Biomedical subjects
Publications and source records attributed to P Ruggieri.
Twelve patients are reported in whom a unicameral bone cyst was found to involve the epiphysis or apophysis across an open growth plate. Nine patients showed pathologic fracture. In four patients a growth disturbance was found. A varying amount of varus angulation was present in most cases. No patient had functional impairment.
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.
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.
Adjuvant chemotherapy comprising Adriamycin (ADM) and Methotrexate (MTX) with Citrovorum Factor (CF) was administered on a randomization basis to 2 groups of patients with osteosarcoma after surgical ablation of the primary tumor. One group received high dose MTX (regimen I) and the other moderate dose MTX (regimen II). In both groups a short period of heparin treatment was also administered to prevent neoplastic emboli during surgery. All patients were free of metastasis at the beginning of therapy. The efficacy of therapy was determined by recording the percentage of continuously disease-free patients. This was compared to the disease-free survival in 132 patients previously treated with other ADM or ADM-MTX regimens and to a group of 39 patients treated during this period with amputation only. The latter did not receive adjuvant chemotherapy for a variety of reasons and are equated to a concurrent control group. Over the ensuing 27-66 months, 31 of 56 patients (55%) treated with regimen I and 25 of 50 (50%) treated with regimen II were disease-free. The overall disease-free survival in both regimens was 53%. This is similar to the 132 patients treated with previous adjuvant chemotherapy protocols (45-50%). However, the percentage of continuously disease-free patients treated with adjuvant chemotherapy was significantly better than the 39 patients (12%) treated contemporaneously with surgery only (P less than 0.0005). Survival in the latter is similar to that of historical control patients. These results do not suggest any change in the natural history of osteosarcoma and reveal benefits which may accrue with adjuvant chemotherapy. These results also demonstrate that in adjuvant treatment of osteosarcoma performed with ADM and MTX the high and the moderate doses of MTX are equally efficacious.
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.
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Two cases of chondrosarcoma involving the proximal femur and the soft tissues are reported. Both patients underwent subtotal femoral resection and quadriceps excision followed by reconstruction with a special prosthesis and arthrodesis of the knee. The tibial stem of the prosthesis was fixed with cement. The advantages of this method are discussed and compared with the use of total femoral prostheses.
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Seventy-eight cases of malignant fibrous histiocytoma (MFH) of soft tissues are reported. All tumors were deeply located in the extremities. An analysis is presented with regard to sex, age, site, macro- and microscopic features. The staging was assessed according to Enneking's classification (IB, one case; IIA, 25 cases; IIB, 42 cases; III, 10 cases). The recurrence rate after surgical treatment was high (37.5%) with significant differences after inadequate surgery (70%), wide excision (38%), or amputation (0%). Adjunctive radiotherapy rarely was effective in preventing local recurrence. The overall 5-year survival rate was 36%. The prognosis was worse in (1) tumors larger than 5 cm in diameter, (2) tumors that recurred early (less than 1 year) after surgery, and (3) tumors that had inadequate surgical treatment (intralesional or marginal excision).
Nine cases of aneurysmal bone cyst arising in juxtaepiphyseal locations with gross invasion of the adjacent growth plate are reported. In five of these patients an abnormality of growth, due to premature fusion of the affected growth plate, ultimately developed. Treatment of these lesions should attempt to avoid this complication, which appears to be more common than has been appreciated in the past. These nine cases represent 23% of 39 cases of aneurysmal bone cyst occurring in a long bone adjacent to an open epiphyseal plate. This series was extrapolated from a total of 198 cases of aneurysmal bone cyst in the files of the Istituto Ortopedico Rizzoli, Bologna, Italy.
The authors report 27 cases in which neoplasms of the proximal or distal femur were treated by resection and replacement with a Kotz modular prosthesis. In 25 cases this was not cemented but in the other 2 cases cement had to be used. After describing the prosthesis and presenting the case material, the authors discuss the advantages and limitations of this surgical technique and compare the results obtained with those reported in the literature.
The authors reviewed 121 cases of aneurysmal cysts of the long bones treated at the Tumour Centre of the Rizzoli Institute of Orthopaedics of which 103 had been followed up for more than one year. A classification is proposed based on 5 morphological groups and 3 grades of aggression. All except 4 of these lesions were treated by curettage or resection (2 were treated by radiotherapy alone, and 2 only had biopsies). The overall results showed a recurrence rate of 13%, none of which were in the inactive group. There was no prognostically significant difference in the recurrence rate between the active and aggressive groups. In the morphological groups there were significant prognostic differences. The authors therefore advise a programme of treatment based on an assessment of the morphological type and aggressiveness of these tumours.
The authors have reviewed 21 cases of extra-articular resection of the shoulder, using the Tikhoff-Linberg technique, carried out at the Tumour Centre of the Rizzoli Institute. The effectiveness of this method has been evaluated both oncologically (by a study of the resected specimens) and functionally. The possible complications are considered. The authors describe a modification of the technique for tumours of the proximal humerus in which only part of the scapula is removed.
The authors report 38 cases of bone metastases of neuroblastoma. They discuss the problems of diagnosis and treatment from the point of view of the orthopaedic surgeon, who is frequently confronted with a patient with localised bone symptoms in whom the primary neuroblastoma has not previously been diagnosed. The authors propose a diagnostic protocol and discuss the situations in which operative intervention by the orthopaedic surgeon may be indicated.
The authors present a case of hypertrophic osteoperiostitis in a patient suffering from Crohn's disease. A review of the literature reveals 10 cases of Crohn's disease or ulcerative colitis with similar affections of the skeletal system, some of which were asymptomatic. This supports the hypothesis that the immunological phenomena which are common to both these intestinal diseases are also the basis of the skeletal affection.
Based on a study of 749 consecutive cases submitted to open biopsy over a 12 year period, the authors discuss the possible grave consequences that can arise out of wrong attitudes or faulty technique. The statistical analysis, together with illustrative cases, demonstrates the difficulties, mistakes and biological damage that can result. Biopsy should always be associated with other methods of investigation, such as C.A.T. scanning, scintigraphy and angiography. It is a delicate and sometimes difficult procedure which requires close collaboration with the radiologist and pathologist. At the present time, our tendency is towards biopsy at the time of operation (with frozen sections) or to needle biopsy.
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