RESUMEN
Osteosarcoma management continues to lack the appropriate prognostic tools to assign personalised treatment. This leaves non-responders to standard care vulnerable to recurring disease and pulmonary metastases. Developing 3D in vitro disease models to serve as a test bed for personalised treatment is a promising approach to address this issue. This study describes the generation of 3D osteosarcoma models termed "tumouroids", which are geometrically compartmentalised to reproduce the bone cancer mass and its surrounding. Although the tumour microenvironment impacts osteosarcoma in many ways, this model focussed on interrogating the influence of a biomimetic matrix on tumour cell behaviour. The 3D matrix was supplemented with the bone-marrow proteins laminin, fibronectin and NuOss® bone granules. This led to increased invasion of osteosarcoma cell aggregates from within the bone-like matrix into the surrounding acellular bone marrow-like ECM. The presence of bone granules also yielded an atypical molecular profile of osteosarcoma cells, suggesting malignant metabolic reprogramming. Changes include decreased MMP-9 (pâ¯<â¯0.05) and increased PTEN (pâ¯<â¯0.05), MCP-1 (pâ¯<â¯0.01) and MCT-4 (pâ¯<â¯0.05) gene expression. This complex 3D biomimetic composition also changed cellular responses to doxorubicin, a common chemotherapeutic agent used to treat osteosarcoma, and reproduced key issues of in vivo treatment like drug penetrance and doxorubicin-induced bone toxicity. This work highlights the importance of a biomimetic matrix in 3D osteosarcoma models for both basic and translational research. STATEMENT OF SIGNIFICANCE: This study describes the generation of 3D osteosarcoma models termed "tumouroids", which are geometrically compartmentalised to reproduce the bone cancer mass and its environment. Utilising this novel model, specific parameters of osteosarcoma growth and invasion were investigated. Osteosarcoma cell lines proliferate at a slower rate, exhibit malignant metabolic reprogramming, and respond to drug intervention at lower concentrations of doxorubicin hydrochloride in matrix-complex compared to basic tumouroids. As such, this study provides evidence that the tumour microenvironment impacts osteosarcoma in many ways. The osteosarcoma tumouroid described herein may form the basis of a personalised-medicine strategy, which will allow the testing of drug effectiveness similar to that used for antibiotic selection for pathogenic bacteria.
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Materiales Biomiméticos/química , Matriz Ósea/química , Neoplasias Óseas , Matriz Extracelular/química , Modelos Biológicos , Osteosarcoma , Neoplasias Óseas/metabolismo , Neoplasias Óseas/patología , Línea Celular Tumoral , Humanos , Invasividad Neoplásica , Osteosarcoma/metabolismo , Osteosarcoma/patologíaRESUMEN
AIMS: Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive and potentially recurrent synovial disease. We present the largest single-centre experience of knee PVNS. Our aim was to evaluate our tertiary hospital's experience in the management of knee PVNS. PATIENTS AND METHODS: Retrospective data collection of consecutive cases of knee PVNS from 2002 to 2015. RESULTS: In total, 214 cases of knee PVNS were identified which represented 53.4% of all PVNS (12.1% were recurrent at presentation). 100 were localised PVNS (LPVNS), 114 diffuse PVNS (DPVNS) and two malignant PVNS. Knee PVNS was more likely to occur in females with a mean age of 39. Following surgery, 47.6% had recurrence with DPVNS as opposed to 8.6% with LPVNS. In LPVNS, there was no significant difference in recurrence between open and arthroscopic synovectomy (8.7% vs 9.1%, P>0.05). However, in DPVNS, there was a significantly higher risk of recurrence with arthroscopic compared to open synovectomy (83.3% vs 44.8%, RR=1.86 95% CI 1.32-2.62, P=0.0004). CONCLUSION: PVNS can be difficult to treat. We found no difference in local recurrence rates between open and arthroscopic treatment of LPVNS but significantly increased rates of recurrence for DPVNS following arthroscopic treatment. We would therefore recommend open synovectomy for DPVNS.
