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  • There are limitations to the

    2019-06-29

    There are limitations to the current study. As with all surveys, there is an inherent bias in those that are contacted and in those that respond. Obtaining 90 responses on this topic is clearly important, however, the study would be strengthened by a greater number of responses. In addition, the majority of respondent were from the GSK 650394 what two most highly populated Provinces in Canada, however 70% were from Ontario and Quebec, representing around 66% of the total Canadian population. As the respondents tend to have an interest in cancer and bone health and the majority is based in academic centers, there is a bias that the results of our study provide greater insight into practice at an academic center, but potentially less so in a broad scope of practice. However, it GSK 650394 what is important to appreciate that, in Canada, most cancer care is delivered in large centers and most anti-cancer drugs are funded through central regulatory bodies with specific funding policies, thus reducing variability. Another limitation of this type of survey is that it might not necessarily reflect what physicians actually prescribe. This is important as one study of “real world” bisphosphonate prescribing has suggested that different treatment schedules may result in differences in skeletal morbidity [20]. This study was retrospective and funded by the manufacturer of zoledronate and therefore does not replace the need for prospective randomised studies.
    Conclusions
    Conflict of Interest Statement
    Introduction Bone metastases are a common complication of cancer, with breast and prostate cancers being the most common types to metastasize to bone [1]. 70–85% of cancer patients are diagnosed as having bone metastases at the time of autopsy [2,3]. These bone metastases and the primary cancer itself can cause patients great pain and functional interference. Radiation therapy has been well established for the treatment of symptomatic bone metastases [4].
    Failures
    Difference in physician vs. patient perspectives
    Challenges
    Conclusion
    Conflict of Interest Statement
    Acknowledgments We thank the generous support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.
    Introduction Osteoblastoma is a rare primary benign neoplasm comprising less than 1% of primary tumors of bone. The age of presentation ranges between 3 and 70 years with approximately 90% of patients diagnosed before the age of 30 years [1]. About 32% of patients develop in the posterior elements of the spine, 12% in the femur, 10% in the tibia, and 9% in the bones of the foot and ankle [2]. Unusual sites included ribs, small bones of the hands and feet, facial bones, calvarium, patella, scapula, and ilium. In some situation, the tumor may reveal aggressive clinical and radiological behavior. Aggressive osteoblastoma is a variant which histologically mimics an osteosarcoma [2]—hence appropriate clinico-radiological correlation is essential to avoid a misdiagnosis. One such case which occurred in an unusual site is being described.
    Case report A male child aged 2 years presented with gradually increasing swelling over the dorsum of right hand for 4 months. There was no history of trauma, fever or similar swelling over the body. The child was otherwise healthy, playful and afebrile. Local examination of right hand and wrist showed a diffuse swelling, about 4×3cm2 in dimension, over mid-dorsal region of hand, without any local rise of temperature (Fig. 1). However the child exhibited signs of local discomfort over the area. The overlying skin was healthy and there was no abnormality in palm. The third metacarpal shaft was poorly delineated. Fingers could be moved to the full extent. There was no local lymphadenopathy or neural deficit. Radiological examination revealed an expansile mass of 3×2.5cm2, in 3rd metacarpal shaft, the mass was radiolucent, divided into poorly defined small locule with focal mineralization (Fig. 2). In some areas, cortical destruction was noted. The clinico-radiologic features were indicative of an aggressive cartilage tumor or an osteomyelitis.