Proximal tibial osteosarcoma in young patients: early diagnosis, modular reconstruction.

Osteosarcoma is the most common bone tumor that occurs in children and young adults with prevalence of teenage. There can be identified many subtypes of osteosarcoma by how they look on X-rays and under the microscope. Osteosarcoma can be classified as high-grade, intermediate grade, or low-grade. This has a significant prognostic value of tumor development suggesting the growth rate and the potential for expansion. Between 2009-2013, in the Department of Orthopedics and Traumatology, University Emergency Hospital of Bucharest, Romania, were treated seven cases of osteosarcoma of the proximal third of the tibia in young, early-diagnosed cases without metastasis. The treatment involved resection of tumor formation and reconstruction with a modular prosthesis. Postoperative patients were mobilized for a week without charging the operated limb under the protection of orthesis. During this period continued active and passive mobilization of the ankle and foot to prevent stiffness and to reduce postoperative swelling. From the second postoperative week, patients are mobilizing with progressive charging but not being allowed to do any flexion in order to protect de insertion of medial gastrocnemius muscle rotation flap used to cover the prosthesis and to protect the patellar tendon reinsertion. This extensive surgery does not improve survival rate of these patients compared to treatment by amputation of this pathology but greatly increases the comfort of life and in all cases ensure socio-professional reintegration of these patients. To ensure optimal postoperative results perform a complete diagnosis and preoperative oncological treatment before surgery, if applicable.

Negative Pressure, a "Solution" in the Treatment of Infected Knee Prosthesis?

INTRODUCTION: Negative-pressure wound therapy is a therapeutic technique that uses a vacuum dressing in order to promote healing in acute or chronic wounds. The continued vacuum draws out fluid from the wound and increases blood flow to the area. The aim of this study was to establish the effectiveness of negative pressure therapy increasing this way the chances of rehabilitation after knee prosthesis infections. MATERIAL AND METHOD: 11 patients with septic complications after total knee joint replacement were involved into this study, from the Department of Orthopaedic and Traumatology of Bucharest Emergency University Hospital. In all of the cases negative pressure wound treatment was applied. The surgical approach was chosen according to the surgeon's preferences or along the pre-existing surgical approach. RESULTS AND DISCUSSIONS: Time from the knee arthroplasty to the clinical and biological manifestation of septic complications was about 35 days with limits between 21 and 42 days. In most cases we managed to keep the implant, the outcome obviously being conditioned by using the negative pressure. Knee infections are still a hazardous problem in orthopedic surgery. Negative-pressure system increased the granulation tissue formation and the local blood flow and enhanced the bacterial clearance function. CONCLUSIONS: The clinical outcome in our cases indicates that the Negative-Pressure Wound Therapy can be a valuable contribution to the treatment of knee joint infections.

Synovial inflammation in patients with different stages of knee osteoarthritis.

The synovium is an intra-articular mesenchymal tissue and essential for the normal joint function. It is involved in many pathological characteristic processes and sometimes specific for this distinctive tissue. In this study, we refer to synovial proliferative disorders according to the stage of osteoarthritis (OA) disease. Forty-three patients with knee OA were treated in the Department of Orthopedics and Traumatology, Emergency University Hospital of Bucharest, Romania, in the last two years. In all cases, we used at least five criteria for the knee OA: knee pain, knee joint tenderness, no palpable warmth over the knee, stiffness, erythrocyte sedimentation rate and C-reactive protein levels. In all the cases the synovial tissue was selected by the orthopedic surgeon. X-ray examination was taken in every case of the affected joint. Patients who were considered to have early OA underwent arthroscopic synovial biopsy of the symptomatic joint. Synovial tissue samples from patients with late OA were obtained at the time of knee joint arthroplasty. Microscopic examination in early osteoarthritis revealed for more than half of patients with synovial biopsy through arthroscopic technique having synovitis lesions with mononuclear infiltrates, diffuse fibrosis, thickening of the lining layer, macrophages appearance and neoformation vessels also. The synovitis seen in advanced OA knees tends to be diffuse and is not mandatory localized to areas of chondral defects, although an association has been reported between chondral defects and associated synovitis in the knee medial tibio-femoral compartment. The overexpression of mediators of inflammation and the increased mononuclear cell infiltration were seen in early OA, compared with late OA.

