Allogeneic platelet gel with autologous cancellous bone graft for the treatment of a large bone defect

BACKGROUND/AIMS: A 50-year-old type 2 diabetic male with a comminuted fracture of the tibia and delayed union after insufficient initial osteosynthesis with a resulting pseudoarthrosis was treated operatively by using a graft composed of platelet gel mixed with autologous cancellous bone. The essential idea of this therapy was to combine the healing capacities of platelet-derived growth factors and osteogenic stem cells and the modeling capacity of the gel. Due to a history of diabetes, allogeneic instead of autologous platelets were used. METHODS: The allogeneic platelet concentrate was ABO- and RhD-matched, leukocyte-depleted, irradiated and activated by human thrombin. The defect of 45 ml was filled with the graft mixture and fixed with an external fixator. RESULTS: Postoperative care was uneventful. After 6 months the graft was incorporated, the bone defect was fully bridged and full weight-bearing capacity was achieved. No side effects were observed and no platelet or HLA class I antibodies were detected. CONCLUSION: This case report shows that the clinical use of allogeneic platelet-derived growth factors is feasible and that a prospective study is necessary to prove the effectiveness and reproducibility of this therapeutic approach.     

The Importance of Flaps in Reconstruction of Locoregionally Advanced Lateral Skull-base Cancer Defects: a Tertiary Otorhinolaryngology Referral Centre Experience

BackgroundThe aim of the study was to identify the value of extensive resection and reconstruction with flaps in the treatment of locoregionally advanced lateral skull-base cancer.Patients and methodsThe retrospective case review of patients with lateral skull-base cancer treated surgically with curative intent between 2011 and 2019 at a tertiary otorhinolaryngology referral centre was made.ResultsTwelve patients with locoregionally advanced cancer were analysed. Lateral temporal bone resection was performed in nine (75.0%), partial parotidectomy in six (50.0%), total parotidectomy in one (8.3%), ipsilateral selective neck dissection in eight (66.7%) and ipsilateral modified radical neck dissection in one patient (8.3%). The defect was reconstructed with anterolateral thigh free flap, radial forearm free flap or pectoralis major myocutaneous flap in two patients (17.0%) each. Mean overall survival was 3.1 years (SD = 2.5) and cancer-free survival rate 100%. At the data collection cut-off, 83% of analysed patients and 100% of patients with flap reconstruction were alive.ConclusionsFavourable local control in lateral skull-base cancer, which mainly involves temporal bone is achieved with an extensive locoregional resection followed by free or regional flap reconstruction. Universal cancer registry should be considered in centres treating this rare disease to alleviate analysis and multicentric research.Key words: temporal bone, microsurgery, parotid region, free tissue flaps, neoplasm staging, ear     

Telemedicine in the blood transfusion laboratory: remote interpretation of pre-transfusion tests

We have developed a telemedicine system for blood transfusion work, to supply the local hospital laboratory with an expert opinion from the central reference laboratory. The telemedicine system allows remote inspection and interpretation of pre-transfusion tests, which are performed by ID-cards (micro-tube gel technology). The system was installed at three blood transfusion laboratories in Slovenia, approximately 70 km apart. Validation of the telemedicine system was performed using 99 clinical cases selected randomly from routine work. Two groups of immunohaematology specialists participated. Group A (n = 8) performed the read-out of the pre-transfusion tests on ID-cards by using the telemedicine system. Group B (n = 2) then read the ID-cards independently using the standard visual method. All 98 final interpretations which were recorded using the telemedicine system were correct. We recorded 591 micro-tube read-outs of agglutination strength using the telemedicine system, of which 582 were correct. For comparison, we recorded 591 micro-tube read-outs using the standard visual method, of which 582 were correct. The validation proved that the telemedicine system was suitable for operational use.     

Severe human granulocytic anaplasmosis transmitted by blood transfusion

A 36-year-old woman acquired severe human granulocytic anaplasmosis after blood transfusion following a cesarean section. Although intensive treatment with mechanical ventilation was needed, the patient had an excellent recovery. Disease caused by Anaplasma phagocytophilum infection was confirmed in 1 blood donor and in the transfusion recipient.     

Influence of foot orthoses on plantar pressures,foot pain and walking ability of rheumatoid arthritis patients–a randomised controlled study

Purpose. To compare the effectiveness of functional foot orthoses and unshaped (flat) orthotic material on plantar pressure redistribution, forefoot pain reduction and walking ability in rheumatoid arthritis (RA) patients.

