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Biomedical subjects

Andreas F Mavrogenis

Publications and source records attributed to Andreas F Mavrogenis.

At least 19 recordsLinked to original sources
PubMed2006

Current trends in the management of extra-abdominal desmoid tumours.

Extra-abdominal desmoid tumours are slow-growing, histologically benign tumours of fibroblastic origin with variable biologic behaviour. They are locally aggressive and invasive to surrounding anatomic structures. Magnetic resonance imaging is the modality of choice for the diagnosis and the evaluation of the tumours. Current management of desmoids involves a multidisciplinary approach. Wide margin surgical resection remains the main treatment modality for local control of the tumour. Amputation should not be the initial treatment, and function-preserving procedures should be the primary treatment goal. Adjuvant radiation therapy is recommended both for primary and recurrent lesions. Chemotherapy may be used for recurrent or unresectable disease. Overall local recurrence rates vary and depend on patient's age, tumour location and margins at resection.

Journal Article↗
PubMed2006

Spondylodiscitis after facet joint steroid injection: a case report and review of the literature.

Spondylodiscitis is a rare complication after facet joint steroid injection. This article presents a 78-y-old male with chronic back pain and facet joint arthritis who developed Pseudomonas aeruginosa L2-L3 and L3-L4 spondylodiscitis after computed tomography-guided facet joint steroid injection. Magnetic resonance imaging, fine needle aspiration and cultures confirmed the diagnosis. The patient was treated with intravenous administration of amikacin, and imipenem plus cilastatin for 4 weeks, followed by oral administration of ciprofloxacin for another 10 weeks. Sterile preparation prior to facet joint steroid injection should be stressed. To the best of our knowledge, this is the only reported case of iatrogenic spondylodiscitis after facet joint steroid injection. This iatrogenic complication should be considered in the risk-benefit analysis of facet joint diagnostic or therapeutic injections.

Aged↗
PubMed2006

Survivorship analysis in patients with periosteal chondrosarcoma.

UNLABELLED: To investigate outcome and identify prognostic factors, we retrospectively reviewed 24 consecutive patients with periosteal chondrosarcomas. There were 17 males and seven females with a mean age of 37.6 years (range, 15-73 years). The femur was involved in 12 patients, the proximal humerus in five, the tibia in two, and the distal fibula, ilium, pubis, metatarsal, and rib in one patient each. The mean greatest dimension of the lesions was 8.1 cm (range, 1.5-27 cm). Based on the histologic pattern, there were 18 Grade 1 tumors and six Grade 2 tumors. All patients were treated surgically. Two patients had intralesional excisions, five patients had marginal excisions, and 17 patients had wide resections. With a mean followup of 17 years (range, 28 months-47 years), seven of 24 patients (29%) had one or more local recurrences. The 5-year local recurrence-free survival was less in patients treated with intralesional or marginal excisions (25%) than for patients treated with wide resections (93%). At the latest followup, six of 24 patients (25%) had died of pulmonary metastases. The overall 5-year metastasis-free survival was 83%. The 5-year metastasis-free survival was less for patients with Grade 2 tumors (50%) than for patients with Grade 1 tumors (94%). LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2006

Advances and challenges in diagnosis and management of skeletal metastases.

The treatment of metastatic disease remains challenging. The number of patients who will be diagnosed with metastatic bone disease will continue to increase as survival from the primary cancer diagnosis continues to improve. Although it often is impossible to cure these patients, the task of maximizing their quality of life must be met with valiant efforts. Although a large number of medical and technological advances have occurred, perhaps the recognition of the importance of a well-qualified multidisciplinary team approach to treatment of these complex patients has done more to improve the field than any other single achievement. As basic science continues to further unravel potential treatment options, we must not forget this integrated approach and we must embrace "the bench" at the bedside.

Bone Neoplasms↗
PubMed2006

Optimal treatment of fibrodysplasia ossificans progressiva with surgical excision of heterotopic bone, indomethacin, and irradiation.

A case report is presented of an 18-year-old boy with advanced fibrodysplasia ossificans progressiva. The patient's right hip was ankylosed in 35 degrees of flexion. Excision of the heterotopic bone from the right hip was followed by a combination of a single fraction irradiation (7Gy) given in the first postoperative day, and an 11-day treatment with indomethacin (25 mg, three times daily, orally). One year postoperatively, the patient ambulates nearly normally and he is able to sit and stand up without significant difficulty. Radiographs of the right hip showed a small amount of heterotopic bone formation at the operative site. In contrast with the results published in the literature, the clinical result of the operation is considered satisfactory. Further investigation of the combined use of indomethacin and single fraction irradiation as a preventive measure after surgical excision of heterotopic bone in patients with fibrodysplasia ossificans progressiva FOP should be performed.

