Surgical Treatment Alternative to the Hip Disarticulation in Pacients with Malignant Tumor of the Proximal Femur

Abstract Background. Primary bone tumors are rare and affect especially young persons, being at the same time very aggressive and mutilating, often also implicating the disarticulation of the affected hip. That is why it is necessary to find alternatives of treatment, so that these young people to be able to keep their normal functionality and mental comfort. Objectives. The objective of this paper was to be able to offer a surgical treatment alternative to the hip disarticulation in case of malignant tumors of the proximal femur in young patients. Methods. We present the case of a 25-year-old female patient, who was hospitalized in our clinic for pain and functional impairment of the right hip. The clinical and radiological exams established the diagnosis of fracture of pathological bone of the proximal femur and it raised the suspicion of a tumor with malignant characters. We performed arteriography of the right inferior member, which showed a very good vascularized tumor, possibly vascular, localized to the proximal femur, arterially powered by the branches of right profunda femoris artery. We surgically intervened and made an incisional biopsy with anatomopathological exam, which established the diagnosis of osteosarcoma. Then, we practiced the segmental resection of the tumor, preceded by the embolization of the right femoral artery and after that the reconstruction with bipolar cemented modular prosthesis of the right hip. The patient had a favorable evolution, she did neuromotor rehabilitation, and then she presented to the oncologist for the initiation of adjuvant chemotherapy, which she followed conformably to the recommendations.

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Hidradenitis Suppurativa (Hurley I/II): Serial Excisions with Primary Wound Closure Under Local Anesthesia As Most Adequate Treatment Approach!

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.148 ◽

2019 ◽

Vol 7 (3) ◽

pp. 400-402 ◽

Cited By ~ 2

Author(s):

Georgi Tchernev ◽

Ivanka Temelkova

Keyword(s):

Surgical Treatment ◽

Local Anaesthesia ◽

Hidradenitis Suppurativa ◽

Wound Closure ◽

Young Patients ◽

Stage I ◽

Inflammatory Disorder ◽

Adequate Treatment ◽

Primary Wound Closure ◽

The Right

BACKGROUND: Acne inversa as a chronic inflammatory disorder can be divided into three stages according to Hurley's classification. It affects the axillary and anogenital region predominantly, and its chronic course of development is associated with a major negative impact on quality of life, especially in young patients. We discuss the different types of treatment in patients with acne inversа and the benefits of two-stage surgical treatment by serial excisions with primary wound closure under local anaesthesia. CASE REPORT: We present a 28-year-old man with hidradenitis suppurativa stage I in the right axillary region and also in the pubic area. The patient is an active smoker. The patient was treated with Rifampicin 2x 300mg / day without any particular effect and preoperatively, systemic therapy with Clindamycin 4x 600mg / day was performed, combined with daily dressings with jodasept ointment for 7 days. The patient was treated through two surgical sessions under local anaesthesia with elliptical excision of the lesions located in the right axillary and the pubic area. Both of the two surgical defects were initially closed with single interrupted sutures. Histological examination of both lesions revealed the presence of suppurative folliculitis. CONCLUSION: The literature describes various methods for treating acne inversа which include both systemic and local approaches. However, it is considered that drug therapy achieves only a temporary improvement in patients with hidradenitis suppurativa. For this reason, the surgical treatment of acne inversа is indicated as the only curative treatment, especially for recurrent lesions and serial excisions under local anaesthesia, followed by primary wound closure is a valuable treatment for patients with mild to moderate HS (Hurly stage I & II).

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Radiation therapy in primary bone tumors for young patients

Current Problems in Cancer ◽

10.1016/j.currproblcancer.2013.07.007 ◽

2013 ◽

Vol 37 (4) ◽

pp. 198-206 ◽

Cited By ~ 1

Author(s):

Virag Dandekar ◽

Ross Abrams ◽

Paul M. Kent

Keyword(s):

Radiation Therapy ◽

Bone Tumors ◽

Young Patients ◽

Primary Bone Tumors ◽

Primary Bone

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Features of diagnostics and surgical treatment of right ventricular thrombosis complicated by pulmonary artery thromboembolism (clinical case)

Ukrainian journal of cardiovascular surgery ◽

10.30702/ujcvs/19.3712/073067-071 ◽

2019 ◽

pp. 67-71

Author(s):

R. M. Vitovsky ◽

P. M. Semeniv ◽

A. O. Rusnak ◽

Y. R. Ivanov ◽

V. F. Onischenko

Keyword(s):

