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1.
Bone Joint J ; 101-B(10): 1313-1320, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564158

RESUMO

AIMS: The aim of this study was to report the outcomes of patients who underwent definitive surgery for secondary chondrosarcomas arising from osteochondromas. PATIENTS AND METHODS: A total of 51 patients with secondary chondrosarcomas occurring from osteochondromas were reviewed. Median age was 36 years (interquartile range (IQR) 15 to 82). Median follow-up was 6.9 years (IQR 2.8 to 10.6). The pelvis was the most commonly affected site (59%). Histological grades were grade I in 35 (69%), grade II in 13 (25%), and grade III in three patients (6%). RESULTS: Preoperative biopsy histology correctly predicted the final histological grade in 27% of patients. The ten-year disease-specific survival (DSS) for all patients was 89.4%. Local recurrence occurred in 15 patients (29%), more commonly in pelvic tumours (37%) compared with limb tumours (19%). Four patients with pelvic tumours died from progression of local recurrence. No patient with limb tumours died of disease. Wide/radical margin was associated with improved local recurrence-free survival (p = 0.032) and local recurrence was associated with worse DSS (p = 0.005). CONCLUSION: We recommend that a secondary chondrosarcoma arising from osteochondroma of the pelvis is resected with wide/radical resection margins. The balance between the morbidity of surgery and risk of local recurrence needs to be considered in patients with limb secondary chondrosarcomas. Cite this article: Bone Joint J 2019;101-B:1313-1320.


Assuntos
Neoplasias Ósseas/patologia , Condrossarcoma/secundário , Recidiva Local de Neoplasia/mortalidade , Osteocondroma/patologia , Adulto , Biópsia por Agulha , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/cirurgia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/mortalidade , Condrossarcoma/cirurgia , Estudos de Coortes , Intervalo Livre de Doença , Extremidades/patologia , Feminino , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Osteocondroma/diagnóstico por imagem , Osteocondroma/mortalidade , Osteocondroma/cirurgia , Ossos Pélvicos/patologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
2.
Anticancer Res ; 39(10): 5747-5753, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570477

RESUMO

BACKGROUND/AIM: Liposarcomas (LS) are one of the most common entities within the heterogenous group of soft tissue sarcomas. The aim of this study was to identify prognostic indicators in patients with LS of the extremities and truncal wall. PATIENTS AND METHODS: We analysed the influence of potential prognostic factors on local recurrence-free survival (LRFS) and overall survival (OS) in 181 patients who were suitable for surgical treatment with curative intent. RESULTS: The median follow-up period was 7.1 years. The 5-year LRFS and OS rates were 79.1 and 93.3%. The 5-year OS rate was 94.7% in patients with R0-resected primary tumors and 72.7% in patients with R1/R2-status (p=0.023). In multivariate analysis, only histologic grade was found to be an independent prognostic factor of OS. CONCLUSION: Negative margins were not an independent prognostic factor in our series. Tumor biology reflected by histologic grade dictated the outcome.


Assuntos
Extremidades/patologia , Lipossarcoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Lipossarcoma/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Prognóstico , Estudos Retrospectivos , Sarcoma/mortalidade , Sarcoma/patologia , Adulto Jovem
3.
Zhongguo Gu Shang ; 32(8): 736-741, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31533386

RESUMO

OBJECTIVE: To investigate ultrasound and MRI features of malignant fibrous histiocytoma (MFH) of soft tissue. METHODS: Ultrasound, MRI images and pathological data of 12 patients with malignant fibrous histiocytoma in soft tissue confirmed by operation and pathology were analyzed from January 2012 to August 2018, inlcuding 7 males and 5 females, aged from 36 to 69 years old with an average age of 53 years old; the courses of disease ranged from 4 to 49 months with an average of 28 months. Clinical manifestations were soft tissue masses and pain in the affected limbs. Ultrasound, MRI and contrast-enhanced examination were performed before operation. The lesions, morphology, echo/signal characteristics, color flow signals and enhancement features were observed and compared with pathology. RESULTS: In 12 patients with MFH, 9 patients were primary lesions and 3 patients were recurrent lesions after operation. There were 7 cases of bilateral thighs, 2 cases of calves, 1 case of upper arm, 1 case of buttocks and 1 case of posterior peritoneum. The size ranged from 5.1 to 17.1 cm with an average of 8.7 cm. Ultrasound feature showed lobulated or agglomerate, and focused on low echo; 5 cases had capsule and with clear border; 7 cases were unclear boundary with surrounding tissues; and 6 cases with irregular echo-free. The blood flow signals were around the CDFI, and the internal blood flow signals were different. MRI feature showed lobulated, agglomerate or irregular shape, T1WI showed slightly lower signal or equal signal, T2WI showed high signal and DWI signal increased. Six patients manifested mixed signal inside, 7 patients manifested low signal separation inside, 5 patients with false envelope, and 9 patients manifested infiltration and growth with peripheral edema. T1WI showed uneven strengthening after enhancement. Immunohistochemical expression of Vim, CD68 were positive. CONCLUSIONS: The age, location and imaging features of soft tissue MFH are characteristic. The diagnosis of MFH should be considered when irregular mass occurred in soft tissues of limbs at middle-aged and old people. Echo and signal are homogeneous or mixed. Separation, necrosis and cystic degeneration could be seen in the mass. When the blood flow signals are abundant and solid components are obviously enhanced, the diagnosis of MFH should be considered.


