The outcomes and prognostic factors of patients with soft-tissue sarcoma.

The present study evaluates the outcomes and prognostic factors in patients with soft-tissue sarcomas of the extremities, trunk, head and neck region. A retrospective study of 104 patients who underwent treatment was conducted on 48 males and 56 females with a mean age of 44.5 years (range, 10-85 years). Seventy-eight patients had high-grade sarcomas and most tumors (89.5 percent) were located at the extremities. One hundred patients were treated by surgery and 51 patients were treated by both surgery and radiation therapy. With the median follow-up time of 24.5 months, local recurrence developed in 26 patients (25 percent) and distant metastasis developed in 29 patients (27.9 percent). The actuarial overall 3-year disease-specific survival rate were 74.2 percent. Multivariate statistical analysis revealed that positive surgical margin and occurrence of distant metastasis were significant predictors for overall survival. Positive surgical margin was the only factor that increased the risk of local recurrence and older age (> or = 60 years) was only the factor that increased the risk of distant metastasis. The results reaffirm the importance of the surgical margin where uncontrolled local disease affects the risk of local failure and disease-specific survival. Occurrence of distant metastasis is associated with older age (> or = 60 years) and decreases disease-specific survival of the patients.

Stability of subchondral bone defect reconstruction at distal femur: comparison between polymethylmethacrylate alone and steinmann pin reinforcement of polymethylmethacrylate.

Polymethylmethacrylate (PMMA) is often used to fill the large subchondral defects following intralesional curettage of a giant cell tumor of the bone. Many authors have reported the use of Steinmann pins to reinforce the bone cement. However, whether this is of real benefit in improving the stability of the defect is controversial. Thirteen matched pairs of cadaveric distal femurs were obtained and tested in uni-axial compression to determine the strength of this reconstruction. The strength of normal distal femurs was compared with the strength of defective femurs using 5 matched pairs of cadaveric distal femurs. A significant difference between the two groups was demonstrated in the failure load, stiffness, yield point and total energy absorbed to failure (p < 0.05). The second part consisted of eight matched pairs of specimens filled with PMMA alone versus PMMA with Steinmann pin reinforcement. There was no significant difference in failure load, stiffness, yield point and total energy absorbed to failure (p > 0.05). The addition of Steinmann pins did not significantly improve the strength of the subchondral defect reconstruction in uni-axial compression compared with PMMA reconstruction alone.

Malignant peripheral nerve sheath tumor with neurofibromatosis type 1: a 2-case report and review of the literature.

Malignant peripheral nerve sheath tumor is a very rare soft tissue tumor in the general population but there is an increased incidence in patients with neurofibromatosis type 1. Two cases of malignant peripheral nerve sheath tumor associated with neurofibromatosis type 1 whom we were able to follow-up long term are presented. Although wide excision was performed successfully in these patients, they suffered from local recurrence of the tumors shortly after surgery and died with distant metastases. The literature concerning the natural history and the management of this specific condition was reviewed.

Reconstruction of the pelvic brim and its role in the reduction accuracy of displaced T-shaped acetabular fracture.

Open reduction of the displaced T-shaped acetabular fracture has a problem of accuracy of the fracture reduction. This study was carried out to demonstrate that the reconstruction of the pelvic brim by approaching the pubo-acetabular fragment plays a role in the accuracy of the reduction of displaced T-shaped acetabular fractures. From 1975 to 1990, a retrospective study was carried out of 22 patients who sustained a displaced T-shaped acetabular fracture. The patients were operated on by open reduction and internal fixation of the ischio-acetabular fragment to the posterior column without restoration of the pelvic brim. Radiographs of the pelvis were reviewed. The result showed that there was displacement of the pubo-acetabular fragment including the medial wall in all cases. As the result of this study, a prospective study between 1990 and 1997 was carried out of 15 patients who sustained displaced T-shaped acetabular fractures including 3 cases with medial displacement of the femoral head. The pubo-acetabular fragment was anatomically reduced and fixed to the anterior column of the acetabulumn as the first approach to restore a disrupted pelvic brim. There, patterns of the acetabular fracture were subsequently re-evaluated especially the ischio-acetabular fragment including the position of the femoral head by using an intraoperative portable X-ray technique. The stability of the hip joint was assessed by hip flexion. The intraoperative radiograph appearances of the ischio-acetabular fragment were visually confirmed by a second surgical exposure. The results showed that the intraoperative radiographs gave spontaneous reduction of the ischio-acetabular fragment in all patients except one. There was a reduction of the displaced femoral head into the hip socket in the three patients. The hip joints were stable in all patients. The second surgical exposure showed that there was good spontaneous reduction of the ischio-acetabular fragment to the posterior column by ligamentotaxis in 14 patients. Therefore, it is not necessary to address the ischio-acetabular fragment. In the exceptional case, the ischio-acetabular fragment was displaced as a free bone which could not be reduced by ligamentotaxis. However, reduction and internal fixation of the ischio-acetabular fragment to the posterior column for complete re-application of the hip joint onto the pelvic ring of this case was facilitated. Postoperative 2 year and 5 year follow-up showed that the fracture had healed without heterotrophic ossification or premature osteoarthrosis of the hip joint. The exceptional case had a broken plate at the anterior column of the acetabulum. Hip function was evaluated clinically using Merle D' Aubigne's hip score. All patients had a "very good score". The study showed that reconstruction of the pelvic brim by anatomical reduction and fixation of the pubo-acetabular fragment to the anterior column plays an important role in the accuracy of fracture reduction of a displaced T-shaped acetabular fracture.