55 research outputs found
Trasplante óseo
We describe the methodology of the Bone and Soft Tissue
Bank, from extraction and storage until use.
Since the year 1986, with the creation of the Bone Bank
in the University Clinic of Navarra, more than 3,000 grafts
have been used for very different types of surgery.
Bone grafts can be classified into cortical and
spongy; the former are principally used in surgery to save
tumour patients, in large post-traumatic reconstructions
and in replacement surgery where there are massive
bone defects and a structural support is required. The
spongy grafts are the most used due to their numerous
indications; they are especially useful in filling cavities
that require a significant quantity of graft when the autograft
is insufficient, or as a complement. They are also of
special help in treating fractures when there is bone loss
and in the treatment of delays in consolidation and
pseudoarthrosis in little vascularized and atrophic zones.
They are also used in prosthetic surgery against the presence
of cavity type defects.
Allografts of soft tissues are specially recognised in
multiple ligament injuries that require reconstructions.
Nowadays, the most utilised are those employed in surgery
of the anterior cruciate ligament although they can be used
for filling any ligament or tendon defect.
The principal difficulties of the cortical allografts are
in the consolidation of the ends with the bone itself and in
tumour surgery, given that these are patients immunodepressed
by the treatment, the incidence of infection is
increased with respect to spongy grafts and soft tissues,
which is irrelevant.
In short, the increasingly widespread use of allografts
is an essential therapeutic weapon in orthopaedic
surgery and traumatology. It must be used by expert
hands
Fractures of allografts used in limb preserving operations
One hundred and thirty-seven allografts used since 1986 in limb preserving
operations for malignant bone tumours were reviewed. The follow up was longer
than two years. There were fourteen fractures (10.2%) in twelve patients at a
mean time of 22 months from the operation. Most of them were in the metaphyseal
area and were related to perforations of the allograft made for stabilisation
with plates, for tendon and ligament reattachment, or any other hole in the
allograft. Fractures occurred always after the allograft-host junction was
united. Healing was achieved in 7 cases by internal fixation with autologous bone
grafting in a mean of 5 months. In cases of multiple fractures of the allograft,
the graft was exchanged. We recommend using intramedullary fixation in order to
reduce the incidence of allograft fracture, and the use of internal fixation,
with intramedullary whenever possible, and autologous bone grafting to achieve
consolidation of the fractures
Consolidation of massive bone allografts in limb-preserving operations for bone tumours
This study analysed the influence of several factors affecting the consolidation time of 83 massive bone allografts in 79 patients with malignant bone tumours: osteosarcoma 57; Ewing's sarcoma 8; malignant fibrous histiocytoma 3; chondrosarcoma 4; fibrosarcoma 5; and giant cell tumours 2. The mean age of the patients was 19 years and the mean length of the allografts was 18 cm. The minimum follow up was for 12 months. The mean consolidation time for metaphyseal and diaphyseal osteotomies was 6.5 and 16 months respectively. Fifteen diaphyseal osteotomies required autologous cancellous grafting. There were 8 allograft fractures after consolidation. The following factors which might influence consolidation were analysed: age of the host and donor; allograft length and site; type of osteotomy and osteosynthesis; intra-arterial and systemic chemotherapy; intraoperative and external radio-therapy. In diaphyseal osteotomies there were statistically significant differences in consolidation time with the use of systemic chemotherapy, external radiotherapy and the recipient's age
Use of brachytherapy in children with cancer: the search for an uncomplicated cure
Brachytherapy is a sophisticated radiation method in which radioisotopes are
placed inside or at a short distance from the tumour. The volume of tissue that
receives the prescribed dose of radiotherapy is therefore fairly small compared
with that used in standard radiotherapy techniques. In paediatric oncology, this
method of radiation delivery can have a favourable effect on several undesirable
long-term side-effects that sometimes develop in children who receive
radiotherapy, such as growth retardation and development of second primary
tumours. Here, we describe the rationale for use of brachytherapy in children
with cancer, the methods of the different brachytherapy techniques available, and
the results obtained with several brachytherapy regimens in expert institutions
throughout the world
Bone metastases from osteosarcoma
Bony metastases in patients with osteosarcoma are unusual and normally appear late in the course of the disease. We report our experience with eight such patients, four with solitary and four with multiple metastases. Those with solitary metastases were treated as new tumours with neoadjuvant chemotherapy and surgery. Three remain alive with no evidence of disease at 5, 7 and 8 years follow-up respectively. Histology and response to neoadjuvant chemotherapy was similar in both the primary and metastatic lesions and is a predictive factor of outcome. Those with multiple metastases were treated by palliative measures, and none survived. We conclude that resection of solitary metastases from osteosarcoma after neoadjuvant chemotherapy can be curative
External fixation in tumour pathology
An appraisal of the clinical records of patients with malignant bone tumours enabled us to identify 61 whom we have treated by external fixation. There were 38 males and 23 females with ages ranging from 4 to 58 years, the mean being 14 years. The average period of follow-up was 6 years (1-12 years). For the purpose of our analysis the patients were divided into three groups according to whether the fixator was fitted before, during or after tumour resection
Methotrexate in Pediatric Osteosarcoma: Response and Toxicity in Relation to Genetic Polymorphisms and Dihydrofolate Reductase and Reduced Folate Carrier 1 Expression
To determine the influence of the genotype and the level of expression of different enzymes involved in folate metabolism on the response to and toxicity of high-dose methotrexate treatment in pediatric osteosarcomas.
