Hand-modelled composite prostheses after resection of peri-acetabular bone malignancies.

PURPOSE: To improve function after pelvic resection involving the acetabulum, using an anatomic composite implant built with screws and cement. MATERIAL AND METHOD: Since 1990, 66 patients with peri-acetabular bone malignancies have been treated by extensive resection followed by hand-modelled innominate prosthesis with partially constrained total hip prosthesis. The hand-modelled innominate prosthesis was made of a titanium cup, a set of long titanium screws and two or three packs of gentamycine-loaded cement. RESULTS: Many postoperative complications were observed: deep infection (14%), hip prosthesis dislocation (25%) and local recurrence (15%). Sixteen patients (25%) had to be reoperated. Nevertheless, at last follow-up, 62 patients still had composite prosthesis. The mean functional result, rated according to a modified Enneking's staging system, was 80% with unlimited walking without support, average hip flexion 100 degrees , length discrepancy less than 1 cm. DISCUSSION: These results were similar to those described in the literature for custom-made innominate prostheses and much better than those of alternative reconstructive procedures. Hand-modelled composite prostheses are cheaper, easier, more adaptable and enables better anchorage than custom-made prostheses. Such a procedure can be used even after total iliac wing resection. CONCLUSION: The advantages of such a procedure plead for its extensive use after acetabular resection. But long-term follow-up is necessary to validate indications.

[Treatment of Ewing's sarcoma with 2 different protocols]. / Traitement du sarcome d'Ewing par deux protocoles successifs.

Since 1985, 54 with localized Ewing's sarcoma of bone were treated at the Onco-Orthopedics Clinic of the Sofia University Hospital (Sofia, Bulgaria). Thirty-two patients received the classical four-drug combination with doxorubicin, dactinomycin, vincristine, and cyclophosphamid. The last 22 patients were treated with six-drug protocols where cisplatinium and ifosfamid were added to the standard four-drug regimens. Local treatment was adapted to the age of the patient and the location and volume of the tumor. Fourteen patients received radiotherapy alone, 24 postoperative radiotherapy and 16 surgery alone as local treatment. At a mean follow-up of 6 years, the disease free survival rate reached 44%. Eleven patients had a good local response and 25 developed metastatic disease. Statistical analysis confirmed the deleterious effect of pelvic localizations and large tumor volume on prognosis and demonstrated the dramatic improvement obtained with the six-drug protocol (5-year disease free survival 61% versus 23%) and surgery (61% versus 25%).

Primary lymphoma of the breast: unusual presentation of breast cancer.

OBJECTIVE: To investigate 4 cases of primary lymphoma of the breast and review previous studies in a search for any preoperative characteristics that could assist the diagnosis of lymphoma of the breast. DESIGN: Retrospective study. SETTING: University hospital, Israel. SUBJECTS: 4 women. MAIN OUTCOME MEASURES: Accurate diagnosis before operation. RESULTS: No special characteristics for early diagnosis of primary malignant lymphoma of the breast were found. The predominant involvement of right breast in primary lymphoma of the breast should be noted. CONCLUSIONS: Even though primary lymphoma of the breast is rare, there are no laboratory or imaging signs of early diagnosis. Excisional biopsy or Tru-cut biopsy are the only correct methods of diagnosis.

[Hand on composite prosthesis after resection of peri-acetabular sarcoma]. / Résultats des prothèses composites au ciment après résection acétabulaire pour sarcome.

PURPOSE OF THE STUDY: To improve function after pelvic resection involving theacetabulum we have used an anatomic composite implant built with screws and cement. MATERIAL AND METHOD: Since 1990, 27 patients with peri-acetabular bone sarcoma have been treated by extensive resection followed by "hand on innominate prosthesis with constrained total hip prosthesis. The hand on innominate prosthesis was made of a titanium cup, a set of long titanium screws and 2 or 3 packs of gentamycin loaded ciment. RESULTS: Many postoperative complications were observed; deep infection (15 p. 100), hip prosthesis dislocation (33 p. 100) and local recurrence (17 p. 100). Nine patients (33 p. 100) had to be reoperated. Nevertheless at last follow up 24 patients still had their composite prosthesis. The mean functional result, rated according to a modified Enneking's staging system, was 83 p. 100 with unlimited walking without support, average hip flexion 100 degrees, length discrepancy less than 1 centimeters. DISCUSSION: These results were similar to those described in the literature for custom made innominate prosthesis and much better than those of alternative reconstructive procedures. Hand on composite prosthesis is cheaper, easier, more adaptable and enables better anchorage than custom-made prosthesis. Such a procedure can be used even after total iliac wing resection. CONCLUSIONS: The advantages of such procedure pleads for using it extensively after acetabular resection. But long term follow up is necessary to validate indications.

[The epidemiology of scabies]. / K épidemiologii chesotki.

Soviet and foreign literature data on scabies morbidity structure in families and organized collective bodies are reviewed. The authors' own data include an analysis of 88 clinical and epidemiological charts, developed and filled in by the authors. The notion of the disease focus in scabies is introduced for the first time. The foci are divided into potential (with an only patient) and irradiating ones (with two and more patients). Organized collective bodies predominate among the potential foci (85.7%), whereas families prevail among the irradiating foci (80.7%). The incidence rate of the condition in a focus depends not on the focus size, but on the time and intensity of the contacts of the patients with healthy subjects.

Clinical-morphological and electron-microscopic studies of the growth plate in solitary bone cysts.

The occasional humeral growth retardation or premature closure of the growth plate medially, documented among more than 120 solitary bone cysts reviewed, was reason to undertake a thorough study of the growth plate in the area of the cyst. The findings in the hyaline zone disclose a considerable number of vessels and slits of the cartilage that are broadened toward the proliferative and hypertrophic zones. In some places they communicate with the vessels or are lined with endothelium. Ultrastructurally, changes of a destructive nature are disclosed, involving the growth plate zone and corresponding to the most active metabolic processes. In the altered chondrocytes substantial increases in glycogen granules and lipid droplets are observed, as well as reduction of the cellular organelles. In rather severely affected cells changes in the nuclei, lysosomal structures, and myelin-like lamellar bodies are established. The disappearance of cellular organelles and the fragmentation of cytoplasm are interpreted as a final phase of the above-listed changes. In conclusion, the cyst is considered a probable primary cause of the changes described.

New method for covalent immobilization of proteins to cellulose and cellulose derivatives.

Cellulose and microcrystalline cellulose are treated consecutively with sodium periodate and urea. The interaction of urea derivatives with formaldehyde results in highly reactive groups, capable of further condensation with the amino acid residues of the proteins. The condensation of chymotrypsin, pepsin, and ovomucoid with such activated matrices has been studied in the pH interval 2 to 10. Differences have been found in the binding properties of basic and acid proteins. Satisfactory values have been obtained concerning the relative enzymatic and inhibitory activity of the immobilized products with respect to high- and low-molecular substrates. Chymotrypsin, immobilized on microcrystalline cellulose matrix, is found to manifest better catalytic properties compared with chymotrypsin immobilized on cellulose matrix. A probable sequence of the stages of chemical activation of the matrices and covalent binding of the proteins to them has been proposed. The main advantages of the proposed method consist of the high reactivity of the binding group in a wide pH range, its suitable length, and its easy synthesis.