Rapid destructive arthritis of the hip revisited.

Rapid destructive arthritis of the hip is a rare entity with unknown pathogenesis and outcome. First described by Forestier in 1957, it is characterized by a rapidly progressive hip disease resulting in rapid destruction of both the femoral and acetabular aspects of the hip joint, with almost complete disappearance of the femoral head within a few months. Since the original description, case reports and small series have been reported, and many names have been proposed to describe the rapid destruction of the femoral head and occasionally the acetabulum. Initial presentation includes acute hip pain with the lack of radiographic evidence of joint destruction, rapidly progressing to complete vanishing of the proximal femur within a few months. This article summarizes the related literature aiming to present the current concepts for the diagnosis and treatment of rapid destructive arthritis of the hip.

Extra-Articular Diffuse Giant Cell Tumor of the Tendon Sheath: A Report of 2 Cases.

Two rare cases of extra-articular diffuse variant giant cell tumor of the tendon sheath are presented, at the elbow of a 68-year-old female and the foot of a 56-year-old male. Both patients presented with a palpable masses and marginal excision was performed; histological sections confirmed the diagnosis of extra-articular giant cell tumor. No adjuvant therapy was administered. At the latest follow-up, minimum 24 months after excision both patients were disease-free.

Adjuvant systemic therapy protocol for Dukes' B2 and C resectable colon carcinoma.

AIMS AND BACKGROUND: Trials of adjuvant systemic therapy in high risk patients with Dukes' B2 and C colon cancer utilizing 5-fluorouracil-based regimens have been ongoing since the 1960s. The aim of this study was to compare the combination of 5-FU and leucovorin with the combination of 5-FU and alfa-2b interferon (IFN) in patients who had undergone "curative" resection foronocarcinoma. STUDY DESIGN: A total of 322 patients with histologically proven adenocarcinoma of the colon, Dukes' stage B2 and C, were entered in the study. They were randomized to A) leucovorin 20 mg/m2 rapid intravenous injection and 5-FU 425 mg/m2 IV days 1-5 every 28 days for six cycles or B) 5-FU 600 mg/m2 24-hour infusion for five days, then 600 mg/m2 IV once a week and IFN 5 MU subcutaneously three times a week for six months. RESULTS: There was no statistically significant difference in either disease-free survival or overall survival. Toxicity was the same in the two groups with the exception of flu-like syndrome, which was universal in IFN-treated patients. CONCLUSIONS: There was no difference in disease-free survival or overall survival between the two combinations in any patient subset. Toxicity was greater with the 5-FU+IFN combination because of the flu-like syndrome. These data do not support the use of IFN in combination with 5-FU as systemic adjuvant therapy for patients with locally advanced colon carcinoma.

Salvage of failed total hip arthroplasty with proximal femoral replacement.

EDUCATIONAL OBJECTIVES: As a result of reading this article, physicians should be able to: 1. Identify the available types of reconstruction for failed total hip arthroplasty. 2. Summarize the preoperative workup of patients with failed total hip arthroplasty and massive proximal femoral bone loss. 3. Assess the surgical technique of proximal femoral replacement for failed total hip arthroplasty. 4. Recognize treatment complications, patient outcomes, and survival of proximal femoral megaprostheses for revision of failed total hip arthroplasty. Despite recent advances in device manufacturing and surgical techniques, the management of proximal femoral bone loss in revision total hip arthroplasty remains challenging. Currently, failed total hip arthroplasty in elderly and less active patients, nonunion of the proximal femur with multiple failed attempts at osteosynthesis, resection arthroplasty, and massive proximal femoral bone loss can be salvaged with proximal femoral replacement using a megaprosthesis. The procedure is technically demanding and requires careful preoperative planning. Instability and aseptic loosening are the major complications, especially in younger and more active patients. The new generation of modular proximal femoral replacement megaprostheses and the increased experience obtained with these surgeries have reduced complication rates and improved outcomes.