scholarly journals Characteristics of endoprosthesis replacement of bones and joints in patients with metastatic lesions

TRAUMA ◽  
2021 ◽  
Vol 22 (3) ◽  
pp. 68-73
Author(s):  
V.V. Protsenko ◽  
О.A. Buryanov ◽  
Obada Bishtawi ◽  
Y.О. Solonitsyn
Keyword(s):  
Bone Metastasis ◽  
Plastic Material ◽  
External Beam Radiotherapy ◽  
Primary Source ◽  
Standard Technique ◽  
Infectious Complications ◽  
En Bloc ◽  
Functional Changes ◽  
Total Radiation Dose ◽  
Multiagent Chemotherapy

The article presents the results of endoprosthesis replacement of joints and bones in 19 patients with bone metastasis. The complications resulted from endoprosthesis replacement of joints and bones in cases of bone metastasis were observed in 4 (21.1 %) patients, and tumor recurrences were observed in 2 (10.5 %) patients. In the preoperative period, 19 patients underwent courses of external beam radiotherapy with a total radiation dose (TRD) of 40 Gray, with a single mediated dose (SMD) of 2–2.5 Gray. Also, all patients received preoperative multiagent chemotherapy treatment cycles depending on the primary source of the tumor, and in cases of hormone-dependent tumors, the patients received hormone therapy. Depending on the specific anatomical and functional changes, special implant designs, tools, and techniques were used, which complemented the standard technique of operations. The basic principles of oncosurgery have been adhered to during endoprosthesis replacement of joints and bones, i.e. standard principles of resection and ablastics, removing en bloc of a biopsy area. In endoprosthesis replacement, a cement type of endoprosthesis fixation was used. For an adequate formation of the muscle envelope of the endoprosthesis, a plastic stage of the ope-ration was performed, which allowed to adequately cover the installed endoprosthesis, and thus, reduce the risk of infectious complications. Both displaced and free vascularized musculocutaneous flaps on microvascular anastomoses were used as plastic material. To limit the contact of the metal part of the endoprosthesis with the surrounding tissues and to reconstruct the tendon ligamentous apparatus, a tube of polyethylene tetraphthalate was used, resected tendon and muscles were sutured to it, which allowed to more fully restore joint action. The functioning of extremity according to the MSTS scale after endoprosthesis replacement of joints ranged from 70 to 92 %, and also the quality of life of patients improved up to 70–75 points.

Ideal Breast LiftSM Augmentation Mastopexy for Moderately to Severely Ptotic Breasts: Previsualizing Breast Shape and Symmetry with an Innovative and Versatile Stapling Technique

2009 ◽  
Vol 26 (3) ◽  
pp. 168-176
Author(s):  
Ted S. Eisenberg
Keyword(s):  
Standard Technique ◽  
En Bloc ◽  
Great Satisfaction ◽  
Small Areas ◽  
Stapling Technique ◽  
Secondary Intention ◽  
Skin Staples ◽  
Implant Size ◽  
Breast Shape ◽  
Augmentation Mastopexy

Introduction: Augmentation mastopexy is one of the more challenging surgeries. This article presents a new technique in which tailor tacking with skin staples provides maximum tightening of the redundant breast tissue and allows me to previsualize breast shape and symmetry—before the scalpel is raised for a 1-stage skin resection. I believe this is a more precise approach than the standard technique of drawing a pattern, resecting skin, and then tailor tacking the tissues together. Materials and Methods: A total of 41 patients with moderate to severe ptosis and hypotrophy were reviewed for this article. They all had bilateral submuscular saline breast augmentation with bilateral mastopexy with this stapling technique. Surgeries were performed over a 5-year period. The technique is described in detail. Preoperative and postoperative photographs are provided. Results: Patients reported great satisfaction with their results. Only 6 had small areas that healed by secondary intention, and only 1 patient had a mildly hypertrophic scar. Subjectively, this technique allowed me to achieve consistent, reproducible symmetry with single en bloc tissue resection and with less anxiety and guesswork. Conclusions: This augmentation/mastopexy technique produces predictable and reproducible results regardless of the implant size or the amount of skin that needs to be resected. With the adage of measure twice, cut once, it is very comforting to be able to preview the surgery results before having to cut skin.