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Artroscopía/métodos , Sinovectomía/métodos , Sinovitis Pigmentada Vellonodular/cirugía , Adulto , Anciano , Artroscopía/efectos adversos , Femenino , Humanos , Articulación de la Rodilla/patología , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Sinovectomía/efectos adversos , Centros de Atención Terciaria , Reino UnidoRESUMEN
The pre-operative differentiation between enchondroma, low-grade chondrosarcoma and high-grade chondrosarcoma remains a diagnostic challenge. We reviewed the accuracy and safety of the radiological grading of cartilaginous tumours through the assessment of, first, pre-operative radiological and post-operative histological agreement, and second the rate of recurrence in lesions confirmed as high-grade on histology. We performed a retrospective review of major long bone cartilaginous tumours managed by curettage as low grade between 2001 and 2012. A total of 53 patients with a mean age of 47.6 years (8 to 71) were included. There were 23 men and 30 women. The tumours involved the femur (n = 20), humerus (n = 18), tibia (n = 9), fibula (n = 3), radius (n = 2) and ulna (n = 1). Pre-operative diagnoses resulted from multidisciplinary consensus following radiological review alone for 35 tumours, or with the addition of pre-operative image guided needle biopsy for 18. The histologically confirmed diagnosis was enchondroma for two (3.7%), low-grade chondrosarcoma for 49 (92.6%) and high-grade chondrosarcoma for two (3.7%). Three patients with a low-grade tumour developed a local recurrence at a mean of 15 months (12 to 17) post-operatively. A single high-grade recurrence (grade II) was treated with tibial diaphyseal replacement. The overall recurrence rate was 7.5% at a mean follow-up of 4.7 years (1.2 to 12.3). Cartilaginous tumours identified as low-grade on pre-operative imaging with or without additional image-guided needle biopsy can safely be managed as low-grade without pre-operative histological diagnosis. A few tumours may demonstrate high-grade features histologically, but the rates of recurrence are not affected.
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Neoplasias Óseas/cirugía , Enfermedades de los Cartílagos/cirugía , Condroma/cirugía , Condrosarcoma/cirugía , Legrado/métodos , Adolescente , Adulto , Anciano , Biopsia con Aguja , Neoplasias Óseas/diagnóstico , Enfermedades de los Cartílagos/diagnóstico , Niño , Condroma/diagnóstico , Condrosarcoma/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Matching the number of surgeons to the demands for orthopedic services has been notoriously difficult. Not only does one need to evaluate current trends in the supply and provision of services but anticipate the impact of future reforms on these variables. The British Orthopaedic Association has aspired to provide consultant to population ratio of 1:15,000 by 2020. Currently, the orthopedic community is tasked with providing care for an aging population with soaring levels of obesity; with both of these factors set to grow and also with an overall decline in productivity. Orthopedic surgeons must brace themselves for an explosion in demand. At the same time, a paradigm shift has occurred in the delivery of services with the creation of specialist centers. We are amidst a generational shift in the demographics and psychology of the orthopedic workforce. The orthopedic community must be aware of the effects of these far-reaching changes when tailoring the supply of surgeons for the future needs.
RESUMEN
Vinasse wastewater of high organic content (COD = 131,000 mg/L) and low biodegradability (BOD5/COD = 0.11) cannot be easily managed and usually require several consecutive treatment steps. The objective of this work was to dilute vinasse wastewater with seawater and then subject them to electrochemical oxidation over boron-doped diamond (BDD) electrodes. The use of seawater is a rational and novel approach for plants close to the seashore since it may achieve the desirable levels of effluent concentration and conductivity without consuming other water resources and extra electrolytes. Experiments were conducted at initial COD values of 830-8,400 mg/L, NaCl concentrations of 34-200 mM and current densities of 70-200 mA/cm(2) for up to 5 hours. The effect of current density and NaCl concentration was marginal on the electrochemical treatment, while the single most important parameter was the initial COD concentration. The order of reaction for COD reduction appears to be 'first' at low effluent concentrations and it decreases to 'zero' at higher concentrations, denoting the importance of the ratio of organics to reactive radicals concentration. Based on COD and total organic carbon data, it is postulated that degradation occurs predominantly through total oxidation (i.e. mineralization) to carbon dioxide and water, which is characteristic of BDD anodes.
