/9), respectively. Accuracy of the virtual laryngoscopy was 76% (29/38). Virtual laryngoscopy is not an alternative to conventional laryngoscopy but may assist direct endoscopy without causing additional radiation exposure or discomfort to the patient. The three-dimensional contribution to interpretation of the results and subsequent manipulation of the data can be used for educational and surgical purposes

Parosteal lipoma as a rare cause of peripheral neuropathy and local irritation: A report of 12 cases

Objective: The aim of this study was to evaluate the clinical features and functional results of patientswith parosteal lipomas.Methods: A total of 12 patients (8 females and 4 males; mean age: 45 (10e62) years) with parosteallipomas who were treated between April 1986 and April 2014, were included into the study. The medicalrecords of the patients were reviewed to analyze the clinical features and functional results of thepatients.Results: Of the 12 lipomas, 5 were localized in the proximal arm, 4 in the forearm, 1 in the distal arm, 1 inthe distal thigh and 1 in the distal tibia. All patients presented with a progressive, slow-growing massthat was associated with thumb extension weakness in 1 case, and brachialgia-like symptoms in 1 case.Plain radiographs showed a juxtacortical mass in all cases and irregular ossiŞcation in 3 cases. In all cases,marginal excision was performed and no clinical recurrence was observed after a mean follow-up of 16months.Conclusion: Parosteal lipomas are uncommon tumors that can be diagnosed with their characteristicradiological features. Parosteal lipomas occurring in the proximal radius may easily cause paralysis of theposterior interosseous nerve or muscle weakness.Level of Evidence: Level IV, Therapeutic study.Objective: The aim of this study was to evaluate the clinical features and functional results of patientswith parosteal lipomas.Methods: A total of 12 patients (8 females and 4 males; mean age: 45 (10e62) years) with parosteallipomas who were treated between April 1986 and April 2014, were included into the study. The medicalrecords of the patients were reviewed to analyze the clinical features and functional results of thepatients.Results: Of the 12 lipomas, 5 were localized in the proximal arm, 4 in the forearm, 1 in the distal arm, 1 inthe distal thigh and 1 in the distal tibia. All patients presented with a progressive, slow-growing massthat was associated with thumb extension weakness in 1 case, and brachialgia-like symptoms in 1 case.Plain radiographs showed a juxtacortical mass in all cases and irregular ossiŞcation in 3 cases. In all cases,marginal excision was performed and no clinical recurrence was observed after a mean follow-up of 16months.Conclusion: Parosteal lipomas are uncommon tumors that can be diagnosed with their characteristicradiological features. Parosteal lipomas occurring in the proximal radius may easily cause paralysis of theposterior interosseous nerve or muscle weakness.Level of Evidence: Level IV, Therapeutic study