Biomedical subjects

B Tomeno

Publications and source records attributed to B Tomeno.

At least 37 records · Page 2Linked to original sources

PubMed1998

Psychological management, prevention and treatment of phantom pain after amputations for tumours.

Amputation for tumours is rarely carried out nowadays and has few specific technical features, apart from the rare cases where ingenuity is required to gain a few centimetres in length of a stump. As far as possible, the decision for amputation should not be imposed; it is better that the patient himself should take the initiative. The prosthesis and its constraints should be described honestly to avoid subsequent disappointment. Prevention of a painful phantom limb must always be undertaken, and based on certain operative and perioperative precautions. The most important factors are treatment by psychotropic agents and the quality of the human relationships between patient and surgeon.

Amputation, Surgical↗

PubMed1998

[A case of hyalinizing spindle cell tumor with giant rosettes in the presacral region. Immunohistochemical and ultrastructural study].

Hyalinizing spindle cell tumor with giant rosettes is a slowly growing tumor with a risk of local recurrence in case of incomplete surgical excision that could be regarded as a distinctive type of low-grade fibroblastic tumor. We report a case involving the presacral area. This tumor was composed of areas of bland spindle cell proliferation with a fascicular pattern in a fibrous or myxoid stroma, intermixed with giant rosettes consisting of rounded cells surrounding a central collagen core. The tumor expressed vimentin, and, for cells comprising the rosettes, S-100 protein, NSE and CD-57. These latter cells exhibited ultrastructural features of Schwann cells, the tumoral cells of fascicular area exhibiting features of fibroblastic cells. Flow cytometry showed DNA-aneuploidy and a very low S-phase fraction. This tumor appeared to be composed of two cellular components, fibroblastic and Schwann cells, located, at the opposite of neurofibroma, in two distinct areas.

Aneuploidy↗

PubMed1998

[Giants schwannoma of the sacrum. Apropos of 3 cases and review of the literature].

Giant sacral schwannoma is a very rare tumor (25 cases reported). The authors report 3 cases of giant sacral schwannoma treated by curettage through posterior approach and discuss symptoms and treatment. These tumors were characterized by their minimal symptoms compared to radiographic findings. Magnetic resonance imaging must be performed in order to detect extraosseous tissue component and intradural invasion. A biopsy was performed to confirm the diagnosis before definitive treatment. Wide resection was proposed by many authors because of the high recurrence rate. We believe that a wide resection is too sever as it causes neurologic sacrifices. A curettage through posterior approach preserves nerve function, and if a local recurrence occurs it remains possible to perform a wide resection. When sacroiliac joint instability is detected, a lumboiliac arthrodesis is indicated. Osteosynthesis could be performed with spine device (using pedicular and iliac screws).

Adult↗

PubMed1998

[Transfer of posterior tibial muscle to the back of the foot: an original procedure for fixing the transplant].

PURPOSE OF THE STUDY: The purpose of the study was to adjust a palliative transfer using the Tibialis Posterior (TP) tendon in case of foot dorsiflexion palsy. The surgical procedure emphasized some functional features, in an attempt to lessen parasitical motion of the foot in abduction or in adduction when patients bear the ankle joint in dorsiflexion, and to strengthen the transfer. MATERIAL AND METHODS: The surgical technique was carried out four times in patients, with a follow-up of six to eighteen months. One 20 cm long leg incision, on the antero-lateral part of tibia, up to the retinaculum of extensors tendons, allowed a section of Tibialis Anterior (TA) tendon as proximal as possible, and an aperture through the tibiofibular fascia in its lower third. One 15 cm long leg incision, along the postero-medial edge of the tibia, toward medial malleolus, allowed a release of the TP tendon after distal section. The tendon was rerouted across the former fascia aperture. One 6 cm foot medial incision face to navicular bone, where the TA tendon was thoroughly extracted and diverted, close to the sole side of the medial cuneiforme, and the two medial metatarsal bones. One 5 cm foot dorsal incision was performed, opposite to the 2d intermetatarsal space, where the diverted TA tendon end was recovered and pulled along a tunnel beneath the retinaculum of extensors. It was thus sutured, with a satisfactory tension to the TP tendon transferred across the tibiofibular fascia. Weight bearing in a short leg cast was allowed. RESULTS, DISCUSSION, CONCLUSION: In the four cases, the results fulfilled the goal, with a satisfactory evaluation of the efficacy of the transfer, even the TA tendon was once intentionally diverted through the 1st metatarsal space instead of the second one, without any damage for the vessels pedicle. Among the widespread use of TP tendon, we think that a more neutral position of the tendon should be adopted with a curse coming along the extension of the leg axis, to the 2d intermetatarsal space. The more distally the transfer may be bound, the much efficient it will be. Obviously, there is no change in a correct automatic use of the transfer in gait. Even though it requires more experience and much longer follow-up time, this technique ensure a reliable and comfortable attachment of the transferred tendon, by a tendon-to-tendon suture, and secure a better restored foot dorsiflexion.

