RESUMO
Adamantinoma (AD) is a rare, slow-growing primary malignant bone tumor characterized by a biphasic morphology of clusters of epithelial cells and spindle cell osteofibrous components. A strong relationship between AD and osteofibrous dysplasia (OFD) has been proposed, while fibrous dysplasia (FD) has been rarely associated with AD. We present an AD case that was followed and histologically evaluated 3 times over 6 years with different morphological patterns. The tumor in the primary biopsy and after complete resection showed classical features of AD and osteofibrous-like pattern, while the recurrent lesion presented with exclusively spindle cell morphology and was thus diagnosed as FD. However, the extensive immunohistochemical analysis in all 3 lesions revealed strong reactivity for pancytokeratin, vimentin, p63, and podoplanin, which are characteristic for AD. Although, in the FD-like section of the tumor from the first recurrence the positivity of podoplanin was stronger than pancitokeratin, which was variably positive on spindle cells. The present case highlights the problem of diagnosing AD based on a single biopsy with one tumor's component predominating over the other, and at the same time emphasizes the importance of using immunohistochemical staining for keratin and podoplanin when the histopathological features of (osteo)fibrous lesion can be linked to AD.
RESUMO
A certain percentage of carpal tunnel syndrome (CTS) is associated with inflammatory conditions. Osteoarthritis (OA) increases the risk of CTS, and both diseases are common in the general population. Moreover, OA and CTS are often present in the same patients. Since inflammation and fibrosis are found in both conditions, the question is whether circulating inflammatory cytokines and cytokines involved in fibrosis in OA and CTS patients could serve as indicators of coexisting CTS and OA pathology. This investigation was performed on 31 CTS patients, 29 hip OA patients, and 15 healthy volunteers. Blood samples were collected, and serum levels of TGF-ß1, BMP-7, IL-1ß, and TNFα were measured using the ELISA method. The statistical analysis was performed to reveal the most significant differences in the serum levels of these cytokines. Statistical significance was set at p-values ≤ 0.05. The serum level of TGF-ß1 was the highest in CTS patients (16.36 pg/mL) and significantly different compared to OA and healthy control. Analysis of the cytokine serum level in the subdivided group revealed that serum levels of TGF-ß1 and BMP-7 were significantly higher in CTS+/OA+ patients as well as BMP-7 in the OA+/CTS+ group. There was no significant difference in serum levels of the inflammatory cytokines TNFα and IL-1ß among all groups. This study showed that in the end stage of CTS and OA, serum levels of inflammatory cytokines (IL1-ß and TNFα) were not altered, while the serum levels of TGF-ß1 and BMP-7 were significantly higher, especially in patients with coexisting OA and CTS. These findings suggest the possible values of TGF-ß1 and BMP-7 as a predictive factor for the comorbidity of CTS and OA.
RESUMO
BACKGROUND: The muscle sparing total hip arthroplasty had generated a distinguishable interest, in both the patients and the surgeons, but its benefits are still often questioned. The main idea of this study was to compare the functional clinical outcome of the patients operated by the anterolateral approach with a muscle-sparing technique (modified Watson-Jones approach), and the patients operated by modified direct lateral approach without the muscle-sparing technique (Bauer/Hardinge approach). METHODS: The patients (N = 130) were divided into two groups: 68 in a standard method group (STAND) and 62 patients in a muscle sparing surgery group (MSS). The hip flexibility, mobility, the strength of the hip abduction, the pain scale, Harris hip scores, the duration of the hospital stay and the overall satisfaction were measured seven days, three months, one year and three years (in 80 patients) after the surgery. There were no differences in any of the parameters between the groups prior to the procedure. RESULTS: The statistically significant differences in first three follow-ups (up to one year) were determined between the groups in passive and active hip flexion ability but the hip abduction strength, which is a crucial parameter for functional recovery, and 50 m walk test remained better in MSS group even after three years. Patients, who underwent MSS suffered also less pain, stayed in hospital shorter and were more satisfied with the operation outcome. CONCLUSIONS: The functional recovery in patients treated with muscle sparing method was faster than in patients operated with conventional lateral approach. Based on the results, we could recommend anterolateral muscle sparing approach for a total hip replacement for its faster and fuller functional recovery.