Adolescent↗
PubMed2005

Diving injuries of the cervical spine in amateur divers.

BACKGROUND CONTEXT: Diving injuries are the cause of potentially devastating trauma, primarily affecting the cervical spine. PURPOSE: Our purpose was to describe our experience with diving injuries treatment. STUDY DESIGN: Retrospective review. PATIENT SAMPLE: Twenty patients with diving injuries. OUTCOME MEASURES: Using the American Spinal Injury Association (ASIA) impairment scales as the primary outcome measure, the patients' neurological status before and after treatment was assessed. In this way we were able to draw conclusions about neurological improvement or deterioration in response to conservative or operative treatment. METHODS: We retrospectively reviewed 20 patients with diving injuries of the cervical spine who were admitted to our institute over a 34-year period from 1970 until 2004. RESULTS: The typical patient profile was of a young, healthy, athletic male who suffered an injury to the cervical spine after diving into shallow water. The number of cases corresponds to 2.6% of all admitted cervical spine injuries. All injures occurred between May and September. The most commonly fractured vertebrae were C5 and C6. Four patients were treated operatively and 16 conservatively. The indications for surgical treatment were posttraumatic instability and persistent neurological deficit. The mean follow-up of the patients was 17 years. Five patients died within the first month of their hospitalization and 1 patient died 1 year after his injury. Of the 14 patients who were available for follow-up 5 years past injury time, 6 improved neurologically and 8 remained unchanged in relation to their neurology upon admission. Of the 11 patients who were available for follow-up 10 years past injury time, 9 remained neurologically unchanged, 1 deteriorated, and 1 improved in relation to their neurology in the 5-year follow-up. CONCLUSION: Diving injuries of the cervical spine demonstrate high mortality and morbidity rates. Recovery depends on the severity of the initial neurological damage. Conservative treatment is justified in specific patients and can lead to improvement of the initial neurological deficit.

Adolescent↗
PubMed2005

Chance-type fractures of the axis.

STUDY DESIGN: A retrospective study was performed to identify horizontal fractures of the body of the axis, with special attention to their pattern, prevalence, and clinical outcome. OBJECTIVE: The prevalence of this type of injury and the long-term clinical behavior are examined. SUMMARY OF BACKGROUND DATA: Although isolated cases have been reported, horizontal Chance-type fractures of the body of the axis are not common cervical spine injuries. METHODS: The medical records of 674 consecutive patients with fractures of the cervical spine admitted to the authors' institute from 1970 to 2002 were reviewed. Of them, 2 (0.3%) had a horizontal Chance-type fracture of the body of the axis. Neurologic deficits were not diagnosed at admission. Mechanism of injury, treatment, and long-term follow-up were evaluated. RESULTS: Both patients were treated nonoperatively. At the latest follow-up, 3 and 12 years, respectively, both patients had a satisfactory clinical outcome. CONCLUSION: Horizontal fractures of the Chance-type of the body of the axis are rare. Conservative treatment proved to be effective.

Aged↗
PubMed2005

Complications after tibia plateau fracture surgery.

High-energy tibial plateau fractures are often the result of blunt trauma and are associated with severe soft-tissue injury. Fixation techniques demand considerable surgical skill and mature judgment. The available surgical options do not always guarantee a favourable outcome. Operative treatment includes internal and external fixation, hybrid fixation and arthroscopically assisted techniques. Operative management of high-energy fractures remains difficult and challenging and may be associated with serious complications, such as knee stiffness, ankylosis, deep infection, post-traumatic arthritis, malunion and nonunion. Prevention of the complications can optimise the clinical outcome in these patients.

Adult↗
PubMed2005

Changes of meniscal interhorn distances: an in vivo magnetic resonance imaging study.

The aim of this study was to evaluate the changes of the internal (IID) and external meniscal interhorn distance (EID) of the medial and the lateral meniscus under loading. Sagittal magnetic resonance images of 15 knees were studied. The medial and lateral meniscus were examined with the knee at 0 degrees and 30 degrees of flexion, under no load, with load equal to 50% of body weight and with load equal to 100% of body weight. Under no load, the mean IID was 19.9 mm for the medial meniscus and 12.3 mm for the lateral meniscus and the mean EID was 44.6 mm for the medial meniscus and 34.4 mm for the lateral meniscus. Under load equal to 50% and 100% of patient's body weight, there was a significant increase in both distances (p<0.05). Under constant loading, flexion of the knee from 0 degrees to 30 degrees , decreased the EID of both menisci. In conclusion, loading increases both IID and EID. Knee position affects only the EID. The quality of magnetic resonance images may affect the reliability of such measurements.

Adult↗
PubMed2005

Tuberculous sacroiliitis. A case report and review of the literature.

