Prognostic factors of recurrence after an intralesional excision of benign bone tumour in the peripheral skeleton

Background: Most aggressive benign bone tumours are treated surgically by an intralesional excision and bone defect filling. The primary aim of our study was to evaluate prognostic factors of recurrence after an intralesional excision of a benign bone tumour in the peripheral skeleton. We asked whether patient age and gender, maximal tumour diameter, histological diagnosis, and the tumour’s location statistically significantly impact postoperative tumour recurrences. The secondary aim was to evaluate preoperative differences between different histopathological groups of benign bone tumours and the impact of age and gender, maximal tumour diameter, histological diagnosis, and the tumour location on the number of diagnostic biopsies and curative surgical procedures. Methods: Retrospective analysis of prospectively collected data included a cohort of patients operated on at a single tertiary tumour centre between 2010 and 2020 with at least one-year follow-up. Ordinal logistic regression was used to assess the influence of input variables on the number of diagnostic/curative surgical procedures and postoperative recurrences. Results: The cohort analysis included 261 patients with 61 local recurrences. The risk of tumour recurrence was significantly lower with higher patient age (p = 0.001) and tumour location in the distal femur (p = 0.033). Higher number of diagnostical procedures correlated with higher patient age (p = 0.028), larger maximal tumour diameter (p = 0.035) and connective tissue tumour diagnosis (p = 0.027). Higher number of curative procedures correlated with larger maximal tumour diameter (p = 0.008) and lower patient age (p = 0.001). Conclusions: Preoperative features of benign bone tumours significant impact the number of surgical procedures needed to treat the tumour and the risk of postoperative recurrence. Although most of these factors are nonmodifiable, they represent an incentive to create evidence-based guidelines for biopsy indications, surgical techniques and consistent postoperative follow-up

Case Report: Non-ossifying fibromas with pathologic fractures in a patient with NONO-associated X-linked syndromic intellectual developmental disorder

The NONO gene encodes a nuclear protein involved in transcriptional regulation, RNA synthesis and DNA repair. Hemizygous loss-of function, de novo or maternally inherited variants in NONO have been associated with an X-linked syndromic intellectual developmental disorder-34 (OMIM # 300967), characterized by developmental delay, intellectual disability, hypotonia, macrocephaly, elongated face, structural abnormalities of corpus callosum and/or cerebellum, congenital heart defect and left ventricular non-compaction cardiomyopathy. Few patients have been described in the literature and the phenotype data are limited. We report a 17-year-old boy with dolihocephaly, elongated face, strabismus, speech and motor delay, intellectual disability, congenital heart defect (ASD, VSD and Ebstein’s anomaly), left ventricular non-compaction cardiomyopathy, bilateral inguinal hernia and cryptorchidism. Additional features included recurrent fractures due to multiple non-ossifying fibromas, thrombocytopenia, and renal anomalies. Exome sequencing revealed a de novo pathogenic variant (NM_001145408.2: c.348+2_ 348+15del) in intron 5 of the NONO gene. Renal anomalies and thrombocytopenia have been rarely reported in patients with NONO—X-linked intellectual disability syndrome, while recurrent fractures due to multiple non-ossifying fibromas have not previously been associated with this syndrome. The phenotypic spectrum of NONO—X-linked intellectual disability syndrome may be broader than currently known

