Giant cell tumor in skeletally immature patients.

The radiographs and clinical and surgical histories of 50 skeletally immature patients with histologically verified giant cell tumor (GCT) of the long and short tubular bones were retrospectively studied to determine the prevalence, location within bone (eg, epiphysis, metaphysis), skeletal distribution, radiographic appearance, and pathogenesis of GCTs. Skeletal immaturity was determined radiographically by the presence of open epiphyses. Patients were selected from a group of 876 patients who were seen in consultation with documented GCT of the tubular bones. Approximately 5.7% of all GCTs occurred in the skeletally immature (this rate must be viewed with caution due to the selection bias inherent in any referral population). The lesions almost invariably involved the metaphysis. The tibia was the most commonly affected site, representing approximately 26% of cases. All were geographic lytic lesions, with margins ranging from sclerotic to ill defined. An expanded (widened), remodeled bone contour was frequently encountered. Approximately 56% of lesions were solid or solid with cystic change; the remaining 44% were predominantly cystic.     

The impact of chemotherapy on the quality of life of breast cancer patients.

One hundred and thirty-seven breast cancer patients, 102 receiving adjuvant chemotherapy and 35 receiving palliative chemotherapy for metastatic disease underwent a 37-item quality-of-life questionnaire to evaluate the impact of disease and treatment on physical, psychological and social well being. Patient groups were designated as follows--Adj CT: patients undergoing the questionnaire during their adjuvant chemotherapy program; Post Adj CT: patients evaluated 3 to 8 months after termination of adjuvant chemotherapy; Mts CT: patients assessed during palliative chemotherapy for metastatic disease, and Post Mts CT: patients 3 to 8 months after termination of palliative chemotherapy. Physical and social activities were reported as unaltered or normal by 64 to 70% and 52 to 67% of patients, respectively. Psychological status was judged normal by 39 to 45% of patients. No significant differences were observed between the patients groups. In 83 to 90% of cases the patient normally took care of herself. In 62 to 87% of cases time dedicated to recreational activities was reported as unaltered. The majority of patients (84%) judged that their relationship with partner and/or family were good. Severe anxiety was reported in 19 to 28% of patients and severe depression was infrequent (3.9%). Information regarding disease and treatment given by health professionals was considered satisfactory by 80 to 100% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mortality rate after hip hemiarthroplasty: analysis of risk factors in 299 consecutives cases

Abstract The femoral neck fracture is actually the most important traumatic event in the elderly, because of its high rate and terrible complications. We reviwed clinical records of 314 patients treated in our institution with a bipolar implant for femoral neck fracture. At a mean follow-up of 5 years, 15 patients (4.8%) were lost to followup so data for 299 patients was studied to identity factors associated with mortality. Ten predictor variables were examined: age, sex, waiting time for surgery, pulmonary dysfunction, fracture etiology, and comorbidity with ischemic heart disease, and heart failure, hypertension, cerebrovascular disease, and chronic renal failure. Cumulative mortality rate during the first 6 months was 19% (55 of 299 patients) and in the first year it was 25% (76 of 299). At logistic regression analysis, mortality was associated with age, male gender, waiting period for surgery and presence of neoplastic disease or pathological fracture. Waiting for surgery was a significant factor for mortality at 6, 12 and 24 months: patients surgically treated in the first 24 hours had lower mortality than those who waited longer. The risk of mortality in the first 6 months doubled for an age increase of 12 years, while mortality within 2 years doubled for an age increase of 9 years. Although the motality rate after surgery for femoral neck fracture was high in the first year (25%), it dropped off in successive years to levels observed in a healthy population. Thus, we agree with the literature that femoral fracture is a risk factor for survival only in the first year after trauma, above all in the elderly.     

Familial partial monosomy 7 and myelodysplasia: different parental origin of the monosomy 7 suggests action of a mutator gene

Two sisters are reported, both with a myelodysplastic syndrome (MDS) associated with partial monosomy 7. A trisomy 8 was also present in one of them, who later developed an acute myeloid leukemia (AML) of the M0 FAB-type and died, whereas the other died with no evolution into AML. Besides FISH studies, microsatellite analysis was performed on both sisters to gather information on the parental origin of the chromosome 7 involved in partial monosomy and of the extra chromosome 8. The chromosomes 7 involved were of different parental origin in the two sisters, thus confirming that familial monosomy 7 is not explained by a germ-line mutation of a putative tumor-suppressor gene. Similar results were obtained in two other families out of the 12 reported in the literature. Noteworthy is the association with a mendelian disease in 3 out of 12 monosomy 7 families, which suggest that a mutator gene, capable of inducing both karyotype instability and a mendelian disorder, might act to induce chromosome 7 anomalies in the marrow. We postulate that, in fact, an inherited mutation in any of a group of mutator genes causes familial monosomy 7 also in the absence of a recognized mendelian disease, and that marrow chromosome 7 anomalies, in turn, lead to MDS/AML.     

Drug interaction microcomputer software evaluation: the Medical Letter Drug Interactions Program

The Medical Letter Drug Interactions Program was evaluated using general and specific criteria. The installation process, ease of learning, and use were rated excellent. The user documentation and technical support were good. The quality of the clinical documentation was excellent. The scope of coverage and overall clinical performance were good. The frequency of updates is fair. The primary advantages of the program are low costs and fast, reliable screening tool for drug interactions.     

Evaluation of patient counseling microcomputer software programs

Five patient counseling drug information programs are evaluated using specific criteria definitions. This article compares the features and ratings of each program. The scope of drug coverage is found to be good to excellent. Most of the programs fared poorly in the timeliness of the database. Updates to the programs range from quarterly to undefined schedule. The ease of readability of all the programs is excellent. The inclusion of key components of information is determined to be good to excellent. The overall patient performance ratings are excellent for each of the programs. The programs are all competitively priced. All of the programs evaluated are easy to use. The only distinguishing feature among the programs is the format of the printed output.     

Prevalence and correlates of multiple organ damage in referred treated hypertensives: data from the ETODH study

This study, carried out in a large cohort of treated essential hypertensives attending an out-patient hospital hypertension clinic, extends previous observations by showing that a clustering of two or three markers of organ damage (OD) has a higher prevalence than a single organ involvement. These findings call for a systematic evaluation of cardiac and extracardiac OD in treated hypertensive patients referred to a specialist setting.     

Biomechanical and clinical study of single posterior oblique cage POLIF in the treatment of degenerative diseases of the lumbar spine

Introduction

Aim of the study was to evaluate the biomechanical stability and the clinical efficacy of a lumbar interbody fusion obtained by single oblique cage implanted by a posterior approach.

Method

Through the realization of three finite element models (FEMs), the biomechanics of POLIF was compared to PLIF and TLIF. Ninety-four patients underwent interbody fusion by POLIF with instrumented posterolateral fusion. Clinical and radiographic outcomes were evaluated at regular intervals for at least 6 months.

Results

The FEMs showed no statistically significant differences in stability in compression and flexion–extension. Mean preoperative VAS score was 7.1, decreased to 2.1 at follow-up. Mean preoperative SF-12 value was 34.5 %, increased to 75.4 % at follow-up. All patients showed a good fusion rate and no hardware failure.

Discussion

POLIF associated to instrumented posterolateral fusion is a viable and safe surgical technique, which ensures a biomechanical stability similar to other surgical techniques.