Tratamiento quirúrgico del tumor de células gigantes: análisis de 20 años de experiencia / Surgical treatment of giant cell tumors: 20 years experience

Giant cell tumor (GCT) is a benign, locally aggressive lesion that primarily affect the long bones epiphyses, which represents 5-9 percent of the bone primary tumors. The purpose of this study is to show the Instituto Traumatológico‘s orthopaedic oncology group experience in the treatment of GCT and suggest a scheme of treatment according to Campanacci’s stage. For which a retrospective study was done, that include 112 patients treated from 1987 to 2007. The average time of follow-up was 9, 2 years, most frequent location was the knee region (69 percent). 85 patients (76 percent) were in stage 3 of Campanaci’s classification. We used different surgical alternatives from basic curettage to resection plus reconstruction with prostheses or aloprostheses. Post surgical complications were seen in 16 patients(14 percent). In the follow-up we had 8 pseudoarthrosis, 7 osteosintesis material failure and 3 allograft fractures. Local recurrence was seen in 15 patients (13,3 percent). 3 cases presented pulmonary metastases (2,6 percent). Mean functional evaluation, using Musculo Skeletal Tumor Society (MSTS) score, was 25, 6 points.

El Tumor de Células Gigantes (TCG) óseo es una neoplasia benigna, localmente agresiva, representa entre el 5-9 por ciento de los tumores óseos primarios. El objetivo del estudio fue revisar la experiencia de nuestra Institución en el tratamiento quirúrgico de esta neoplasia y sugerir un esquema de tratamiento según la etapa de Campanacci. Para esto se realizó un estudio retrospectivo que incluyó 112pacientes tratados desde el año 1987 hasta 2007. El tiempo promedio de seguimiento fue de 9,2 años, el tumor se ubicó alrededor de la rodilla en 78 pacientes (69 por ciento). 85 casos (76 por ciento) se encontraban en etapa III de Campanacci. Utilizamos distintas alternativas quirúrgicas desde el curetaje simple a la resección más reconstrucción con prótesis o aloinjerto. Dieciséis pacientes (14 por ciento) presentaron complicaciones post operatorias. A largo plazo hubo 8 pseudoartrosis, 7 fallas del material de osteosíntesis y 3 fracturas del aloinjerto. Recidivaron 15 pacientes (13,3 por ciento). Tres casos presentaron metástasis pulmonares (2,6 por ciento). La evaluación funcional promedio con la escala de la Musculo Skeletal Tumor Sociaty (MSTS) realizada al año del post operatorio, fue de 25,6 puntos.

Manejo de tumores de la pelvis / Treatment of primary pelvic tumors

Pelvic resection surgeries due to primary bone tumors are infrequent. According to the compromised area we can divide it in three zones, being those who affect the acetabulum the ones with the major functional alterations, pelvic stability and leg length discrepancy. The aim of this study is to present our experience in the surgical management of this type of lesions. From series of 17 patients, eight (47 percent) presented complications, the most frequents was surgical wound infection (23 percent) and deep venous thrombosis (18 percent). 4 patients died (23 percent). The other 13 patients answered the Musculo Skeletal Tumor Society (MSTS) scale being the average score 22,3. One local recurrence appeared in this group. The acceptance of the patients in this kind of surgeries is very good. These surgeries are complex, there is a high rate of complications. They must be performed in centers with a suitable professional and technical equipment.

Las cirugías de resecciones pélvicas por tumores óseos primarios son infrecuentes. Según el área comprometida se divide principalmente en 3 zonas, siendo las que afectan al acetábulo las que producen mayor alteración (funcional, en la estabilidad pélvica y la longitud de las extremidades inferiores). El objetivo de este trabajo es presentar la experiencia del equipo de tumores del Instituto Traumatológico y la Clínica Santa María en el manejo quirúrgico de este tipo de lesiones. Con un total de 17 pacientes, 8 presentaron complicaciones (47 por ciento), la más frecuente fue la infección de herida operatoria (4 pacientes 23 por ciento) y la trombosis venosa profunda (3 pacientes 18 por ciento). Cuatro pacientes (24 por ciento) fallecieron, los 13 restantes respondieron la escala Musculo Skeletal Tumor Society (MSTS) siendo el puntaje promedio de 22,3. Se presentó una recidiva local en este grupo. El grado de aceptación de los pacientes es muy bueno. Deben realizarse en centros con el equipamiento profesional y técnico adecuado para las exigentes y complejas cirugías a realizar.

