Giant-cell tumor of the spine. A case report.
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Adult↗
Biomedical subjects
P Ruggieri
Publications and source records attributed to P Ruggieri.
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↗
Aneurysmal bone cyst of the sacrum.
A series of five cases of sacral aneurysmal bone cyst is presented. There were three females and two males, the youngest patient being 11 years old, the oldest 41 years old. All patients had pain of long duration with varying signs of nerve root compression. Three patients had micturitional problems. Four patients had a palpable mass which was tender. All had standard radiographs. Tomograms, computed tomography (CT) scans or MRI (magnetic resonance imaging) were obtained in some patients. In all patients a definite histologic diagnosis was established. Four lesions healed after resection (two cases) or curettage (two cases). One patient is considered to have a stable lesion which is not progressing.
Adolescent↗
Osteoid osteoma of the elbow. A study of twelve cases.
The authors report 12 cases of osteoid osteoma of the elbow. They emphasize the peculiarity of the clinical, radiographic and histological pictures and discuss the criteria for differential diagnosis with other tumours, pseudotumours and inflammatory lesions of bone. The results obtained are discussed in the light of data emerging from a review of the literature on the subject.
Adolescent↗
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↗
Case report 489: Hibernoma of left thigh.
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Adult↗
Staging of intraosseous extent of osteosarcoma: correlation of preoperative CT and MR imaging with pathologic macroslides.
The accuracy of preoperative computed tomography (CT) and magnetic resonance (MR) imaging in the measurement of intraosseous tumor extent in 17 cases of osteosarcoma of an extremity was compared with macroslides of surgical specimens. Longitudinal intraosseous extension of tumor from the adjacent articular surface was measured on imaging studies and macroslides to the nearest millimeter. The average difference between macroslide and CT measurements (15 cases) was 16.5 mm +/- 10.7, and the average difference between macroslide and MR imaging measurements (17 cases) was 4.9 mm +/- 4.3. However, much of the latter difference appears to be caused by use of a different plane of section in MR imaging compared with that in macroslides, since in a subgroup of five specimens with an identical plane of section, the average difference was 1.8 mm +/- 1.6. The authors conclude that MR imaging is extremely accurate in the assessment of intraosseous extent of osteosarcoma.
Adolescent↗
Resection of the proximal humerus and I.O.R. modular prosthesis in the treatment of metastatic lesions.
The authors report a series of 20 patients affected with metastatic lesions of the proximal humerus (19 cases) or scapula (one case) treated by intra-or extra-articular resection of the humerus and successive reconstruction with an I.O.R. type shoulder modular prosthesis. This method is indicated for the treatment of patients with extensive destruction of the epiphysis and cortical bone and limited invasion of the surrounding soft tissues. Prosthetic implant does not contraindicate the use of postoperative radiotherapy, and the cement used to anchor the endomedullary shaft contributes to the sterilization of any metastatic microfoces present by means of an intense esothermic polymerization reaction. The results obtained were satisfactory, with regression of pain and good functional recovery of the limb. There were no postoperative complications.
Adult↗
Lumbar disc herniation: diagnosis, surgical treatment, recurrence. A review of 872 operated cases.
This review is based on 972 cases treated surgically for lumbar disc herniation between 1974 and 1984. The authors discuss several problems related to this condition. The importance of the history and clinical assessment are emphasized, as well as the role of instrumental tests such as radiculography and CT scan. The authors report what they believe to be the treatment of choice to avoid recurrence, based on an analysis of two groups of patients. The first group consisted of patients in whom lumbar and radicular pain persisted after operation. The second group consisted of patients in whom these symptoms recurred after an interval of complete relief. This analysis leads to the following conclusions: 1) clinical examination is pre-eminent; CT scan and radiculography are complementary to an accurate neurological examination; 2) hemilaminectomy is the operation of choice because it is sufficient to ensure accurate exploration of both root and disc; 3) most recurrences are due to errors in diagnosis or surgical technique.
Adolescent↗
Case report 437: Solitary (unicameral, simple) bone cyst of the scapula.
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Bone Cysts↗
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↗
The Mazabraud syndrome: case report and review of the literature.
The authors report a case of Mazabraud's syndrome in a patient aged 57 years with a history of fibrous dysplasia of the skeletal system which had commenced at the age of 10. This became associated with myxomas of the soft tissues at the age of 42. This rare association was described by Mazabraud in 1957. A review of the literature up to 1985 shows that 16 cases have been reported. These are reviewed.
Adult↗
Resection of the distal tibia in bone tumours.
The authors report five cases of tumour of the distal tibia treated by resection and reconstruction by autoplastic grafting and tibiotarsal arthrodesis with fixation by a Kuntscher nail or a plate. This type of surgery is indicated for the treatment of benign tumours, aggressive pseudotumours (Enneking stage 3), or for Enneking stage 1A or 2A malignant tumours. Infection was the most frequent complication (2 out of 5 cases, both of which healed after surgical cleansing). The long-term functional results were good in all cases, and there was neither pseudoarthrosis nor recurrence.
Adolescent↗
[CT evaluation of sacrococcygeal chordoma].
From June 1985 to September 1986, eight patients affected by sacrococcygeal chordoma were examined by means of conventional radiography and tomography first, and then by high-resolution CT. All patients underwent surgery and an histologic examination of the surgical specimen was carried out. CT always allowed to detect the sacro-coccygeal neoplasm, which looked like a solid non-homogeneous mass; in 50% of cases coarse calcifications were found. CT made it possible to evaluate the growing side of the tumor, its relation with the adjacent anatomical structures-especially the longitudinal extension and the involvement of the sacral hiatus; these findings proved to be very useful in order to choose the most appropriate surgical technique. CT findings also suggested the nature of the tumor but rarely allowed a definitive diagnosis. CT is, at any rate, mandatory in order to evaluate the real extent of the tumor and to plan surgery.
Adult↗
Neoadjuvant chemotherapy for osteosarcoma of the extremity.
Eighty-five patients with nonmetastatic, high-grade osteosarcoma of an extremity received intravenous methotrexate and intraarterial cisplatinum and then a definitive surgical resection. The preliminary results suggest that preoperative chemotherapy with a delayed surgical resection is as safe as immediate surgery. More patients are candidates for limb salvage after chemotherapy. The tumor response to the preoperative chemotherapy also has prognostic value. Reducing the postoperative chemotherapy can be dangerous. A high dose methotrexate may not be necessary.
Adolescent↗
[Acute congestive heart failure during therapy with lithium carbonate].
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Acute Disease↗