Spinal infection multidisciplinary management project (SIMP): from diagnosis to treatment guideline.

Spine infections require a multidisciplinary approach to be treated and solved. A guide line to drive physicians in the deep complexity of such a disease is extremely helpful. SIMP suggests a flow-chart built up on clear concepts such as right and well managed antibiotic therapy, sound stability of the spine, correct and smart use of the standard and functional imaging techniques, such as f18 FDG PET/CT. In 16 months a total of 41 patients have been treated for spondylodiscitis, discitis and vertebral osteomyelitis by our team of physicians and 25 patients have been enrolled in a prospective study whose target is the assessment of the SIMP flow-chart and of every single aspect that characterize it.

[Spontaneous pneumothorax in patients with osteosarcoma treated by combined chemotherapy]. / Pneumotorace spontaneo in pazienti affetti da osteosarcoma trattati con chemioterapia combinata.

A report is presented on 5 cases of pneumothorax which occurred during chemotherapy in patients suffering from osteogenic sarcoma of the extremities. None of them presented radiographically detectable substitutive pulmonary lesions. It was hypothesised that the origin of pneumothorax was the necrosis produced by agents of a pulmonary micrometastasis.

[Usefulness of stratigraphy and computerized tomography in the initial staging of osteosarcoma of the extremities. Retrospective study of 217 cases]. / Utilità della stratigrafia e della T.C. polmonare nello staging iniziale dell'osteosarcoma delle estremità. Studio retrospettivo di 217 casi.

The value of stratigraphy and pulmonary CT in the initial work-up of osteosarcoma of the extremities is assessed with reference to 217 patients encountered in the Bone Tumour Centre of Rizzoli Orthopaedic Institute in May 1983-May 1986. Stratigraphy revealed lung metastases not identified by standard radiography in 4 patients (1.8%), while CT revealed metastases not identified by either standard X-rays or stratigraphy in a further 6 cases (2.7%). It is concluded that the increase in the percentage of cures (about 30%) reported in the last 10 years in osteosarcoma cases given adjuvant chemotherapy cannot be explained by any difference in initial selection due to the use of these techniques that were not adopted in the historical series.

Fracture of the posterior arch of the atlas.

The authors analyzed the results obtained in 10 fractures of the posterior arch of the atlas treated nonsurgically. There was consolidation in all of the cases at the end of treatment. According to the authors the element which most characterizes this fracture is constituted by its radiological diagnosis which principally makes use of lateral projection. In particular cases, when patients are characterized by multiple trauma, the fracture may go unrecognized.

Intraoperative ultrasonography imaging in spinal surgery (technique and indications).

Intraoperative ultrasonography was conducted in 20 patients; the technique of intraoperative ultrasonography for use in spinal surgery is described. The authors emphasize that this non-invasive method obtains real time images of considerable diagnostic importance, allowing for a significantly minor use of image intensifier, with a consequent reduction in doses for both the patient and the staff.

[The exposure dose of the sella turcica in panoramic dental radiography with an intraoral radiogenic source]. / La dose di esposizione alla sella turcica in radiografia panoramica dentaria con sorgente radiogena intraorale.

Panoramic dental radiography using an intraoral X-ray source exposes critical organs, such as the crystalline and the thyroid, as well as organs of fundamental importance such as the pituitary gland, to X-rays. An experimental study was carried out to assess the exposure dose to the sella turcica during the radiological examination of the upper and lower dental arches using an X-ray source within the oral cavity. The comprehensive exposure dose for the upper and lower dental arches exceeded that found in orthopantomography (110 micro Gy/examination vs 47 micro Gy/examination) with errors which are respectively inferior to 15% and 30%. The authors conclude that the risk of provoking anatomical or functional changes of the pituitary gland is extremely remote using this type of examination.

Radiofrequency thermal ablation of non spinal osteoid osteoma: remarks on method.

Osteoid osteoma is a small benign tumor, with a ''nidus'' that rarely exceeds 15 mm in diameter. It is relatively common in males, especially teenagers and young adults. It involves mainly the appendicular skeleton, the femur in particular, and rarely the axial skeleton. It requires treatment because it causes intense pain. In recent years alternative, less invasive, treatments have been proposed, such as drilling combined with ethanol injections, and thermal ablation with laser or radiofrequency. This study assesses 117 patients affected by osteoid osteoma, treated by radiofrequency thermal ablation between June 2001 and November 2003. We describe the patient recruitment procedure, CT-guided technique, the percutaneous approach, thermal ablation, and the instruments used. Data were analyzed thoroughly, and modifications that have improved the effects of treatment have been highlighted. The results achieved since the method was perfected have been extremely encouraging, confirming that the technique is very effective if performed correctly. For that reason radiofrequency thermal ablation has become the treatment of choice for non-spinal osteoid osteoma at Rizzoli Orthopaedic Institute.

Radiofrequency thermoablation of primary non-spinal osteoid osteoma: optimization of the procedure.

Osteoid osteoma is a small benign tumor that requires treatment due to the intense pain it causes. Surgical therapy has been the ablative technique of choice after a failure of medical therapy. Recently, numerous less invasive, alternative procedures have been proposed: drill trepanation with or without ethanol injections, cryoablation, and thermoablation with laser or radiofrequency. The aim of this review is to retrospectively assess the effect of radiofrequency (RF) thermoablation in the treatment of primary non-spinal osteoid osteoma. From June 2001 to July 2003, we treated 106 patients affected by osteoid osteoma with RF thermoablation. Five patients with spinal osteoid osteoma and four with a previously treated osteoma were excluded from the study. In this paper, we assess the results obtained in a selected group of 97 primary non-spinal osteoid osteoma. The lesions were predominantly in the metaphysics of the femur. Central nidus calcifications were frequent and there was no prevalence for which side they occurred. Primary success was achieved in 82 patients (85%), while we obtained secondary success in 15 patients (15%). In two patients (2%), pain persisted between the two treatments and failed to be resolved, even after the second treatment; therefore, surgical excision was performed and complete resolution was obtained. No complications were reported. In conclusion, our results confirm that the treatment of choice for non-spinal osteoid osteoma is RF thermoablation, offering several advantages over ablative techniques.