Assuntos
Histiocitoma Fibroso Maligno , Adulto , Idoso , Edema , Extremidades , Feminino , Histiocitoma Fibroso Maligno/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ultrassonografia
4.
J Surg Oncol ; 120(3): 540-549, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31267571

RESUMO

BACKGROUND AND OBJECTIVES: Isolated limb perfusion (ILP) and infusion (ILI) are treatment modalities for unresectable melanoma in-transit metastases and extremity soft tissue sarcomas (STS). We sought to characterize the national trend in their utilization in the context of novel melanoma therapies introduced in 2011. METHODS: Using the National Inpatient Sample (2005-2014), patients with a primary diagnosis of limb melanoma or STS who underwent ILP/ILI were identified by diagnosis and procedure codes. Annual percent change (APC) in ILP/ILI procedures was determined. RESULTS: From 2005 through 2014, 670 and 130 ILP/ILI procedures were performed for melanoma and STS, respectively. Mean age was 64 (SD 15) years for melanoma and 59 (SD 18) years for STS. Over time, procedures for melanoma decreased with an APC of -17 (P = .019). Comparing 2005-2010 and 2011-2014, the mean number of procedures for melanoma decreased from 91 to 32 per year (P = .007). In contrast, there was no change for STS (APC 6.5, P = .39; mean 11 and 16 per year in 2005-2010 and 2011-2014, respectively, P = .46). CONCLUSIONS: ILI/ILP utilization has decreased for melanoma, but not for STS. Whether trends for ILP and ILI differed could not be determined. ILP/ILI remains an important option to consider for regional disease control.


Assuntos
Quimioterapia do Câncer por Perfusão Regional/métodos , Melanoma/tratamento farmacológico , Sarcoma/tratamento farmacológico , Adulto , Idoso , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Zhonghua Shao Shang Za Zhi ; 35(7): 532-536, 2019 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-31357824

RESUMO

Objective: To explore the clinical effect of negative pressure wound therapy (NPWT) in emergency limb-salvage operation of destructive injury of limb. Methods: From July 2014 to December 2017, 43 patients with destructive injury of limb in one side conformed to the inclusion criteria were admitted to our hospital. The patients were divided to NPWT group of 24 patients [ 21 males and 3 females, aged (38±10) years] and routine dressing change group of 19 patients [ 17 males and 2 females, aged (37±10) years] according to their treatment methods. After the emergency debridement, fracture external fixation, neurovascular exploration, and microsurgical repair were performed, NPWT were applied on wounds of patients in NPWT group and routine dressing change treatment on wounds of patients in routine dressing change group. On 7 to 10 days after the emergency operation, incidence of arterial embolism of patients in the two groups were calculated, and condition of wound infection of patients in the two groups were observed. Complete wound healing time and survival condition of limb were recorded. Data were processed with independent sample t test or chi-square test. Results: Incidence of arterial embolism of patients in NPWT group on 7 to 10 days after the emergency operation was 6.67% (3/45), which was close to 5.56% (2/36) of patients in routine dressing change group (χ(2)=0.043, P>0.05). There was 1 patient with wound infection in NPWT group on 7 to 10 days after the emergency operation, obviously less than 6 patients in routine dressing change group (χ(2)=5.847, P<0.05). Complete wound healing time of patients in NPWT group was (30±4) d, significantly shorter than (36±8) d of patients in routine dressing change group (t=2.813, P<0.01). Limbs of 24 patients in NPWT group survived, which was close to 18 patients in routine dressing change group (χ(2)=1.293, P>0.05). Conclusions: NPWT can significantly reduce tthe wound infection rate and shorten the time of wound healing of limb with destructive injury after emergency operation, which is worthy of popularization in clinic.


