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PubMed1990

The case for revision arthroplasty using antibiotic-loaded acrylic cement.

For managing infected joint implants, revision arthroplasty using antibiotic-loaded acrylic cement (ALAC) has proven to be superior to other methods of treatment that are currently available. Ablation of the implant, cement, and necrotic tissue is essential. Further refinement of the ALAC method is possible. Analysis of complications shows that disarticulation and a permanent Girdlestone can become rare surgical procedures.

Anti-Bacterial Agents↗
PubMed1990

Lengthening of below-the-knee amputation stumps using the Ilizarov technique.

Patients with short, traumatic, below-the-knee amputations (BKAs) frequently function as if they have knee disarticulations. The goal of this study was to evaluate the results in patients who had lengthening of their BKA stumps to improved prosthesis fit and increase ambulation. Three patients with traumatic BKAs, who were left with insufficient stumps for proper prosthesis wear, have had their stumps lengthened by Ilizarov's technique of distraction osteogenesis. The lengthening process produced a moderate degree of pain, and all patients had a temporary decrease in their range of motion. Two patients lost a substantial amount of gained length secondary to early full weight-bearing. Despite these difficulties, the procedure produced longer, more durable stumps in all patients with no final loss of knee range of motion.

Adult↗
PubMed1990

Total femur replacement. A case report with 35-year follow-up study.

In 1965, Buchman published a report of a total femur and knee joint replacement he had performed the previous year. He reported this was his second total femur replacement and made passing reference to his first such case, noting only that it had been undertaken in a desperate effort to avert a hip disarticulation. The present authors report a 35-year follow-up study of Buchman's first case, the earliest known case of a total femur and knee joint replacement.

Adult↗
PubMed1990

Applications of the KTP laser in chronic ear surgery.

Several types of lasers have been applied to otologic surgery for such procedures as laser stapedotomy and acoustic tumor vaporization. The KTP laser has even broader applications in the field of chronic ear surgery. A three and a half year experience with the KTP laser is described. This laser's performance characteristics makes it well suited for chronic ear surgery. A quartz fiber delivery device enables the surgeon hand control of the laser beam in a microscopic field. Several applications are reviewed. Specifically, the KTP laser has been effective in removing hyperplastic infected mucosa engulfing the stapes, in safely disarticulating a mobile stapes suprastructure for complete cholesteatoma removal, and in atraumatically removing previously inserted ossicles or other middle ear implants. The KTP laser enables the surgeon to avoid mechanical trauma possible with traditional instrumentation and obtain more effective disease removal.

Cholesteatoma↗
PubMed1979

Sarcoma in Paget's disease (11 cases).

Eleven cases of sarcoma in Paget's disease of bone are presented, together with an extensive review of the literature. These neoplasms are rare but not exceptional, and mostly affect male subjects in the seventh decade of life. The sites most frequently affected are the pelvis, femur and humerus. In 30 per cent of cases these neoplasms are multifocal. Radiographically the lesions are nearly always osteolytic. The radiographic diagnosis may, however, be quite difficult, especially in the presence of the severe (but benign) osteolyic lesions that sometimes occur in Paget's disease. Morphologically these tumours are mostly highly polymorphic sarcomas. The cases in this series were diagnosed histologically as osteosarcoma, grade 3 fibrosarcoma, and malignant fibrous histiocytoma; but there are no prognostic differences between the various histological types. The prognosis is very serious, only about 3 per cent of patients surviving for five years from the time of diagnosis. Therapy, unfortunately nearly always palliative, is based on amputation or disarticulation after sections biopsy in cases where the disease is localised to the limbs, and on radiotherapy in cases not amenable to surgery.

Adult↗
PubMedDate not supplied

The torsion meter: a critical review.

The purpose of this study was to determine how effectively the torsion meter measures vertebral rotation. Nine thoracic vertebrae from three disarticulated spines were individually rotated through an arc of 0-60 degrees and measured with a torsion meter by three investigators. One hundred forty-four errors were made in the 351 measurements, of which greater than 92% were within +/- 5 degrees. We concluded that use of the torsion meter is an effective way to measure vertebral rotation.

Anthropometry↗
PubMed1990

Van Nes rotationplasty with segmental limb resection.

Segmental limb resection is becoming a practical alternative to limb ablation in tumor surgery. The addition of Van Nes rotationplasty to provide a pseudo knee joint has been found to be a practical, functional addition facilitating prosthesis use. This procedure has now been used successfully in 21 children with malignant neoplasms, with few complications. The surgical technique, as outlined, produces significantly improved functional results over an above-knee amputation or hip disarticulation.

