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Biomedical subjects

S Gitelis

Publications and source records attributed to S Gitelis.

48 records · Page 3Linked to original sources
PubMed1983

The treatment of severe scoliosis in osteogenesis imperfecta. Case report.

Surgical stabilization of the scoliotic spine in osteogenesis imperfecta (OI) is technically difficult owing to the mechanical weakness of the bone. Brittle bone makes instrumentation of the spine a procedure all too often associated with complications. Combining the instrumentation of the OI spine, both anteriorly and posteriorly, with the use of methylmethacrylate to augment the fixation may prove valuable as a surgical technique. This usage of methylmethacrylate in correcting severe scoliosis in OI has not been previously reported.

Adolescent↗
PubMed1982

The treatment of localized Ewing's sarcoma: the experience at the Istituto Ortopedico Rizzoli in 163 cases treated with and without adjuvant chemotherapy.

Eighty consecutive patients with localized Ewing's tumor treated with adjuvant chemotherapy for two years plus local tumor control were retrospectively reviewed. Adjuvant chemotherapy protocol was constant for all patients, but local treatment consisted of amputation, resection (complete or incomplete) plus radiotherapy, or radiotherapy alone. The follow-up ranged from 21--101 months (mean = 50 months). The mortality rate and incidence of metastasis were significantly lower than in a comparable group of 83 patients previously treated by radiotherapy, or surgery plus radiotherapy but without chemotherapy. The percentage of local recurrence was not significantly different between the two groups. Of the patients treated with adjuvant chemotherapy, the percentage of local recurrence and metastases was much lower when the primary lesion was located in the extremities and when this lesion was treated by conservative surgery followed by irradiation. This was also true when the resection was not complete. Little discrepancy in functional results was observed using either resection plus radiotherapy or radiotherapy alone. The above data suggest that in treating Ewing's sarcoma, conservative surgery, even incomplete, can play an important role when associated with radiotherapy and adjuvant chemotherapy.

Adolescent↗
PubMed1982

The natural history of unicameral bone cyst after steroid injection.

Ninety-five consecutive cases of unicameral bone cyst treated at the Istituto Ortopedico Rizzoli by intracystic injections of methylprednisolone acetate were retrospectively reviewed. Eighty per cent of the patients had a satisfactory result. Of the 20% failures, 13.5% had a recurrence of the cyst. Recurrence after methylprednisolone acetate treatment is a previously unrecognized entity, with recurrence risk factors associated with multiloculation, cyst size and age of the patient.

Adolescent↗
PubMed1982

The influence of early weight-bearing on experimental total hip arthroplasties in dogs.

The bone-cement interface is an area of concern in the long-term fixation of endoprostheses. The effect of early weight-bearing on the interface has been discussed as an important parameter influencing the characteristics of the interface. In this study, a total hip arthroplasty was performed in two groups of six dogs each. One group was allowed immediate weight-bearing, while in the other, a knee disarticulation amputation was done to prevent weight-bearing. Three animals of each group were killed at three months and three of each group at six months, and a histological study of the interface was done. No morphologic difference was observed between weight-bearing and nonweight-bearing animals in the interface area. Endosteal bone remodeling occurred regardless of weight-bearing stresses. A fibrous membrane was found between the cement and the endosteal surface of the femur, and membrane thickness was similar in all animals. The membrane between the cement and acetabular bone, however, was consistently thicker. Quantitative studies revealed increased femoral cortical bone resorption in the nonweight-bearing animals.

Acetabulum↗
PubMed1981

Adamantinoma of the long bones. The experience at the Istituto Ortopedico Rizzoli.

All cases of adamantinoma seen at the Istituto Ortopedico Rizzoli were retrospectively reviewed. Although this tumor is exceedingly rare, nine cases were collected. The tumor is composed of four histological patterns: spindle, basaloid, squamoid, and tubular. The prognosis of this tumor depends on the adequacy of therapy. Surgery that is expedient and adequate tends to offer the best prognosis.

Adolescent↗
PubMed1981

Chondrosarcoma of bone. The experience at the Istituto Ortopedico Rizzoli.