Assuntos
Extremidades/lesões , Tratamento de Ferimentos com Pressão Negativa , Terapia de Salvação , Adulto , Bandagens , Desbridamento , Extremidades/cirurgia , Feminino , Fixação de Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Cicatrização , Infecção dos Ferimentos/prevenção & controle
6.
Br J Radiol ; 92(1102): 20190252, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31322910

RESUMO

OBJECTIVE: To assess the impact of adjuvant volumetric modulated arc therapy (VMAT) compared with three-dimensional conformal radiation therapy (3DCRT) in terms of toxicity and local control (LC) in patients with soft tissue sarcoma of the extremities. METHODS: From 2004 to 2016, 109 patients were treated, initially using 3DCRT and subsequently with VMAT. Clinical outcome was evaluated by contrast-enhanced MRI, thoracic and abdominal CT 3 months after treatments and then every 6 months. Toxicity was evaluated with Common Terminology Criteria for Adverse Events scale v. 4.3. RESULTS: Patients presented Stage III soft tissue sarcoma disease (77%), localized tumor (95%) at the lower extremity (87%), adipocytic histotype (46%). Surgical resection was performed in all patients, followed by adjuvant 3DCRT in 38, and VMAT in 71. The median total dose was 66 Gy/33 fractions (range 60-70 Gy;25-35 fractions). More successful bone sparing was recorded using VMAT (p < 0.001). Median follow-up was 61 months, 93 and 58 months for 3DCRT and VMAT group, respectively. The 2- and 5 year LC were 95.3±2.1%, and 87.4±3.4% for the whole cohort, 92.0±4.5%, 82.9±6.4% for 3DCRT, 97.1±2.0%, 89.6±4.1% for VMAT (p = 0.150). On univariate and multivariate analysis the factors recorded as conditioning LC were the status of the surgical resection margins (p = 0.028) and the total dose delivered (p = 0.013). CONCLUSION: The availability of modern radiotherapy technique permit a better conformity on the target with maximum sparing of normal tissue and acceptable side-effects. VMAT is a safe and feasible treatment with limited rate of toxicity, compared to 3DCRT. Results on LC of VMAT are encouraging. ADVANCES IN KNOWLEDGE: Soft tissue sarcoma of the extremities can benefit from the use of VMAT, with a reduction of the high dose to bones to avoid radiation osteonecrosis. An adequate total dose of at least 66 Gy and a radical surgical margin allow a good local control.


Assuntos
Radioterapia Conformacional/métodos , Radioterapia de Intensidade Modulada/métodos , Sarcoma/radioterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Meios de Contraste , Extremidades , Feminino , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Radioterapia Conformacional/efeitos adversos , Radioterapia Conformacional/mortalidade , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/mortalidade , Estudos Retrospectivos , Sarcoma/diagnóstico por imagem , Sarcoma/mortalidade , Sarcoma/patologia , Adulto Jovem
7.
Unfallchirurg ; 122(7): 555-572, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31270552

RESUMO

Neurovascular injuries in fractures threaten at least the function of extremities. The timely interaction between diagnosis and treatment of vascular injuries helps to avoid a poor outcome or even fatal complications. An important parameter is to "think about it" for injuries under strain. An ankle-brachial index (ABI) of <0.9 is an indicator. Massive bleeding, manifest and long-lasting peripheral ischemia and a rapidly expanding hematoma necessitate an immediate surgical intervention. Endovascular techniques are recommended on the extremities of stable patients with circumscribed vascular lesions. The debate about the sequence of repair (vascular vs. osseous) has to be decided on an individual basis; however, when in doubt vascular repair should be given priority. Vessel reconstructions should be performed without tension and must be covered by vital soft tissues, the indications for fasciotomy should be liberally interpreted. The prognosis with respect to preservation of the extremity and long-term functional outcome substantially depends on the quality of treatment of accompanying injuries.


Assuntos
Fraturas Ósseas , Lesões do Sistema Vascular , Extremidades , Fasciotomia , Humanos , Procedimentos Cirúrgicos Vasculares
8.
Naturwissenschaften ; 106(7-8): 38, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31209559

RESUMO

Xiphosurida-crown group horseshoe crabs-are a group of morphologically conservative marine chelicerates (at least since the Jurassic). They represent an idealised example of evolutionary stasis. Unfortunately, body fossils of horseshoe crabs seldom preserve appendages and their associated features; thus, an important aspect of their morphology is absent in explorations of their conservative Bauplan. As such, fossil horseshoe crab appendages are rarely considered within a comparative framework: previous comparisons have focussed almost exclusively on extant taxa to the exclusion of extinct taxa. Here, we examine eight specimens of the xiphosurid Tachypleus syriacus (Woodward, 1879) from the Cenomanian (ca 100 Ma) Konservat-Lagerstätten of Lebanon, five of which preserve the cephalothoracic and thoracetronic appendages in exceptional detail. Comparing these appendages of T. syriacus with other fossil xiphosurids highlights the conserved nature of appendage construction across Xiphosurida, including examples of Austrolimulidae, Paleolimulidae, and Limulidae. Conversely, Belinuridae have more elongate cephalothoracic appendages relative to body length. Differences in appendage sizes are likely related to the freshwater and possible subaerial life modes of belinurids, contrasting with the primarily marine habits of other families. The morphological similarity of T. syriacus to extant members of the genus indicates that the conserved nature of the generic lineage can be extended to ecological adaptations, notably burrowing, swimming, possible diet, and sexual dimorphism.