Adolescent↗
PubMed1989

[Spinocellular epithelioma of the hand. Apropos of a diffuse and extensive commissural form].

The authors report a case of squamous cell carcinoma of the hand unusual because of its very rapid extension: A 64 year old man was referred to us for treatment of a keratoacanthoma located in the thumb web (histological diagnosis on two occasions). In fact, the histological frozen-section examination at the time of surgery revealed a well differentiated squamous cell carcinoma. A wide excision of the tumor was carried out together with amputation of the index finger according to Chase's technique. Axillary lymphadenectomy was performed due to clinical evidence of regional lymphatic spread (large node) twenty one days following surgery. Four months later, a recurrence in the thumb web required radiocarpal disarticulation. Three months later, a new recurrence at the stump, spreading to the forearm, necessitated an above-elbow amputation. In relation to this unusual case, the authors emphasize the importance of initial diagnosis and the difficulties of surgical management of this tumor, especially in palmar and web or deep locations.

Amputation, Surgical↗
PubMed1989

Major amputation for advanced malignant melanoma.

The Memorial Sloan-Kettering Cancer Center experience with major amputation for advanced malignant melanoma from 1965 to 1984 is reported. This is a retrospective review of 58 patients who underwent hemipelvectomy, disarticulation of the hip and above knee or forequarter amputation for advanced or recurrent malignant melanoma. Major amputation with curative intent was performed upon 43 patients. There were three deaths that occurred 30 days postoperatively (7 per cent). Intransit metastasis was one of the indications for amputation in 33 patients, and local control of disease was achieved in 30 of 43 patients. The median time to recurrence in those patients who did have a recurrence was 12 months (a range of 18 days to 16 years). Fifteen of 40 patients who survived the operation had no evidence of disease five years after undergoing a major amputation. Age, sex, primary site, stage of disease at diagnosis and amputation, disease-free interval and positive node status at any time during the course of the disease were not predictive of the outcome. Neurovascular involvement with melanoma and positive margins of resection predicted early failure. A palliative amputation for impending major vascular disruption or extensive, fungating disease was performed upon 15 patients. There was one death 30 days after the operation, and generally, hospitalization did not exceed 30 days. Median survival time was five months. All of the patients died of local or distant disease within 33 months of treatment. Local recurrence preceded death in nine of 15 patients.

Adolescent↗
PubMed1989

[Clinical treatment of 37 cases of soft tissue sarcomas in the past 6 years].

Since 1981, 37 cases of soft tissue sarcomas have been treated in our clinic. There were 20 males and 17 females with an average age of 43.5 years old. Histopathological classifications were liposarcomas 9 cases, MFH 8 cases, synovial sarcoma 5 cases, rhabdomyosarcoma 3 cases etc. Twenty-four cases (65%) were located in lower extremity, 11 cases (30%) in upper extremity, and 2 cases (5%) in trunk. All cases were treated with surgical intervention. Postoperative radiation was undertaken in 4 cases and adjuvant chemotherapy in 12 cases, respectively. There were 28 cases (76%) of excisional surgery; i.e., so-called limb salvage operation, and 9 cases (24%) of amputation or disarticulation. In August 1987, 10 cases had died of disease (DOD) and 27 cases were alive, but 4 cases were alive with disease (AWD). Each of the DOD and AWD cases were in stage III (by Enneking's surgical staging system) at first arrival to our clinic, or multioperated cases or cases with rapid distant metastases soon after operation. In conclusion, it was emphasized that in order to improve the clinical results, the soft tissue sarcomas must be treated earlier and that more effective chemotherapeutical protocols should be developed in the future.

Adolescent↗
PubMed1989

[Technics of primary and secondary amputation of the foot].

Maintenance therapy of the traumatized foot by partial amputation, in contrast to lower-leg amputation with subsequent artificial leg adjustment, should always be attempted if there is any possibility of shaping a stump that is independent of the prosthesis. As in former years, the disarticulation technique is performed; however, today the technique has been modified to obtain more functional results and to conserve tissue, which may mean that transosseous amputation is practicable. The quality of the soft-tissue flap and stability are the determining factors in the quality of the stump. These prerequisites mean that the operative technique must be adapted to the requirements of the patients; the soft tissue must be preserved and procedures used that will permit reconstructive procedures later.

Amputation, Surgical↗
PubMed1989

[Current state of amputation surgery].

