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.

Preoperative and postoperative evaluations by means of three-dimensional computed tomography in cases of Chiari osteotomy.

Three-dimensional computed tomography was employed to investigate the changes of pelvic and hip morphology in nine adult cases of congenital hip dysplasia. Six cases were treated with Chiari pelvic osteotomy and were reexamined postoperatively using the same technique. This new method clearly showed a number of important anatomic features that were not easy to detect with conventional roentgenography. Information provided by three-dimensional computed tomography imaging is useful in selecting the appropriate type of surgical treatment and in evaluating the results of Chiari pelvic osteotomy.

Mimickry in osteogenic sarcoma. Clinical considerations and report of 2 cases.

The authors report two cases of osteogenic sarcoma which presented under the false diagnosis of aneurysmal bone cyst and benign fibrous histiocytoma respectively. This mimickry is discussed: a) It is certainly more common than would appear from the literature, particularly in the case of aneurysmal bone cyst; b) this mimickry applies particularly to the lytic type of osteosarcoma; c) the adjective telangiectatic which is often used to describe malignant bone aneurysms is equivocal; d) immature forms of osteogenic sarcoma all possess a common factor with regard to onset, course and outcome of the disease; e) microscopic anaplastic elements may not always be observed in these imitations; f) clinical examination may often achieve or at least get closer to a true diagnosis of the disease: it is necessary to be aware of the existence of mimetic forms of osteogenic sarcoma and carefully evaluate all the available information; g) surgery should be delayed where clinical doubt exists and the histological report is negative. Such a delay may allow the tumour to reveal its true nature so that the surgeon and oncologist can select the correct treatment.

Grice-Green extra-articular subtalar arthrodesis in the treatment of infantile valgus pronated flat foot.

The Grice-Green operation was designed to correct pronated valgus flat foot. Initially, poliomyelitis provided the majority of candidates for this operation. Now, with the disappearance of poliomyelitis, its idiopathic variety in childhood has become the most common indication for this operation, whose effectiveness is universally acknowledged. The present paper is concerned with a quantitative assessment of its corrective potential, but the opportunity has also been taken to investigate more fully the evolution of the bone graft that is interposed as an arthrodesing agent between the talus and calcaneus.

Repair of rupture of flexor pollicis longus by "Z" lengthening at the wrist.

Rupture of the flexor pollicis longus in the digital canal can be repaired by one of the following methods: a) end-to-end suture, b) tendon grafting, c) transplantation of the flexor sublimis tendon of the ring finger, d) fixation of the proximal stump to the base of the second phalanx following elongation at the wrist. The efficacy of the first two methods has been confirmed by many authors on the basis of extensive clinical experience, but very few reports have been made on the other two techniques. The authors therefore report eleven cases of repair of the flexor pollicis longus by the technique of elongation at the wrist in the hope that this might be of value and might serve to reawaken interest in this method among specialists in hand surgery.

High tibial osteotomy for arthrosis of the knee: general considerations and surgical technique.

High osteotomy of the tibia is now internationally recognised as the treatment of choice in most cases of osteoarthrosis of the knee in which surgery is indicated. It has been favourably reviewed in the recent specialist literature. The author describes two techniques in current use at the Orthopaedic Clinic at Trieste which have proved both reliable and rewarding.

Grice-Green's extra-articular subtalar arthrodesis. 1. Notes on the operative technique.

Although Grice's operation has been used all over the world, no systematic account of it has been found in the literature (including publications dealing with technique), which presents it in terms related to the basic "classical" principles on which the operation was conceived. The present description of the authors' special technique is presented with these basic principles in mind. If executed with precision, it appears to be reliable and to conform to these basic requirements. The various stages are illustrated and a typical case is shown which supports the validity of the concept.

The origins of modern orthopaedics.

The modern cult of "selfwareness", today so fashionable among young people, calls on past experiences to interpret modern attitudes and reactions; and gives a new credibility to the old Latin dictum "Historia, magistra vitae". It involves all aspects of human enterprise, not least the professional aspect, which undoubtedly gains by taking account of the contributions of previous generations. Orthopaedic surgery is no exception, and those of us who would aspire to a fuller understanding of our specialty will find benefit in retracting its history over at least the last 250 years. In taking such a backward glance, the writer tried to seek out those events and those men whose contributions have stood the test of time and earned them the recognition and prestige in which they are still held today.

Meta-echinococcal arthrosynovitis: a clinical, anatomical and pathological entity not previously recognised.

The authors describe a case of echinococcosis of the tibia which occurred twice in seven years, the first time with signs of active involvement of the knee joint. Certain special aspects of articular echinococcosis, not up to now reported in the literature, are dealt with. The conclusion reached is that in an articular site the parasite can give rise either to a veritable "echinococcal" arthritis or, as in the case presented, to a the synovial affection which cannot be defined as "echinococcal" because the synovium did not contain living larval forms of the parasite, but only microscopic chitinous inclusions, arising from the disintegration of sterile hydatids, which had escaped from the adjacent bony focus into the joint. The synovium reached to their presence with an intense inflammatory response of a predominantly histiocytic nature. The term "meta-echinococcal arthrosynovitis" is suggested as a more accurate designation of this syndrome.