The effect of individualized exercise interventions during treatment in pediatric patients with a malignant bone tumor

Background

While research on exercise interventions during anticancer treatment is well-established in adults, only very few studies exist in children. However, pediatric patients experience great limitations to being physically active, and appropriate interventions are desired.

Procedure

The present study aimed at investigating the effects of individualized exercise interventions during inpatient stays on pediatric patients with a malignant bone tumor. The parameter of interest was physical activity (PA). Patients’ PA during home stays was assessed 6 weeks as well as 3, 6, 12, and 18 months post-surgery. Patients were distinguished into an intervention group and a control group. All patients received endoprosthetic replacement of the affected bone in the same institution.

Results

A constant increase in all PA parameters was observed during follow-up. Exercise interventions were possible and appeared worthwhile. The intervention group showed better PA results at all measurements; however, no significant differences between groups were found. Furthermore, differences decreased especially after the cessation of the intervention. General problems in reaching appropriate power and compliance were observed.

Conclusions

Individualized exercise interventions in pediatric bone tumor patients are possible and appear to be beneficial. Such interventions should be implemented in adjuvant care; however, future research is needed to understand more about the effects of different interventions.     

Treatment options for recurrent giant cell tumors of bone

Background  Although the recurrence rate of giant cell tumors of bone (GCTB) is relatively high exact data on treatment options for the recurrent cases is lacking. The possible surgical procedures range from repeated intralesional curettage to wide resection. Methods  Two hundred and fourteen patients with histologically certified GCTB have been treated at the authors department from 1980 to 2007. Sixty-seven patients with at least one local recurrence were included in this study. The mean follow-up was 77.3 months. The data was evaluated according the re-recurrence rate with regard to the surgical procedure for the recurrence. Results  The mean time until the first local recurrence was 22.0 months; the mean number of recurrences per patient was 1.4. The recurrence occurred in 69.7% (46 out of 66 patients) within the first 2 years. If after intralesional procedures (curettage or intralesional resection) no adjunct was used the re-recurrence rate was 58.8% (10 out of 17 patients) and decreased to 21.7% (5 out of 23 patients) if a combination of all adjuncts (PMMA + burring) was used. The likelihood of re-recurrence was reduced by the factor 5.508 which was clearly significant (P = 0.016). In case of wide resection no re-recurrence occurred. Seven patients (10.5%) developed pulmonary metastases. Fourteen patients (20.9%) finally received an endoprosthesis; 12 due to tumor recurrence, 2 due to secondary arthritis. Conclusion  Recurrent GCTB can be treated by further curettage with additional burring and cementing with an acceptable re-recurrence rate of 21.7%. The rate of patients finally needing an endoprosthesis is 20.9%. Due to the high rate of pulmonary metastases recurrent GCTB may be considered as a severe disease. Ethical Board Review statement: Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.     

Uncommon cause for anterior knee pain - Aggressive aneurysmal bone cyst of the patella

Traumatic injury and surgical meniscectomy of a medial meniscus are known to cause subsequent knee osteoarthritis. However, the difference in the prevalence of osteoarthritis caused by the individual type of the medial meniscal tear has not been elucidated. The aim of this study was to investigate what type of tear is predominantly responsible for the degradation of articular cartilage in the medial compartment of knee joints. Five hundred and forty eight cadaveric knees (290 male and 258 female) were registered in this study. The average age of cadavers at death was 78.8 years old (range: 52-103 years). The knees were macroscopically examined and their medial menisci were classified into four groups according to types of tears: "no tear", "radial tear of posterior horn", "other types of tear" and "worn-out meniscus" groups. The severity of cartilage degradation in their medial compartment of knee joints was evaluated using the international cartilage repair society (ICRS) grading system. We statistically compared the ICRS grades among the groups using Mann-Whitney U test. The knees were assigned into the four groups: 416 "no tear" knees, 51 "radial tear of posterior horn" knees, 71 "other types of tear" knees, and 10 "worn-out meniscus" knees. The knees with substantial meniscal tears showed the severer ICRS grades of cartilage degradation than those without meniscal tears. In addition, the ICRS grades were significantly severer in the "radial tear of posterior horn" group than in the "other types of tear" group, suggesting that the radial tear of posterior horn in the medial meniscus is one of the risk factors for cartilage degradation of joint surface. We have clarified the relationship between the radial tear of posterior horn in the medial meniscus and the severer grade of cartilage degradation. This study indicates that the efforts should be made to restore the anatomical role of the posterior horn in keeping the hoop strain, when patients' physical activity levels are high and the tear pattern is simple enough to be securely sutured.     

Effects of random breath testing on hospital admissions of traffic-accident casualties in the Hunter Health Region

During the period of six years from 1977 to 1982, the number of admissions of victims of traffic accidents to public hospitals in the Hunter Health Region of New South Wales fell from 2099 to 1734, a decline of 21%. About three-quarters of these patients were male; one-quarter were in the 15-20 year age group. Since the introduction of random breath testing (RBT) in 1982, there has been a further decline in admissions of traffic accident victims to hospitals of nearly 20%, attributable to the introduction of RBT. The initial decline of 30% appears to have stabilized at 20% after 12 months. The decline in admissions occurred in the urban hospitals (31%), and not in the rural hospitals; it was greater among male (31%) than among female (8%) accident victims. In the Hunter region, it is estimated that RBT has resulted in a saving of more than 3000 hospital bed-days in its first year.     