Methods. Forty patients with RA were randomised to receive unshaped material (UM) (n = 20) or functional foot orthoses (n = 20). Plantar pressure measurement was performed with an F-scan system. Foot pain was assessed by the pain subscale of the Foot Function Index. Walking ability was assessed by the 6-min walking test. Investigations were performed at baseline, 1 week after the patient received shoes with orthoses and 6 months later.

Results. Plantar pressures were significantly higher at painful than at non-painful foot areas. No differences in plantar pressure redistribution were found between the groups. Notable reduction of pain and improvement of activity (walking ability) was observed in both groups. Foot pain has moderate impact on the walking ability of RA patients.

Conclusions. The study showed no clear advantage of functional foot orthoses over UM.     

Capecitabine as a radiosensitizing agent in neoadjuvant treatment of locally advanced resectable rectal cancer: prospective phase II trial

Aim

To evaluate the efficacy and toxicity of preoperative chemoradiotherapy with capecitabine in locally advanced rectal cancer.

Methods

Between June 2004 and January 2005, 57 patients with operable, clinical stage II-III adenocarcinoma of the rectum entered the prospective phase II study. Radiation dose was 45 Gy (25 × 1.8 Gy). Concurrent chemotherapy with a daily dose of 1650 mg/m² capecitabine was administered orally, divided into two equal doses per day, including weekends. Patients were evaluated weekly for acute toxicity and compliance with the protocol. Surgery was scheduled 6 weeks after the completion of the chemoradiotherapy.

Results

A single female patient died after receiving 27 Gy, because of pulmonary embolism. All other patients completed the preoperative chemoradiotherapy according to the protocol and a definitive operation was performed in all but one of these patients. The complete pathological response was recorded in 5 patients (9.1%). Tumor (T), lymph nodes (N), and overall downstaging rates were 40%, 52.9%, and 49.1%, respectively. Total sphincter preservation rate was 65.5% (36 out of 55 patients) and the rate in 27 patients with tumors located within 5 cm of the anal opening was 37% (10 out of 27 patients). The most frequent side-effect of the combined therapy was dermatitis (grade 3 in 19 patients). After surgery, a single patient died due to sepsis during the early perioperative period. Nonlethal perioperative complications were recorded in 24/55 patients.

Conclusion

Preoperative chemoradiotherapy with oral capecitabine is safe and well tolerated. It has a downstaging potential and can increase the possibility for sphincter preservation surgery.Preoperative chemoradiation has become a standard part of treatment protocols in stage II and III rectal cancer. Compared to postoperative chemoradiotherapy, the advantage of preoperative application of chemotherapeutics and irradiation includes improved compliance, reduced toxicity, and downstaging of the tumor in a substantial number of patients. The latter may enhance the rate of curative surgery, permit sphincter preservation in patients with low-sited tumors, and have a positive impact on the quality of life of these patients (1).Although several innovative agents are being investigated in combination with radiotherapy, 5-fluorouracil (5-FU) in continuous infusion remains the gold standard in preoperative chemoradiotherapy schedules. The prolongation of exposure of cells to 5-FU results in improved antitumor activity, but requires prolonged infusion, usually through a vascular access port (VAP). Complications resulting from long-term venous access, such as bleeding and thrombosis, are not uncommon (2).Orally administered capecitabine (Xeloda^®, Hoffmann-La Roche Ltd, Basel, Switzerland) mimics the pharmacokinetics of continuous 5-FU infusion and makes chemoradiotherapy more patient-friendly. The mechanism of capecitabine activation, preferably in tumor cells, may further enhance its efficacy and tolerability, offering the potential for an enhanced therapeutic ratio (3-5). The use of capecitabine allows chronic dosing and, at the same time, avoids the discomfort and complications associated with prolonged intravenous infusion of 5-FU (2,6). Thus, the majority of patients prefer oral chemotherapy to 5-FU infusions (7).The aim of the present prospective phase II study was to evaluate the efficacy and toxicity of preoperative chemoradiotherapy with capecitabine in patients with locally advanced rectal cancer. The primary endpoint of the study was a pathologically determined complete remission rate of the disease, locally and regionally. Secondary outcomes were the rate of sphincter preservation in low-sited tumors, overall downstaging rate, and toxicity.