ABSTRACT
CLINICAL PROBLEM: Resection of malignant tumors of the pelvis is demanding. To avoid disabling hemipelvectomies, years ago internal hemipelvectomy combined with partial pelvic replacements had become a surgical procedure. To achieve adequate reconstructions custom-made replacements were recommended. In early stages of the surgical procedure using megaprostheses, individual pelvic models were manufactured. AIM OF THE STUDY: Since little is known about the accuracy of such models we analysed the charts of 24 patients (25 models) for whom an individual model of the osseous pelvis had been manufactured. RESULTS: Two patients refused surgery. In 23 patients partial resection of the bony pelvis was performed followed by a partial pelvic replacement (13x), hip transposition procedure (5x), ilio-sacral resection (4x), or revision surgery. In all patients who received a partial pelvic replacement, the fit of the replacement was optimal. No major unplanned resection was necessary. The same was observed in patients who received a hip transposition procedure or an ilio-sacral resection. Oncologically, in most of the patients we achieved wide resection margins (14x). In 5 patients the margins were marginal (4x) or intralesional (1x). In two cases the aim was a palliative resection because of a metastatic disease (1x) or benign entity (1x). CONCLUSION: Pelvic models are helpful tools to planning the manufacture of partial pelvic replacements and ensuring optimal osseous resection of the involved bone. Further attempts have to be made to evaluate the aim of navigational techniques regarding the accuracy of the osseous and soft-tissue resection.
Subject(s)
Bone Neoplasms/diagnostic imaging , Bone Neoplasms/surgery , Hemipelvectomy/methods , Models, Anatomic , Pelvic Bones/diagnostic imaging , Pelvic Bones/surgery , Tomography, X-Ray Computed , Adult , Aged , Bone Neoplasms/pathology , Female , Humans , Male , Middle Aged , Osteotomy , Pelvic Bones/pathology , Polyurethanes , Plastic Surgery Procedures , Reoperation , Treatment OutcomeABSTRACT
During the last 30 years the analysis of human speech with powerful computers has taken great strides; therefore, cost-effective, comfortable solutions are now available for use in professional routine work. The advantages of using voice recognition are the creation of new documentation or archives, reduced personnel costs and, last but not least, independence in cases of unforeseen notification of illness or owing to annual leave. For voice recognition systems to be used easily, a considerable amount of time must be invested for the first 3 months. Younger colleagues in particular will be more motivated to dictate more precisely and more detailed because of the introduction of voice recognition. The effects on other sectors of medical training, quality control, histology report preparation, and transmission can only be speculated.
Subject(s)
Artificial Intelligence , Decision Making, Computer-Assisted , Medical Informatics/trends , Voice , Humans , Speech Discrimination Tests/trends , Word Processing/methods , Word Processing/trends , WorkforceABSTRACT
Bone alterations in Paget's disease, have been studied by histomorphometrical evaluation iliac creat bone biopsies before and after long-term treatment with human ans salmon calcitonin. Therapeutic effect was controlled from 12, up to 48 months. All-together 28 bone biopsies were taken from 9 patients (aged 46 to 71 years) with Paget's disease of their os ileum. The biopsies were prepared for histological examination without previous decalcification, cut, stained and quantitatively analysed at the light microscopic level. By means of a point counting method we determined the parameters of bone structure, bone formation and bone resorption. Before therapy was started, trabecular bone alterations could be observed which were typical for Paget's disease of bone as there were bulky trabeculare, increased remodelling surfaces and giant osteoclasts. Following treatment with calcitonin a dramatic reduction of bone remodelling surfaces and a normalization of bone structure occurs. Considering our previous electon microscopy findings, a reduction of the number of osteoclasts as well as their nuclear content, might be explained by an inhibitory effect of calcitonin on cell fusion of osteoclastic precursor cells. In 2 cases, an interruption or hormonal treatment of 5 to 12 months, presented no risk of losing the therapeutic effect.
