Faculty Bibliography

The authors analyze the complications of acetabuloplasty in the treatment of CHD during the growth age, evaluating the incidence and the possible causes, that emerged from a review of cases at the Rizzoli Orthopaedic Institute including 238 patients treated from 1970 to 1986 using different methods. The techniques adopted were: acetabuloplasty for lowering in 100 cases, Salter osteotomy in 30 cases, triple pelvic osteotomy in 48 cases and acetabuloplasty according to the Chiari method in 50 cases. Complications of various types were observed in 9.6% of the cases after a mean follow-up of 5 years. It is the purpose of ths study to discuss the complications that are observed during each operation, and to compare them with those reported in the literature, as well as to present a pathogenetic interpretation. A study of complications influences indications and surgical technique.

The authors report a comparative study between endorectal ultrasonography (EU) and computed tomography (CT) in the preoperative assessment of 94 patients with rectal cancer. In evaluating the depth of wall penetration of rectal tumors EUS and CT offered good results: EUS confirmed a clear superiority with overall accuracy of 88.4% versus 80% of CT. On the contrary, in detecting lymph node metastases both techniques had poor results obtaining a correct diagnosis in 75.6% of the cases with EUS and in 69.4% of the cases with CT. In conclusion, the authors believe that EUS and CT may by very useful in the study of tumor penetration of the rectal wall; while in the study of lymph node involvement new techniques for a more accurate diagnosis are needed.

Postoperative infections are an outstanding problem in a surgical department. We have been studying them from a clinical and experimental point of view has a long time. In this study we present a method standardisation of postoperative peritoneal lavage as prevention of surgical infections. Winstar mice, infected with intra peritoneal E. coli cultures, underwent peritoneal lavage with saline solution or sterile water. The results showed the right amount of solution and the exact administration of lavage according to grade of infection. Encouraged by this result we are going to test the efficacy of anti microbial agents for the postoperative peritoneal lavage.

The authors report 11 cases of bone metastasis treated with selective arterial embolization (SAE). One case of adjuvant SAE and ten cases of palliative SAE. Pain regression was observed in 66% of patients. The low number of cases treated and the short life expectancy of these patient doesn't allow prognostic evaluations. However SAE is useful in pain control and helps patients to improve quality of life. The increased use of SAE is due to lack of alternative treatment.

The authors report the experience acquired by the Rizzoli Orthopedic Institute in the treatment of vertebral metastases (1481 cases). In view of the growing role of surgery as a therapy for vertebral metastases and the experience acquired in the treatment of primary bone tumours, an aggressive approach was adopted in a small series of patients suffering from solitary metastasis of the lumbar vertebral column involving anterior surgical access and corporectomy. The functional outcome was good and the oncological results were encouraging. The authors comment on the principles of treatment in the light of the latest literature.

The authors report their experience of surgical infections and particularly peritoneal intraoperative lavage. In a previous study they have standardized the technique. In this study they report on the lavage adding antiseptic substances in the solution. The experimental, controlled study, was carried out on Wistar rat stock, which were submitted to median laparotomy through which was injected a standard bacterial dose composed of 5 bn E. Coli. The peritoneal cavity was washed out after a few minutes with physiological solution with clorhexidine or PVPI dissolved. The main results were an increase of aderential syndrome and a less survival percent age (physiological solution = 100%, clorhexidine = 60%, iodophors = 23%). The authors concluded by pointing out that the use of antiseptic peritoneal lavage solution is a method that should be proscribed from operating rooms because it is unnecessary and detrimental to health.

PURPOSE/OBJECTIVE:To evaluate more accurately the effectiveness of preoperative chemotherapy in the treatment of patients with Ewing's sarcoma, we studied histopathologically the chemotherapeutic response and correlated it to oncologic outcome. PATIENTS AND METHODS/METHODS:Between June 1983 and December 1989, 68 patients with nonmetastatic Ewing's sarcoma of the extremities were treated at our institute with preoperative chemotherapy (without radiation therapy) and surgery. The specimens were retrospectively evaluated for areas of viable tumor cells and graded from I to III (macroscopic, microscopic, or no residual disease, respectively) in a blinded fashion. Clinical follow-up data were available on all patients for a mean of 60 months (range, 32 to 111). RESULTS:This histopathologic analysis was strongly correlated with oncologic outcome (P = .004). Patients who demonstrated grade III response (no identifiable viable tumor nodules present) had improved 5-year disease-free survival rates as compared with patients with grade II (microscopic nodes present; P = .023; 90% v 53%) and grade I responses (macroscopic nodules present; P = .0003; 90% v 32%). Patients with grade II necrosis had statistically improved survival rates over those with grade I necrosis (53% v 32%; P = .074). CONCLUSION/CONCLUSIONS:This new histopathologic analysis technique for the evaluation of neoadjuvant chemotherapy effectiveness (which does not rely on tumor volume for its assessment) is a valuable prognostic indicator for patients with Ewing's sarcoma treated with surgery. Based on this preliminary report, cases of grade I or II chemotherapeutic tumor response should be considered clinical failures and a different, more aggressive postoperative chemotherapy regimen should be considered.

From September 1986 to December 1989, 144 patients with osteosarcoma of the extremities were treated with combined surgery and neoadjuvant chemotherapy. The disease-free survival was 79% for good responders (necrosis greater than 90%) and 72% for poor responders (necrosis less than 90%), and the local recurrence rate was low. Improvement in long-term prognosis and the increase of limb-sparing surgery determine a higher rate of immediate and late complications. Most of the complications were observed in limb-salvage procedures; 63% of these procedures presented one or more complications. In nine rotationsplasties, there were four complications, and in 13 amputations no complications were observed. Therefore, 55% of patients were affected by surgical complications. Twenty-eight complications were considered minor (not requiring surgery), whereas 77 complications were major. Functional results, evaluated according to Enneking's new system, were higher than 50% in two thirds of the limb-salvage procedures. Complications in limb-salvage procedures are more influenced by the type of reconstruction than by the surgical procedure used. Probably the most troublesome consequence of surgical complications in osteosarcoma is the deviation or delay in administering postoperative chemotherapy, which jeopardizes survival.