[Hemipelvectomy in chondrosarcoma of the femur neck].
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The Anaesthesia and Recovery Service at the Galeazzi Orthopaedic Centre in Milan has an HOT unit where various cases of necrosis following radiotherapy for neoplasias have been and are still being treated. Some cases of radiodermitis and osteoradionecrosis only cured after HOT treatment are presented. The recovery of the scarring and granulation processes in these cases is attributable to the increased perfusion and above all diffusion of oxygen which activates the heating processes in the hypoxic tissues. An additional advantage of HOT is that patients can be treated in outpatients department (for periods ranging from 25 to 70 days according to the seriousness of the case), thus avoiding long-term hospitalisation and withdrawal from normal working life.
Forty-two patients with giant-cell tumor of bone were treated by various surgical procedures. Local recurrence and pulmonary metastasis were surveyed with respect to the operation performed. A high incidence of local recurrence was observed in the group who underwent curettage for the bone lesion. Four cases had pulmonary metastasis and three died of tumor. Adequate surgical treatment of giant-cell tumors of bone needs at least en bloc resection of the bone lesion with reconstruction. Although the microscopic findings in our malignant cases differed somewhat from benign ones, it was very difficult to predict later malignant change from the histological features of the initial stage.
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Metastases of the bones frequently are the first sign of the generalisation of a tumour disease. Generally at this stage a systemic therapy (cytostatic and/or hormone therapy), providing effectiveness, has to be initiated. In certain situations however local radiation therapy must additionally or even exclusively be induced. The indications for radiation therapy are shown by demonstration of cases.
In a series of 33 bone graft operations, antigen-extracted, autolyzed, allogeneic (AAA) bone matrix gelatin was substituted for autologous bone. The period of follow-up was 2.0 to 3.5 years. AAA bone gelatin was resorbed more rapidly than whole bone. AAA bone gelatin was replaced by new bone in the same intervals of time as observed with autologous bone. In treatment of bone tumors with AA bone gelatin, the results of the operation depend upon the nature of the pathologic processes in the host bed. In normal host bed, tight contact between implant and recipient bone is essential for success. The overall results of a preliminary study of 33 cases of 91% successful.
A female of 53 and male of 35 complained of myasthenia and pain in the bones. Biochemically, they had severe hypophosphatemia secondary to a sharp decline in tubular reabsorption of phosphates. X-ray showed tumor of bone tissue. The patients were diagnosed to have oncogenic osteomalacia. Literature data on pathogenesis, clinical features and treatment of this rare disease are reviewed.
Immunohistochemical evaluation of 24 osteosarcoma using an anti-p53 protein monoclonal antibody (Moab p53-12) showed strong positive reaction in the nuclei of tumor cells in 14 osteosarcoma (58.3%). Many studies have proved that this overexpression of p53 protein in tumor cells is associated with mutation of the p53 gene. Contrast study with DNA flow cytometry made on osteosarcoma showed that most of the p53 strongly positive tumors have higher DNA Index value than negative or slightly positive ones, though no statistically difference existed between two groups. Southern blot hybridization of p53 gene was also made in osteosarcomas. 5 of 20 cases (20%) had the structural changes of p53 gene. 3 of them were part or whole deletion of the gene. 2 of them had the extra-band, indicating the rearrangement of the gene.
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A patient with hyperparathyroidism secondary to chronic renal failure had multiple bony lesions with increased activity on both immediate static as well as delayed scintiphotos. One lesion in the distal femur was also exceptionally hot on the flow phase. Plain radiographs demonstrated lytic lesions with sclerotic margins and a narrow zone of transition. Open biopsy revealed histology consistent with brown tumor (osteoclastoma).
In the Department of Orthopedics at the University of Vienna, tumor endoprostheses have been implanted after resections of tumors of the upper extremities since 1974 and of the knee joint since 1976. For replacement of the humerus after tumor resection, a system of modular tumor endoprostheses was developed very early. Initially, it was ceramic and later on made of titanium alloys, which were also implanted in combination with custom-made prostheses with cementless stem-plate fixation in 57 patients until February 1990. In 43 of these patients (75.4%) adequate resection (2 radical and 41 wide) had been performed. Of 49 patients with a follow-up period of at least 24 months, 36 patients had a mean disease-free survival time of 106.1 months. Between 1976 and 1981, 16 custom-made endoprostheses were used after tumor resection of the knee joint. Since 1982 we have used a modular system of tumor endoprostheses suitable for replacement of the proximal and distal femur, proximal tibia, total femur and total knee joint. Of 75 patients who had been operated on up to February 1990, 67 patients (89.3%) had undergone adequate resection (2 radical and 65 wide). Out of 32 of these patients, 24 (75%) exhibited a disease-free survival time of at least 24 months (mean 48.2 months). Out of 213 patients with resection/reconstruction (160 endoprostheses), 77.8% had a survival time of at least 24 months, a results which is considerably better than in 146 patients with amputation in which case the respective value was 69.4%.(ABSTRACT TRUNCATED AT 250 WORDS)
Malignant fibrous histiocytomas (MFH) are known to arise in benign pre-existing conditions. We present here a case where MFH occurred more than 40 years after a fracture and infection. The diagnosis was established only after repeated clinical and histopathologic examinations. DNA flow cytometric and chromosomal analyses were also done.
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Between 1972 and 1975, 11 total hip replacements were performed on ten patients with advanced neoplastic disease. Eight of ten patients survived more than one year after total hip replacement. Eight of 11 hips were rated as having excellent or good functional results six months postoperatively. We suggest that total hip arthroplasty be considered an appropriate procedure in the operative management of patients with advanced neoplastic disease involving the hip.
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