The IlluminOss® System (IS) based on photodynamic bone stabilization (PBS) is a recent option in between the minimally invasive surgical techniques available to treat bone metastases when medical or ...radiation therapy is neither effective nor indicated, and major surgery is not possible. In this study, the results obtained using IS in the treatment of impending fractures or bone metastases of the upper limb have been analyzed in terms of improvement in pain, quality of life and recovery of function.
Between January 2017 and October 2019, 8 patients over 65 years old with impending fractures or pathological fractures or myeloma of the upper limb have been treated in our institute with IS. All patients were assessed about pain, general health and function of the affected limb before surgery and 1, 3, 6 (consistent with survival) months after the procedure.
Mean VAS score improved from 8.88 before surgery to 1.00 six months after surgery, mean Karnofsky index improved at 1 and 3 months post-operative follow-up, and Musculoskeletal Tumor Society Score (MSTS) raised from 44.6 before surgery to 74.7 six months after surgery. Moreover, good reduction and stable fixation of the osteolytic lesion were achieved in all patients, and no complications were found.
Numerous studies have been reported in the literature on the use of this system in osteoporotic elderly fractures, whereas only few articles are currently available regarding its use in the treatment of bone metastases or pathological fractures. From our study PBS seems to be an effective solution in the management of bone metastases or myeloma in both pathological fractures and impending upper limb fractures in patients with low life expectancy.
Acrometastasis: a literature review Stomeo, D; Tulli, A; Ziranu, A ...
European review for medical and pharmacological sciences,
08/2015, Letnik:
19, Številka:
15
Journal Article
Recenzirano
Acrometastases are a rare observation, and account for approximately 0.1% of metastases. Every age can be affected, with a male predominance. The most common primary cancer site is the lung, followed ...by the colo-rectal, breast and genito-urinary tract. They are most commonly seen in pre-terminal patients with wide-spread disseminated disease. Rarely, they may be the first presentation of occult silent cancer, mimicking a benign condition. There is no standard treatment. We reviewed last 20 years literature in order to describe the most common sites of primary tumours and the more commonly used treatments.
We searched the Cochrane Central Library (CENTRAL), MEDLINE/PubMed (from 1940 to February 2014), SCOPUS database, and EMBASE/Ovid using a combination of controlled vocabulary and text word terms.
Lung cancer was the first most common cause of acrometastases both in hands and feet, with 32.9% of all the cases; 20% of cases were renal cell cancer (RCC) metastases, followed by breast (12.9%) and colon (10%). Primary malignancies and site of metastasis (hand vs foot) suggest that the tumour cells reach the bones through the circulation and not the lymphatic system; in foot acrometastases Batson's plexus may play a fundamental role in dissemination.
Treatment depends on staging and tumor extent. Amputation or disarticulation is the most common approach. It allows a wide margin resection and pain control. In some cases palliative treatment with radiation therapy, bisphosphonates and chemotherapy have been attempted with good results. The prognosis of the patients with acrometastases is poor; the mean survival time after diagnosis is 7 (±7) months. Special reference needs to be made to metastasis from renal cell carcinoma; if treated with radical surgical resection and nephrectomy a better outcome and survival rate shall be expected.
•Euthyroid Sick Syndrome is strictly realated to an increased risk of post-operative anemia.•This is the first study that links ESS to proximal femur fracture.•A pre-operative diagnostic screening ...for ESS in fragile elderly patients affected by proximal femur fracture could become a mandatory preoperative step
Incidence of hip fractures is increasing with upward estimates representing one of the most current health problems. According to some authors this condition is associated with an early mortality rate ranging between 20% and 35% and low outcomes. One of the predictive factors of poor outcome after hip fracture is anaemia. In fragile patients, hormonal changes due to fracture and surgical trauma, may occur in the hypophyseal hypothalamus axis which may lead to the Euthyroid Sick Syndrome (ESS). This pathological condition is characterized by a reduction in the concentration of triiodothyronine (T3) with normal or slightly reduced thyrotropin (TSH) values and with or without a reduction (cancellata) of thyroxine (T4). ESS has been associated to an increased mortality in elderly patients.
Inclusion criteria were: age > 65y, X-ray diagnosis of proximal femoral fracture classified as AO 31A or 31B requiring surgical treatment, admittance to the emergency room within 72 hours from trauma. Exclusion criteria were: any thyroid-related pathology, concomitant acute coronary syndrome, active pneumonia, concomitant neoplastic disease, assumption of medications able to affect thyroid function, refusal to undergo surgical treatment. All patients underwent routine blood testing and a complete thyroid-hormone profile dosage before surgical operation. The same blood tests performed before surgical operation were repeated on the first and third post-operative days.
Thirtytwo patients met the inclusion criteria and were enrolled after they accepted to participate to the study. Sixteen patients presented with ESS on admission and 16 patients did not. The mean age was 82,5 yo. There was no statistically significant difference in bleeding risk factors among the two groups. In the ESS group there was a number of blood transfusions of 1.06 units higher than the control group (p=0.01).
We have demonstrated that patients with ESS have a higher need of red blood cells transfusion compared to patients without ESS and, thus they have a higher risk to develop
anemia in the peri-operative period. We believe it would be useful to diagnose ESS in fragile patients at their arrival to the emergency room and apply a peri-operative therapeutic protocol to prevent anemia.