Upper extremities: Traumatic amputations should be re-planted whenever possible. Lower extremities: Traumatic amputations must never be replanted! Arterial occlusive diseases cause the majority of amputations (ref. to indication, technique, rehabilitation). Borderline amputations are considered only after arterial reconstruction (profundaplasty) or in diabetics. The major preferential amputation is the knee disarticulation, since it results in less trauma and promotes quick rehabilitation, especially in geriatric patients.

Amputation, Surgical↗
PubMed1989

[Determining the amputation level].

The peripheral amputation level (at the knee or below the knee) is the most important factor in obtaining optimal functional results and reducing the relatively high operative mortality of above-knee amputations in patients with occlusive arterial disease. Measurement of transcutaneous oxygen tension has proved to be a helpful tool for realizing this therapeutic principle. Comparison with another group of amputees without pO2 measurement indicates that the ratio of above-knee to below-knee amputation or knee disarticulation could be changed from 2:1 to 1:4. The reduced number of above-knee amputations also resulted in decreased operative mortality (3.2% vs 11.4%).

Amputation, Surgical↗
PubMed1989

[3-dimensional reconstructions of the skull, axial and extremity skeleton].

In a prospective study, 150 threedimensional reconstructions of patients with bone diseases were analyzed. It could be seen that 3 D images were relevant for therapeutic considerations in diseases of craniofacial bones, and to a lesser degree for other skeletal regions. In no case was the 3 D reconstruction the only important factor for the therapeutic decision. The study demonstrated that 3 D imaging of the pelvic bones, especially for necroses of the femoral head, is severely limited without the possibility of computer-aided disarticulation.

Bone Diseases↗
PubMed1989

Lymphangiosarcoma in chronic hereditary oedema (Milroy's disease).

Lymphangiosarcoma arising in chronic lymphoedema is extremely rare. In a reference population of about four million people, during a thirty year period (1957-1987), only four patients were treated for such a tumour. The neoplasm is almost exclusively seen in elderly patients after mastectomy but in two of our patients, reported in this paper, it arose in chronic hereditary oedema (Milroy's disease). In both these patients there was a considerable treatment delay because of wrong diagnosis. The tumour extent was difficult to assess macroscopically and ablative surgery had to be a disarticulation of the involved extremity. Macular or papular purple lesions in a lymphoedematous extremity should be a manifestation of this aggressive neoplasm.

Adult↗
PubMed1989

[Reconstruction of large femoral defects in exchange operations following artificial hip replacement].

Loosening of the implant is one of the most serious complication in case of total hip replacement. It is caused by the growth of a secondary cancellous channel and in destroyed bone cement. From 1981 to 1986 we operated 63 patients to exchange a loosened hip prosthesis. With 15 patients we have seen a severe damage of the femur shaft. Big parts of the bone tube were missed. To insert the new stem we had to reconstruct the proximal femur and the calcar region by autogenous cortico-cancellous bone grafts in seven cases. In three cases a large defect of the lateral femur cortex was reconstructed by extended cancellous bone graft. In five cases we found a cominuted fracture of the femur shaft. The osteosynthesis was performed by plating. The screws were inserted through the bone into the stem. They find a very strong grip in the polyacetal material. 14 of 15 patients operated in this manner could achieve a walking ability. Most of them improved one step higher in the evaluation scheme according to Merle d'Aubigne. One patient suffering from a septic loosening showed a severe exacerbation with septicemia and ended in a disarticulation of the hip joint. The so called isoelastic prosthesis gives a chance to reconstruct the femur tube. It allows unhindered calcification of bone graft and acts as a forming model for new bone. With this we are able to restore the movement of hip joint as well as weight bearing and working ability of the limb. Additional osteosynthesis is possible to perform.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Malignant eccrine poroma with metastatic involvement of the long bones.

A case report of a malignant eccrine poroma metastasizing to long bones is described. This rare tumor of intraepidermal eccrine sweat duct origin usually metastasized to visceral organs. This is the second reported case of bone metastasis. Although a hip disarticulation was performed for ipsilateral femoral and tibial metastases presenting seven years after resection of the primary tumor, this 43-year-old man died six months later, from pulmonary metastases.

Adenoma, Sweat Gland↗
PubMed1979

Multiple skeletal metastases of osteogenic sarcoma in a dog.

A 9-year-old male German Shepherd Dog with osteogenic sarcoma involving the right humerus was treated by scapulohumeral disarticulation and adjuvant chemotherapy. Doxorubicin was used, at a dosage of 30 mg/m2 of body surface. Chemotherapy was unsuccessful, and 4 months after surgery, the dog developed multiple metastases of osteogenic sarcoma in the appendicular skeleton, a metastatic pattern rarely observed with primary bone tumors.

Animals↗