Transitory osteonecrosis of the head of humerus after fracture of the clavicle.

The authors present a rare case of transitory osteonecrosis of the humeral head with anterior instability of the glenohumeral joint, which occurred in a young male aged 19 years, three months after fracturing his clavicle in a fall. Core decompression of the humeral epiphysis and anterior capsulomioplasty according to Symeonides was performed. Five months after surgery the patient was clinically cured. After having excluded the possibility of metabolic imbalance in the patient, we presumed a direct relationship between the trauma and degenerative pathology affecting the humeral epiphysis.

Prospective sonographic and arthroscopic evaluation of proliferative knee joint synovitis.

The objective of this study was to verify the accuracy of ultrasonography in assessing the topography, morphology, and extent of synovial proliferation in rheumatoid and psoriatic knee joint synovitis. Findings were compared to those obtained using prospective arthroscopy as the gold standard; in addition, topographically defined sonographic findings before and after arthroscopic synovectomy were compared. Sonographic examination was performed in 12 patients with rheumatoid arthritis (13 knees) and 13 patients with psoriatic arthritis (14 knees) who had synovitis of the knee using an electronic linear transducer (7.5 MHz) or a mechanical sector transducer (10 MHz). This examination was followed within 1 week by arthroscopy, to compare the topography (intra-articular localization) and the morphology (sonographic patterns) of synovial proliferation. In 15 knees undergoing arthroscopic synovectomy, preoperative sonographic measurement of synovial thickness in the suprapatellar, medial parapatellar, and lateral parapatellar recesses was compared with arthroscopic visualization of synovial proliferation; 13 knees were reevaluated 2 months after arthroscopic synovectomy by sonography at the same sites. Three distinct sonographic patterns of synovial proliferation were confirmed by arthroscopic examination: a villonodular aspect in 12 knees; uniform thickening in eight knees, and overlapping layers in seven knees. About 50% of the knees showed more than one sonographic pattern, with no differences in pattern distribution between rheumatoid arthritis and psoriatic arthritis patients. A significant correlation was found between sonographic and arthroscopic evaluations of synovial thickness in the suprapatellar (P < 0.02) and medial parapateoffr recesses (P < 0.02), the sites of maximal synovial proliferation in our patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Phase II study on neoadjuvant hyperthermic-antiblastic perfusion with doxorubicin in patients with intermediate or high grade limb sarcomas.

BACKGROUND: Locoregional control of soft tissue sarcomas of the limbs is achieved generally using a multidisciplinary approach consisting of conservative surgery combined with radiation therapy, intraarterial chemotherapy, or hyperthermic antiblastic perfusion (HAP). Before surgery, HAP seems to be the more suitable tool in decreasing tumor mass and allowing limb-sparing surgery. The authors' aim was to ascertain the activity of HAP with doxorubicin against intermediate or high grade limb tumors. METHODS: In 23 patients with limb sarcomas (2 patients International Union Against Cancer Stage IIA, 4 stage IIB, 1 stage IIIA, 11 stage IIIB, and 5 stage IVB) doxorubicin was administered via HAP 4-6 weeks before surgery. The drug (bolus, 0.7-1.4 mg/kg) was perfused for 60 minutes with a tumor temperature of at least 40.5 degrees C (range, 40.5-42.6 degrees). Tumor necrosis was then assessed radiologically and pathologically. RESULTS: Systemic toxicity was hematologic grade (G) 2 in 2 patients, gastrointestinal (hepatic) in 6, G1 in 2, G2 in 3, and G3 in 1; 2 patients had alopecia; locoregional toxicity (graded according to Wieberdink) was G1 or G2 in 18, G3 in 4, and G4 in 1. Tumor necrosis was more than 50% in 17 patients (74%). Limb-sparing surgery was feasible in 20 patients (91%). At present, 14 patients are alive. Six had local recurrences, and eight had distant metastases. CONCLUSIONS: Our findings show that HAP with doxorubicin is an active and well-tolerated procedure within a multidisciplinary approach to treatment of limb sarcomas.

