Biomedical subjects

R Capanna

Publications and source records attributed to R Capanna.

At least 19 recordsLinked to original sources

PubMed1992

Osteoblastoma of the spine.

Osteoid osteomas and osteoblastomas have similar histologic characteristics, although their clinical course in the spine may be significantly different. At the authors' institution, spinal osteoblastomas constituted 46% (30/65) of all osteoblastomas treated. Sixteen of the lesions occurred in the lumbar spine (53%), eight in the thoracic spine, and six in the cervical spine. In all regions of the spine, the posterior elements and pedicles were more frequently involved than the vertebral body. Twenty patients had pain or other symptoms for more than 12 months before diagnosis. Six of eight patients had thoracic lesions that demonstrated neurologic involvement. Twelve patients presented with painful scoliosis. Fourteen patients had lesions with well-circumscribed margins confined within the vertebral structure (Enneking Stage 2), and 16 had ill-defined margins with soft-tissue extension (Enneking Stage 3). Well-defined lesions were treated with curettage, with excellent results in 12 of 14 patients. The more extensive lesions were treated by intralesional excision (15/16) and adjuvant radiation therapy (9/16).

Adolescent↗

PubMed1992

[Inherent problems of the use of magnetic resonance in patients with metallic implants currently used in orthopedic practice].

Forty-eight patients with oncologic prosthetic devices (modular rotatory shoulder, Kotz, custom made) and metallic means of fixation (Sherman's plates, Ender's rods, etc.) underwent MRI in order to: 1) assess possible physical changes in the magnetic field or the alloys under examination; 2) detect the presence and type of artifacts, and 3) verify the onset of eventual noxious effects of the alloy on the patient. The diagnostic investigation was preceded by an experimental phase which was characterized by: A) a study of the temperature fluctuations of the alloys when submitted to the magnetic field and to radiofrequency; B) the identification and characterization of the artifacts, as well as C) their physical interpretation. During examination, there was no evidence of any mobilization of the means of fixation, sensation of endogenous heat, or other subjective complaints on the part of the patient. The authors observed that, even in the presence of artifacts, MRI provided good evaluation of the soft tissues around the devices by identifying tumor recurrences in the presence of an oncological prosthesis. MRI was also capable of showing trophic changes in the tissues surrounding the means of fixation. Thus, the method exhibits no contraindications in the study of these patients but, on the other hand, does not allow the evaluation of the integrity or mobilization of the prosthetic devices.

Adolescent↗

PubMed1991

Non-metastatic Ewing's sarcoma: results in 98 patients treated with neoadjuvant chemotherapy.

From June 1983 to December 1987, 98 patients with non-metastatic Ewing's sarcoma of bone were treated by a protocol of neoadjuvant chemotherapy consisting of two months of preoperative chemotherapy with vincristine, adriamycin, and cyclophosphamide followed by local treatment and one year of chemotherapy aimed at preventing recurrence using the same drugs plus dactinomycin. Local treatment consisted of surgery in 39 cases (40%), radiation in 34 (34%), and both surgery and radiation in 25 (26%). After an average follow-up of five years, 51 patients (52%) had remained continuously disease-free (CDF), 46 had developed metastasis, of which 20 with local recurrence, and one had developed a radioinduced sarcoma. The site of the tumor (61% of patients with Ewing's sarcoma of the extremities were CDF vs. 35% with tumor of the pelvis) and the kind of local treatment (61% of patients who underwent surgery with or without radiation therapy were CDF vs. 35% of patients treated with radiation therapy alone) were important prognostic factors. These results are similar to those obtained in 59 patients treated from 1979 to 1982 (average follow-up, 10 years) using the same drugs administered according to adjuvant chemotherapy procedure as well as those reported in the only other large study on this subject in the literature (the multi-institution German study CESS-81). The authors conclude that even though neoadjuvant chemotherapy makes surgery possible and easier in Ewing's sarcoma, it does not significantly increase survival when compared to traditional adjuvant treatment.

Adolescent↗

PubMed1991

[Osteoid osteoma of the spine. The experience of the Rizzoli Institute].

The authors report their experience at the Rizzoli Institute in treating osteoid osteomas localized to the spine (40 cases). This clinical study confirms that osteoid osteomas are tumors of adolescence, which are often diagnosed late due to their spinal localization. The role of additional investigations, dominated by bone scan and computed tomography is discussed. Their use should decrease the diagnosis delay. Mean follow-up in this series was 4 years, and confirmed that surgical excision had a favorable outcome. The outcome of associated scoliosis was also studied (8 cases). After tumor excision, there were 6 complete or partial corrections. Two cases remained unchanged. Curvature worsening after excision was not encountered.

Adolescent↗

PubMed1991

Telangiectatic osteogenic sarcoma of the extremities. Results in 17 patients treated with neoadjuvant chemotherapy.

