Biomedical subjects

E Gozzi

Publications and source records attributed to E Gozzi.

At least 19 recordsLinked to original sources

PubMed2004

Osteosarcoma of the pelvis.

AIMS: To describe the outcomes of a large number of patients with pelvic osteosarcoma, and to define the guidelines for appropriate treatment. METHODS: We reviewed 60 consecutive patients with primary pelvic high-grade osteosarcoma. The tumour involved the whole hemipelvis in 15 cases, while the most common location was the iliac wing in 29 cases (48.3%): 25 of these adjacent to or passing the sacroiliac joint. RESULTS: Thirty patients underwent surgery; there were 16 hindquarter amputations and 14 internal hemipelvectomies. All the patients who presented with metastasis died of their disease. In 18 cases wide margins were achieved, however, eight patients experienced local recurrence. Of the series, only eight patients are still alive. CONCLUSION: The use of intense chemotherapy and surgical wide margin, hardly seems to achieve local control, however, tumour necrosis was correlated with positive prognosis. When internal hemipelvectomy it is not safe enough, amputation must be considered, particularly for cases with sacrifice of the sciatic nerve roots or for older patients where a shorter surgical procedure can be less risky.

Adolescent↗

PubMed2002

Knee arthrodesis with a temporary spacer performed in malignant tumor around the knee.

The issue of utilizing a temporary cement spacer after a knee resection arthrodesis of a highly malignant bone tumor is discussed. In our experience, this is the first type of reconstruction performed in the early days of the limb salvage. Now, after more than 12 years of follow-up based on the results of 84 patients, the usefulness and mechanical performance of this type of reconstruction are considered. Of these patients, 45 died of disease. Wound complications were present in 31% of the patients and led to amputation in 7 and healing failure in 6. Mechanical complications occurred in 39%, but radiographic analysis of the implant showed 32 cases (38%) with an inadequate spacer. Only 9 patients are still walking on the original reconstruction, 6 of them uncomplicated (the remaining 3 had rod migrations and shortening). The survival curve showed no statistical difference between the two groups (adequate vs inadequate spacer). In 33 patients who are still alive and retain their limb, the final functional results were excellent in 6, good in 8, fair in 14, and poor in 5. This type of reconstruction can still be considered in developing countries, or when a definitive arthrodesis is planned where there is a lack of a bone source (children, no bone bank). In our institution, reconstruction with cement is still suggested for patients with a large tumor around the knee, when the quadriceps is completely sacrificed, and the patient prognosis is markedly unfavorable.

Adolescent↗

PubMed2002

Allograft arthrodesis treatment of bone tumors: a two-center study.

The current study consists of an outcome review of a consecutive series of 92 patients with knee arthrodesis using an allograft, done for malignant or aggressive tumors in two centers on different continents during a period of 18 years (mean followup, 5 +/- 4 years). The data were compiled by creating a computerized file using the information provided by both centers. Seventy-five of the patients (81%) had high-grade nonmetastatic tumors (Stage II), mostly osteosarcoma. In addition seven (8%) had metastases at outset (Stage III) and the remaining 10 (11%) had benign disease, mostly giant cell tumor or revision procedures for failed allograft or total joint replacement. Seventy-two patients (78%) had distal femoral lesions (78%) whereas the proximal tibia was the site of the tumor in 20 patients (22%). The average age of the patients was 23 +/- 16 years; 51 were males and 41 were females. Tumor complications were a major problem for patients in the series. Thirty-four percent of the patients died, 47% had metastases develop, and 9% had a local recurrence. Allograft complications included an infection rate of 20%, a fracture rate of 25%, and a nonunion rate of 44%. Repeat surgery was required for more than 50% of the patients with 26 requiring one additional operation, 11 requiring two, and 10 requiring three or more operations. Nineteen of the patients required an amputation (20%), only four of which were for recurrent tumor. When these data were compared with data for a control series of 880 patients with allografts other than allograft arthrodeses, the complications were greater and the outcome less successful, suggesting that other approaches should be considered unless there are special indications for this procedure.

Adult↗

PubMed2001

Modular prosthetic replacement of the proximal femur after resection of a bone tumour a long-term follow-up.

We describe 25 patients who were treated for a tumour of the proximal femur by resection and replacement with an uncemented, bipolar, modular prosthesis. When followed up after more than ten years four prostheses (16%) had required revision. Two joints showed wear and another necrosis of the acetabulum. One patient with loosening of the stem had been treated by radiotherapy to the femur. Articular cartilage seemed to be a reliable barrier to acetabular wear. Very few signs of the formation of particulate debris were observed. The most obvious feature in the bone-stem relationship was stress shielding, seen as osteoporosis of the proximal part of the femur around the stem in 68%. Functional activity was satisfactory in 68% of the patients. A better system of reattachment of the soft tissues is needed to avoid pain and a persistent limp.

Adolescent↗

PubMed1993