Adriamycin in hyperthermic perfusion for advanced limb sarcomas.

From February 1989 to April 1991, 12 hyperthermic limb perfusions (HLP) with adriamycin (ADR) were performed in 12 patients with high grade soft tissue sarcomas (9 in the leg and 3 in the arm); two were at A.J.C. stage IIb, eight stage IIIb and two stage IV. ADR (0.7-1.5 mg/kg) was administered in bolus at a mean temperature of 41.5 degrees C and perfused for 60 min. No systemic toxicity was reported; seven patients had grade II locoregional toxicity, another four grade III and one grade IV. Tumor necrosis (radiological evaluation) was less than 25% in two patients, 25% to 50% in two, 50% to 75% in five and greater than 75% in three. Limb sparing surgery was feasible in ten patients. At present eight patients are alive; three had local recurrence and four distant metastases.

Orientación actual en el tratamiento quirúrgico de la sinovitis hemofilica con la sinovectomía / Recent surgical treatment of the synovitis haemophilic with the synovectomy

Han sido revisadas 350 sinovectomías (hombro, codo, cadera, rodilla, tobillo) con un seguimiento de 8 meses a 15 años. Del examen minucioso, se pudo observar que la sinovectomía da los mejores resultados cuando la artropatia presenta las siguientes características: HISTORIA DE HEMARTROSIS repetidas sin intervalos de completa remisión; signos de inicial flogosis articular; signos radiológicos de leve sufrimiento osteo-condoral. Se demostró no resolutiva cuando la actividad destructora de la sinovial ha llegado al ápice se ha extinguido, cuando los daños articulares son con deformación de los extremos óseos y desviaciones axiales y el síntoma más importante es el dolor a la carga (cadera, rodilla, tobillo). Los autores se refieren a una larga experiencia con la sinovectomía, recogida en 10 años, en el tratamiento de la artropatia hemofílica. Los resultados de una revisión a distancia de la casuística operatoria presentados en el Congreso de Dousseldorf (1985) fueron satisfactorios en la evolución de la artropatía y respecto al dolor y a la función articular

La osteotomía correctora de miembros inferiores en la artropatía hemofílica / The osteotomy corrector of lower extremite in the hemophilic arthropaty

En los pacientes afectados de Artropatía Hemofílica, es frecuente observar, especialmente en los miembros inferiores, la presencia de posiciones viciosas y de desviaciones axiales. Las alteraciones osteoarticulares prevalentes en los estados avanzados de la artropatía son las responsables del desequilibrio mecánico, de las recidivas de la hemartrosis y del dolor. Para el tratamiento de la artropatía con deformidad articular hemos recurrido alguna vez a intervenir realizando una osteotomía correctora asociada a sinovectomía o a "Rebaja Articular", y otras veces a intervenir realizando osteotomía solamente. Han estado seguidas 23 osteotomías (5 inter-trocantéricas para cadera; 6 supracondíleas y 12 osteotomías altas de tibia, para la rodilla) Tabla 1. Osteotomías 23, Cadera , Supracondilea fémur 6, Proximales de Tibia 12, Pacientes 20. Los controles a larga data (de 1 a 6 años), han constatado en la mayoría de los pacientes operados, además de la estabilidad de la corrección obtenida, el reinicio de una marcha más correcta y de la capacidad para el trabajo, la desaparición del dolor y de las recidivas de hemartrosis. Resultados que hemos obtenido también en aquellos pacientes en los cuales se les realizó osteotomía solamente. El juicio del paciente fue casi siempre muy satisfactorio e igualmente, si el cuadro radiológico de la articulación no ha mostrado variaciones relevantes, la mejor distribución de carga ha producido una función articular más correcta y con mejoramiento de la sintomatología

Chondromyxoid fibroma of the iliac bone: a case report with ultrastructural observations.

