[Thoraco-scapular amputation in sarcomas of the shoulder girdle]. / Intertorakoskapulaer amputation ved sarkomer i skulderbaeltet.

A total of 121 patients with sarcomas localized to the shoulder girdle were referred to the Sarcoma Centre in Arhus. Of these, 17 (14%) underwent interscapulothoracic amputation. At the time of treatment, the average age was 51 years (17-82 years). Eleven of these patients had sarcomas of bone and six had soft tissue sarcomas. Late diagnosis or previous surgical interventions contributed to the indication for the mutilating procedure. At the time of referral, six of the 11 cases of bone sarcomas were complicated by a pathological fracture and all six soft tissue sarcomas had been submitted to incisional biopsy or non-radical treatment. The soft tissue sarcomas were usually large with an average maximum diameter of 10 cm (4-15 cm). Postoperative recovery was uncomplicated in all cases. Local recurrence occurred in three patients (18%). Eight patients (47%) developed metastases and died from the tumour on an average of 32 months (7-94 months) after operation. Two patients died from other causes without tumour. Seven patients (41%) were tumourfree and alive for an average of 69 months (21-128 months) after operation. Only three of these seven patients wore their shoulder-arm prosthesis regularly while the remainder preferred to be either without a prosthesis or to use a lightweight shoulder prosthesis. None of the seven patients still experienced phantom pain necessitating analgetics. All of the patients were self-reliant in everyday life and the five patients who had been occupationally active until the time of operation had returned to work. The prognosis after interscapulothoracic amputation depends upon the primary malignant disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intraoperative autologous transfusion (erythrocyte saving) in surgery for scoliosis. A case-controlled study]. / Intraoperativ autolog transfusion (erytrocytgenvinding) ved skoliosekirurgi. En case-kontrolunderslgelse.

A Haemonatics Cell Saver 3+ was used for intraoperative autologous transfusion in a case control study of 20 patients with idiopathic adolescent scoliosis. Ten of the patients were treated surgically by Cotrel-Dubousset instrumentation (CDI) with intraoperative autologous transfusion and ten patients were submitted to Harrington' method of operation with device for transverse traction (DTT). In the CDI group the mean peroperative blood loss was 1,700 ml and a mean of 804 ml or 69% was transfused intraoperatively with a hematocrit of 60%. Out of a total blood loss of 2,701 ml 44% of the red blood-cells were autotransfused in all. Seven patients did not required blood transfusion and two patients did not require blood transfusion postoperatively. In the Harrington group the mean total blood loss the was 2,390 ml and the mean peroperative blood loss was 1,715 ml. The total requirement for transfusion was 34 units peroperative and 15 units postoperatively. In a series of ten patients submitted to operative treatment for scoliosis, the need for blood transfusion was reduced by 49% compared with a control group.

[Radiation induced sarcoma of the shoulder girdle]. / Stråleinducerede sarkomer i skulderbaeltet.

A well-known complication after irradiation of tissue is development of postradiation sarcomas, and the shoulder girdle is in this connexion a frequent location, because it relatively often is exposured to x-rays. During the period 1956 to 1989 121 patients with sarcomas located to the shoulder girdle were referred to the Sarcoma centre in Arhus. Of these, six were postradiation sarcomas. The indication for the initial irradiation was in two cases cancer of the breast, in one malignant lymfogranulomatosis, in one a metastasis from malignant melanoma and finally two cases of peritendinitis humeroscapularis. In average 15 years (7-26 years) elapsed from irradiation to the diagnosis of the sarcomas. There were four bone sarcomas, two located in the clavicles and 2 in the humeri. Of these, three were osteogenic sarcomas and one a malignant fibrous histiocytoma. There were two soft tissue sarcomas, both located subcutaneously with involvement of deep fascia and muscle. Both tumors were extraskeletal osteogenic sarcomas. Three patients died of tumor on an average after 11 months. Two died without tumor from other causes, and one patient is alive without tumor 11 years after the treatment. If a patients presents with pain at the side of prior radiation, the diagnosis postradiation sarcoma must be considered and the patient referred to the Sarcoma centre. Radiation therapy should not be used in patients with benign lesions.

[Complications after osteosynthesis using Partridge's method in femoral fracture near the prosthesis]. / Komplikationer efter osteosyntese a.m. Partridge af protesenaere femurfrakturer.

The object of the investigation is to illustrate the results and complications following Partridge's osteosynthesis of proximal fractures in the neighbourhood of the prosthesis. During a period of 40 months, eight consecutive patients (two men and six women) with proximal fractures of the femur in the neighbourhood of a hip prosthesis were subjected to osteosynthesis by Partridge's method. All of the fractures resulted from low energy trauma. The average age was 72 years (51-84) and the average duration of observation was 2.3 years. Weight-bearing was permitted after an average of 14.5 weeks and the radiographically assessed healing time was 16 weeks on an average. In all of the patients, cortical erosion developed under the Partridge bands 10-16 weeks postoperatively. In five patients, the initial erosions were of limited extent and were stationary during the period of observation. In three patients, the osteolysis was progressive and reoperation with introduction of a long-shafted femur prosthesis proved necessary. In addition, homologous boney transplants were necessary in two of these patients. Stability and healing of the fracture are obtained by osteosynthesis by Partridge's method but, on account of the osteolysis which is frequently pronounced and progressive, the patients should be followed-up meticulously in view of the possibility of removal of the Partridge material and possible replacement by a long-shafted femur prosthesis before the bone is completely eroded.

The clinical significance of asymptomatic mid-trimester low placentation diagnosed by ultrasound.

A prospective investigation of the problem of low placentation in mid-trimester, in uncomplicated pregnancies was performed. 773 pregnant women were included and 70 (9.1%) had a low-positioned placenta, defined as a placenta reaching or partially covering the cervical os, diagnosed by ultrasound between the 19th and 21st week of pregnancy. In no case did the placenta completely cover the cervical os. By repeat ultrasound examination in the 36th week of pregnancy, all low placentations had converted to normal position. Low placentation in mid-trimester was not associated with pregnancy complications or neonatal complications. A placenta reaching or partially covering the cervical os, in early pregnancy, seems to be normal, not influencing the subsequent course of pregnancy.