En bloc resection of cervical adenocarcinoma with late recurrence to the iliopsoas

2021 ◽  
Vol 14 (2) ◽  
pp. e239466
Author(s):  
Sofia Isabel Tamesa Manlubatan ◽  
Marc Paul Jose Lopez ◽  
Carlo Martin Hilomen Garcia ◽  
Czar Louie Lopez Gaston
Keyword(s):  
Iliac Artery ◽  
Femoral Vein ◽  
External Beam Radiotherapy ◽  
External Iliac Artery ◽  
Late Recurrence ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Cervical Adenocarcinoma ◽  
Iliopsoas Muscle ◽  
En Bloc

This is a case of a 50-year-old woman diagnosed with recurrent cervical adenocarcinoma presenting with chronic and persistent low back pain. She underwent myomectomy for myoma uteri 8 years prior. Histopathology report revealed cervical cancer. She underwent chemotherapy, brachytherapy and external beam radiotherapy. All surveillance work-up, over the years, were negative until she was found to have a solitary recurrent lesion in the right iliopsoas muscle on CT scan. A multidisciplinary team of surgeons collaborated to perform wide excision of pelvic recurrence en bloc right internal hemipelvectomy, right hemicolectomy en bloc resection of external iliac artery and vein, external ilio-iliac artery interposition graft and external iliac vein–common femoral vein bypass. Final histopathologic results showed adenocarcinoma with endometrioid features with associated poorly differentiated high-grade carcinoma involving the iliopsoas, cecum and terminal ileum. Two months postoperatively, the patient is ambulating with minimal assistance.

Long-term outcomes after local treatments for prostate cancer by functional categories: Late changes, different results

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4507-4507
Author(s):  
R. C. Chen ◽  
J. A. Clark ◽  
S. P. Mitchell ◽  
J. A. Talcott
Keyword(s):  
Prostate Cancer ◽  
Sexual Function ◽  
External Beam Radiotherapy ◽  
Normal Function ◽  
Urinary Continence ◽  
Nerve Sparing ◽  
Functional Categories ◽  
Prognostic Information ◽  
Functional Changes ◽  
Patient Reported

4507 Background: Although patient-reported treatment outcomes have gained wide acceptance, numerical changes in validated instruments are difficult to interpret by patients and physicians. Using functional categories derived from numerical scales, we report 24- and 36-month outcomes after treatments for localized prostate cancer, presented by patients’ baseline (pre-treatment) functional status, to provide more useful prognostic information and to identify further changes in the third year after treatment. Methods: Using validated symptom indices, we prospectively measured sexual, urinary, and bowel functions of 438 men at baseline, and at fixed intervals post treatment. We translated numerical scores into functional categories: good (normal), intermediate, and poor (severe dysfunction). Results: Abnormal baseline function and surgery in men with normal function uniformly produced poor sexual function ( table ), and more external beam radiotherapy (EBRT) and brachytherapy (BT) patients deteriorated between 24 and 36 months. For those with normal urinary continence, NNSRP (non-nerve sparing radical prostatectomy) produced poor outcomes (26%) more frequently than NSRP (9%) at 24 months and 36 months, despite improvement in some NNSRP patients. Severe incontinence was rare after EBRT (1%) and BT (3%), though slightly more frequent in EBRT patients by 36 months. For patients with normal bowel function, EBRT and BT caused worse outcomes than RP; no change occurred after 24 months. Conclusions: Abnormal baseline sexual function and surgery produced uniformly poor sexual function outcomes and poor function increased significantly between 24 and 36 months after radiation therapy. Significant changes in functional category occurred despite unchanged average numerical scores, indicating that stable numerical indices may conceal significant functional changes. [Table: see text] No significant financial relationships to disclose.

Endoscopic Mucosal Resection for Early Cancers of the Upper Gastrointestinal Tract

2005 ◽  
Vol 23 (20) ◽  
pp. 4490-4498 ◽  
Author(s):  
Roy Soetikno ◽  
Tonya Kaltenbach ◽  
Ronald Yeh ◽  
Takuji Gotoda
Keyword(s):  
Gastrointestinal Tract ◽  
Endoscopic Mucosal Resection ◽  
Standard Technique ◽  
Upper Gastrointestinal Tract ◽  
Major Surgery ◽  
En Bloc ◽  
Mucosal Resection ◽  
Efficacious Treatment ◽  
Invasive Techniques ◽  
Upper Gastrointestinal

The purpose of this literature review is to examine recent advances in technique and technology of endoscopic mucosal resection of superficial early cancers of the upper gastrointestinal tract. Endoscopic mucosal resection (EMR) of superficial early cancers of the upper gastrointestinal tract is standard technique in Japan and is increasingly used in Western countries. Newer techniques of EMR allow removal of larger lesions en-bloc. These minimally invasive techniques, when applied correctly, allow safe and efficacious treatment in situations that would otherwise require major surgery. Through the establishment of long-term outcomes data, standardization of endoscopic and pathologic reporting, and newer EMR technology and techniques, the future treatment of early cancers in the upper gastrointestinal tract may be achieved primarily through the endoscope.

