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Dealing with Bone Metastases from Breast Cancer - A Pathological and Clinical Overview

Abstract

From breast malignant tumors, bone is the most frequent site of metastasis. Bone metastases from breast cancer are correlated with pathological fractures, spinal cord compression and other skeletal-related events as well as bone pain and hypercalcemia. These lead to impaired mobility, decreased quality of life, and overall decrease in survival. Clarification of mechanisms regulating bone metastasis has advanced greatly in the last years and this has translated into plentiful unused therapeutic options. Greater understanding of the pathophysiology of bone metastases has led to the detection and clinical efficiency of bone-targeted agents. This review summarizes the key evidence for current clinical practice and future directions.

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Defect Reconstruction After Hip Tumor Resection - Our Clinical Experience

Abstract

Aim. Short and mid-term analysis of postoperative results after hip vicinity tumor resection and reconstruction with salvage of the lower limb. Material and method. Retrospective study on a number of 13 cases: 6 pelvis tumors, 3 femur tumors and 4 femur and pelvis tumors. 3 out of the total pelvis tumors were treated using custom pelvis reconstruction prosthesis, the other ones using bone graft and standard implants. The femoral tumors were treated using modular prosthesis and bone graft and osteosynthesis implants. Results. Short-term outcome was favorable. Conclusion. Bone defect reconstruction after hip vicinity tumor resection is a technically difficult procedure, which requires significant material resources. In terms of quality of life, the results are clearly superior compared to tumor resection with the sacrifice of the affected member.

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Reconstructive Surgery in Nose Tumors

Abstract

Introduction. Cutaneous malignancies localized on the nasal pyramid are one of the most frequent non-melanocytic skin cancers with a great psychosocial impact. A predominant pathology of the elderly is distinguished by slow development, with a tendency to ulceration and addressability to medical services in advanced local stages. Reconstruction after oncologic intervention is diverse, locoregional flaps, grafting, and simple direct sutures can be made, the case per se dictating the appropriate attitude. The variables to be considered are location, size of the remaining defect and quality of potential donor areas. The following are also taken into account: reduction of morbidity, increasing quality of life, patient’s psychological impact. Materials and methods. 7 cases of basocellular carcinoma of the nose addressed between 2017- 2018 are described throughout an observational analysis based in the Emergency Hospital for Plastic Reconstructive Surgery and Burncare in Bucharest, referred to by various reconstructive methods, depending on the particularities encountered. Locoregional flaps-bilobed, nasogenian, frontal, dorsal nasal - as well as full-thickness skin grafts and simple direct sutures were performed. Results. Carcinoma excision was complete and safety margins were confirmed histopathologically. Evolution of postoperative patients was favorable without complications. Conclusion. There are numerous surgical options for repairing nose defects. Oncological radicality and satisfactory aesthetic and functional outcome are the main objectives in choosing the method. The aims of reconstructive surgery are functionality of the nose, aesthetic appearance with finer scars, preserving the aesthetic subunits of the nose, but also the relationship with the neighboring structures.

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Perioperative Pain Management in Primary Bone Tumors