Evaluación de 1497 adultos mayores institucionalizados, usando el sistema de clasificación de pacientes RUG T-18 / Assessment of 1497 Chilean nursing home residents, using the Resource Utilization Group method, RUG T-18

Background: There is little information about Chilean elderly residents of long term care facilities, regarding their characteristics and need for resources. Aim: To describe main characteristics and resource utilization of residents of one of the largest nursing homes in Chile, Fundación Las Rosas de Ayuda Fraterna. Material and Methods: In a cross sectional and descriptive study, all residents were evaluated using the RUG T-18 method, that assess activities of daily living and the complexity of their clinical situation. Results: We assessed 1497 subjects 60 years old and over (73 percent women), with an age range of 60-106 years. Thirty six percent had urinary incontinence, 19 percent required assistance for feeding, and 38 percent needed help for walking or moving. Fifty seven percent were in the lowest category of complexity, ½Institutionalization¼. Very few residents were in the most demanding categories, no one classified as ½Rehabilitation¼, and only 0.7 percent were in ½Special Care¼. Conclusions: This study is an important start point to learn more about elderly subjects living in nursing homes in Chile (Rev Méd Chile 2004; 132: 701-6).

Impacto biomÚdico de los viajes en adultos mayores chilenos / Biomedical impact of traveling for Chilean elderly

Background: In Chile there is a program named "Vacations for Elderly during Low Season". Aim: To characterize participants of this program and to measure the impact of traveling in their health and wellbeing. Material and methods: Two anonymous and voluntary questionnaires were applied to 4200 participants, before and after a ten days vacation package. Results: Before traveling, questionnaires were answered by 802 subjects, and after traveling by 4057 (69 percent women, 22 percent older than 75 years old, 15.8 percent living alone). The presence and maintaining of good health were most appreciated at this age and 59 percent classified their health as good or excellent. Twenty five percent referred sensory problems (seeing or hearing), 12 percent reported urinary incontinence and 21 percent presented falls in the last three months; depression screening (GDS-5) was positive in 16 percent. Chronic disease prevalence was similar to the general Chilean elderly population. After traveling they reported significant improvements in the items sociability, wellbeing, mood, appetite, insomnia and ostheoarthritic pain. Conclusions: Elderly who traveled were mainly women, who thought that maintaining good health is the most precious value. After traveling they improved significantly different aspects of wellbeing. Promotion of this kind of recreation programs is an important tool for integration and enhancement of quality of life in elderly subjects in our country (Rev MÚd Chile 2004; 132: 573-8).

Estudio comparativo de mujeres mayores de noventa años y ancianas menores institucionalizadas / A comparative study of institutionalized nonagenarian and younger elderly women

Background: The number of nonagenarians is rapidly growing in Chile. This age group is mainly female, with higher frailty markers and in higher risk of being placed at nursing homes. Aim: To describe features of nonagenarian women and compare them with a group of women between 60-89 years, both living in nursing homes, in terms of disability and resource use at the institution. Subjects and methods: A total of 230 nonagenarian women and 460 women, aged 60-89 years, were evaluated in the nursing home Fundación Las Rosas de Ayuda Fraterna (only for poor elderly) in Santiago, Chile. The assessment instruments were the Geriatric Assessment instrument FEGAUC, functional and mental evaluation scales of Spanish Red Cross and the Resource Utilization System, RUG T18, an independent diagnostic classification system that allows the determination of resource use in terms of cost and personnel needs. Results: Nonagenarian women had significantly (p <0.05) more disability (falls, urinary incontinence, memory problems and mobility difficulties), and were classified in RUG categories of higher resource utilization and dependency than younger women. Nevertheless, nonagenarians were a very heterogeneous group, almost half of them were able of moving by themselves or required little assistance and had minimal memory problems. Conclusions: Nonagenarian women assessed in this institution are an heterogeneous group, some with minimal disability and other more frail and dependent than the younger elderly women, being classified in higher categories of resource utilization RUG T18 (Rev Méd Chile 2004; 132: 33-9).