Functional results in patients with sarcoma around the knee joint.

Authors evaluated functional outcomes after three different surgical procedures for sarcoma around the knee joint. Sixteen patients with sarcoma were given four to six preoperative courses of chemotherapy. Patients were separated into three groups according to the pattern of tumour excision. The first group underwent the resection of proximal fibula and tibialis anterior muscle resection, the second group underwent resection of distal femur or proximal tibia with total knee replacement, and the third group underwent radical amputation. The mean functional evaluations were 100, 95 and 80%. All marginal resections of proximal fibula resulted in excellent function. No local evidence of tumour recurrence was seen at mean follow-up of 24 months (Tab. 1, Fig. 2, Ref. 7).

[First experience with correction of limb-length inequality and angular and rotational deformities of the tibia using the Taylor spatial frame]. / Korekcia uhlových, dlzkových a rotacných deformít predkolenia Taylorovým priestorovým rámom--prvé skúsenosti.

The authors analyse the first results of correction surgery for limb-length inequality and rotational and angular deformities of the tibia using the Taylor spatial frame in combination with the Ilizarov external fixator in three patients. The shortening of the tibia, 65 mm on the average (55, 60 and 80 mm, respectively), was due to tibial hemimilia in two patients and traumatic epiphyseolysis of the distal tibia in one patient. Distraction at a rate of 1 mm/day was controlled three-times a day on two contralateral struts. It started on the seventh day after osteotomy in all three patients. On the second post-operative day, rehabilitation started with standing up and walking with crutches. The additional fixation of the heel and foot was removed at 3 months after distraction was terminated so that ankle exercise would be possible. No serious complications were recorded. The average distraction index was 0.91 and the average tibial lengthening was 65 mm. Callus consolidation was achieved at 131 days after the end of distraction phase. Approximately at 10 months post-operatively, the patients reported full weight-bearing of the extremity.

[Comparison of the treatment of juvenile bone cysts by corticoids and bone grafting.]. / Porovnanie liecby juvenilných kostných cýst kortikoidmi a spongioplastikou.

Juvenile bone cysts are frequent affections. Their treatment develops in the direction of the application of less invasive methods. The authors treated 43 patients with this diagnosis in the period of six years. The aim of the article is to specify the criteria for the indication of two most frequently used methods of treatment of juvenile bone cysts, namely. a)percutaneous instillation of methylprednisone acetate (MPA); b)surgical curettage and bone grafting of the cyst by an autograft or allograft. They state that significant for the prognosis of the juvenile bone cyst are: 1. the age of the patient, 2. activity or latency of the juvenile bone cyst, 3. its location. Worse results were recorded in the treatment of active cysts. The highest incidence of active cysts falls into the period of growth acceleration, i. e. between the seventh and tenth year. Worse results were achieved in the treatment of younger patients. In younger patients with juvenile bone cyst they recommend as the method of choice a less invasive MPA treatment. If the cyst does not heal after instillation repeated three times, the juvenile bone cyst is MPA resistant and it is necessary to change the method of treatment. In older patients with large cysts (femur, tibia) the authors recommend to apply bone grafting as the primary method. Worse results in both methods were recorded on weight bearing bones (a more frequent incidence of MPA resistant juvenile bone cysts). In MPA resistant juvenile bone cysts the authors had to use bone grafting five times more often due to the persisting difficulties. Key words: juvenile bone cyst, methylprednisone acetate, bone graft.

[Selected immunologic indicators in malignant bone tumors]. / Vybrané imunologické ukazatele pri kostních maligných nádoroch.