Ultrastructural findings in an unusual case of chondromyxoid fibroma are reported. The tumor was located in the iliac bone of a 42-year-old woman with left hip pain of 5 years duration.

Early synovectomy in haemophilia.

The Authors reviewed, after from 1 to 11 years, 28 joints of patients with A and B haemophilia operated on with synovectomy at an early stage. Investigation is made into the diagnostic elements for evaluating the earliness of arthropathy and indications for surgery. The results from early synovectomy are compared with the case histories reported in the literature when synovectomy was done at an advanced stage.

[Postoperative cervical spondylitis. Apropos of 5 cases]. / Spondylodiscite cervicale post-opératoire. A propos de cinq cas.

The authors reported 5 cases of post-operative cervicalgia of spondylodiscitic nature. Authors deem that this severe complication is to be attributed to the three following factors: microtraumatisms of cervical rachis with consequent local microcirculatory troubles; bacteremia provoked by anesthesiological manipulation (intubation, tracheal or oropharyngeal aspiration) or by the surgical operation and decrease in the immune response caused by operation and by used anesthetic drugs. Severe radiological alterations of the structure of cervical vertebrae and of the intersomatic space appear around 2-3 months after the surgical operation. They recover 8-12 months after the operation. They are preceded and accompanied by clinical signs and symptoms that lead the patient to go for several specialists' visits and subsequent hospitalizations. The authors think that the identification of cervicalgia of spondylodiscitic nature must lead the anesthetist to take necessary measures i.e. to immobilize the neck and to administer antibiotics.

False positive bone scan in bone tumors of the lower limb.

When examined using bone scanning agents, eight out of nine patients with lower limb malignancy, and neither of two affected in the upper limb showed a pathologic focus of isotope uptake in an area distal to the tumor. On pathologic examination the positive findings proved false. Such misleading results were found to be avoidable if a tumor-seeking agent instead of a bone scanning one is used.

[Current orientations in the treatment of bone metastases]. / Moderni orientamenti nel trattamento delle metastasi ossee.

Bone metastases are the most frequently occurring tumours of the skeletal system. Clinically, diagnosis is important but more so the treatment, taking into account the type of lesion, its localization and diffusion. Early and combined treatment by general surgeon, radiotherapist and orthopaedic surgeon will provide a longer survival rate and relative physical and psychological well-being for the patient. Following the diffusion on surgical techniques designed to cope with tumor in different bones the wait-and-see attitude of the past has been abandoned. More vigorous attempts to excise metastatic tumours and aims at reconstruction and substitution of weightbearing bones by means of modern methods of osteosynthesis and application of prostheses, can be achieved. The more controversial clinical and radiological aspects and the results of 281 cases, seen at the Clinica Ortopedica of the University of Padua, are illustrated.

[Solitary bone cysts]. / Le cisti ossee solitarie.

Fifty-eight cases of solitary bone cyst are reported. Clinical and radiological features and the results of surgical treatment are discussed. In the evolution of bone cysts and in particular those of the humerus two forms of the disease can occur; that of the metaphysis and that of the diaphysis with pecliar features and indications for treatment. Permanent repair of a cyst is possible only after internal reconstruction of the involved segment.

[Combined treatment of Ewing's sarcoma]. / II Trattamento combinato del sarcoma di Ewing.

Twenty cases of Ewing's bone tumor, seen at the Orthopaedics Clinic of Padua from 1958 to 1975, were classified into two groups on the basis of results obtained from different schemes of treatment. In the first group of patients, treated during the period 1958-69 by surgery and irradiation, the mean survival rate was one year with two exceptions still surviving since 17 and 11 years respectively (treatment: only amputation). The mean survival rate was prolonged to 5 years in the second group. Here, combined treatment included irradiation (4.000-6.000 r), medical treatment (Adriamycin, CCNU, Vincristine) vaccine therapy and surgery. In the Author's opinion it is more convenient to use the latter therapeutic approach because of the promising results, the improved survival rate and the more effective control of relapses and metastases.