Osteoid osteoma of the glenoid: Arthroscopic treatment.

Osteoid osteoma is a benign tumor that is rarely found in the scapula. We report a clinical case involving a 36-year-old female patient who suffered from progressive pain in her right shoulder for 1 year. This patient was initially diagnosed with impingement syndrome and was treated unsuccessfully with medication and physical therapy for approximately 2 months. Based on imaging exams, a juxta-articular osteoid osteoma of the glenoid was identified. The patient underwent a shoulder arthroscopy that included tumor removal and treatment of the resulting chondral lesion. At 6-, 12- and 36-month assessments, the patient was asymptomatic, with a normal range of motion and experienced a pain intensity corresponding to 0 points on the Visual Analog Scale (VAS) and 35 points on the University of California, Los Angeles (UCLA) Scale. A postoperative MRI indicated the absence of any residual tumor tissue or inflammatory signs. We believe that the approach described in this paper allows juxta-articular osteoid osteomas to be accessed in a minimally invasive manner and permits not only adequate resection but also the treatment of chondral lesions that could remain after tumor resection.

Increased EMG response following electromyographic biofeedback treatment of rectus femoris muscle after spinal cord injury.

OBJECTIVE: To study increases in electromyographic (EMG) response from the right and left rectus femoris muscles of individuals with long-term cervical spinal cord injuries after EMG biofeedback treatment. DESIGN: Repeated measure trials compared EMG responses before and after biofeedback treatment in patients with spinal cord injuries. MAIN OUTCOME MEASURES: The Neuroeducator was used to analyse and provide feedback of the EMG signal and to measure EMG response. SETTING: Department of Traumatic Orthopaedics, School of Medicine, University of São Paulo, Brazil. PARTICIPANTS: Twenty subjects (three men and 17 women), between 21 and 49 years of age, with incomplete spinal cord injury at level C6 or higher (range C2 to C6). Of these subjects, 10 received their spinal cord injuries from motor vehicle accidents, one from a gunshot, five from diving, three from falls and one from spinal disc herniation. RESULTS: Significant differences were found in the EMG response of the right rectus femoris muscle between pre-initial (T1), post-initial (T2) and additional (T3) biofeedback treatment with the subjects in a sitting position [mean (standard deviation) T1: 26µV (29); T2: 67µV (50); T3: 77µV (62)]. The mean differences and 95% confidence intervals for these comparisons were as follows: T1 to T2, -40.7 (-53.1 to -29.4); T2 to T3, -9.6 (-26.1 to 2.3). Similar differences were found for the left leg in a sitting position and for both legs in the sit-to-stand condition. CONCLUSIONS: The EMG responses obtained in this study showed that treatment involving EMG biofeedback significantly increased voluntary EMG responses from right and left rectus femoris muscles in individuals with spinal cord injuries.

[Current status of the treatment of high grade bone sarcomas]. / Momento atual do tratamento dos sarcomas ósseos de alta malignidade.

The authors present a review of the changes occurred in the treatment of high grade bone sarcomas in the last 20 years. It was discussed the multidisciplinary approach for the local and systemic control of these tumors particularly the neoadjuvant chemotherapy that leads to an increase in the overall survival not only for the osteosarcoma but also for the Ewing sarcoma. They showed the possibilities for limb reconstruction after wide resection of the lesion that includes non conventional endoprosthesis and allografts.

Chondromyxoid fibroma: a study based on 18 cases.

The authors report on 18 cases of chondromyxoid fibroma seen at the Institute of Orthopedics and Traumatology, University of São Paulo, from 1953 to 1990. A survey of the literature on chondromyxoid fibromas was conducted and radiographic analysis of all cases is presented, with a mean follow-up of 64 months. The surgical treatment employed in each case is discussed, with emphasis on the use of cement as an adjuvant. This procedure was used in 10 patients, who have been free of recurrence up to the present time.

[Surgical treatment of malignant bone neoplasms at level of the knee with wide resection and reconstitution with non-conventional endoprosthesis]. / Tratamento cirúrgico dos tumores ósseos malignos ao nível do joelho através da ressecção ampla e reconstituição com endoprótese não convencional.

Forty-five patients with malignant bone tumors of the knee were submitted to wide resection and reconstitution of the joint with a custom made endoprosthesis. The mean follow-up was seven years and seven months. There were observed nine complications: in four cases the tumor recurred locally and in one case an artery was injured. The end result was considered good in 36 patients and poor in nine patients. The better results achieved in recent years were due to modifications introduced in chemotherapy for the osteosarcoma, the new system of staging of the bone tumors and new oncological and compartmental surgical techniques.

Intrauterine diagnosis of congenital dislocation of the knee.

The authors present a case of congenital dislocation of the knee diagnosed in utero, when an abdominal radiograph was performed on a woman in the eighth month of pregnancy.

[Surgical approach to giant cell tumors of the distal radius]. / Abordagem cirúrgica do tumor de células gigantes da extremidade distal do rádio.

The authors review 15 patients with giant cell tumor of the distal part of the radius in the period from 1980 to 1993. Pain was always present. The treatment of stage 2 with marginal resection and methylmethacrylate yielded excellent result. In the treatment of stage 3 the authors emphasize the need of wide resection. In these patients the best functional results were obtained with the use of vascularized proximal epiphyseal fibular graft, preserving some painless mobility of the wrist and forearm.

[Osteoblastoma: analysis of the treatment of 24 cases]. / Osteoblastoma: análise do tratamento de 24 casos.

The authors study 24 patients with the histologic diagnosis of osteoblastoma treated from 1953 to 1996, with a mean follow-up of 33.4 months. Two were considered as a malignant osteoblastoma. Twenty-two cases were operated, and in 2 of these was performed only a selective embolization to pelvic and spine localization. It was discussed clinical and radiographic aspects and the response to treatment. It was obtained 20 good and 4 poor results.