Follow-Up Studies↗

PubMed1998

[Complications from the hinged GUEPAR prosthesis after resection of knee tumor. 102 cases].

PURPOSE: The purpose of this study was to present the complications which occurred in knee replacement with the GUEPAR prosthesis, after bone tumor resection. We tried to point out complications in relation to prosthetic design and surgical technique. MATERIAL AND METHOD: Between 1972 and 1993, 90 patients had a knee resection, for 80 malignant and 10 benign tumors. There were 51 males and 49 females, aged 12 to 75 years (mean age 35). Fifty-six distal femur resections and 34 proximal tibial resections were performed. Length of resection averaged 16 cm (9 to 30). The reconstruction was always achieved with a cemented, custom-made GUEPAR prosthesis. Including revisions, there was a total of 102 prostheses in 90 patients. A patellar resurfacing was performed in 64 cases. An allograft reconstruction was associated in 39 knees. In all tibial resections and in two extra-articular femoral resections, the extensor mechanism had to be reconstructed. Several reconstruction techniques were associated, in which 19 medial gastrocnemius transfers. The prosthesis design was slightly modified with time. Ten patients received radiotherapy, and 55 had chemotherapy. RESULTS: Results and complications were retrospectively assessed, with an average follow-up of 4.3 years (1 to 22). Six patients were lost for follow-up, 62 patients were alive, with no evolutive disease, 13 had an evolutive disease and 10 were deceased from disease. Nineteen patients had distant metastasis and 17 had local recurrences. Apart from intraoperative complications, late mechanical complications included: 13 aseptic loosening, 2 femoral shaft fractures, 18 knee contractures, 5 femoral stem fractures and, 18 intra-articular instabilities related to wear of the hinge-axis. In the 39 allograft-composite prostheses, only 15 had a favorable evolution. There were 15 extensor mechanism failures and 13 knees had persistent infection. There was a total of 94 reoperations in the 90 patients. In 28 cases, the initially implanted prosthesis was removed. There were also 18 revisions, 7 amputations and 3 arthrodeses. Survivorship analysis showed a 60 per cent probability for the initial prosthesis not to be revised at 10 year-follow-up, apart from oncologic complications. DISCUSSION: Results with allograft-composite reconstruction were not better than with massive prosthesis. When needed, soft tissue coverage and patellar tendon augmentation would better be performed with gastrocnemius plasty. Polyethylene and steel bushes were not solution for hinge axis wear.

Actuarial Analysis↗

PubMed1997

Subacute osteomyelitis presenting as a bone tumour. A review of 21 cases.