Seventeen patients with telangiectatic osteogenic sarcoma (TOS) of the extremities were treated with neoadjuvant chemotherapy, according to two different protocols. Preoperatively, the patients received high-dose methotrexate (HD-MTX) and cisplatinum (CPD) (HD-MTX/CPD) and doxorubicin. CPD was delivered intraarterially, the other drugs intravenously. Limb-salvage surgery was performed in 12 instances, and five patients were treated with amputation. Postoperative chemotherapy was tailored according to the grade of chemotherapy-induced necrosis. In 13 cases (86%), the resultant grade of necrosis was greater than 90% (good responders). The mean follow-up interval was 3.5 years with a range of 18 to 78 months. Fourteen patients (82%) remained continuously disease-free, while three patients developed lung metastases. Two of these died because of uncontrolled disease, whereas the third patient is alive and disease-free after metastasectomy. No local recurrences were observed. These results are better than those observed in 215 contemporary cases of conventional osteosarcoma treated with the same protocols. This study confirms that TOS is not a uniformly lethal tumor as suggested by prior reports. By employing neoadjuvant chemotherapy, a high percentage of patients with TOS can be cured, and in most of them, a limb-sparing surgery is possible and safe.

Amputation, Surgical↗

PubMed1991

Pelvic resections: the Rizzoli Institute experience.

Materials, methods, and techniques of pelvic resections are discussed. Results, including the complications of nerve damage, infection, and vascular, visceral, and reconstructive complications are tabulated.

Adolescent↗

PubMed1991

The management of malignant bone tumors in children and adolescents.

A series of 205 pediatric patients affected by osteosarcoma, Ewing's sarcoma, fibrosarcoma, and malignant fibrous histiocytoma of bone were treated from 1978 to 1988. Ninety-eight percent of the patients received chemotherapy and 63% had a surgical resection. Sixty-five percent of all patients were alive at 30 months and were considered disease free. The functional results after surgery were evaluated according to the Musculoskeletal Tumor Society score. In all diaphyseal resections and resections of the upper extremity and pelvis, the results were excellent or good in 60% of the cases. In resections of the proximal femur, distal femur, or proximal tibia and reconstruction with nonexpansible prostheses, the results were excellent or good in 75%. On the other hand, when arthrodeses of the lower extremity were used, only 14% of cases had a good result. This correlates with the resulting lack of articulation and serious limb shortening seen with progression of skeletal growth.

Adolescent↗

PubMed1991

The effect of quadriceps excision on functional results after distal femoral resection and prosthetic replacement of bone tumors.

Although resection and reconstruction with a prosthesis is an accepted form of treatment for tumors of the distal femur, minimal effort has been made to correlate the functional result with the degree of adjacent muscle excision. From 1983 to 1986, 65 patients had distal femoral resection and prosthetic reconstruction. Ten patients had only the vastus intermedius excised (Group A), 30 patients had excision of the vastus intermedius plus either the vastus medialis or lateralis (Group B), nine patients had only the rectus femoris spared (Group C), and 16 patients had the entire quadriceps excised or conversion of the previous arthrodesis (Group D). Based on the rating system of the Musculoskeletal Tumor Society, satisfactory results were obtained in 70% of Group A patients (30% excellent and 40% good), with no poor results. In group B, 80% had good or excellent results and 7% poor results. In Group C, 78% of the patients had good results but no excellent results, whereas Group D had only 50% satisfactory results. The parameters that most often led to functional impairment were restricted motion and inadequate extensor powers. Muscle transfers, however, (flexors to extensors) were effective only in Group C patients. With proper technique and prosthetic design, satisfactory results can be achieved after distal femoral resection and prosthetic reconstruction, even after extensive quadriceps excision.

Adolescent↗

PubMed1990

Primary chemotherapy and delayed surgery (neoadjuvant chemotherapy) for osteosarcoma of the extremities. The Istituto Rizzoli Experience in 127 patients treated preoperatively with intravenous methotrexate (high versus moderate doses) and intraarterial cisplatin.

Between March 1983 and June 1986 127 patients with localized osteosarcoma of the extremity were treated with neoadjuvant chemotherapy. Preoperative chemotherapy consisted of two cycles of methotrexate (MTX) (high or moderate doses) followed by 6 days by cisplatin (CDP). Surgery was an amputation or a rotation plasty, or a limb salvage. Necrosis was good in 52% of cases, fair in 36%, and poor in 12%. Postoperative chemotherapy consisted of Adriamycin (doxorubicin [ADM]) and bleomycin (BCD) for poor responders; and ADM, MTX, and CDP for fair responders. Good responders were treated as fair responders or with only MTX and CDP. At a 47-month follow-up, 66 patients remained continuously disease free and 61 patients developed metastases. Six of these patients had also a local recurrence. According to the grade of necrosis, the cumulative disease-free probability at 5 years was 67% for good responders, 42% for fair responders, and for poor responders 10% at 45 months. According to the doses of MTX, survival at 5 years was 58% for patients who received high doses and 42% for patients treated with moderate doses. No differences in the rate of survivors were observed between amputated patients and patients treated with limb salvage. The authors conclude that (1) a limb salvage procedure is possible in about 70% of cases and as safe as demolitive surgery, if adequate surgical margins are achieved; (2) good responders have a better prognosis than fair and poor responders if postoperative chemotherapy is sufficiently prolonged and also includes ADM; (3) a different postoperative chemotherapy for poor responders did not improve their prognosis; and (4) a multidrug regimen using high doses of MTX is probably more effective than moderate doses.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1990