We retrospectively reviewed the records of 125 patients with chondrosarcoma seen at the Istituto Ortopedico Rizzoli. All of the patients had been followed for at least five years, and ninety-six patients had been followed for at least ten years. The requirements for the adequacy of treatment were carefully defined. Metastasis and survival were related to the histological grade of the tumor. Nine per cent of the grade-1 lesions and 44 per cent of the grade-3 lesions metastasized. Ninety-four per cent of the patients with grade-1 lesions survived for five years, compared with only 44 per cent of patients with grade-3 lesions. The ten-year survival rates were 87 per cent and 27 per cent, respectively. Adequacy of treatment had an important influence on the incidence of recurrence, length of survival, and length of disease-free survival. The incidence of recurrence in adequately treated patients was 6 per cent, but in inadequately treated patients it was 69 per cent. The five-year survival rates in these two groups were 81 per cent and 53 per cent, respectively. Seventy-eight per cent of the adequately treated patients were disease-free at follow-up (mean, 11.1 years) compared with only 6 per cent of the inadequately treated patients. We compared the results of this review with those of other reviews of chondrosarcoma.

Adolescent↗
PubMedDate not supplied

Allograft prosthetic composite replacement for bone tumors.

Limb salvage for bone tumors has become the standard method of treatment. This technique involves removal of large segments of bone, most commonly around the hip and knee. Various types of reconstructive options are currently available, including osteoarticular allograft arthroplasty, modular oncology prosthetic arthroplasty, allograft prosthetic composite (APC) arthroplasty, and arthrodesis. Compared to other techniques, APC arthroplasty has many advantages, including restoration of bone stock, customization with conventional implant components, soft tissue attachment of tendons and ligaments, and preservation of the medullary canal of the host bone. The disadvantages of this technique include slow healing in the presence of chemotherapy, the possibility of disease transmission, and availability. The technique is suited either for aggressive benign tumors or for low-grade sarcomas where chemotherapy is not necessary. Further, it represents a good alternative for a failed modular oncology prosthesis, and also for the failed osteoarticular allograft because it restores bone stock. Good functional results have been reported with APC replacements, but long-term follow-up is needed to determine their durability.

Adolescent↗
PubMedDate not supplied

Cartilage tumors: evaluation and treatment.

The proper treatment of cartilaginous tumors is dependent on the clinicopathologic and radiologic findings. Enchondroma is a benign tumor that is usually asymptomatic and thus should be treated nonoperatively. Symptomatic enchondromas are often treated by intralesional excision. Intramedullary low-grade chondrosarcoma is a malignant tumor that is usually painful. The treatment of low-grade chondrosarcoma may range from intralesional excision with or without adjuvant therapy to wide excision. Although intralesional excisions have a higher bone and joint preservation rate than wide excisions, they may be associated with a higher local recurrence rate. Intermediate- and high-grade chondrosarcomas are treated with wide excisions. The treatment of these cartilaginous lesions should involve a multidisciplinary team including a musculoskeletal surgeon, a radiologist, and a pathologist.

Bone Neoplasms↗
PubMedDate not supplied

The use of a closed expandable prosthesis for pediatric sarcomas.

PURPOSE: The purpose of this paper is to review our experience with a non-invasive expandable prosthesis for skeletally immature patients following limb-salvage for malignant tumors about the knee. MATERIALS & METHODS: Between 1998 and 2002, Repiphysis prostheses (Wright Medical Technology, Memphis, Tenn.) were implanted in 18 patients. 16 patients had at least 12 months follow-up. There were 10 males and 8 females. The diagnosis was Stage IIB osteosarcoma in all patients. Sites included femur 14, and 4 proximal tibias. The average age was 10.7 years (range 8-16); the average age for males was 12 years and females, 9 years. Fifteen of the prostheses were implanted at the time of surgical resection and the remainder was conversions of previous surgery. RESULTS: Follow-up averaged 24.8 months (range 12-47). Fourteen patients have undergone a total of 58 lengthening procedures. Average expansion 38 mm per patient (range, 10-76 mm). An average of 8.5 mm per lengthening procedure. There was only one failure to lengthen. ISOLS functional scores averaged 83.5%. For those with a current functional prosthesis, the ISOLS score averaged 94%. Three patients have reached maximal expansion and converted to a conventional prosthesis. There were complications in 7 patients: 2 expandable component fractures, 1 femoral component fracture, 2 stem fractures, 1 stem loosening and 1 deep infection. Of the two expandable component fractures, 1 patient reached full expansion and was converted to an endoprosthesis. The femoral component fracture and 2 stem fractures were revised to a new prosthesis 13 months post-op and are functioning well. The 1 loose stem was revised to an APC. CONCLUSIONS: The Repiphysis prosthesis utilizes energy stored in a spring that is held compressed by a locking mechanism. Controlled release of the locking mechanism via an external electromagnetic field allows for lengthening of the device. In our early experience, the functional results were excellent similar to conventional modular devices. Complications should be anticipated but are salvageable. This device allows limb salvage in pediatric patients when amputation would be otherwise chosen.

Adolescent↗