Twenty-one patients with subacute osteomyelitis who were initially considered to have bone tumours were reviewed, with an average follow up of 3 years. The clinical symptoms were not specific and laboratory investigations were normal. The radiographic findings were limited osteolysis surrounded by bone sclerosis in 14 cases, osteolysis without definite borders in 6, and onion-layer periosteal bone formation in one. The preoperative diagnoses included osteoid osteoma, osteosarcoma, chondroblastoma, Ewing's sarcoma, giant cell tumour, fibrosarcoma, eosinophilic granuloma, and bone tumour of unknown aetiology. The definitive diagnosis was made by surgical biopsy, histology and cultures which grew staphylococcus in 9 cases. The gross specimens all showed lymphocytes, plasma cells and granulation tissue with osteogenesis. All the patients recovered completely; 17 were treated with antibiotics and immobilisation, and 4 did not need an antibiotic. There was no recurrence of infection after curettage and excision of the infected tissues.

Adolescent↗

PubMed1997

[Long-term results of condylar reconstruction using patella as vascularized graft].

PURPOSE OF THE STUDY: In 1966, R. Merle d'Aubigné published 4 cases of unicondylar destructions (due to trauma or tumor) reconstructed with the patella replacing the joint surface. Since this time the same technique has been used in 6 other cases. The results of these 10 patients are studied. MATERIAL AND METHOD: Six of the examined patients were treated initially for a giant cell tumor, 1 for a low-grade osteosarcoma, and 3 for post traumatic arthritis. The patellar transplant remains vascularized by it's supero-medial vascular bundle. The femoral condyle was affected in 9 cases, the tibial plateau in one. RESULTS: The long term follow-up of these 10 patients revealed unexpected satisfactory results. None of the operated knees was clinically "excellent", due to instability or axial deterioration, but function remained correct, with a good range of motion, active professional possibilities, and, often, regular practice of some sports, like skiing or tracking. Function was not correlated with radiological aspect. The arthritic remodeling of the knee was obvious in all of the cases, and regularly increasing. Five of the 10 knees had to be reoperated (one or several times): 3 during the first months of follow-up (1 for sepsis, 2 for supracondylar fractures), 5 during the first years, to improve function (2 arthrolysis, 2 valgus osteotomies, 1 loose bodies removal). Three patellar plasties had to be converted into a total knee prosthesis, after 8, 27 and 40 years. The follow-up of the 7 patients still walking on their patellar plasty is of 2, 4, 17, 19, 24, 24 and 25 years. DISCUSSION AND CONCLUSION: Condylar reconstruction using a vascularized patellar transplant is mechanically speaking an approximative, obsolete and rather rough procedure. Nowadays one would prefer a knee prosthesis, with or without auto or allografts, preserving the patella. The immediate functional result would certainly be better, but the future remains uncertain. The patellar plasty can delay for 10, 20 years or even more the time of a prosthesis. This technique might also be useful in countries where prosthetic implants are not easily available.

Arthroplasty, Replacement, Knee↗

PubMed1996

[Medical environment of total hip prosthesis].

Total hip replacement is an extremely frequent operation for the treatment of degenerative joint disease. Indication for surgery must take into account the patient's general status, associated diseases, multiple joint involvement, and the efficacy and tolerance to medical treatments. The decision to operate is taken together by the physician and the patient. The degree of functional impairment and the patient's age are important factors. The patient must be informed that the period of hospitalization will be approximately 15 days and that good results are obtained in approximately 98% of the cases. Preoperative consultation with the anesthesist will focus on associated diseases with special attention to possible infectious foyers. Early post operative care includes a 48 hour antibiotic reginien, thromboprophylaxy with low molecular weight heparin for 3 days followed by anti-vitamin K for 6 weeks, and non-steroid antiinflammatory drugs for 5 days of up to 6 weeks in case of suspected risk of ossification. At mid-term, complications may include hematomas, infection and luxation. The fixation may also fail in certain cases where transtrochanter access was used. Long-term follow-up monitors for possible late onset infection and late luxations which usually result from prosthesis wear and more rarely from muscular causes.

Hip Prosthesis↗

PubMed1996

[Low grade intramedullary osteosarcoma. Apropos of 8 cases].

