Tomáš

Současné ortopedické postupy v léčbě kostních sarkomů

Autoři předkladaji souhrn chirurgických postupů při lecbě kostnich nadorů. Lecba kostnich nadorů, zejmena malignich, je lecbou komplexni a patři do specializovaných multidisciplinarnich center obvykle univerzitniho typu. Vedle zvysujiciho se procenta přeživajicich pacientů a zlepseni jejich životniho komfortu upozorňuji autoři na druhe straně na narůstajici dobu od prvnich klinických přiznaků po stanoveni definitivni diagnozy, na nejcastějsi chyby a z nich plynouci doporuceni.28 consecutive patients (age 15-58 years) with refractory acute leukaemia (24 AML, 4 ALL) have been treated with high or intermediate dose cytosine arabinoside (AraC). Twenty patients received AraC at a dose of 3000 mg/m2, twice daily for 6 days (13 patients AraC alone, 7 patients AraC and doxorubicin) and 8 patients received AraC at a dose of 1000 mg/m2, twice daily for 6 days and daunorubicin. 10 of the 20 patients treated with high dose AraC achieved a complete remission (50%) and 2 a partial remission. No patients in the intermediate dose AraC group achieved a remission (p = 0.05). Toxicity of these protocols was acceptable. Vomiting, headache, somnolence, fever, conjunctivitis, and minor cardiac arrhythmias were found most frequently. The pancytopenic period ranged from 16-30 days for the high dose protocol and 14-23 days for the intermediate dose protocol. Sophisticated isolation and blood banking facilities are required in this period. Median duration of remission was 6 months. Results obtained are in favour of the high dose protocol in refractory leukaemia. Only a large dosage increment of AraC can overcome refractoriness of leukaemic blast cells.

Use of the harmonic system in total hip arthroplasty: a prospective, comparative, observational study.

We compared technical issues, postoperative outcomes and surgical complications of total hip arthroplasty when using the harmonic scalpel (HS) when compared with conventional techniques (CT) in a prospective, comparative observational study. Thirty patients undergoing total hip arthroplasty were assessed. Operative time, blood loss in drains, postoperative pain, soft tissue injury and complications were recorded. We found no significant differences between the HS and CT groups at baseline. Mean operative time was longer in the HS group compared with the CT of total hip arthroplasty (61 minutes vs. 54 minutes; P<0.05). We found no difference in postoperative pain using a visual analogue scale score, or use of paracetamol. The use of tramadol was reduced in the HS group compared to CT group at the 7th day (83.3 mg vs. 113.3 mg; P<0.05). Drainage volume was significantly lower in the HS group at 24 hours (332 ml vs. 429 ml; P<0.05) and at 48 hours (429 vs. 537 ml; P<0.05). C-reactive protein blood levels were significantly lower in the HS group 75 mg/l vs. 96 mg/l at the third day (P<0.05) and 26 mg /l vs. 54 mg /l at the seventh day (P<0.01). Creatine kinase blood levels were significantly lower in the HS group at 3 and 7 days (2.4 ukat/l compared to 5.3 ukat/l at the 3rd day (P<0.01), respectively 1.1 ukat/l compared to 1.8 ukat/l at the 7th day (P<0.01). We found no significant differences in blood myoglobin levels between the two groups. The use of the HS may reduce postoperative pain, drainage volume, and soft tissue injury in patients undergoing total hip arthroplasty, which may justify the cost of the technique. The use of HS may have further applications in revision hip arthroplasty and tumour surgery.

Advantages in Prognosis of Adult Patients with Ewing Sarcoma: 11-years Experiences and Current Treatment Management

Ewing sarcoma (ES) is an exceptionally rare tumor in adults. Data regarding outcomes of adult patients with ES and experiences with age-adapted therapeutic strategies are very limited. The aim of this study was to evaluate prognostic factors and clinical outcome in a cohort of adult patients treated according to pediatric protocols in the Czech Republic. The records of 58 adult ES patients diagnosed between 2002 and 2013 were reviewed and factors relevant to prognosis and survival were analyzed. The median age of study cohort was 29 years (range, 18–59). The most frequent location was axial (36.2%), followed by involvement of extraskeletal tissues (34.5%) and bones of the extremities (29.3%). Twenty-eight (48.3%) patients had metastatic disease. In cases with localized ES, the 5-year overall survival (OS) was 76.5%. Using the log-rank test, the presence of metastasis at diagnosis, local treatment without surgery and a failure to achieve complete remission were associated with significantly shorter survival. In a multivariate Cox proportional hazard analysis, the achievement of complete remission was an independent predictor of patients’s survival time. Outcomes of adults with localized ES treated according to multimodal pediatric protocols are similar to children. The achievement of complete remission is an independent predictor of survival time in ES patients. Severe hematological toxicity is foreseeable and manageable. Prognosis of patients with metastases or progression remains dismal.