Multiple enchondromatosis: Ollier's disease

In contrast to solitary enchondroma,patients with multiple enchondromatosis of bone (Ollier's disease) get affected in childhood by bone swelling and growth retardation. In adults, the main problem is the risk of malign transformation up to 40%.Pain, increasing local tumor and thinning of the corticalis are the typical clinical and radiological signs of transformation to a low grade chondrosarcoma. There is no need for a regular radiological screening. If a malign transformation occurs,marginal or wide resection of the lesion should be performed.     

Umkehrplastik im operativen Behandlungsplan der primär malignen Knochentumoren

Zusammenfassung Durch die Einführung einer multimodalen Therapie mit Chemo- und evtl. Strahlentherapie bei malignen Knochentumoren konnte die Langzeitüberlebensrate deutlich gesteigert werden. Heute überleben bis zu 80% der Patienten mit einem Ewing- oder Osteosarkom. Daher kommt der Funktion der betroffenen Extremität und der Lebensqualität des Patienten nach der Tumorresektion eine entscheidende Bedeutung zu.Die Umkehrplastik, die 1974 von Salzer in die Tumorchirurgie eingeführt und von Winkelmann modifziert wurde, ersparte vor der Ära der Tumorendoprothetik vielen Patienten die Amputation. Aber auch im Zeitalter des Extremitätenerhalts (limb salvage) muss die Umkehrplastik hinsichtlich der Funktionalität und der Akzeptanz den Vergleich mit der Endoprothetik nicht scheuen. Insbesondere bei Tumoren mit ausgedehnter Weichteilkomponente, des proximalen oder gesamten Femurs und der proximalen Tibia und bei Patienten unterhalb des 10. Lebensjahres ist die Umkehrplastik eine ernstzunehmende Alternative. Des Weiteren kann sie nach misslungenem Extremitätenerhalt (Infektion, mehrfache Prothesenwechsel) den Patienten vor einer Amputation bewahren.     

Bone Tumors in Adolescents and Young Adults

Opinion statement  Bone tumors, particularly osteosarcomas and members of the Ewing Sarcoma Family of Tumors (ESFT), are typical malignancies of adolescents and young adults. Current diagnostic and therapeutic guidelines for patients of all ages were developed in this specific age group. The aim of bone sarcoma therapy should be to cure the patient from both the primary tumor and all (micro-)metastatic deposits while maintaining as much (extremity) function and causing as few treatment-specific late effects as possible. Bone sarcoma therapy requires close multidisciplinary cooperation. Usually, it consists of induction chemotherapy, followed by local therapy of the primary tumor (and, if present, primary metastases) and further, adjuvant chemotherapy. Local treatment for osteosarcoma should be surgery whenever feasible. Surgery is also gaining importance in ESFT, which was long considered a domain of radiotherapy. Modern reconstructive techniques continue to expand the indications for limb salvage, particularly for patients who have not yet reached skeletal maturity. Treatment within the framework of prospective, multi-institutional trials should be considered standard of care not only for children, but also for affected adolescents and (young) adults. Such trials are essential in guaranteeing that all patients have access to appropriate care and that progress from biological studies can be translated into prognostic improvements without undue delay. The rarity of bone sarcomas increasingly requires trials to be multinational.     

Effects of Lamotrigine and Topiramate on Glial Properties in an Astrocyte-Microglia Co-Culture Model of Inflammation

BackgroundAstrocytes and microglia are involved in the pathophysiology of epilepsy and bipolar disorder with a link to inflammation. We aimed to investigate the effects of the antiepileptic and mood-stabilizing drugs lamotrigine (LTG) and topiramate (TPM) on glial viability, microglial activation, cytokine release, and expression of gap-junctional protein connexin 43 (Cx43) in different set-ups of an in vitro astrocyte-microglia co-culture model of inflammation.MethodsPrimary rat co-cultures of astrocytes containing 5% (M5, representing “physiological” conditions) or 30% (M30, representing “pathological, inflammatory” conditions) of microglia were treated with different concentrations of LTG and TPM for 24 hours. An 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was performed to measure the glial cell viability. The microglial activation state was analyzed by immunocytochemistry. The pro-inflammatory tumor necrosis factor-α (TNF-α) and anti-inflammatory transforming growth factor-ß1 (TGF-ß1) cytokine levels were measured by enzyme-linked immunosorbent assay. The astroglial Cx43 expression was quantified by western blot.ResultsA significant reduction of the glial cell viability after incubation with LTG or TPM was observed in a concentration-dependent manner under all conditions. LTG caused no significant alterations of the microglial phenotypes. Under pathological conditions, TPM led to a significant concentration-dependent reduction of microglial activation. This correlated with increased astroglial Cx43 expression. TNF-α levels were not affected by LTG and TPM. Treatment with higher concentrations of LTG, but not with TPM, led to a significant increase in TGF-ß1 levels in M5 and M30 co-cultures.ConclusionsDespite the possible glial toxicity of LTG and TPM, both drugs reduced inflammatory activity, suggesting potential positive effects on the neuroinflammatory components of the pathogenesis of epilepsy and bipolar disorder.