Fibrocystic disease of the bones. Benign cysts, osteitis fibrosa, osteitis fibrosa with formation of tumours and giant-cell sarcomata (Von Recklinghausen), and mollities ossium with giant-cell sarcomata
1914; Oxford University Press; Volume: 2; Issue: 5 Linguagem: Inglês
10.1002/bjs.1800020505
ISSN1365-2168
Autores Tópico(s)Bone Tumor Diagnosis and Treatments
ResumoULOODCOOD.writing upon this subject in 1910, opens his paper with the statement t.hnt in many surgical lesions technique is tthend of diagnosis.This stateincnt undoiil)tcdl.vcontains a very important truth.Thc dhgnosis of thesc obscure honc conditions is difficult, and a t present uncertain; to many surgcons the very csistence of bone cysts and the allicd coditions is actually 1111known : :tiid this ignorance has led to thc pcrformuncc of operations of a inagnitudc which is not justificd by thr lesion present.In Germany, more particularly.:I.110 t hcr e s t r e ine h a s h ee n rcachcd.The li umber of cascs placed upon rccord of honc cysts, ost.citis fibrosa, etc.. is v e y great.Each dissertation i q m ~ thc subject contains.as a riilc, an elaborate pathological description of the specimens 01.1- taincd, and a survry of the litcraturc.Rut.these investigationst ralirablc as they are, have bcen largcly pathological.and liavc failed to classify the diseases iipon any clinicd systcin ; and so they have not led to the record of a clcar cliiiicnl pict.irre which might ilssist.suhscquc1lt observers in innking a diagnosis. It is just this clinical picturctime of the fracture.(Page 21.) which is wanting, and which the wealth of niaterial a t our disposal ought now to enable 11s to establish.The history of solitary cysts of the long bones may be dated froin thc description in 1.877 of a cyst in thc uppcr end of the humerus found by Virchow VOL.11.-NO.5 .fl FIG.12.--Rndiograph of the humorus of E.O. at the 1-10. 1 6 .4 .R. At the time of t.he frnctum.AFFECTIONS OF SINGLE BONES.Humerus.-Virchow's classical case, drcady referred to, consisted of a cyst found post inortern in thc iippcr end of the hilinerus of a wornail, aged 33.Upo!i t.hc gronnd that sinall masses of cnrtilage were found in the bone in the ncighbourhood of the cyst, this author ascribed it to the breaking doivn of an cnchondroma.Cysts in this situation h a w 1 ) e m rcrordcd by inany observers.The following thrcc CHSCS, originally rccordcd by thc author in thc Rrifish Medical Joiiriiul in 1912.well illustrate this Flu.17.--C.R. O m lllontll prticulwr &ss.E. 0.. a boy, age 9. on May IfLth, 1909.Cell and fractured his right humerus ininietliately below the surgical neck.A skiagram taken in the ordinary routine showed that tlic fracture had occurred through a cystic spacc in thc bone.There was slight uniform expansion of the bone.the ripper limit of the space being t in.bclow t.he epiphyseal line : the outline of the cavity was Aarp, the bone around not sclerosed ; H clear thin shell of bone covered the cavity except where interrupted by the fracturc.and the cavity itself was not divided by trabeculE.A diagnosis of endosteal sarcoma was made, and on May 21 an exploratory operation was performed.On removing a portion of the outer wall of the cavity, t.he Iiitter was found to extend vertically for about 2 in.; it contained a little viscid bloodstained fluid.The interior was scraped, a little soft tissue coming away.A frwwn VOL.II.---HO. 5.3 after tho frncture. E'IBROCI'STIC DISEASE 01' THE BOXES2:3 surrounded by decalcified bone.found, nnd these contained nmny pigment granules ( A S S ( ' H ~-l ~. ;.\ girl.age (1.liatl pain and swcllitig ufter an iiijttry to the anti.Four r e e l i n after t l i e injury.H frac-tiire tliroitgli B cyst was diagtiosed by a radiogmplt.The cyst was opened a i d rurcttwl.t l w fracture being: completed in order t o correct a delortiiity wliicli Iiitd nrisrri.Good iinion rcstiltrd.The cyst owupid about t w o iltclies of tltr v l i r l t of tlie liiirnerus, tlierc being n i i ~r r o w interval between it atid tlte epipliyscal liite. ( B ~~~T I < ' H KR.).4 girl.nge 18. ltad sulTerrcl froni p i t i in the artti rrint.e an nwident rt 13.. l'lic.(:\st WIIS wrettrd, tlie restilt %is niontlis litter being good.
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