Pulmonary Embolism ◽

Surgical Treatment ◽

Pulmonary Artery ◽

Right Ventricle ◽

Right Ventricular ◽

Young Patients ◽

The Body ◽

Blood Clots ◽

The Right ◽

Clinical Conditions

The case of differential diagnosis and treatment of a patient with pulmonary embolism (PE), the source of which was the thrombus formed in the right ventricle of the heart, is presented. The peculiarity of this case was the untimely diagnosis of the disease, which simulated pneumonia, the treatment of which did not improve the clinical condition of the patient. Tomography allowed to determine the thrombosis of the right branch of the pulmonary artery and to send the patient to the cardiac surgery center for further treatment. Diagnosis of a probable source of embolism occurred after echocardiography, which revealed a tumor-like lesion of the right ventricle of large size and dense consistency. The results of surgical treatment of the patient, during which extensive formation of the right ventricle was removed, a dense elastic consistency with signs of fragmentation confirmed the prediction of this particular source of pulmonary embolism. Removal of blood clots from the right branch of the pulmonary embolism showed their similar macrostructure with right ventricular formation. The appearance and macrostructure of the formation did not allow to determine with certainty its character. Only histological examination was able to determine the thrombogenicity of the origin of this formation. The recurrent nature of pneumonia, without the presence of risk factors, in young patients may be the basis for more thorough examination to identify atypical clinical conditions. The restoration of the source of the body is of great importancefor the prevention of its relapse. Finding the source of pulmonary embolism should necessarily include echocardiography to carefully examine possible lesions of intracardiac structures with the formation of blood clots that may be responsible for its occurrence.

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Borderline ovarian tumors

Archive of oncology ◽

10.2298/aoo0602062m ◽

2006 ◽

Vol 14 (1-2) ◽

pp. 62-63

Author(s):

Katarina Mastilovic ◽

Tatjana Ivkovic-Kapicl ◽

Milica Zivaljevic ◽

Jelka Rajovic ◽

Dejan Nincic

Keyword(s):

Surgical Treatment ◽

Malignant Tumors ◽

Young Patients ◽

Ovarian Tumors ◽

Disease Stage ◽

Early Disease ◽

Oncogenic Potential ◽

Stage Of Disease ◽

Borderline Ovarian Tumors ◽

Early Disease Stage

Borderline ovarian tumors are classified between benign cystadenoma and malignant cystadenocarcinoma. They are characterized as malignant tumors by histopathological features, which make them different from the benign ones. These tumors are commonly diagnosed at the early disease stage. The treatment of these tumors is surgical. The prognosis depends on the stage of disease and histopahtological types. We present 10 patients operated at the Institute of Oncology Sremska Kamenica because of malignant tumors with low malignant oncogenic potential in the period between 2000 and 2005. All patients had surgical treatment with ex tempore diagnostics, hysterectomy and adnexectomy with total omentectomy, or unilaterals adnexectomy. All patients had negative cytoanalytic findings of the small pelvis. Histopathological findings are necessary to confirm the diagnosis of disease. In young patients who had no children fertility can be preserved.

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Differential Diagnosis of Metastases in Bone Scans: Chemotherapy induced Bone Necrosis

Nuklearmedizin ◽

10.1055/s-0038-1632187 ◽

1999 ◽

Vol 38 (02) ◽

pp. 38-42

Author(s):

E. Kaiserling ◽

T. Klingebiel ◽

U. Feine ◽

D. Niethammer ◽

P. Reuland

Keyword(s):

Hot Spots ◽

Young Patients ◽

Final Diagnosis ◽

Tracer Uptake ◽

Bone Necrosis ◽

Primary Bone Tumors ◽

Incorrect Diagnosis ◽

Primary Bone ◽

Bone Scans

Summary Aim: Influenced by the incorrect diagnosis of a bone metastasis caused by bone necrosis we evaluated reasons and frequency of bone necrosis in patients referred for bone scanning in follow-up of tumors. Methods: Bone scans performed within two years on patients with primary bone tumors or tumors metastatic to bone were reviewed in respect to the final diagnosis bone necrosis. Results: We found the cases of three young patients who presented the appearance of hot spots on bone scintigrams which were finally diagnosed as bone necrosis. In two cases the diagnosis was based on histological findings, in one case the diagnosis was made evident by follow-up. All the three patients had been treated by chemotherapy and presented no other reason for the development of bone necrosis. Enhanced tracer uptake in all sites decreased within eight weeks up to two years without therapy. Conclusion: Single and multiple hot spots after chemotherapy may be originated by bone necrosis but mimikry metastases.

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Surgical Treatment of Primary Cardiac Tumors

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239700500208 ◽

1997 ◽

Vol 5 (2) ◽

pp. 101-103 ◽

Cited By ~ 2

Author(s):

Gu Chun Jiu ◽

Bao Wei Ke ◽

Guo Bin Xun ◽

Yuan Hong ◽

Xiu Zhong Yi

Keyword(s):

Surgical Treatment ◽

Malignant Tumors ◽

Right Atrial ◽

Benign Tumors ◽

Cardiac Tumors ◽

Long Term Result ◽

The Right ◽

Medical University ◽

Primary Cardiac Tumors

During a 16-year period from 1980 to 1996, 101 patients with primary cardiac tumors underwent surgery at the 1st Affiliated Hospital of China Medical University, which represented 2.44% of 4142 open-heart surgical cases during this period. Most tumors were benign; 94 were myxomas, 2 were fibromas, and 1 was a hemangioma. Three myxomas were in the right atrium and 91 were in the left atrium. The 4 malignant tumors comprised 2 mesothelioma, 1 histiocytoma, and 1 right atrial malignant myxoma. All benign tumors were completely excised with 4.95% mortality. Only 1 malignant tumor was completely excised. In our experience, the long-term result of surgical treatment of benign cardiac tumors is excellent, whereas the prognosis for patients with malignant cardiac tumors is very poor. The incidence of malignant tumors was lower than in other studies.