Diagnostična obravnava in zdravljenje enhondromov

Enhondromi so benigni intramedularni tumorji iz zrelega hialinega hrustanca, ki obsegajo 10–25 % vseh benignih kostnih tumorjev. Kot naključna najdba brez simptomov so prisotni pri 2–3 % magnetnoresonančnih preiskavah kolen in ramen. Članek predstavi enhondrome z vidika epidemiologije, klinične slike, slikovne diagnostike, diferencialne diagnostike, indikacij za biopsijo, histopatologije, kliničnega spremljanja in zdravljenja. Naključno odkritih intramedularnih solitarnih enhondromov dolgih kosti brez izraženih simptomov v večini primerov ni treba zdraviti, tveganje za kasnejšo maligno alteracijo pa je manjše od 1 %. Enhondrome v malih kosteh rok in nog se zdravi z ekskohleacijsko biopsijo zaradi možnosti patološkega zloma. Hrustančne spremembe, ki rastejo, povzročajo bolečine ali imajo po slikovnih preiskavah t.i. agresivne značilnosti, zahtevajo obravnavo v terciarni ustanovi in odločitev glede indikacij za biopsijo, opazovanje, izpraznitev ali izrez. Najtežji klinični izziv je razločevanje pogostih enhondromov od redkih atipičnih hrustančnih tumorjev in še redkejših hondrosarkomov, pri čemer pa so nam v oporo smernice BACTIP

Patient survival after surgical resection of pelvic bone sarcomas: A nationwide cohort study

Background: Pelvic bone sarcomas are extremely rare malignant tumours. Patients require a multidisciplinary approach to plan the treatment and complex surgical resections and limb-sparing reconstructions associated with complications, revisions, and functional limitations. The presented nationwide study in the Republic of Slovenia aims to analyse the oncological survival and functional outcomes of patients after primary resection of pelvic bone sarcomas. Methods: The retrospective observational cohort included 21 consecutive patients who underwent limb-sparing pelvic resection at a specialized orthopaedic oncology centre in the Republic of Slovenia between 2004-2022. Patient survival, complication rates, and functional outcomes were analysed according to to the primary diagnosis. Results: Wide margins with R0 resection were achieved in 16 (76%) cases. After a median follow-up of 5.7 (0.6-18.1) years, 7 (33%) patients died of oncological disease, 3 (14%) patients were alive with oncological disease, and 11 (53%) patients were alive with no evidence of disease. The estimated Kaplan-Meier survival probability at 2 years, 5 years, and 10 years after pelvic resection was 85%, 73%, and 45%, respectively. The major complication rate was 29%. The mean Musculoskeletal Tumour Society Score was 17.5 (range 2-29). Conclusions: Patient survival after resection of pelvic bone sarcomas in Slovenia between 2004-2022 is comparable to previously published reports of European and North American countries. Wide resection of tumours with reconstruction provides a relatively good survival rate, although complications are common and functional outcomes are often poor

Utjecaj poslijeoperacijske epiduralne analgezije na poslijeoperacijsku bol i stresni odgovor nakon veće operacije kralježnice – randomizirano kontrolirano dvostruko slijepo ispitivanje