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Electrólisis , Aguas Residuales/química , Purificación del Agua , Análisis de la Demanda Biológica de Oxígeno , Boro/química , Cinética , Saccharum , Salinidad , Agua de Mar/químicaRESUMEN
INTRODUCTION: Chondral and osteochondral lesions of the knee are notoriously difficult to treat due to the poor healing capacity of articular cartilage and the hostile environment of moving joints, ultimately causing disabling pain and early osteoarthritis. There are many different reconstructive techniques used currently but few are proven to be of value. However, some have been shown to produce a better repair with hyaline-like cartilage rather than fibrocartilage. METHODS: A systematic search of all available online databases including PubMed, MEDLINE(®) and Embase™ was undertaken using several keywords. All the multiple treatment options and methods available were considered. These were summarised, and the evidence for and against them was scrutinised. RESULTS: A total of 460 articles were identified after cross-referencing the database searches using the keywords. These revealed that autologous and matrix assisted chondrocyte implantation demonstrated both 'good to excellent' histological results and significant improvement in clinical outcomes. CONCLUSIONS: Autologous and matrix assisted chondrocyte implantation have been shown to treat symptomatic lesions successfully with significant histological and clinical improvement. There is, however, still a need for further randomised clinical trials, perfecting the type of scaffold and the use of adjuncts such as growth factors. A list of recommendations for treatment and the potential future trends of managing these lesions are given.
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Enfermedades de los Cartílagos/terapia , Cartílago Articular , Artropatías/terapia , Enfermedades de los Cartílagos/diagnóstico , Condrocitos/trasplante , Predicción , Humanos , Péptidos y Proteínas de Señalización Intercelular/uso terapéutico , Artropatías/diagnóstico , Articulación de la Rodilla , Trasplante de Células Madre Mesenquimatosas/métodos , Osteoartritis de la Rodilla/terapia , Andamios del Tejido , Trasplante Autólogo , Trasplante HomólogoRESUMEN
Between 1997 and 2007, 68 consecutive patients underwent replacement of the proximal humerus for tumour using a fixed-fulcrum massive endoprosthesis. Their mean age was 46 years (7 to 87). Ten patients were lost to follow-up and 16 patients died. The 42 surviving patients were assessed using the Musculoskeletal Tumor Society (MSTS) Score and the Toronto Extremity Salvage Score (TESS) at a mean follow-up of five years and 11 months (one year to ten years and nine months). The mean MSTS score was 72.3% (53.3% to 100%) and the mean TESS was 77.2% (58.6% to 100%). Four of 42 patients received a new constrained humeral liner to reduce the risk of dislocation. This subgroup had a mean MSTS score of 77.7% and a mean TESS of 80.0%. The dislocation rate for the original prosthesis was 25.9; none of the patients with the new liner had a dislocation at a mean of 14.5 months (12 to 18). Endoprosthetic replacement for tumours of the proximal humerus using this prosthesis is a reliable operation yielding good results without the documented problems of unconstrained prostheses. The performance of this prosthesis is expected to improve further with a new constrained humeral liner, which reduces the risk of dislocation.
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Neoplasias Óseas/cirugía , Húmero/cirugía , Prótesis Articulares , Articulación del Hombro/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo/métodos , Neoplasias Óseas/patología , Niño , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Diseño de Prótesis , Resultado del Tratamiento , Adulto JovenRESUMEN
Disarticulation of the hip in patients with high-grade tumours in the upper thigh results in significant morbidity. In patients with no disease of the proximal soft tissue a femoral stump may be preserved, leaving a fulcrum for movement and weight-bearing. We reviewed nine patients in whom the oncological decision would normally be to disarticulate, but who were treated by implantation of an endoprosthesis in order to create a functioning femoral stump. The surgery was undertaken for chondrosarcoma in four patients, pleomorphic sarcoma in three, osteosarcoma in one and fibrous dysplasia in one. At follow-up at a mean of 80 months (34 to 132), seven patients were alive and free from disease, one had died from lung metastases and another from a myocardial infarction. The mean functional outcome assessment was 50 (musculoskeletal tumor society), 50 and 60 (physical and mental Short-form 36 scores). Implantation of an endoprosthesis into the stump in carefully selected patients allows fitting of an above-knee prosthesis and improves wellbeing and the functional outcome.
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Muñones de Amputación , Neoplasias Femorales/cirugía , Prótesis e Implantes , Sarcoma/cirugía , Adolescente , Adulto , Anciano , Amputación Quirúrgica/métodos , Terapia Combinada , Desarticulación , Femenino , Neoplasias Femorales/terapia , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Diseño de Prótesis , Implantación de Prótesis/métodos , Infecciones Relacionadas con Prótesis/etiología , Estudios Retrospectivos , Sarcoma/terapia , Resultado del Tratamiento , Adulto JovenRESUMEN
Defects in knee articular cartilage (AC) can cause pain and disability and present the clinician with an extremely challenging clinical situation. This article describes the most up-to-date surgical techniques that aim to repair and/or regenerate symptomatic focal defects in AC, which include arthroscopic debridement, microfracture bone marrow stimulation and autologous osteochondral allografting, with an emphasis on autologous chondrocyte implantation. In the future, refinement of tissue-engineering approaches promises to further improve outcome for these patients.