Osteoarthrosis is a degenerative musculoskeletal disease that presents a major public health problem, due to the increasing average age of the active population, as well as the increasing percentage ...of obesity or overweight of the general population. New therapeutic approaches have been developed, such as regenerative medicine that uses mesenchymal stromal cells taken from adipose tissue. This study analyzed the clinical potential benefits of using autologous adipose tissue to treat patients with moderate–severe knee osteoarthritis.
In 2021, a total of 50 knees, affected by moderate–severe knee osteoarthritis, were treated with an intra-articular injection of micro-fragmented subcutaneous adipose tissue. Patients were submitted to the KOOS questionnaire before the operation and one year after the operation and VAS pain score at time 0, 3, 6, 12 months.
Of the 50 patients treated, 2 patients were excluded from the study. Of the remaining 48 patients, improvements have been achieved in all subclasses of KOOS. In particular, VAS score proves that improvements are more considerable starting from the 3rd month after surgery.
The results obtained in this study show the safety and potential benefit of the use of autologous micro-fragmented adipose on people who are affected by moderate–severe knee osteoarthritis.
In the orthopaedic field the foreign body reaction is well known for therapeutic purposes in the alleged Masquelet technique consisting of segmental bone loss two-stage reconstruction. The induced ...membrane creates advantageous local conditions that promote bone graft remodeling and osteointegration. The aim of our study was to describe the first two cases in Literature of induced membrane observed following silver-coated knee megaprosthesis reconstruction. In addition, it was our interest to evaluate their histological features.
Infection is a significant complication in oncological megaprostheses. The purpose of our study is to indagate the innovations and new trend about the prevention of infection in this kind of surgery. ...The research focused on the use of antimicrobic prophylaxis, the defensive antibacterial coating and the use of silver coated.
Sarcomas are a heterogeneous group of rare tumours. Improvements in immunotherapy and the important role of PD1 and PD-L1 expression in advancement and prognosis have opened new fields of research ...for the treatment of these neoplasia. We evaluated the immunohistochemistry of PD1 and PD-L1 expression in 60 adults' patients affected by high-grade sarcomas of the limbs. PD1 expression was 65% while PD-L1 was 68.3%. PD-L1 expression seems to correlate to Ki67 in liposarcomas, fibrosarcoma's and pleomorphic sarcomas, while it does not show any correlation to chondrosarcomas, while in rhabdomyosarcomas there is a correlation but, given the small sample size, it was not possible to perform a statistic analysis. Our study shows positivity among the different subgroups of positive PD1 lymphocytes infiltration and PD-L1 expression in high-grade sarcomas of the limbs.
In lung cancer patients, metastases to soft tissues (STs), including skeletal muscle, subcutaneous tissue and skin, are rarely reported. Besides, lung cancer, primary carcinomas of the kidney and ...colon are the most commonly associated with ST metastases.
To determine the prevalence, clinical-pathological features and treatment options of ST metastases originating from lung carcinoma.
A literature search was performed using the following terms: lung cancer, ST metastasis, skeletal muscle metastasis, cutaneous metastasis, subcutaneous metastasis.
Autopsy series have detected STs metastases in 0.75-9% of patients who died from metastatic lung carcinoma. Pain and the presence of a palpable mass are the most frequent clinical features. The biopsy is recommended after MRI for diagnosis. Due to the rarity of ST metastases, the differential diagnosis must be posed especially with primary ST sarcomas. The type of treatment depends on the patient's clinical status and prognosis, and includes observation, radiotherapy, chemotherapy and surgery.
In lung cancer patients, ST metastases are rare, but not exceptional. Their presence should be suspected in the presence of a palpable mass either painful or asymptomatic. Radiological and histological examinations are required for the definite diagnosis. The choice of treatment should be based on considerations related to the stage of the primary tumor and the patient's global health status.
The solitary bone cyst is a typical tumor-like lesion of the immature skeleton, whose etio-pathogenesis is still unclear. The purpose of this work is to perform a review of the literature about the ...different surgical approaches focusing on the role of bone substitutes and growth factors. Literature analysis shows injection techniques of substances such as methylprednisolone, autologous bone marrow, demineralized bone matrix, calcium sulphate and surgical techniques that involve the resection and curettage associated with bone graft and/or intramedullary nailing. Although there are good results currently associated to these techniques and the different ways of treatment, the only evidence-based treatment is given by injections of steroids. However, given the high rate of failure, autologous bone marrow and platelet gel represent a viable therapeutic option.
Pathological fractures have a high incidence in musculo-skeletal oncology, and localization in long bone causes severe pain, disability and poor quality of life. The aim of this retrospective case ...series is to evaluate the clinical results, in particular regarding the quality of life, in patients affected by lower long bone pathological fractures surgically treated. We analyzed 93 patients with pathological fractures of tibia and femur surgically treated in our Orthopaedic Department and followed up for at least 3 years or until their death. Intramedullary nailing or endoprosthetic reconstruction for pathologic fractures located in the metadiaphyseal and diaphyseal or proximal regions in advanced-stage cancer patients are suitable methods for a stable fixation or reconstruction. These approaches guarantee a good mechanical stability, a faster mobilization, a better control of pain with an overall improvement in quality of life in all patients, confirmed also by the trend of the ECOG performance status and QOL-ACD.
