Current 5-year survival after complete resection of pulmonary metastases is ≈ 30%, and many patients develop pulmonary recurrences. Obviously new treatment options are needed for this indication. Isolated lung perfusion (ILuP) is an experimental technique to deliver high-dose chemotherapy to the lung without systemic exposure. Recently, a phase I trial of ILuP combining 45 mg melphalan followed by pulmonary metastasectomy for resectable lung metastases proved to be feasible and safe. The current 3-center phase II study (including University Hospital Antwerp/P. van Schil and Anthonius Hospital Nieuwegein/F. Schramel) allows patients with resectable lung metastases from colorectal cancer, soft tissue- and osteosarcoma to be treated with ILuP prior to metastasecomy. At Leiden University Medical Center we treated 8 patients: 4 with colorectal cancer (age 54–59 y), 2 osteosarcoma (19–20 y), 1 sarcoma NOS of bone (38 y) and 1 sarcoma NOS (56 y) of soft tissue. The number of metastases was 1–2 and one patient had resection of 9 metastases. The procedure was uncomplicated in 7 cases and 1 patient had reversible pulmonary edema. Hospital admission duration was 6–8 days in the uncomplicated group and 14 days in the one patient with a complication. No long term toxicity was observed with extensive follow-up including lung function tests. With a median follow-up of 7 months (range 2–16), only the patient with 9 metastases had a recurrence and died of disease. Our single center prelimininary data show that ILuP is feasible and does not lead to irreversible or severe toxicity. Compared to retrospective data with metastasectomy alone, perfusion did not add toxicity. Follow-up is too short to draw any conclusions on efficacy.
Published experimental data on BMP-7(OP-1), carried by collagen type 1 (Osigraft), related to reconstructive surgery attest that: it accelerates and improves the incorporation of strut allograft; the combination of OP-1 with auto or allograft results in an improvement of critical size defect healing from radiological, histological and mechanical perspective. In human revision hip surgery, OP-1 has been used with morcellized allograft, proximal femoral allograft and bulk femoral head allograft for acetabular or femoral reconstruction: a faster and more evident new bone formation as well as a faster incorporation of grafts has been shown compared to what expected without OP-1 usage. Even if OP-1 usage in hip surgery is not approved by regulatory agencies, because of lack of randomised clinical studies, we decided to use it in patients with serious acetabular defects (II/III GIR). In our experience, we treated eight patients with OP1, in conjunction with allografts. Clinical, radiographic and densitometric analysis has been done at 3, 6 and 12 months. Preliminary densitometric results show that the quantity and features of new formed bone are superimposable to natural bone.
High Tibial Osteotomy (HTO) is an established treatment for unicompartmental osteoarthritis of the knee with malalignment. The classic procedure for correcting varus deformity is the lateral closed wedge osteotomy of the tibia with osteotomy of the fibula. The disadvantages of this technique are well known. Open wedge osteotomy from the medial sideeliminates the risk of compartment syndrome and peroneal nerve injuries. A new fixation device (TomoFix(tm)) with an adapted surgical technique allows stable fixation of the osteotomy without the need to fill the osteotomy gap with bone grafts. In a prospective study, 92 consecutive cases were treated with this procedure. Bony healing with remodelling of the medial and posterior cortical bone was observed. Full weight-bearing was possible ten weeks after surgery. There were no implant failures. Complications included one delayed union, two revarisations and one deep infection. Keywords: High Tibial Osteotomy (HTO), openwedge osteotomy, TomoFix(tm) plate, medial osteoarthritis, varus knee
All cases were biopsied. 37% of these were excisional biopsies, 29% were incisional biopsies and 17% were needle biopsies. 21 patients (88%) received definitive surgery. Of these 5 had forequarter amputations (24%), 11 cases were excised marginally (52%), and 5 cases curetted (24%). Surgical choice was highly dependent on grade (X2=4.9256, p=0.005). In all cases the intent was curative. 2 patients had metastasis disease at diagnosis, and 5 developed metastases after definitive surgery. 4 patients had local recurrence (all had undergone wide local excision). All patients with grade 1 tumours remained disease free. Cumulative survival at 5 years was 57% and at 10 years 42%. Patient age did not affect survival. 5 year survival in grade 1, 2 and 3 tumours was 100%, 83% and 20% respectively. 4 of 5 patients undergoing amputation developed metastases and survival was significantly worse in the amputation group. Local recurrence in the wide local excision group did not diminish prospects for survival.
Curettage was chosen for most grade 1 and some grade 2 tumours. Although maintenance of function is far better, our study provides no evidence that curettage results in increased local recurrence rates. Indeed, local recurrence in the wide local excision group did not depress survival figures. Because of early death in the amputation group, we would recommend avoidance of amputation in favour of wide local excision in almost all cases if possible. Age alone should not be a factor in determining surgical treatment.
Purpose: To assess the long-term outcome of Schanz subtrochanteric abduction osteotomy (SO) in patients with long-standing dislocation of the hip Patients and methods: Between 1962–1981, 11 patients were treated with a SO. Nine patients, in whom 16 SO procedures were performed, were available for follow-up. Seven hips had had failed surgery in infancy, 9 hips had not been operated on previously. The average age at the time of SO was 17.8 (12–29) years. The degree of dislocation at the time of SO was classified according to Eftekhar type B: subluxation; (4 hips); type C: dislocation with neo-acetabulum, (8 hips) patients, and type D: high dislocation, no neo-acetabulum (4 hips). The indications to perform SO were fatigue and a painful lurch in 14 hips and a flexion/adduction contracture with pain in 2 hips. Post-operatively, patients were immobilised in suspended traction for 6–8 weeks, followed by progressive weight-bearing. Follow-up averaged 21 (14–37) years. Follow-up included the Harris-Hip score and ADL-score (Barthel-index); working status, sexual problems, ROM, hip/knee instability and radiographic examination. Results: Ten secondary surgical procedures were performed at an interval of 6–19 years following SO: shelf procedure ( 5); Epiphyseodesis (3) and total hip (2). The shelf procedures were performed for residual hip pain, at an average of 12 years. The total hips were performed after 17 and 19 years following SO. Both have failed and had complicated hip-revisions. ROM was severely restricted in 4 patients. The mean Harris hips score was 76 ( 27–97). One of six bilateral cases and 2 of 4 unilateral cases had poor functional results. All patients had unlimited ADL activities; 7 patients regularly participated in cycling and swimming. Three female patients experienced minor sexual problems, due to limited abduction. Four patients had 400 excessive valgus at the knee, without clinical or radiographic symptoms. Leg-length discrepancy varied from 0–3 cm. Conclusion: 1. The results of SO in patients with Eftekhar C/D were surprisingly fair, and poor in type B, subluxation.