scholarly journals Detection of Primary Source of Bone Metastasis

1974 ◽  
Vol 23 (3) ◽  
pp. 310-312
Author(s):  
K. Yamamoto ◽  
I. Maeyama ◽  
K. Ikemoto ◽  
A. Fukushima ◽  
W. Seike
Keyword(s):  
Bone Metastasis ◽  
Primary Source

scholarly journals ANALYSIS OF ENDOUROLOGICAL TREATMENT TECHNIQUES OF URINARY BLADDER TUMORS

InterConf ◽  
2021 ◽  
pp. 290-298
Author(s):  
Ivan Vladanov ◽  
Alexei Plesacov ◽  
Vitalii Ghicavii
Keyword(s):  
Urinary Bladder ◽  
Transurethral Resection ◽  
Standard Technique ◽  
Tumor Stage ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Diagnosis And Treatment ◽  
Bladder Tumors ◽  
En Bloc ◽  
Treatment Techniques

Transurethral resection is very important not only for diagnosis and treatment of NMIBC, but also for its management. The application field of transurethral resection includes establishing histological diagnosis, determination of prognostic factors including the tumor stage, complete resection of all detected tumors of urinary bladder. Transurethral resection of bladder tumor (TURBT) is the standard technique for the diagnosis and treatment of non-muscle invasive bladder cancer. This method has also some limitations. One of the limitations is the insufficient assessment of the resection depth. It leads to the necessity of intravesical tumor fragmentation, but its disadvantage is that it limits the histopathological evaluation. In order to improve the treatment outcome for patients with non-muscular invasive bladder tumors, several new techniques such as En-bloc resection were proposed.

scholarly journals Percutaneous Nephrolithotripsy in the Position of the Patient Lying on His Back

Health of Man ◽  
2021 ◽  
pp. 105-111
Author(s):  
Andrii Sagalevich ◽  
Serhii Vozianov ◽  
Fedir Gaysenyuk ◽  
Andrii Boyko ◽  
Viktor Kogut ◽  
...  
Keyword(s):  
Prone Position ◽  
Supine Position ◽  
Small Sample Size ◽  
Standard Technique ◽  
Objective Evaluation ◽  
Infectious Complications ◽  
Small Sample ◽  
Control Group ◽  
Average Hospital ◽  
Percutaneous Nephrolithotripsy

The objective: evaluation of the effectiveness and safety of percutaneous nephrolithotripsy in patients in the supine position. Materials and methods. For the period 2017–2021, 521 mini-PNL were performed according to the standard technique, where in 458 (87,9%) cases the operation was performed in the patient’s prone position, and in 63 (12,1%) cases on the supine position (group 1). The control group (2 group) consisted of 70 patients, sporadically selected among 458 patients to whom PML performed in a standard prone position. Mini-PNL was performed under combined regional (spinal-epidural) anesthesia in 98,7% (514) cases, in 1,3% (7) under endotrachial anesthesia. Results. The average time of surgery was 41,1±11,4 minutes in the 1st group and 57,4±10,3 minutes in the 2nd group (р<0,05), due to the lack of need to revolutionize the patient on the abdomen. Statistically greater (p<0,05) of the ability to perform/ additional percutaneous access in patients in the supaine position. Infectious complications (9,5 vs. 7,1%; p>0,05), stone-free conditions (96,4 vs. 98,2%; p>0,05) and average hospital stays (2,3 vs. 2,2 days; p>0,05). None of the patients in both groups had complications higher than Clavien IIIa. When performing PNL in the supine position, in contrast to performing PNL on the prone position, there is always the possibility of using combined endoscopic methods. Where 3 (4,8%) patients underwent combined retro- and antegrade approaches for combination of nephrolithiasis with «wedged» calculi of the pyelourethral segment and in distal ureter, and retrograde laser endoureterotomy was performed in one (1,6%) patient. The limitation of our study includes a small sample size and a lack of group randomization. Conclusions. The patient’s position on the supine position, during the implementation of PNL, is a safe technique and can be a particularly attractive option for the category of patients with high anesthesiological risk; in the case of planned simultane (transurethral and percutaneous) interventions on the UMP; in patients who are obese or with severe deformityof the spine.

