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A patient with multiple osteolytic metastases--ribs, pelvis, spine, skull and mandible--from carcinoma of the prostate is described.
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Sacral resection was carried out in two patients presenting chordoma. Clinical and laboratory results are reported, with particular reference to preservation of anal and vesical continence. In the first case, double continence was virtually unaltered after unilateral resection of S2. In the second, continence was markedly perturbed by bilateral resection of S2.
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Degenerative disease of the cervical spine is a common cause of neck pain in the elderly. This article reviews the pathogenesis, clinical features, and management of cervical spondylitic radiculopathy and myelopathy in the elderly.
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60 cases of monoclonal (benign and malignant) are presented. All the patients are divided into two sub-groups according to the age (until and after 65th years old). They were recovered in the Medical and Geriatric divisions of "Renzetti" civic Hospital in Lanciano. The differences between the two groups with respect to different types of gammapathy, median survival rates, response to therapy, are discussed.
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A new segmental spine plate fixation system, utilizing a posterior approach and screw fixation, has been developed for disorders of the lower thoracic or lumbar spine. The indications are significant instability and severe pain relieved by immobilization. This new system uses multiple segmental fixation points through the pedicle "force nucleus" of the vertebral body. The spine plates can be contoured for anatomic positioning, reduction, and rigid stabilization to enhance graft consolidation and fusion. The surgical fixation technique is demonstrated in five case presentations illustrating the application and versatility of the method.
Chordomas constitute between 1% and 4% of primary malignant bone tumors. Approximately 50% originate in the sacrum, 35% at the base of the skull, and 15% in the true vertebrae. The majority of tumors are encountered from the fifth through seventh decades, with a male preponderance. The clinical symptoms and signs are nonspecific and lead to frequent errors in clinical diagnosis. Radiographic findings include nonspecific destruction of the vertebral body, with reactive sclerosis; calcification is more often seen in sacral tumors. Computed tomography (CT) frequently reveals an anterolateral soft-tissue mass, which is often more extensive than the osseous involvement. The optimal treatment for sacral tumors should be en bloc resection of the tumor performed through intact bone a level above (wide local excision); for vertebral lesions, an anterior surgical approach with resection of the vertebral body should be performed. While conventional radiation has little efficacy in this tumor, a variety of innovative newer approaches may prove more effective in the future. Conventional chemotherapy has not proved effective in this tumor. With early diagnosis, and more effective surgical therapy, the current disease-free survival at five years should be between 30% and 50%.
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Six sacrococcygeal chordomas were studied with CT at the Institut Gustave-Roussy. Only one was examined at the time of the initial diagnosis and CT made a valuable contribution to this. In other cases, CT determined the possibility of initial surgical excision and the field of radiotherapy and helped make a reliable diagnosis of local recurrences. CT seems to be the best examination to use for the early diagnosis of chordomas and recurrences, which will perhaps help improve the prognosis of this serious disease.
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Fat in the fissure for the ligamentum teres, if abundant and sagittally oriented, will outline the right margin of the lateral segment of the left lobe of liver. This produces the appearance of a right paraspinal mass on plain abdominal radiographs. The nature of the anatomical relationships has been demonstrated using computed tomography.
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