PURPOSE OF THE STUDY: The authors reviewed eight patients treated for Low Grade Intramedullary Osteosarcoma (LGIO). They analyzed the radiographical and histological features and evaluated the prognosis of this disease. MATERIALS: Eight cases of LGIO were studied. The mean follow-up period was 3.9 years. LGIO is defined as a Broders classification grade I osteosarcoma. The study involved 3 males and 5 females. Mean age at the time of diagnosis was 28. METHODS: Clinical records, radiographs and C.T. Scan were available and reviewed in all cases. Five patients had had MRI. In addition to the conventional histological study, ultrastructural studies were conducted in three of the cases. On their last examination, all patients received a clinical and X-ray assessment. RESULTS: The tumor was localized around the knee in six cases on the humerus and on the proximal femur in one case. The tumor was situated in the metaphysis and was most often lytic. A malignant tumor was suspected at the outset for only two of the patients. The scanner and the MRI revealed a cortical discontinuity and extraosseous involvement in five cases. Seven patients had a wide resection, which was intra-tumoral once. The histological examination of two of those resections revealed limited areas of anaplasia; complementary chemotherapy was then conducted. We did not observe any local recurrence in this group. We observed, however, an iliac metastasis, for which another wide resection was performed. This last patient remained free of disease three years later. One patient had radiotherapy and chemotherapy; he died from pulmonary metastasis after his LGIO turned into high grade osteosarcoma. DISCUSSION: LGIO are rare, they represent 1.8 per cent of all Osteosarcomas in the Cochin file. The mean age of patients contracting LGIO is higher than that of conventional osteosarcoma patients. Observation of the radiographs and histological examination could lead to think the tumor is benign, and mistake it with a fibrous displasia. The C.T. Scan and the MRI have the advantage of showing soft tissue invasion and help the histological examination. The wide resection is the only treatment able to cure the patient. Chemotherapy would be useful for LGIO cases containing limited arcas of anaplasia. CONCLUSION: LGIO is a slowly-evolving tumor. It remains localized for a long period of time. The histological diagnosis is difficult and requires a pathologist familiar with bone tumors. Its treatment requires surgery. LGIO must be distinguished from conventional osteosarcomas because of its better prognosis.

Adult↗

PubMed1996

[Synovial chondromatosis and chondrosarcoma. A study of the relationship between these two diseases].

PURPOSE OF THE STUDY: This retrospective study concerns six patients in whom chondrosarcoma was suspected to develop in synovial chondromatosis. We discuss for these cases different diagnosis. The authors expose the clinical signs and radiological aspects which suggest malignant transformation. We report the indispensable criteria for established diagnosis of malignant transformation of synovial chondromatosis and appropriated forms of therapeutic management were suggested. MATERIALS AND METHODS: Six patients, 3 males and 3 females from 36 to 58 years of age were included in this study. Three patients presented 6 months, 3 years and 25 years history of synovial chondromatosis of the knee joint. When the malignant transformation appeared, a surgical biopsy was performed and the pathologist diagnosed a chondrosarcoma in all cases. For the other three patients, the chondrosarcoma and synovial chondromatosis were diagnosed at the same time. The localization was shoulder, hip and knee. A surgical biopsy was performed and the pathologist diagnosed chondrosarcoma. Synovial chondromatosis was diagnosed by histologic examination of the resection or amputation specimen. TREATMENT AND RESULTS: Four patients had thigh amputation, one patient had "en bloc resection" of the hip-joint and the last patient had resection of the shoulder joint. In all cases, the histologic examination diagnosed chondrosarcoma and synovial chondromatosis. All patients were free of disease. DISCUSSION: The malignant transformation of synovial chondromatosis is rare but this diagnosis must be established to perform appropriate treatment. Other possible diagnosis are: low grade synovial chondrosarcoma initially diagnosed as a synovial chondromatosis. Bertoni believes that all cases of malignant transformation of synovial chondromatosis are initially low grade chondrosarcoma. We believe that his criteria are too strict for diagnosed chondrosarcoma. coexistence of synovial chondromatosis and synovial chondrosarcoma. These 2 diagnosis are extremely rare and their coexistence are unlikely. secondary synovial chondromatosis developed into chondrosarcoma. We don't have histologic criteria to confirm this diagnosis in all our cases. The symptoms that should suggest a malignant transformation of synovial chondromatosis were: rapid late deterioration of clinical conditions, bone invasion diagnosed by X-ray films and medullar invasion discovered by MRI. According to us, the indispensable criteria to diagnose malignant transformation were: 1.) histologic diagnosis of synovial chondromatosis established before diagnosis of chondrosarcoma, 2.) histologic diagnosis of chondrosarcoma on the same anatomic site as the synovial chondromatosis, 3.) diagnosis of chondrosarcoma and synovial chondromatosis on the same resection specimen. Only the three first cases were in accordance with these criteria. The treatment must be a "en bloc resection" of the joint or an amputation. CONCLUSION: Malignant transformation is rare, but this diagnosis should be established to perform adequate treatment. This diagnosis should be suspected when a rapid deterioration of the clinical status appeared and when bone involvement was detected by MRI. However, the danger still lies in the misinterpretation of the synovial chondromatosis as chondrosarcoma. This diagnosis can be made with clinical, radiological and pathological criteria. The treatment must be a wide resection or an amputation.

