Low-grade chondrosarcoma of bone: experiences from the Vienna Bone and Soft Tissue Tumour Registry.

In a retrospective single-centre study, 70 low-grade chondrosarcoma (LCS) (31 female/39 male patients with a mean age of 40 years) were reviewed to evaluate surgical management. The mean overall follow-up was 81 months (median: 73 months, range: 6-317 months). Seventeen lesions (24.3%) in the trunk and 53 (75.7%) in the extremities were treated by curettage (48.6%) or resection (51.5%). Local recurrence occurred in eight patients (11.4%) 18 months postoperatively (median: 18 months, range: 0-41 months). Recurrence-free survival was significantly better for patients with extremity lesions compared to truncal lesions, but was not affected by resection margin. The anatomical site "trunk" and an "intralesional" resection margin had a significant independent prognostic influence in multivariate analysis. Curettage with local adjuvants is a viable treatment option for most extremity LCS. In truncal LCS wide resection is recommended despite a potentially higher complication rate.

Intensified adjuvant IFADIC chemotherapy in combination with radiotherapy versus radiotherapy alone for soft tissue sarcoma: long-term follow-up of a prospective randomized feasibility trial.

Adjuvant chemotherapy for grade 2 and 3 soft tissue sarcoma (STS) patients still has to be considered experimental. Fifty-nine patients underwent primary surgery by wide or marginal excision and were subsequently randomized to receive radiotherapy alone or in combination with six courses of chemotherapy consisting of ifosfamide, DTIC, and doxorubicin administered in 14-day intervals supported by G-CSF on days 5-13. Twenty-eight patients received radiotherapy (control group) and 31 patients were treated with additional chemotherapy. After a median observation period of 97 months (range: 13-158 months), 58 patients were followed up to assess long-term relapse-free survival (RFS), time to local failure (TLF), time to distant failure (TDF), and overall survival (OS). Fifteen patients (56%) in the control group vs. 19 patients (61%) in the chemotherapy group were free of disease. Within the control group, tumor relapses occurred in 12 patients (44%) vs. 12 patients (39%) in the chemotherapy group. RFS (P = 0.87), TLF (P = 0.58), TDF (P = 0.60) as well as OS (P = 0.99) did not differ significantly between the two groups. Adjuvant chemotherapy was not translated into a significant benefit concerning RFS, TLF, TDF, and OS for STS patients.

Elevated risk of myocardial infarction in very young immigrants from former Yugoslavia.

We performed a hospital based case-control study to assess if the risk of myocardial infarction at a very young age (< or =40 years) was elevated in immigrants from the region of former Yugoslavia. Patients were classified as "exposed" if they or both their parents were born in former Yugoslavia. Consecutive myocardial infarction patients were recruited in the immediate post-infarction period from two Viennese hospitals over a 3.5-year period. Control patients free of myocardial infarction were frequency matched on age, gender, centre, and time in an approximate 1:2 ratio. Logistic regression was used for the assessment of an association between Yugoslavian descent and myocardial infarction. Overall, we recruited 102 myocardial infarction patients and 200 controls. The median age of infarction patients was 37.3 years. Yugoslavian descent was strongly associated with myocardial infarction (crude OR 7.3, 95% CI 3-18). This association was attenuated after multivariate adjustment (OR 3.9, 95% CI 1.2-13) but remained statistically significant. Using Miettinen's formula for population attributable risk, we calculated that between 15.3% (adjusted) and 17.8% (unadjusted) of myocardial infarction cases in very young patients could be attributable to immigrants from the studied region. In conclusion, we found that the risk of developing myocardial infarction at a young age is elevated in immigrants from the region of former Yugoslavia and their offspring. Even though residual confounding cannot be ruled out definitively, this risk seems to be independent of established cardiovascular risk factors.

Familial-combined hyperlipidaemia in very young myocardial infarction survivors (< or =40 years of age).

AIMS: Myocardial infarction (MI) in very young individuals is a rare disease associated with an unfavourable prognosis. Familial-combined hyperlipidaemia (FCHL) increases the risk for MI in individuals below 60 years; however, its role in very young MI patients below 40 years is not as well established. We investigated the prevalence and impact of FCHL in these very young MI patients. METHODS AND RESULTS: We prospectively enrolled 102 consecutive MI survivors (< or =40 years) from two high-volume cardiac catheterization centres. Patients were frequency-matched for age, gender, and centre to 200 hospital controls free from coronary heart disease. Myocardial infarction patients were invited to send family members for FCHL screening. Overall, 37 families were screened. Familial-combined hyperlipidaemia was diagnosed using a nomogram, which takes into account total cholesterol, triglycerides, and Apo B(100) levels. Thirty-eight acute myocardial infarction (AMI) patients (38%) and five controls (2.5%) displayed the FCHL phenotype, 21 of these MI patients sent family members for screening, and FCHL was confirmed in 16 families (76%). The FCHL phenotype was associated with a 24-fold increased adjusted risk for MI (95% CI 7.5-81, P < 0.001). Of all lipid parameters, VLDL-cholesterol, and non-HDL-cholesterol were most strongly associated with MI. CONCLUSIONS: The present study suggests that the FCHL phenotype seems to be a major risk factor for the occurrence of MI at a very young age. It remains to be determined whether this excessively increased risk can be favourably modified by therapeutic interventions.

Reconstructing the extensor apparatus with a new polyester ligament.

We analyzed the clinical outcome of patients who had reconstruction of the extensor apparatus with a new polyester ligament after extensive resection of malignant tumors around the knee. Twenty-two patients were included; 19 were evaluated after a mean followup of 44 months (range, 8-67 months) to assess active and passive knee range of motion, walking ability, need for revision, and TESS and Enneking scores. The patients were divided into two groups; patients in Group A had a weakened extensor mechanism and patients in Group B had a completely dissected extensor mechanism. Seven patients had excellent knee function with an extension lag less than 5 degrees. Five patients had an extension deficit less than 20 degrees, three patients had a deficit less than 40 degrees, and four patients could not extend their limb against gravity. However, all patients were able to walk without walking aids. They had a mean Enneking score of 83 points and a mean TESS score of 82 points. Patients who had distal femur resections had worse results than patients who had proximal tibia resections. The LARS ligament proved promising for augmentation and complete reconstruction of the extensor apparatus of the knee after extensive tumor resection, with excellent and good results in 59% of patients.