Assuntos
Evolução Biológica , Fósseis/anatomia & histologia , Caranguejos Ferradura/anatomia & histologia , Caranguejos Ferradura/classificação , Adaptação Fisiológica , Animais , Ecossistema , Extremidades/anatomia & histologia , Filogenia , Especificidade da Espécie
9.
Pathologe ; 40(4): 431-435, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31240451

RESUMO

Soft-tissue sarcomas are rare malignant tumors. Surgery remains the most important treatment modality. Neoadjuvant and/or adjuvant chemo- and radiotherapy may be administered to improve the local and systemic outcome. Advances in oncological and reconstructive surgery, combined with the use of multimodal therapies, have made mutilating surgery rare events in extremity sarcomas. In retroperitoneal sarcomas, local recurrences are life-threatening events and multivisceral resection has become the standard surgical procedure. The subjects of this review are diagnostics, multimodal therapy, and resection strategy from a surgical point of view.


Assuntos
Neoplasias Retroperitoneais , Sarcoma , Neoplasias de Tecidos Moles , Terapia Combinada , Extremidades , Humanos , Recidiva Local de Neoplasia , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia
10.
J Surg Oncol ; 120(3): 332-339, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31172536

RESUMO

OBJECTIVE: Our aim was to compare outcomes in patients who underwent unplanned excisions (UE) of soft-tissue sarcomas (STS) against patients with planned excisions (PE). METHODS: The retrospective 7-institution US Sarcoma Collaborative database was used. Patients with curative-intent resection of truncal/extremity STS between 2000 and 2016 were included. Propensity score weighting analysis (PSWA) was performed. Endpoints were locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-specific survival (DSS). RESULTS: One thousand five hundred and ninety-six patients were included. Eighty-two percent (n = 1315) underwent PE and 18% (n = 281) underwent UE. Compared with PE, patients with UE were younger with smaller tumors with similar tumor grade. Unmatched analysis revealed PE was associated with worse DMFS (hazard ratio [HR] 1.95, P = .009) and DSS (HR 1.78, P = .039), but not LRFS compared with UE. On PSWA, UE had earlier LRFS (3-year LRFS: 80.5% vs 89.8%, P = .039), but not DMFS or DSS. By grade, patients with high-grade tumors and UE had worse LRFS (1-year LRFS: 90% vs 94%, P = .015), but similar DMFS and DSS compared with PE. In low-grade patients, UE and PE had similar LRFS, DMFS, or DSS. CONCLUSIONS: UE of STS is not associated with worse prognosis compared to PE, though UE is associated with earlier locoregional recurrence in patients with high-grade tumors. Multimodality therapy is needed to achieve improved outcomes in these patients.


Assuntos
Sarcoma/cirurgia , Estudos de Coortes , Procedimentos Cirúrgicos de Citorredução/métodos , Extremidades/patologia , Extremidades/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Sarcoma/patologia , Tronco/patologia , Tronco/cirurgia , Resultado do Tratamento
11.
J Surg Oncol ; 120(3): 366-375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236956

RESUMO

BACKGROUND: Desmoid tumors are rare locally invasive, benign neoplasms that develop along aponeurotic structures. Current treatment is complicated by associated morbidity and high recurrence rates. METHODS: A retrospective, single-institution review identified 23 patients (age: 16-77) with extra-abdominal desmoid tumors who received CT-guided percutaneous cryoablation as either a first-line (61%) or salvage (39%) treatment in 30 sessions between 2014 and 2018. Median maximal lesion diameter was 69 mm (range: 11-209). Intent was curative in 52% and palliative in 48%. Contrast-enhanced cross-sectional imaging was obtained before and after treatment in addition to routine clinical follow-up. RESULTS: Technical success was achieved in all patients. The median follow-up was 15.4 months (3.5-43.4). Symptomatic improvement was demonstrated in 89% of patients. At 12 months, the average change in viable volume was -80% (range -100% to + 10%) and response by modified response evaluation criteria in solid tumors (mRECIST) was CR 36%, PR 36%, and SD 28% No rapid postablation growth or track seeding was observed. Four patients underwent repeat cryoablation for either residual or recurrent disease. Two patients sustained a major procedural complication consisting of significant neuropraxia. CONCLUSION: Cryoablation for desmoid tumors demonstrates a high degree of symptom improvement and local tumor control on early follow-up imaging with relatively low morbidity.