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Malignant Peripheral Nerve Sheath Tumor of the Inguinum and Angiosarcoma of the Scalp in a Child with Neurofibromatosis Type 1

Case Reports in Pathology ◽

10.1155/2017/7542825 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Marija Milković Periša ◽

Tihana Džombeta ◽

Jasminka Stepan Giljević ◽

Božo Krušlin

Keyword(s):

Peripheral Nerve ◽

Neurofibromatosis Type 1 ◽

Malignant Tumors ◽

Young Patients ◽

Neurofibromatosis Type ◽

Nerve Sheath Tumor ◽

Peripheral Nerve Sheath Tumor ◽

Nerve Sheath ◽

The Right

Benign and malignant tumors are common in the setting of neurofibromatosis type 1 (NF1). Malignant peripheral nerve sheath tumor (MPNST) and angiosarcoma are rare tumors in children and adolescents and mostly occur in young patients in relation to NF1. Both histological types can be present in the same tumor mass in patients with NF1. We present a case of 12.5-year-old girl with NF1 who first presented with MPNST of the right inguinal region and 1.5 years later with unrelated angiosarcoma of the scalp.

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Strategies for managing the destruction of calcar femorale

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04324-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jin Mei ◽

Lili Pang ◽

Zhongchao Jiang

Keyword(s):

Proximal Femur ◽

Bone Tumors ◽

Bone Cyst ◽

Treatment Strategies ◽

Femoral Neck Fractures ◽

Anatomical Structure ◽

Pathological Fractures ◽

Main Text ◽

Primary Bone Tumors ◽

Primary Bone

Abstract Background The calcar femorale was identified long ago. However, our current understanding of the calcar is insufficient, and its related concepts are sometimes confused. The calcar femoral is an important anatomical structure of the proximal femur, and its function can be overlooked. In trauma, tumors, or other diseases, the calcar femorale can be destroyed or changed pathologically. As a result, the mechanical structure of the proximal femur becomes destroyed, causing pathological fractures. How to address the destruction of the calcar femorale or the damage to the calcar femorale is discussed in this article. Main text Destruction of the calcar femorale is accompanied by many conditions, including trauma, tumors, and other diseases. The types of hip fractures caused by trauma include femoral neck fractures and intertrochanteric fractures. Dynamic hip screws, proximal femoral nail anti-rotation, and multiple parallel cannulate pins can be used in different conditions. When metastatic and primary bone tumors involve the calcar femorale, endoprostheses are widely used. Other diseases, such as fibrous dysplasia and aneurysmal bone cyst are treated differently. Conclusions The calcar femorale can redistribute stresses and the destruction of the calcar femorale can lead to an increase in posterior medial stress. Many factors need to be considered when deciding whether to reconstruct the calcar femorale. Effective treatment strategies for managing the destruction of calcar femorale will need first establishing the precise mechanism of the destruction of the calcar and then designing therapies towards these mechanisms. Further investigation to the calcar needs to be carried out.

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A New Proximal Femur Reconstruction Technique after Bone Tumor Resection in a Very Small Patient: An Exemplificative Case

Children ◽

10.3390/children8060442 ◽

2021 ◽

Vol 8 (6) ◽

pp. 442

Author(s):

Carmine Zoccali ◽

Silvia Careri ◽

Dario Attala ◽

Michela Florio ◽

Giuseppe Maria Milano ◽

...

Keyword(s):

Proximal Femur ◽

Bone Growth ◽

Tumor Resection ◽

Young Patients ◽

Femoral Stem ◽

Distal Humerus ◽

Limb Salvage Surgery ◽

Reconstruction Technique ◽

Bone Tumor Resection ◽

The Right

For patients too young to be fitted with an expandable prosthesis, limb salvage surgery requires other strategies. The main problems are related to the impossibility of implanting an expandable prosthesis to the residual bone growth that is much too big in relation to the bone size, with the precocious implant loosening and/or the residual absence of bone growth, as well as the problem of limb length and shape difference. In this paper, we report a possible reconstruction solution using a composite prosthesis for an Ewing’s sarcoma of the proximal femur in an infant patient. After resection, a femoral stem was cemented into the distal third of a homoplastic humerus; a carbon fiber plate was used to stabilize the bone/homograft interface. At the one-year follow-up, the patient was free of disease and able to walk with only a slight limp. This case report describes a possible solution for very small patients. An adult humerus is of the right size to replace a child’s lower limb segments, and the distal humerus can be shaped, maintaining a cortex stiff enough to support a prosthesis. Very young patients might obtain a faster osteointegration of the graft than adults, due to their higher biological activity and, in this case, the diapasonal shape of the allograft might also have contributed to accelerated fusion. Moreover, the use of a graft to fit the prosthesis avoids loosening issues due to canal widening, hypothetically providing more growing time before system failure and revision surgery. However, although this technique is promising, further studies are necessary to confirm our findings and to verify if this procedure allows easier future prosthesis implantation.

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