The detection of hepatic nodules during follow-up of survivors of solid tumors in childhood raises a diagnostic dilemma. Focal nodular hyperplasia (FNH) is an uncommon, benign tumor and must be differentiated from late hepatic metastasis.

We retrospectively analyzed patients, treated for pediatric solid tumors between January 1990 and December 2007, and performed abdominal imaging as part of the follow-up.

Four survivors with FNH were detected, out of 450 who received chemotherapy with/out irradiation including patients who underwent autologous bone marrow transplantation (ABMT). Case 1: A 23 years(y) adolescent, presented at age 10y with acute abdomen due to embryonal sarcoma of liver, she received VACAIEx4, relapsed locally, and underwent ABMT with high-dose carboplatin/melphalan and radiotherapy. Asymptomatic multiple liver lesions were disclosed by US and MRI 5y later, biopsy proved FNH. Case 2: A 21y adolescent who at age 3y had alveolar rhabdomyosarcoma of the calf with positive inguinal nodes. She received VACAIE x6, and VP16/carboplatin x3 with local radiation. She developed ovary disorder and received oral contraceptive (OC) at age 14.5y, routine US 1.5y later disclosed nodular lesions in liver, diagnosed as FNH by CT, pills were stopped. At follow-up some lesions reduced in size and few disappeared. Case 3: A 9y old girl, operated for choroid plexus carcinoma at age 1.5y, received VP16/carboplatin x16 and underwent ABMT preceded by thiotepa/melphalan. Abdominal US at age 5.5y disclosed multiple liver lesions, biopsy proved FNH, that disappeared 2y later. Case 4: An 11y old girl operated at age 8 months for retroperitoneal germ cell tumor, received VIP/BVPx4, routine US at 10y disclosed 2 liver lesions diagnosed by CT as FNH.

We conclude that FNH can be differentiated from late metastasis by imaging; in questionable cases by biopsy, close follow-up is recommended, alkylating agents especially during ABMT, and OC may be risk factors.

Increased intensity of therapy for osteosarcoma in the last 30 years has improved prognosis. 70–80% of patients with non metastatic osteosarcoma can now be cured, but late side effects occur. Fertility of survivors is becoming of greater importance.

We retrospectively studied all consecutive female long term survivors of localized osteogenic sarcoma of childhood and adolescence treated at the Schneider Children‘s Medical Center of Israel. Patients were treated with 3 different protocols including the use of Methotrexate, Adriamycin, Cisplatin, Bleomycin, Cytoxan, Vincristine, Actinomycin D, Melphalan and Ifosfamide.

Sixteen female survivors of non metastatic osteogenic sarcoma were treated from 1/1977 to 12/2001, with a minimum follow up of 6.3 years (max. 29 years) from the end of therapy. Median age at diagnosis was 11.7 (range 9.0–16.8) years. Twelve out of 16 (75%) are married and have between them 31 children, mean 2.7 (range 1–7) children. Of these 11 have children and one is currently pregnant with her first child. None of the females reported difficulties in conceiving their first child. The maximum interval from marriage to first delivery was 2.5 years. Two females had 3 spontaneous abortions between the 2nd–4th pregnancies. Four out of 9 female survivors who received > 360mg/m2 of adriamycin were treated with cardiomimetic drugs and/or ACE inhibitors during pregnancy. All four had 2–4 children/ female survivor. The children of survivors are healthy with no birth defects. Mean length of pregnancy was 38.6 weeks and mean birth weight was 2865 grams. No survivors had undergone invasive fertility preservation procedure and only one unmarried patient was using GnRH analogs.

Despite reports of transient disturbances in menstruation, all married females were fertile. Our results question the need for fertility preservation using GnRH analogs or invasive procedures such as ovary or egg preservation for non metastatic osteogenic sarcoma female patients.

The proper management of radial head fractures is difficult and controversial. The radial head is intra-articular, part of the forearm ring and participates in both flexion and extension as well as in pronosupination. Our main goal in treating those fractures is anatomic restoration of the joint surface and early mobilization. Excision of the radial head, a well described procedure, may result in elbow instability and proximal migration of the radius. In this work we tried to avoid those complications by either conserving the head (ORIF) or by using a Radial head prosthesis.

Material and Methods: 20 Patients were enrolled into the study between 2003–2004. They were divided into 2 groups. 10 patients had ORIF and in patients the Corin Radial head prosthesis was used. Post-op all patients started immediate CPM. All patients were followed-up for 12–28 months (average 18.6). XR were taken each time and clinical examination was done, ROM was noted as well as muscle strength. Elbow stability was tested only on the 2^nd month post op. Patient satisfaction was noted based of their function ability, and the amount of pain. Pain was rated on a scale of 1–10.

Results: Both groups passed the surgery uneventfully. No neurovascular damage nor infection were noted. In clinical examination the elbow was found to be stable in both groups. Decreased ROM in compare with the other elbow was found in both groups, but was more prominent in he ORIF group. One patient in the ORIF group in which biodegradable rod was used developed moderate synovitis that passed without intervention after 9 weeks. XR reveled that one patient in the ORIF group developed Heterotopic ossification, no dislocation or subluxation of the prosthesis was seen. Regarding to pain, in the ORIF group the patients rated their pain as milder in compare to those in the prosthetic group.

