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Biomedical subjects

B Rööser

Publications and source records attributed to B Rööser.

At least 19 recordsLinked to original sources
PubMed1996

Simplified external fixation for primary management of severe musculoskeletal injuries under war and peace time conditions.

This study was undertaken to document whether a basic set of a new unilateral external fixation device could provide sufficient stability in complex musculoskeletal injuries involving upper and lower extremities and in patients with unstable pelvic ring disruptions. The initial clinical evaluation was performed in Sweden (stage 1) followed by field evaluation at the Swedish Field Hospital during the Mogadishu conflict in Somalia (stage 2). In stage 1, there were 90 patients with 116 acute limb injuries and six patients with an unstable pelvic ring disruption. Ninety limb injuries and all six pelvic fractures were primarily stabilized by the external fixation device. The other 26 fractures were managed at the index operation with intramedullary nailing, open reduction, and internal fixation or cast immobilization. Twelve patients had a local pedicle or free vascularized flap for soft tissue coverage. One multiply injured with an open Gustilo IIIB tibial shaft fracture had an early amputation. The basic set provided adequate stabilization for soft tissue recovery in 89 limb injuries (89 of 90), thereby providing optimal conditions for continued management to skeletal consolidation in 88 patients. Hemodynamic stabilization was achieved in all six patients with unstable pelvic fractures. In stage 2, there were 63 patients with war injuries and 33 patients injured in traffic accidents. All were managed under field conditions. The basic set was sufficient for soft tissue recovery in all 96 cases. It is concluded that the rigidity of this device is adequate for stabilization of severe musculoskeletal injuries requiring major surgical procedures. In addition, the simplicity of this device, which allows for only a limited number of possible configurations makes it suitable for inexperienced surgeons working under war or mass-casualty conditions to manage these complex musculoskeletal injuries.

Adolescent↗
PubMed1991

Is local recurrence of minor importance for metastases in soft tissue sarcoma?

The authors analyzed the relationship between treatment, local recurrence, and metastases in a population-based series of 375 patients with soft tissue sarcoma of the extremities and the trunk wall. Treatment was inadequate (marginal excision alone) in 107 patients, local recurrence occurred in 112, and 128 patients developed metastases. Local recurrence was 3.5 times more common after inadequate treatment than after adequate and 2.5 times more common in patients with metastases than in those without. However, metastases were only 1.2 times more common after inadequate treatment than after adequate. Of the 128 patients who developed metastases, 63 had local recurrence and 65 had not. In these two subgroups the timing of metastases and the distribution of clinicopathologic factors--age, sex, tumor size, localization, depth, histotype, and malignancy grade--were similar. These findings indicate that local recurrence is of minor importance for development of metastases in soft tissue sarcoma. The increased local recurrence rate in metastatic tumors may be an expression of the aggressiveness of the primary tumor; highly malignant tumors combine a potential both for local and distant spread.

Adolescent↗
PubMed1991

Malignant fibrous histiocytoma of soft tissue. A population-based epidemiologic and prognostic study of 137 patients.

Epidemiology and prognosis were analyzed in a consecutive, population-based series of 137 patients with malignant fibrous histiocytoma of soft tissue in the extremities and trunk wall, with a complete follow-up of minimum 3 years. All but one patient were treated by surgery in 28 cases combined with adjuvant radiotherapy or chemotherapy. The annual incidence was 0.42/10(5). The ratio men to women was 1.1. The median age was 64 years (range, 22 to 87 years). The thigh was the most common location. The median size was 6 cm. Superficial tumors constituted 43% and were smaller than deep-seated tumors. Eighty-three tumors were storiform-pleomorphic, 53 were myxoid, and one was of inflammatory type. The myxoid tumors were smaller and more often superficial. The cumulative 5-year survival rate for all patients was 0.7, but differed markedly between the histologic types; it was 1.0 in patients with myxoid tumors and 0.5 in patients with storiform-pleomorphic tumors. In the 77 patients with storiform-pleomorphic tumors without metastases at presentation, only tumor size larger than 10 cm and tumor necrosis independently impaired survival. The 23 patients who had none of these risk factors had a 5-year survival rate of 0.8.

Adult↗
PubMed1991

Acute compartment syndrome from anterior thigh muscle contusion: a report of eight cases.

Eight patients with an anterior thigh muscle contusion or rupture developed an acute anterior compartment syndrome. All patients had an increased pressure in the quadriceps muscle, ranging between 41 and 80 mm Hg. At fasciotomy, three cases had a hematoma in the rectus femoris and four in the vastus intermedius, and in one case only, edema of the anterior compartment was found. Postoperatively, there was immediate pain relief in all cases, and after about 4 weeks, all patients had normal function. We recommend broad indications for fasciotomy and evacuation of hematoma after thigh muscle contusion or rupture.

