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Biomedical subjects

A Giunti

Publications and source records attributed to A Giunti.

At least 73 records · Page 4Linked to original sources
PubMed1982

The surgical treatment of bone metastases.

The Authors consider the surgical treatment of 122 patients (125 operations) with metastatic lesions of the skeleton. They outline the most commonly used surgical techniques (arthro- and endoprostheses, endomedullary implants, plates). Operations need to be planned with special standards and methods since the bone tissue is undergoing serious structural changes and the patients need rapid rehabilitation. To this end, the utility is emphasized of the substitution with prostheses even of extensive skeletal segments and the use of acrylic cement is recommended to replace loss of substance caused by neoplastic osteolysis. The results obtained are classified as good, fair and bad according to the degree of solidity of the synthesis obtained, disappearance or relief of pain and recovery of function. The complications are discussed and the incidence of survival.

Adolescent↗
PubMed1981

Adamantinoma of the long bones. The experience at the Istituto Ortopedico Rizzoli.

All cases of adamantinoma seen at the Istituto Ortopedico Rizzoli were retrospectively reviewed. Although this tumor is exceedingly rare, nine cases were collected. The tumor is composed of four histological patterns: spindle, basaloid, squamoid, and tubular. The prognosis of this tumor depends on the adequacy of therapy. Surgery that is expedient and adequate tends to offer the best prognosis.

Adolescent↗
PubMed1981

Judet's arthromyolysis in the treatment of stiff knee in extension.

After a brief historical review of the surgical treatment of long-established stiffness of the knee, and a discussion of the related indications, the authors describe the surgical technique used in their Division of the Rizzoli Institute. Basically, we use Judet's arthromyolysis, but we often perform, as an initial stage, medial arthrolysis without particular concern for the medial collateral ligament. Our results prove that this does not cause instability. Twenty-seven of the thirty knees in our series presented as sequelae of fractures of the femur where there had been complications, or in which immobilisation had been unduly prolonged. Analysis of the results shows that: a) average pre-operative flexion of 25 degrees was increased to 95 degrees, without sacrificing stability; b) section of the collateral ligaments does not cause long term instability; c) proximal disinsertion of the rectus femoris tendon may lead to loss of active extension, although this was always well tolerated; d) persisting pain is always due to the development of arthrosis; e) The age of the patient, the duration and aetiology of the stiffness have no effect on the results. The complications consisted of two cases of skin necrosis and one of infection, but these were quickly resolved and did not affect the end results.

Adolescent↗
PubMed1980

Hemangioendothelioma of bone: a study of 29 cases.

Twenty-nine cases of hemangioendothelioma (H.E.) of the bone have been studied. In addition to the clinical and radiologic features of the tumor, attention was principally paid to the relationships between a tentative histologic grading of malignancy and the clinical course and final outcome of the cases. Three histologic grades are identified: Grade I H.E., Grade II H.E., and Grade III H.E. (or hemangiosarcoma). Grades I and II H.E. are frequently multicentric in the same lower limb. Grade I H.E. has a constantly good prognosis. It may remain stationary for several years even without treatment and it may be cured even by curettage or radiation. Grade II H.E. often has a good prognosis. In one of our cases the initial biopsy was interpreted as being a low grade tumor but the subsequent histology of the local recurrence indicated a Grade III malignancy and the patient died with metastases. Another case was graded II and the patient died with metastases. There are three explanations for this discrepancy: (1) some tumors are malignant in spite of a seemingly low grade histology; (2) low grade and fully malignant areas are present in the same tumor; (3) malignancy may progress in some low grade tumors in the course of time. On the basis of our experience we lean towards the last two possibilities, and therefore recommend histological study of large and multiple sections. Grade III H.E. has a very bad prognosis. The study of H.E. of the bone presents several problems. More information from a larger series of cases is needed to define the value of the histological grading in determining a prognosis, therefore indicating treatment.

Adolescent↗
PubMed1980

Multiple-drug chemotherapy for the primary treatment of osteosarcoma of the extremities.