Abstract

Introduction. The increasing number of tumor prosthesis in the last decade shows the advance in musculoskeletal oncology. Limb sparing surgery nowadays has to be the focus in surgery, maintaining the patient’s quality of life. Prognosis depends on the histological type of tumor, size, and local extension. Pain is present in almost any cases of bone tumors and can vary in intensity and character. Being the leading symptom is strongly correlated to the quality of life. The purpose of this study was to evaluate pain in patients with primary bone sarcomas before and after surgery. Material and methods. 11 patients were involved in this study over a period of 4 years (2014-2017) from the Orthopedics and Traumatology Department in the University Emergency Hospital in Bucharest. Tumor resection and reconstruction with modular prosthesis was performed in 4 cases, and tumor resection was necessary in 3 cases and amputation in 4 cases. Pain was evaluated before and after surgery using the Visual Analog Scale (VAS). Early postoperative pain control was achieved with epidural catheter, followed by opioid therapy, NSAIDs and Paracetamol in the early stages of mobilization. Results. Surface sarcomas and tumors close to the periosteum, or periosteal involvement has shown a localized and increased pain. Multimodal-analgesia was used for pain management. Within the first 48 hours, analgesia was performed with an epidural catheter by continuous infusion of ropivacaine 0.2% and fentanyl 2mcg/ ml at a rate ranging between 3-6 ml/ h, obtaining a VAS score between 0 and 3. Conclusions. Perioperative pain management has to be individualized to the localization and local soft tissue involvement of the tumor. In late stages of sarcomas or local recurrence, conventional analgesics can be inefficient. Early diagnosis and surgical removal of these tumors is the most important objective for a good prognosis.

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Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot

. 17. Botezatu I, Laptoiu D. Minimally invasive surgery of diabetic foot - review of current techniques. J Med Life. 2016 Jul-Sep; 9(3):249-254. 18. DiDomenico L, Flynn Z, Reed M. Treating Charcot Arthropathy Is a Challenge: Explaining Why My Treatment Algorithm Has Changed. Clin Podiatr Med Surg. 2018 Jan; 35(1):105-121. doi: 10.1016/j.cpm.2017.08.012. 19. Wukich DK, Mallory BR, Suder NC, Rosario BL. Tibiotalocalcaneal Arthrodesis Using Retrograde Intramedullary Nail Fixation: Comparison of Patients With and Without Diabetes Mellitus

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Mechanisms of Bone Metastasis of Malignancies of the Genito-Mammary Area

Abstract

Bone metastasis is a frequent complication of advanced genito-mammary cancer patients. Skeletal involvement is particularly common in breast cancer. Bone metastases induce a wide range of symptoms, lowering the quality of life and shortening survival. The normal bone remodeling process is deeply affected in all types of metastases: osteolytic, osteoblastic, and mixed. The main mechanisms involved in bone metastatic dissemination are the expression of adhesion tumor molecules and corresponding receptors within bone marrow and bone matrix cells; local growth factors, molecular mechanisms of remodeling the hematopoietic stem cell activity, and alteration of the expression of the post-transcriptional regulatory microRNAs of the gene expression are the new theories developed from recent studies. Abnormalities in the number of copies of the 16q23 gene explain the increased risk of bone metastasis of breast cancer compared to its dissemination to the other organs; the mutual interaction between tumor cells and the bone microenvironment constitutes the element that stimulates both bone destruction and tumor development. Endothelin -1, bone morphogenic proteins, platelet-derived growth factor, Wnt proteins stimulate proliferation and osteoblastic activity. Genomic and proteomic studies underlie the development of new therapeutic agents for the treatment and prevention of bone metastases.

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Modular Reconstruction Systems – Final Solution for Critical Bone Defects Treatment

Abstract

Introduction. The management of critical bone defects has experienced an unprecedented improvement in the last few decades. A good primary mechanical stability and versatility of the modular reconstruction systems allowed the conversion to universal setups and the expansion of indication. The progression and reliability of the reconstruction possibilities available nowadays are outlined using the experience of our department. Material and method. A retrospective review of critical bone defect cases and the reconstruction management using endoprosthetic systems is presented. Ten reconstruction surgeries performed in the last 18 months in our department were observed. The patients were 3 males and 7 females with a mean age of 45.3 (range 19 to 75). Modular systems were used for the reconstruction of bone defects subsequent to resections of benign or malignant musculoskeletal tumors (76%) and to non-neoplastic conditions (24%). Results. On the latest follow-up, all the patients were alive, with one case of tumoral recurrence. No aseptic loosening, soft tissue or structural failure were recorded following surgery, with one case under treatment for infection after it required an open procedure for a prosthetic hip dislocation. The early functional results were adequate in all cases, with good secondary stability and satisfactory quality of life. Conclusion. The evolution of endoprosthetic reconstruction surgery has improved the prognosis for many patients diagnosed with critical bone defects. Continuous advances in implant design, fixation, and soft tissue attachment combined with the improvement of surgical techniques will ensure a bright future for this type of procedures.

