The Use of Iliac Stem Prosthesis for Acetabular Defects following Resections for Periacetabular Tumors

Introduction. The management of pelvic tumors is a challenge for orthopaedic oncologists due to the complex anatomy of the pelvis and the need to have extensive exposure. Various reconstructive techniques have been proposed with poor functional results and a high percentage of complications. Our purpose is to determine the functional results and the rate of complications of iliac stem prosthesis for acetabular defects following resections for periacetabular tumors. Materials and Methods. Between 1999 and 2012, 45 patients underwent pelvic resections for periacetabular bone tumors followed by reconstruction with stem cup prosthesis. The most common diagnosis was CS (chondrosarcoma, 29 cases), followed by OS (osteosarcoma, 9 cases) and metastasis (3 cases). In 33 cases, this implant was associated with massive bone allografts. Minimum follow-up required to evaluate functional outcome was 2 years. We classified pelvic resections according to Enneking and Dunham’s classification and we used MSTS (musculoskeletal tumor system) score to evaluate functional outcomes. Results and Discussion. Sixteen patients died of their disease, three were lost to follow-up, four are alive with disease, and twenty-two are alive with no evidence of disease. Fifteen patients had local recurrence. Sixteen patients had bone or lung metastasis. We have had 6 infections, 2 aseptic loosening, and 2 cases of hip dislocation. Iliac sovracetabular osteotomy was fused in all cases at 10 months from surgery. Functional results were good or excellent in 25 of 31 patients with long-term follow-up (77%), with a percentage similar to that reported in the literature. Conclusion. The use of iliac stem prosthesis is a simple reconstructive technique that reduces operative times and risk of infection. It allows having good results and low rate of complications, but it should be performed in selected cases and centres of reference

Ground-breaking Exoplanet Science with the ANDES spectrograph at the ELT

In the past decade the study of exoplanet atmospheres at high-spectral resolution, via transmission/emission spectroscopy and cross-correlation techniques for atomic/molecular mapping, has become a powerful and consolidated methodology. The current limitation is the signal-to-noise ratio during a planetary transit. This limitation will be overcome by ANDES, an optical and near-infrared high-resolution spectrograph for the ELT. ANDES will be a powerful transformational instrument for exoplanet science. It will enable the study of giant planet atmospheres, allowing not only an exquisite determination of atmospheric composition, but also the study of isotopic compositions, dynamics and weather patterns, mapping the planetary atmospheres and probing atmospheric formation and evolution models. The unprecedented angular resolution of ANDES, will also allow us to explore the initial conditions in which planets form in proto-planetary disks. The main science case of ANDES, however, is the study of small, rocky exoplanet atmospheres, including the potential for biomarker detections, and the ability to reach this science case is driving its instrumental design. Here we discuss our simulations and the observing strategies to achieve this specific science goal. Since ANDES will be operational at the same time as NASA's JWST and ESA's ARIEL missions, it will provide enormous synergies in the characterization of planetary atmospheres at high and low spectral resolution. Moreover, ANDES will be able to probe for the first time the atmospheres of several giant and small planets in reflected light. In particular, we show how ANDES will be able to unlock the reflected light atmospheric signal of a golden sample of nearby non-transiting habitable zone earth-sized planets within a few tenths of nights, a scientific objective that no other currently approved astronomical facility will be able to reach.Comment: 66 pages (103 with references) 20 figures. Submitted to Experimental Astronom

Vascularized fibular autograft as salvage technique in failure of allograft intercalary reconstructions after tumor resections

Intercalary allografts after diaphyseal resections for bone tumors represent the most frequent option of reconstruction. Main complications are non-unions, fractures and infections. The purpose of the current study was to report our experience with the use of vascularized fibular autograft as rescue technique in failed previous reconstructions after intercalary bone tumor resection of the extremities. Twenty-eight patients were followed over time. Causes of failure were non-union, allograft fracture and infection. Vascularized fibular autograft was used with mechanical support of massive bone allograft in 13 cases. Functional results were excellent in 19 cases, good in 8 and fair in one patient. Among complications we reported 4 non-unions, 2 allograft fractures, 1 non-union with plate breakage, 1 plate breakage, 1 infection, 1 limb shortening and 1 knee varus deformity. The rationale of vascularized fibular autograft is to provide biologic support. The association with massive bone allograft provides mechanical strength and early stability