Assuntos
Criocirurgia/métodos , Fibromatose Agressiva/cirurgia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Adolescente , Adulto , Idoso , Extremidades/diagnóstico por imagem , Extremidades/patologia , Extremidades/cirurgia , Feminino , Fibromatose Agressiva/diagnóstico por imagem , Fibromatose Agressiva/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Parede Torácica/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
12.
J Spec Oper Med ; 19(2): 41-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31201750

RESUMO

BACKGROUND: To investigate questions about application of emergency tourniquets in very young children, we investigated practices of Combat Application Tourniquet (C-A-T) use on a simulated infant-sized limb to develop ways to improve readiness for caregiving. METHODS: This study was conducted as investigations of C-A-Ts used by two individuals in deliberate practice. The practice setup simulating a limb of infants aged 3-5 months included a handrail (circumference, 5.25 in.). This setup needed a specific modification to the instructions for use to adhere the band between the clips. Each user performed 100 practices. RESULTS: With accrual of experience, application time was shorter for each user, on average in a power law of practice, and more ease was associated when less time was taken to apply the tourniquet. The ease of use was associated with accrued experience through deliberate practice of a tourniquet user while under coached learning. A check of tourniquet fit on a 4.25-in. limb also entailed the modification used in the 5.25-in. limb. However, an additional modification of wrapping the band in a figure-8 pattern around the rod was needed because the rod and clip could not meet. The fit on a 3.25-in. limb was impracticable for a workaround. Tourniquet use was harder for smaller limbs (i.e., 4.25 in. and 3.25 in.). A map of tourniquet fit was sketched of which sized limbs were too big, too small, within the fit zone, or at its borders. CONCLUSION: C-A-Ts mechanically fit the simulated limbs of infants aged 3-5 months, and C-A-T use was practicably easy enough to allow experienced users to fit tourniquets to limbs well using a specific modification of the routine technique. The findings and knowledge generated in this study are available to inform researches and developments in best preparation practices for instructing first aid.


Assuntos
Primeiros Socorros , Hemorragia/prevenção & controle , Torniquetes , Simulação por Computador , Desenho de Equipamento , Extremidades , Humanos , Lactente
13.
Int. j. morphol ; 37(2): 568-575, June 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1002260

RESUMO

The aim of this study was to compare body composition (BC) and morphological symmetry differences among elite athletes (n = 132) in six martial arts (judo, karate, fencing, wrestling, taekwondo, kickboxing). Multivariate analysis of variances (MANOVA) was used to compare the following variables: absolute (FFM) and relative (FFMrel) value of fat free mass, percentage of fat mass (FMp), bone mass, protein mass, basal metabolic rate, absolute (TBW) and percentual (TBWp) value of total body water, segmental proportion of muscle mass, phase angle, and percent-age differences between the upper and lower limbs. MANOVA revealed significant differences in BC among the groups (λ = 0.01, F104, 256 = 10.01, p< 0.01, ηp2 = 0.67). No significant differences were observed for FMp, FFMrel, and TBWp (p>0.05). In all other BC variables, significant differences were detected (p<0.05). The comparison of paired differences between limbs revealed significantly greater fluid volume in the preferred arm compared to the non-preferred arm in karate and fencing athletes. Significant differences (p<0.05) in favour of the preferred leg in all combat athletes were detected. This study revealed morphological differences among practitioners of different martial arts and between paired limbs.


El objetivo de este estudio fue comparar la composición corporal (CC) y las diferencias de simetría morfológica entre atletas de élite (n = 132) en seis artes marciales (judo, karate, esgrima, lucha, taekwondo, kickboxing). Se utilizó el análisis multivariado de varianzas (MANOVA) para comparar las siguientes variables: valor absoluto (FFM) y relativo (FFMrel) de la masa libre de grasa, porcentaje de masa grasa (FMp), masa ósea, masa proteica, tasa metabólica basal, absoluto (TBW) y el valor porcentual (TBWp) de líquido corporal total, la proporción segmentaria de la masa muscular, el ángulo de fase y las diferencias porcentuales entre los miembros superiores e inferiores. MANOVA reveló diferencias significativas en BC entre los grupos (λ = 0,01, F104, 256 = 10,01, p <0,01, ηp2 = 0,67). No se observaron diferencias significativas para FMp, FFMrel y TBWp (p>0,05). En todas las demás variables de BC, se detectaron diferencias significativas (p<0,05). La comparación de las diferencias pareadas entre los miembros reveló un volumen de líquido significativamente mayor en el brazo dominante en comparación con el brazo no dominante en karate y atletas de esgrima. Se detectaron diferencias significativas (p<0,05) a favor de la pierna dominante en todos los atletas de combate. Este estudio reveló diferencias morfológicas entre los practicantes de diferentes artes marciales y entre las miembros emparejadas.


