A 72-year old hypertensive woman on nifedipine had an intracapsular fracture of the right femoral neck, following a fall. She did not give any history of food or drug allergies, or of any atopic diseases such as asthma or eczema. Her blood pressure was 150/90 mmHg.Preoperative echocardiography revealed an ejection fraction of 50%, and her chest xray and ECG were normal. Her blood urea (8.3 mmol/L), haemoglobin (11g/dL), fasting blood glucose (6.4 mmol/L) and serum electrolytes (Na 138 mmol/L, K 4.2 mmol/L) were within normal limits.
Histological assessment with a well representative adequate sample would be the key step in diagnosis of musculoskeletal tumors, but poorly performed biopsy remains a common finding in patients with musculoskeletal tumors who are referred to orthopaedic units. Success of a biopsy in musculoskeletal tumour pathology is based on the answers to several vital questions. These questions are when to biopsy? Who should perform the biopsy? where to take the biopsy? And How to biopsy? Errors in answers to these questions will lead to errors in biopsy, misleading the diagnosis and adversely affecting the survival of the patient. Subsequently patients may require an amputation to achieve an adequate surgical resection instead of a limb salvage procedure. In order to minimize the errors related to biopsy, it is mandatory to follow a set of guidelines during the biopsy procedure. This article will discuss the proper biopsy procedure by seeking answers to the above questions.
Vanishing bone disease (VBD) is a rare bone disorder of unknown etiology. Histologically it is characterized by non-malignant proliferation of epithelial lined vascular and lymphatic channels and increased number of osteoclasts that result in resorption of osseous matrix. Lost bone is replaced by granulation tissue. The clinical presentation of VBD is variable and depends on the site of involvement.
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