Assuntos
Artroplastia de Quadril/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Músculo Esquelético/cirurgia , Osteoartrite do Quadril/cirurgia , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Osteoartrite do Quadril/fisiopatologia , Fatores de TempoRESUMO
Molecular network of the osteogenic BMPs and extracellular inhibitors maintains homeostasis of the skeletal tissues. It is important to determine relationship between BMP-2, -4 and -7 and their inhibitors: gremlin, follistatin, chordin and noggin, during normal osteogenesis. To determine their expression pattern we conducted investigation by inducing ectopic bone formation in rats. The results shown that levels of the BMP-2 and BMP-4 expression in chondrocytes are similar to noggin and follistatin. The latter BMPs and inhibitors have increased levels of the expression at day 14th of the osteogenesis, which suggests their important roles in early phases of the chondrogenesis. Gremlin and chordin have shown increased levels of expression in late phase of chondrogenesis, which suggests their important role in regulation of the osteogenesis initiation. In this study, BMPs and inhibitors have the highest levels of the expression at 21st day in the osteocytes, which suggests their strong interactions in osteogenesis.
Assuntos
Proteína Morfogenética Óssea 2/biossíntese , Proteína Morfogenética Óssea 4/biossíntese , Proteína Morfogenética Óssea 7/biossíntese , Proteínas Morfogenéticas Ósseas/biossíntese , Proteínas de Transporte/biossíntese , Folistatina/biossíntese , Glicoproteínas/biossíntese , Peptídeos e Proteínas de Sinalização Intercelular/biossíntese , Osteogênese , Animais , Citocinas , Feminino , Proteínas , Ratos , Ratos WistarRESUMO
The aim of this study was to evaluate the impact of total hip or knee arthroplasty upon quality of life in elderly patients. The study was carried out at the Clinic for Orthopaedic Surgery Lovran on 74 total hip arthroplasty and 70 total knee arthroplasty patients. All patients had completed the Medical Outcomes Study 36-Item Short Form in the week having preceded their surgery and then again postoperatively, 2 years after. The data obtained were statistically processed at the level of physical function, role limitations due to physical problems, role limitations due to emotional problems, social function, mental health, energy or vitality, pain and general health perception, and change in health. The primary total hip arthroplasty patients showed significant improvement at all levels measured. Similarly, the primary total knee arthroplasty patients expressed significant improvement according to all the parameters but the mental health assessment. Comparison of outcomes between the two assessment groups of patients resulted in slightly superior quality of life outcomes in total hip arthroplasty patients. It can be concluded that total hip or knee arthroplasty significantly enhances the health related quality of life in elderly patients.
Assuntos
Artroplastia de Quadril/reabilitação , Artroplastia do Joelho/reabilitação , Inquéritos Epidemiológicos , Qualidade de Vida , Recuperação de Função Fisiológica , Idoso , Feminino , Nível de Saúde , Humanos , Masculino , Atividade Motora , Inquéritos e QuestionáriosRESUMO
The "cello technique" is a new calcaneoplasty technique for the treatment of Haglund disease. It is an ultrasound-assisted technique for resection of the posterosuperior part of the calcaneus. It is possible to resect the posterosuperior part of the calcaneus under direct ultrasound control with the patient in the prone position, with a dorsally positioned ultrasound probe, in line with the Achilles tendon fibers (sagittal line), and with the abrader in the posteromedial working portal. We describe in detail the technique for this new procedure in foot and ankle surgery. This innovative technique offers the possibility of expanding the indications for ultrasound-guided surgery in other fields of orthopaedic surgery.
RESUMO
PURPOSE: The purpose of this study was to simplify and enhance the ultrasound (US) analysis of the infant's hip by introducing a novel parameter named "L value" into the widely used Graf method. METHODS: We analysed 508 ultrasonographic images of the hips in infants aged three months. The images were first evaluated using the Graf measurements. On the same images, two additional measurements were performed in order to define the new parameter that was named L value. The threshold values of the new L value were identified based on the highest specificity as well as sensitivity for discrimination between the Graf groups. Those values were then used in order to reclassify the hips into three simplified groups. Inter-observer agreement was estimated by Cohen's kappa coefficient. RESULTS: The threshold values for the L value between Graf groups Ia and Ib was 0.46, between Ib and IIb was 0.68 and between IIb and IIc was 0.92. Correlation analysis between Graf's classification and the values of the L value was performed and was proved to be statistically significant, r = 0.49; p < 0.001. After simplifying the classification into three newly defined groups of patients depending on the degree of hip development, the correlation coefficient was much higher, r = 0.94, r (2) = 0.88 for p < 0.001. Inter-observer agreement for the L value was substantial. CONCLUSIONS: The new L value parameter in Graf's ultrasound hip evaluation enables a faster, simpler, more reliable and more unbiased classification for developmental dysplasia of the hip as the L value changes proportionally with the hip maturity.