Influence of chemotherapy on perioperative complications in limb salvage surgery for bone tumors.

From 1970 to 1986, 304 patients underwent limb salvage resections for 271 malignant and 33 benign tumors of the extremities. Reconstruction was with a prosthesis or nonbiologic spacer. Nonmechanical complications were analyzed to determine the influence of the site and method of reconstruction and the use of chemotherapy on their incidence and severity. There were 82 shoulder resections, 53 proximal femur resections, and 169 knee resections. No chemotherapy was used in 115 patients; neoadjuvant therapy was used in 128 patients and adjuvant therapy was used in 61. There were 120 complications. The most common complication was infection (36 of 304 patients; 11.8%), which led to amputation in eight patients. Resections about the knee led to more complications than the other sites, particularly if reconstructed with a large cement spacer. Patients who did not receive any chemotherapy had a 25.2% (29 of 115) incidence of complications and those who received adjuvant treatment had a 32.8% (20 of 61) incidence. This compares with a 55.4% (71 of 128) incidence in the neoadjuvant group. After neoadjuvant chemotherapy, reconstruction with an uncemented prosthesis led to the fewest complications.

Antineoplastic Agents↗

PubMed1990

Ewing's sarcoma of the pelvis.

Two hundred and thirty-nine patients with Ewing's sarcoma were treated at our institution between 1972 and 1987: 42 of these had lesions in the pelvis, 29 were in the wing of the ilium or involved the sacroiliac joint (type I), 5 were periacetabular (type II), and 8 were in the anterior pelvic arch (type III). Radiotherapy alone was used for the primary lesion in 11 cases, adjuvant chemotherapy in 20 and a neoadjuvant protocol in 22. The overall disease-free survival at a mean follow up of 34 months was 19%. There was no difference in survival related to age or the site in the pelvis, none in disease-free survival with adjuvant and neoadjuvant chemotherapy, or in the incidence of local recurrence and metastases in these two groups. Similarly, there was no difference in disease-free survival between operative treatment, with or without radiotherapy, and radiotherapy alone. There was a slight trend towards better local control of the disease in the former group compared to the latter, although this difference was not statistically significant. Our conclusion is that treatment needs to be planned for each individual patient.

Adolescent↗

PubMed1990

The Tikhoff-Linberg procedure for bone tumors of the proximal humerus: the classical "extensive" technique versus a modified "transglenoid" resection.

The authors report on two groups of patients (each with 12) with primary bone tumors of the humerus who underwent either a classical Tikhoff-Linberg (T-L) procedure or a modified technique by which the body of the scapula was saved. The latter procedure was an "en bloc" resection of the glenohumeral joint after an extra-capsular osteotomy of the neck of the scapula, followed by reconstruction with a modular prosthesis. Indications, perioperative differences, and complications of both procedures are discussed. Besides producing better aesthetic and functional results, the modified technique offered the advantages of shorter anesthesia time, less blood loss, and a better anchorage of the prosthesis. The results of this study show that the proposed modification of the T-L procedure is indicated in patients with bone tumors of the proximal humerus in which invasion of the joint capsule is present without macroscopic involvement of the glenoid.

Adolescent↗

PubMed1990

Hemipelvectomy in malignant neoplasms of the hip region.

The authors report the results of 76 hemipelvectomies performed from 1978 to 1988 in malignant neoplasms of the hip region. Several surgical techniques were employed, including King and Steelquist's "classic" technique (77%), the technique involving the anterior flap of the thigh (9%), and the technique involving the subcutaneous gluteal flap (14%). In 8 cases palliative surgery was performed. Of the remaining 68 patients, 31 (45%) are alive and show no signs of the disease after an average of 44 months. Postoperative complications are discussed in relation to surgical technique and previous adjuvant therapy; the subcutaneous gluteal flap technique exposes the patient to the greatest risk of major complications (54%), while the "classic" technique is the most reliable, although there was superficial infection in 18% of cases. Fifty percent of the patients previously treated with radiotherapy suffered local postoperative complications. In order to reduce local recurrence, special care is advised in the preoperative stages and in the execution of the pelvic osteotomies.

Adolescent↗

PubMed1990