In patients with the malignant tumor of bone (17 osteosarcomas, 8 Ewing tumors) longterm observations were made, and namely at the beginning of the disease, after the surgical removal of the tumor, during chemotherapy and in the terminal phase of the disease. The observations concentrated on the following selected immunology parameters: active lymphocytes T, lymphocytes T, lymphocytes B, large granular lymphocytes, IgG, IgA, IgM and circulating immune complexes. In non-treated patients prior to diagnosing the disease, reduction of active lymphocytes T was found out while the total lymphocytes T remained unchanged. However, no significant differences were found out between benign and malignant tumors. The surgical removal of the tumor results in the change in imunologic indicators, the increase of active lyphocytes T, lymphocytes T and the decrease in the circulating immune complexes. The change is of temporary nature, the subsequent deterioration is caused by both the progression of the disease and chemotherapy. The values of immunoglobulins and lymphocytes B fluctuated during the whole course of the disease in physiological levels. The observation of active lymphocytes T and lymphocytes T can be used for monitoring of the immunosuppression in cytostatic treatment. The levl of IgG is differentially diagnostically used to distinguish between the tumor and inflammatory processes.

[Is it possible to objectively study back pain in orthopedic practice?]. / Je mozné objektivizovat vertebralgie v ortopedickej praxi?

The authors concentrate on vertebral diseases in the polyclinic practice, they emphasize their sociomedical significance. The statistical data are presented to document the number of examinations and the prevalence of work inability during the last 5 years which has an increasing tendency. To emphasize the problem of the objectification of the vertebral painful syndrome at the polyclinic they present two case reports, draw attention to the dissension of views of polyclinic specialists as concerns etiopathogenesis of vertebral diseases and related to it the problem of objectification with regard to work ability. According to the authors' view the vertebral syndrome can be precisely objectified on the basis of a profound functional examination. This important sociomedical problem of vertebral diseases in relation to work ability could be improved from the organizational view point also by appointing one physician at the polyclinic who would pursue this task comprehensively substituting a number of specialists who at present have to deal with it as part of their duties.

[Problems in the diagnosis of Ewing's sarcoma]. / Problémy diagnostiky Ewingovho sarkómu.

The aim of the work was to analyze by the method of retrospective study the difficulties in diagnosing the Ewing sarcoma at the Department of Orthopaedic of the Teaching Hospital in Bratislava in the years 1967-1987. The authors found out that there were diagnosticated 28 cases of the Ewing sarcoma, the boy-girl ratio was: 1:1. Most frequently it occurred between 12 and 18 years of age. Apart from clinical examination they use classical sciagraphy, macropictures, tomography, arteriography, gammagraphy of the skeleton, computer tomography, lymphography, histological, and electron microscopic examination. In the conclusion the authors point out that the timely treatment may be ensured by a precise and demanding screening carried out by pediatricians, practitioners in charge of adolescents and orthopaedists and by further reduction of the time interval necessary for performing all above mentioned examinations. The care of the Ewing sarcoma is the responsibility of suitably equipped special centres of bone oncology.

[Arteriography, lymphography, gammagraphy and computer tomography in the diagnosis of musculoskeletal tumors]. / Artériografia, lymfografia, gamagrafia a pocítacová tomografia v diagnostike muskuloskeletárnych nádorov.

The authors emphasize the importance of early and exact diagnosis of musculoskeletal tumours of the extremities and spine. This aim cannot be achieved by common biochemical, haematological and X-ray examinations. Therefore the authors recommend to use already during the initial examination of the patient a combination of classical roentgenography, arteriography, possibly lymphography, gammagraphy and computed tomography. The authors present a detailed account of experience with the application of the above diagnostic methods in 146 patients. On arteriograms of 37 patients dislocated main arteries were found 16 times, blood lakes 20 times. Lymphography revealed metastatic affection of regional lymph nodes in 21% of all patients, most frequently in bone reticulosarcoma and in synovial sarcoma. All-body gammagraphy helped to make the localization and assessment of size of the tumour more accurate, in two-thirds of the patients it was larger when visualized by this method than on native roentgenograms. In 3 of 14 Ewing sarcomas all-body gammagraphy revealed a polyostotic localization of the tumour. Computed tomography revealed the extent of infiltration and destruction of bone and soft tissues in pelvic and spinal tumours.