Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis.

INTRODUCTION AND OBJECTIVES: Spinal metastases (SM) account for 5-30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. MATERIALS AND METHODS: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC - surgical site infection, hematoma, and/or dehiscence - at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. RESULTS: 198 patients (121 males and 77 females) with an average age of 65 years (range 54-73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37-45.35, p=0.021), prostate cancer as primary tumor (6.73, 1.14-39.65, p=0.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02-5.22, p=0.044). There was no difference between groups on 90 days survival rate (p=0.714). CONCLUSIONS: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.

Wound-related complications in the surgical treatment of vertebral metastatic disease - A case series analysis. / [Artículo traducido] Complicaciones relacionadas con la herida en el tratamiento quirúrgico de la enfermedad metastásica vertebral: análisis de una serie de casos.

INTRODUCTION AND OBJECTIVES: Spinal metastases (SM) account for 5-30% of patients with cancer, causing pain, deformity and/or neurological deficit. Postoperative complications are a concerning subject and wound-related complications (WRC) may delay adjuvant treatment. The objective of this study was to analyze the incidence of WRC in patients with SM that underwent surgical treatment as well as possible risk factors related to the occurrence of complications. MATERIALS AND METHODS: Patients with SM operated between 2011 and 2021 were analyzed. Demographics characteristics, primary tumor, general and neurological status, Tokuhashi score, type of surgical treatment, surgical length, preoperative serum albumin and hemoglobin, pre and postoperative adjuvant treatment were analyzed. The incidence and risk factors of WRC -surgical site infection, hematoma, and/or dehiscence- at 90 days was evaluated. Patients were classified in two groups according to the absence/presence of WRC. RESULTS: 198 patients (121 males and 77 females) with an average age of 65 years (range 54-73 years) were analyzed. WRC were observed in 44 patients (22%). On multivariable analysis, significant predictors for developing WRC were low Tokuhashi score (OR=7.89, 95% CI=1.37-45.35, p=.021), prostate cancer as primary tumor (6.73, 1.14-39.65, p=.035), and preoperative serum albumin level ≤3.5g/dL (2.31, 1.02-5.22, p=.044). There was no difference between groups on 90 days survival rate (p=.714). CONCLUSIONS: In our series, the incidence of WRC was 22%, main risk factors for complications were low Tokuhashi score, lower preoperative serum albumin, and prostate cancer. Finally, short-term survival rate was not affected by the occurrence of WRC.

Ferrokinetic studies with stable isotopes as tracers.

A methodology for ferrokinetic studies based on the administration of iron stable isotopes was developed. Fractional plasma clearance and intestinal iron absorption in rabbits were determined using the double tracer technique. Three rabbits were given 58Fe solution intravenously and about 40 min later 57Fe solution orally. Blood samples were drawn at different times following administration. The analysis of the single iron isotopes content in plasma samples was made by proton nuclear activation. The results were compared with those obtained from the administration, to the same rabbits, of the radioactive isotopes 55Fe and 59Fe. The agreement was found to be satisfactory.

An iron metabolism study in humans by means of stable tracers.

An investigation of iron metabolism in a female patient volunteer by administration of stable iron isotopes as tracers was performed. The applied methodology had already been tested in rabbits in comparison with radioactive tracer technique. The subject under study was given 58Fe solution intravenously and about 45 min later 57Fe solution orally. Ten blood samples were drawn at different times within 522 min from injection. Single iron isotopes content in plasma samples was determined by proton nuclear activation. A Compton suppressor system was utilized to improve the detector limits. The characteristic parameters of iron plasma clearance and of iron intestinal absorption were determined.

Molybdenum metabolism studied by means of stable tracers.

An investigation on molybdenum metabolism by administration of molybdenum stable isotopes was performed. Fractional intestinal absorption was determined in animals by the double tracer technique. The investigated subjects were given an enriched solution of Mo-96 orally and, a few minutes later, an enriched solution of Mo-95 intravenously. Blood samples were drawn at different times following the tracer administration. The Mo-95 and Mo-96 contents in plasma samples were determined by proton nuclear activation. The described methodology offers a means for the study of molybdenum metabolism in humans without radiation risk.

Dose-response curve slope improvement and result reproducibility of ferrous-sulphate-doped gels analysed by NMR imaging.

Ferrous sulphate gel analysed by relaxation time measurements with NMR imaging is considered a useful dosimeter for 3D determinations of absorbed dose. A protocol for the gel preparation with agarose SeaPlaque that leads to a dosimeter with very high dose sensitivity is described. The dose-response curve slope is about 0.2 s(-1) Gy(-1) and the G factor turns out to be approximately 185 ions per 100 eV of absorbed energy. A method for making the measurements and analysing the results that brings about good result reproducibility is suggested. A thorough experimental study of the dependence of the dosimeter response on the elapsed time from preparation to irradiation and from irradiation to NMR measurement has revealed good reproducibility. The above characteristic of the gel system is very interesting, because it shows the possibility of utilizing the dosimeter for absolute dose determinations with satisfactory reliability.

Response to a single oral test of molybdenum stable isotopes for absorption studies in humans.

Two volunteer subjects were given orally enriched solutions of Mo-95 and Mo-96 respectively. Blood samples were drawn at various times following the tracer administration. The Mo-95 and Mo-96 content in plasma samples was determined by proton nuclear activation and the response to the single oral test of enriched stable molybdenum isotopes was determined. Assuming a simple two-open-compartment model where the first compartment is the gastrointestinal tract and the other is the plasma, an indicative value of the fractional intestinal absorption for the two subjects is given. The feasibility of direct quantitative measurements of Mo intestinal absorption by the double-tracer technique, using stable tracers, is evidenced.

[Strain gauges for measuring the tension at the site of sutures. Use of the original instrument with a personal technic]. / Strain gauges nella misurazione della tensione in sede di sutura. Impiego di strumentario originale con tecnica personale.

The Authors have developed an instrumentation suitable for suture line tension measuring during plastic operations for large incisional hernias. A full description is given of the measuring technique and of the original instrumentation, including two steel bars called "fachiri" and an electric measuring system with strain gauges. With the employment of this technique, relaxing incisions of the muscle aponeurosis can be reduced to the minimum. Being the suture line tension one of the most important causes of relapsing, the Authors believe that this technique provides a sure advantage for the long term results of plastic operations.

Trace elements analysis in biological samples by proton nuclear activation.

A method for the multielemental analysis of trace elements in biological samples by medium energy proton nuclear activation (PNA) has been developed. The response linearity, reproducibility and reliability of the method have been tested by a set of preliminary measurements. Results concerning the quantitative determination of the concentrations of Sr, Cu, Fe, Zn and Se in human serum are presented. Activation was induced with a 23 MeV proton beam from the AVF cyclotron of the University of Milan, by means of (p, 2n) reactions on the nuclei of the elements under study. The quantitative determination was obtained by an internal reference method and by comparison with a standard sample of serum doped with known quantities of the elements of interest. A clinical investigation of the zinc content of serum in children has been performed.