Conclusions: Both methods result in stable elbow but the ORIF group showed tendency to experience less pains and the prosthesis group showed tendency to better ROM.

Background: Heterotopic ossification is a common feature that follows total hip arthroplasty, and affects up to 70% of patients with clinical implications, such as pain and restricted hip movements. Previous clinical observation showed negligible heterotopic ossification in our patients who underwent total hip arthroplasty due to familial Mediterranean fever, and received colchicines on a daily basis.

Aims: To evaluate in vitro, in vivo and during clinical studies whether colchicines, given on a prophylactic daily basis to all total hip arthroplasty patients, was responsible for the negligible heterotopic ossification.

Methods: In vitro: cell lines of fibroblasts and osteoblasts were cultured with increasing concentrations of colchicines. Direct cell counts [3H]thymidine uptake, and mineralization were measure. In vivo: heterotopic ossification was induced in the thigh muscle of rabbits by injecting bone marrow. Animals were given colchicines, and X-ray radiographs, ultrasound the histological studies measured its effect on heterotopic ossification. Clinical study: Fifty-two patients admitted for total hip arthroplasty were randomly selected to receive colchicines on a daily basis, starting 10 days pre-operatively, and 6 weeks postoperatively. Clinical evaluation was made according to Harris Hip Score and heterotopic ossification according to Brooker classification.

Results: In vitro: colchicines was found to be a strong, nonselective inhibitor of cell proliferation, and an even greater inhibitor of tissue mineralization. In vivo: statistically significant reduction in the amount of hetero-topic ossification induced in the thigh muscle of rabbits was measured in the groups that received colchicines. Clinical study: Patients who received colchicines pre-operatively developed a negligible amount of hetero-topic ossification after total hip arthroplasty at 1-year follow-up without adversely affecting the Harris Hip Score.

Conclusions: Colchicine is a strong inhibitor of cell proliferation and tissue mineralization, and an effective means of reducing heterotopic ossification after total hip arthroplasty. These effects may be used in other bone-forming processes: after hip/pelvic trauma, head injury, and possibly in other bone-forming conditions.

Introduction: Soft-tissue sarcomas (STS) in children and young adults are rare. This is a heterogeneous group of tumors, which is traditionally divided to rhabdomyo-sarcomas and non-rhabdomyosarcoma soft-tissue sarcomas (NRSTS). These tumors are further classified to high- and low-grade tumors.

Material and Methods: Between 1988 and 1999, the authors treated 50 patients (25 males, 25 females) under the age of 20 who were diagnosed with a soft-tissue sarcoma.

Histopathological Diagnoses: rhabdomyosarcoma – 11, synovial sarcoma – 6, other high-grade STS (extraskeletal Ewing’s sarcoma, epitheloid sarcoma, neurofibrosarcoma, hemangiopericytoma, fibrosarcoma, and unclassified sarcoma) – 17. Seven patients were diagnosed with low-grade STS and 9 patients with an aggressive desmoid tumor.

Anatomic Location: Lower extremities – 30, upper extremities – 9, shoulder girdle – 2, trunk – 4, pelvic girdle – 5.

Preoperative Treatment: Thirty patients received neo-adjuvant chemotherapy, four patients underwent isolated limb perfusion with TNF and melphalan, and one patient received preoperative radiation therapy. Surgery: Forty-seven underwent limb-sparing resections and 3 underwent primary amputation. Wide margins were achieved in 37 patients and marginal margins in 10. Intralesional resection was performed in 3 patients.

Postoperative Treatment: Thirty-seven patients received adjuvant chemotherapy and 34 received radiation therapy.

Oncological Status: At the most recent follow-up, 24 patients of the 37 patients with high-grade STS have no evidence of disease, three are alive with disease, and seven are dead. Fourteen of the 16 patients with low-grade tumors have no evidence of disease and 2 are alive with disease. There were 4 secondary amputations due to local tumor recurrence.

Conclusions: Management of soft-tissue sarcomas in children and young adults requires the judgmental use of pre- and postoperative treatment modalities. Local tumor control can be achieved in the majority of the patients. A longer follow-up is required to determine the overall survival of these patients.

Colchicine is often used in the treatment of diseases such as familial Mediterranean fever (FMF) and gout. We have previously reported that patients with FMF who had colchicine on a daily basis and who had a total hip arthroplasty showed no heterotopic ossification after surgery. The mechanism by which colchicine causes this clinical phenomenon has never been elucidated. We therefore evaluated the effect of various concentrations of colchicine on cell proliferation and mineralisation in tissue culture, using rat and human cells with and without osteogenic potential. Cell proliferation was assessed by direct cell counts and uptake of (³H)thymidine, and mineralisation by measuring the amount of staining by Alizarin Red.

Our findings indicate that concentrations of colchicine of up to 3 ng/ml did not affect cell proliferation but inhibition was observed at 10 to 30 ng/ml. Mineralisation decreased to almost 50%, which was the maximum inhibition observed, at concentrations of colchicine of 2.5 ng/ml. These results indicate that colchicine at low concentrations, of up to 3 ng/ml, has the capacity to inhibit selectively bone-like cell mineralisation in culture, without affecting cell proliferation. Further clinical and laboratory studies are necessary to evaluate the effects of colchicine on biological processes involving the proliferation of osteoblasts and tissue mineralisation in vivo, such as the healing of fractures, the formation of heterotopic bone and neoplastic bone growth.