Aim

To compare pre-referral microbiology and previous bone excision in long bone osteomyelitis with intra-operative microbiology from a specialist centre.

With modern polychemotherapy Ewing’s sarcoma exhibit remarkable chemosensitivity leading to 5-year survival rates approaching 60–70%. However, in the last decade, no significant progress has been achieved in terms of improved cure rates and quality of life. In addition, prognosis is poor either in relapsed patients and in patients with metastasis at diagnosis. Thus, it is imperative to develop novel therapeutic strategies and to identify markers for risk-adapted therapies.

The PROTHETS European Consortium through collaborative studies defined prognostic markers and new therapeutic targets in the Ewing’s sarcoma family of tumours (ESFT), to provide rigorous scientific justifications for the development of clinical trials for this rare disease. Genetic studies have been performed for the screening of high-risk patients and patients responding differently to chemotherapy.

Between others, these studies identified in gluthation metabolism a major pathway regulating Ewing’s sarcoma chemoresistance. The prognostic relevance of glutathione metabolism pathway was validated by RT-PCR and the expression of MGST1, the microsomal glutathione transferase (GST), was found to clearly predict EWS prognosis. MGST1 expression was associated with doxorubicin chemo sensitivity. This prompted to assess the in vitro effectiveness a new anticancer agent (NBDHEX) that efficiently inhibits GST enzymes..

The consortium have collected more than 600 cases in specific tissue arrays for validation studies. Their use allowed the identification of some markers of prognosis, either conventional or new (ki-67, adhesion proteins, GAL3BP). Overall, theses studies started to define possible forthcoming risk-adapted strategies.

Another goal of the project was the creation of new tools and drugs as well as the optimization of molecular approaches against three therapeutic targets, EWS-FLI1, CD99 and IGF-IR that have great potential in terms of clinical application. The studies on IGF-IR have provide the rationale for the currently on-going clinical studies in Ewing’s sarcoma.

The results of treatment in 242 patients with intracapsular fractures of the neck of femur treated with Garden screws are presented with reference as to whether the screws were crossed or parallel. The incidence both of nonunion and of avascular necrosis was less in those fractures treated with parallel screws. The outcome was also superior if the reduction was good.

Fifty-nine cases of trochanteric wire revision following hip arthroplasty with trochanteric osteotomy and reattachment were identified and their outcome was studied. Two were infected and were excluded. Five were revised for instability: four became stable while one continued to have persistent dislocation. Fifty-two were revised for pain, 36 by removal of the trochanteric wire and 16 by reattachment of the greater trochanter. Successful relief of pain was obtained in less than half the cases. There was no difference in the incidence of back pain, wiring technique, trochanteric advancement, previous surgery to the same hip, trochanteric size or the pattern of wire breakage in the successfully treated group and the unsuccessful group. Neither was the removal of intact wire from a united trochanter any more certain of relieving pain than removal of broken wire from an un-united trochanter. Six patients later required revision for loosening or infection. These results indicate the need for full radiological and haematological investigation before exploration of the greater trochanter. At exploration for pain the wires should simply be removed as we could show no successful union after late reattachment of the trochanter in the absence of instability.