[Primary retrofascial abscess in the iliopsoas muscle caused by salmonella enteritidis.]. / Primární retrofasciální absces iliopsoatického svalu zpusobený Salmonelou enteritidis.

This case report and review of literature demonstrates a rare entity of a primary retrofascial abscess in the iliopsoas muscle caused by Salmonella enteritidis, that progressed into the iliac fossa. It is of importance to the orthopedic surgeon in his differential diagnosis of hip pain and vertebrogenic disorders. It can also resemble other infectious diseases or tumors as it occurs mainly in young or imunosuppressed individuals. The primary and secondary etiology of this disease and it's different names are discussed together with the underlying bacteria. Clinical, laboratory and radiological findings are compared as well as the outcome of different types of treatment. When clinically suspecting this disease it is useful to confirm it with sonography and then perform CT scans for accurate planing of surgery. n the initial phase a CT guided drainage together with antibiotics and exceptionally only conservative treatment can cure the patient. In delayed cases it is necessary to preform an open drainage and cases with fatal outcomes have also been reported mainly in secondary abscesses. If early diagnosed and properly treated, this disease can be easily managed, therefore we have to keep it in mind in our differential diagnosis of indicated cases. Key words: primary pyogenic retrofascial abscess of the iliopsoas muscle, iliac fossa abscess, nontuberculous psoas abscess, psoitis, Salmonella enteritidis, clinical diagnosis, radiological diagnosis, surgical treatment, antibiotic treatment, ethiology.

[Osteosarcoma - Clinical, Radiological and Histologic Evaluation of Preoperative Chemotherapy in Correlation with Long-term Survival.]. / Osteosarkom - klinické, radiologické a histologické hodnocení úcinku predoperacní chemoterapie ve vztahu k dlouhodobému prezívání nemocných.

This paper evaluates the clinical, radiological and histomorphologic effect of neoadjuvant chemotherapy in 37 patients with II B osteosarcomas. The results are compared according to the type of surgery, local recurrence and lung metastasis at a minimal follow up of five years in patients who underwent surgery at the orthopedic clinic in Prague Bulovka in 1982 - 1992. All patients continued with adjuvant chemotherapy after surgery. Bad clinical response (increase of circumference, decrease in range of motion and increase of pain) correlated with the bad histologic response evaluated according to the COSS criteria. Accurate evaluation of a complete radiological documentation (tumor calcification on plain radiographs and CT scans, decrease of tumor volume on plain radiographs and CT scans or MRI and the disappearance of pathologic vascularisation) can quite precisely estimate a good response to preoperative chemotherapy and indicate limb sparing surgery. The radiological evaluation, especially of an incomplete record, does not always fully correlate with the histomorphologic response. Good prognosis for long term survival was observed in patients with a more then 80% tumor cell necrosis. CT scans or MRI performed immediately before the beginning and at the end of preoperative chemotherapy are necessary for a reliable evaluation of tumor calcification and intramedullar tumor spread. The persistence or disappearance of pathologic vascularisation seems to be the most significant marker to evaluate residual vital tumor cells. A good radiological response enables a safe indication for a limb sparing procedure as an alternative to amputation. The radiological evaluation must be correlated with different histomorphologic osteosarcoma subtypes as well as with possible changes, especially in vascularisation, due to an incorrect biopsy or pathologic fracture. Key words: osteosarcoma, neoadjuvant chemotherapy, long term survival, indication for limb salvage.