ABSTRACT
Interventional radiology is a minimally invasive therapeutic approach that may be of benefit for some gynecological conditions. We present the case of a 40-year-old nulliparous woman with postoperative pyometra following open myomectomy who was considered for a hysterectomy, but the gynecologist requested that an attempt be made at percutaneous drainage of the abscess to salvage her uterus. We achieved a successful computed-tomography-guided percutaneous drainage of the abscess.
Subject(s)
Abscess , Radiology, Interventional , Humans , Female , Adult , Drainage , Tomography, X-Ray Computed , Uterus/diagnostic imaging , Uterus/surgeryABSTRACT
The purpose of this study was to assess whether the use of a joint-sparing technique such as curettage and grafting was successful in eradicating giant cell tumours of the proximal femur, or whether an alternative strategy was more appropriate. Between 1974 and 2012, 24 patients with a giant cell tumour of the proximal femur were treated primarily at our hospital. Treatment was either joint sparing or joint replacing. Joint-sparing treatment was undertaken in ten patients by curettage with or without adjunctive bone graft. Joint replacement was by total hip replacement in nine patients and endoprosthetic replacement in five. All 11 patients who presented with a pathological fracture were treated by replacement. Local recurrence occurred in five patients (21%): two were treated by hip replacement, three by curettage and none with an endoprosthesis. Of the ten patients treated initially by curettage, six had a successful outcome without local recurrence and required no further surgery. Three eventually needed a hip replacement for local recurrence and one an endoprosthetic replacement for mechanical failure. Thus 18 patients had the affected joint replaced and only six (25%) retained their native joint. Overall, 60% of patients without a pathological fracture who were treated with curettage had a successful outcome.
Subject(s)
Femoral Neoplasms/surgery , Giant Cell Tumor of Bone/surgery , Adolescent , Adult , Arthroplasty, Replacement, Hip , Bone Transplantation , Curettage/methods , Female , Femoral Fractures/surgery , Femoral Neoplasms/diagnosis , Follow-Up Studies , Fractures, Spontaneous/surgery , Giant Cell Tumor of Bone/diagnosis , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neoplasm Recurrence, Local , Treatment Outcome , Young AdultABSTRACT
The influence of pathological fracture on surgical management, local recurrence and survival was established in patients with high grade, localised, extremity osteosarcoma (n=484), chondrosarcoma (n=130) and Ewing's sarcoma (n=156). Limb salvage was possible in 79% of patients with a fracture compared to 84% of patients without a fracture (p=0.17). No difference in local recurrence was found between fracture and control groups. In univariate analysis, survival in the fracture group was lower than in the control group for osteosarcoma (34% versus 58%, p<0.01) and chondrosarcoma (35% versus 63%, p=0.04), but not for Ewing's sarcoma (75% versus 64%, p=0.80). In multivariate analysis, fracture remained a significant predictor of survival for osteosarcoma, but not for chondrosarcoma, where dedifferentiated subtype appeared to be decisive. Pathological fracture independently predicts worse survival in osteosarcoma, but not chondrosarcoma and Ewing's sarcoma. Limb saving surgery seems safe, if adequate resection margins are achieved.
Subject(s)
Arm Bones/injuries , Bone Neoplasms/mortality , Chondrosarcoma/mortality , Fractures, Spontaneous/mortality , Leg Bones/injuries , Osteosarcoma/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Bone Neoplasms/pathology , Bone Neoplasms/surgery , Child , Child, Preschool , Chondrosarcoma/pathology , Chondrosarcoma/surgery , Female , Fractures, Spontaneous/pathology , Fractures, Spontaneous/surgery , Humans , Limb Salvage , Male , Middle Aged , Multivariate Analysis , Neoplasm Recurrence, Local/etiology , Neoplasm Recurrence, Local/mortality , Osteosarcoma/pathology , Osteosarcoma/surgery , Prognosis , Retrospective Studies , Sarcoma, Ewing/mortality , Sarcoma, Ewing/pathology , Sarcoma, Ewing/surgery , Survival Analysis , Treatment OutcomeABSTRACT
AIMS: To review the oncological and functional outcome in 80 patients who underwent disarticulation of the hip as part of their treatment. METHODS: Eighty patients had disarticulation, of whom 46 had a bone sarcoma and 34 a soft tissue sarcoma. In 42 patients the operation was done as the first definitive surgical procedure for that patient. In 38 patients the disarticulation followed local recurrence after unsuccessful limb salvage, three of these patients had palliative amputations already having metastatic disease. All patients had adjuvant therapy when appropriate. RESULTS: The overall survival of the patients following the amputation was 56% at 1 year, 39% at 2 years, 27% at 5 years and 21% at 10 years. The 5-year survival of patients having the amputation as a primary procedure was 32%, for those with local recurrence it was 25% whilst for those with a palliative amputation it was nil. Local recurrence developed in 10 patients following the amputation, and was related to close margins of excision; all of these patients subsequently died. Function was on the whole poor, with only one surviving patient regularly using an artificial limb. CONCLUSION: Disarticulation of the hip remains a disabling procedure usually carried out for high grade sarcomas with extensive involvement of bone and soft tissues in the thigh. Long term survival is possible if wide margins of excision can be achieved.