BACKGROUND: Infections of the musculoskeletal system are tuberculous in nature in 1-5% of cases. The sacroiliac joint is involved in 3-9.7%. We describe the case of a 32-year-old man with tuberculous sacroiliitis presented as a growing mass on the lateral aspect of his right proximal and mid-thigh. Open biopsy, histology, cultures and PCR established the diagnosis of tuberculosis. RESULTS: After surgical drainage of the abscess, the patient was administrated a triple antibiotic regimen for 12 months. Seven years postoperatively, the patient is disease-free with no functional limitation. This case report highlights the importance of continued awareness for early detection and treatment of a tuberculous sacroiliac joint infection.

Adult↗
PubMed2005

Unusual presentation of osteoid osteoma of the scaphoid.

The small carpal bones are infrequent sites for osteoid osteomas, and their clinical and imaging pictures may be quite confusing leading to suspect other etiologies. The authors present herein an unusual case of osteoid osteoma of the scaphoid superimposed on a wrist injury caused by a fall on the outstretched hand.

Adult↗
PubMed2005

Lateral malleolus en bloc resection and ankle reconstruction for malignant tumors.

UNLABELLED: Four children and six adults required en bloc resection of the lateral malleolus for malignant tumors. There were four osteosarcomas, three chondrosarcomas, two Ewing's sarcomas, and one adamantinoma. Surgical margins were wide in seven patients, marginal in two, and intralesional in one. A primary ankle arthrodesis was done in four adults and bracing without any reconstruction was done in four children and two adults. During a mean followup of 14.5 years (range, 3-30 years), there were two local recurrences (two of 10 patients) after a marginal excision and an intralesional excision. One patient had reoperation for a skip osteosarcoma lesion in the proximal fibula. Other complications included chronic osteomyelitis, a lateral talus subluxation and cavovarus deformity, and recurrent ankle instability and degenerative changes of the ankle. At the latest followup, all 10 patients showed no evidence of disease. Five patients who had primary or late ankle arthrodesis had a Musculoskeletal Tumor Society and International Society of Limb Salvage functional score of 28 points (92%), and two adolescents who had postoperative bracing alone had a functional score of 24 points (80%). The three remaining patients had a salvage amputation. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Improvement of proximal tibial osteotomy results by lateral retinacular release.

UNLABELLED: We sought to compare the clinical and radiographic outcomes of patients who had high tibial osteotomies with or without lateral retinacular release with an emphasis on patellofemoral symptoms. We prospectively studied 64 patients who had proximal tibial osteotomies from 1990 to 1999. The minimum followup was 5 years. Preoperative varus deformity and medial compartment osteoarthritis were present in all patients. A Coventry proximal tibial osteotomy was used in all patients. Retinacular release was not used in 32 patients (Group A) but was added for the other 32 patients (Group B). Flexion was greater for patients in Group B (mean, 110 degrees ; range, 100 degrees -125 degrees ) than for patients in Group A (mean, 95 degrees ; range, 90 degrees -115 degrees ). The Knee Society score also was greater for patients in Group B (mean, 91 points) than for patients in Group A (mean, 80 points). The cohorts were small, but there was a difference favoring patients who had a lateral retinacular release. LEVEL OF EVIDENCE: Therapeutic study, Level II (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

Cartilage, Articular↗
PubMed2005

Reinforced iliotibial tenodesis for chronic anterolateral instability of the knee: a 6-year follow-up.

Reinforced iliotibial tenodesis is an extra-articular procedure to eliminate anterolateral instability of an anterior cruciate ligament-deficient knee. The procedure carries a low complication rate and offers an easy rehabilitation program. This study evaluated the use of reinforced iliotibial tenodesis in a select group of 52 patients with a mean age of 41 years (range: 38-50 years). Obese patients, professional athletes, and patients with more complex injuries (eg, concomitant posterior cruciate or medial collateral ligament injuries) were excluded. Results are encouraging after a mean follow-up of 6 years (range: 2-10 years). Although 24 patients had a positive anterior drawer or Lachman test, none had a positive pivot test. In addition, all patients reported giving way was eliminated after surgery.

Adult↗
PubMed2005

Minimally invasive techniques in orthopedic oncology: radiofrequency and laser thermal ablation.

Image-guided percutaneous thermal ablation is a safe and effective method to reduce pain in patients with painful bone tumors. Computed tomography-guided radiofrequency or laser ablation is the modality of choice for most osteoid osteomas. Radiofrequency or laser thermal ablation also offers an alternative method for palliation of localized, painful osteolytic metastatic lesions. Pain can be reduced and neural damage prevented, improving the quality of life for patients with cancer who often have multimorbid conditions and limited life expectancy. A multidisciplinary approach that includes orthopedic surgeons, neurosurgeons, medical and radiation oncologists, and interventional radiologists is essential to manage these patients.

Bone Neoplasms↗