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Results Evaluation of Resection-Reconstruction of Knee Periarticular Tumors

Abstract

Oncological resection and articular reconstruction through modular tumor prosthesis is a challenge for the surgeon, but at the same time gives the patient the certainty of keeping the function and hope for healing. Due to technical evolution, the recovery of osteoarticular post-resection tumor is today much more versatile and permissive, providing the comfort of the orthopedic oncologist surgeon during reconstruction and at the same time the patient satisfaction. Purpose of the paper. Short-term and medium-term evaluation of surgical treatment outcome of bone oncological pathogenesis of the knee with modular tumor prosthesis. Material and method. Recording based on the unique tumor registry of the Clinic in a monocentric, retrospective continuously study between 2009 and 2017, of all orthopedic oncology patients with malignant/ borderline tumors with metaphyso-epiphyseal knee periarticular involvement, beneficiaries of the resection-reconstruction with prosthesis modular tumor - a total of 21 cases. Case analysis included details of histopathological types of tumors, followed by Enneking staging, which was performed, alongside classical demographics. The Malaware oncological resection technique was followed and the learning curve and results of the prostatic modular prosthetic reconstruction were registered, considering failure for any of the following reasons: revision, necessity exhaustion of the prosthesis - infection, relapse, or amputation. The functional evaluation was based on the revised Muscular-skeletal Tumor Society Score (rMSTS). Results and discussions. Only one case of failure was registered - a periprosthetic infection. The overall rate of apparently postoperative complications followed the literature data for this type of intervention - 40-50%. Compared to amputation, the lower limb salvage process in the knee malignant tumors has proven to be cost-effective and has contributed to improving the quality of life, becoming one of the sustainable options for onco-surgical management in good cases selected. The limits of the study are determined by the relatively short duration of follow-up, and the apparently large number of complications is nevertheless included in the international statistics related to such interventions.

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GCT of knee treated with modular prosthesis-case presentation

References 1. Turcotte RE. Giant cell tumor of bone. Orthop Clin North Am. 2006; 37(1):35–51. 2. Klenke FM, Wenger DE, Inwards CY, Rose PS, Sim FH. Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res. 2011; 469(2):591–9. 3. McGrath PJ. Giant-cell tumour of bone: an analysis of fifty-two cases. J Bone Joint Surg Br. 1972; 54(2):216–29. 4. Bertoni F, Present D, Sudanese A, Baldini N, Bacchini P, Campanacci M. Giant-cell tumor of bone with pulmonary metastases. Six case reports and a review of the literature. Clin

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Pelvic Chondrosarcoma - Therapeutic Options (Literature Review)

Abstract

Chondrosarcoma is a mesenchymal malignant tumor (primary or secondary) which is characterized by a cartilaginous mass formed out of neoplastic cells. It is one of the most frequent malignant bone tumors (after multiple myeloma and osteosarcoma), affecting more males than females (Ratio M:F=2:1). It appears with predilection in the pelvis and long bones - mainly the proximal portion of the humerus and femur. It is a unique primary bone tumor through its chemotherapy and radiotherapy resistance, the only effective treatment being the surgical one. As far as the pelvis is concerned, it is important to determine the location, the dimension, and the relation with the nearby structures of the tumor, in order to establish if it is possible to do a complete excision of the tumor and adapt the subsequent reconstruction of the pelvis. In the excisions of the pelvic chondrosarcoma, the choices are conservatory surgery (limb saving) and the radical surgery (conventional pelvic resection). The oncological resection is the primary goal, but the functional result and the patient’s quality of life are also very important.

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