Curettage of giant cell tumor of bone. The effect of surgical technique and adjuvants on local recurrence rate.
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Bone Neoplasms↗
Biomedical subjects
G Bettelli
Publications and source records attributed to G Bettelli.
Curettage of giant cell tumor of bone. Reconstruction with subchondral grafts and cement.
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Bone Cements↗
Awareness, treatment, and control of hypertension in the elderly in a general practice experience. Study Group on Hypertension in the Elderly.
In 3858 ambulatory elderly people (age greater than or equal to 65 years) prevalence of hypertension was 67.8%. The hypertensive status was unknown to both the doctor and the patient in 21.4% of cases. More than 90% of known hypertensives were treated, but hypertension could be considered as controlled in less than 30% of them.
Aged↗
Temporary resection-arthrodesis of the knee using an intramedullary rod and bone cement.
A temporary arthrodesis of the knee, using an intramedullary Küntscher rod and bone cement, was carried out in 76 patients after resection of tumours of the distal femur or proximal tibia. In contrast to primary arthrodesis with bone grafting, this procedure allows the patient to bear weight on a stable limb a few days after operation, reduces the risk of infection and avoids the negative effect of chemotherapy on graft incorporation. In 12 cases (16%) the implant failed mechanically by fracture, or by bending or migration of the rod, at from 13 to 54 months after operation. Deep infection occurred in 11 patients (14%). A second reconstruction was carried out in 14 patients, 10 using Kotz prostheses and 4 arthrodeses with bone grafting. The operation we describe has advantages for patients with high grade tumours which require chemotherapy and resection-arthrodesis of the knee joint.
Adolescent↗
[The prevention of occupational exposure to anesthetics: the standards aspects].
Prevention of damage of occupational exposure to anaesthetic gases and vapors consists in limitation of pollution and in biological and environmental monitoring. Reduction of polluting concentrations can be obtained only by using both ventilation of the operating room and active scavenging; proper behaviour in accordance with prevention rules and psychologic involvement of personnel is also needed. Biological and environmental measurements are useful in order to evaluate the efficiency of prevention and to early detected overexposures. Acts and regulations in force at present in Italy and technical specifications concerning this problem are than reviewed. The author notices that in many cases, standards dealing with requirements to be satisfied should be established before performance standards; at any rate, regulations should also be more compulsive.
Air Pollutants, Occupational↗
Vertebral needle biopsy with CT scan monitoring.
The authors report the method used and the results obtained in 42 vertebral needle biopsies with CT scan monitoring. Material sufficient for a positive histological diagnosis was obtained in 67% of the cases. Indications for the use of this method are conditioned by a suitable clinical and instrumental evaluation, and limited to cases where a histological monomorphous lesion or when en bloc resection are predicted. The need to follow precise rules in terms of technique and manual skill is emphasized.
Adult↗
Osteoid osteoma and osteoblastoma of the pelvis.
Benign osteoblastic tumors of the pelvis are rarely encountered in orthopedic practice. In most of the cases they involve the acetabular area, as was the case in nine of 14 cases of osteoid osteoma and osteoblastoma presented in this study. Especially with small tumors, such as osteoid osteomas, such a rare occurrence together with difficulties in the interpretation of roentgenograms can lead to mistakes and delays in diagnosis. To reduce these risks, a high grade of clinical suspicion and the use of tomograms or computed tomography (CT) scan and isotope bone scan are required. CT scan is an invaluable tool also for planning the surgical treatment in cases in which the tumor involves the acetabulum. Whereas an intracapsular excision is an adequate treatment for pelvic osteoid osteoma, pelvic osteoblastoma due to its size may need more aggressive surgery, even leading in some cases to a partial pelvic resection. The risk of recurrence is higher for osteoblastoma than for osteoid osteoma, as well as the rate of complications.
Adolescent↗
Antihypertensive treatment of the elderly in general practice.