Titanium preformed implants in orbital floor reconstruction - case presentation, review of literature.

The management of orbital fractures is one of the most interesting and difficult areas in facial trauma. The consequences of an orbital fracture are sometimes dramatic. They include varying types of defects from a loss of vision to diplopia, loss of an eye, epiphora, a disturbing loss of facial sensation, or even an unacceptable appearance of the eye and the hard and soft tissues around it. The controversies surrounding orbital fractures, and orbital floor fractures in particular include the following: the timing of primary surgery (early or late), bone grafting versus alloplastic materials, the management and prevention of diplopia, the prevention of enophtalmos, the management of infraorbital nerve numbness or dysesthesia.

Methods of investigating metastatic lymph nodes in head and neck cancer.

ABSTRACT: When dealing with patients who have head and neck cancer - squamous cell carcinoma and have clinically N0 neck disease it is very difficult to assess the real extension of the malignant proccess. This is why several techniques are curently in use to determine the actual TNM clasiffication for each patient in order to apply best suited therapy management. Up until today the staging of the neck has been done by using a combination of the physical exam and conventional imaging studies. Recent studies and research have tried to determine weather the use of sentinel lymph node biopsy is a more reliable tool in predicting occult metastasis in cancer patients with clinically N0 neck disease. There are no guidelines in this matter and as such the use of the sentinel lymph node detection technique is yet to be used on a routine basis. The authors are trying to assess the benefits of different paraclinical investigation regarding the improvement of overall survival rates in patients with T1/T2 squamous cell carcinoma of the head and neck and N0 neck disease.

Rationale for management of frontal sinus fractures.

ABSTRACT: The optimal treatment of frontal sinus fractures remains controversial. Multiple treatment options and algorithms have been proposed by multiple specialties throughout the years; however, the optimal method of frontal sinus repair has yet to be discovered. Overwhelming complications such as meningitis, encephalitis or brain abscess are quite uncommon nowadays. Nevertheless, late development of invasive mucoceles is not a rarity and therefore long-term follow-up is mandatory.

The Role of EGFR and HER2- Activating Mutations in Maxillary Sinus Cancer.

Head and neck cancers account for less than 5% of all cancers worldwide and for less than 1% of all cancer deaths in Romania. Sinonasal squamous cell carcinomas are malignant tumors with origin in the respiratory mucosa of the paranasal sinuses and the nasal cavity. Because of the proximity to different important structures such as the brain, the eye the relevance of a multimodal therapy is well known. We take into discussion not only the most recent data from novel agents targeting EGF receptor (EGFR), VEGF and p53 pathways for the management of sinonasal cancer, but also further development of multimodal approach, and the use of biomarkers to appreciate the progression of the disease and the prognostic and overall survival rate in clinical practice. EGFR alterations have been implicated in the pathogenesis and progression of many malignancies. EGFR overexpression has been studied extensively regarding its clinical use but the results are yet to be analyzed.

Sentinel lymph node - work hypothesis in sinonasal carcinoma treatment.

Although rare, sinonasal malignancies (SNM) can be lesions of immense importance. Approximately 60-70% of sinonasal malignancies (SNM) occur in the maxillary sinus and 20-30% occurs in the nasal cavity itself. The lymphatic drainage of the sinuses and nasal cavity include levels I-III as well as the parapharyngian nodes. Elective regional lymph node dissections became controversial because of overtreatment of the many patients without lymph node metastases. Lymphatic metastasis is the most important mechanism of spread in sinonasal squamous cell carcinoma considering the vast network of vessels in this area. The indications and type of neck dissection to be performed in the positive node neck and management of the N0 neck remain controversial. The sentinel lymph node concept is based on the Halsted theory that stressed the importance of locoregional cancer treatment because of the far site spread. Each patient with head and neck malignancies, including sinonasal carcinoma have about 2-3 sentinel lymph nodes of which up to 40% of them contain metastases.