Assuntos
Humanos , Masculino , Composição Corporal , Artes Marciais , Extremidades/anatomia & histologia , Antropometria , Tecido Adiposo , Análise Multivariada
14.
Bone Joint J ; 101-B(6): 739-744, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154835

RESUMO

AIMS: The aim of this study was to identify factors that determine outcomes of treatment for patients with chondroblastic osteosarcomas (COS) of the limbs and pelvis. PATIENTS AND METHODS: The authors carried out a retrospective review of prospectively collected data from 256 patients diagnosed between 1979 and 2015. Of the 256 patients diagnosed with COS of the pelvis and the limbs, 147 patients (57%) were male and 109 patients (43%) were female. The mean age at presentation was 20 years (0 to 90). RESULTS: In all, 82% of the patients had a poor response to chemotherapy, which was associated with the presence of a predominantly chondroblastic component (more than 50% of tumour volume). The incidence of local recurrence was 15%. Synchronous or metachronous metastasis was diagnosed in 60% of patients. Overall survival was 51% and 42% after five and ten years, respectively. Limb localization and wide surgical margins were associated with a lower risk of local recurrence after multivariable analysis, while the response to chemotherapy was not. Local recurrence, advanced patient age, pelvic tumours, and large volume negatively influenced survival. Resection of pulmonary metastases was associated with a survival benefit in the limited number of patients in whom this was undertaken. CONCLUSION: COS demonstrates a poor response to chemotherapy and a high incidence of metastases. Wide resection is associated with improved local control and overall survival, while excision of pulmonary metastases is associated with improved survival in selected patients. Cite this article: Bone Joint J 2019;101-B:739-744.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Extremidades/cirurgia , Osteossarcoma/cirurgia , Neoplasias Pélvicas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/patologia , Criança , Pré-Escolar , Condrossarcoma/patologia , Terapia Combinada , Extremidades/patologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Osteossarcoma/patologia , Neoplasias Pélvicas/patologia , Estudos Retrospectivos , Resultado do Tratamento
15.
Zhen Ci Yan Jiu ; 44(5): 335-40, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31155865

RESUMO

OBJECTIVE: To observe the therapeutic effect of electroacupuncture (EA) of "Zusanli" (ST36) and "Ashi"-point on the healthy side (opposing needling) on muscular injury and expression of myogenin (myoG) and fast myosin skeletal heavy chain (Fast MyHC) proteins in the gastrocnemius muscle (GM) tissues in skeletal muscle contusion rats,so as to explore its mechanism underlying improvement of skeletal muscle injury. METHODS: A total of 54 male SD rats were divided into normal control (n = 6),model (n=24) and opposing needling (EA, n=24) groups. The latter two groups were further randomized into 3, 5, 7 and 14 d subgroups (n=6 per subgroup). The skeletal muscle contusion model of the hind-limb was established by using a self-made striking device. EA (1 Hz/3 Hz,1-2 mA) was applied to ST36 and "Ashi"-point on the uninjured side of the hind-limb for 15 min every time, once a day for 3, 5, 7 and 14 days, respectively. The injured GM was harvested on the 3rd, 5th, 7th and 14th day after muscular contusion. The morphological changes of the injured GM and the mean cross-sectional areas (CSAs) of the neonatal muscle cells were observed by microscope after H.E. staining. The immunoactivity of desmin protein (myogenic marker protein of myoblast cell) of GM was detected by immunofluorescence stain on the 7th day after injury, and the expression levels of myoG (on the 3rd and 5th day after injury) and fast MyHC protein of GM tissues (on the 7thand 14th day after injury) were detected by Western blot. RESULTS: H.E. staining of GS tissue showed fewer neuronal myocytes with disordered arrangement at different sizes, and appearance of some collagenous fibers among the mesenchyme on day 7 and 14 after muscular contusion, which was relatively milder in the EA group. In the EA group, the CSA values of the neonatal muscle cells were significantly larger than those in the model group on the day 7th (P<0.05), 14th (P<0.001) after injury. On day 7 after muscular contusion, the desmin was found to express on the cellular membrane of GM in the normal control group, while in the model group, the desmin expressed mainly in the cellular plasma in the model group, and on the cellular membrane of neonatal myocytes in the EA group, respectively. The desmin positive myocytes showed disordered arrangement and different sizes after muscular contusion, whereas the situations of the EA group were close to those of the normal control group. Desmin expression was up-regulated in the EA group compared with the model group which was not significant difference (P>0.05). On the 3rd and 5th day after muscular contusion, the expression level of myoG protein was significantly up-regulated in the model group compared with the normal control group (P<0.001), and significantly up-regulated in the EA group than that in the model group (P<0.001). On the 7th and14th day after contusion, the expression level of fast MyHC protein was significantly down-regulated in the model group relevant to the normal control group (P<0.001), and markedly up-regulated in the EA group relevant to the model group (P<0.01).. CONCLUSION: EA of ST36 and "Ashi"-point on the contralateral limb can up-regulate the expression of myoG and fast MyHC proteins of GM in acute skeletal muscle contusion rats, which may contribute to its effect in promoting the repair of skeletal muscle injury.