In order to assess the antihypertensive care received by the elderly, where clear therapeutic guidelines are lacking, a population of 3,858 aged over 64 years was studied. Data were derived from a large Italian 'Study on Blood Pressure in the Elderly', carried out in general practice. Over 90% of the 2,059 known hypertensive patients were receiving drug treatment, with no age or sex-related differences. A single drug was prescribed to 50.2% of treated patients; only 5.5% were receiving three or more drugs. Diuretics and older sympatholytic agents were by far the most frequently prescribed categories, with four drugs (hydrochlorothiazide, amiloride, methyldopa and chlorthalidone) accounting for over 50% of all prescriptions. Low-dosage treatment schedules were frequently used, often associated with less-often-than-daily drug administration. Our study shows that physicians' attitudes to the treatment of arterial hypertension in the elderly are fairly uniform, with treatment of all subjects but with low drug dosages.
Aged↗
Prevalence of symptoms generally attributed to hypertension or its treatment: study on blood pressure in elderly outpatients (SPAA).
A number of symptoms that appear to be associated with high blood pressure (headache, dizziness, epistaxis, tinnitus, weakness, drowsiness), and are usually regarded as secondary to hypertension or to antihypertensive drug therapy, were studied in 3858 elderly patients, 67.8% of whom were hypertensive. Of the hypertensive patients, 71.2% were under treatment. Headaches and dizziness were significantly more prevalent in the hypertensive than in the normotensive subjects (32.5 versus 27.4% and 41.5 versus 35.3%, respectively; P less than 0.05) and in treated compared with untreated hypertensives (33.3 versus 29.4% and 43.3 versus 37.1%; P less than 0.05). These differences disappeared after statistical correction for 'awareness of hypertension'. In multiple logistic analysis, female sex, age and awareness of hypertension were significantly associated with a higher prevalence of symptoms, whereas hypertension and antihypertensive treatment were not. We conclude that the presence of these symptoms does not constitute a reliable criterion for starting antihypertensive treatment or judging its efficacy.
Aged↗
Dedifferentiated chondrosarcoma.
The cases of forty-six patients who had dedifferentiated chondrosarcoma were reviewed. Two groups were identified: one in which a low-grade malignant chondrosarcoma was the precursor lesion and one in which a moderate to high-grade malignant chondrosarcoma was the precursor lesion. The radiographic features of these lesions ranged from that of a cartilaginous lesion that appeared to be benign to that of a destructive osteolytic tumor in which the cartilaginous component was overshadowed by the dedifferentiated component. Only three of the forty-six patients survived for more than two years. Resection alone, even when it was wide or radical, was not successful in controlling this lethal sarcoma.
Adult↗
Feasibility of a large prospective study in general practice: an Italian experience. Gruppo di Studio sulla Pressione Arteriosa nell'Anziano.
A study of blood pressure control in elderly outpatients was carried out with the participation of 444 Italian general practitioners. Of 4096 patients aged 65 years or over who were considered for recruitment, 3959 (96.7%) fulfilled all the criteria of admission and were followed up for 12 months. The findings regarding one of the aims of the study--that is, to assess the feasibility of a large scale trial in general practice--are reported. Most (87%) of the doctors completed the study. Their adherence to the protocol was highly satisfactory, leading to an acceptable quality of work. Patients' compliance was also good; 98.6% (3898) of the patients who had fulfilled the admission criteria agreed to participate in the study, and only 4% (158) dropped out. Both of these observations support the feasibility of carrying out prospective studies in general practice. The creation of networks of general practitioners who are prepared to carry out research in their practices would allow treatment and preventive measures to be studied simply and at low cost in the appropriate setting.
Aged↗
Complications of pelvic resections.
The authors report on complications that occurred with 63 pelvic resections. There were 43 complications: 13 infections, seven cases of nerve palsy, 12 cases of vascular or visceral damage, six mechanical and five aesthetic complications. Infection and vascular and visceral damage were more frequent in anterior arch resections, neurological damage in iliac wing resections, and mechanical complications in periacetabular resections. The treatment and outcome of the complications are reported.