Major spinal surgery is associated with severe postoperative pain and stress response, bowel dysfunction, and a potential for chronic pain development. Epidural analgesia has been shown to be advantageous compared to intravenous analgesia alone. The aim of the study was to investigate whether postoperative addition of epidural levobupivacaine to intravenous opioid analgesia offers advantage over intravenous opioid analgesia alone. Eighty-one patients scheduled for spinal fusion were enrolled in the study and randomized into two groups. Postoperatively, group A received 0.125% epidural levobupivacaine and group B received saline. Both groups also received intravenous piritramide as a rescue analgesic. Pain intensity, rescue analgesic consumption, blood glucose, cholesterol and cortisol levels, postoperative blood loss, paresthesia, time to first postoperative defecation, and length of hospital stay were recorded. Sixty-eight patients completed the study. The visual analog scale score (mean 2 vs. 4, p=0.01), consumption of piritramide (25 mg vs. 51.5 mg, p=0.01) and metamizole (1400 vs. 1875 mg, p<0.01), incidence of nausea (6% vs. 28% p=0.02) and blood loss (450 mL vs. 650 mL, p<0.05) were significantly lower in group A. Bowel recovery and first postoperative defecation also occurred earlier in group A (6% vs. 45%, p<0.01). Blood cortisol, glucose and cholesterol levels and the incidence of paresthesia did not differ between the groups. In conclusion, after spinal fusion, postoperative epidural administration of levobupivacaine provides better analgesia and fewer side effects with no impact on stress response.Cilj naše studije je bio usporediti poslijeoperacijsku epiduralnu analgeziju s intravenskom analgezijom piritramidom koju bolesnik kontrolira sam (patient controlled analgesia, PCA). Ocjenjivali smo poslijeoperacijske bolove i stresni odgovor. U ovu prospektivnu randomiziranu dvostruko slijepu studiju bio je uključen 81 bolesnik u razdoblju od srpnja 2007. Do studenoga 2010. godine. Bolesnici su bili podijeljeni u skupinu A koja je dobila levobupivakain kroz epiduralni kateter i skupinu B koja je istim putem dobivala fiziološku otopinu za poslijeoperacijsku analgeziju. Obje skupine su poslijeoperacijski dobile piritramid putem PCA pumpe. Poslijeoperacijski smo ocjenjivali bolove prema vizualno analognoj ljestvici (VAS), potrošnju analgetika, koncentraciju glukoze, kolesterola i kortizola u krvi, gubitak krvi, peristaltiku, razdoblje do prve defekacije i trajanje boravka u bolnici. Na kraju studije bilo je uključeno 68 bolesnika. Ocjena bolova prema VAS, potrošnja piritramida, metamizola, incidencija mučnine i gubitak krvi su bili značajno niži u skupini A (p<0,05). Peristaltika i prva poslijeoperacijska defekacija su se pojavile ranije u skupini A (p<0,01). Među skupinama nije bilo razlike u koncentraciji kortizola, kolesterola i glukoze u krvi. Nakon operacije kralježnice epiduralni levobupivakain je omogućio bolju poslijeoperacijsku analgeziju i manje nuspojava, manji gubitak krvi i raniji povratak crijevne funkcije u usporedbi s intravenskom analgezijom piritramidom

Utjecaj poslijeoperacijske epiduralne analgezije na poslijeoperacijsku bol i stresni odgovor nakon veće operacije kralježnice – randomizirano kontrolirano dvostruko slijepo ispitivanje

Major spinal surgery is associated with severe postoperative pain and stress response, bowel dysfunction, and a potential for chronic pain development. Epidural analgesia has been shown to be advantageous compared to intravenous analgesia alone. The aim of the study was to investigate whether postoperative addition of epidural levobupivacaine to intravenous opioid analgesia offers advantage over intravenous opioid analgesia alone. Eighty-one patients scheduled for spinal fusion were enrolled in the study and randomized into two groups. Postoperatively, group A received 0.125% epidural levobupivacaine and group B received saline. Both groups also received intravenous piritramide as a rescue analgesic. Pain intensity, rescue analgesic consumption, blood glucose, cholesterol and cortisol levels, postoperative blood loss, paresthesia, time to first postoperative defecation, and length of hospital stay were recorded. Sixty-eight patients completed the study. The visual analog scale score (mean 2 vs. 4, p=0.01), consumption of piritramide (25 mg vs. 51.5 mg, p=0.01) and metamizole (1400 vs. 1875 mg, p<0.01), incidence of nausea (6% vs. 28% p=0.02) and blood loss (450 mL vs. 650 mL, p<0.05) were significantly lower in group A. Bowel recovery and first postoperative defecation also occurred earlier in group A (6% vs. 45%, p<0.01). Blood cortisol, glucose and cholesterol levels and the incidence of paresthesia did not differ between the groups. In conclusion, after spinal fusion, postoperative epidural administration of levobupivacaine provides better analgesia and fewer side effects with no impact on stress response.Cilj naše studije je bio usporediti poslijeoperacijsku epiduralnu analgeziju s intravenskom analgezijom piritramidom koju bolesnik kontrolira sam (patient controlled analgesia, PCA). Ocjenjivali smo poslijeoperacijske bolove i stresni odgovor. U ovu prospektivnu randomiziranu dvostruko slijepu studiju bio je uključen 81 bolesnik u razdoblju od srpnja 2007. Do studenoga 2010. godine. Bolesnici su bili podijeljeni u skupinu A koja je dobila levobupivakain kroz epiduralni kateter i skupinu B koja je istim putem dobivala fiziološku otopinu za poslijeoperacijsku analgeziju. Obje skupine su poslijeoperacijski dobile piritramid putem PCA pumpe. Poslijeoperacijski smo ocjenjivali bolove prema vizualno analognoj ljestvici (VAS), potrošnju analgetika, koncentraciju glukoze, kolesterola i kortizola u krvi, gubitak krvi, peristaltiku, razdoblje do prve defekacije i trajanje boravka u bolnici. Na kraju studije bilo je uključeno 68 bolesnika. Ocjena bolova prema VAS, potrošnja piritramida, metamizola, incidencija mučnine i gubitak krvi su bili značajno niži u skupini A (p<0,05). Peristaltika i prva poslijeoperacijska defekacija su se pojavile ranije u skupini A (p<0,01). Među skupinama nije bilo razlike u koncentraciji kortizola, kolesterola i glukoze u krvi. Nakon operacije kralježnice epiduralni levobupivakain je omogućio bolju poslijeoperacijsku analgeziju i manje nuspojava, manji gubitak krvi i raniji povratak crijevne funkcije u usporedbi s intravenskom analgezijom piritramidom

