Surgical treatment of central grade 1 chondrosarcoma of the appendicular skeleton.

Diagnosis and treatment of low-grade chondrosarcoma remain controversial. We performed a review of a single-center series with the aims of assessing the oncologic outcome of these patients, verifying if intralesional curettage can be adequate treatment, and defining clinical criteria to support the surgeon and the oncologist in decision-making for surgery and subsequent follow-up

How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient populations.

Abstract BACKGROUND: We recently developed a clinical decision support tool, capable of estimating the likelihood of survival at 3 and 12 months following surgery for patients with operable skeletal metastases. After making it publicly available on www.PATHFx.org , we attempted to externally validate it using independent, international data. METHODS: We collected data from patients treated at 13 Italian orthopaedic oncology referral centers between 2010 and 2013, then applied to PATHFx, which generated a probability of survival at three and 12-months for each patient. We assessed accuracy using the area under the receiver-operating characteristic curve (AUC), clinical utility using Decision Curve Analysis (DCA), and compared the Italian patient data to the training set (United States) and first external validation set (Scandinavia). RESULTS: The Italian dataset contained 287 records with at least 12 months follow-up information. The AUCs for the three-month and 12-month estimates was 0.80 and 0.77, respectively. There were missing data, including the surgeon's estimate of survival that was missing in the majority of records. Physiologically, Italian patients were similar to patients in the training and first validation sets. However notable differences were observed in the proportion of those surviving three and 12-months, suggesting differences in referral patterns and perhaps indications for surgery. CONCLUSIONS: PATHFx was successfully validated in an Italian dataset containing missing data. This study demonstrates its broad applicability to European patients, even in centers with differing treatment philosophies from those previously studied

Mesenchymal chondrosarcoma: prognostic factors and outcome in 113 patients. A European Musculoskeletal Oncology Society study

BACKGROUND: Mesenchymal chondrosarcoma (MCS) is a distinct, very rare sarcoma with little evidence supporting treatment recommendations. PATIENTS AND METHODS: Specialist centres collaborated to report prognostic factors and outcome for 113 patients. RESULTS: Median age was 30 years (range: 11-80), male/female ratio 1.1. Primary sites were extremities (40%), trunk (47%) and head and neck (13%), 41 arising primarily in soft tissue. Seventeen patients had metastases at diagnosis. Mean follow-up was 14.9 years (range: 1-34), median overall survival (OS) 17 years (95% confidence interval (CI): 10.3-28.6). Ninety-five of 96 patients with localised disease underwent surgery, 54 additionally received combination chemotherapy. Sixty-five of 95 patients are alive and 45 progression-free (5 local recurrence, 34 distant metastases, 11 combined). Median progression-free survival (PFS) and OS were 7 (95% CI: 3.03-10.96) and 20 (95% CI: 12.63-27.36) years respectively. Chemotherapy administration in patients with localised disease was associated with reduced risk of recurrence (P=0.046; hazard ratio (HR)=0.482 95% CI: 0.213-0.996) and death (P=0.004; HR=0.445 95% CI: 0.256-0.774). Clear resection margins predicted less frequent local recurrence (2% versus 27%; P=0.002). Primary site and origin did not influence survival. The absence of metastases at diagnosis was associated with a significantly better outcome (P<0.0001). Data on radiotherapy indications, dose and fractionation were insufficiently complete, to allow comment of its impact on outcomes. Median OS for patients with metastases at presentation was 3 years (95% CI: 0-4.25). CONCLUSIONS: Prognosis in MCS varies considerably. Metastatic disease at diagnosis has the strongest impact on survival. Complete resection and adjuvant chemotherapy should be considered as standard of care for localised disease

Soluble proteins of chemical communication: an overview across arthropods

Detection of chemical signals both in insects and in vertebrates is mediated by soluble proteins, highly concentrated in olfactory organs, which bind semiochemicals and activate, with still largely unknown mechanisms, specific chemoreceptors. The same proteins are often found in structures where pheromones are synthesised and released, where they likely perform a second role in solubilising and delivering chemical messengers in the environment.A single class of soluble polypeptides, called Odorant-Binding Proteins (OBPs) is known in vertebrates, while two have been identified in insects, OBPs and CSPs (Chemosensory Proteins). Despite their common name, OBPs of vertebrates bear no structural similarity with those of insects. We observed that in arthropods OBPs are strictly limited to insects, while a few members of the CSP family have been found in crustacean and other arthropods, where however, based on their very limited numbers, a function in chemical communication seems unlikely.The question we address in this review is whether another class of soluble proteins may have been adopted by other arthropods to perform the role of OBPs and CSPs in insects. We propose that lipid-transporter proteins of the Niemann-Pick type C2 family could represent likely candidates and report the results of an analysis of their sequences in representative species of different arthropods

"Pelvic Resections: The Rizzoli Institute Experience"

Materials, methods, and techniques of pelvic resections are discussed. Results, including the complications of nerve damage, infection, and vascular, visceral, and reconstructive complications are tabulated

Osteofibrodisplasia de Campanacci

La osteofibrodisplasia regresiva de los huesos largos o displasia de Campanacci fue descrita por primera vez como entidad clínica autónoma por Campanacci en 1976. Es una enfermedad benigna que aparece sobre todo en niños menores de 10 años y afecta a la tibia y al peroné. La lesión se caracteriza por una osteólisis excéntrica intracortical que puede acompañarse de una incurvación anterior o en varus-valgus de la diáfisis. El examen histológico muestra una proliferación de tejido fibroso que engloba una red de finas trabéculas óseas, rodeada de osteoblastos activos. La inmunohistoquímica es positiva, en el 85 % de los casos, con anticuerpos anticitoqueratinas. Este fenómeno ha permitido que algunos autores subrayen la similitud de la enfermedad con el adamantinoma. La patogenia de la osteofibrodisplasia y su diagnóstico diferencial con el adamantinoma son objeto de numerosas discusiones. La lesión evoluciona generalmente hacia una curación espontánea tras la pubertad. La tasa de recidiva es muy elevada en los casos tratados quirúrgicamente antes de los 10 años. Por esta razón, la mejor actitud antes de esta edad es el control. La intervención quirúrgica sólo está indicada en las osteofibrodisplasias altamente agresivas y en los casos que se acompañan de importantes deformaciones esqueléticas o con riesgo de fractura patológica

Differenti tipi di trapianti omoplastici e loro indicazioni

Viene discussa la cinetica di riabilitazione degli innesti ossei omeoplastici. Vengono illustrate le modificazioni sulla immunologia, capacità osteoinduttive e resistenza meccanica degli innesti dovute alle varie tecniche di procesazione,sterilizzazione e conservazione degli stessi

Prothèse de coude pour tumeur

Prothèse de coude pour tumeu