Abstract

Abstract

Summary Statement

Combination of antibiotics with N-acetylcisteine and sub-MIC concentration of erythromycin was evaluated in two collection and 16 clinical strains of staphylococci isolated from PJI. The results were strain-dependent, so it evidences the necessity of perform individual studies of biofilm susceptibility.

Introduction: Malignant bone tumors are rare. In a sample of 1000 pediatric tumors diagnosed in our hospital only 4% were primary bone tumors.

Material and Methodology: The authors present a series of Primary Malignant Bone Tumors, in children and adolescents treated in their Department, referred to a period of 14 years (1991–2004). It’s a series of 45 cases, of which 41 were evaluated. There were excluded 3 malignant low-grade osteosarcomas and 1 Askin tumor (thoracic PNET). The authors evaluated 24 Osteosarcomas, 14 Ewing Sarcomas and 3 PNET. The cases correspond to a population of 24 girls and 17 boys. The study correlate survival rate with tumor histological characteristics, size, stage, chemotherapy protocol used, the percentage of necrotic induction after neoadjuvant chemotherapy and type of surgical plane of dissection.

Results: From patients with high-grade osteosarcomas 71,2% are alive and without disease, with a minimum follow-up of 4 years (1 case) and a maximum of 17 years. On the Ewing Sarcomas/PNET the survival rate is 76%, with the same follow-up period.

Discussion and Conclusions: Due to the improvement of imaging techniques a fast diagnostic orientation is possible. The stage evaluation, combined with chemo and radiotherapy advances, as well as the progress of the surgical techniques to preserve limbs, together contribute to a better prognosis of the disease. The high survival rates permit to face this pathology as a chronic disease.

Introduction: Most of the bone metastases have origin in breast, lung, prostate, thyroid and kidney neoplasms. The commonest locations are the axial skeleton and the proximal region of the long bones, being the femur the most affected one. The main objectives of the surgical treatment are a quick functional recuperation and immediate pain relief.

Objectives: The aim of this work was to define a strategy for the surgical treatment of the bone methastasis located in the femur.

Material: The study includes 94 patients with femoral methastasis (100 metastasis) surgicaly treated in the last 10 years in our department.

Methods: Retrospective descriptive study based on medical records evaluation.

Results: The proximal third of the femur was involved in 80 % of the cases. Pathological fracture was identified in 72 cases and impending fracture in 28. Half of the primitive neoplasms was originated in the breast. It was identified as solitary metastatic lesion only in 33 % of the situations. The mean patient survival time was 9,2 months. They were treated with a cemented calcar-replacing prosthesis in 40 patients, 10 patients submited to conventional arthroplasty and 36 with intramedullary fixation (usually a cephalomedullary nail). The remainder 14 were treated with other surgical techniques.

Discussion: The surgery is indicated in case of painful lytic injury or unresponsive to radiotherapy, pathological or impending fracture. The surgical technique depends on the location and size of the lesion and if it is a solitary or multiple bone lesion, choosing between arthroplasties, of preference with long femoral stem, and intramedullary fixation. As we have performed a retrospective study, a functional rigorous evaluation was not possible.

Conclusion: The treatment of metastatic femoral disease is not performed with the intention of cure but to improve significantly the patient’s life quality. The proximal third of the femur is the most reached place. Breast cancer was responsible for around 50 % of the cases. In 50% of the patients the surgical option was an arthroplasty and techniques of femoral nailing were performed in 36%. The cemented replacement prosthesis is used in proximal large injuries with periarticular involvement: The intramedullary fixation is reserved for situations in which the femoral head and neck are not involved. The length of patient survival must exceed the predictable surgical recovery period.

Introduction: Soft tissue sarcomas (STS) are rare tumors. A multidisciplinary approach including surgery, chemotherapy and radiation therapy is recommended.

Materials and Methods: In the last 12 years, 249 patients with STS were teated in our Institution. All of them were treted with a multidisciplinary approach using all or some of the previous refered treatments.

Results: The overall local recurrence rate in the group of patients submited to surgery was 25% and this factor was related mostly with contaminated margins. Surgical resections were associted with soft tissue reconstructions when needed.

Radiation therapy was used in both regimens pre and post operativly, chemotherapy was also used in 85% of the patients, and was not dependent of tumor histotype.

23 patients were submited to surgery of lung metastasis.

Survival rates were determined and compared with stage (AJCC), tumor histotype and surgical margins.

Conclusions: Multidisciplinary approach is the recommended treatment for STS.