Smernice za diagnostiko, zdravljenje in sledenje bolnikov s sarkomi mehkih tkiv in kosti

no abstractni abstrakt

Additional file 1: of Geometric analysis of indications for minimally invasive distal metatarsal osteotomy in treatment of hallux valgus

Freeware computer program - MIDMO. A freeware computer program in .XLS format allows preoperative planning of MIDMO in individual patients. The required input parameters include measurements of α, W, E, L and x from anetrior-posterior standing radiograph of the foot. (XLS 27 kb

Clinical and laboratory predictors for prosthetic joint infection within the first postoperative days following primary total hip and knee arthroplasty

Purpose To identify clinical and laboratory predictors for low- and high-grade prosthetic joint infection (PJI) within the first postoperative days following primary total hip/knee arthroplasty (THA/TKA). Methods Institutional bone and joint infection registry of a single osteoarticular infection referral centre was reviewed to identify all osteoarticular infections treated between 2011 and 2021. Among them were 152 consecutive PJI (63 acute high-grade PJI, 57 chronic high-grade PJI, and 32 low-grade PJI) who also had primary THA/TKA performed at the same institution, which were retrospectively analyzed with multivariate logistic regression and covariables. Results For each additional day of wound discharge, persistent wound drainage (PWD) predicted PJI in the acute high-grade PJI group with odds ratio (OR) 39.4 (p = 0.000, 95%CI 1.171–1.661), in the low-grade PJI group with OR 26.0 (p = 0.045, 95%CI 1.005–1.579), but not in the chronic high-grade PJI group (OR 16.6, p = 0.142, 95%CI 0.950–1.432). The leukocyte count product of pre-surgery and POD2 >100 predicted PJI in the acute high-grade PJI group (OR 2.1, p = 0.025, 95%CI 1.003–1.039) and in the chronic high-grade PJI group (OR 2.0, p = 0.018, 95%CI 1.003–1.036). Similar trend was also seen in the low-grade PJI group, but was not statistically significant (OR 2.3, p = 0.061, 95%CI 0.999–1.048). Conclusions The most optimal threshold value for predicting PJI was observed only in the acute high-grade PJI group, where PWD >three days after index surgery yielded 62.9% sensitivity and 90.6% specificity, whereby the leukocyte count product of pre-surgery and POD2 >100 showed 96.9% specificity. Glucose, erythrocytes, hemoglobin, thrombocytes, and CRP showed no significant value in this regard