Fifty-five cases of osteosarcoma of the extremities were treated between 1972 and 1976 by combined surgery and chemotherapy (vincristine, adriamycin and methotrexate in medium doses) for 18 months. The follow-up ranges from 30 to 80 months (mean = 48 months). Twenty-six patients remained free from any evidence of disease, two had local recurrences but no metastases and 27 had metastases (four of these also had local recurrences). In 12 patients, the metastases appeared after the end of chemotherapy. Both metastases and local recurrences were more frequent in patients who had segmental bone resection (7/8) than in those treated by more radical surgery (22/47). Comparison with an "historical" group (94 osteosarcoma patients treated by operation alone in our Institute between 1960 and 1971) showed that the percentage of patients free from evidence of disease was higher in the group who receiving chemotherapy. In addition, the appearance of metastases in this group was delayed (mean = 16 months) as compared with the historical controls (mean = 8 months). On the other hand, after the same kind of operative treatment, the rate of local recurrences and the time of their appearance was almost identical in both groups.

Adolescent↗
PubMed1980

Pseudo-tumoral ossification of the muscles and/or periosteum. (A study of 57 cases).

The authors present a study of fifty-seven cases of pseudo-tumoral ossification of the muscles ("circumscribed ossifying myositis") and of the periosteum, supported by clinical, radiographic and histological evidence. This pathological condition is characterised by the formation of hyperplastic bone callus in muscle or periosteum, with a typical radiographic appearance, and with a relationship to trauma. We have excluded from our study pseudo-tumoral periosteal ossification in conditions of congenital origin (osteogenesis imperfecta, neurofibromatosis, Sane et al., 1971; Kullman et al., 1972), hyperplastic fracture callus in cranial trauma, ossification of muscles in limbs which are paretic or paralysed due to cerebral or cord lesions, and hyperplastic fracture callus in congenital syphilis. The form which is the subject of this study is absolutely benign, develops over a period of twelve to twenty-four months, with spontaneous maturation and partial regression. It can abe treated by radiotherapy to accelerate maturation, or by surgery when maturation has been completed.

Adolescent↗
PubMed1979

Sarcoma in Paget's disease (11 cases).

Eleven cases of sarcoma in Paget's disease of bone are presented, together with an extensive review of the literature. These neoplasms are rare but not exceptional, and mostly affect male subjects in the seventh decade of life. The sites most frequently affected are the pelvis, femur and humerus. In 30 per cent of cases these neoplasms are multifocal. Radiographically the lesions are nearly always osteolytic. The radiographic diagnosis may, however, be quite difficult, especially in the presence of the severe (but benign) osteolyic lesions that sometimes occur in Paget's disease. Morphologically these tumours are mostly highly polymorphic sarcomas. The cases in this series were diagnosed histologically as osteosarcoma, grade 3 fibrosarcoma, and malignant fibrous histiocytoma; but there are no prognostic differences between the various histological types. The prognosis is very serious, only about 3 per cent of patients surviving for five years from the time of diagnosis. Therapy, unfortunately nearly always palliative, is based on amputation or disarticulation after sections biopsy in cases where the disease is localised to the limbs, and on radiotherapy in cases not amenable to surgery.

Adult↗
PubMed1977

Epiphyseal chondroblastoma (a study of 39 cases).

A fully documented series of thirty nine cases of epiphyseal chondroblastoma is described. This is a remarkable series because of the rarity of this tumour. There is a slight predilection for the male sex. The age most affected is ten to twenty years. The tumour progresses slowly and joint involvement and pain are slight. The commonest site is the proximal epiphysis of the humerus, followed by the epiphyses of the knee. The classical appearances are of a clearly defined area of osteolysis, central or eccentric, with foci of calcification, in the epiphyseal or apophyseal regions, and often transgressing the epiphyseal cartilage. We have never observed involvement of the opposite bone in the affected joint. In four of our thirty nine cases the neoplasm invaded the point and/or soft tissues. The differential diagnosis, especially in localisations at the knee, is with giant cell tumour. The tumour is slow growing and the prognosis is always good. We have never seen malignant transformations or so-called "benign" pulmonary metastases. The few recurrences in this series (five out of thirty nine) were all cured by a second operation. Curettage and grafting is the operation of choice.

Adolescent↗
PubMed1976

Periosteal osteosarcoma. Review of 41 cases, 22 with long-term follow-up.

This study is based on 41 cases of parostesl (or juxta cortical) osteogenic sarcoma, which the authors prefer to define as periosteal osteosarcoma. The clinical features, radiological and histological characteristics are analysed. Treatment and prognosis are discussed. The treatment usually indicated is amputation, but in selected cases radical segmental resection is appropriate. The prognosis is comparatively favourable if the correct surgical treatment is carried out without delay.

Adolescent↗