Acute Disease↗
PubMed1991

Limb-sparing surgery without radiotherapy based on anatomic location of soft tissue sarcoma.

From 1980 through 1986, 119 patients with soft tissue sarcomas of the extremities were referred to our tumor center either before surgery (n = 78) or immediately after incisional biopsy or marginal excision (n = 41). The tumors were classified according to anatomic location at admittance as subcutaneous (n = 40), intramuscular (n = 30), and extramuscular tumors (n = 49). Open biopsy was omitted in 75 of the 78 patients referred before surgery; the preoperative diagnosis was based on physical and radiographic findings and fine-needle aspiration cytology. The surgical intention for subcutaneous tumor was to obtain a wide margin, which required a cuff of fat tissue around the tumor and inclusion of the deep fascia beneath the tumor. A wide margin for an intramuscular tumor implied no open biopsy and an unbroken muscle fascia or thick muscle cuff around the tumor (primary myectomy). The 70 patients with subcutaneous and intramuscular tumors were all treated by local surgery. A wide margin was obtained in 56 patients who were not given radiotherapy. During a median follow-up of 5 years (range, 3.5 to 10 years), four of these 56 patients--47 of whom had high-grade malignant tumors--had a local recurrence. We conclude that routine combination of limb-sparing surgery with adjuvant radiotherapy is not necessary in patients with soft tissue sarcoma. Two thirds of soft tissue sarcomas of the extremities are primarily subcutaneous or intramuscular tumors, the majority of which can be treated by local surgery without local adjuvant therapy with a local recurrence rate of less than 10%, irrespective of malignancy grade.

Adult↗
PubMed1991

Subcutaneous sarcoma. A population-based study of 129 patients.

We reviewed 129 patients with subcutaneous sarcoma diagnosed from 1964 to the end of 1985 in a population-based series of sarcoma cases from southern Sweden. The annual incidence was 0.4 per 100,000, comprising 32% of all soft-tissue sarcomas of the extremities or the trunk wall. Compared to deep-seated sarcomas, subcutaneous tumours were half the size at diagnosis, more common in the lower leg and foot, more often malignant fibrous histiocytoma, and of a lower grade of malignancy. None of the low-grade and only 7% of the high-grade tumours recurred locally after wide local excision without radiotherapy. The cumulative five-year survival for all 129 patients was 80%. Multivariate analysis identified only high grade of malignancy and the size of the tumour (greater than 5 cm) as independent prognostic factors. We conclude that systemic or local adjuvant therapy is not generally indicated for subcutaneous sarcoma because of the good prognosis and low local recurrence rate after wide excision.

Adolescent↗
PubMed1990

Is there no influence of local control on the rate of metastases in high-grade soft tissue sarcoma?

Primary host and tumor-related prognostic factors, the occurrence of local recurrence, and the time interval between diagnosis of the primary tumor and metastatic disease were analysed in 39 patients with metastatic Grade 4 soft tissue sarcoma. The pattern of prognostic factors and the timing of metastases were the same in patients with and without local recurrence. Thus, primary prognostic factors alone may determine the risk of metastases in high-grade soft tissue sarcoma; local recurrence per se may not influence the prognosis in these cases.

Female↗
PubMed1990

Prediction of survival in patients with high-grade soft tissue sarcoma.

Using the Cox proportional hazards model, and considering tumour necrosis and vascular invasion by tumour as additional factors in assessment, a series of 88 patients with primary Grade III and IV soft tissue sarcomas of the locomotor system was analysed for factors associated with death due to the tumour. Grade IV malignancy, a tumour size larger than 10 cm., tumour necrosis, and vascular invasion by tumour cells were significant risk factors. Patients with 0 or 1 risk factor, one half of the cases, had a 3 year survival rate of more than 90%, whereas the figure was 65% for those with 2 risk factors and 20% for those with 3 or 4 risk factors.

Adult↗
PubMed1990

External fixation of femoral fractures: experience with 15 cases.

We report our experience with external fixation in 15 femoral fractures in 14 patients. Follow-up times ranged from 4 to 56 months. Thirteen patients had multiple injuries. All but two fractures healed. In one patient with a supracondylar fracture, a knee arthrodesis had to be performed. One septic osteomyelitis of the femur led to amputation. The range of active knee joint motion was greater than or equal to 90 degree in 13 knees. Only six knees, however, regained a flexion of greater than or equal to 120 degrees. Pin tract infection occurred in one case and resolved uneventfully after revision and systemic antibiotics. External fixation should not be routinely used for fixation of femoral fractures, but may be considered in multiply injured and critically ill patients or in case of extensive soft tissue injury.

Adolescent↗
PubMed1989

Prognostic factors in synovial sarcoma.