Adult↗

PubMed1996

[Clear cell chondrosarcoma. Study of 13 clinical cases and review of the literature].

PURPOSE OF THE STUDY: Clear cell chondrosarcoma is a variant of bone chondrosarcoma. These unusual tumors are peculiar by their epiphyseal location in long bones, by their cytology and by their cytology and by their protracted course. Clinical, radiographical and histological features are described before therapeutic approach. MATERIAL AND METHODS: We report a series of thirteen cases of clear cell chondrosarcoma identified and treated between 1965 and 1995 in Cochin Hospital. RESULTS: Clear cell chondrosarcoma represented 5.4 per cent of the whole chondrosarcomas registered in the same period. There was a male prevalence (8 cases). Most patients were in their third decade (8 cases). Clinical course was usually of long duration ranging from three months to nine years. Roentgenographically, the lesion was often indistinguishable from chondroblastoma; this tumor involved the proximal part of the femur in 8 cases, located in the epiphysis. Histologically, cells with clear cytoplasm were always present, and areas of conventional chondrosarcoma were seen in half of cases. All patients underwent surgical treatment: "en bloc" resection was performed in 12 cases, after a curettage with bone grafting in 2 cases; a simple curettage with bone grafting was performed in one case. Two recurrences occurred: a local recurrence after a bone grafting treated by resection with good result, and another recurrence with pulmonary metastasis leading to death within 8 years. DISCUSSION: Clinical, radiographical and histological features are the same in our series and in the series published by Unni et al. in 1976 and by Bjornsson et al. in 1984. Treatment consists in "en bloc" resection because the lesion may recur after curettage. Rarely the tumor may metastasize. Prognosis is good with a five year survival rate similar to grade 1 chondrosarcoma (O'Neal and Ackerman classification). CONCLUSION: These rare bone tumors are characterized by their good prognosis when the treatment is an "en bloc" resection.

Adult↗

PubMed1995

[Alveolar sarcomas of soft tissues. Immunohistochemical, ultrastructural study and flow cytometry].

Alveolar soft tissue sarcoma is an unusual tumor, known to have a poor prognosis. Although a muscular origin has been supported by most authors, the histogenesis of such tumors remains unclear. We report a case of alveolar soft tissue sarcoma with histological, ultrastructural, immunohistochemical and flow cytometry study. Pour results support a myogenic origin of these tumors and demonstrate its aneuploid nature. Pulmonary metastasis occurred early in spite of intensive chemotherapy and surgical removal of the tumor.

Adult↗

PubMed1994

Infection in massive bone allografts sterilised by radiation.