Adult↗
A study of the bone-cement interface in upper limb prostheses not subjected to loading.
The appearance of a radiolucent band at the cement-bone interface is a frequent finding in lower limb prostheses. This is still a controversial subject, but almost certainly has a multifactorial basis. Stress related to loading may be one of the causal factors. The authors therefore studied the evolution and behaviour of this radiolucent line at the bone-cement interface in 31 upper limb prostheses not subjected to significant loading or stress. These were special prostheses designed to replace the upper humerus after the radical excision of bone tumours. The development of a radiolucent band was not significantly different from the usual conditions in which loading is present but in our cases it was nonprogressive and there was never any evidence of loosening of the prosthesis.
Adult↗
Osteoid osteoma and osteoblastoma of the talus. A report of 40 cases.
Forty patients with osteoid osteoma or osteoblastoma of the talus are presented. Clinical and radiographic findings, histologic features, and therapy of these lesions are discussed. The body of the talus was involved in two patients, all other lesions being located in the neck of the bone. Subperiosteal lesions accounted for 75% of cases, and medullary lesions for 25%. Thirty of the 40 lesions were paraarticular. Five radiographic appearances in the talus are discussed: subperiosteal target lesions of the neck (54%); medullary lesions of the neck (20%); subperiosteal radiolucent lesions of the neck (13%); medullary lesions of the body (5%); and exostotic osteoid osteoma of the talar neck (3%).
Adult↗
Sacral osteoid osteoma and osteoblastoma: a report of 13 cases.
The authors present 13 cases (nine males and four females) of osteoid osteoma and osteoblastoma of the sacrum. All patients were less than 20 years old. Clinical and radiographic findings, histological features, and therapy of these rare lesions are discussed. Surgical excision with a posterior approach is considered the treatment of choice, except for tumors localized in the body of S-1, which require an anterior approach. The prognosis is good, even when the neoplasm has been incompletely removed. Nevertheless, a marginal or wide resection is the recommended surgical treatment. Radiotherapy is necessary only for inoperable tumors.
Adolescent↗
Aneurysmal bone cysts of the pelvis.
Twenty-three cases of pelvic aneurysmal bone cysts treated at the Istituto Ortopedico Rizzoli were reviewed after a mean follow-up of 7 years. Eighteen cysts involved the anterior arch, four extended into the iliac wing and the anterior arch, and one invaded the entire hemipelvis. The acetabulum was involved in 56.5% of the cases. Fourteen patients were treated with surgery (curettage 11; resection 3), and five with radiation therapy; two patients had both modalities; two additional patients refused any treatment after biopsy. The overall recurrence rate was 13% (one case after curettage, one after radiation therapy, and one after combined treatment). Significant complications affected the final functional result in four of seven patients who received radiation therapy, while only one minor complication was seen in the surgical group.
Adolescent↗
A humeral modular prostheses for bone tumour surgery: a study of 56 cases.
Fifty six humeral prostheses were inserted from 1974 to 1984 for primary bone tumours of the shoulder. In 40 patients a proximal humeral resection was performed and in the remaining 16 cases a Tikhoff-Linberg procedure was employed. The length of humeral resection ranged from 9 cm to 24 cm. A detailed analysis of the oncological and functional results was made. The resection was well clear in 42 patients (75%), marginal in 12 (21.5%), and through tumour in 2 (3.5%). Eight local recurrences were noted. The functional results were satisfactory, the patients having a wide range of active rotation and being able to do sedentary work. A new modified humeral modular prosthesis was introduced in 1984 and is presented.
Adolescent↗
Reconstruction after resection of the distal fibula for bone tumor.
We have reviewed 11 patients after distal fibular resection for benign or malignant tumors with different techniques of reconstruction. Seven patients had normal function and four had reduced mobility, one of whom had a lateral subluxation of the talus. All the patients were without pain. After resection of the lateral malleolus without replacement the soft tissues should be reinforced.
Adolescent↗