Chirurgische Therapieoptionen bei malignen Knochentumoren

Beside the susceptibility to a (neo-) adjuvant therapy, the surgical margin is the most important prognostic factor in the treatment of primary malignant bone tumors. If adjuvant therapy is not possible, the outcome of the disease depends on the selected surgical treatment.Limb salvage has proven to be a safe procedure for local tumor control and provides good functional results.The surgeon has to consider the best surgical option depending on the site and size of the tumor but also depending on the patient's age and the overall prognosis.Surgical techniques and possible complications of the most common procedures in tumor surgery are described.     

Hospital Discharge Rates and Deaths from Asthma in the Hunter Health Region (NSW) 1971–72 to 1975–76

Summary: During the five years 1971–72 to 1975–76 annual total discharges of patients with a primary diagnosis of asthma from public hospitals in the Hunter Health Region (NSW) fluctuated only slightly. The number of discharges did not reflect consistently the underlying population distribution. Significantly more discharges than expected occurred among people living in the drier inland areas of the Region.
Over the same period 65 residents of the Hunter Health Region were certified dead with asthma as the primary cause. In 29, death occurred at one of the Region's public hospitals but only eight were admitted as hospital inpatients primarily with asthma. Of the 65 asthma deaths, 36 (55.4%) occurred outside the Region's public hospitals.     

Coronary heart disease mortality trends and related factors in Australia

Coronary heart disease (CHD) has been the greatest single cause of mortality in Australia over the past 30 years. For most age and sex groups CHD mortality rates peaked in 1965-67. Since that time, rates have decreased by nearly 40% and are currently the lowest for 30 years. CHD mortality rates are highest in the eastern areas of Australia, among those who were born in Australia, and among lower socio-economic groups. Changes in CHD mortality have been accompanied by changes in life-style (particularly recent decreases in the prevalence of cigarette smoking, large reductions in tar content of cigarettes and a large change in preference for margarine over butter) and changes in treatment (especially in the control of hypertension and surgical interventions). Concurrent studies of the incidence and case fatality rates in two population centres (Perth and Newcastle) coupled with periodic surveys of changes in treatment and population risk factor levels are being undertaken over a 10-year period to try to understand the current and future trends in CHD mortality.     

Cigarette smoking and drug use in schoolchildren: IV--factors associated with changes in smoking behaviour

Factors associated with changes in the smoking behaviour of approximately 6000 schoolchildren (two cohorts aged between 10 and 12 years in 1979) over 12 months are described. They were measured twice as part of a randomized controlled trial of a smoking prevention programme. Four groups were defined: (a) those who became smokers (adopters); (b) those who remained non-smokers; (c) those who became non-smokers (quitters), and, (d) those who remained smokers. Personal and social variables were ordered using a logistic regression model according to the strength of their association with adopting and quitting smoking. Factors distinguishing adopters from children who remained nonsmokers were, being a member of the older cohort, having friends who smoke, having siblings who smoke, approving of cigarette advertising and having a relatively large amount of money to spend each week. Factors distinguishing quitters from children who continued to smoke were, having siblings who do not smoke, being a member of the younger cohort, disapproving of cigarette advertising and having a relatively small amount of money to spend each week. Initial attitude scores were indicative of future smoking behaviour and where smoking behaviour changed, attitudes also changed so that the two remained congruent. The younger cohort improved their knowledge of smoking hazards over the year irrespective of their smoking behaviour. The older cohort showed significant differences in knowledge which were dependent upon smoking category, with 1980 smokers having lower knowledge scores than non-smokers and showing an apparent decrement in their previous knowledge.     