Multidisciplinary approach to osteosarcoma

Osteosarcoma is a malignant bone tumor composed of mesenchymal cells producing osteoid and immature bone. Osteosarcoma is the most frequent primary malignant bone tumor, if we excluded myeloma, a haematologic disease.The incidence of osteosarcoma is 2–3/million/year, but is higher in adolescence, in which the annual incidence peaks at 8–11/million/year at 15–19 years of age.Local pain, followed by localized swelling and limitation of joint movement, are the typical signs and symptoms.  Correct diagnosis can be achieved through a correct approach to the disease and the combination of clinical and radiographic aspects. The final step to confirm the diagnosis is the biopsy.Computer Tomography of the chest and Positron-Emission Tomography are mandatory to complete the staging, which is performed according the Musculoskeletal Tumor Society staging system.A multidisciplinary approach is needed both to get to a correct diagnosis (orthopaedic surgeon, radiologist and histopathologist) and to perform definitive treatment. Multidisciplinary approach should be performed in reference centers able to provide access to the full spectrum of care and where orthopaedic surgeon, oncologist, histopathologist, radiologist and radiotherapist can cooperate.

Bi-unicompartmental versus total knee arthroplasty: long term results

Objectives. The hypothesis of the current study is that Bi-Unicompartmental knee arthroplasty (Bi-Uni) could have long term outcomes equivalent to totl knee arthroplasty (TKA).Methods. A total of 19 patients treated from January 1999 to March 2003 with the simultaneous implantation of 2 Unicompartmental knee arthroplasties (UKA) were matched with 18 patients who had undergone a computer-assisted TKA for bicompartmental tibio-femoral osteoarthritis of the knee between August 1999 and September 2002.Results. At the last follow-up no statistical significant differences were seen for KSS, Function score and WOMAC Arthritis Index (pain score), while statistical differences were reported for the function (p<0.05) and stiffness (p<0.01) WOMAC indexes, respectively, in favor of the Bi-Uni group.Conclusion. The results of this study indicate that Bi-Uni is a valid alternative to address medial and lateral tibio-femoral osteoarthritis of the knee in selected cases at least as well as TKA

Benchmarking on managerial practices: a tool for SMEs

Purpose \u2013 Literature and practice highlight the need to stimulate processes of qualitative growth in SMEs. The aim of the research presented in this paper is to identify a type of benchmarking and a benchmarking tool which can support the qualitative growth of these companies. Design/methodology/approach \u2013 During the study, literature review and empirical research had been carried out and further information was gathered by means of workshops and interviews to experts. Finally, the achieved results were tested on a sample of eight Italian SMEs. Findings \u2013 Approaches to benchmarking were reviewed and classified; synthetic benchmarking based on managerial practices was chosen as the most appropriate approach to stimulate improvement and qualitative growth in SMEs; moreover a tool for synthetic benchmarking on managerial practices tool was developed. Practical implications \u2013 The research has practical implication; it provides SMEs with adequate tool and methodology able to support the development of management system. The tool is able to allow SMEs to learn best managerial practices, assess itself with respect to these practices and at the same time understand what must be done to carry out improvement. Originality/value \u2013 The developed tool has a general validity, it does not consider particular situation, but if some codified practices are not applicable to a specific company, it is possible to rule out these practices without compromising the effectives of the tool

Scapular reconstructions after resection for bone tumors: A single-institution experience and review of the literature

Scapulectomy and limb-salvage surgery are indicated for low and high-grade tumors of the scapula and soft-tissue sarcomas that secondary invade the bone. After total or partial scapulectomy there are 3 options of reconstruction: humeral suspension (flail shoulder), total endoprosthesis and massive bone allograft. Nowadays prosthesis and allograft reconstructions are the most used and humeral suspension is reserved only as salvage technique when no other surgery is possible. Several studies reported dislocations and wound infections as the most frequent complications of scapular prosthesis, account for 10-20%. Recently, in the attempt to prevent these complications, some authors have used homologous allografts to replace shoulder girdle after scapulectomy for bone tumors, avoiding common complications of scapular prosthesis. Scapular reconstruction following tumor resection is a safe procedure and can be performed with good functional, oncological and cosmetic results but in reference centres and by skill surgeons. In this paper we present three cases of scapular reconstructions following resections for scapular tumors (chondrosarcoma in all cases) performed in our Institute and we analyse the different options of reconstruction described in the current literature. The final message is to send these rare tumors to reference centres where a multidisciplinary team is able to treat these rare entities and where a group of skill oncology surgeons are able to plan this complex surgery