STUDY DESIGN: DHFR and Reduced folate carrier 1 (RFC1) semiquantitative expression was analyzed in 34 primary and metastatic osteosarcoma tissues by real-time polymerase chain reaction. The following polymorphisms were also analyzed in peripheral blood from 96 children with osteosarcoma and 110 control subjects: C677T, A1298C (MTHFR), G80A (RFC1), A2756G (MTR), C1420T (SHMT), the 28bp-repeat polymorphism, and 1494del6 of the TYMS gene. Treatment toxicity was scored after each cycle according to criteria from the World Health Organization.
RESULTS: DHFR and RFC1 expression was lower in initial osteosarcoma biopsy specimens than in metastases (P = .024 and P = .041, respectively). RFC1 expression was moderately decreased in samples with poor histologic response to preoperative treatment (P = .053). Patients with osteosarcoma with G3/G4 hematologic toxicity were more frequently TT than CT/CC for C677T/MTHFR (P = .023) and GG for A2756G/MTR (P = .048 and P = .057 for gastrointestinal and hematologic toxicity, respectively).
CONCLUSIONS: The role of C677T/MTHFR and A2756G/MTR on chemotherapy-induced toxicity should be further investigated in pediatric osteosarcomas receiving high-dose methotrexate. Altered expression of DHFR and RFC1 is a feasible mechanism by which osteosarcoma cells become resistant to methotrexate
Feasibility report of conservative surgery, perioperative high-dose-rate brachytherapy (PHDRB), and low-to-moderate dose external beam radiation therapy (EBRT) in pediatric sarcomas
This study was undertaken to determine the feasibility of perioperative
high-dose-rate brachytherapy (PHDRB) as an accelerated boost in patients with
pediatric sarcomas. METHODS AND MATERIALS: Five pediatric patients (ages 7-16)
with soft tissue sarcomas (STS) or soft tissue recurrences of previously treated
osteosarcomas were treated with surgical resection and PHDRB (16-24 Gy) for R0-R1
resections. Patients with STS and osteosarcomas received 27 Gy and 45 Gy of EBRT
postoperatively. RESULTS: After a median follow-up of 27 months (range, 12-50)
all the patients remain locally controlled. Only 1 patient developed regrowth of
pulmonary metastases and died of distant disease at 16 months. CONCLUSIONS: The
use of PHDRB is safe in the short-term in this pediatric population. Only 1
patient suffered a partial wound dehiscence that may not be entirely related to
PHDRB. Patients with recurrent osteosarcomas can be treated in a fashion similar
to their adult soft tissue counterparts and avoid limb amputation. Younger
patients with STS may achieve local control and prevent growth retardation with a
combination of PHDRB and moderate doses of EBR
Limb salvage in bone sarcomas in patients younger than age 10. A 20-year experience.
The authors present their experience over the last 20 years in limb salvage procedures of a consecutive series of 40 children under 10 years of age (range 2-10 years) with bone sarcomas. Nineteen were osteogenic sarcomas and 21 were Ewing sarcomas. Only one case, located in the distal phalanx of the toe, was treated by straightforward amputation. Intercalary allografts and Canadell's technique were used to preserve joints whenever possible, and prosthesis or osteoarticular allografts were used when the joint surface was involved. Survival rate in this series was 75%. There were four local recurrences. At the last follow-up (mean 11.2 years, range 5-19 years postop), 90% of the patients preserved their limbs. Eighty percent of the authors' results were excellent or good according to the Musculoskeletal Tumor Society Scale. Limb salvage is a real possibility even in young children with bone sarcomas. The age of the patient itself is not a contraindication for limb salvage
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