The authors analyzed the prognosis in a population-based series of 24 patients with primary synovial sarcoma in the extremities (22) and trunk wall (two), all of whom were principally treated by surgery. No patient had evidence of metastatic disease at the time of diagnosis of the primary tumor. After 3 to 19 years of follow-up, six patients had developed local recurrence and 12 had died of metastatic disease including those six with local recurrence. All patients with tumors smaller than 4 cm were alive without evidence of disease, as were also four of the five patients who had larger tumors, but with a mitotic rate lower than 15 per 10 high-power fields. The association between local recurrence and metastatic disease may be more statistical than causal, since patients with both these events had more often larger tumors with a high mitotic rate.

Adolescent↗
PubMed1989

Surgical margin in soft tissue sarcoma. The Scandinavian Sarcoma Group experience.

Two-hundred and forty adult patients with a high-grade soft tissue sarcoma were treated surgically in 18 hospitals participating in the Scandinavian Sarcoma Group Protocol I. The patients were randomized to either postoperative doxorubicin or control; patients whose surgical margin was judged marginal also received radiotherapy. The outcome after different surgical margins was analyzed in 185 tumors of Grades III or IV in the extremities. The total cumulative local tumor control was 91 percent (168 of 185) after a median of 47 months. The cumulative local control rates in the surgical groups were: compartmental or wide amputation--37/37 (100 percent), compartmental local excision--23/24 (96 percent), wide local excision--77/84 (92 percent), marginal excision and radiotherapy--19/21 (90 percent), and marginal excision alone (reevaluated margin)--12/19 (63 percent, significantly lower than others). The risk of local recurrence was 13 times higher after marginal than after compartmental surgery (P = 0.02) and 3 times higher if the tumor was larger than 10 cm (P = 0.05). The treatment with doxorubicin did not influence the risk of local recurrence. The survival rates did not differ significantly in the groups.

Combined Modality Therapy↗
PubMed1989

Prognosis in high-grade soft tissue sarcomas. The Scandinavian Sarcoma Group experience in a randomized adjuvant chemotherapy trial.

From 1981 to 1986, 240 patients with primary, malignancy grade III or IV soft-tissue sarcoma were entered into a randomized adjuvant chemotherapy multicenter trial, conducted by the Scandinavian Sarcoma Group. After a median follow-up time of 46 (2-97) months, a multivariate analysis of risk factors for metastases was performed in 138 radically operated on patients with tumors of the extremities. Adjuvant single-agent doxorubicin did not improve the metastasis-free survival. Histologic malignancy grade IV, tumor size greater than 10 cm, vascular invasion by tumor, and male sex were identified as risk factors. Patients with no or one risk factor had a 5-year metastasis-free survival of 0.7, with two risk factors 0.5, and with three or four risk factors 0.2. The combination of different risk factors provides a prognostic model for soft tissue sarcomas, which could be a basis for therapeutic trials.

Adolescent↗
PubMed1988

Prognostication in soft tissue sarcoma. A model with four risk factors.

A multivariate analysis of risk factors for death due to tumor was performed in 82 patients with highly malignant, histologic Grades III and IV primary soft tissue sarcoma of the locomotor system. All the patients had been operated on with a wide or radical surgical margin. Male sex, histologic malignancy Grade IV, extensive tumor necrosis, and tumor size greater than 10 cm were identified as risk factors. Patients with no or one risk factor had a 6(10)-year survival rate of 100% (100%), equal to 96% (96%) in a group with Grade I and Grade II tumors operated on with the same margin. These two groups comprised 50% of all the patients operated on with a wide or radical margin. The 6(10)-year survival rate decreased to 75% (75%) for patients with two risk factors and to 33% (22%) for patients with three or four risk factors. The risk factor model also applied to 62 patients operated on with marginal surgery; and for patients with three or four risk factors, more extensive surgery only had a small effect on long-term survival. The model could be of value when eligibility criteria for trials with adjunctive chemotherapy are determined.

Female↗
PubMed1988

Preoperative diagnosis of soft tissue tumours.

Over a period of 3 years in Southern Sweden 35 patients were seen with deep-seated limb sarcomas without metastases, 30 of whom were referred before any operation had been carried out. Thirty seven patients with deep-seated benign lesions were referred during the same period because of suspected malignancy. A preoperative diagnosis considered sufficient for a definitive operation was made from the clinical findings, aspiration cytology and radiographic examination, but without open biopsy, in 59 of these 67 cases. The differentiation between a benign and a malignant tumour was correct in all but one. The extent of excision necessary to achieve adequate margins for a soft-tissue sarcoma can often be reduced if open biopsy is avoided, with preservation of function. We conclude that treatment without open biopsy is possible in the great majority of patients with soft-tissue sarcoma.

Adult↗