Assuntos
Contusões , Eletroacupuntura , Pontos de Acupuntura , Animais , Extremidades , Humanos , Músculo Esquelético , Ratos , Ratos Sprague-Dawley
16.
BMC Surg ; 19(1): 57, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146705

RESUMO

BACKGROUND: However, the application of limb salvage with joint preservation is controversial. The purpose of this study is to propose a selection strategy of joint-sparing operative procedures for humeral malignancies based on tumor origin, site and bone strength. METHODS: The medical data of 28 patients with humeral malignancies treated at our institute from January 2010 to December 2016 were analyzed retrospectively. The patients had a median age of 51 years (range, 8-82 years). Bone strength scoring system was utilized to evaluated bone strength of the tumor. Four joint-sparing surgical methods were performed on selected patients. Evaluation of limb function was based on the Musculoskeletal Tumor Society scoring system. Two-sample t-test was used to compare patient group data such as bone strength score and postoperative Musculoskeletal Tumor Society score. RESULTS: The mean follow-up period for the 7 patients with primary malignancies was 45 months (range, 15-66 months). One patient died due to recurrence and lung metastasis, while the remaining 6 patients (6/7, 85.7%) survived without recurrence. For the 21 patients with metastases, 5 survived with tumors, with an average survival time of 25.8 months (range, 9-48 months). The rest died from progression of the primary tumors. The mean bone strength score for the biological reconstruction group and non-biological reconstruction group was respectively 9.7 ± 1.3 and 12.9 ± 1.2. A significant difference between the 2 groups (p < 0.05) was found. Mean postoperative Musculoskeletal Tumor Society score was respectively 27.2 ± 1.8 and 26.1 ± 1.7 for the 2 groups. There was no significant difference between the 2 groups (p > 0.05). Non-oncological complications included fracture (1), aseptic loosening (1) and radial nerve injury (1). CONCLUSIONS: Alcohol devitalized autograft replantation is applicable for diaphyseal humeral primary malignancies, with a good response to chemotherapy and a low bone strength score (≤10). In situ microwave ablation is suitable for diaphyseal and (or) metaphyseal low-grade malignant bone tumors or metastases with a low bone strength score (≤10). Intercalary prosthetic reconstruction is preferred for diaphyseal metastases with a high bone strength score (> 10).


Assuntos
Neoplasias Ósseas/cirurgia , Úmero/cirurgia , Salvamento de Membro/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Diáfises/cirurgia , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
17.
Zoology (Jena) ; 134: 16-26, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31146904

RESUMO

Segmentation gives rise to the anterior-posterior axis in many animals, and in vertebrates this axis comprises serially arranged vertebrae. Modifications to the vertebral column abound, and a recurring, but functionally understudied, change is the elongation of the body through the addition and/or elongation of vertebrae. Here, we compared the vertebral and axial kinematics of the robustly limbed Fire skink (Riopa fernandi) representing the ancestral form, the limbless European glass lizard (Ophisaurus apodus), and the Northern water snake (Nerodia sipedon). We induced these animals to traverse through channels and peg arrays of varied widths and densities, respectively, using high-speed X-ray and light video. We found that even though the snake had substantially more and shorter vertebrae than either lizard, intervertebral joint angles did not differ between species in most treatment levels. All three species decreased the amplitude and wavelength of their undulations as channels narrowed and the lizard species increased wave frequency in narrower channels. In peg arrays, both lizard species decreased wave amplitude, while the snake showed no differences. All three species maintained similar wavelengths and frequencies as peg density increased in most cases. Our results suggest that amplitude is decoupled from wavelength and frequency in all three focal taxa. The combination of musculoskeletal differences and the decoupling of axial kinematic traits likely facilitates the formation of different undulatory waves, thereby allowing limbless species to adopt different modes of locomotion.