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Artroscopía/métodos , Enfermedades de los Cartílagos/terapia , Cartílago Articular/lesiones , Traumatismos de la Rodilla/terapia , Médula Ósea/fisiología , Cartílago/trasplante , Enfermedades de los Cartílagos/rehabilitación , Condrocitos/trasplante , Desbridamiento/métodos , Predicción , Humanos , Inestabilidad de la Articulación/terapia , Traumatismos de la Rodilla/rehabilitación , Cuidados Posoperatorios/métodos , Cuidados Preoperatorios/métodosRESUMEN
Autologous chondrocyte implantation is an option in the treatment of full-thickness chondral or osteochondral injuries which are symptomatic. The goal of surgery and rehabilitation is the replacement of damaged cartilage with hyaline or hyaline-like cartilage, producing improved levels of function and preventing early osteoarthritis. The intermediate results have been promising in terms of functional and clinical improvement. Our aim was to explore the hypothesis that the histological quality of the repair tissue formed after autologous chondrocyte implantation improved with increasing time after implantation. In all, 248 patients who had undergone autologous chondrocyte implantation had biopsies taken of the repair tissue which then underwent histological grading. Statistical analysis suggested that with doubling of the time after implantation the likelihood of a favourable histological outcome was increased by more than fourfold (p < 0.001).
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Cartílago Articular/patología , Condrocitos/trasplante , Traumatismos de la Rodilla/patología , Adolescente , Adulto , Biopsia , Cartílago Articular/lesiones , Condrocitos/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo , Adulto JovenRESUMEN
Chondral damage to the knee is common and, if left untreated, can proceed to degenerative osteoarthritis. In symptomatic patients established methods of management rely on the formation of fibrocartilage which has poor resistance to shear forces. The formation of hyaline or hyaline-like cartilage may be induced by implanting autologous, cultured chondrocytes into the chondral or osteochondral defect. Autologous chondrocyte implantation may be used for full-thickness chondral or osteochondral injuries which are painful and debilitating with the aim of replacing damaged cartilage with hyaline or hyaline-like cartilage, leading to improved function. The intermediate and long-term functional and clinical results are promising. We provide a review of autologous chondrocyte implantation and describe our experience with the technique at our institution with a mean follow-up of 32 months (1 to 9 years). The procedure is shown to offer statistically significant improvement with advantages over other methods of management of chondral defects.
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Cartílago Articular/trasplante , Condrocitos/trasplante , Traumatismos de la Rodilla/rehabilitación , Adolescente , Adulto , Fenómenos Biomecánicos , Cartílago Articular/cirugía , Células Cultivadas , Condrocitos/fisiología , Femenino , Estudios de Seguimiento , Humanos , Traumatismos de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ingeniería de Tejidos , Trasplante Autólogo , Adulto JovenRESUMEN
The recurrence of osteosarcoma is rare. Local recurrence occurs in 4-10% of patients following effective treatment. So far, recurrences as late as 15 years have been reported in the literature. We report a unique case of local recurrence of intramedullary osteosarcoma 17 years from initial diagnosis and treatment. Regular long-term follow-up of patients with this diagnosis is crucial to ensure early detection and treatment of potential recurrences.