Free vascularized fibular grafting for reconstruction after tumor resection in the upper extremity

BACKGROUND: Limb salvage is viable in the majority of patients with malignant bone tumors, but especially in case of extensive tumors and bad soft tissue conditions, it is challenging in upper extremity. OBJECTIVES/METHOD: The clinical and radiological results of 21 patients, who had free vascularized fibular grafts (VFG), for diaphyseal (14), and epipyseal (7) defect reconstruction of the upper extremity, are presented. The indications for VFG were resection after osteosarcoma (9 cases), Ewings sarcoma (9 cases), chondrosarcoma (1 case), rhabdomyosarcoma (1 case), and 1 case of fibrous dysplasia. The 20 malignant tumors were staged as follows: 2a (1), 2b (18), 3 (1). The mean follow-up was 43.6 months (min 6.0-max 131.9). Functional results were described and graded quantitatively according to the MSTS-score. RESULTS: Results were satisfactory with regard to pain, emotional acceptance, manual dexterity, and function. Lifting ability was decreased in two patients. Hypertrophy index was 31% (min 13%-max 71%). Main complications were fracture (5), pseudoarthrosis (4), prolonged wound healing (4), temporary nerve irritation (2), and deep infection (1). Re-operation was required in eight patients (12 operations). CONCLUSION: VFG offers a good possibility for biological reconstruction of large skeletal defects, with an acceptable complication and re-operation rate. When conservative treatment of complications was not successful, further surgery led to recovery in the majority of cases.     

Intramedullary and total femur replacement in revision arthroplasty as a last limb-saving option: is there any benefit from the less invasive intramedullary replacement?

There has been a substantial increase in the number of hip and knee prostheses implanted in recent years, with a consequent increase in the number of revisions required. Total femur replacement (TFR) following destruction of the entire femur, usually after several previous revision operations, is a rare procedure but is the only way of avoiding amputation. Intramedullary femur replacement (IFR) with preservation of the femoral diaphysis is a modification of TFR. Between 1999 and 2010, 27 patients with non-oncological conditions underwent surgery in our department with either IFR (n = 15) or TFR (n = 12) and were included in this study retrospectively. The aim of the study was to assess the indications, complications and outcomes of IFR and TFR in revision cases. The mean follow-up period was 31.3 months (6 to 90). Complications developed in 37% of cases, 33% in the IFR group and 4% in the TFR group. Despite a trend towards a slightly better functional outcome compared with TFR, the indication for intramedullary femur replacement should be established on a very strict basis in view of the procedure's much higher complication rate.     

Monarthritis des oberen Sprunggelenks bei Osteoidosteom des Talus

The case of a 22-year-old man with an osteoid osteoma of the right talus neck is reported. After 2 years of pain and swelling we confirmed the diagnosis by CT and MRI scan. Afterwards we performed CT-guided thermocoagulation; 12 months afterwards the patient shows no symptoms anymore.     

Monarthritis of the ankle due to osteoid osteoma of the talus. Difficulties in diagnosis and treatment

The case of a 22-year-old man with an osteoid osteoma of the right talus neck is reported. After 2 years of pain and swelling we confirmed the diagnosis by CT and MRI scan. Afterwards we performed CT-guided thermocoagulation; 12 months afterwards the patient shows no symptoms anymore.     

Management of Bone Tumours in Paediatric Oncology

The management of bone tumours in paediatric oncology requires careful multidisciplinary planning due to the need for multimodal therapy approaches. The non-specific symptoms often lead to a delayed definitive diagnosis of a bone tumour. Imaging procedures are of major importance for an individualised and optimised treatment planning. They have to be carried out before any surgery, including biopsies. The introduction of multi-agent chemotherapy has led to a significant improvement in survival rates in patients suffering from Ewing's sarcomas and osteosarcomas. However, local therapy still remains indispensable in order to achieve long-term survival. For osteosarcoma, surgery remains the only adequate local therapy modality. Radiotherapy may be considered if surgery is not feasible. In these cases, high radiation doses need to be applied. The choice for local therapy modality is not as clear in patients with Ewing's sarcoma. Today, surgery is often preferred if a wide or at least marginal resection can be carried out. Additional radiotherapy is advised in patients with marginal/intralesional resection or poor histological response to induction chemotherapy. Definitive radiotherapy is recommended for inoperable lesions. In the future, new radiotherapy approaches, such as intensity-modulated radiotherapy or proton therapy, may yield better results with minor risks of late effects.