Assuntos
Luxação Congênita de Quadril/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Feminino , Articulação do Quadril/crescimento & desenvolvimento , Humanos , Interpretação de Imagem Assistida por Computador , Lactente , Masculino , Valor Preditivo dos Testes , Curva ROC , Valores de Referência , UltrassonografiaRESUMO
PURPOSE: As the blood loss after the total knee arthroplasty (TKA) is not only a potentially serious medical problem but also an economical concern, the purpose of the study was to investigate the effectiveness of different combinations of knee positioning and the applied wound dressings on blood saving after TKA. METHODS: A randomized controlled trial including 147 TKA-operated patients was conducted. The subjects were assigned to one of the four groups; Group 1-controls, Group 2-flexion, Group 3-flexion and compression, Group 4-compression. The main outcome measures of the study were the blood loss volumes during the procedure and in the intensive care rooms and the decreases in haemoglobin, haemotocrit and red blood cells on the first and the second postoperative day. RESULTS: The MANOVA results showed no differences between the groups in any of the observed parameters. The post-hoc comparisons of the each group to the control group also revealed no influence of any of the proposed blood saving techniques on the actual blood loss. CONCLUSION: No significant differences among the four proposed blood saving methods were determined.
Assuntos
Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Hemostasia Cirúrgica/métodos , Prótese do Joelho , Hemorragia Pós-Operatória/terapia , Idoso , Artroplastia do Joelho/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Hemorragia Pós-Operatória/diagnóstico , Estudos Prospectivos , Radiografia , Valores de Referência , Medição de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
We report a case of a traumatic pseudocyst, in a recreational soccer player, after rupture of rectus femoris muscle. 37-year-old male, with history of repetitive painful accidents, was examined because of a double fist-sized mass in the anterior thigh. Ultrasound examination revealed a cystic mass in the rectus femoris muscle. Surgical removal of the mass and proximal remnant of muscle was done. Primary healing and functional recovery was achieved. Histological analysis revealed pseudocyst filled with degenerating clot and surrounded with thick fibrous capsule. The repetitive strain muscle injury, with prolonged period of healing, can occur like pseudocyst.
Assuntos
Transtornos Traumáticos Cumulativos/patologia , Cistos/patologia , Músculo Quadríceps/lesões , Músculo Quadríceps/patologia , Futebol/lesões , Adulto , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/patologia , Transtornos Traumáticos Cumulativos/diagnóstico por imagem , Cistos/diagnóstico por imagem , Humanos , Masculino , Músculo Quadríceps/diagnóstico por imagem , Índice de Gravidade de Doença , Ultrassonografia , CicatrizaçãoRESUMO
Various materials are used to fill osteotomy defects created in the medial opening wedge high tibial osteotomy (MOWHTO). Our hypothesis was that a bone allograft would provide the osteotomy site bone healing within the expected time. We performed the MOWHTO using a cancellous bone allograft in 310 knees in 284 patients between 2000 and 2005. Internal fixation was achieved with a T-profile AO plate. Preoperative and postoperative radiographic measurements were taken and statistically processed. All patients were followed up for a period ranging from three to eight years, or 5.9 years on average. Implanted cancellous bone allografts Assuntos
Artroplastia/métodos
, Transplante Ósseo
, Articulação do Joelho/cirurgia
, Osteotomia/métodos
, Tíbia/cirurgia
, Adulto
, Idoso
, Artroplastia/instrumentação
, Artroplastia/reabilitação
, Placas Ósseas
, Feminino
, Seguimentos
, Humanos
, Fixadores Internos
, Deformidades Articulares Adquiridas/etiologia
, Deformidades Articulares Adquiridas/fisiopatologia
, Deformidades Articulares Adquiridas/cirurgia
, Articulação do Joelho/diagnóstico por imagem
, Articulação do Joelho/patologia
, Masculino
, Pessoa de Meia-Idade
, Osseointegração
, Osteoartrite do Joelho/complicações
, Osteoartrite do Joelho/fisiopatologia
, Osteoartrite do Joelho/cirurgia
, Osteotomia/instrumentação
, Osteotomia/reabilitação
, Radiografia
, Transplante Homólogo
, Cicatrização
RESUMO
The results of arthroscopic removal of metallic fragments from knee joint due to explosive war injuries are presented. In period from 1991-1995 during war in Croatia we have operated 25 knee joints. Indications for arthroscopy were based on radiographic and clinical findings. The foreign bodies in the joint were found in 19 patients while additional 6 had foreign bodies in the periarticular soft tissues. Arthroscopies were performed on average one month after wounding. The foreign bodies were placed in different parts of the joint with no prediction sites. In 8 knees foreign bodies were freely mobile, and in 11 were anchored to different intraarticular structures. There were no complications during early postoperative period as well as in follow up period.