Assuntos
Extremidades , Articulações/anatomia & histologia , Lagartos/anatomia & histologia , Serpentes/anatomia & histologia , Coluna Vertebral/anatomia & histologia , Animais , Fenômenos Biomecânicos , Lagartos/classificação , Locomoção , Serpentes/classificação
19.
Zhonghua Shao Shang Za Zhi ; 35(4): 253-260, 2019 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-31060172

RESUMO

Objective: To establish a method for repairing extremities with extensively deep burn using large piece of fresh allogeneic scalp spliced by Meek glue combined with autologous microskin and observe its effect. Methods: Medical records of two male patients with extremely extensive deep burn admitted to our hospital from May to November in 2018 were retrospectively analyzed. Two patients aged 44 and 25 years respectively, with total burn area of 90% and 97% total body surface area (TBSA) and full-thickness burn area of 85% and 70% TBSA, respectively. Preoperatively, the surgical area on the extremities was calculated to estimate the necessary amount of allogeneic scalp and Meek miniature skin. The large piece of fresh allogeneic scalp spliced by Meek glue combined with autologous microskin was prepared according to the methods described as follows. Thin medium-thickness fresh scalps with 3% TBSA and 0.30-0.35 mm in depth were harvested from each donor and spliced into a large piece with epidermis upward by spraying Meek glue. Then the spliced scalp was punched after covered with a single-layer gauze. Autologous microskin was transported onto the dermis of fresh large piece of allogeneic scalp by traditional floating method. Bilateral extremities with full-thickness burn of two patients were selected for self-control. The left upper extremity was denoted as treatment group while the right upper extremity was denoted as control group in Patient 1. The right lower extremity was denoted as treatment group while the left lower extremity was denoted as control group in Patient 2. Wounds in the treatment group were treated with fresh large piece of allogeneic scalp spliced by Meek glue and autologous microskin with expansion ratio of 1∶15 after escharectomy, while wounds in control group received grafting of Meek miniature skin with expansion ratio of 1∶6 and or 1∶9 after escharectomy. The donors of allogeneic scalp were 32 males who were the relatives or friends of the patients, aged 21-50 years, with scalp area of (548±48) cm(2). The healing conditions of donor sites of scalp were observed on post operation day 10, and were followed up within 3 months after operation to observe whether forming alopecia and hypertrophic scar or not. Wound healing condition was evaluated during follow-up in post operation week (POW) 2-5 and 4 months after operation. Wound coverage rates were calculated in both treatment and control groups in POW 2, 3, 4, and 5. Results: The donor sites of all allogeneic scalp of donors healed completely on post operation day 10. There was no alopecia or hypertrophic scar within 3 months after operation for follow-up. In POW 2, allogeneic scalp grafts basically survived in treatment group without obvious exudation, and most of the Meek miniature skin survived in control group with obvious exudation. Part of allogeneic scalp grafts dissolved and detached in treatment group in POW 3, and the surviving grafts scabbed. The eschar detached and new epithelium was observed in treatment group in POW 4 and 5. In POW 3-5, surviving Meek miniature skin in control group creeped and was incorporated, and the wounds shrank. Hypertrophic scar was observed in both treatment and control groups 4 months after operation, without obvious difference in scar as a whole. The wound coverage rates were respectively 84%-98% and 76%-92% in treatment group of two patients in POW 2-5, close to or higher than those of control group (35%-97% and 28%-81%, respectively). Conclusions: The study establishes a novel method for splicing fresh allogeneic scalps into a large piece as the covering of microskin, which has good effect for repairing extensively deep burn wounds. Considering that allogeneic skin is scarce, this method may be a new option in clinical treatment for extensively deep burn patients.


Assuntos
Queimaduras/cirurgia , Couro Cabeludo , Transplante de Pele/métodos , Cicatrização , Adulto , Extremidades , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Pele/patologia , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
20.
Anticancer Res ; 39(5): 2459-2466, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092440

RESUMO

BACKGROUND/AIM: This study aimed to identify the prognostic factors and outcomes of osteosarcoma (OS) located in proximal versus distal extremity long bones. PATIENTS AND METHODS: A nationwide cohort comprising all Norwegian high-grade OSs in extremity long bones between 1982 and 2009 was investigated. RESULTS: The univariate analysis results identified no significant differences in survival between patients with OS in proximal long bones (101 cases) as a group in comparison to patients with OS in the distal part of these bones (120 cases). However, proximal femur and primary metastasis were both independent adverse prognostic factors for sarcoma-specific survival in multivariate analyses, while elevated LDH and secondary OS were inferior prognostic factors for event-free survival. Adequate surgery and chemotherapy had a positive impact on survival. CONCLUSION: OS of the proximal femur had an unfavorable outcome in comparison to OS in other anatomical locations in extremity long bones.


Assuntos
Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/fisiopatologia , Extremidades/fisiopatologia , Osteossarcoma/fisiopatologia , Prognóstico , Adolescente , Adulto , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Osteossarcoma/epidemiologia , Adulto Jovem
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