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Neoplasias Óseas/diagnóstico por imagen , Recurrencia Local de Neoplasia/diagnóstico por imagen , Osteosarcoma/diagnóstico por imagen , Adulto , Detección Precoz del Cáncer , Femenino , Hemipelvectomía , Humanos , Ilion , Cuidados a Largo Plazo , RadiografíaRESUMEN
Chordomas are radio- and chemo-resistant tumours and metastasise in as many as 40% of patients. The aim of this study was to identify potential molecular targets for the treatment of chordoma. In view of the reported association of chordoma and tuberous sclerosis complex syndrome, and the available therapeutic agents against molecules in the PI3K/AKT/TSC1/TSC2/mTOR pathway, a tissue microarray of 50 chordoma cases was analysed for expression of active molecules involved in this signalling pathway by immunohistochemistry and a selected number by western blot analysis. Chordomas were positive for p-AKT (92%), p-TSC2 (96%), p-mTOR (27%), total mTOR (75%), p-p70S6K (62%), p-RPS6 (22%), p-4E-BP1 (96%) and eIF-4E (98%). Phosphatase and tensin homologue deleted on chromosome 10 expression was lost in 16% of cases. Mutations failed to be identified in PI3KCA and RHEB1 in the 23 cases for which genomic DNA was available. Fluorescence in situ hybridisation analysis for mTOR and RPS6 loci showed that 11 of 33 and 21 of 44 tumours had loss of one copy of the respective genes, results which correlated with the loss of the relevant total proteins. Fluorescence in situ hybridisation analysis for loci containing TSC1 and TSC2 revealed that all cases analysed harboured two copies of the respective genes. On the basis of p-mTOR and or p-p70S6K expression there is evidence indicating that 65% of the chordomas studied may be responsive to mTOR inhibitors, rapamycin or its analogues, and that patients may benefit from combined therapy including drugs that inhibit AKT.
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Cordoma/genética , Fosfatidilinositol 3-Quinasas/genética , Proteínas Proto-Oncogénicas c-akt/genética , Factores de Transcripción/genética , Proteínas Supresoras de Tumor/genética , Adulto , Anciano , Anciano de 80 o más Años , Western Blotting , Cordoma/patología , Femenino , Humanos , Inmunohistoquímica , Hibridación Fluorescente in Situ , Masculino , Diana Mecanicista del Complejo 1 de la Rapamicina , Persona de Mediana Edad , Complejos Multiproteicos , Análisis de Secuencia por Matrices de Oligonucleótidos , Fosfatidilinositol 3-Quinasas/metabolismo , Análisis por Matrices de Proteínas , Proteínas , Proteínas Proto-Oncogénicas c-akt/antagonistas & inhibidores , Proteínas Proto-Oncogénicas c-akt/metabolismo , Serina-Treonina Quinasas TOR , Factores de Transcripción/metabolismo , Esclerosis Tuberosa/tratamiento farmacológico , Esclerosis Tuberosa/genética , Esclerosis Tuberosa/patología , Proteína 1 del Complejo de la Esclerosis Tuberosa , Proteína 2 del Complejo de la Esclerosis Tuberosa , Proteínas Supresoras de Tumor/metabolismo , Adulto JovenRESUMEN
BACKGROUND: Extra-thoracic solitary fibrous tumours (ESFTs) have traditionally been regarded as indolent neoplasms similar to their intra-thoracic counterparts. However there has been some evidence that a subset of more aggressively malignant tumours exist. We examined our experience with these rare tumours in an effort to clarify their clinico-pathological behaviour and relate this to their histopathological findings. PATIENTS/METHODS: All patients with a histopathological diagnosis of solitary fibrous tumour (SFT) who presented to the Royal Marsden Hospital between 1998 and 2006 were reviewed. Clinico-pathological data were recorded for all cases and subset analysis performed to compare rates of locoregional recurrence, distant metastases and death. RESULTS: There were 33 cases included in the study. 18 cases had malignant features on histological examination. Locoregional recurrent disease was more common in those with malignant histopathological findings compared to those with benign histopathology (6/18 vs 0/15 p 0.021). Distant metastatic disease was more common in those with malignant histopathological findings (7/18 vs 1/15 p 0.046) and these patients were at increased risk of death (10/18 vs 0/15 p<0.01). The presence of malignant histopathology was the only factor to affect survival with no benign cases dying of disease and malignant cases having a median survival of 59 months (p 0.003). CONCLUSION: In our experience ESFTs have a higher rate of malignant behaviour than that classically described. Those tumours with atypical or malignant features on histological examination have poor prognosis and should be managed and followed up in the same manner as other high-grade soft tissue tumours.
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Tumores Fibrosos Solitarios/patología , Tumores Fibrosos Solitarios/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Londres , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
We report two rare cases of very late local recurrence of Ewing's sarcoma, occurring 16 years and 19 years after treatment of the primary tumour. In both cases, disease remission had been achieved. Both patients originally underwent non-surgical combined modality therapy following initial diagnosis and both were rendered disease-free. After a long latent phase, both started experiencing unexplained local symptoms. These were investigated at their local hospital but tumour recurrence was not initially considered as a cause of these symptoms. The two patients were eventually referred back to our institution after the diagnosis of recurrent Ewing's sarcoma was established. Both have successfully undergone complete excision of the recurrences and are receiving postoperative adjuvant therapy. These cases highlight the need to remain vigilant for local recurrence, however long after the initial diagnosis.
