Proximal humerus chondrosarcoma in a young male patient.

Proximal humerus chondrosarcoma is a rare localization of the common primary malignant cartilaginous tumor. Management is based on oncological surgical excision because of the inherent resistance to chemotherapy and radiation therapy. The most important prognostic factors with great impact on treatment strategy are histological grading and localization of the tumor. Proximal humerus chondrosarcoma carries a slightly better prognosis, especially for the low and moderate grade tumors. We present the case of a young patient with proximal humerus chondrosarcoma surgically managed in our Department, with the purpose of underlining the challenges posed by this localization for oncological excision and reconstruction but also the importance of histological grading for the treatment algorithm.

Chondrosarcoma of the pelvis - case report.

Chondrosarcoma (CHS) is the third most common primary bone tumor after myeloma and osteosarcoma. Histologically, it is made of pure hyaline cartilage differentiation. The tumor itself may have myxoid modification and calcification. It occurs especially after 50 years, with an equal gender distribution. Most CHS are solitary, the etiology is still unclear and most of them are discovered accidentally. Early diagnosis is crucial for a good prognosis. In this paper, we would like to present a case of a female patient with an accidentally discovered CHS of the iliopubic and ischiopubic ramus of the pelvis. The purpose of this report is to highlight the importance of multidisciplinary management of tumor pathology, especially when the site of the tumor is surgically hardly accessible and to underline possible common genetic aspects of benign and malignant tumors.

Morphological study of cephalothoracopagus deradelphus type conjoined twins. A case report.

Cephalopagus is a rare variety of conjoined twins. They are fused with their heads, thoracic and upper abdominal cavities. The exact mechanism for development of conjoined twins cannot be clearly explained. It appears that there is an alteration in the normal developmental process of monozygotic twins, which fail to separate from each other. We present the morphology of a cephalothoracopagus, revealed through anatomical dissection, emphasizing the arrangement of the viscera in the thoracic and abdominal cavities. They are fused with their heads, thoracic and upper abdominal cavities. The lower abdomen and pelvic cavities are free. Each twin has two upper and lower limbs, normally shaped. Each twin has a heart and two lungs. There is a single pharynx, esophagus and stomach, but normal lower abdominal systems. The genital and urinary systems are apparently normal. Due to the fusion of the heads and abnormal arrangement of the superior central nervous system, surgery is not attempted in these cases, the prognosis being very poor.

Proximal tibial osteosarcoma in young patients: early diagnosis, modular reconstruction.

Osteosarcoma is the most common bone tumor that occurs in children and young adults with prevalence of teenage. There can be identified many subtypes of osteosarcoma by how they look on X-rays and under the microscope. Osteosarcoma can be classified as high-grade, intermediate grade, or low-grade. This has a significant prognostic value of tumor development suggesting the growth rate and the potential for expansion. Between 2009-2013, in the Department of Orthopedics and Traumatology, University Emergency Hospital of Bucharest, Romania, were treated seven cases of osteosarcoma of the proximal third of the tibia in young, early-diagnosed cases without metastasis. The treatment involved resection of tumor formation and reconstruction with a modular prosthesis. Postoperative patients were mobilized for a week without charging the operated limb under the protection of orthesis. During this period continued active and passive mobilization of the ankle and foot to prevent stiffness and to reduce postoperative swelling. From the second postoperative week, patients are mobilizing with progressive charging but not being allowed to do any flexion in order to protect de insertion of medial gastrocnemius muscle rotation flap used to cover the prosthesis and to protect the patellar tendon reinsertion. This extensive surgery does not improve survival rate of these patients compared to treatment by amputation of this pathology but greatly increases the comfort of life and in all cases ensure socio-professional reintegration of these patients. To ensure optimal postoperative results perform a complete diagnosis and preoperative oncological treatment before surgery, if applicable.

Negative Pressure, a "Solution" in the Treatment of Infected Knee Prosthesis?

INTRODUCTION: Negative-pressure wound therapy is a therapeutic technique that uses a vacuum dressing in order to promote healing in acute or chronic wounds. The continued vacuum draws out fluid from the wound and increases blood flow to the area. The aim of this study was to establish the effectiveness of negative pressure therapy increasing this way the chances of rehabilitation after knee prosthesis infections. MATERIAL AND METHOD: 11 patients with septic complications after total knee joint replacement were involved into this study, from the Department of Orthopaedic and Traumatology of Bucharest Emergency University Hospital. In all of the cases negative pressure wound treatment was applied. The surgical approach was chosen according to the surgeon's preferences or along the pre-existing surgical approach. RESULTS AND DISCUSSIONS: Time from the knee arthroplasty to the clinical and biological manifestation of septic complications was about 35 days with limits between 21 and 42 days. In most cases we managed to keep the implant, the outcome obviously being conditioned by using the negative pressure. Knee infections are still a hazardous problem in orthopedic surgery. Negative-pressure system increased the granulation tissue formation and the local blood flow and enhanced the bacterial clearance function. CONCLUSIONS: The clinical outcome in our cases indicates that the Negative-Pressure Wound Therapy can be a valuable contribution to the treatment of knee joint infections.

Synovial inflammation in patients with different stages of knee osteoarthritis.

The synovium is an intra-articular mesenchymal tissue and essential for the normal joint function. It is involved in many pathological characteristic processes and sometimes specific for this distinctive tissue. In this study, we refer to synovial proliferative disorders according to the stage of osteoarthritis (OA) disease. Forty-three patients with knee OA were treated in the Department of Orthopedics and Traumatology, Emergency University Hospital of Bucharest, Romania, in the last two years. In all cases, we used at least five criteria for the knee OA: knee pain, knee joint tenderness, no palpable warmth over the knee, stiffness, erythrocyte sedimentation rate and C-reactive protein levels. In all the cases the synovial tissue was selected by the orthopedic surgeon. X-ray examination was taken in every case of the affected joint. Patients who were considered to have early OA underwent arthroscopic synovial biopsy of the symptomatic joint. Synovial tissue samples from patients with late OA were obtained at the time of knee joint arthroplasty. Microscopic examination in early osteoarthritis revealed for more than half of patients with synovial biopsy through arthroscopic technique having synovitis lesions with mononuclear infiltrates, diffuse fibrosis, thickening of the lining layer, macrophages appearance and neoformation vessels also. The synovitis seen in advanced OA knees tends to be diffuse and is not mandatory localized to areas of chondral defects, although an association has been reported between chondral defects and associated synovitis in the knee medial tibio-femoral compartment. The overexpression of mediators of inflammation and the increased mononuclear cell infiltration were seen in early OA, compared with late OA.

Giant ovarian mucinous cystadenoma with borderline areas: a case report.

Nowadays, giant ovarian mucinous cystadenomas are a rare condition, due to early diagnose and treatment. We report the case of a 44-year-old patient, who was diagnosed and admitted in our department with a giant pelvi-abdominal mass. The patient was operated with very high-risk consent, thus an enormous ovarian cyst of approximately 30 kg was extirpated. Afterwards, an extensive histopathological analysis was performed in order to determine the exact clinicopathological entity of the giant tumor-enteric type of multilocular mucinous ovarian cyst adenoma with borderline areas, with benign proliferation. Although giant ovarian mucinous cyst adenoma with borderline areas is an extremely rare condition, when encountered it is a real challenge for both surgeon and pathologist.