RESUMEN
Twenty-two adult patients with recurrent high grade astrocytomas [18 glioblastoma multiforme (GBM) and 4 anaplastic astrocytoma (AA) at time of implant] underwent therapy at the University of Washington from October 1991 through March 1995, with repeat craniotomy, maximal debulking of tumor, and placement of permanent low activity 125I seeds. Median age was 41 years and median Karnofsky performance status was 90. Median survival for the entire group was 65 weeks from the time of implant. For the subgroup of GBM patients, median survival was 64 weeks from the time of implant. One-year survival from the date of implant was 57% for the entire group and 59% for those with GBM. The site of first failure after implant was local (within 2 cm of the resection cavity) in 70%, distant (noncontiguous, beyond 2 cm) in 18% and concurrently local and distant in 12%. There was one case of symptomatic radiation injury that resolved with steroid therapy, and no patient required repeat craniotomy for parenchymal necrosis. For patients with recurrent GBM, treatment with resection and permanent low activity 125I brachytherapy yielded improved survival compared to an internal historical control group treated with resection and chemotherapy (p = 0.023). Craniotomy with maximal tumor debulking and placement of low activity 125I seeds yields encouraging results with minimal morbidity in patients with recurrent high-grade astrocytomas.
Asunto(s)
Braquiterapia , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirugía , Glioblastoma/radioterapia , Glioblastoma/cirugía , Radioisótopos de Yodo/uso terapéutico , Recurrencia Local de Neoplasia/radioterapia , Recurrencia Local de Neoplasia/cirugía , Adolescente , Adulto , Anciano , Terapia Combinada , Humanos , Persona de Mediana Edad , Dosificación Radioterapéutica , Estudios Retrospectivos , Análisis de Supervivencia , Insuficiencia del TratamientoRESUMEN
Subcapital fractures after open reduction and internal fixation of intertrochanteric hip fractures have not previously been attributed to osteomyelitis. We report a unique case of a 63-year-old man with isolated subclinical osteomyelitis of the femoral neck causing ischemic necrosis and subcapital fracture after sliding screw plate fixation of an ipsilateral intertrochanteric fracture.
Asunto(s)
Placas Óseas/efectos adversos , Tornillos Óseos/efectos adversos , Fracturas del Cuello Femoral/etiología , Necrosis de la Cabeza Femoral/etiología , Infecciones por Bacterias Grampositivas/etiología , Fracturas de Cadera/cirugía , Osteomielitis/etiología , Infección de la Herida Quirúrgica/etiología , Antibacterianos/uso terapéutico , Terapia Combinada , Desbridamiento , Fracturas del Cuello Femoral/diagnóstico por imagen , Fracturas del Cuello Femoral/terapia , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Necrosis de la Cabeza Femoral/terapia , Infecciones por Bacterias Grampositivas/diagnóstico por imagen , Infecciones por Bacterias Grampositivas/terapia , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/diagnóstico por imagen , Osteomielitis/terapia , Radiografía , Infección de la Herida Quirúrgica/diagnóstico por imagen , Infección de la Herida Quirúrgica/terapiaRESUMEN
Two cases of bilateral radius and ulnar fractures in adolescent weight lifters are described. The fractures healed without complications. However, the authors stress that these injuries can be prevented if coaches, trainers, and sports medicine physicians are aware of their occurrence and undertake necessary preventative measures. Adequate supervision with spotters at the end of each bar, appropriate foot wear, and, above all, the maximum level of concentration are key factors in preventing these injuries.