Total Hip Replacement in Severe Sequelae of Its Injury

2004 ◽  
Vol 11 (2) ◽  
pp. 13-17
Author(s):  
O Sh Buachidze ◽  
V P Voloshin ◽  
B C Zubikov ◽  
G A Onoprienko ◽  
D V Martynenko ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Hip Joint ◽  
Joint Replacement ◽  
Hip Replacement ◽  
Standard Technique ◽  
Joint Injury ◽  
Functional Changes ◽  
Technical Modifications ◽  
Standard Techniques ◽  
Observation Period

Experience of the orthopaedic and trauma clinic of the Moscow Regional Scientific Research Clinical Institute in large joints replacement is presented. Hip replacement was performed to 458 patients with sequelae of the joint injury. Depending on the severity of hip joint injury all patients were subdivided into 2 groups. In the first group of patients joint replacement was performed by standard technique, in the second group of patients certain technical modifications were required. Use of special implant constructions and methods to supplement standard techniques was considered in relation to concrete anatomic and functional changes. The results of large joints replacement were successful in 96% of cases with maximum observation period of 21 years.

Cost of palliative external beam radiotherapy (EBRT) utilization for bone metastases secondary to prostate cancer (PC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16091-e16091
Author(s):  
Nancy A. Nickman ◽  
Xiangyang Ye ◽  
David K Gaffney ◽  
Reed B. Barney ◽  
Joseph E. Biskupiak ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Confidence Interval ◽  
Bone Metastases ◽  
External Beam Radiotherapy ◽  
Patient Specific ◽  
First Episode ◽  
Total Cost ◽  
Percentile Method ◽  
Patient Reported ◽  
Episodes Of Care

e16091 Background: Evaluations of palliative EBRT costs for patients with bone metastases are limited. The objective of this study was to summarize documentation of usual care patterns and episode costs of EBRT to bone in deceased men with metastatic PC treated in a United States specialty cancer hospital. Methods: An Electronic Health Record (EHR)-based retrospective review was used to identify deceased PC (ICD-9 185.xx) patients ≥18 years of age with bone metastases (ICD-9 198.5) treated between 1995 and 2012 with EBRT for metastasis and pain management. Variables of interest encompassed patient-specific demographic and clinical characteristics, including length and number of EBRT treatments and total cost of EBRT usage (standardized to 2011$US).Common Procedural Terminology (CPT) codes related to EBRT and hospital assigned visit numbers were used in an algorithm to identify EBRT episodes of care (defined as all billed professional and technical EBRT services provided between initial and final evaluation by radiation oncologist). Bootstrapping (percentile method) was used to approximate the 95% confidence interval for final EBRT cost estimates. Results: A cohort of 176 men were identified; 19 (10.8%) had metastases in >1 site, and an average (±SD) Charlson Comorbidity Index of 6.4 ± 3.9 at metastasis diagnosis (excluding cancer). An average of 5.1 ± 4.6 years elapsed between PC and bone metastasis diagnoses. Prior to bone metastasis diagnosis, patient-reported symptoms included bone pain (54%). All men received at least 1 episode of EBRT, and 89 (50.6%) received >1 episode (range 1-6, median = 2). The length of first episode of EBRT ranged from 1 - 44 calendar days (average ± SD, 13.4 ± 8.4), with an average cost totaling $7,084 ± $4,028. Approximately 70% of costs were attributable to hospital (technical) charges and 30% to physician (professional) charges. Bootstrapping resulted in a 95% confidence interval of total cost between $6,641 and $7,527. Conclusions: Results suggest thatpalliative EBRT may constitute a significant burden in time and healthcare system costs.

Olfactory neural tumours—the role of external beam radiotherapy

1996 ◽  
Vol 110 (11) ◽  
pp. 1012-1016 ◽  
Author(s):  
N. J. Slevin ◽  
C. J. R. Irwin ◽  
S. S. Banerjee ◽  
N. K. Gupta ◽  
W. T. Farrington
Keyword(s):  
Lymph Node ◽  
Natural History ◽  
External Beam Radiotherapy ◽  
Olfactory Neuroblastoma ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
External Beam ◽  
En Bloc ◽  
Node Disease

AbstractOlfactory neuroblastoma is an uncommon tumour arising in the nasal cavity or paranasal sinuses. We report the management of nine cases treated with external beam radiotherapy subsequent to sureery, either attempted definitive removal or biopsy only. Recent refinements in pathologicalevaluation of these tumours are discussed. Seven cases were deemed classical olfactory neuroblastoma whilst two were classified as neuroendocrine carcinoma. The clinical features, radirap technique and variable natural history are presented. Seven of eight patients treatecall were controlled locally, with a minimumfollow-up of two years. Three patients developedcervica lymph node disease and three patients died of systemic metastatic disease. Suggestios are made as to which patients should have en-bloc resection rather than definitive radiotherapy.

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