Massive bone allografts sterilised by radiation have been used in our hospital since 1985. The 164 consecutive reconstructions which we carried out before December 1990 were in equal part for tumour resections and revision arthroplasties associated with major bone defects. The allografts were used as intercalary or composite graft-prosthesis reconstructions. Fourteen (8.5%) skin sloughs or infections occurred, all but one after operations for malignant tumours. The grafts never appeared to be responsible. Infection after malignant tumour resection most commonly occurred at the knee when preoperative radiation had been used. Twenty-five reconstructions were performed in the presence of infection, which only recurred in one case. Twelve infections were treated, but 2 other patients died for other reasons within a year. One patient had to have an amputation and one had persistent infection. In the other cases, the infection healed. Only two debridements alone were successful. Removal of the graft and replacement with antibiotic-loaded cement was the most effective treatment.

Adolescent↗

PubMed1994

[Comparison of Orth-Evac and Solcotrans Plus devices for the autotransfusion of blood drained after total knee joint arthroplasty].

Surgical wound blood which is ched through drains after total knee replacement surgery with a tourniquet may be returned to the patient using special collecting devices. This study aimed to compare two systems, Orth-Evac and Solcotrans Plus an to assess the safety of the reinfusion of non washed blood cells. It included 30 patients scheduled for total knee replacement surgery, free from tumoral or coagulation disease and allocated randomly in three groups of 10 each: the Orth-Evac group (OGr), the Solcotrans Plus group (SGr) and the Control group (CGr). The devices, not containing an anticoagulant, were connected to the deep suction drains in the operating room, after skin closure and before the tourniquet removal. The salvaged blood was reinfused in the subsequent six hours via a 40 microns filter. The volume of collected blood was measured and homologous blood was added as required, to maintain a hematocrit of 30%. A blood sample was obtained the day before surgery (D - 1), before reinfusion (D0), two hours later (D + 2h), one day later (D + 1), and from the collecting device before reinfusion. The statistical analysis used the Kruskal-Wallis test and Steel-Dwass procedure to confirm the difference between two groups. The three groups did not differ in age, weight, height and gender. The volume of salvaged and autotransfused blood was 925 +/- 156 mL in OGr and 605 +/- 178 mL in SGr respectively, transfusion of homologous blood was required in two patients of OGr, four of SGr and six of CGr. At D + 1, the hematocrit was comparable in all groups (OGr = 28%, SGr = 28.2% and CGr = 28.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1994

[Dedifferentiated chondrosarcoma. A study of 13 clinical cases and review of the literature].

PURPOSE OF STUDY: Dedifferentiated chondrosarcoma is a variant of chondrosarcoma of bone consisting in a highly anaplasic sarcoma associated with low grade chondrosarcoma. The histopathology and the poor prognosis characterize these tumors. The clinical, radiographical and histological features are described before proposing a therapeutic approach to improve prognosis. MATERIAL AND METHODS: Thirteen cases of dedifferentiated chondrosarcoma having the histological requirements described by Dahlin and Beabout were identified and treated between 1977 and 1992 at the Cochin Hospital. These tumors represented 10 per cent of all chondrosarcomas registered in the same period. Eleven cases were primary and in two cases the dedifferentiated chondrosarcomas were first found in recurrent tumors. The average of age was 53 years. This was a retrospective study. The clinical reports, radiograms and histological reports were reevaluated. In doubtful cases the histological sections were reviewed. RESULTS: The clinical features were no different from chondrosarcoma except for the high incidence of pathological fractures. The histology was associated in all cases with a grade 1 or 2 chondrosarcoma and a grade 3 or 4 anaplasic component. The anaplasic components were: 5 osteosarcomas, 5 fibrosarcomas, 2 fibrous histiocytomas, 1 rhabdomyosarcoma. All the patients underwent surgical treatment. Only one patient was treated by adjuvant chemotherapy. Among the eleven primary chondrosarcomas: two disarticulations were performed. En bloc resection was performed in nine patients: one wide margin, six marginal and two intralesional. The two secondary dedifferentiated chondrosarcomas were treated by disarticulation. No local recurrences were observed after disarticulation or wide resection. All patients presented pulmonary metastasis leading to death except one patient with only three months follow up. The average survival time was nine months (1 to 36 months). DISCUSSION: Prognosis is uniformly poor. The five years survival rate is 0 per cent in our series and 10.5 per cent in the series published by Unni and Frassica. The physiopathologic hypothesis which prevails is that the two histologic components originate from two different primitive cell clones, one of which differentiates into a low grade chondrosarcoma while the others fails to differentiate and remains a high grade sarcoma expressing different morphologic features. Treatment was not always adequate, because the diagnosis was missed at time of biopsy in five cases. The biopsies showed the two histological components in only six cases. All our patients presented pulmonary metastasis excepted one patient. This feature was also noted in other series (70 to 100 per cent). Those metastasis originate from the anaplasic component. Chemotherapy has not been well evaluated for these tumors but its effectiveness is evident for treatment of osteosarcoma. CONCLUSION: These tumors, which are characterized by their histology and their poor prognosis, are frequently inadequately treated. It is necessary to improve the prognosis: by performing a large biopsy adjusted on the lytic bone. by performing a wide resection or amputation. We believe that it is necessary to associate a chemotherapy to surgical treatment. We have decided to treat our patients with an osteosarcoma protocol.