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Neoplasias Óseas/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Sarcoma de Ewing/diagnóstico , Adulto , Neoplasias Óseas/terapia , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/terapia , Sarcoma de Ewing/terapiaRESUMEN
The pre-commissioning strategy, the start-up procedure and the analytical data obtained during the commissioning period for the first of the four new anaerobic gigantic digesters, with active volume of 10,000 m3 each, are presented in this paper. The digester was initially filled up with water, and the temperature was raised to 36 +/- 1 degrees C. Then, a total amount of 1,860 m3 of digested primary sludge was transferred, in four equal daily batches, into the digester from neighbouring digesters, performing routine operation. Following this, the digester was gradually fed with fresh primary thickened sludge, up to the point that the retention time reached approximately 20 d. A number of significant operational parameters (pH, alkalinity, total and volatile solids concentration, volatile fatty acids concentration, biogas production rate and composition) were monitored several times per day, and the appropriate adjustments were performed in order to achieve stable operation. The time duration of the whole process was about two and a half months. Later on, the digester was supplied with a mixture of primary and biological sludge.
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Aguas del Alcantarillado/química , Eliminación de Residuos Líquidos/métodos , Contaminantes Químicos del Agua/análisis , Purificación del Agua/métodos , Anaerobiosis , Reactores Biológicos , Diseño de Equipo , Ácidos Grasos/análisis , Fermentación , Grecia , Concentración de Iones de Hidrógeno , Metano/química , Modelos Químicos , Temperatura , Factores de Tiempo , Contaminantes Químicos del Agua/químicaRESUMEN
Chondral damage to the young knee is common. In symptomatic patients current surgical treatment has focused on filling the defect with fibrocartilage; however, this tissue has poor resistance to shear forces, leading to failure and the onset of degenerative osteoarthritis.
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Enfermedades Óseas/terapia , Cartílago Articular/lesiones , Condrocitos/trasplante , Adolescente , Adulto , Cartílago Articular/fisiología , Cartílago Articular/trasplante , Condrogénesis/fisiología , Ensayos Clínicos como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trasplante AutólogoRESUMEN
We describe two cases of osteochondritis dissecans (OCD) affecting both femoral condyles in the same knee. The patients presented with recurrent episodes of pain and swelling, but these were initially thought to be 'growing pains'. Eventually, a delayed diagnosis of bicondylar OCD was established and both patients were referred for further management. After assessing the extent of the disease on MRI, matrix-induced autologous chondrocyte implantation was performed to treat the defects of the lateral condyle in each case, with a plan to address the medial defects at a later stage. Proposed theories on the aetiology of the condition and available methods of treatment are discussed. A diagnosis of OCD should be considered in young patients with persistent knee pain and effusions, and MRI is the investigation of choice for early detection.
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Condrocitos/trasplante , Articulación de la Rodilla/patología , Osteocondritis Disecante/patología , Osteocondritis Disecante/cirugía , Adolescente , Artroscopía/métodos , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/normas , Masculino , Resultado del TratamientoRESUMEN
Between 1988 and 2006, 18 patients had a custom-made endoprosthetic replacement of the distal humerus for bone tumours at our institution. There were 11 primary malignant neoplasms, six secondary deposits, and one benign aggressive tumour. The mean follow-up was for 4.4 years (1 to 18.2). Complications occurred in nine patients and included aseptic loosening in three (16.6%), local recurrence in two (11%), infection in two (11%), neuropraxia of the radial nerve in one (5.5%) and a peri-prosthetic fracture in one (5.5%). Excision was inadequate in four patients (22%), all of which developed local recurrence and/or metastases. There were seven deaths from the primary disease after a mean of 2.3 years (1 to 5), one of whom had an above-elbow amputation for local recurrence seven months before death. The remaining six had satisfactory elbow function at their last follow-up. The 11 living patients were evaluated using the Musculoskeletal Tumour Society and Toronto Extremity Salvage scoring systems. The mean scores achieved were 76% (67% to 87%) and 73% (59% to 79%), respectively. Overall, 17 of 18 patients had significant improvement in the degree of their pain following operation. Custom-made endoprosthetic reconstruction of the elbow for bone tumours is a viable treatment in carefully selected patients. It maintains satisfactory function and provides good pain relief.