Assuntos
Artroscopia/métodos , Traumatismos por Explosões/cirurgia , Corpos Estranhos/cirurgia , Traumatismos do Joelho/cirurgia , Articulação do Joelho , Guerra , Adulto , Feminino , Humanos , Masculino , Metais , Pessoa de Meia-IdadeRESUMO
The paper presents an operative technique proposed for treating severe Hallux Valgus deformity with arthrosis of the first metatarsal joint in elderly people. The procedure consists of the Keller's arthroplasty in combination with basal osteotomy of the first metatarsal bone, whereby the head of the metatarsal is displaced laterally and plantarward. The osteotomy is fixed with a reconstructive plate. The results show a significant improvement in the hallux valgus angle, the first metatarsal angle, as well as in the plantar pressure distribution.
Assuntos
Artroplastia/métodos , Hallux Valgus/cirurgia , Ossos do Metatarso/cirurgia , Osteotomia/métodos , Idoso , Feminino , HumanosRESUMO
Although articular hyaline cartilage typically has low potential for regeneration, numerous methods and techniques have been proposed to induce the reparation process. In our work, we used microfracture techniques in combination with intraarticular application of hyaluronic acid in rabbit knee articular cartilage defect. In comparison with the control group, after 6 and 10 weeks we observed a higher potential of healing in the experimental group, with thicker and more organized repair tissue filling the defect. In conclusion, a combination of the microfracture technique and application of hyaluronic acid might be potentially beneficial in inducing articular cartilage defect reparation.
Assuntos
Ácido Hialurônico/farmacologia , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/terapia , Viscossuplementos/farmacologia , Cicatrização/efeitos dos fármacos , Animais , Cartilagem/lesões , Cartilagem/fisiologia , Cartilagem/cirurgia , Terapia Combinada , Desbridamento , Modelos Animais de Doenças , Masculino , Coelhos , Regeneração/efeitos dos fármacos , Regeneração/fisiologiaRESUMO
It is well known that the periosteum is capable of bone formation. In the present study, the value of the vascularized periosteal graft in healing the long-bone defect filled with the allogenous bone graft was studied. The aim of the study was to verify the efficiency of the rotational vascularized periosteal graft as a optional surgical method as well as to prove its advantages in comparison with the nonvascularized periosteal graft. The study was undertaken on 40 rabbits. Four rabbits served as allogenous bone graft donors, while the remaining 36 were divided into two equal groups. In the control group, the experimentally created bone defect on the junction of the tibial proximal and median thirds was filled with allogenous bone graft and then covered with avascular periosteal graft. In the experimental group, the allogenous bone graft filled defect was covered with the rotational vascular periosteal graft. Groups of 6 rabbits from each group were sacrificed after 2, 5 and 12 weeks following surgery. The results were evaluated with radiographical, histological and morphometric methods. The results obtained 2 and 5 weeks after surgery demonstrated better tibial bone defect healing in the experimental group. The defect was bridged in both analysed groups after 5 weeks and was completed after 12 weeks with no difference between the control and the experimental groups. The obtained results have confirmed the efficiency of the method using the rotational vascularized periosteal graft in the treatment of tibial bone defect in rabbits. The advantage of the vascularized periosteal graft as compared to the avascular one has been proved by better quality of bone healing in the early stage.
Assuntos
Periósteo/transplante , Tíbia/cirurgia , Animais , Masculino , Coelhos , Radiografia , Rotação , Tíbia/diagnóstico por imagem , Tíbia/patologia , Transplante Homólogo , CicatrizaçãoRESUMO
Limb saving surgery is today's tendency in treating the musculoskeletal tumours. Preserving the limb should not only pursue a good oncological and functional result but also aim at good psychological outcome. Our aim was to treat a very rare case of proximal femoral leiomyosarcoma with present solitary lung metastasis by conservative operative procedures.
Assuntos
Neoplasias Femorais/cirurgia , Fêmur/cirurgia , Leiomiossarcoma/cirurgia , Salvamento de Membro , Neoplasias Pulmonares/secundário , Feminino , Neoplasias Femorais/patologia , Humanos , Leiomiossarcoma/patologia , Pessoa de Meia-IdadeRESUMO
AIM: At University Department of Orthopedic Surgery in Lovran, bone bank was established in 1985 for preserving and storage of musculoskeletal tissue. At first, storage was only done for femoral heads as surgical residues of hip replacement. Since 1993, storage is also done for transplants obtained by retrieving bone allografts from cadavers during multiorgan explantations. METHODS: Transplant donors are chosen on the basis of medical history, physical examination and laboratory analysis of blood samples. Transplants are kept at the bone bank, by deep freeze method, at temperature of -80 degrees C. RESULTS: During the 2002-2006 period, bone bank delivered a total of 729 bone allografts, which were succesfully used in surgical treatment. CONCLUSION: Good results of the surgeries using bone allografts stimulated us for further development of bone banking.