Adult↗

PubMed1992

[Ewing's tumor].

Ewing's tumour is an undifferentiated round-cell sarcoma of children and adolescents arising from the skeleton. The translocation (11; 22) (q24; q12) is specific and could serve as a diagnostic marker. It has also enabled this tumour to be classified in the group of primary neuro-ectodermal tumours. Concerning treatment, intensive chemotherapy alternating with local therapy has improved the prognosis of localized Ewing's sarcoma of the limbs and, to a lesser degree, of the axial skeleton.

Bone Neoplasms↗

PubMed1992

[One stage revision of infected total hip replacements with replacement of bone loss by allografts. Study of 90 cases of which 46 used bone allografts].

We usually manage infected total hip replacements by a one stage revision. We have reviewed 90 cases operated on before 1988. Notable bone loss was frequently encountered and reconstructed using allografts. In all cases complete surgical debridement was performed and a cemented total hip replacement implanted. Bone allografts were used in 46 cases. Systemic antibiotics and antibiotic loaded cement were utilised. There were 17 failures (19%); one patient died soon after operation, there were 8 obvious infections (9%), 1 hip was thought to be infected although the prosthesis was not loose, and 7 femoral prostheses became loose of which 3 were due to mechanical failure and the remainder had no obvious explanation. Infection with staphylococcus aureus and pseudomonas had a statistical correlation with failure, but other factors including the preoperative status and the use of allografts did not appear to influence the result. Allograft femoral heads from the bone bank were found to be reliable for reconstruction of the acetabulum and small femoral defects. With major femoral bone loss we preferred massive irradiated cortical allografts. The quality of the bone reconstruction was probably the most important factor in the good functional results observed in 79% of cases. Effective surgical debridement and an appropriate antibiotic regime will allow a successful one stage revision procedure. The use of allografts gave a reliable reconstruction of the bone loss and was not associated with an increased rate of failure.

Acetabulum↗

PubMed1992

[Synovial sarcoma. A study of a series of 46 cases].

Synovial sarcoma is a rare malignant soft tissue tumor. The histological diagnosis remains sometimes difficult. The authors report 46 cases, treated in different hospitals in Paris. The medium survival rate of this group (which includes cases treated long ago) is of 30 per cent at 5 years. But only 24 per cent are disease free at this time. At the last follow up, the patients deceased after the fifth year included, the survival rate drops down to 12 per cent. Local recurrences and metastasis are analysed with reference to the different treatments applied. It seems that the association of polychimiotherapy and wide surgical excision might increase the survival rate, but this has to be confirmed in future. Radiotherapy is still a valuable treatment when excision is only limited, or when excision is impossible, due to localisation or extension of the tumor.

Adolescent↗